While students do learn real-world knowledge and skills in virtual worlds, educators have yet to adequately theorise how students' virtual world experiences bring about this learning. This paper critically reviewed theories currently used to underpin empirical work in virtual worlds for education. In particular, it evaluated how applicable these theories' learning mechanisms are to virtual world-based learning. Eleven theories were identified from 80 journal papers. Four learning mechanisms were found to be applicable to virtual worlds: that students learn through reflection, verbal interactions, mental operations, and vicarious experiences. However, one commonly implied learning mechanism was found to be inapplicable to virtual worlds: that students undergo a physical sensorimotor experience of the real-world phenomenon through their virtual world actions. An alternative theory is needed to explain how students' virtual world actions might bring about learning, so as to help educators determine what exactly students can learn by performing virtual world actions.

Several scholars contend that learning with computer games and simulations results in students thinking more like professionals. Bearing this goal in mind, we investigated how a group of pharmacy students learnt with an in-house developed computer simulation, SimPharm. Adopting situated cognition as our theoretical lens, we conducted a case study involving 20 undergraduate students to tease out how they made meaning of a clinical case differently in two different contexts: a typical paper-based workshop and one enabled by SimPharm. The data collected included audio recordings of classroom discourse, focus group interviews and class observations. The findings identified differences in four areas: framing of the problem; problem-solving steps and tools used; sources and meaning of feedback; and conceptualisation of the patient. These four areas can serve as axes along which future evaluations of educational simulations can be carried out based on their affordances.

<span>While the potentials of virtual worlds to support experiential learning in medical education are well documented, assessment of student learning within these environments is relatively scarce and often incongruent. In this article, a conceptual framework is proposed for formatively assessing dispositional behaviours in scenario-based learning within a virtual world. The framework was devised for use with medical students playing the roles of junior doctors as they solve open-ended clinical cases within an environment called the </span><em>Otago Virtual Hospital</em><span>. Drawing upon Perkins, Jay and Tishman's (1993) dispositional theory of thinking, it is proposed that the assessment of dispositional behaviours in scenario-based activities can be carried out by measuring the number of times students either seize or miss an opportunity to engage in a particular dispositional behaviour. The approach can potentially also be used for assessing scenario-based learning in other disciplines (e.g. law, business, military).</span>

Complex systems are typically difficult for students to understand and computer simulations offer a promising way forward. However, integrating such simulations into conventional classes presents numerous challenges. Framed within an educational design research, we studied the use of an in-house built simulation of the coagulation network in four pharmacy undergraduate classes. Drawing upon audio recordings of small group discussions, focus group interviews, and class observations, we identified implementation challenges related to: adaptation of simulation to align with student needs; compromises to learning design; and classroom infrastructure. These findings can serve to guide teachers and staff developers on the common challenges that are likely to arise from integrating computer simulations meaningfully into realistic contexts.

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