Medical education is rapidly changing as global trends swing from traditional to competency-based education systems. Computer simulations and video game technology arc also changing rapidly, allowing players to become totally immersed in virtual worlds. By combining simulation technology and medical education needs, Indiana University (IU) School of Medicine and the School of Informatics at Indiana University-Purdue University Indianapolis (IUPUI) created an alpha version of an interactive hospital game simulation. Through engagement in the game, physicians in training will develop healthcare and practice management skills within a synchronous virtual environment. As the learner completes difficult tasks within the virtual hospital, their skills arc assessed for competency and progress. Each action the student takes in their character persona will impact future interactions and outcomes in the virtual environment. Available online, this learning tool will fit the schedules of all medical students and residents, while the XML database will make assessment results quickly available to the curriculum coordinator and the student. Combining video game technology with medical pedagogy has allowed a virtual environment to become a leaching tool for lifelong learning, practice-based learning and improvement, and systems-based practice competencies.