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The research about effective learning resonates with this truth: in order for learners to process energetically and learn deeply, they must choose to engage (Blumenfield, Kempler, & Krajcik, 2006;Jonassen, 1988;Keller & Suzuki, 1988). Learning is an act: It requires the learner's energy, choice, and employment of effective learning strategies. Because learning is an act-something a learner must do-motivation is fundamental.Some instructional and simulation designers avoid serious attempts to incorporate motivational design in their instructional products because of perceptions that motivation is either too vague a concept (Weiner, 1992) or lacks predictive power in respect to learning outcomes (Gagné, 1965). It is true that motivation is complex, but it is so foundational to learning that it must be thoughtfully addressed in instructional design. This article examines the unique motivational challenges and opportunities of instructional simulations and provides guidelines for their motivational design. First, let us define two key terms: instructional simulation and motivation. What is motivation? Motivation is about whypeople do what they do. Simply defined, it is what people desire to do, choose to do, and commit to do (Keller, 2009). It is an internal process, but can be inferred from observed choices, effort, intensity, and persistence. It is what initiates behavior, controls its intensity, maintains behavior, stops behavior, and mediates choice (Weiner, 1992).The study of motivation should also be focused on how goal-oriented activity is initiated and sustained (Ford, 1992;Schunk, Pintrich, & Meece, 2002). As previously mentioned, motivation is sometimes considered a vague concept. It is helpful to recall that the word "motivate" is a derivative of the Latin word, movere, which simply means "to move" (The Latin Dictionary, 2013). Motivation, then, in its broadest sense, is about what makes people move.Learner motivation is focused on those factors that affect a learner's engagement with the task of learning. It can be thought of in two ways: as either stimulating and empowering a learner's intrinsic motivation; or, as providing extrinsic motivators that

The majority of health outcomes are determined by social determinants of health (SDOH) while medical care is responsible for as little as 20% of health outcomes. This article is an introduction to the Virtual Family (VF) approach to case based instruction; a novel strategy for addressing SDOH in medical school. The VF theoretical framework is presented and practical considerations and challenges for implementation of the VF approach at three different medical schools are offered. VFs are defined as representations of families or social groups that are not real. "Virtual," in this instance, refers to people or things that do not physically exist. The VF approach allows students and educators to adjust the "lens" of a case's focus to view the relevant determinants. The VF approach is presented as an extension of the virtual patient approach. Theoretical support for the VF approach is argued drawing on principles from modeling and simulation, effective story design, establishing a sense of human presence, serious gaming, visual design, identity leveraging, and flow theory. Challenges and benefits of the approach are described. Measures of efficacy designed to match learning goals are proposed. The VF approach is presented as practical, accessible, economical, and potentially powerful.

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