Smart learning environments can be defined as systems aimed at proposing innovative uses of emerging pedagogical approaches and technologies to support effective learning experiences. In the past years, rather than designing and developing even more advanced technological solutions attention has been focused on defining environments that adopt appropriate strategies to sustain student motivation and engagement. Game-based learning and gamification approaches could be a promising solution, since there is much experimental evidence that proves their effect. In this context, our research aims at defining and developing a Smart Learning Environment able to improve engagement and motivation by means of game-based learning and gamification approaches. In particular, the paper presents two serious games that, using the gamification dimensions, aim at sustaining engagement and motivation in learning processes in medical contexts. In particular, the games involve both the patients, who have to acquire knowledge and skills about their disease, in order to become responsible for their choices, and the medical and paramedical staff, who must acquire knowledge and skills about diagnostic procedures, therapeutic interventions and follow-up of patients. Some results of a user test show that the games enhance student motivation and this means improvement also in knowledge acquisition

-The education in e-health play an important role in particular in context of chronic diseases. The empowerment process aims at enhancing the patient knowledge and skills in order to allow them to be aware of their health status. The paper presents a serious game that is addressed to young children with type I diabetes and uses the coaching strategy. The coach has been designed and developed as an Intelligent Agent using a knowledge base about the diabetes intervenes to suggest the best action to do or to correct wrong behaviours. A first pilot test was conducted to measure the learning effectiveness and usability of the game. The results were promising.

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Abstract. One of the basic conditions to learn is motivation. Thus it is essential for learning environments to motivate the students to proceed into the learning process. Several researches propose the inclusion of new technological trends, such as the Gamification, to engage the users. In this paper the solution adopted in UBICARE system, where the Gamification approach has been used for training and learning purposes, is presented. The Gamification was used in the simulation of clinical cases aimed to both empower the patients to adopt healthy life-style and train the medical and paramedical staff about diagnostic procedures, therapeutic interventions and follow-up of patients. In particular, the paper presents the trainer interaction that is useful in order to keep the system up to date over time and to allow the definition of clinical cases tailored on the basis of users' needs.