How can we design engaging and effective online learning? How can we perform tele simulation? How can we make digital learning authentic and not over-produced? How can we apply gamification strategies to enhance online cooperation? Tele-simulation and online cooperation are essential today for medical simulation: The e- REAL® online platform for healthcare simulation, aimed at fostering effective teamwork, knowledge sharing and cooperation, is a solution that we designed to work within a highly immersive setting where learners and simulation instructors may interact all together in real time among themselves, as well as with virtual objects and avatars. This solution allows simulations in a virtual environment that display challenging situations; unlike other VR and AR solutions, e REAL allows users to experience full immersion without the need for glasses or goggles, providing a memorable experience with a robust learning outcome. e-REAL is user-centric and easy to use: an Internet connection and a browser are the only requirements.