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PIVOTE is a virtual learning authoring system for virtual worlds. It was developed as part of the JISC funded PREVIEW project, where it was used to develop training material for Paramedic students at St George's Hospital and Kingston University. Although based on the Medbiquitous Virtual Patient standard the feeling of all involved in the project was that the system could be used for any sort of structured learning in virtual worlds. The result was that JISC have funded the creation of PIVOTE - this open source project.