Background: Virtual worlds provide a promising means of delivering simulations for developing interprofessional health skills. However, developing and implementing a virtual world simulation is a challenging process, in part because of the novelty of virtual worlds as a simulation platform and also because of the degree of collaboration required among technical and subject experts. Thus, it can be difficult to ensure that the simulation is both technically satisfactory and educationally appropriate. Methods: To address this challenge, we propose the use of de Freitas and Oliver's four-dimensional framework as a means of guiding the development process. We give an overview of the framework and describe how its principles can be applied to the development of virtual world simulations. Results: We present two virtual world simulation pilot projects that adopted this approach, and describe our development experience in these projects. We directly connect this experience to the four-dimensional framework, thus validating the framework's applicability to the projects and to the context of virtual world simulations in general. Conclusions: We present a series of recommendations for developing virtual world simulations for interprofessional health education. These recommendations are based on the four-dimensional framework and are also informed by our experience with the pilot projects.