Interview with Valerie M. Howard, Ed.D., RN, President International Nursing Association for Clinical Simulation and Learning

Dr. Valerie Howard was interviewed by group Editor Marty Kauchak on June 21, 2012 at the 2012 INACSL conference in San Antonio Texas. The interview addressed a wide range of policy, technology and other areas of interest.

Valerie M. Howard.Image Credit: INACSL

MEdSim: First, thank you for taking time from your very busy schedule at the INACLS conference to meet with us. Let's start by learning more about INACSL in terms of its mission, organization and members.

Valerie Howard: This is INACSL's 11th year of operation. Our mission: to promote research and disseminate evidence based practice standards for clinical simulation methodologies and the learning environment. And we would like to be nursing's portal to the world of clinical simulation pedagogy and learning environments – that’s our vision.

As I stated earlier, we started 11 years ago with two co-founding presidents, Teri Boese and Debra Spunt. They had the vision for the organization, believing that simulation was certainly on the rise. Using simulation was an innovative, new creative way to teach, certainly in alignment with all of the educational theories. Simulation was a way of applying what participants learned in the classroom, which aligns with experiential learning theories.

This INACSL conference used to be a skills lab conference, but our co-founding presidents realized the power of this educational strategy and had the foresight 11 years ago to include simulation as the thread throughout.

MEdSim: During your opening conference remarks this morning, you said there is record attendance at the 2012 INACSL with significant international participation. That appears to be yet another metric of the healthcare professions' rising interest in simulation.

VH: Yes, absolutely. We have 850 attendees and delegates from 21 nations, including Oman, Lebanon and Switzerland, among others.

Our membership has increased 50 percent during the past two years – from 1,000 to 1,500 members. This is really due to the strategic planning of the past president, Kim Leighton, Ph.D. She started the process to build the organization and move it forward.

MEdSim: Here's a follow up to your stated organization mission. What is the status of establishing those standards in educational institutions, medical simulation centers and other learning sites?

VH: We've published the first set of standards – there were seven – last year. The document is the Standards of Best Practice-Simulation. These standards for simulation apply to any discipline - medicine, nursing, respiratory therapy and others. They have been published and widely accepted. We are now in the process of publishing guidelines, the last step in the process of developing standards. So, we've released the standards and published them. We're due to have guidelines for each of the standards and those are to be released next year, in 2013.

MEdSim: Are the standards applicable to the private and public sector health care communities?

VH: Certainly, nothing like this has ever been done as far as the publication of standards. It has been very hard to get people to agree and to reach consensus. Our INACSL Board led the development of the standards, but we also included our membership's inputs, and included expert peer review outside of our organization before these were published.

And we continue. We know that perhaps revisions will have to be made, because our environments constantly change – simulation is changing rapidly. They'll need to be revised and revisited. It's all part of an ongoing process. We also have a Standards Chair on our board to guide the process.

MEdSim: I also saw several of your members in military uniforms on the conference floor. That's a lead to learning about INACSL's level of collaboration with the public sector – the U.S. DoD, VA, and other organizations.

VH: We certainly accept members from any sector, we have some members from the military and we have a strong VA presence. We are an affiliate of the Society for Simulation in Healthcare, as well as the Association for Standardized Patient Educators, although we haven't had formal collaborative efforts. Our healthcare experts from the military can certainly be members.

MEdSim: Can you provide a very broad overview of the technologies your members use in their simulation centers and other venues?

VH: As far as simulators go, we're mainly talking about the high fidelity, human patient simulators – the ones that are highly technical, but can be physiologically programmed to respond in that manner. Simulation also includes an audiovisual component, as many facilitators record the sessions and play them back during debriefing. This adds another layer of technological complexity to simulation. And, we do know that gaming and computer-based simulation are emerging.

Technology is one of the challenges. Essentially, nursing faculty members are not technology gurus. We're not IT specialists, but suddenly we find, as a result of a donor, a $75,000 high fidelity simulator placed in front of us. We know with all of those technologies, as wonderful as they are, they don't run by themselves. When you teach with them, we're talking about good academic teaching principles – that is really behind everything that we are doing. So, not only do you have to have an understanding of the technology, you have to have an understanding of how to teach, how to evaluate, how to develop objectives and create a clear learning plan for that simulated experience. We try to provide support for both of those areas – for the technology and the educational experience, and the research that is behind all of this.

MEdSim: And what about the basic and more complex skillsets these technologies help your nurses obtain through the continuum of learning?

VH: When simulation first began, many people thought this was just a method for teaching psychomotor skills: skills like IV insertion; collecting vital signs; assessing lung and heart sounds; inserting a foley catheter. However, we’re finding more opportunities related to simulation training. We found that with simulation we can really make significant improvements with team training, communication and other issues related to patient safety. These techniques will help decrease medical errors and enhance our patient outcomes.

MEdSim: We also heard during several presentations the community’s increased emphasis on team training and debriefing. These are long standing areas of interest to the users of simulation in the military and civil aviation sectors.

VH: That is one of our standards – debriefing. We feel that every simulation experience should have a debriefing component, whether it’s computer-based, mannequin-based or whether you’re using a standardized patient. The debriefing is where the learning occurs. It’s not simply in the action but the participants review and reflect upon their performance. That’s where the learning occurs and is solidified, and that’s where our learners can really understand how they can improve their performance. If we just simulated and sent the participants out without providing an opportunity to reflect upon their performance, we are doing them a disservice, we feel very strongly that debriefing is needed.

MEdSim: Your “help wanted list” for the simulation and training system vendors – the new and enhanced technologies and products your community needs.

VH: Yes, definitely culturally diverse simulators. They seem to be white, male and English speaking. Ways that we can enhance the realism would be through skin color changes, but also culturally relevant features. I believe the vendors and simulation facilitators need to continue to have conversations and develop new technologies jointly, to ensure that the needs of our participants, faculty, and educators are being met. Also in computer-based simulation and gaming. As we look at this age of new learners coming up, how they learn and multi-task, and the importance of gaming and what we can do through gaming, we need to ask how we can we really enhance the realism and ease of use with some of those games. And we need to look at the cost, too. The costs tend to be very expensive. If I want to buy a game to use with 100 students, what’s the cost of that: 100 times the cost of one game? It has to be cost-effective. Let’s face it. Institutions are not designating a lot of money for education and training. It’s unfortunate.

MEdSim: You’ve mentioned gaming. Another positive development is serious gaming’s maturing in the adjacent military sector – which we follow in MEdSim’s sister publication MS&T.

VH: Absolutely, this is unchartered territory – games for learning. I am not simply talking about Call of Duty. I am talking about students learning through other gaming – and through YouTube and other delivery methods. They are doing these things and not even realizing that they are learning. This is a huge, huge opportunity. But the problem now in some games, it is very hard to learn with that technology and then integrate that in the classroom, which is what we found with simulation, too. We were first led to believe that you push a button on the mannequin, it takes you through a scenario down a decision tree and your students learn. That’s not what happens. You still need that guidance from faculty.

MEdSim: INACSL’s priorities for the next several years, please.

VH: We just completed our strategic plan. In the next four to five years we want to increase our educational offerings to our members, so essentially everything we do will support the needs of our members. We also plan to increase our research support and mentoring opportunities for our members, and extend our reach globally. We did a needs analysis last year, so, we’re basing a lot of our decisions on what our members wanted.

MEdSim: Are those educational offerings through continuing education?

VH: It could be continuing education, webinars, conferences, or faculty development opportunities. But not just for educational institutions, also for hospital educators and education – all areas of service.

The other thing we would like to do, and we are branching out into the international arena, is we’re establishing our first European chapter of INACSL. This was just decided on this week, so this is “hot news.” We have a group of people in Europe who are willing to run this chapter.  You still join INACSL but it gives people a more local feel. We know the ‘American’ way is not always the ‘global’ way, we think there is value in having chapters in different pockets of the world to meet those members’ needs.

MEdSim: Well, this is more evidence that simulation is of ever-increasing interest to your community around the globe.

VH: Yes, it really is. People are just searching for something to help, for some sort of standards. That’s why our standards are so important. I have heard that people are translating them into different languages. I don’t think it’s a formal translation, but people are sharing these standards within their own environments. It’s very exciting. We’re an international organization and we had international input when we created the standards.

Here’s another really exciting thing we’re doing.

Currently there are not a lot of frameworks out there – models – that people can use to design the simulation experiences. One of the models out there was developed in 2006 by Dr. Pamela Jeffries and the National League for Nursing – The NLN Jeffries Framework. What we’re doing during this session is analyzing all the constructs. We’re seeing what information has been published about each of the constructs of the model. We’re going to report on them during this meeting, and also publish some manuscripts on that and try to move that forward into a framework.

MEdSim: Any final thoughts?

VH: People need to know that while “nursing” is in the INACSL name, that we welcome any members form outside the nursing community and we do have them. We have some physicians, EMTs and others. It’s a bit deceiving to see “nursing” in the title, but we welcome that interdisciplinary membership, and certainly feel that INACSL can assist them as they implement simulation teaching modalities into their own education and training programs.