An Interview with Valerie Howard, President of the International Nursing Association for Clinical Simulation & Learning (INACSL)

By Val Fulmer

My curiosity was piqued by the MEdSim interview with Valerie Howard, published in March 2013 (, on the use of SP educational methodology in nursing training. The interview took place on the heels of the 11th annual INACSL conference in San Antonio Texas, and focused on the growth of the organization as well as how technological developments have improved the high fidelity simulation experience for learners.  INACSL is affiliated with the Society for Simulation in Healthcare (SSIH) and with ASPE, although no formal collaboration has occurred to date.  In my medical school environment, apart from a few communication courses, gyne and male genital teaching, and some physical exam training courses run with our affiliated nursing school, nursing training with SP encounters and mannequin simulation is still a very small part of what constitutes daily practice here.

According to the INACSL mission statement, its purpose is to promote research and disseminate evidence based practice standards for clinical simulation methodologies and learning environments, so who better to learn more about SPs in nursing training than Valerie Howard?

Valerie graciously agreed to respond to questions targeting SP methodology and its role in nurse training and simulation. As ASPE’s membership continues to reflect a growing number of nurses and representatives from other health professions, her answers underscored the importance of Standardized Patient methodology in nurse training.

Val Fulmer: Mannequin simulation is a large part of the content discussed in the March 2013 MedSim article. ASPE was also mentioned as an affiliate of INACSL. We know that many ASPE members come from the nursing community, among others. Could you tell us what part SP methodology plays in nursing education from your perspective?

Valerie Howard: When we (INACSL) use the word simulation we are not specifically referring only to mannequins but to any effort to recreate the reality of a health care environment, which includes the use of SPs.

INACSL’s standards in simulation education were released in 2011 and new updated guidelines will be released soon. These standards can apply to all health education and simulation modalities across multiple disciplines, and are available to the public at:

Our definition of simulation includes multiple typologies (including SPs): however, the simulation community as a whole tends to use the word simulation to mean working with mannequins.  It’s important to keep in mind that SPs are included in this so that when we say “simulation” we understand how others define this term.

I don’t want to be naïve and say that mannequin simulation is the same as working with SPs. There are many nuances involved in developing an SP program; there is training to consider, developing cases or “scripts” for the SPs, training feedback and debriefing, payroll cost, scheduling concerns, etc.   There are obviously big differences in dealing with the human element as opposed to mannequins.  However, the advantages of working with SPs are clear, especially in behavioral health and other communications areas such as adolescent mental health, psychological based health, breaking bad news training and end of life scenarios.

VF:  A completed “needs analysis” of INACSL members was mentioned in the article as having been done last year. What did you hear from your membership regarding the growing role of SPs in nursing education?

VH:  We don’t separate our work with SPs from the term “simulation,” but some of the significant findings identified in the survey dealt with length of debriefing time, what ratio of simulation hours count as clinical hours, mandatory recording of simulations, the use of summative evaluations and the need for inter-professional simulation. The results of the needs assessment is published in Vol 8, issue 4, 2004 of Clinical Simulation and Nursing (see link above).

We recognize the growth of SP work in the INACSL community. Our conference and journal committees are receiving more abstracts and manuscripts that involve work with SPs than we have in the past. SP work is an active part of the INACSL conference content.  In fact, our Key Note Speaker at the conference this year is Monika Brodmann Maeder, who has done quite a bit of work with SPs as an ER Physician and a leader in simulation internationally. (Read more about the conference at

Many thanks to Valerie Howard for taking the time to share her views regarding the relevance of the work we do as SP Educators, and congratulations to her on her work leading INASCL forward. We welcome all of you in the field of nursing attending this year’s ASPE conference, and look forward to seeing and hearing about your innovations in nursing training and education with SPs!

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