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Simulation Excellence: A Conversation with INACSL President Ashley Franklin sponsored by UbiSim

• Deb Tauber • Season 3 • Episode 100

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Ashley Franklin takes us on a fascinating journey through the evolution of healthcare simulation, drawing from her 16 years of experience as a nurse educator who has never taught without simulation technology. As the current president of INACSL (International Nursing Association for Clinical Simulation and Learning), Ashley offers a unique perspective on how simulation bridges the gap between classroom learning and clinical competence.

The conversation buzzes with excitement about the upcoming INACSL 25 Conference in Denver (June 19-22), featuring keynote speakers Dan Weberg and pilot Amelia Earhart, plus a panel on artificial intelligence in nursing education. Ashley shares the heartwarming tradition of hosting shelter pets in the exhibit hall, where conference attendees can decompress with puppy cuddles between sessions. This practice has even led to adoptions by INACSL members in previous years.

We dive deep into the Healthcare Simulation Standards of Best Practice, currently undergoing their sixth iteration with four updated standards being released this summer. Ashley explains how INACSL's endorsement program has recognized 40 high-quality simulation centers across academic and practice settings worldwide, reflecting the organization's commitment to international excellence. Her personal simulation story about first-semester nursing students successfully managing complex fluid and electrolyte scenarios demonstrates the profound impact of well-designed simulation experiences on building student confidence and competence. Ashley leaves us with a powerful message about the importance of speaking up when something isn't working – because modifiable simulation programs lead to better learning outcomes and ultimately, improved patient safety. Connect with Ashley through Texas Christian University or LinkedIn to continue the conversation about advancing healthcare simulation education.

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Disclaimer/ UBISim Ad/ Intro:

The views and opinions expressed in this program are those of the speakers and do not necessarily reflect the opinions or positions of anyone at Innovative Sim Solutions or our sponsors. Ubsim is a proud sponsor of The Sim Cafe podcast and the annual INASCL Conference taking place in Denver this year from June 19th through the 22nd. Taking place in Denver this year from June 19th through the 22nd. Recognized as a time-best invention, the UBSIM Immersive VR Simulation Platform empowers nurses to safely develop clinical judgment, confidence and a heart for patient-centric care. Learn more at UBSIMcom. That's U-B-I-S-I-M-V-R dot com. We'll see you in Denver. Welcome to The Sim Cafe, a podcast produced by the team at Innovative Sim Solutions, edited by Shelly Houser. Join our host Deb Tauber and co-host Jerrod Jeffries as they sit down with subject matter experts from across the globe to reimagine clinical education and the use of simulation. So pour yourself a cup of relaxation, sit back, tune in and learn something new from The Sim Cafe ne fro th Si C.

Deb Tauber:

Welcome to another episode of The Sim Cafe. Today we're here with Ashley Franklin, and we're really grateful that you're here with us today, Ashley. We're excited to hear your story, and why don't you go ahead and get started by sharing some things about yourself and then your journey into simulation?

Ashley Franklin:

Thank you so much for the invitation to join you. I am an academic nurse educator and I live in the Dallas-Fort Worth area in North Texas and have facilitated simulation for about 16 years at two different schools of nursing, always with pre-licensure nursing students and for about the same amount of time I've been very involved with INASCL, the International Nursing Association for Clinical Simulation and Learning, and have learned a lot as a committee member and working on team projects and on the board of directors and also in my current role as president of that organization.

Deb Tauber:

Thank you for sharing that and thank you for your all of your leadership there and currently what you're doing now.

Jerrod Jeffries:

So I'm curious on both sides of the coin, but maybe I'll start with some of the actual pieces, if you don't mind, actually. So first there's I attended the conference last year in Raleigh, but where is it this year? And yeah, what's the tea?

Ashley Franklin:

That's great, yeah. So our conference is in Denver June 19th through 22nd and we're going to be at the Sheraton Hotel, and I'm really excited about INASCL 25. There are pre-con sessions that are published on our website. We do a great job of recruiting peer simulation experts from other professional associations to come in, and we all give pre-con workshops at each other's meetings, and so that's always a highlight.

Ashley Franklin:

In Denver, the University of Colorado Anschutz Medical Campus is right downtown, and so they have six simulation centers on their campus across colleges of nursing and a pediatric hospital and an adult hospital, and so there are some very robust. They're welcoming an Axel conference attendees to learn about how they do simulation and some of their unique spaces and attributes of their program. There are two great keynotes planned for an Axel 25. We always have a keynote focused on nursing innovation, and Dan Wieberg is going to give that keynote. It's our named keynote session for the Hayden Vanguard Lectureship, so I'm really excited to learn from him. And then we have a leadership motivational speaker who's coming in and is not a nurse. Her name is Amelia Earhart, which is just cool.

Ashley Franklin:

And she's also a pilot, and so she's going to come and we'll learn from her. And then our final keynote. We've gotten in the habit of doing a panel with experts who are more familiar to us, who are nurse educators, and so the panel this summer will be around artificial intelligence, and Kelly Bryant is going to facilitate that, and she's a very engaging speaker, so we have a great program lined up.

Deb Tauber:

Yes, so those are the highlights. Are you guys going to have the pets there there?

Ashley Franklin:

There are pets on the exhibit hall floor. We've done that two or three summers in a row and it's such a neat way to engage with the community. I'm usually an animal shelter from the local community and I remember when we were in I think Rhode Island was the first time we did it and all the pets they brought were adopted by our members and taken home in various you know airplane travel or road trips home. So yes, I'm not sure if it's dogs and cats, but we always partner with one of our vendors to do animal shelter and it's just good for the soul, you know when you've been in learning mode all day and you can just hold a puppy or get some puppy kisses.

Ashley Franklin:

They make for cute pictures too.

Deb Tauber:

That is for sure.

Jerrod Jeffries:

Well, I also know. So it's 25 and there's probably some updates to the Healthcare Simulation Standards of Best Practice.

Deb Tauber:

Are those coming out?

Jerrod Jeffries:

before the conference, or are they going to be shared at the conference and if so, how?

Ashley Franklin:

Yeah, so they'll be shared at the conference and if so, how? Yeah, so they'll be shared at the conference. In summer of 25, we anticipate releasing four updated of the healthcare simulation standards of best practice, and those are living documents. The first were published in 2011. And I believe this is the sixth iteration, and for the last few years, teams of INASCL members have partnered with healthcare science librarians and done four systematic reviews around the topics we call cornerstones. They relate to professional integrity and then phases of simulation for pre-briefing, facilitation and debriefing. So actually in April, the systematic reviews will be published in our journal, which is clinical simulation and nursing, and then the updated standards with guidelines and criteria will probably be published around July is what I anticipate.

Ashley Franklin:

But at the conference in June there are two deep dive pre-con workshops and they're small. Only 50 people can register for each one of them. One is at the novice level, one is at a more advanced level, and then during the conference, the standards committee will give a concurrent presentation that has the capacity for a much bigger audience related to standards capacity for a much bigger audience related to standards. And I know that other non-standards committee simulation experts submitted abstracts that relate to the healthcare simulation standards at best practice. So those are on the conference program also and the program's available online. I actually was looking at it on my phone. It's real easy in a mobile format or on a traditional web browser.

Deb Tauber:

Is there anything unique about the new cornerstones of best practice?

Ashley Franklin:

Yeah. So about the standards specifically, just to kind of bridge that, what I appreciate is that we update those cyclically, and so there are lots of new references that underpin the standards, and we haven't done systematic reviews before. So we have also added in the layer of analysis of publication bias that goes with systematic reviews, the cornerstones of best practice, since you asked about that. Those are educational modules that we offer, and we've offered cornerstones for several years around those topics professional integrity, pre-briefing, facilitation and debriefing so those modules came first, and then the systematic reviews came second.

Ashley Franklin:

What's new in the cornerstones, though, is that this summer we'll also release advanced cornerstone modules around the other six of the healthcare simulation standards of best practice. So volunteers from our education committee have worked very hard over the last year with a designer to develop those modules, and they're hosted on our learning management system. The neat thing about Cornerstones is they're asynchronous, completely self-paced, and an individual member can do them one at a time, kind of a la carte, or bundle them together, and we also offer institutional pricing. So if there's a group of five or 10 people from the same institution who want to start that professional development journey together, then they can work together on a bundle of modules. So there are new things about the Cornerstones and we're real excited about them.

Deb Tauber:

Excellent, thank you. Now, INASCL's endorsement program celebrating three years in 2025. Inaskel's endorsement program is celebrating three years in 2025. So how would you kind of articulate the value of the Inaskel endorsement to administrators and communities of interest? Tell us a little bit about the endorsement for anybody who might not be familiar with it.

Ashley Franklin:

The endorsement program is very closely related to the healthcare simulation standards of best practice and it recognizes simulation centers or programs, which is different than recognizing individuals. So we recognize simulation centers, and they can be in academic settings or in practice settings who demonstrate high quality simulation, and so the endorsement program is based on those four cornerstones, and so programs put together an application. It's like a dossier paper application with tons of artifacts, most often shared electronically in Google Drive or Dropbox or whatever version of electronic sharing that your sim center uses. But centers provide evidence of how they operationalize the healthcare simulation standards of best practice and then write a short narrative to kind of weave together. Most programs tell the story with two or three case exemplars that are like scenarios of how they orient learners, how they maintain psychological safety, how they scaffold pre-briefing and performance criteria across their simulation program.

Ashley Franklin:

The dossier-based application does not require, like a site visit, and so that's maybe one of the pieces that a member might use to get buy-in from their administrator to apply. When you apply for an Axel endorsement, we do two application cycles a year, typically around March and around like October, and when you are endorsed that's good for three years initially, and so you mentioned, we're doing our three-year kind of celebration. So this is the first year we're doing re-endorsement with programs that were in our pilot phase back in 2022. But we intend for endorsement to be an ongoing thing to recognize high-quality simulation, that sim centers continue and the re-endorsement application isn't quite as large. Just kind of narrating what changes have happened in the interim.

Ashley Franklin:

And how many programs have been endorsed to date 40 programs have been endorsed and they represent academics and practice settings, and they're not all in the United States either. So we're very proud of the sim centers that have put together their dossier to demonstrate high quality simulation, because we continue to learn from them, and that's what simulation is all about.

Jerrod Jeffries:

I love seeing the bridge you know internationally and the growth to say, okay, simulation sites exist outside the US and Axel pushing that direction too, so well done and excited for the reaccreditation ones as well. Hopefully there's a good retention there.

Ashley Franklin:

You know we had a lot of international focus in our strategic plan over the last three years, so this is one way we've operationalized that and I love building the connections.

Deb Tauber:

Great, great. Now, Ashley, do you have a favorite simulation story? A little bit we'll get into a little bit of you know simulation and that you have from your vast experience.

Ashley Franklin:

Sure, One of the unique parts of my simulation journey and journey as a nurse educator is that I've never been an educator without simulation. So I came to simulation in 2008 directly from clinical practice and I had worked in academic medical centers. I'm an adult med surge, ICU nurse and I had precepted new graduates. I had an initial interest in technology and then I had an unexpected love for the pedagogy of simulation. When I first started Early on, my interest was around helping students set priorities and delegate care as they managed multiple patients concurrently, just like new graduates do. That's probably the hardest part of transition to practice and in the last eight or so years I've kind of migrated a few steps back in our academic curriculum. So I've facilitated simulation with first semester med-surg learners for about eight years and I don't know if this is my favorite simulation experience, but one that happened recently. At this point in the semester I'm facilitating scenarios that are a bit more complex. We are doing fluid and electrolyte type concepts in simulation just last week and my group of learners.

Ashley Franklin:

We got to the end of our four-hour sim block.

Ashley Franklin:

They had taken care of three different patients One had severe dehydration, another had fluid volume overload and then we did an anaphylaxis case and at the end of the day my learners were reflecting and they said you know what we could do, that that was hard but we could do that because of the preparation materials and because of the care planning we did at home and we came to consensus on with our groups and the way that you oriented us to the room.

Ashley Franklin:

We knew the equipment we needed and it was a foreshadow of hey, you might need to give a fluid bolus and here's how that works. And so I felt like my learners, even though they were very young in our curriculum, were able to see the intentionality of you, know the instructional design and then also able to take care of the patients, titrate oxygen, give fluid bolus, question and order for a fluid, a patient. That didn't quite make sense. So it helped us bring together concepts of fluid and electrolyte that are really hard for new nurses and they felt good and they had performance behaviors that looked pretty good too.

Jerrod Jeffries:

So it was just a great day good, that's great, and I love hearing all these different stories because, I mean, I haven't heard something with fluids, electrolytes, uh and such. But it's always great to see the change you and the growth you see in learners and it comes from almost every simulation and seeing them reflect and and I think that's really rewarding to be able to experience that. So thank you.

Ashley Franklin:

I agree, and it doesn't happen often that they share that verbally at the end of the day, that they're like, hey, we did that.

Ashley Franklin:

Sometimes they can share it in writing and a reflection, you know, but I don't get to see facial expressions. And so this young woman was so proud of herself and shared it with her group and I'll remember it for a long time. It was really neat. You know, we want to improve their confidence, but we also want to improve their skill, performance and their safety, and she was capturing that. We did both of those that day.

Deb Tauber:

Excellent. Now, Ashley, are there any things that you'd like to leave our listeners with any final words? That's a great question.

Ashley Franklin:

Thanks for asking. You know what I would say. I'm so pleased to be able to represent INASCL in lots of different venues. IN has given to me tremendously over the last 15 years and I hope I've returned some of that sharing and contributions to the organization. I guess what I would share is the importance of high quality simulation and that that is relevant across modalities and across learner groups, for example, in academic settings and also in practice settings, and also in practice settings In my every week experience.

Ashley Franklin:

I always want to encourage people to speak up when they see something, to say something, and I think that applies to learners who are learning how to communicate with each other, but it applies to sim facilitators too, because our simulation programs are modifiable.

Ashley Franklin:

You know, when we do PDSA cycles and we evaluate our outcomes from various different sources, just like my learner's behaviors are modifiable, that I can help them learn to wash their hands and learn to do skills or learn to communicate with their patients, I want our sim programs to be modifiable too. So if something doesn't work, we have to speak up, and I want all of the simulationists in my community of interest to have permission to change their simulation program as they go along, especially if they're evaluating you know, a new scenario or simulation in a new course and the pilot data looks like it's not working. I know that speaking up is hard, but that's what I want people to do, because I think speaking up is going to help us change our simulation programs. It's going to help us improve learner outcomes and ultimately make the impact of the simulation we facilitate more profound so that we can improve patient safety.

Deb Tauber:

Thank you, I like that speaking up and it's very, very true and very important because see something, say something right, and how can we get better if nobody speaks up?

Ashley Franklin:

Yeah, totally agree. Thank you for echoing that. Thanks for sharing.

Jerrod Jeffries:

Totally agree. Thank you for echoing that.

Deb Tauber:

Thanks for sharing. Yeah, now, if our listeners actually want to get a hold of you, where would they get a hold of you If they want to ask questions about a INASCL or standards or anything?

Ashley Franklin:

as president, Sure, so my day job is at Texas Christian University and that information is really easy to find on the website. I use that email every day and I'm very open to somebody reaching out. I've tried to be active on LinkedIn and check those messages as well, so please do reach out because I would love to help people get plugged into an Axel or other you know, nursing education simulation projects.

Deb Tauber:

Thank you, Jerrod. Do you have anything? Any other questions or?

Jerrod Jeffries:

No, this is great. Appreciate all that E was doing and how you're leading them this year. So hopefully you have a great conference in Denver and thanks for everything you do.

Ashley Franklin:

Yes, yeah, echo, thank you for what you guys do as well and for helping our colleagues tell their story, because we can learn a lot from one another. Thank you.

Deb Tauber:

And with that, happy simulating.

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Thanks to UBSim for being a proud sponsor of this week's Sim Cafe and the annual Naxal Conference. We'll see you in Denver. Thanks for joining us here at The sim cafe. We hope you enjoyed. Visit us at www. innovativesimsolutions. com. innovativesimsolutionscom and be sure to hit that like and subscribe button so you never miss an episode. Innovative Sim Solutions is your one-stop shop for your simulation needs. A turnkey solution.

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