By: Victoria Brazil (@SocraticEM)
There are many fun activities for simulation practitioners. One is the creative challenge of making the injuries or illnesses of our ‘patients’ look real, whether on human SPs or mannikins. This can involve special effects make up, silicon, talc, and an increasingly diverse array of synthetic materials to represent the pathology required. A post from Healthy Simulation described it as “pairing artistry with medical accuracy”. There are many online resources and recipes available for inspiration and guidance.
But moulage needs to be done thoughtfully, with the educational objectives in mind. In their systematic review, Stokes-Parish et al found that there was a “widely held assumption that moulage is essential in simulation-based education for improved realism and subsequent learner engagement, but … no clear evidence from the literature that this is the case”. So moulage efforts should be intentional and purposeful.
This is especially important if moulage is being used for OSCEs (objective Structured Clinical Examinations) or other assessments. Moulage needs to be standardized and durable. And we shouldn’t let the limitations of moulage drive our assessment approach. With these challenges in mind, Korimbocus et al have just published ‘Having skin in the game’: guiding principles for incorporating moulage into OSCEs.in Advances in Simulation. (1)
The article draws upon literature and expert practice to provide practical guidelines for those using moulage for assessment, but I think is also relevant to other educational purposes. The authors highlight the under-representation of skin conditions in medical assessments and the potential of moulage to address this gap. More of their tips include:
- Working in a multidisciplinary team, including moulage experts, healthcare professionals, and simulated participants (SPs).
- Ensuring clinical authenticity, especially if used for diagnostic assessment.
- Durability: Moulage should be robust enough to withstand repeated examinations by multiple candidates.
- Cost-Effectiveness and Efficiency: The application process should be quick and cost-effective, with multiple individuals trained to apply it efficiently.
- Inclusivity and Safety: Moulage should represent various skin tones to promote equality, diversity, and inclusion, and ensure the physical, psychological, emotional, and cultural safety of SPs and candidates.
The article is practical, visual, easy to read, and raised a few issues I hadn’t previously considered. Full text is open access, and we also reviewed it on Simulcast if you are interested
Happy moulaging …
Victoria
References
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