News & Press: Moulage

Do You Moulage?

Wednesday, February 26, 2020  
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by SimGHOSTS Board Member, Billie Paschal

Considerations for Implementing or Increasing Moulage in Your Simulation Program

I LOVE moulage and admire the handiwork of my peers and mentors.  I will unashamedly call myself an experienced novice! What about you?  What is your level of expertise? Is it encouraged in your program?  Here are some things to ponder if you are planning to incorporate or increase the use of moulage in your program. 

Healthcare Simulation Technology Specialists see examples of moulage through articles, exciting posts on social media, and during conference workshops focused on moulage.  There is a definite passion for moulage and sometimes a correlation with years of experience in simulation and a theatrical background. Seeing examples of how others use moulage we begin to wonder “Should our program be doing this too?” 

Healthcare Simulation requires planning encompassing scheduling space, equipment, ‘manpower’, building and testing, just to highlight a few tasks.  Putting everything together is an amazing feat no matter if you are scheduling one simulation per semester, per level in a one-person show or over twenty-five thousand learner hours like my home program.  It takes time, vision, flexibility and a little bit of magic.  Incorporating moulage adds another level of complexity. It will change the timing needed for preparation depending on which manikin, what supplies are used, and who the learners are.  Do you need to create a rash, gunshot wound, or even postpartum hemorrhage? Each of these vary greatly regarding time, supplies, re-setting, and clean up.   

Your level of moulage experience will determine the time of trial and error involved.  I have mentors that can “MacGyver” their way through a mass casualty event with $20 spent at a dollar store. Being an experienced novice, I have some go-to ingredients that can be used to replicate almost anything.  However, I always want to “dry run” a new moulage recipe.  Is the right consistency achieved in the drool?  Does the bruise look fresh or too old for the scenario? Is the blood the correct color to reflect venous or arterial?  Trial and error takes time, energy and sometimes money.  

Before getting gung-ho on the moulage, PLEASE consider the warranty of your equipment.  I say equipment because I have been asked to do some crazy things to beds and IV pumps.  If you are unsure of the warranty status, verify it!  Never do anything that could jeopardize your warranty.  A standard one year is typically free but is important.  If the program has invested the money for extended protection/warranty plans, it is your responsibility as the Healthcare Simulation Technology Specialist to keep it valid.  Moulage is not forbidden while under warranty, but precautions should be made to prevent permanent discoloration, tearing, damaging the skin or computer components.  All these items would require a substantial cost to repair.  

Lastly, consider the immersion level of the participants. I recently read an article published in the BMJ STEL journal, titled, “Simulating a self-inflicted facial gunshot wound with moulage to improve perceived realism, immersion, and learning in simulation-based airway management training.” I was impressed by many things shared in the article and encourage you to take the time to read it. Their moulage took approximately three hours to create and they used an out of warranty Laerdal ALS simulator.  The scenario was a self-inflicted gunshot wound that created a complicated airway.  The realism of the wound and airway created an immersive scenario and the learners were surprised by the level of emotion triggered by the injury. The gaping wound created obstacles present in a facial gunshot wound allowing the learner to experience points of reference that can be translated if faced with a similar real situation.  Feedback was obtained indicating the moulage in this scenario created a high level of immersion which enhanced the learning experience.  

If you are the Healthcare Simulation Technology Specialist in a center that currently does not moulage but you are interested in advocating for its use in your simulations I am hopeful this blog has offered you things to ponder when considering moulage.  

Santomauro, C., Host, D., Arthur, D., Alexander, M., & King, C. (2020). Simulating a self-inflicted facial gunshot wound with moulage to improve perceived realism, immersion, and learning in simulation-based airway management training. BMJ Simulation and Technology Enhanced Learning, bmjstel-2019-000492.