The Case for Moulage
Simulation education is dependent upon the premise of suspension of disbelief. This is a contract with learners in which there is acknowledgment of the limitations and artificiality of simulation. Yet, this is not a pass for educators to shrink from every opportunity to make the simulation experience as realistic as possible. In the simulation field, realism is described as fidelity, i.e. a high-fidelity simulation has a high level of realism. Every time we ask a learner to pretend, we make it a little harder for them to truly engage in simulation exercise.
- Hand with partial thickness burn
- Polytrauma patient with forehead laceration and evisceration from explosion
Moulage is defined as applying mock injuries (with makeup, paint, or molding) for the purpose of training medical teams. Moulage has a powerful effect on learners. Part of staying calm during a medical emergency is the ability to look at injuries and maintain composure. Additionally, it is important to actually examine injuries and develop a plan based on the assessment. When we do a trauma case, and we ask a student to read a card taped onto a manikin or worse, “imagine there’s bruising behind the ear,” we take a simulation and turn it into a discussion, thus we lose the power of a simulation based education event. When moulage is incorporated into regular simulation practice, learners know that they have to examine the manikin, the same as they do a patient, and soon they stop asking, “what do I see?”
- Forearm with partial thickness burn with blistering
- Hand laceration with embedded “glass,” (flexible, safe material)
Many simulation centers will invest in an expensive manikin, with many bells and whistles. Understandably, there is a desire to keep the manikin in good condition. Unfortunately, this sometimes translates into, “Don’t moulage the manikin, you'll stain it!” Review your simulator manufacturer recommendations. Also review the moulage kit directions. In general, for most manikins, 70% isopropyl alcohol is the preferred cleaning solution. Cleaning promptly is recommended, as most stains occur due to the moulage being left on for days. Also, in warm conditions, such as outside, the moulage can bake into the skin. Talcum powder can be used to remove sticky items. Apply baby powder to clean, dry manikin skin to keep it fresh, as alcohol dries the skin out over time. If you’re worried about staining a manikin, see if you have an extra skin, or save a skin to use for moulage testing.
Want to take your simulations to the next level? Add in smells! Moulage Concepts offers a variety of aromas you can place on cotton balls and strategically place in your simulation to add a heightened level of realism. Smells available include gunpowder, blood and burnt flesh! While this may seem silly, activation of the senses through sight and smell can be powerful tools to increase memory formation, which improves learning retention.
For the busiest of educators and centers, there are pre-made moulage options. There are myriads of silicone wounds that only require the addition of a little wax to adhere to the manikin. Also, there are sleeves that can be applied to the manikin or a live actor, for example, circumferential burns around an arm. There are also sticker tattoos for live actors. These time saving techniques can be very helpful for multiple casualty scenarios.
- Complex facial burns, lacerations secondary to explosion. This silicone creation could be applied overtop of a manikin.
- Forearm burn with imbedded debris from explosion
Moulage does take time to learn how to do, although it’s not as complicated as you think! In a two-day course, I learned to make lacerations, burns, open fractures, bruising and abscesses. These moulage techniques can be applied within minutes, thus your additional prep time is minimal. I promise the educational effects will pay dividends. The look on my learners’ face when I do a really intense moulage is priceless, and I can watch them transform into “this is just another boring sim,” to “Oh wow, that looks crazy!” I can watch them instantly begin to take the case more seriously and snap into action.
Lastly, as a physician-educator, moulage is fun because I get to channel my inner artist. Medical school and residency left little time for creative outlets. Through simulation and moulage, I get to be an artist that designs interesting and realistic educational events.
