Use Of Moulage Research Articles

‘Having skin in the game’: guiding principles for incorporating moulage into OSCEs

BackgroundDermatological conditions are a common reason for patients to seek healthcare advice. However, they are often under-represented in Objective Structured Clinical Examinations (OSCEs). Given the visual nature of skin conditions, simulation is suited to recreate such skin conditions in assessments such as OSCEs. One such technique often used in simulation is moulage—the art and science of using special effects make-up techniques to replicate a wide range of conditions on Simulated Participants or manikins. However, the contextual nature of OSCEs places additional challenges compared to using moulage in more general forms of simulated-based education.Main bodyOSCEs are high-stakes assessments and require standardisation across multiple OSCE circuits. In addition, OSCEs tend to have large numbers of candidates, so moulage needs to be durable in this context. Given the need to expand the use of moulage in OSCE stations and the unique challenges that occur in OSCEs, there is a requirement to have guiding principles to inform their use and development.ConclusionInformed by evidence, and grounded in experience, this article aims to provide practical tips for health profession education faculty on how best to optimise the use of moulage in OSCEs. We will describe the process of designing an OSCE station, with a focus on including moulage. Secondly, we will provide a series of important practice points to use moulage in OSCEs—and encourage readers to integrate them into their day-to-day practice.

How to Use Moulage as a Simulation Tool in Medical Education?

The promotion of student engagement in simulation-based learning depends on authenticity, fidelity, and realism. Moulage is a simulation of illnesses or physical signs onto standardized patient or manikin via using makeup techniques or other elements acting as visual and tactile cues to promote learner engagement through more real-world experience. Therefore, moulage may be used broadly in medical education wherein its authenticity helps to improve the learning outcomes and performance of students in different medical branches such as dermatology, surgery, emergency medicine, anatomy, and forensic medicine. Nowadays, Moulage is already used in the assessment of a medical student as well as in the learning process in many medical schools. However, although the use of moulage as a creative simulation tool in medical education has a positive impact on the educational process, it faces many obstacles and challenges at the same time along with its tangible benefits. Therefore, moulage is not magic as well as it is not fantasy or mock, but it is a fantastic vehicle for representing and simulating the real event promoting realism and motivating students' engagement and immersion.

For the students, by the students: Student perceptions of low cost medical moulage in a resource-constrained environment.

IntroductionSimulation-based learning affords participants the opportunity to practice high-acuity, low-incidence situations without risk to the patient. The realism of a simulated scenario is often referred to as fidelity. High levels of fidelity imply high levels of realism. One method of enhancing fidelity is the use of moulage. Commercially available moulage kits and professionally applied moulage are often expensive and therefore not practical in the resource-constrained environment. Cost-effective alternatives are required for the resource-constrained environment.MethodsStudents at a South African university used readily available, low cost materials to apply self-constructed, low cost moulage for a bandaging practical. A cross sectional design used a purpose-designed, validated questionnaire to gather data related to face and content validity of the self-constructed moulage. Frequency analysis formed the cornerstone of Likert-type quantitative data analysis. An open-ended question afforded participants the opportunity to express their own opinions related to the moulage experience.ResultsThe results revealed that there was both high face validity and high content validity of the self-constructed moulage. Participants found the activity enjoyable and a generally positive learning experience. The self-constructed moulage was realistic and added to the fidelity of the scenario. Participant confidence was improved and their engagement in the learning activity was enhanced. Participants found the self-constructed, low-cost moulage more realistic that commercial products that they had been exposed to.ConclusionThe use of low-cost, self-constructed moulage is a feasible and economically viable means of enhancing fidelity within the resource-constrained simulation setting. This technique is not necessarily limited to emergency medical care and can be used in other areas of healthcare simulation.

Can simulation impact on first year diagnostic radiography students' emotional preparedness to encounter open wounds on their first clinical placement: A pilot study

IntroductionThis study reports on the use of moulage within a simulation to introduce first year diagnostic radiography students to open wounds in preparation for clinical practice. MethodologyA mixed-method quasi-experimental design was used. Visual Analogue Scales were used to capture state feelings at the point of seeing open wounds. Interpretative Phenomenological Analysis was used to draw themes from focus groups and an interview following clinical placement. ResultsThe simulation reduced negative feelings whilst emotional preparedness, distraction and excitement increased. Five major themes were identified including emotional engagement, engagement with wound, building relationships, developing professional self and simulation impact. ConclusionThe use of moulage and a simulation provides an opportunity to explore initial reactions. Students actively reflect on this experience during clinical practice changing practice. The impact of open wounds can be long lasting and support from radiographers should allow these new experiences to be processed reducing the risk of burnout.

Use of Moulage in Multi-Disciplinary Mass Casualty Incident (MCI) Training: Cost-Effective Tool or an Expectation?

Introduction:A 2018 poll by the American College of Emergency Physicians shows 93% of surveyed doctors believe their emergency department is not fully prepared for patient surge capacity in the event of a natural or man-made disaster. While an emergency disaster plan is activated during any incident where resources are overwhelmed, many US emergency physicians today think of a mass casualty incident (MCI) as the inciting event. To better prepare our communities, an MCI simulation took place in Chicago 2018 with participation from local and federal representatives. Included were Chicago fire, police, and emergency medical services agencies, emergency medicine physicians, resident participants, and medical student volunteer victims.Aim:The study’s aim was to determine whether resource intensive moulage was an expected component or a beneficial adjunct, if moulage-based training would improve physician preparedness, and if such a training would increase the likelihood of future involvement in local disaster preparations. Analysis was performed on pre- and post-training surveys completed by participants. By reviewing the benefits versus cost, future MCI simulation planners can efficiently use their funds to achieve training goals.Methods:Thirty-two emergency medicine physicians were surveyed before and after a five-hour training session on October 20, 2018, which included 89 moulage victims. Twenty-four after-event surveys were completed. All completed surveys were utilized in data analysis.Results:Of polled participants, a 68% improvement in general preparedness was achieved. While only 19% of participants cited current involvement in their facility’s disaster planning in pre-event survey, the likelihood of involvement after training was 8.2/10. Overall, the importance of moulage an essential component to such trainings remained constant.Discussion:Moulage is an expected and crucial element to MCI training and should be incorporated as extensively as resources allow. MCI trainings improve physician preparedness and potentially increase physician involvement in disaster planning at home institutions.

The Effect of Moulage on Immersion, Realism, and Learning in a Traffic Accident Training Scenario for Police, Rescue Service, and Ambulance Students

Introduction:Moulage is the art of creating faked injuries on actors for training purposes. Moulage is commonly used in disaster and emergency medicine training, as it is believed to improve learning through enhanced realism.Aim:The aim of the current study was to test the effect of moulage on perceived realism and learning during a joint exercise featuring students from the police, rescue service, and ambulance service.Methods:The scenario was a car accident with two victims. Students (n = 135) were divided into 12 groups. Moulage was applied to the victim actors for half the groups (n = 67), whereas the other half (n = 68) experienced the scenario without moulage. Victim cards were used in both scenarios. Immersion, realism, and learning was measured on a 100-point scale immediately post-scenario using a questionnaire.Results:Two (moulage group) by three (student population and police, rescue service, or ambulance) ANOVAS on realism, immersion, and learning found no effects on realism or immersion (all p>0.10). There was an effect of student group on learning, F(2, 92) = 3.518, p = 0.034, partial eta square = 0.071, such that the rescue service students had overall lower scores on learning (M = 53.87, SD = 28.29) compared to the police (M = 66.07, SD = 27.55) and ambulance students (M = 74.99, SD = 24.51). Cohen’s ds for moulage effect was calculated to 0.144 for immersion, 0.112 for realism, and 0.003 for learning.Discussion:The current study did not find any effects of moulage on immersion, realism, or learning. The effect sizes indicate that any effect of moulage on realism and immersion, should it exist, is in the approximate size of 2-3 points on a 100-point scale. The lack of effect may be due to limitations in the study design, but may also indicate that the use of moulage in addition to victim cards is not necessarily beneficial for novice students’ learning.

Use of Moulage to Evaluate Student Assessment of Skin in an Objective Structured Clinical Examination

This study investigated the physician assistant (PA) student evaluation of skin and the use of moulage in an objective structured clinical examination (OSCE). Clinical-year PA students participated in an OSCE, taking a history, completing a physical examination, and writing a focused clinical note. The standardized patient's history simulated a primary diagnosis of right-sided carpal tunnel syndrome and an incidental skin lesion consistent with melanoma, only if the student made an inquiry in this replication study. Faculty members' assessments of students' physical examinations were standardized using an agreed-upon rubric. Students completed an anonymous survey on the OSCE experience immediately following the activity. All students identified the primary diagnosis of carpal tunnel. Sixty-three percent of students verbalized examination of the skin; however, only 38% identified an atypical skin lesion in their clinical note documentation. Of those, only 33% of students referred the patient for biopsy. Most students believed that the use of moulage increased the realism of the standardized patient encounter. Sixty percent of students reported that they noticed a skin lesion but did not believe that it was part of the simulated experience. Moulage increased the realism of the OSCE. This study found that the ability of a student to verbalize the evaluation of a particular body system did not necessarily mean that they adequately or correctly assessed that system upon physical examination. Implementation of an OSCE and use of moulage provided an opportunity to explicitly assess student performance related to evaluation and assessment of skin. It provided a mechanism for meaningful, formative feedback of students' performance.

Does Appearance Matter? Current Issues and Formulation of a Research Agenda for Moulage in Simulation.

The use of moulage is assumed to add realism and authentic context in simulation. Despite the expense required to utilize moulage effectively, there is little exploration in the literature as to both its necessity and its accuracy of portrayal. We explore engagement, authenticity, and realism theories in the context of moulage and highlight the need for more evidence on moulage in simulation-based education, including suggestions for future research. In particular, we urge the simulation community to move beyond descriptive papers to investigate moulage in terms of justification and clarification.

Using Moulage to Enhance Educational Instruction

An understood goal of faculty when using simulations and role play as teaching strategies is to make them as realistic as possible. The author discusses moulage, a makeup technique that can be used to enhance a simulated learning experience and reinforce prior learning regarding cellular damage and repair. The use of moulage in other undergraduate didactic courses such as nursing research is presented.

Recognizing Biothreat Diseases

The UofL Center for the Deterrence of Biowarfare and Bioterrorism's (CDBB's) training involving standardized patients, who can make convincingly accurate representations of clinical signs and symptoms, and patient simulators has proven to be an effective means of enhancing bioterrorism preparedness. In addition to providing ready access to formative measures of preparedness, both of these teaching and learning tools also offer the option of summative evaluation of skills and knowledge acquired during training sessions. The use of moulage allows for very realistic representations of cutaneous anthrax and smallpox as well as other conditions such as recluse spider bites and chickenpox with which these biothreat infections can be confused. Exercises and drills expose deficiencies and permit essential reinforcement of skills developed in training. Unannounced exercises are especially useful in assessing public health preparedness.

An Introduction to the Medical Wilderness Adventure Race (MedWAR)

First-aid competitions have a long history. For example, the American Red Cross helped publicize its first-aid classes (which began in 1910) by holding first-aid contests all over the United States.1.American Red Cross. Brief History of ARC First Aid Program. Information Letter #6; revised November 1964.Google Scholar These contests are still held in some states, though they have become much less common. St John Ambulance also has a long tradition of first-aid competitions, going back more than a century. St John Ambulance, like the Red Cross, is a volunteer-based organization that provides first-aid services and training. It was founded in Canada in 1882 and now has branches in many other countries, including Great Britain, Australia, and Austria. Volunteers from St John Ambulance and the Red Cross participate in both national and European first-aid competitions. These competitions are much more popular and better publicized than the relatively few remaining competitions in the United States. (For more information about this topic, do Google searches on first-aid competitions and St John Ambulance.) The Medical Wilderness Adventure Race (MedWAR) revives an old tradition and gives it a new context. Wilderness emergency care courses often include realistic scenarios in an outdoor setting, and any role-playing scenario includes a competitive element, though participants are generally competing against a standard of performance rather than each other. Scenarios also usually require teamwork, which instills camaraderie in the participants. MedWAR not only puts emergency care competition into a wilderness setting, it also adds to the challenge by having the simulated emergencies occur during a wilderness activity, such as hiking, mountaineering, or canoeing. Thus, participants are tested on wilderness as well as emergency care skills. This strategy has already attracted several wilderness organizations, such as the Boy Scouts, and should lead to alliances with many other organizations. For example, the National Ski Patrol, the Civil Air Patrol, mountain rescue teams, search and rescue teams, park medics, survival schools, and wilderness guides are all potential participants; collaboration with such organizations could also lead to cross-training. MedWAR events can be made very realistic by the use of moulage (accident make-up).2.Donelan S. The wilderness instructor. Staging simulated accidents.Wilderness Environ Med. 2000; 11: 52-55Abstract Full Text PDF PubMed Scopus (7) Google Scholar Realistic simulation of injuries, along with effective acting-out of symptoms (and the real wilderness setting) can give MedWAR problems the physical and psychological impact of real wilderness emergencies. Moreover, effective acting by well-coached victims can largely eliminate the need for written exams. For example, a victim can simulate many of the symptoms of altitude illness (eg, fatigue and shortness of breath for high-altitude pulmonary edema) with the disembodied voice of a monitor supplying the data that cannot be simulated (eg, “Pulse is 110” [when the rescuer checks pulse] and “You hear crackles” [when the rescuer listens to lung sounds]). And if the scenario is not actually at high altitude, the scene can be set with a sign on a hill top (eg, “Mt Whitney, 14 000 feet”). In other words, whatever the victim cannot simulate can be provided by visual or auditory cues, which enable the rescuers to stay in their roles and the monitors (by convention) to remain invisible. In summary, MedWAR events have the potential not only to test the skills of wilderness rescuers, but also to stimulate interest in wilderness emergency care, create alliances with many wilderness organizations, and even generate publicity that can greatly enhance both recruiting and fund raising for volunteer organizations.