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Simulation in the Faculty of Health Sciences: Moulage Workshop

WARNING: Graphic images below. Although these images may shock you, rest assured they are simulated – easily created using special make up, gels and techniques to portray very realistic injuries and clinical presentations.

Moulage – the art of applying mock wounds or injuries or manifestations of medical conditions to increase the perceived realism of a simulation (Australian Society for Simulation in Healthcare Simulation Directory Data Dictionary, 2015).

In December 2015, the Faculty of Health Sciences held a moulage workshop that enabled staff from across the faculty to gain some hands-on experience at creating various wounds. The workshop (hosted by the School of Nursing, Midwifery and Paramedicine) also helped staff learn more about the products and technologies available to increase the realism, visual fidelity and participant engagement within a range of simulated learning activities.

This image is a simulation of a burn injury
This image is a simulation of a burn injury

The purpose of the workshop was to demonstrate the capacity of the moulage to add depth and realism to simulation teaching and learning activities. Although traditionally this field is associated with the areas of emergency management simulation, defence force training and replication of acute and chronic medical presentations (burns, ulcers, wounds), there is scope for moulage to be extended and utilised with other areas of teaching practice across all health professions.

During the workshop, teaching staff from pharmacy and social work discussed how the use of moulage, such as this simulated facial bruise on the School of Pharmacy staff member Kiran Parsons, could be utilised in teaching students about how to raise the issue of domestic violence. This is particularly important when people have not disclosed this information.  Staff also discussed how these simple techniques to improve realism could be incorporated into interprofessional education, where teams of health professionals are required to act in a coordinated and effective way to assist people who  present for services with appearances that may portray evidence of physical abuse,  self-harming behaviours or drug/alcohol abuse.

moulage of a black eye and facial wounds
Moulage of a black eye and facial wounds

School of Pharmacy simulation lead Laetitia Hattingh discussed the response she received when she travelled home after work without removing the moulage that depicted a black eye and facial wounds. “The simulated wounds had a major impact on my behaviour when I stopped at a service station as I tried to hide my black eye by keeping my sunglasses on and also tried to hide the wounds on my arm. It also made me avoid people and significantly impacted on my confidence. That made me realise how powerful the use of simulation and moulage can be in facilitating students’ understanding of how someone who is exposed to domestic violence must feel and behave”.

Moulage of skin rashes
Moulage of skin rashes

Similarly, creating skin rashes (as illustrated above) provides visual cues for students to extend their noticing and inquiry skills in scenarios where hospitalised patients react to antibiotics or when consumers may present with concerns about medications at their local pharmacy.

Michelle Kelly, Director – Community of Practice (School of Nursing, Midwifery and Paramedicine) reports that moulage is a simple and valuable technique in increasing the ‘environmental’ fidelity of a learning activity by providing students with important visual cues, critical for real world practice. “In their professional role as a paramedic or nurse, students often don’t have a choice in terms of what injuries and conditions they treat. By virtue of having a simulated patient present with a rash, a chemical burn or a wound with embedded glass, students have to engage in clinical reasoning, problem solving and respond in appropriate ways to safely and effectively work with that person. Moulage can really assist in conveying a situation that is close to real practice. Students and staff can work through appropriate responses for such contexts and examine how inappropriate responses might impact on patient outcomes or client interactions. In simulation, rehearsal of practice enables errors to be identified and mitigated with less risk for those we provide care for”.

The workshop was delivered by Nola Pearce from TraumaSim, who specialises in providing moulage training, workshops and equipment:   http://traumasim.com.au/

Interestingly, the website and learning portal EMSWorld (Emergency Medical Services) offer a ‘Moulage of the Month’ feature, where a particular condition is described in terms of how to portray this and what supplies are required. Recent topics have included carbon monoxide poisoning, shark bites, paediatric stroke, heroin overdose, measles, melanoma and pneumothorax, which makes for very interesting reading! http://www.emsworld.com/article/10731960/ems-moulage

However, whilst there is often an immediate connection of moulage for professions such as medicine, nursing, midwifery and paramedicine, there is equal applicability for the use of moulage in areas such as public health, biomedicine, pharmacy, psychology and other allied health professions. You are limited only by your imagination but moulage adds to the emotional engagement of students within contemporary learning and teaching strategies.

If you are interested in learning more about moulage to enhance learning and teaching, please liaise with Alison Kelly or with your school simulation lead.