Modern Medical Moulage in Health Professions Education

Bauer, Daniel; Lörwald, Andrea Carolin; Wüst, Sandra; Beltraminelli, Helmut; Schnabel, Kai (23 March 2018). Modern Medical Moulage in Health Professions Education. In: 13th International Skills Lab Symposium (pp. 22-23). Maribor: University of Maribor, Faculty of Medicine

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Medical moulage is the art of reproducing a healthy or afflicted body part as macroscopic model for the purpose of documentation, training or assessment. Casts, additionally modified by colouring or other techniques, and wax moulages have served as models since ancient times until photography was established. Modern moulage includes a complex combination of silicone casts, temporary tattoos, professional make-up, and other techniques to depict particular signs of disease on a healthy person or on a mannequin in simulation-based education. In the literature a comprehensive overview about the use of modern medical moulage in health professions education is missing. We aim to provide medical educators with such an overview of this promising aspect of simulation in education, describing how the moulages are being used in health professions education and assessment, and how the use of moulage is evaluated regarding its effectiveness.

Hits for the search term “moulage” in the journal websites’ search option of InCites Journal Citation Report listed journals of dermatology (all, n=63) and education journals (health related, including nursing and military medicine, n=22) constituted an initial data basis and included publications up until December 2017. Original research articles in English and German describing the use of modern medical moulage in health professions education (teaching and assessment) or evaluating such use were included. Based on these search results, iterative forward search (sources citing an included hit) as well as iterative backward search (sources cited within an included hit) was performed until no more articles matching inclusion criteria were found. For inclusion, articles had to specify either the depicted condition, information on whom the moulages were used, the training’s or assessment’s target population, the educational scenario in which moulages were used, or the mode of moulage evaluation.

In sum, 50 articles were included in this review. The use of modern moulage included the simulation of signs of trauma like hematoma, abrasions, lacerations, burns, open and closed fractures, evisceration, or amputations and, in a more dermatological setting, integumentary diseases such as melanoma, herpes, psoriasis, diabetic ulcer or Ebola rashes. Moulage was either applied to mannequins or simulated patients. Target populations covered undergraduate and postgraduate learners in health professions including nursing students and registered nurses, medical students, residents, physicians, pharmacy students, emergency medical technicians, firemen, first responders, and army and navy personnel. 39 studies reported the use of moulage in teaching settings. These were predominantly instances of clinical skills teaching, but a different, noteworthy application was to facilitate affective learning objectives by applying the moulage to the students themselves and letting them experience certain illnesses. Eleven studies described the use of moulage for assessment purposes. In both, teaching and assessment, moulages were evaluated regarding the extent to which they looked realistic and the extent to which their use enhanced the credibility of the simulation. For teaching, moulage was additionally evaluated regarding its usability and teaching effectiveness. Different teaching modalities (with or without or with different moulages) were compared regarding their effect on learners’ self-efficacy and performance. In assessment, moulages were evaluated indirectly by the extent to which simulated lesions (like incidental melanoma) were correctly detected by the examinees.

In this review, we analysed and describe how modern moulage is used in health professions education. A certain degree of validity can be argued for both teaching and assessment settings. The range of signs and symptoms being simulated with moulage is probably wider then could be reported here, since the details of moulage simulation are often not elaborated upon in literature. As in other simulation settings, there is little understanding so far, as to how much simulation authenticity is necessary, i.e. when moulage application is worth the effort and makes a meaningful difference. On a more practical side, studies have demonstrated that moulage produced by professional make-up artists is of higher quality than health professions educators’ own creations. Therefore, we suggest there should be more opportunities for health professions educators to professionalize themselves and we highlight the value of exchanging recipes and techniques of preparing modern medical moulage. Lastly, we emphasize the educational potential of modern medical moulage, as it offers possibilities well beyond clinical skills training.

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