Authentic moulage: exploring participant engagement in simulation

Moulage in the traditional sense is the art of replicating illnesses and wounds through casting wax moulds. Origins are traced to Ancient Egypt and forbidden practices of 17th century Europe. While traditional moulage is now housed in musea across the world, modern moulage is used to replicate illness and effects in simulation using special effects makeup techniques. Simulation is a well-established technique to prepare health professionals for clinical practice, and is grounded in a strong evidence base. Despite the strong evidence for the use of simulation, the conditions of moulage is an underexplored topic within the context of simulation research, and we know very little regarding how it works, under what conditions and what the effect is on participants of simulation. In order to better understand how and why moulage impacts on participants of simulation, a series of complementary studies were completed. Initially a Systematic Review of authentic moulage in simulation was undertaken to understand the current research on moulage. This provided a useful baseline for the current use and evidence for moulage in simulation. Subsequently, a further study was undertaken to define authentic moulage in simulation via an electronic Delphi consensus method. This study recruited international experts on moulage and resulted in the development of the Moulage Authenticity Rating Scale (MARS) to measure moulage authenticity. Finally, a third study was conducted to explore how the authenticity of moulage effects participant engagement in simulation using a randomized control experiment design. This study utilized the MARS tool developed from the previous study to design moulage that was low-authenticity and high-authenticity, and compared levels of engagement using measures of self-report, eye tracking and interview methods. The results of this work presents previously unrecognized information on how medical students perceive the authenticity of moulage and how it contributes to their performance and engagement in simulation. In summary, I present a number of suggestions as to how simulation users and designers might consider moulage in their everyday practice. This thesis presents a series of philosophical research questions and findings that collectively make an original contribution to the future of moulage in simulation and undergraduate Medical Education using simulation-based curriculum, teaching and learning.