Moulage is a visual technique that adds a layer of realism to health care simulation education. Simulated injuries or conditions created on mannequins and standardized patients through moulage can add value by allowing students to see and repair injuries as part of their training session, instead of just imagining how the affected anatomy might look. These sometimes-graphic visuals also enable students to practice maintaining a calm, confident demeanor while keeping control of any medical scenario. In this Q&A, resident moulage expert Camila Venegas explains how she pairs artistry with medical accuracy to make learning more lifelike at S.H.A.R.E. Simulation Hospital Advancing Research & Education®.
How did you find your way to S.H.A.R.E.?
Camila Venegas: I was at a crossroads in my career, unsure on what path to take, when my younger sister, a current student at UM, mentioned that the School of Nursing and Health Studies, had posted an advertisement for a position that I would be a great fit for. After applying I received a call back, and within a few weeks I was a proud employee of S.H.A.R.E.
What are some of your responsibilities as a simulation technologist?
We take care of a lot. We make sure all equipment and supplies are in good working order for the students and set up according to the scenario or skill taking place. In addition, we are the voice behind the mannequins during scenarios, whether it's a patient that's in hospice care, in the ICU, or a pediatric patient with a caregiver, we alter our voices and emotions to fit the script. We run the simulator vitals, carry out the script, and act out the symptoms. As you can see, it's a little bit of everything: we're actors, we're AV technicians. A lot goes on behind the scenes, but it has helped me learn how to think and act quickly.
What is moulage?
Moulage is a unique technique within the field of health care simulation that brings a level of realism to learning through simulation. Simulated injuries created through moulage can provide added value to training sessions, allowing students to actually see and repair the injuries in said sessions, instead of just having to imagine what they may look like.
How do you use moulage for S.H.A.R.E.?
It depends on what is needed to fulfill the objectives of the course, what is being incorporated into the curriculum. Moulage has a larger place in sim than it did in the past. I didn’t know much about it when I started at S.H.A.R.E., then a year ago I created stomas for students to practice skills on: I used simulator skin to create intestines sticking out of the “patient’s” stomach. The rest is history. I have been more and more involved in creating models for simulation use, and am improving my technique every time I work. Last May, for example, we were part of a mass casualty training event where two of us were in charge of creating the moulage. We had to create many gunshot wounds, compound leg fractures with bone sticking out of the skin, scrapes, and bruises. That was challenging but very rewarding. I was kind of thrown in the deep end. They had so much faith that I could do it, so I just ran with it. Since then, many new requests have come in, especially from our acute care program.
How do you feel moulage enhances simulation experiences for students?
Honestly, I look at it as if I were one of the students. You can be in a class, and they can explain concepts to you, show you pictures and videos. That often doesn’t truly prepare you for the hospital environment. During a simulation exercise, I can create a specific bruising pattern on the shoulder of a mannequin. Seeing that bruising in real life, and not just being told about it by an educator, allows the student to make connections. Maybe they’ll suspect this person is being abused, and they’ll treat them differently than if they just fell down the stairs or had an accident. If we give them everything we can to make the simulation as real as possible, the students take more from that experience.
How do you collaborate with the other simulation techs at S.H.A.R.E.?
The rest of the technicians are very tech savvy, especially since they’ve been working at S.H.A.R.E. longer, so whenever there's something going on with the technical system and I'm not aware of what the issue might be, they’re always my first call. The same goes for them. If they need moulage, they just come straight to me. We all have our specialty.
What has been your most unusual experience using moulage at S.H.A.R.E.?
Definitely the mass casualty training. The volume and complexity of injuries was beyond what I had anticipated, bullet wounds, deep cuts, open fractures. I was informed ahead of time there were supposed to be two open fractures, and it takes time to create those. But the day of they gave me an extra one, so I was nervous. Just as I finished working on the last person, she was called to begin the scenario. I had made it in time.
How long does it usually take you to create these special effects?
It could take anywhere from 30 seconds for a bruise up to maybe an hour or two, depending on the complexity of the injury. With this newfound passion of mine, I am learning that it’s big in the world of simulation education. I learned about the possibility of presenting at the International Meeting on Simulation in Healthcare (IMSH) SimVentors. This year I showcased a range of my moulage work there, including stomas for ostomy care, which is something our undergraduate nursing students learn about. I was tasked with creating the stomas for this skill. Presenting these wounds was a great way to showcase to other simulation centers around the world a low-cost, high-quality method of creating simulated wounds.
How did you come to specialize in moulage in the first place?
It happened by chance. I've always found it fascinating how people could do special effects makeup on themselves or on others, but I’d never done it. I had just started in this position, and the Gordon Center for Simulation and Innovation in Medical Education at the University of Miami Miller School of Medicine was having an all-day course in moulage. I attended mostly out of curiosity and then I took it from there. When I first started, I would work from home and watch videos on simulation to expand my understanding. I have received lots of support from my team and supervisors. I spend time doing different moulage techniques. Some of them are extreme, but there's a lot of creativity going into it, and oh my gosh, I have so much fun. Sometimes I get frustrated because it's not going how I want it, but in the end, I have to trust the process. If you had told me two years ago this is what I would be doing, I would not have believed you at all. Now, it is one of my passions.
