How does moulage contribute to medical students’ perceived engagement in simulation? A mixed-methods pilot study

Abstract

Introduction: Moulage is used frequently in simulation, with emerging evidence for its use in fields such as paramedicine, radiography and dermatology. It is argued that moulage adds to realism in simulation, although recent work highlighted the ambiguity of moulage practice in simulation. In the absence of knowledge, this study sought to explore the impact of highly authentic moulage on engagement in simulation. Methods: We conducted a randomised mixed-methods study exploring undergraduate medical students' perception of engagement in relation to the authenticity moulage. Participants were randomised to one of three groups: control (no moulage, narrative only), low authenticity (LowAuth) or high authenticity (HighAuth). Measures included self-report of engagement, the Immersion Scale Reporting Instrument (ISRI), omission of treatment actions, time-to-treat and self-report of authenticity. In combination with these objective measures, we utilised the Stimulated Recall (SR) technique to conduct interviews immediately following the simulation. Results: A total of 33 medical students participated in the study. There was no statistically significant difference between groups on the overall ISRI score. There were statistically significant results between groups on the selfreported engagement measure, and on the treatment actions, time-to-treat measures and the rating of authenticity. Four primary themes ((1) the rules of simulation, (2) believability, (3) consistency of presentation, (4) personal knowledge) were extracted from the interview analysis, with a further 9 subthemes identified ((1) awareness of simulating, (2) making sense of the context (3) hidden agendas, (4) between two places, (5) dismissing, (6) person centredness, (7) missing information (8) level of training (9) previous experiences). Conclusions: Students rate moulage authenticity highly in simulations. The use of high-authenticity moulage impacts on their prioritisation and task completion. Although the slower performance in the HighAuth group did not have impact on simulated treatment outcomes, highly authentic moulage may be a stronger predictor of performance. Highly authentic moulage is preferable on the basis of optimising learning conditions.

Student engagement in undergraduate medical education: A scoping review

“…As shown in Figure 2 (upper panel), most of the articles (94.1%, n = 48) are published in the last 8 years. The lower panel of Figure 2 shows that 47.1% ( n = 24) of the studies are conducted in the United States, 26–49 9.8% ( n = 5) in the United Kingdom, 50–54 9.8% ( n = 5) in Australia, 55–59 4% ( n = 2) in Germany, 60,61 4% ( n = 2) in the Netherlands, 62,63 2% ( n = 1) in Canada, 64 2% ( n = 1) in Norway, 65 2% ( n = 1) in Ireland, 66 5.8% ( n = 3) in China, 67–69 4% ( n = 2) in Turkey, 70,71 2% ( n = 1) in Pakistan, 72 2% ( n = 1) in Malaysia, 73 2% ( n = 1) in Korea, 74 2% ( n = 1) in India 75 and 2% ( n = 1) in Brazil 76 . The methodology in the included studies were quantitative in 66.7% ( n = 34), qualitative in 11.8% ( n = 6) and mixed methods in 21.6% ( n = 11).…”

“…From the selected studies, 43 studies have used one or more than one instrument for measuring student engagement. The most frequently used instrument is the self‐report in 51.0% ( n = 22) of the studies, 26–28,32,34,37–39,43,53,57,59,62–67,69,73–75 although real‐time measures were used in 19.0% ( n = 8), 29,31,33,36,40,46,47,76 multiple methods represented 16.0% ( n = 7), 41,44,45,50,51,56,60 direct observation represented 7.0% ( n = 3) 42,70,71 and interviews used in 7.0% ( n = 3) of the studies 55,58,68 . For the level of measuring student engagement, 42% ( n = 18) studies are measuring at the activity level, 29,32–34,41,42,44,45,56,59,60,62,65,66,70,71,73,76 37% ( n = 16) at the course level 27,31,36–40,46,47,50,51,53,55,57,58,68 and 21% ( n = 9) at the medical school level 26,28,43,63,64,67,69,74,75 …”

“…The most frequently used instrument is the self-report in 51.0% (n = 22) of the studies, [26][27][28]32,34,[37][38][39]43,53,57,59,[62][63][64][65][66][67]69,[73][74][75] although real-time measures were used in 19.0% (n = 8), 29,31,33,36,40,46,47,76 multiple methods represented 16.0% (n = 7), 41,44,45,50,51,56,60 direct observation represented 7.0% (n = 3) 42,70,71 and interviews used in 7.0% (n = 3) of the studies. 55,58,68 For the level of measuring student engagement, 42% (n = 18) studies are measuring at the activity level, 29,[32][33][34]41,42,…”

“…49 An additional 17 studies examined the role of the TEL environment in facilitating the medical student engagement. The use of technology in these studies includes simulation-based learning, 29,44,56,68 microblogs, 47 social media, 46,52,75 adaptive tutorials, 59 videoconference sessions, 31,41 digital games, 55 three-dimensional printed models, 58 virtual reality using 360 videos, 32,57,66 learning dashboards 60 and audience response systems. 51 Furthermore, there are five studies that examined the factors which facilitate students' state of connection with the school community (school engagement).…”

So Much Moulage, So Little Time: A Guide to Performing Moulage for Mass Casualty Scenarios

“…Our method of mass casualty moulage successfully increased the level of realism. Studies have reported that increased realism has been shown to improve the learners' engagement and suspension of disbelief in simulated scenarios [10][11][12]. The key steps in our moulage process were preparation, creation, and application.…”