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Simulating a self-inflicted facial gunshot wound with moulage to improve perceived realism, immersion, and learning in simulation-based airway management training
  1. Chiara Santomauro,
  2. Daniel Host,
  3. Davin Arthur,
  4. Marissa Alexander,
  5. Colin King
  1. Clinical Skills Development Service, Metro North Hospital and Health Service, Herston, Queensland, Australia
  1. Correspondence to Dr Chiara Santomauro, Clinical Skills Development Service, Metro North Hospital and Health Service, Herston, QLD 4029, Australia; chiara.santomauro{at}


Moulage is used to create mock wounds and injuries for clinical education and training. We developed a moulage technique to simulate a facial gunshot wound for use in simulation-based training. We removed sections of a manikin’s face and used moulage materials to mock various aspects of the wound. The manikin was used in a simulated scenario that teaches clinicians how to manage a complicated airway. The moulage was evaluated with a self-report questionnaire that assessed participants’ perceptions of the realism of the wound, the degree to which the wound contributed to their scenario immersion, and the degree to which the wound enhanced their learning experience on a 5-point Likert scale ranging from ‘strongly disagree’ to ‘strongly agree’. Participants’ average response to each item was significantly higher than the neutral midpoint, and the median response was ‘strongly agree’. Our work suggests that the simulated facial gunshot wound contributed to perceived scenario immersion and enhancement of the learning experience, supporting existing literature that suggests moulage is a valuable tool in healthcare simulation. Future work could investigate the effect of moulage using objective measures and explore the potential to use extended reality technology in conjunction with moulage to improve immersion even further.

  • simulation
  • manikin
  • simulation training
  • airway

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  • Contributors CS: created the questionnaire items specific to the simulated facial gunshot wound, collected, analysed and interpreted the data, and drafted the manuscript. DH, DA, MA and CK: designed and developed the simulated facial gunshot wound, as well as the immersive simulated scenario. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This evaluation was exempt from review by the Royal Brisbane and Women’s Hospital Human Research Ethics Committee (HREC/18/QRBW/311) because it was deemed to be a quality assurance activity. A statement describing the voluntary and confidential nature of the responses is included at the beginning of the course evaluation questionnaire.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Deidentified participant data are available upon reasonable request. Please contact the corresponding author.

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