Moulage safety practice around the world: a framework for best practice

Moulage is ubiquitous with simulated participant (SP) practice. Moulage presents a physical and psychological risk to SPs, due to the application of active products, ingredients, and the creation of highly realistic wounds, which could evoke emotional distress or overidentification. The Moulage international Virtual Community of Practice convened in 2023 to commence standards of best practice in relation to moulage use with SPs. Using consensus methodology, the 9 authors catalogued their usual practice, reviewed relevant literature and standards to iteratively develop a conceptual framework and checklist. As a result, a conceptual framework and checklist were developed for safe moulage practice for pre-simulation, during-simulation, and post-simulation phases. The framework highlights key roles and corporate governance to achieve risk mitigation regardless of the simulation setting. To augment the framework, the authors developed the Moulage Application Safety Checklist, a 17-item tool for moulage in use. The conceptual framework and checklist provide an evidence-informed tool for considering moulage safety with SPs. Safe use of moulage should not be an afterthought.