Table 3.

Summary of qualitative findings from n = 9 studies reporting the impact of moulage on student experience

Citation	Method of collection	Method of analysis	Identified themes	Quotes
DAasta et al., 2019	Survey questions: • strengths • potential improvements • other comments	Not reported	• Course’s ability to emphasize and teach principles • Opportunity to practice teamwork	“Make-up and actors felt very real.” “In situ simulation makes me better immerse into the scenario.”
Sezgunsay & Basak, 2020	Semi-structured feedback form with questions: • How did you feel? • Did you face difficulty? • How did the lab practice affect, your pressure injury assessment in the clinical setting?	Content analysis, manifest style: • Decontextualization • Recontextualization • Categorisation • Compilation	Difficulties: • Intervention group was unfamiliar with what they were seeing • Control group found it hard to differentiate between tissue, bone, tendon visuals. Positive feedback: • Simulation supported the integration of theory and practice. • Intervention group found the simulation more realistic Negative feedback	“…the staging was easy for me; it was good for me to work on the moulage beforehand.” “Touching and communicating with a real patient is different, of course, but I felt less stressed in the simulation.” “Pre-defining on the moulage made it visually a lot easier and more memorable.”
Mills et al., 2018	Semi-structured face-to-face interview immediately post-simulation.	Pragmatic, action-research oriented, interpretive inquiry approach. Audio-recorded, transcribed, QST NVivo software.	Visual cues: • Highly realistic • Blood served as visual cue to provide immediate feedback to guide decisions • Gave indication of severity of condition Realism: • Moulage would have facilitated them taking the task more seriously Immersion: • Moulage helped them treat the patient faster	“I was able to walk-in and just immediately see what the problem was.” “You don’t feel that urgency for it, or the same urgency as you would if you actually saw that” “The process is faster…you’re getting that instant feedback.” “Staying calm under pressure and keeping a clear head and that sort of thing. The more sort of crazy factors like that you throw in, the better equipped we’re going to be by the time we graduate.”
Saideen et al., 2013	In-depth interviews and focus groups completed post-simulation	Audio-recorded, transcribed verbatim and coded based on topic guide.	• Participants’ authentic behaviour • Increased cognitive load • Increased confidence • Applicability of the scenario as a training tool	“Everything. The sounds…the child, her screaming, make-up feedback.” “I will still be thinking about this scenario…previously thought to be a ‘daunting task’ but in fact it is ‘manageable’”
Stokes-Parish et al., 2020	Individual interviews post simulation, using video-stimulate recall technique.	Audio-recorded, transcribed verbatim. Grounded Theory technique: • familiarisation • initial code • categorical coding • making meaning	Rules of simulation: • Aware they were in a simulation yet mentally processing the conditions of simulation vs. reality. Believability: • Background awareness of simulation depending on authenticity presented. Consistency of presentation: • Consistency of presentation of visual cues. Personal knowledge: • Previous simulation experiences leading to treat future simulations with less believability	“As soon as I looked and then saw it was like crystal clean…it just like kind of pulls you back in, okay it’s a simulation.” “[I]…have to switch out of the scenario to check things out. In real life you can either see it’s happening or it’s not.” “The moulage is good and it’s showing what it’s meant to…but if it’s just like a sticker or something that says, ‘blood here’, then that might detract from the situation”
Mills et al., 2020	Focus groups with eight participants in each, post-simulations	Audio-recorded, transcribed verbatim, QST NVivo software. Pragmatic, action-research orientated, interpretive inquiry approach.	• Virtual Reality (VR) experience graphically realistic to the simulation • VR unable to replicate the human interaction and emotional immersion • VR experience a ‘steppingstone’ to live simulation	“I found the VR really good just to practice that skill alone without the extra stress” “I think the live one was a bit more intense, like more full-on.”
Shiner., 2019	Semi-structured focus groups post first clinical placement.	Data transcribed verbatim. Phenomenological analysis six-step approach. Data reviewed blindly in duplicate and themes agreed upon together.	Engagement with wound: • Distracted by curiosity • Intervention group had a more pragmatic response to seeing their first wound compared to control Emotional engagement: • Challenged by the unknown • Early career experiences Developing professional self: • Continual challenges • Processing past experiences • Coping mechanisms Simulation impact: • Positive experience to prepare for seeing open wounds Building relationships	“Because it hasn’t phased me, I’m not nervous or anxious about it.” “You can’t go back from that, you can’t unsee it” “Bloods red, reds a colour that’s it.” “Treating it as a patient and not a body part.” “Oh no it prepared, fully. For me it did because it made me think outside the box.”
Shiner & Howard., 2019	Focus groups conducted three months post experience	Audio-recorded, transcribed verbatim. Thematic analysis using six-phase coding process. Concordance check between two researchers.	Patient centredness: • What others see • Non-verbal cues/reactions Learning: • Experiential learning had improved their memory recall for their exam Realism: • Wounds appeared realistic • Thought it was an actual burns patient.	“I saw some people’s faces and they looked pretty scared.” “During the OSCE I thought back and its kinda helped.” “The makeup was really realistic looking I couldn’t tell it was makeup at first.” “To be honest, you couldn’t really hide it was intense.” “For me it felt like definitely one of the topics I was most prepared for as I’m a visual learner.”
Santomauro., 2020	Anecdotal comments from the simulation staff.	N/A	• Participants are taken aback when they first see the manikin. • Participants display caution and apprehension when examining.	N/A