# ‘Having skin in the game’: guiding principles for incorporating moulage into OSCEs

## TL;DR

This paper provides practical guidelines for using special effects makeup, called moulage, in high-stakes medical exams to better simulate skin conditions.

## Contribution

The paper introduces specific, evidence-based guiding principles for integrating moulage into OSCEs, addressing unique challenges in high-stakes assessments.

## Key findings

- Moulage is effective for simulating skin conditions in OSCEs but requires special considerations for durability and standardization.
- Practical tips are provided for designing OSCE stations with moulage, based on evidence and experience.
- The paper emphasizes the importance of integrating moulage into OSCEs to improve realism and assessment quality.

## Abstract

Dermatological conditions are a common reason for patients to seek healthcare advice. However, they are often under-represented in Objective Structured Clinical Examinations (OSCEs). Given the visual nature of skin conditions, simulation is suited to recreate such skin conditions in assessments such as OSCEs. One such technique often used in simulation is moulage—the art and science of using special effects make-up techniques to replicate a wide range of conditions on Simulated Participants or manikins. However, the contextual nature of OSCEs places additional challenges compared to using moulage in more general forms of simulated-based education.

OSCEs are high-stakes assessments and require standardisation across multiple OSCE circuits. In addition, OSCEs tend to have large numbers of candidates, so moulage needs to be durable in this context. Given the need to expand the use of moulage in OSCE stations and the unique challenges that occur in OSCEs, there is a requirement to have guiding principles to inform their use and development.

Informed by evidence, and grounded in experience, this article aims to provide practical tips for health profession education faculty on how best to optimise the use of moulage in OSCEs. We will describe the process of designing an OSCE station, with a focus on including moulage. Secondly, we will provide a series of important practice points to use moulage in OSCEs—and encourage readers to integrate them into their day-to-day practice.