Simulcast Journal Club August 2019


Introduction :  

Simulcast Journal Club is a monthly series that aims to encourage simulation educators to explore and learn from publications on Healthcare Simulation Education.  Each month we publish a case and link a paper with associated questions for discussion.  Inspired by the ALiEM MEdIC series, we moderate and summarise the discussion at the end of the month, including exploring the opinions of experts from the field. 

The journal club relies heavily on your participation and comments and while it can be confronting to post your opinions on an article online, we hope we can generate a sense of “online psychological safety” enough to empower you to post!  Your thoughts are highly valued and appreciated, however in depth or whatever your level of experience.  We look forward to hearing from you. 

Title :  “The Uncanny Valley 

The Case :  

Nimali hung up her phone and hyperventilated for a moment in the dark of the simulation storage room. As she breathed in the darkness the light of her phone swung temporarily across a shadow in the corner.  It was Snythe’s body, stored carefully by Nitin and Brad an hour ago to minimise the distress to her staff. 

She hesitantly walked over and stared at the pale and lifeless face of her colleague.  He’d been many things to her, a thorn in her side, a bitter clinician, but lately he’d been a stranger mix : a previous sceptic who’d suddenly become very enthusiastic about simulation education.  They weren’t close, but the impact of his death would potentially destroy her centre and lose her friends their jobs.  Getting to the bottom of this murder was vital to their survival as a unit, but who could she trust? 

She marvelled at how lifelike Snythe still looked on the bench.  In the pitch black of the room, you could have mistaken him for being asleep, a hole in his side where the trochar had pierced his chest was all that suggested anything was wrong. 

Everything was so confusing right now… Her ex-husband had just phoned to make claims that didn’t make sense.  That Nitin wasn’t registered with the medical board, that he’d been listed as a person of interest in the case of a simulation educator who’d disappeared during a conference in Malaysia 18 months ago. 

She gently placed her hand on Snythe’s with the intent of a warm farewell gesture, but his hand felt odd somehow.  Firmer, less textured, somehow less human; maybe it was the rigor mortis.  She froze suddenly at the sound of the door opening and the light being turned on.  Nitin was in the doorway, looking concerned. “Nimali, what are you doing here?  Everyone’s worried.”. 

Nimali blinked in the sudden bright light and stared instead at the sight of Snythe’s body below her, confused.  She grasped Snythe’s hand again and ran her fingers firmly down his chest and deeply into the wound.  Thick syrupy fluid dripped out on her fingers.  She sniffed it cautiously. 

“Nimali, don’t’…” said Nitin, but he paused at her expression. 

“I’ve always admired good moulage.” Nimali stated, detached. “I never had the knack for it, and the conversation afterwards always seemed more important than the sim itself, but I’ve watched Louise do it a few times and it’s a real art.  The engagement it can create is impressive, but this?  This, Nitin, is next level stuff.  If I hadn’t touched… well I would’ve believed….” she frowned and held up her hand.  Her tan fingers soaked in vivid red.  “I guess sometimes physical fidelity is important after all?”.  She grasped her face in grief. 

“This isn’t blood, Nitin.  And this isn’t even Snythe.  It’s a Lifecast mannequin and some very impressive effects work.  What the hell is going on?  Is he even dead?” 

She folded her arms and stared at him fearlessly, daring him to explain.  He held her gaze for a moment, his facial muscles held tight and expressionless.  He reached behind him and locked the door. 

“It’s never about fidelity, Nimali.  It’s about functional task alignment.”. 

The Article : 

Stokes-Parish, J., Duvivier, R. and Jolly, B. (2019). Expert opinions on the authenticity of moulage in simulation: a Delphi study. Advances in Simulation, 4(1). 

Discussion :  

As described in our salacious case study, moulage is often considered important for realism or fidelity.  In this new article from Stokes-Parish et al, the authors describe a synthesis of expert opinions on moulage through a delphi study. 

We look forward to your reflections on their findings, the process, and any of your own misadventures into ‘the uncanny valley’. 

References : 

Stokes-Parish, J., Duvivier, R. and Jolly, B. (2019). Expert opinions on the authenticity of moulage in simulation: a Delphi study. Advances in Simulation, 4(1). 


About Ben Symon

Ben is a Paediatric Emergency Physician at The Prince Charles Hospital in Brisbane and a Simulation Educator at Lady Cilento Children's Hospital. He currently teaches on a variety of paediatric simulation based courses on paediatric resuscitation, trauma and CRM principles. Ben has a growing interest in encouraging clinical educators to be more familiar with simulation research.


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6 thoughts on “Simulcast Journal Club August 2019

  • Robbert Duvivier

    Great post Ben, such a creative way to discuss research! Looking forward to reading more thoughts from around the globe!

    • Ben Symon Post author

      Thanks Robert, it’s been a long held belief of mine that the fastest road to academic credibility is writing niche romantic thrillers with an incredibly limited potential audience.

  • David Halliwell

    We love this…, all of our lifecast bodies are real people who are very much alive … and I guess that is so important to us as we try and explain our journey it’s inportant for us to let people know who our bodies are and why they chose to allow us to copy their body and turn it into a manikin.

    Vivien our older lady (84) is an actor in Star Wars, a dancer and a psychologist – she went sky diving aged 80 and challenges perception of older people. Vivien is our hero and our favourite manikin for challenging words like Geriatric or Elderly – we would argue that Vivien has a More active life than many of us.

    Pete our older man (82) is a lovely guy – if my body looks like his at his age I will be very happy!

    Carl / Karl works at Elstree – he is a draper and a lovely man- we see him most days and his body is good for his age…

    Megan – Megan is actually a Goth – but her body is that of a 24 year old lady – a complete lifecast and 3D scan

    Alice – Alice is a lifecast and scan of a lady aged 22 called Alice –

  • Noel Roberts

    Hi Ben,
    You’re wasted in medicine! I’d certainly buy a “Simulation Romantic Thriller” category novel.
    I’ve always thought the best piece of moulage was a falling oximetry tone with a bradycardia. Maybe I’ll need to rethink after this article but hard to concentrate when wondering about Nitin ☺
    Looking forward to the next instalment.