MoneyTreeMoney doesn’t grow on trees, and neither do simulation manikins, not even on simulated trees. So what to do when you are looking for a cheaper, more easily replicated solution to simulation dilemmas? This is the perfect time to fall back on skills developed in childhood during Arts & Crafts hour. Consider paper mache!  So easy to use, and guaranteed to bring back childhood memories!

Simulator manikins are wonderful creations. They can cry, vomit, and show diaphoresis. But they are heavy! Even task trainers can be bulky to work with. Additionally, manikins need expensive components to be replaced. For example, after the learners perform the “task” repeatedly, the skin should be changed because the next learner will know exactly where to enter the skin with the needle, such as in the example of an internal jugular central line torso.

Trick of the Trade

Paper mache can be a solution, albeit for specific problem – but a solution, and a cheap one as well! In particular, paper mache is useful to simulating cavities such as abdominal and uterine. This wikiHow explains the principles behind paper mache. 

The essential principle is that the paper mache creation will be a mixture of paper, flour, and water. It will coat the outside surface of a structure, such as a balloon or ball. This structure can be prefilled with material if desired to go along with a particular simulation, such as Kool-Aid to resemble blood.

Bottom line, mix flour and water in bowel to create adhesive liquid.  Dip scraps of paper into liquid.  Take paper that is coated and drape it onto the structure that forms the basis of the shape/cavity.


  • Its cheap!  
  • The component parts are readily available and nontoxic
  • Its lightweight to transport


  • Can’t be reused after the cavity has been penetrated
  • Could be destroyed in transport if not careful

I was unable to find any publications on this technique, but have used it personally as a model for perimortem c-section and it worked well with great satisfaction from the learners. The following pictures are from the workshops that we have conducted. We will also be showcasing our tips in a pre-conference workshop at Society for Simulation in Healthcare Conference upcoming January 2014 in San Francisco. The workshop is titled: “Being Crafty: Using Everyday Household Objects and Your Grandmother’s Crafts to Create Low-Fidelity Simulation on a County Budget.” This will be spearheaded by Dr. Clare Desmond. It will include tips such as paper mache, but go beyond and include other crafty ideas such as the use of crochet in the development of low fidelity simulation.


Please share if you have another tricks of the trade or nifty ideas of your own!


Nikita Joshi, MD

Nikita Joshi, MD

ALiEM Chief People Officer and Associate Editor
Clinical Instructor
Department of Emergency Medicine
Stanford University
Nikita Joshi, MD


Emergency Medicine Doctor Associate Editor of ALiEM Gun Sense Advocate #FOAMed #Docs4GunSense #MomsDemandAction Tweets represent my own views and opinions