Aims/Objectives/Background Emergency Medicine (EM) is a unique speciality often meeting people at the worse moments of their life. Death is an everyday occurrence, and with that comes the skills needed to talk to patients and families about when their end of life may be nearing, what treatments may or may not be beneficial and whether cardio pulmonary resuscitation is suitable. These conversations can be very challenging for all concerned, including junior doctors. The Royal College of Emergency Medicine’s guidelines suggest doctors need to have the skills to talk to these patients. Therefore, we felt we needed to develop a series of realistic EM in-situ simulations for our staff to learn and practice on.

Methods/Design We created 3 simulations designed to enable junior doctors to have difficult conversations with patients who are approaching the end of life in the ED. Scenario 1 was the end of life patient with COPD who was not for further interventions. Scenario 2 is of a very frail patient with multiple comorbidities with another pneumonia. Scenario 3 revolved around a massive upper gastro intestinal bleed with known oesophageal cancer. These simulations were tested in-situ in the ED over several months and the feedback collected from all team members.

Results/Conclusions These simulations were trailed over January – March 2019 as part of our weekly in-situ simulation. 20 people took part in the above simulations. All had a doctor plus nursing support. Feedback data was pooled from all the simulation sessions. 80% of people moved from being not confident or lacking in confidence to fairly confident or confident after doing the simulations. All participants felt their knowledge had increased significantly following the simulations. Positives described by participants include ‘Learning to recognise when CPR may be futile in patients and balancing delivering treatment and assessing futility of discussing of patients’.