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. The Royal College of Emergency Medicine‘s guidelines suggests health care practitioners need the skills to talk to these patients. Within our department, we have advanced care practitioners (ACP) working as independent practitioners. Theses ACPs come from a nursing, paramedic or physiotherapy background. They have had further masters level training to do this role. Our department advocates early conversations with patients who have a frailty score of 7, 8 or 9 as per the Rockwood frailty score. With our hospital supporting the signing of do not resuscitate forms by ACPs, provided they have had sufficient training.

Aims We developed a full day course which is incorporates some lecture-based teaching and then in-situ simulation within the emergency department. Our aim was to gather feedback to see what educational benefit this brought to our ACPs.

Methods Following teaching around difficult conversations, do not attempt cardiopulmonary resuscitation and legal aspects we then gave the participants 4 in-situ simulations.

Results 9 participants completed the pilot course, none of which had, had formal training to have this type of conversation. This is despite these ACPs all having a minimum of 5 years post qualification. All felt their confidence had increased from no confidence to neutral or fairly confident. All felt this was useful for their training.

Conclusion This course has provided our ACPs skills to have the conversation with patients. We will look to gather feedback 1 month and 6 months following the course to see how and if this has influenced clinical practice.