Background Our adapted Advanced Communication Skills Training (ACST) now embeds impactful direct evidence base from Conversation Analysis (CA) of real-life conversations (RealTalk. Engaging people in end of life talk [internet]), meeting the specialist needs for Tier 3 competencies (Health Education England & Skills For Health. Common core principles and competences for social care and health workers working with adults at the end of life. 2017), aimed at enhancing confidence. Assumptions lead to lack of confidence and barriers in effective communication (Royal College Physicians. Talking about dying: how to begin honest conversations about what lies ahead. 2021; General Medical Council. Understanding communication failures involving doctors. 2019). The impact of using CA to embed the learning of micro skills within ACST was explored and evaluated.

Aims To evaluate our ACST courses, delivered over a 12 month period to multiprofessional groups, via a blended approach with RealTalk and authentic clinical scenarios, using the adapted EMET (Whittaker, Parry, Bird, et al. BMJ Support Palliat Care. 2018; 8(4):439–446) capturing (a) pre and post evaluation of confidence/competence, and (b) the impact of CA evidence base RealTalk on learning.

Methods Addition of CA evidence base to ACST April 2022-March 2023: pre and post evaluation using EMET (Whittaker, Parry, Bird, et al., 2018); adaption of pre course preparation based on stakeholder feedback; data collected from EMET and goal setting returning to practice; data on impact of RealTalk on learning; data collected on professional demographics.

Results EMET has shown increases in confidence of the nuances and tacit skills that can be taught (Land, Parry, Pino, et al. Patient Educ Couns. 2019; 102(4): 670–679), enhancing professional behaviours. Post learning questionnaire showed 97.3% of delegates feel confident to listen to and talk with a dying person about issues surrounding their death. 100% feel competent in recognising a person’s cues. Demographics: Doctor, 53%; EOLC facilitator, 4%; ACP, 14%; Therapist, 3%; CNS, 25%; Other, 1%.

100% agreed that they felt safe in the learning environment, the course met their needs and they would recommend the course to colleagues.

Conclusion Having adapted ACST, RealTalk has added the next step in widening the dissemination of talk as action in clinical practice, confidence has increased following the embedding of basic principles that underpin a range of complex communication skills. Practitioners can draw on these to facilitate compassionate conversations role modelling into clinical practice.