Background Simulation is considered a mainstay methodology for healthcare education (Jeffries. Simulation in nursing education: From conceptualization to evaluation. 2020), however, it has been under-utilised in end of life care (Bassah, Seymour, Cox. BMC Palliat Care. 2014; 13(1):1–0). Challenges exist surrounding the design of end of life simulations in non-traditional environments who lack ultramodern equipment and space to run high fidelity simulations. High fidelity simulation is often pursued by the simulation community in the belief that it leads to greater learning (Carey & Rossler. The how when why of high-fidelity simulation.) Simulation, however, is a technique not a technology (Gaba. BMJ Qual Saf. 2004; 13(S1): i2–10), and there is significant evidence to suggest that low fidelity simulation may be superior (Massoth, Röder, Ohlenburg, et al. BMC Medical Educ. 2019; 19:1–8) as it is less anxiety-provoking and leads to a less burdensome cognitive load for participants (Lapierre, Arbour, Maheu-Cadotte, et al. Simulation & Gaming. 2022; 53(5):538–63).

Aims To design and deliver a low-fidelity simulation programme for roll out across the hospice, with relevant subject matter that engages both our clinical and non-clinical teams across the organisation, leading to clear learning.

Methods A rolling simulation programme with sessions at least twice a month was run from March 2022 to Dec. 2022. Our sample was 160 participants who took part in 29 simulations. Prior to the beginning of the simulation programme, baseline data was collected via questionnaire. After 10 months of simulation implementation, the questionnaire was repeated to analyse the impact of low- fidelity simulation on the organisation.

Results Baseline questionnaires showed 35% of the organisation had never heard the term ‘simulation’, and over 40% felt anxious around simulation. Following participation in simulations, the repeat questionnaire showed awareness of simulation within the organisation had increased to over 90%. Anxiety around simulation participation dropped by 10%, and we saw a 30% increase in the confidence of staff to undertake challenging conversations. Based on our significant findings, we also developed Cards against Calamity – an end of life simulation game – and began to share this with other hospices.

Conclusion Low-fidelity end of life simulation can be used with positive effect for clinical and non-clinical staff in the hospice setting.