1 We need to talk about dying… A novel approach at a large NHS teaching trust

Introduction Clear and sensitive communication are key priorities of care for the dying person, outlined in 'One Chance to get it right'.1 Junior doctors report feeling unprepared to provide End-of-life care, identifying specific knowledge gaps in communication.2 End-of-life care is a focus in the new Internal Medicine Trainee (IMT) curriculum.3 We detail a novel postgraduate teaching initiative led by IMTs aimed at improving End-of-life communication. Methods A dynamic and evolving End-of-Life Faculty was established in 2021 at King's College Hospital NHS Trust, consisting of Palliative and Geriatric medicine specialists. Two IMT fellows were recruited in 2022 to deliver communication teaching at both acute hospital sites. Teaching consisted of in-person small group communication sessions, supplemented by newly designed electronic resources. Simulated sessions, with a relative of a dying patient, were facilitated by the IMT Fellows together with Palliative and Geriatric medicine specialists. Feedback was obtained for evaluation. Results Six communication sessions were delivered between January and September 2023. Attendees were mainly junior doctors, 38% were in a training programme and 68% were international medical graduates (IMGs). Between five and ten participants attended each session. Feedback post session was overwhelmingly positive - 90% strongly agreed that sessions were useful. Prior to the session, 81% of participants surveyed expressed concerns about End-of-life communication. Post session, all participants felt their concerns were addressed. Conclusion Interestingly, most attendees were IMGs or not in a formal training programme; representing a possible unmet educational need which we will explore further. Four new fellows were recruited in September 2023, from a variety of training backgrounds. We will deliver eight sessions over the next year, with greater focus on peer-led teaching and participation of the wider multi-disciplinary team. The faculty has created a blueprint that could be used by NHS trusts in improving the provision of postgraduate End-of-life teaching. References Leadership Alliance for the Care of Dying People. One Chance to Get it Right. London: UK Government, 2014. Bharmal A, Morgan T, Kuhn I, Wee B, Barclay S. Palliative and end-of-life care and junior doctors: a systematic review and narrative synthesis. BMJ Supportive Palliative Care. 2019;12(e6). doi:10.1136/bmjspcare-2019-001954. Joint Royal Colleges of Physicians Training Board. Curriculum for Internal Medicine Stage 1 Training. London: JRCPTB, 2019.