ObjectivesTo develop, test and validate a versatile questionnaire, the East Midlands Evaluation Tool (EMET), for measuring effects of end of life care training events on trainees’ self-reported confidence and competence.MethodsA paper-based questionnaire was designed on the basis of the English Department of Health's core competences for end of life care, with sections for completion pretraining, immediately post-training and also for longer term follow-up. Preliminary versions were field tested at 55 training events delivered by 13 organisations to 1793 trainees working in diverse health and social care backgrounds. Iterative rounds of development aimed to maximise relevance to events and trainees. Internal consistency was assessed by calculating interitem correlations on questionnaire responses during field testing. Content validity was assessed via qualitative content analysis of (1) responses to questionnaires completed by field tester trainers and (2) field notes from a workshop with a separate cohort of experienced trainers. Test–retest reliability was assessed via repeat administration to a cohort of student nurses.ResultsThe EMET comprises 27 items with Likert-scaled responses supplemented with questions seeking free-text responses. It measures changes in self-assessed confidence and competence on 5 subscales: communication skills; assessment and care planning; symptom management; advance care planning; overarching values and knowledge. Test–retest reliability was found to be good, as was internal consistency: the questions successfully assess different aspects of the same underlying concept.ConclusionsThe EMET provides a time-efficient, reliable and flexible means of evaluating effects of training on self-reported confidence and competence in the key elements of end of life care.

consultant responsibility to diagnose dying and/or withdraw treatments. Both juniors and seniors described being less inclined to diagnose dying if the patient is young and/or has young children. Conclusions This study has revealed challenges in recognition of dying perceived by Scottish doctors. The findings suggest this area of patient care is complex and uncertain, even for experienced practitioners. Comparing perceptions of senior and junior doctors gives insights for potential means of improved medical education. Recommendations include clearly defining the responsibilities of junior and senior team members, being explicit with learners about the often uncertain nature of recognising dying, and improved organisational factors to facilitate continuity of care. Within a research and training development programme, we designed novel training resources -'Real Talk' incorporating research findings and clips from video-recorded hospice consultations. We designed Real Talk to complement rather than replace existing resources. We report a preliminary evaluation of Real Talk's strengths and weaknesses. Method Mixed-methods, qualitative evaluation entailing observations, interviews, and participant-completed feedback questionnaires. Results We collected data from 11 events, 10 trainers across England, and 150 trainees. Conclusions Trainees and trainers alike appreciated the video clips and their authentic nature. Observations and reports indicated Real Talk was particularly effective for encouraging participants to both emotionally engage with the nature of palliative care, and actively engage in discussion and overall learning about communication practices. Trainers used the video clips more than they did the research findings components; with a similar pattern seen in most trainees' feedback. Our decision to design Real Talk for trainers to use without initial intensive training meant we could rapidly and widely distribute the resources and evaluate their use. However, this also meant heavy reliance on trainers' existing facilitation skills, and on their allocation of adequate time to familiarise themselves with the materials. We argue that this is also why the research findings-based components were not put to full use by trainers. We are revising Real Talk and its delivery on the basis of our evaluation. 20

Method Connected with two local partner organisations. Recruited six existing volunteers and co-produced a three-hour training course entitled 'Challenging Conversations'. Our volunteers delivered a train the trainer course to staff and volunteers from our partner organisations who then delivered the training to their own volunteers. Evaluation was run alongside this project. Results A comprehensive training resource has been produced for our partner organisations. Ten staff members and eight volunteers from our partner organisations were trained in how to successfully deliver the course. 94% of the delegates said they felt confident in delivering the course to others. 62 partner organisation volunteers are in the process of being trained. Our aspiration is that around 200 of our partner service users will be enabled to influence the care they receive at the end of life. Conclusions This is a sustainable way for St Christopher's to extend its reach into the community to deliver an appropriate education intervention for those giving time in other organisations. Acknowledgments With thanks to the Heath Innovation Network (HIN) for funding this work. And to our partner organisations Entelechy Arts and Age UK Bromley and Greenwich.