Beyond the ABCDE: Improving F1 Preparedness for Mental Capacity Assessment and End-of-Life Care through Targeted Simulation

Background: Newly qualified Foundation (F1) doctors frequently care for older people and encounter delirium, mental capacity assessments, deprivation of liberty safeguards (DoLS) and end-of-life care. A pre-induction needs assessment suggested a mismatch between anticipated and subsequently valued learning needs: F1s predominantly requested acute scenarios including cardiac arrest, A–E assessment, and airway management. This informed a quality improvement intervention exploring whether less acute but commonly encountered scenarios were valued alongside acute emergency training.

Aim: To improve F1 doctor confidence and preparedness for common clinical responsibilities through targeted induction simulation.

Methods: A Plan-Do-Study-Act (PDSA) cycle was undertaken. Plan: Pre-induction questionnaire data (n=43) informed scenario selection. Do: Simulation covered mental capacity assessment, DoLS, delirium and de-escalation, and end-of-life care including death verification and certification, with facilitated debriefing and focus on local protocols and guidance. Study: Post-session questionnaires assessed confidence, relevance and programme ratings using 5-point Likert scales and free-text feedback (delirium/capacity n=37; end-of-life n=15). Act: Findings will inform future induction cycles. Pre- and post-induction responses were unpaired and analysed descriptively.

Results: Mean overall confidence starting F1 increased from 2.67/5 pre-induction to 3.78/5 post-induction, a cohort-level increase of 1.11 points. Geriatric medicine scenarios were highly valued. The mental capacity session, incorporating DoLS, was rated highly (mean 4.89/5; 89.2% rated 5/5). End-of-life care and death verification were similarly highly rated (mean 4.67/5; 80% rated 5/5), with 100% rating relevance ≥4/5. These were comparable to acute scenarios e.g. the major haemorrhage scenario was rated mean 4.78/5. Qualitative feedback particularly valued delirium management, capacity assessment, DoLS, end-of-life care, death certification and local processes.

Conclusion: The PDSA cycle addressed a gap in preparation for common F1 responsibilities. Although F1s initially prioritised acute emergencies, simulation addressing common geriatric medicine scenarios were similarly highly valued. Future PDSA cycles will refine these scenarios and incorporate further ward-based situations relevant to caring for older people.