distracting them from other learning objectives. There is specifically a lack of research regarding medical students' own beliefs and attitudes towards sim man dying. This pilot study explores whether final year medical students feel it is acceptable for sim man to die and to gain insight into their attitudes and beliefs regarding death in simulation. Methods A paper questionnaire was distributed to final year medical students on placement at Swindon Academy in December 2016. The survey

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... quantitative dichotomous questions with white space for students' comments. The free text comments regarding concerns and benefits from sim man dying were analysed using thematic analysis and coding. Results A total of 34 out of 35 students completed the questionnaire. 97% of final year students felt they should have end of life simulation scenarios. 88% of final year students felt that sim man should be allowed to die in acute scenarios. 94% said there were benefits of sim man dying during simulations. The four themes within this included preparing to deal with death; experiencing death in a safe environment; realism of simulation and practicalities/skills regarding death. 27% of final year students had concerns about sim man dying. The three main themes were emotional distress; feeling underprepared and negatively impacting on confidence. Conclusions The large majority of final year medical students feel that sim man should be allowed to die in both end of life and acute simulations. Educators should not assume sim man dying is too distressing for medical students and should consider utilising this as an undergraduate learning tool for dealing with death but providing a sensitive and supportive environment with a focus on debrief is essential.