Background At BSUH we saw the potential to convert the learning and impact from a two-yearly national audit into a rolling, two-monthly audit. Much of the care of dying patients documented in the health record is done by junior doctors. Therefore, who better to learn audit their own performance and develop as leaders to share this knowledge throughout their own clinical teams? Twelve junior doctors were recruited and overseen by senior BSUH staff. Our primary aim was for junior doctors to document and deliver better care for dying patients. Our secondary aim was for these junior doctors to become leaders in supporting other staff to achieve these standards.

Interventions 1) Learning by talking: Audit induction and two-monthly group meetings discussing national policy, educational resources, reviewing results, encouraging them to lead their own quality improvement projects.

2) Learning by doing: reviewing and completing care plan documents which reflect the Priorities for Care of the Dying Person. Audit of health records, data entry, and analysis of information relating to care of dying patients.

3) Learning by reflection: Two-monthly submissions of anonymised reflections of the impact that participating has on their documentation and care of dying patients, which are shared with the whole team.

Results Audit participants feel more confident delivering and documenting care for dying patients, and crucially, sharing good practice with colleagues. All are now aware of the Priorities for Care of the Dying Person, whereas only 14% were beforehand. Our education sessions are now part of Trust mandatory teaching to all junior doctors. We anticipate these doctors will be clinical leaders who continue to educate and inspire other to deliver and document quality care.

Conclusion Education and involvement of junior doctors in a Trust-supported, rolling audit is a powerful learning experience which can improve the delivery and documentation of care of dying patients.