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Introduction Foundation Doctors are frequently required to participate in in-hospital cardiac arrest responses; however, Advanced Life Support (ALS) training is no longer a mandatory requirement within the UK Foundation Programme curriculum, and access to fully funded ALS courses has become increasingly limited, in part due to caps on study budgets. Consequently, many Foundation Doctors may not receive formal ALS training, despite being expected to contribute to high-stakes cardiac arrest responses where effective performance under pressure is critical. Where ALS training is undertaken, recertification typically occurs only once every four years, despite evidence from resuscitation literature demonstrating that both technical and non-technical ALS skills deteriorate within months of training. Furthermore, system-level improvements such as early escalation strategies have reduced the frequency of in-hospital cardiac arrests, inadvertently limiting junior doctors’ exposure to arrest scenarios and contributing to low confidence in key resuscitation roles. This project aimed to address this gap by developing a low-cost, reproducible, locally delivered simulation-based intervention to reinforce ALS principles, support role familiarity, and improve confidence in managing cardiac arrest scenarios within a safe, supportive, and realistic learning environment.Methods A structured staged cardiac arrest simulation programme was implemented within mandatory Foundation Doctor teaching day at a UK teaching hospital. The intervention used a novel Stop–Revise–Reverse–Repeat method, intentionally designed to target recognised cardiac arrest failure points, by allowing repeated exposure to key arrest phases with progressive role escalation, targeted interruption, and immediate correction of technical and non-technical errors, particularly during phases associated with hesitation, role confusion, and delayed decision-making in real cardiac arrest responses.Participants completed pre- and post-simulation surveys evaluating self-reported confidence across ten Advanced Life Support (ALS) domains, measured using a 5-point Likert scale. Following initial evaluation (Pre n = 38; Post n = 34), the intervention was continued and refined through iterative Plan–Do–Study–Act cycles, with cumulative analysis performed across successive cohorts (Pre n = 56; Post n = 44). As responses were anonymised, pre- and post-intervention data were analysed as independent samples using the Mann–Whitney U test.The programme was embedded within existing mandatory teaching and delivered using a minimal faculty model, comprising an experienced cardiac arrest team leader and a single additional faculty member to support basic simulation equipment (a simulated patient monitor and manikin).Results Cumulative analysis demonstrated statistically significant improvements across all ten ALS domains following the intervention (p < 0.001 for most comparisons), with consistent improvement demonstrated across all assessed domains ( figures 1A & B). Improvements were observed across both technical and non-technical domains, with the largest gains seen in leading a resuscitation, defibrillator use, understanding ALS algorithm sequencing, and use of digital decision-support tools. These domains are recognised contributors to human-factor–related error during in-hospital cardiac arrests. Mean overall confidence increased from 2.00 to 3.34 on a 5-point scale, with consistent improvement demonstrated across successive cohorts, confirming reproducibility beyond a single teaching session.Conclusion A structured staged cardiac arrest simulation programme significantly improved Foundation Doctors’ confidence across critical technical and non-technical ALS domains, with reproducible gains demonstrated across successive cohorts. By directly addressing recognised preparedness gaps arising from reduced access to formal ALS training and declining real-world arrest exposure, this intervention provides a practical mechanism to reinforce ALS principles, confidence and role clarity in cardiac arrest situations. Embedded within existing mandatory teaching and delivered using a minimal faculty model, the programme is low-cost, repeatable, and scalable across training settings. Follow-up evaluation (n = 34) demonstrated that 94% of participants supported repetition at 3–6-month intervals, reinforcing the acceptability and perceived educational value of the intervention. Work is underway with Chief Registrars, the Resuscitation Lead, and the Acute Medicine Lead to support sustainable implementation and improve integration within existing cardiac arrest training and governance structures.As such, it represents a patient-safety–focused system response that is readily transferable across postgraduate training programmes, local curricula, and routine teaching timetables, offering a pragmatic means of mitigating ALS skill decay and reduced real-world cardiac arrest exposure.Abstract 293 Figure 1ASide-by-side comparison of pre- and post-simulation mean confidence scores across ALS domains, showing consistent improvement across all areas assessedAbstract 293 Figure 1BHeatmap of mean confidence scores across ten Advanced Life Support (ALS) domains before and after the staged cardiac arrest simulation. Colour intensity represents mean confidence on a fixed 1–5 scale, with darker colours indicating higher confidence