1. Provide an environment in which learners can benefit from the opportunity to practice primary palliative care skills in a low-stakes high-intensity clinical scenario. 2. Apply simulation to teach primary palliative care, including symptom management and medical decision making, utilized in acute resuscitation for children with serious illnesses and limitations on life-prolonging interventions. Pediatric residents are often frontline providers during acute resuscitation and end-of-life care. Due to limited exposure, pediatric residents often feel underprepared to care for hospitalized children at the end of life, which may result in interventions that are inconsistent with the family's goals. In these scenarios, primary palliative care skills are critical in delivering family-centered, goal-concordant care to children. Residents may practice these skills through simulation; however, symptom management and team communication are the least addressed primary palliative care skills in existing simulation trainings. The "Mock 'No Code'" simulation curriculum is designed for pediatric residents to practice and gain exposure to these primary palliative care skills. Biannual "Mock 'No Code'" sessions are hour-long, facilitated, case-based sessions during which residents encounter a pediatric patient with an advance care plan in an acute clinical scenario. Pediatric residents were surveyed before and after participation, up to three times per year over a 3-year period. Surveys asked about residents' confidence or comfort-level in various aspects of care, including managing symptoms, leading end-of-life discussions, and explaining "DNR" to a family. Preliminary results from the final year of data collection indicate that residents who have been exposed to the "Mock 'No Code'" curriculum report generally higher levels of comfort and confidence in caring for children at the end of life than those who have not been exposed. The "Mock 'No Code'" curriculum fills the gaps in existing palliative care simulation by utilizing high-fidelity simulation to focus on the acute care and management of children with advance care plans in a team-based setting. Since its onset, "Mock 'No Code'" has increased resident exposure to caring for patients with advance care plans and is associated with increased resident comfort and confidence in caring for these patients in a goal-concordant manner. [ABSTRACT FROM AUTHOR]