Schmidt Michelle, Schauwinhold Michael Tobias, Loeffler Leonie Anne Kathrin, Klasen Martin, Lambert Sophie Isabelle, Sopka Saša, Vogt Lina
AIXTRA - Competence Center for Training and Patient Safety, Medical Faculty, RWTH Aachen University, Aachen, Germany.
Department of Anaesthesiology, University Hospital RWTH Aachen, Medical Faculty, RWTH Aachen University, Aachen, Germany.
Ann Med. 2024 Dec;56(1):2408458. doi: 10.1080/07853890.2024.2408458. Epub 2024 Oct 7.
Cardiopulmonary resuscitation (CPR) is among the most important skills in clinical practice. Errors can happen here, just like everywhere, and potentially have severe consequences. Two common error handling strategies known from practice are Error Management (EM) and Error Avoidance (EA). However, its effects on medical performance outcomes remain unclear. This study aimed to examine the role of error framing in basic life support (BLS) training for future healthcare professionals.
In an equivalence trial ( = 430), first-year medical, dentistry, physiotherapy, and midwifery students underwent BLS training. In the three study arms, participants received either (1) instructions framing errors positively (EM), (2) instructions framing errors to be avoided (EA), or (3) no further instructions (Control). CPR performance was assessed using a resuscitation manikin measuring compression depth (CD) and compression rate (CR). The self-confidence ratings were assessed using a questionnaire. Equivalence margins for the outcome parameters and sample size calculations were based on previous standard BLS studies, using two-sided 95% confidence intervals to determine significance of equivalence.
The results regarding CD revealed equivalence with a trend toward superiority of EM over EA (proportional difference 23.3%-points; 95% CI 11.4%-34.2%) and EM over control (proportional difference 23.4%-points; 95% CI 11.5%-34.2%.) and significant equivalence of EA and control (proportional difference 0.1%-points; 95% CI -11.6%-11.7%). Significant equivalence was determined for all study arms with respect to CR and self-confidence.
Our study revealed that EM was not detrimental to learners' CPR performance. Given existing research on long-term beneficial effects of EM on patient safety, coupled with the proven equivalence of EM and EA concerning short-term performance, we argue that EM is a promising approach for future medical education purposes. Raising awareness of error framing and teaching error-handling strategies is expected to benefit ongoing safety management efforts in medical education and beyond.
心肺复苏术（CPR）是临床实践中最重要的技能之一。与其他任何地方一样，这里也可能出现错误，并可能产生严重后果。实践中已知的两种常见错误处理策略是错误管理（EM）和错误避免（EA）。然而，其对医疗绩效结果的影响仍不明确。本研究旨在探讨错误框架在未来医护人员基础生命支持（BLS）培训中的作用。
在一项等效性试验（n = 430）中，医学、牙科、物理治疗和助产专业的一年级学生接受了BLS培训。在三个研究组中，参与者分别接受（1）将错误正向构建的指导（EM），（2）将错误构建为应避免的指导（EA），或（3）无进一步指导（对照组）。使用复苏人体模型测量按压深度（CD）和按压频率（CR）来评估心肺复苏表现。使用问卷评估自信心评级。结果参数的等效性界限和样本量计算基于先前的标准BLS研究，使用双侧95%置信区间来确定等效性的显著性。
关于CD的结果显示等效，且有EM优于EA的趋势（比例差异23.3个百分点；95%CI 11.4% - 34.2%）以及EM优于对照组（比例差异23.4个百分点；95%CI 11.5% - 34.2%），并且EA和对照组显著等效（比例差异0.1个百分点；95%CI -11.6% - 11.7%）。在CR和自信心方面，所有研究组均确定为显著等效。
我们的研究表明，EM对学习者的心肺复苏表现无害。鉴于现有关于EM对患者安全长期有益影响的研究，以及EM和EA在短期表现方面已证实的等效性，我们认为EM是未来医学教育的一种有前景的方法。提高对错误框架的认识并教授错误处理策略有望有益于医学教育及其他领域正在进行的安全管理工作。
