Safety management within the scope of teaching practical clinical skills: framing errors for cardiopulmonary resuscitation training - a multi-arm randomized controlled equivalence trial

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 ( 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.