Team Strategies And Tools To Enhance Performance And Patient Safety Research Articles

Partnering with Schools to Adapt a Team Science Intervention: Processes and Challenges

AbstractPublic schools are a major provider of mental health services for children in the US. Mental and behavioral health services range from universal programming to individualized clinical supports to address student needs. These services in schools are delivered by various professionals including non-teaching and teaching school personnel, school-employed clinicians, and/or contracted community mental health partners. Provision of mental health services requires complex coordination of providers across disciplines, although few professionals have training in multidisciplinary collaboration strategies. Attention to team processes, such as delineating team members' roles, improving communication, and identifying collaboration strategies, may impact the effectiveness of evidence-based mental health service provision in real world settings. One intervention, Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), has been used in healthcare with positive outcomes and has been adapted to educational settings. The current paper describes the community-partnered subsequent adaptation of TeamSTEPPS for schools. Needs assessment interviews identified challenges, successes, and goals for student mental health. Overarching themes extracted from interviews include limited resources at multiple levels (e.g., financial support, time, and personnel), communication challenges, and poor role clarity. A community advisory board provided guidance during the adaptation and implementation planning process. Adaptations to the intervention included tailoring the intervention to the school context and the development of flexible training plans. In addition, individualized implementation plans were developed with each school partner to mitigate foreseeable barriers to rolling-out TeamSTEPPS. Our team is currently piloting the adapted TeamSTEPPS intervention and implementation strategies in partnership with three school districts.

Analysis of patient safety event report categories at one large academic hospital.

Given the persistent safety incidents in operating rooms (ORs) nationwide (approx. 4,000 preventable harmful surgical errors per year), there is a need to better analyze and understand reported patient safety events. This study describes the results of applying the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) supported by the Teamwork Evaluation of Non-Technical Skills (TENTS) instrument to analyze patient safety event reports at one large academic medical center. Results suggest that suboptimal behaviors stemming from poor communication, lack of situation monitoring, and inappropriate task prioritization and execution were implicated in most reported events. Our proposed methodology offers an effective way of programmatically sorting and prioritizing patient safety improvement efforts.

TeamSTEPPS improves patient safety

BackgroundExamine how Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) can be used to manage patient safety and improve the standard of care for patients.MethodsIn order to...

Application effect study of a combination of TeamSTEPPS with modularization teaching in the context of clinical instruction in trauma care

To explore the effect of a combination of Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) with modularization teaching in the context of clinical instruction in trauma care. A total of 244 nursing students who participated in clinical practice in orthopaedic wards from March 2020 to April 2022 were divided into two groups that received the same trauma care teaching content. The control group (n = 119) used the traditional teaching approach, and the experimental group (n = 125) utilized a combination of TeamSTEPPS with a modularization teaching model. A questionnaire was used to assess students’ theoretical knowledge, practical skills, self-concepts and professional benefits after one month with the goal of determining their end-of-course performance. The theoretical knowledge scores obtained by the control group and the experimental group were 89.56 ± 4.06 and 91.62 ± 2.84, respectively, and these results were statistically significant (P < 0.05). Students preferred the combination of TeamSTEPPS with the modularization teaching model to the traditional instructional method in terms of practical skills, professional self-concepts and professional benefits (P < 0.05). The application of the combination of TeamSTEPPS with modularization teaching in the context of clinical instruction in trauma care made significant contributions to nursing students’ mastery of theoretical knowledge and practical skills, enhanced their sense level of professional identity, instilled a correct occupational ideology in such students, and enhanced the professional benefits they were able to obtain.

Partnering for Integrated Care: A Learning Collaborative for Primary Care and Oral Health Teams.

The Teaming and Integrating for Smiles and Health (TISH) Learning Collaborative was developed to help health care organizations accelerate progress in integrating delivery of oral and primary care. By providing expert support and a structure for testing change, the project aimed to improve the early detection of hypertension in the dental setting and of gingivitis in the primary care setting, and to increase the rate of bidirectional referrals between oral and primary care partners. We report its outcomes. A total of 17 primary and oral health care teams were recruited to participate in biweekly virtual calls over 3 months. Participants tested changes to their models of care through Plan-Do-Study-Act cycles between calls. Sites tracked the percentages of patients screened and referred, completed the TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) and Interprofessional Assessment questionnaires, and provided qualitative feedback and updates in storyboard presentations. On average, with implementation of the TISH Learning Collaborative, sites displayed a nonrandom improvement in the percentages of patients screened for hypertension, referred for hypertension, referred to primary care, and referred for gingivitis. Gingivitis screening and referral to oral health care were not markedly improved. Qualitative responses indicated that teams made progress in screening and referral workflows, improved communication between medical and dental partners, and furthered understanding of the connection between primary care and oral care among staff and patients. The TISH project is evidence that a virtual Learning Collaborative is an accessible and productive avenue to improve interprofessional education, further primary care and oral partnerships, and achieve practical progress in integrated care.

Team training program’s impact on medication administration, teamwork and patient safety culture in an ambulance service (TEAM-AMB): a longitudinal multimethod study protocol

IntroductionMedication administration errors (MAEs) have the potential for significant patient harm, and the frequency of MAEs in the ambulance services is not well known. Effective teamwork is paramount for providing...

The Impact of TeamSTEPPS Training on Obstetric Team Attitudes and Outcomes on the Labor and Delivery Unit of a Regional Perinatal Center.

We investigated the effect of TeamSTEPPS training on teamwork perceptions and patient safety outcomes in an inpatient obstetrics setting. Physicians and nurses from the regional perinatal center were offered TeamSTEPPS instruction and administered a voluntary survey to assess subjective perceptions of team dynamics and patient safety prior to and six months following TeamSTEPPS training. Responses were analyzed using ANOVA and chi-square analysis. Objective measures of patient safety outcomes were the incidence and blood loss of postpartum hemorrhage after vaginal delivery (PPH-VD) or cesarean section (PPH-CS) and incidence of shoulder dystocia (SD). Outcomes were analyzed using Mann-Whitney and Kruskal Wallis testing. Surveys were collected from 20 physicians and 15 nurses prior to training and from 9 physicians and 20 nurses six months following training. Survey data showed an overall positive perception of teamwork and patient safety behaviors across all respondents. However, we found no significant changes in perception of team dynamics or behaviors to promote patient safety between pre- and post-training timepoints. Physicians and nurses differed in perception of team dynamics (p=0.001) and patient safety behaviors (p<0.001), with nurses reporting more negative perception of safety behaviors post-training. Physician attendees experienced a non-significant lower rate of PPH-VD and PPH-CS with unchanged blood loss, and an increased rate of SD compared to non-attendees in the six months following TeamSTEPPS training (p=0.058, p=0.20, p=0.21, respectively). Our experience with perinatal TeamSTEPPS training as a singular intervention was not demonstrative of improvement in teamwork and patient safety perceptions or incidences of obstetric emergencies suggesting that integration into a more comprehensive patient safety program and ongoing training of a larger proportion of providers per department may be necessary to realize tangible benefits of TeamSTEPPS. Our survey results also highlight important differences between physician and nursing staff perceptions.

Risk Reduction Strategy to Decrease Incidence of Retained Surgical Items.

Retained surgical items (RSIs) are rare but serious events associated with significant morbidity and costs. We assessed the effectiveness of radiofrequency (RF) detection technology and Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) in reducing the incidence of RSIs. All RSIs reported to the New York Patient Occurrence Reporting and Tracking System at five large urban teaching hospitals from 2007 to 2017 were analyzed. In 2012, TeamSTEPPS training was provided to all perioperative staff at each site, and use of RF detection became required in all procedures. The incidence of events before and after the interventions were compared using odds ratios. A total of 997,237 operative procedures were analyzed. After the interventions, the incidence of RSIs decreased from 11.66 to 5.80 events per 100,000 operations (odds ratio [OR] [95% CI] = 0.50 [0.32 to 0.78]). The frequency of RSIs involving RF-detectable items decreased from 5.21 to 1.35 events per 100,000 operations (OR [95% CI] = 0.26 [0.11 to 0.60]). The difference in RSIs involving non-RF-detectable surgical items was not statistically significant. The incidence of RSIs was significantly lower during the time period after implementing RF detection technology and after TeamSTEPPS training, primarily driven by a decrease in retained RF-detectable items. RF detection technology may be worth pursuing for hospitals looking to decrease RSI frequency. The benefit of TeamSTEPPS training alone may not result in a reduction of RSIs.

Development of an Interprofessional Handoff Assessment for Doctor of Physical Therapy Students

Background and Purpose: Handoff communication, especially interprofessional (IPE) handoff communication, has been shown to make up a large portion of communication errors in health care. There is variability in the way professionals are trained and deliver the pertinent patient information in handoffs, which, causes confusion, makes recall difficult, and increases the incidence of medical errors. Thus, this study aimed at assessing IPE handoffs for individuals who are trained in SBAR (Situation, Background, Assessment, and Recommendation) method of IPE communication developed by TEAM STEPPS®. Method: To assess IPE handoffs for those who are trained with the SBAR method, an existing tool was modified to make it more explicit to IPE handoff communication using descriptors from SBAR. Reliability and internal consistency were evaluated using videos of IPE handoffs of doctor of physical therapy (DPT) students. Results: Spearman rank coefficients for the revised assessment domains ranged from 0.56 to 0.86, indicating a strong correlation. The communication and content domains had the highest level of correlation. The interrater reliability of the 5 raters was 0.85, indicating high reliability. Discussion and Conclusion: This assessment proved to be simple and reliable to measure IPE handoff communication skills during emergent situations between DPT students and standardized nurses. Thus, this assessment can be used to assess interprofessional handoffs, develop competencies improved teamwork, and reduce medical errors.

Evaluation of Interprofessional Education on Effective Communication Between Pharmacy and Physician Assistant Students.

The purpose of this study was to assess the effect of Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) on student self-perceived competencies and perceptions of interprofessional (IP) communication and teamwork in a clinical case review activity. TeamSTEPPS is an evidence-based curriculum that is used to enhance and support IP healthcare communication. A repeated-measures, pretest/posttest study evaluated physician assistant students' and student pharmacists' perceptions of TeamSTEPPS. Students completed Performance Assessment for Communication and Teamwork (PACT) surveys, evaluating teamwork, knowledge, attitudes, and skills perceptions before and after a TeamSTEPPS lecture and associated activity with peer feedback. Overall, 87.4% (n = 429) completed pre- and post-PACT surveys. Apart from the Mutual Support domain (p = .898), all changes were significantly positive (p < .004), with the greatest improvements occurring in the Attitudes and Perceived Skills domains. TeamSTEPPS IP education, application, and peer feedback improved students' perceptions of multiple domains, including effective communication. Using TeamSTEPPS tools in IP formats enabled the students to safely practice and collaborate in preparation for clinical practice.

General Hospital Agitation Management: Leadership Theory and Health Care Team Best Practices Using TeamSTEPPS.

Acute agitation management is an emergency clinical intervention, often presenting acute danger to patients and medical staff. Unlike many other emergency clinical interventions, acute agitation management lacks a substantial evidence base regarding leadership and teamwork best practices. The Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) framework is a comprehensive strategy for improving health care outcomes in acute clinical situations. Practical application of TeamSTEPPS frameworks in team-based acute agitation management in the medical setting. A literature review was performed from January 1990 to March 2021 for verbal de-escalation in acute agitation management, leadership and teamwork in psychiatry and medicine, and TeamSTEPPS. No literature was found that applied TeamSTEPPS for acute agitation management in the general medical unit context although limited application has been trialed in the inpatient psychiatric context. The verbal de-escalation literature describes applicable content including conflict management approaches, communication strategies, security presence management, modeling therapeutic behavior, and debriefing strategies. Several articles were found regarding a rapid response team model for acute agitation management and describing handoff tools in psychiatric care contexts. Translation of the TeamSTEPPS approach provided many additional approaches for operation of a rapid response team in acute agitation management. The leadership and teamwork best practices in TeamSTEPPS provide a clear and actionable framework for team-based acute agitation management as an emergency clinical intervention.

The Effects of Leadership Curricula With and Without Implicit Bias Training on Graduate Medical Education: A Multicenter Randomized Trial.

To determine whether a brief leadership curriculum including high-fidelity simulation can improve leadership skills among resident physicians. This was a double-blind, randomized controlled trial among obstetrics-gynecology and emergency medicine (EM) residents across 5 academic medical centers from different geographic areas of the United States, 2015-2017. Participants were assigned to 1 of 3 study arms: the Leadership Education Advanced During Simulation (LEADS) curriculum, a shortened Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) curriculum, or as active controls (no leadership curriculum). Active controls were recruited from a separate site and not randomized to limit any unintentional introduction of materials from leadership curricula. The LEADS curriculum was developed in partnership with the Council on Resident Education in Obstetrics and Gynecology and Council of Residency Directors in Emergency Medicine as a novel way to provide a leadership toolkit. Both LEADS and the abbreviated TeamSTEPPS were designed as six 10-minute interactive web-based modules.The primary outcome of interest was the leadership performance score from the validated Clinical Teamwork Scale instrument measured during standardized high-fidelity simulation scenarios. Secondary outcomes were 9 key components of leadership from the detailed leadership evaluation measured on 5-point Likert scales. Both outcomes were rated by a blinded clinical video reviewer. One hundred ten obstetrics-gynecology and EM residents participated in this 2-year trial. Participants in both LEADS and TeamSTEPPS had statistically significant improvement in leadership scores from "average" to "good" ranges both immediately and at the 6-month follow-up, while controls remained unchanged in the "average" category throughout the study. There were no differences between LEADS and TeamSTEPPS curricula with respect to the primary outcome. Residents who participated in a brief structured leadership training intervention had improved leadership skills that were maintained at 6-month follow-up.

Resuscitation Team Members 'Experiences of Teamwork: A Qualitative Study.

Despite the obvious importance of teamwork in emergency care, the dimensions of teamwork in resuscitation remain a subject of debate among specialists and researchers. The aim of this study was to identify the dimensions of teamwork based on the experiences of members of the resuscitation team. This study was conducted between March 2020 and April 2021. By purposive sampling, participants were selected. Sixteen semi-structured interviews were conducted with experienced emergency nurses and emergency medicine residents individually and analysed through deductive content analysis by using the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) model. Interviews were encoded for analysis using MAXQDA software (version 2020). Three main categories were identified around teamwork in resuscitation. These categories were as follows (1) leadership, (2) teamwork, and (3) essential prerequisites for resuscitation. The main leadership category consisted of three sub-categories of time management, resource allocation, and task management. From sub-categories, situation monitoring, communication, and mutual support, the main category of teamwork emerged. Also, the emerging category of essential prerequisites for regeneration included two generic categories: professional requirements and workplace requirements and the teamwork category included situation monitoring, communication, and mutual support. Based on the experiences of the resuscitation team members, leadership, teamwork, and essential prerequisites for resuscitation are the most important dimensions of teamwork in resuscitation. Recognizing the dimensions of teamwork in resuscitation is an initial step and then should be reflected in educational programs and future guidelines.

Promoting System Thinking and Professionalism Through Simulated Hospital Experiences for Nursing and Clinical Laboratory Science Students.

A simulation laboratory was developed for prelicensure nursing and undergraduate clinical laboratory science students using scripted patient cases with laboratory test results. The experience was guided by TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety). Participants ( n = 66) completed the modified Interprofessional Professionalism Assessment pre- and postsimulation. Journal reflections provided qualitative data. All aspects of interprofessional professionalism increased after the simulation; the most significant gain was confidence in working with other health care professionals. Analysis of journal themes indicated the students perceived increased communication and collaboration skills concerning patient care and safety.

Lessons learned – RN Led interprofessional teams in primary care

Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is one program designed to improve communication and performance across all roles and disciplines of the health care team. This paper describes the lessons learned during a quality improvement project at a Federally Qualified Health Center (FQHC) based in a Midwestern urban community. One objective was to expand collaboration and team function among the health care providers and support staff by training RN Chronic Care Coordinators to develop, facilitate and lead interprofessional teams to improve chronic care coordination. The project used RN complex care managers to help improve team communication using the TeamSTEPPS approach.

The Development of an Assessment Rubric for the Core and Contingency Team Interaction Among Rapid Response Teams.

Teamwork training is critical in the development of high-functioning rapid response teams (RRT). Rapid response teams involve interactions between a patient's core care team and a hospital contingency team, which can lead to disorganized and unsafe resuscitations, largely due to problems with communication and information dissemination. An extensive literature search found no assessment tools specific to the unique communicative challenges of an RRT, and thus, this study sought to develop an assessment rubric validated for training RRTs. This study elucidates the development, implementation, and testing of an RRT rubric based on Kane's framework for validating testing instruments. Twenty-four inpatient code teams underwent team training using a Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) didactic, an online module on the TeamSTEPPS RRT program, and a subsequent presimulation and postsimulation experience. Two raters were randomized to give a bedside assessment for each team using the proposed RRT rubric. Simulation scores were assessed with Wilcoxon signed-rank tests. Interrater reliability was assessed using intraclass correlation coefficients. These analyses were then used to argue Kane's scoring, generalization, and extrapolation inferences. All teams significantly improved from the presimulation to postsimulation scenarios across all TeamSTEPPS domains. Content validity was obtained from 5 resuscitation experts with a scale-level content validity index of 0.9, with individual content validity index of 0.8 to 1.0. Intraclass correlation coefficient for "pre" scores were 0.856 (n = 24, P < 0.001), "post" scores of 0.738 (n = 24, P < 0.001), and a total of 0.890 (n = 48, P < 0.001). The authors argue for the validity of a new RRT rubric based off Kane's framework, with a specific focus on teamwork training to improve coordination and function of core and contingency teams. A follow-up study with longitudinal data along with external validation of this rubric is needed.

Longitudinal team training program in a Norwegian surgical ward: a qualitative study of nurses\u2019 and physicians\u2019 experiences with implementation

BackgroundTeam training interventions to improve team effectiveness within healthcare are widely used. However, in-depth knowledge of how healthcare professionals experience such team training curricula and their implementation processes, as well as how contextual factors impact implementation, is currently missing. The aim of this study is therefore to describe healthcare professionals’ experiences with the implementation of a longitudinal interprofessional team training program in a surgical ward.MethodsA descriptive design was applied based on qualitative semi-structured focus group interviews with 11 healthcare professionals. A convenience sample of physicians (n = 4), registered nurses (n = 4), and certified nursing assistants (n = 3) was divided into three professionally based focus groups, which were interviewed at three time intervals over a period of 1 year.InterventionThe validated and evidence-based team training program Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) was implemented in a surgical ward at a hospital between January 2016 and June 2017. The team training program included three phases: 1) assessment and planning, 2) training and implementation, and 3) sustainment.ResultsHealthcare professionals’ experiences with the content of the team training program varied from valuing the different elements of it to seeing the challenges in implementing the elements in clinical practice. A one-day training course was found to be especially beneficial for interprofessional collaboration at the ward. Over time, the nursing staff seemed to maintain their motivation for the implementation of the tools and strategies, while the physicians became less actively involved. Contextual ward factors influenced the adoption and utilization of the tools and strategies of the program both positively and negatively. The healthcare professionals’ experienced the implementation of the team training program as positive for the patient safety culture at the ward in the forms of increased awareness of teamwork and open communication.ConclusionsThe study suggests that the implementation of a team training program in a surgical ward is dependent on a set of factors related to content, process, context, and impact. Knowledge on how and why a team training program work supports the transferability to clinical practice in further planning of team training measures.Trial registrationThe study is part of a larger research project with a study protocol that was registered retrospectively on 05.30.17, with the trial registration number ISRCTN13997367.

Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) to Improve Collaboration in School Mental Health: Protocol for a Mixed Methods Hybrid Effectiveness-Implementation Study.

BackgroundPublic schools in the United States are the main providers of mental health services to children but are often ill equipped to provide quality mental health care, especially in low-income urban communities. Schools often rely on partnerships with community organizations to provide mental health services to students. However, collaboration and communication challenges often hinder implementation of evidence-based mental health strategies. Interventions informed by team science, such as Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), have the potential to improve treatment implementation and collaboration within schools.ObjectiveThe objective of this study is to improve communication and collaboration strategies among mental health and school staff by adapting an evidence-based team science intervention for school settings. We present a protocol for a hybrid effectiveness-implementation study to adapt TeamSTEPPS using stakeholder feedback, develop a tailored implementation plan, and pilot the adapted content in eight schools.MethodsStudy participants will be recruited from public and charter schools and agencies overseeing school mental health services in the local metro area. We will characterize current services by conducting a needs assessment including stakeholder interviews, observations, and review of administrative data. Thereafter, we will establish an advisory board to understand challenges and develop possible solutions to guide additional TeamSTEPPS adaptations along with a complementary implementation plan. In aim 3, we will implement the adapted TeamSTEPPS plus tailored implementation strategies in eight schools using a pre-post design. The primary outcome measures include the feasibility and acceptability of the adapted TeamSTEPPS. In addition, self-report measures of interprofessional collaboration and teamwork will be collected from 80 participating mental health and school personnel. School observations will be conducted prior to and at three time points following the intervention along with stakeholder interviews. The analysis plan includes qualitative, quantitative, and mixed methods analysis of feasibility and acceptability, school observations, stakeholder interviews, and administrative data of behavioral health and school outcomes for students receiving mental health services.ResultsRecruitment for the study has begun. Goals for aim 1 are expected to be completed in Spring 2021.ConclusionsThis study utilizes team science to improve interprofessional collaboration among school and mental health staff and contributes broadly to the team science literature by developing and specifying implementation strategies to promote sustainability. Results from this study will provide knowledge about whether interventions to improve school culture and climate can ready both mental health and school systems for implementation of evidence-based mental health practices.Trial RegistrationClinicalTrials.gov NCT04440228; https://clinicaltrials.gov/ct2/show/NCT04440228International Registered Report Identifier (IRRID)DERR1-10.2196/26567

Interprofessional simulation education to enhance teamwork and communication skills among medical and nursing undergraduates using the TeamSTEPPS® framework

BackgroundLearning in silos during the undergraduate years results in ineffective collaborative practice leading to adverse events. Simulation training using the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS)® framework has been shown to be effective in enhancing teamwork skills among healthcare professionals. This study aims to evaluate an interprofessional simulation education (IPSE) module for undergraduate medical and nursing students on teamwork and communication skills using the TeamSTEPPS® framework. MethodsAn IPSE module was developed by an interprofessional team of faculty. A convenient sample of medical and nursing undergraduate interns participated in trauma simulation scenarios before and after a didactic session on interprofessional education (IPE) and TeamSTEPPS® 2.0. The pre-post performance was assessed by faculty and pre-post self-assessment of the IPSE training and interprofessional education collaborative (IPEC) competencies by the participants. Quantitative data were analysed using a paired t-test of the mean scores and analysis of variance. The themes that emerged from audio recordings of the debriefing, and written reflections of the participants, yielded data for qualitative thematic analysis. ResultsThe scores of team performance, self-assessment of IPSE training, and IPEC competencies revealed statistically significant values. Themes that emerged included the need for IPSE in the curriculum, impact of structured tools for communication on patient safety, and awareness of the roles and responsibilities in interprofessional teamwork. A survey conducted two weeks after completion of the module showed positive feelings among participants about interprofessional collaboration. ConclusionThe study specifically assessed the effectiveness of an IPSE module based on TeamSTEPPS® guidelines in improving communication and teamwork skills among medical and nursing undergraduates.

TeamSTEPPS online simulation: expanding access to teamwork training for medical students

BackgroundThe Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) programme is an evidence-based approach to teamwork training. In-person education is not always feasible for medical student education....