TeamSTEPPS® toolkit: CUS

Tutor notes

Estimated module duration: 15 minutes

Successful teamwork and positive patient outcomes rely on all team members feeling confident to voice issues when something seems off. But nurses often face a range of barriers to raising their concerns in an impactful way, such as lacking confidence or preparedness.

The TeamSTEPPS® technique CUS (Concerned, Uncomfortable, Safety) can help nurses discuss clinical issues with cohesion and clarity, which ultimately contributes to ensuring patient care and safety. This structured approach guides nurses through escalating the issue in stages, avoiding any ambiguity that might delay understanding or action.

This module helps nurses and nursing students to understand and practice using the CUS technique in realistic clinical scenarios. Starting with guided exercises, learners gain the confidence needed to voice concerns clearly and professionally, before practicing using CUS in a freeform activity.

About this resource

This document provides an overview of each of the learning activities featured in this programme, including:
Key learner outcome and goals
Purpose of the activities
Estimated duration
Characters
Environments
Video walkthroughs
Journal entries

Key learner outcome and goals

Learning outcome

Feel prepared to escalate concerns using the CUS formula.

Learning goals

  • Identify how to use each component of CUS to advocate for patients
  • Apply CUS in practice to ensure patient safety

A word about terminology

As a medium, Virtual Reality is not best suited to didactic teaching methods.

However, our intention is that all Bodyswaps modules follow a student-centered constructivist pedagogy. This means creating rich experiences in which learners can explore key concepts and ideas and reach their own conclusions.

This is why our documents speak in terms of learning goals and outcomes, rather than measurable ‘learning objectives’ (a la Bloom’s Taxonomy) per se. 

What is TeamSTEPPS®?

TeamSTEPPSⓇ – Team Strategies and Tools to Enhance Performance and Patient Safety 3.0 – is an industry-recognised, evidence-based collection of teamwork tools and techniques. It’s designed to optimize collaboration between healthcare staff and improve the delivery of care.

The framework helps to develop four key skills (communication, leadership, situation monitoring, and mutual support), equipping staff to handle industry-wide interprofessional challenges.

This module gives learners a safe space to learn and practice a key Mutual Support skill from the TeamSTEPPSⓇ framework: CUS.

We worked with subject matter expert Sam Smith – Certified Registered Nurse Anesthetist and TeamSTEPPSⓇ master trainer (completed training 3.0) – to ensure the medical scenarios and application of the technique in this module are realistic and engaging.

TeamSTEPPS® Simulator

Our TeamSTEPPS® Simulator module provides an opportunity for learners to practice five key tools (SBAR, Check-Back, CUS, Task Assistance, and Call-Out) in a series of interactive, true-to-life freeform activities. It’s a virtual roleplaying space where nurses can gain essential experience and build confidence in using the tools.

But nurses have varying levels of preparedness in these tools, and may not be ready to put their skills to the test.

For that reason, we’ve designed a collection of short modules – our TeamSTEPPS® Toolkit – which act as a companion to the Simulator. The modules in the Toolkit allow nurses to explore the theory behind these five techniques, providing scaffolded learning and practice before or after they enter the TeamSTEPPS® Simulator. This module takes a closer look at CUS.

Aside from a playground in which nurses can hone their skills, the TeamSTEPPS® Simulator can also be used as a competency test for assessing performance before and after enrollment in the TeamSTEPPS® Toolkit modules. All learners who play the Simulator receive an LLM-powered personalized report of their overall use of the tools, helping you understand where they excel and where they may need further training and practice.

Module structure

The complete journey takes the learner through two interactive topics, as well as ancillary activities such as introduction, self-reflection, debrief and the exit survey.

It is a linear experience, meaning the learner will be guided step by step through all the activities by the virtual coaches.

We recommend that learners fully interact with each activity to get the full benefit.

It is estimated that each topic will take the learner approximately 5 minutes to complete, although completion times vary depending on whether the learner chooses to fine-tune their freeform responses.

Learner journey

Introduction and self-reflection
Next topic
Topic 1: Understanding the CUS formula
Scaffolded conversation
Next topic
Topic 2: Use CUS to escalate a concern
Freeform conversation
Next topic
Debrief and self-reflection
Next topic
Exit survey
Next topic

Characters

NurseSam_Avatar
Nurse Sam
Virtual coach
Nurse_Carlos_Avatar
Nurse Carlos
Virtual coach
DrHuan_Avatar
Dr. Huan
Cardiologist

Environments

Hospital Tutor Room

Hospital tutor room

A professional, yet cozy office space in the fictional setting of Summerview Hospital, where virtual coaches Nurse Sam and Nurse Carlos run their TeamSTEPPS® Training Program.
Central Nursing Station

Central nursing station

The central administrative working area for nurses at Summerview Hospital, connecting to various patient rooms. Here, the learner will practice communicating with their virtual colleague, Dr. Huan.