Figure 1: illustration of the dynamic influences on ANTS in Rwanda. Communication is placed centrally as it influences and pervades the categories of ANTS. Cultural elements (e.g. discomfort taking leadership) and habituation to resource shortages impair effective team communication and coordination. The ANTS domains influence and are influenced by communication patterns (e.g. inadequate role definition). As practice of ANTS affects patient safety, our findings suggest that communication skills should be actively targeted for future teaching interventions to improve ANTS