***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE : To determine whether residents perceived oral , face-to-face feedback about their continuity clinic performance as better than a similar , written version . DESIGN : Single-blind , r and omized controlled trial . SETTING : Two university-based , internal medicine residency clinics . PARTICIPANTS : All 68 internal medicine and combined program ( medicine-pediatrics , medicine-psychiatry , medicine-neurology , and preliminary year ) residents and their clinic preceptors . MEASUREMENTS AND MAIN RESULTS : Residents at each program were separately r and omized to oral or written feedback sessions with their clinic preceptors . The oral and written sessions followed similar , structured formats . Both groups were later sent question naires about aspects of the clinic . Sixty-five ( 96 % ) of the residents completed the question naire . Eight of the 19 questions dealt with aspects of feedback . A feedback scale was developed from the survey responses to those eight questions ( α=.86 ) . There were no significant differences in the responses to individual questions or in scale means ( p>.20 ) between the two feedback groups . When each university was analyzed separately , one had a higher scale mean ( 3.10 vs 3.57 , p=.047 ) , but within each university , there were no differences between the oral and written feedback groups ( p>.20 ) . CONCLUSIONS : No differences were observed between the oral and written feedback groups . In attempting to provide better feedback to their residents , medical educators may better apply their efforts to other aspects , such as the frequency of their feedback , rather than the form of its delivery Second-year medical students performed a head-to-toe screening physical examination on trained patient instructors ( PIs ) as a high-stakes examination before beginning clinical clerkships . PIs completed a 138-item checklist and instructed the students in the proper performance of any incorrectly executed or omitted items . To assess the accuracy of the PI ratings , ' monitor ' PIs watching the encounter by video completed checklists for 11 retests of failed students in 2001 and for 28 r and omly selected encounters in 2002 . Checklist-level discrepancies measured by mean absolute checklist difference were 8 % in 2001 and 9 % in 2002 . Case-level mean difference between raters in 2002 was -2.9 % . The inter-rater reliability for a single rater , estimated by the intra-class correlation coefficient for total encounter scores , was 0.95 . The assessment and feedback were well received by the students . The Head-to-Toe examination provides a reliable assessment of a student 's ability to carry out a complete screening physical examination . Patient instructors can be trained to acceptable accuracy and reliability despite the length and complexity of the exercise , and can provide effective feedback and teaching targeted to individual student deficiencies Learning proper techniques in physical examinations is m and atory for a physician . Although students may examine each other in early training , examination of the female pelvis does not readily conform to this reciprocity . A r and omized study was conducted , comparing teaching methods utilizing professional patients or plastic models . Training on a professional patient significantly increased a student 's chance of palpating one or both ovaries , reduced the student 's anxiety about performing a pelvic examination , and may have improved the student 's gentleness . Costs of the professional patient method were minimal . It is recommended that teaching pelvic examinations with the professional patient replace teaching on the plastic model PURPOSE : To evaluate two smoking-cessation practice exercises , one using st and ardized patients ( SPs ) , the other using role playing by medical students .  METHOD : In the spring of 1994 all 120 first-year University of California , San Francisco , School of Medicine Students were given lectures on the health effects of smoking and how physicians can help patients quit . Afterward some of the students were r and omly assigned to two groups in which to practice counseling patients : Group 1 ( n = 35 ) used SPs , Group 2 ( n = 37 ) used role playing . Each of the Group 1 students practice d smoking-cessation techniques with an SP ; the SP evaluated the student on cognitive and communication skills , assigned an overall rating , and provide feedback using a st and ardized form . The Group 2 students ( as well as the 48 students not assigned to a group ) role-played in pairs and used the same form to provide feedback . All the students evaluated their respective practice practice s. Two weeks later 24 Group 1 and 31 Group 2 students participated in a  clinic-skills- assessment exercise using SPs . As in the Group 1 practice exercise , each student was evaluated by an SP on cognitive and communication skills and assigned an overall rating . Data were analyzed through a number of statistical methods . The cost of the SP program was determined . RESULTS : The Group 1 students rated their practice exercise much more favorably than did the Group 2 students . However , there was no significant difference between the groups in their ratings by the SPs on the clinical -skills- assessment exercise . The use of SPs  cost a great deal more than did the use of role playing . CONCLUSION : Although the students rated the SPs higher than they did the role playing , the two tools produced similar levels of skills attainment . The data suggest that having students practice smoking-cessation techniques through role playing may be as effective as using the more extensive SPs Purpose To compare two methods of teaching physical assessment , a traditional faculty-taught course and a course with components taught by  specially trained st and ardized patients ( SPs  ) , with respect to students ' performances and costs . Method Medical students in their second year and without preliminary course work in physical assessment were taught by faculty-led small groups . Students in their first year were taught by faculty-led lecture — demonstrations and exercises led by physical examination teaching associates ( PETAs ) . Both groups of students were tested with a performance-based examination  that involved six identical stations . The costs of both courses were calculated using faculty and SP salaries . Results There was no difference in students ' performances on two of the stations , those involving the eye and abdominal examinations . The class that had been taught by PETAs , however , demonstrated a statistically significant performance advantage on the remaining four stations . The cost saving from using the PETAs was conservatively estimated at $ 24,155 . Conclusion Specially trained SPs can effectively teach the normal physical examination to medical students and are a less expensive alternative to traditional faculty small-group teaching methods The area of communication skills in adolescent medicine is emerging as a distinct and important part of the undergraduate curriculum . An appropriate level of confidence in dealing with the adolescent population is deemed a necessary educational requirement . Skills in psychosocial communication with adolescents differ from those required for younger patients and adults ; they include discussing confidentiality and adolescent risk-taking activities .  Simulated patients can be used effectively in teaching and evaluating of communication skills . However , there is no report of using  adolescent simulated patients  to teach communication skills . The evidence available is inconclusive regarding the teaching time required to promote retention of communication skills , although a recent review suggests that one day ’s training or less is not effective . Long-term retention of these skills has been supported by only one paper , suggesting a need to follow students over time to ascertain the effect of communication skills training . Our study addressed two questions : ( 1 ) does feedback from a simulated adolescent patient and simulated mother lead to improvements in  fourth-year medical students ’ psychosocial interviewing of adolescent patients ? and ( 2 ) does this skill persist following the intervention A class of 100 second-year medical students was r and omly divided into two groups for instruction in the techniques of the gynecologic examination . Each group received a lecture and a demonstration film . The control group then had practical instruction on office or clinic patients . The study group was instructed by specially trained clinical teaching associates who acted both as professional patients and as teachers . After practice in clinics and offices , both groups received a  common evaluation  by gynecologists and teaching associates . Students who were instructed by clinical teaching associates performed better on subsequent pelvic examinations and demonstrated superior communications skills compared with the control group Two nonphysician mothers were each trained to give a consistent and authentic history of a child 's common medical problem . At the beginning of a Pediatric Clerkship , one half the students were r and omly assigned to interview one of the trained mothers . The interviews were videotaped and then replayed in an evaluative feedback session with each student . At the end of the clerkship these students were rated significantly higher on the process of interviewing than those students who did not have the initial evaluative feedback session OBJECTIVES Facing dramatic reductions of inpatient beds and fewer faculty tutors , the Queen 's University medical school has had to consider alternatives to the traditional inpatient encounter for the early acquisition of clinical skills . The purpose of this study was to investigate the feasibility and impact on students of a model for a first-year clinical skills course , using exclusively st and ardized patients in place of in patients , and using a smaller ratio of faculty to students . DESIGN Twenty volunteers were selected from the first-year class of 75 students to participate as the experimental group . The remaining 55 students formed the control group . SETTING Queen 's University medical school , Ontario , Canada . SUBJECTS First-year medical students . RESULTS In measures of student satisfaction with the amount of performance feedback received during the course , there was a non-significant trend towards greater satisfaction among the experimental group compared to the control group . This occurred despite a tutor to student ratio of 1.5:10 in the experimental group compared to 3:10 in the control group . In the student evaluation of their tutors , mean scores for the two groups were 4.28 for the experimental group and 4 . 06 for the control group ( P = 0.10 ) . The mean OSCE scores for the two groups were 76.4 for the experimental group and 76.5 for the control group ( P = 0.93 ) . There is no practical or statistical difference in either of these two scores . CONCLUSIONS We conclude that this new model is feasible , was well received by the students and that the reduced tutor to student ratio and lack of inpatient encounters did not appear to adversely affect their learning The increasing difficulty in obtaining appropriate hospitalized patients to give enlarging classes of medical students their first exposure to abnormal physical findings has led to the development of an instructor-patient program .  Sixteen community residents with relatively stable respiratory , cardiovascular , musculoskeletal , or neurological findings were recruited and trained as instructor- patients to teach the technical elements of the examination of the affected organ system . Evaluation of the technical skills of 46 second-year students trained by instructor- patients and those of 41 r and omly selected students trained in these skills by physician instructors demonstrated that the two have comparable technical skills five to eight weeks after the training sessions . Faculty recruitment , instructor-patient recruitment and training , and evaluation are discussed PURPOSE : This r and omized controlled study compared the interviewing skills of first-year medical students receiving feedback primarily from st and ardized patients ( SPs )  with those of students receiving feedback primarily from faculty . METHOD : All 154 first-year students at the University of Oklahoma College of Medicine in 1993 - 94 were video-taped  to assess baseline and post-instruction interviewing skills . All the students , r and omized to one of three study groups , attended two four-hour workshops on interviewing skills . Instruction in the groups was as similar as possible except in the matter of who provided feedback . Two rating systems were used to rate the videotaped interviews for performances of targeted skills . RESULTS : Complete , usable data were available for 120 ( 78 % ) of the students .  Skill ratings using the Arizona Clinical Interview Rating Scale were significantly higher for the “ types of questions used ” and “ use of empathy ” items in the SP-led feedback group . No significant difference in ratings was detected among the groups as measured by the Rotor Interactional Analysis System . CONCLUSION : The SPs were at least as effective as the faculty in effecting behavioral changes in the first-year medical students ' interviewing skills 
    Output:
    
Although feedback from the patient 's perspective is generally recommended , most SPs provided feedback on clinical skills and communication skills .
DISCUSSION There appear to be no clear st and ards with regard to effective feedback training for SPs .