***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: BACKGROUND AND AIMS A structured comprehensive curriculum ( SCC ) that uses simulation-based training ( SBT ) can improve clinical colonoscopy performance . This curriculum may be enhanced through the application of progressive learning , a training strategy centered on incrementally challenging learners . We aim ed to determine whether a progressive learning-based curriculum ( PLC ) would lead to superior clinical performance compared with an SCC . METHODS This was a single-blinded r and omized controlled trial conducted at a single academic center . Thirty-seven novice endoscopists were recruited and r and omized to either a PLC ( n = 18 ) or to an SCC ( n = 19 ) . The PLC comprised 6 hours of SBT , which progressed in complexity and difficulty . The SCC included 6 hours of SBT , with cases of r and om order of difficulty . Both groups received expert feedback and 4 hours of didactic teaching . Participants were assessed at baseline , immediately after training , and 4 to 6 weeks after training . The primary outcome was participants ' performance during their first 2 clinical colonoscopies , as assessed by using the Joint Advisory Group Direct Observation of Procedural Skills assessment tool ( JAG DOPS ) . Secondary outcomes were differences in endoscopic knowledge , technical and communication skills , and global performance in the simulated setting . RESULTS The PLC group outperformed the SCC group during first and second clinical colonoscopies , measured by JAG DOPS ( P < .001 ) . Additionally , the PLC group had superior technical and communication skills and global performance in the simulated setting ( P < .05 ) . There were no differences between groups in endoscopic knowledge ( P > .05 ) . CONCLUSIONS Our findings demonstrate the superiority of a PLC for endoscopic simulation , compared with an SCC . Challenging trainees progressively is a simple , theory-based approach to simulation whereby the performance of clinical colonoscopies can be improved . ( Clinical trial registration number : NCT02000180 . ) BACKGROUND Little is known regarding the value of esophagogastroduodenoscopy ( EGD ) simulators in education . The purpose of the present paper was to vali date the use of computer simulation in novice EGD training . METHODS In phase 1 , expert endoscopists evaluated various aspects of simulation fidelity as compared to live endoscopy . Additionally , computer-recorded performance metrics were assessed by comparing the recorded scores from users of three different experience levels . In phase 2 , the transfer of simulation-acquired skills to the clinical setting was assessed in a two-group , r and omized pilot study . The setting was a large gastroenterology ( GI ) Fellowship training program ; in phase 1 , 21 subjects ( seven expert , intermediate and novice endoscopist ) , made up the three experience groups . In phase 2 , eight novice GI fellows were involved in the two-group , r and omized portion of the study examining the transfer of simulation skills to the clinical setting . During the initial validation phase , each of the 21 subjects completed two st and ardized EDG scenarios on a computer simulator and their performance scores were recorded for seven parameters . Following this , staff participants completed a question naire evaluating various aspects of the simulator 's fidelity . Finally , four novice GI fellows were r and omly assigned to receive 6 h of simulator-augmented training ( SAT group ) in EGD prior to beginning 1 month of patient-based EGD training . The remaining fellows experienced 1 month of patient-based training alone ( PBT group ) . Results of the seven measured performance parameters were compared between three groups of varying experience using a Wilcoxon ranked sum test . The staffs ' simulator fidelity survey used a 7-point Likert scale ( 1 , very unrealistic ; 4 , neutral ; 7 , very realistic ) for each of the parameters examined . During the second phase of this study , supervising staff rated both SAT and PBT fellows ' patient-based performance daily . Scoring in each skill was completed using a 7-point Likert scale ( 1 , strongly disagree ; 4 , neutral ; 7 , strongly agree ) . Median scores were compared between groups using the Wilcoxon ranked sum test . RESULTS Staff evaluations of fidelity found that only two of the parameters examined ( anatomy and scope maneuverability ) had a significant degree of realism . The remaining areas were felt to be limited in their fidelity . Of the computer-recorded performance scores , only the novice group could be reliably identified from the other two experience groups . In the clinical application phase , the median Patient Discomfort ratings were superior in the PBT group ( 6 ; interquartile range [ IQR ] , 5 - 6 ) as compared to the SAT group ( 5 ; IQR , 4 - 6 ; P = 0.015 ) . PBT fellows ' ratings were also superior in Sedation , Patient Discomfort , Independence and Competence during various phases of the evaluation . At no point were SAT fellows rated higher than the PBT group in any of the parameters examined . CONCLUSION This EGD simulator has limitations to the degree of fidelity and can differentiate only novice endoscopists from other levels of experience . Finally , skills learned during EGD simulation training do not appear to translate well into patient-based endoscopy skills . These findings suggest against a key element of validity for the use of this computer simulator in novice EGD training BACKGROUND AND STUDY AIM As for any manual procedure , the learning curves for medical interventions can have undesirable phases , occurring mostly in the early experience of applying a technique . There have been impressive advances in endoscopic procedures during recent years , and there is an emerging trend that the number of procedures is increasing in parallel with these . In addition , the introduction of screening programs for colorectal cancer will also increase the numbers of procedures needed . Recent developments in medical simulation seem promising with regard to the possibility of " training out " undesirable parts of the learning curve outside the operating room . The aim of this study was to investigate whether the use of the AccuTouch flexible endoscopy simulator improves the early part of the learning curve in colonoscopy training . METHOD 12 endoscopy trainees , 10 surgeons and two medical gastroenterologists , all with experience in gastroscopy but with no specific colonoscopy experience , were r and omly assigned to either simulator training or to a control group . They all received the same theoretical study package and the training group practice d with the AccuTouch colonoscopy simulator until a predefined expert level of performance was reached . All trainees performed their first ten individual colonoscopies described in detail in a separate protocol . RESULTS Trainees in the simulator-trained group performed significantly better ( P=0.0011 ) and managed to reach the cecum in 52 % of their cases ( vs. 19 % in the control group ) , and were 4.53 times more likely to succeed compared with the controls . Additionally , there was a significantly shorter procedure time and less patient discomfort in the h and s of the simulator-trained group . CONCLUSION Skills acquired using the AccuTouch simulator transfer well into the clinical colonoscopy environment . The results of this trial clearly support the plan to integrate simulator training into endoscopic education curricula BACKGROUND The GI Mentor is a virtual reality simulator that uses force feedback technology to create a realistic training experience . OBJECTIVE To define the benefit of training on the GI Mentor on competency acquisition in colonoscopy . DESIGN R and omized , controlled , blinded , multicenter trial . SETTING Academic medical centers with accredited gastroenterology training programs . PATIENTS First-year GI fellows . INTERVENTIONS Subjects were r and omized to receive 10 hours of unsupervised training on the GI Mentor or no simulator experience during the first 8 weeks of fellowship .  After this period , both groups began performing real colonoscopies . The first 200 colonoscopies performed by each fellow were grade d by proctors to measure technical and cognitive success , and patient comfort level during the procedure . MAIN OUTCOME MEASUREMENTS A mixed-effects model comparison between the 2 groups of objective and subjective competency scores and patient discomfort in the performance of real colonoscopies over time . RESULTS Forty-five fellows were r and omized from 16 hospitals over 2 years . Fellows in the simulator group had significantly higher objective competency rates during the first 100 cases . A mixed-effects model demonstrated a higher objective competence overall in the simulator group ( P < .0001 ) , with the difference between groups being significantly greater during the first 80 cases performed . The median number of cases needed to reach 90 % competency was 160 in both groups . The patient comfort level was similar . CONCLUSIONS Fellows who underwent GI Mentor training performed significantly better during the early phase of real colonoscopy training BACKGROUND Changes in medical practice have constrained the time available for education and the availability of patients for training . Computer-based simulators have been devised that can be used to achieve manual skills without patient contact . This study prospect ively compared , in a clinical setting , the efficacy of a computer-based simulator for training in upper endoscopy . METHODS Twenty-two fellows with no experience in endoscopy were r and omly assigned to two groups : one group underwent 10 hours of pre clinical training with a computer-based simulator , and the other did not . Each trainee performed upper endoscopy in 19 or 20 patients . Performance parameters evaluated included the following : esophageal intubation , procedure duration and completeness , and request for assistance . The performance of the trainees also was evaluated by the endoscopy instructor . RESULTS A total of 420 upper endoscopies were performed ; the computer pretrained group performed 212 and the non-pretrained group , 208 . The pretrained group performed more complete procedures ( 87.8 % vs. 70.0 % ; p < 0.0001 ) , required less assistance ( 41.3 % vs. 97.9 % ; p < 0.0001 ) , and the instructor assessed performance as " positive " more often for this group ( 86.8 % vs. 56.7 % ; p < 0.0001 ) . The length of procedures was comparable for the two groups . CONCLUSIONS The computer-based simulator is effective in providing novice trainees with the skills needed for identification of anatomical l and marks and basic endoscopic maneuvers , and in reducing the need for assistance by instructors Background Flexible endoscopy is an integral part of surgical care . Exposure to endoscopic procedures varies greatly in surgical training . The Society of American Gastrointestinal and Endoscopic Surgeons has developed the Fundamentals of Endoscopic Surgery ( FES ) , which serves to teach and assess the fundamental knowledge and skills required to practice flexible endoscopy of the gastrointestinal tract . This report describes the validity evidence in the development of the FES cognitive examination . Methods Core areas in the practice of gastrointestinal endoscopy were identified through facilitated expert focus groups to establish validity evidence for the test content . Test items then were developed based on the content areas . Prospect i ve enrollment of participants at various levels of training and experience was used for beta testing . Two FES cognitive test versions then were developed based on beta testing data . The Angoff and contrasting group methods were used to determine the passing score . Validity evidence was established through correlation of experience level with examination score . Results A total of 220 test items were developed in accordance with the defined test blueprint and formulated into two versions of 120 questions each . The versions were administered r and omly to 363 participants . The correlation between test scores and training level was high ( r = 0.69 ) , with similar results noted for contrasting groups based on endoscopic rotation and endoscopic procedural experience . Items then were selected for two test forms of 75 items each , and a passing score was established . Conclusions The FES cognitive examination is the first test with validity evidence to assess the basic knowledge needed to perform flexible endoscopy . Combined with the h and s-on skills examination , this assessment tool is a key component for FES certification BACKGROUND New Residency Review Committee requirements in general surgery require 50 colonoscopies . Simulators have been widely suggested to help prepare residents for live clinical experience . We assessed a computer-based colonoscopy simulator for effective transfer of skills to live patients . METHODS A r and omized controlled trial included general surgery and internal medicine residents with limited endoscopic experience . Following a pretest , the treatment group ( n = 12 ) practice d on the simulator , while controls ( n = 12 ) received no additional training . Both groups then performed a colonoscopy on a live patient . Technical ability was evaluated by expert endoscopists using previously vali date d assessment instruments . RESULTS In the live patient setting , the treatment group scored significantly higher global ratings than controls ( t(22 ) = 1.84 , P = .04 ) . Only 2 of the 8 computer-based performance metrics correlated significantly with previously vali date d global ratings of performance . CONCLUSIONS Residents trained on a colonoscopy simulator prior to their first patient-based colonoscopy performed significantly better in the clinical setting than controls , demonstrating skill transfer to live patients . The simulator 's performance metrics showed limited concurrent validity , suggesting the need for further refinement BACKGROUND  GI endoscopy simulation-based training augments early clinical performance ; however , the optimal manner by which to deliver training is unknown . OBJECTIVE We aim ed to vali date a simulation-based structured comprehensive curriculum ( SCC ) design ed to teach technical , cognitive , and integrative competencies in colonoscopy . DESIGN Single-blinded , r and omized , controlled trial . SETTING Endoscopic simulation course at an academic hospital . PARTICIPANTS AND INTERVENTIONS Thirty-three novice endoscopists were allocated to an SCC group or self-regulated learning ( SRL ) group . The SCC group received a curriculum consisting of 6 hours of didactic lectures and 8 hours of virtual reality simulation-based training with expert feedback . The SRL group was provided a list of desired objectives and was instructed to practice on the simulator for an equivalent time ( 
    Output:
    
Based on qualitative analysis , we found no significant differences between VR training and other forms of simulation training .
VR curricula based in educational theory provided benefit with respect to composite score of competency , compared with unstructured curricula .
: VR simulation training is advantageous over no training and can supplement conventional endoscopy training .
There is insufficient evidence that simulation training provides benefit over conventional training