***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: AIM The aim of this paper is to present the results of a study design ed to determine the effect of scenario-based simulation training on nursing students ' clinical skills and competence . BACKGROUND Using full-scale , realistic , medical simulation for training healthcare professionals is becoming more and more common . Access to this technology is easier than ever before with the opening of several simulation centres throughout the world and the availability on the market of more sophisticated and affordable patient simulators . However , there is little scientific evidence proving that such technology is better than more traditional techniques in the education of , for example , undergraduate nursing students . METHODS A pretest/post-test design was employed with volunteer undergraduate students ( n = 99 ) from second year Diploma of Higher Education in Nursing programme in United Kingdom using a 15-station Objective Structured Clinical Examination . Students were r and omly allocated to either a control or an experimental group . The experimental group , as well as following their normal curriculum , were exposed to simulation training . Subsequently , all students were re-tested and completed a question naire . The data were collected between 2001 and 2003 . RESULTS The control and experimental groups improved their performance on the second Objective Structured Clinical Examination . Mean test scores , respectively , increased by 7.18 and 14.18 percentage points . The difference between the means was statistically significant ( P < 0.001 ) . However , students ' perceptions of stress and confidence , measured on a 5-point Likert scale , was very similar between groups at 2.9 ( 1 , not stressful ; 5 , very stressful ) and 3.5 ( 1 , very confident ; 5 , not confident ) for the control group , and 3.0 and 3.4 for the experimental group . CONCLUSIONS Intermediate-fidelity simulation is a useful training technique . It enables small groups of students to practise in a safe and controlled environment how to react adequately in a critical patient care situation . This type of training is very valuable to equip students with a minimum of technical and non-technical skills before they use them in practice setting Nowadays simulation is taking an important place in training and education of healthcare professionals . The University of Hertfordshire is carrying out a study which aims to determine the effect of realistic scenario-based simulation on nursing students '  competence and confidence . This project is sponsored by the British Heart Foundation and takes place in the Hertfordshire Intensive Care and Emergency Simulation Centre ( HICESC ) , a simulated three adult beds Intensive Care Unit . The simulation platform used is a Laerdal SimMan Universal Patient Simulator . A unique and robust study design , and results of the study are presented in this article . Consecutive cohorts of students are being assessed and reassessed after six months using an Objective Structured Clinical Examination ( OSCE ) .  Students are r and omly divided into a control and experimental group for the period intervening between the two examinations . The experimental group is exposed to simulation training while the other students follow their usual nursing courses . Comparison is made between the OSCE results of the two groups of students . The experimental group had a greater improvement in performance than the control group ( 13.43 % compared with 6.76 % ( p<0.05 ) ) . The results and feedback received from students and lecturers suggest that simulation training in nursing education is beneficial The project purpose was to determine whether measures of critical thinking show differences between three groups ( simulator , non-simulator , control ) of baccalaureate nursing students . The second purpose was to determine the moderating effect of students ' preferred learning style . All groups experienced a moderate to large effect size in critical thinking scores . The corrected model for the total scale gain score was statistically significant but not significant for learning style or group Background Despite the recent wave of interest being shown in high‐fidelity simulators , they do not represent a new concept in healthcare education . Simulators have been a part of clinical education since the 1950s . The growth of patient simulation as a core educational tool has been driven by a number of factors . Declining inpatient population s , concerns for patient safety and advances in learning theory are forcing healthcare educators to look for alternatives to the traditional clinical encounter for skill acquisition for students . Objective The aim of this review was to identify the best available evidence on the effectiveness of using simulated learning experiences in pre‐licensure health profession education . Inclusion criteria Types of studies : This review considered any experimental or quasi‐experimental studies that addressed the effectiveness of using simulated learning experiences in pre‐licensure health profession practice . In the absence of r and omised controlled trials , other research design s were considered for inclusion , such as , but not limited to : non‐r and omised controlled trials and before‐ and ‐after studies . Types of participants : This review included participants who were pre‐licensure practitioners in nursing , medicine , and rehabilitation therapy . Types of intervention(s)/phenomena of interest : Studies that evaluated the use of human physical anatomical models with or without computer support , including whole‐body or part‐body simulators were included . Types of outcome measures Student outcomes included knowledge acquisition , skill performance , learner satisfaction , critical thinking , self‐confidence and role identity . Search strategy Using a defined search and retrieval method , the following data bases were accessed for the period 1995‐2006 : Medline , CINAHL , Embase , PsycINFO , HealthSTAR , Cochrane Data base of Systematic Review s and ERIC . Method ological quality Each paper was assessed by two independent review ers for method ological quality prior to inclusion in the review using the st and ardised critical appraisal instruments for evidence of effectiveness , developed by the Joanna Briggs Institute . Disagreements were dealt with by consultations with a third review er . Data collection Information was extracted from each paper independently by two review ers using the st and ardised data extraction tool from the Joanna Briggs Institute . Disagreements were dealt with by consultation with a third review er . Data synthesis Due to the type of design s and quality of available studies , it was not possible to pool quantitative research study results in statistical meta‐ analysis . As statistical pooling was not possible , the findings are presented in descriptive narrative form . Results Twenty‐three studies were selected for inclusion in this review including partial task trainers and high‐fidelity  human patient simulators . The results indicate that there is high learner satisfaction with using simulators to learn clinical skills . The studies demonstrated that human patient simulators which are used for teaching higher level skills , such as airway management , and physiological concepts are useful . While there are short‐term gains in knowledge and skill performance , it is evident that performance of skills over time after initial training decline . Conclusion At best , simulation can be used as an adjunct for clinical practice , not a replacement for everyday practice . Students enjoyed t he sessions and using the models purportedly makes learning easier . However , it remains unclear whether the skills learned through a simulation experience transfer into real‐world setting s. More research is needed to evaluate whether the skills acquired with this teaching methodology transfer to the practice setting such as the impact of simulation training on team function & NA ; The purpose of this study was to compare the effectiveness of an interactive , multimedia CD‐ROM with traditional methods of teaching the skill of performing a 12‐lead ECG . A r and omized pre/posttest experimental design was used . Seventy‐seven baccalaureate nursing students in a required , senior‐level critical‐care course at a large midwestern university were recruited for the study . Two teaching methods were compared . The traditional method included a self‐ study module , a brief lecture and demonstration by an instructor , and h and s‐on experience using a plastic manikin and a real 12‐lead ECG machine in the learning laboratory . The second method covered the same content using an interactive , multimedia CD‐ROM embedded with virtual reality and supplemented with a self‐ study module . There were no significant ( p < .05 ) baseline differences in pretest scores between the two groups and no significant differences by group in cognitive gains , student satisfaction with their learning method , or perception of self‐efficacy in performing the skill . Overall results indicated that both groups were satisfied with their instructional method and were similar in their ability to demonstrate the skill correctly on a live , simulated patient . This evaluation study is a beginning step to assess new and potentially more cost‐effective teaching methods and their effects on student learning outcomes and behaviors , including the transfer of skill acquisition via a computer simulation to a real patient As computer-assisted instruction ( CAI ) use has increased during the past few years , nurse educators have expressed concern regarding its effectiveness . The purpose of this quasiexperimental study was to determine if completion of a computerized simulation about a surgical patient increased  baccalaureate nursing students '  self-efficacy about caring for surgical patients in the clinical environment . Such an association is desirable because increased levels of self-efficacy have been associated with increased motivation , goal - setting , and achievement . A nonprobability , convenience sample ( N = 23 ) of second-year baccalaureate nursing students was assigned r and omly to experimental and control groups . The self-efficacy of the experimental group was measured three times : on an initial pretest ; following the intervention of a computer simulation ; and after an 8-week clinical rotation . The self-efficacy of the control group was measured on an initial pretest and after the 8-week rotation . Higher pre clinical self-efficacy scores ( p<.01 ) of the experimental group support the use of CAI as an important aspect of clinical education . Implication s for nursing education , practice , and research are addressed . Computer-assisted instruction ( CAI ) has been available for several decades ; however , its use in nursing education has escalated during the past few years . This intensified interest is the result of a decrease in the cost of computer hardware and an increase in the availability of relevant educational software ( Wright , 1995 ) . Cutbacks to educational funding , along with the rising costs of clinical teaching , have motivated studies of this method of nursing education . The purpose of this pilot study was to determine if completion of a supplemental computerized simulation about a surgical patient increased baccalaureate nursing students ' self-efficacy about caring for surgical patients in the clinical area . The exploration of a link between CAI and self-efficacy focused on the processes of learning , thereby extending the literature The actual effect of the use of simulations on clinical decision making is inconclusive . This pilot study used a posttest design to determine the effect of a simulation strategy on the clinical decision-making process of midwifery students . Thirty-six graduate diploma students volunteered and were r and omly assigned to two groups , with the experimental group receiving two simulation sessions ( normal labor and physiological jaundice )  , and the  control group  receiving the two usual lectures . The main findings were that students who received the simulation strategy  collected more clinical information , revisited collected clinical information less , made fewer formative inferences , reported higher confidence levels , and for the posttest normal labor simulation , reached a final decision more quickly . Such effects are reasonable for this type of intervention with the existent variability in each group . Further research with a larger sample size and more rigorous data collection strategies is required R and omised controlled trials are the best way to compare the effectiveness of different interventions . Only r and omised trials allow valid inferences of cause and effect . Only r and omised trials have the potential directly to affect patient care — occasionally as single trials but more often as the body of evidence from several trials , whether or not combined formally by meta- analysis . It is thus entirely reasonable to require higher st and ards for papers reporting r and omised trials than those describing other types of study . Like all studies , r and omised trials are open to bias if done badly.1 It is thus essential that r and omised trials are done well and reported adequately . Readers should not have to infer what was probably done , they should be told explicitly . Proper methodology should be used and be seen to have been used . Yet review s of published trials have consistently found major deficiencies in reporting,2 3 4 making the task 
    Output:
    
The results indicate that the use of human patient simulation manikins improved knowledge acquisition and critical thinking ; and enhanced students ' satisfaction with learning .
There is lack of unequivocal evidence on the effectiveness of using high-fidelity human patient simulation manikins in the teaching of clinical reasoning skills to undergraduate nursing students .
CONCLUSION Further research is required to ascertain the effectiveness of the use of human patient simulation manikins as an educational strategy to improve clinical reasoning skills of undergraduate nursing students .
The importance of this research is underscored by the potential for patient outcomes to be improved by enhancing the clinical reasoning skills of undergraduate graduate nursing students and graduates .
IMPLICATION S FOR EDUCATION This review presents evidence to suggest that using HPSMs significantly improve learning outcomes related to clinical reasoning namely : critical thinking ; clinical skill performance and knowledge acquisition .
In addition , results indicate high student satisfaction with HPSMs simulation experience .