***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 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 Developing technical skill is essential to surgical training , but using the operating room for basic skill acquisition may be inefficient and expensive , especially for laparoscopic operations . This study determines if laparoscopic skills training using simulated tasks on a video-trainer improves the operative performance of surgery residents . STUDY DESIGN Second- and third-year residents ( n= 27 ) were prospect ively r and omized to receive  formal laparoscopic skills training  or to a control group . At baseline , residents had a vali date d global assessment of their ability to perform a laparoscopic cholecystectomy based on direct observation by three evaluators who were blinded to the residents ' r and omization status . Residents were also tested on five st and ardized video-trainer tasks . The training group practice d the video-trainer tasks as a group for 30 minutes daily for 10 days . The control group received no formal training . All residents repeated the video-trainer test and underwent a second global assessment by the same three blinded evaluators at the end of the 1-month rotation . Within-person improvement was determined ; improvement was adjusted for differences in baseline performance . RESULTS Five residents were unable to participate because of scheduling problems ; 9 residents in the training group and 13 residents in the control group completed the study . Baseline laparoscopic experience , video-trainer scores , and global assessment s were not significantly different between the two groups . The training group on average practice d the video-trainer tasks 138 times ( range 94 to 171 times ) ; the control group did not practice any task . The trained group achieved significantly greater adjusted improvement in video-trainer scores ( five of five tasks ) and global assessment s ( four of eight criteria ) over the course of the four-week curriculum , compared with controls . CONCLUSIONS Intense training improves video-eye-h and skills and translates into improved operative performance for junior surgery residents . Surgical curricula should contain laparoscopic skills training This study examined the impact of virtual reality ( VR ) surgical simulation on improvement of psychomotor skills relevant to the performance of laparoscopic cholecystectomy Background : This study was undertaken to investigate operating room performance of surgical residents , after participating in the Eindhoven virtual reality laparoscopic cholecystectomy training course . This course is the first formal surgical resident trainings course , using a variety of complementary virtual reality ( VR ) skills training simulation in order to prepare surgical residents for their first laparoscopic cholecystectomy . The course was granted EAES certification . Methods : The four-day course is based on multimedia and multimodality approach . A variety of increasingly difficult simulation training sessions , next to intimate focus-group “ knowledge sessions ” are included . Both basic and procedural VR simulation is featured , using MIST-VR and the Xitacts ' LapChol simulation software . The operating room performance of twelve surgical residents who participated in the course and twelve case-control counterparts were compared . The case-control grup was matched for clinical number laparoscopic cholecystectomy performance ( maximum of 4 procedures ) . Two observers analyzed a r and omly mixed videotape , featuring the part of the “ clip- and -cut ” procedure of the laparoscopic cholecystectomy , and were blinded for participants ' group status . Structured question naires including multiple observation scales were used to assess performance . Results : Residents of both the experimental and control group did not differ in demographic parameters , except for number of laparoscopic cholecystectomies in favor of the control group ( p-value 0.008 ) . Both observers judge the experimental group to perform significantly better ( p-value 0.004 and 0.013 ) . Experimental group residents valued their course highly in terms of their laparoscopic surgical skills improvement and the use of VR simulators in the surgical curiculum . Conclusions : The Eindhoven Virtual Reality laparoscopic cholecyctectomy training course improves surgical skill in the operating room above the level of residents trained by a variety of other training methods Objectives : Surgical simulation has been shown to enhance the training of general surgery residents . Since catheter-based techniques have become an important part of the vascular surgeon 's armamentarium , we explored whether simulation might impact the acquisition of catheter skills by surgical residents . Methods : Twenty general surgery residents received didactic training in the techniques of catheter intervention . Residents were then r and omized with 10 receiving additional training with the Procedicus , computer-based , haptic simulator . All 20 residents then participated in 2 consecutive mentored catheter-based interventions for lower extremity occlusive disease in an OR/angiography suite . Resident performance was grade d by attending surgeons blinded to the resident 's training status , using 18 procedural steps as well as a global rating scale . Results : There were no differences between the 2 resident groups with regard to demographics or scores on a visuospatial test administered at study outset . Overall , residents exposed to simulation scored higher than controls during the first angio/OR intervention : procedural steps ( simulation/control ) ( 50 ± 6 vs. 33 ± 9 , P = 0.0015 ) ; global rating scale ( 30 ± 7 vs. 19 ± 5 , P = 0.0052 ) . The advantage provided by simulator training persisted with the second intervention ( 53 ± 6 vs. 36 ± 7 , P = 0.0006 ) ; global rating scale ( 33 ± 6 vs. 21 ± 6 , P = 0.0015 ) . Moreover , simulation training , particularly for the second intervention , led to enhancement in almost all of the individual measures of performance . Conclusion : Simulation is a valid tool for instructing surgical residents and fellows in basic endovascular techniques and should be incorporated into surgical training programs . Moreover , simulators may also benefit the large number of vascular surgeons who seek retraining in catheter-based intervention OBJECTIVES : Computer-based colonoscopy simulation ( CBCS ) is being utilized in endoscopy training without supporting evidence that it improves patient-based colonoscopy performance . The goal of this pilot study was to determine if CBCS training improves gastroenterology ( GI ) fellows ' patient-based colonoscopy skills . METHODS : Competency at colonoscopy among 4 novice GI fellows who completed a 6-h CBCS curriculum was compared with 4 novice fellows who were not CBCS-trained .  Measurements of competency were rendered by supervising faculty by recording “ insertion time,”“depth of unassisted insertion,”“independent procedure completion,”“ability to identify endoscopic l and marks,”“inserts in a safe manner,”“adequately visualizes mucosa on withdrawal , ” and “ responds appropriately to patient discomfort ” with each colonoscopy . RESULTS : Simulator-trained fellows outperformed traditionally trained fellows during their initial 15 colonoscopies in all performance aspects except “ insertion time ” ( pp < 0.05 ) . Simulator-trained fellows inserted the endoscope significantly further and reached the cecum independently nearly twice as often during this early training period . Three parameters ( “ depth of insertion,”“independent completion , ” and “ ability to identify l and marks ” ) demonstrated a continued advantage out to 30 colonoscopies . Beyond 30 procedures , there was no difference in the performance of the two groups . CONCLUSION : In this pilot study , a 6-h CBCS curriculum provides an early training advantage by enhancing competency at the early stages of patient-based colonoscopy . These advantages are negligible after approximately 30 patient-based procedures . CBCS-enhanced training may allow faculty to be more efficient with their colonoscopy practice Background : Flexible sigmoidoscopy , a core skill for the primary care physician , requires learned h and -eye skills that can be difficult to master during residency training . With recent advances in virtual reality simulation technology , simulated flexible sigmoidoscopes are available to family medicine residents for training before their initial and subsequent live patient examinations . The purpose of the study was to determine whether a virtual reality flexible sigmoidoscope simulator would improve the h and -eye skills and various performance parameters in a live patient . Methods : Residents were assigned to a control ( n = 5 ) or experimental group ( n = 5 ) in which the experimental group trained on a  virtual reality sigmoidoscopy simulator before their first sigmoidoscopies on live patient volunteers . After the initial live patient sigmoidoscopies , both control and experimental groups trained on the simulator so that it was possible to evaluate presimulator and postsimulator training effects on live patient performance and to compare speed and skill between the groups at different levels of training . Results : Training on the virtual reality simulator produced substantial improvements in examination times and h and -eye skill measures . After 6 to 10 hours of training on the simulator , the experimental group achieved significantly faster insertion times to 30 cm ( 119 versus 357 sec , P = 0.03 ) , 40 cm ( 211 versus 518 sec , P = 0.03 ) , and a shorter mean length of examination ( 323 versus 654 sec , P = 0.01 ) . There was also significant improvement of h and -eye skill measures of the experimental group in directional errors ( 1.6 versus . 8.6 , P < 0.01 ) , percentage of colon visualized ( 79 versus 45 percent , P = 0.02 ) , and viewing quality of examination when compared with the control group 's initial performance on live patients . Resident survey findings after the study confirmed the trainee 's perception of the benefit of the simulator training . Conclusions : This study shows the value of virtual reality simulator training for accelerating the development of the h and -eye skills to perform adequate sigmoidoscopy BACKGROUND AND STUDY AIMS Clinical investigation using endoscopy simulators is now possible due to recent advances in virtual reality technology . A prospect i ve r and omized trial was conducted to compare the exclusive use of a virtual reality endoscopy simulator with bedside teaching for training in sigmoidoscopy . MATERIAL S AND METHODS Internal medicine residents were r and omly assigned to training exclusively using a virtual reality simulator ( group 1 ) or via bedside teaching ( group 2 ) . Residents were then observed performing five  sigmoidoscopic procedures in asymptomatic patients referred for colorectal cancer screening . Endoscopic examinations were evaluated for procedure duration , completion , ability to perform retroflexion , and level of patient comfort/discomfort . Each examination was scored from 1 ( inability to insert the endoscope beyond the rectum ) to 5 ( able to complete the entire examination independently in less than 20 min ) 
    Output:
    
Skills acquired by simulation-based training seem to be transferable to the operative setting .