***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 Before a simulator becomes widely accepted , it must be relevant , affordable , and accessible . We have developed a low-cost model emphasizing the basic skills required for endoscopic sinus surgery ( ESS ) . It is noninvasive , free from risk of infection , and an excellent low-pressure learning opportunity . The current study was design ed to assess the construct validity of our simulator . Methods We conducted a stratified r and omized crossover-control study . Otolaryngology residents , fellows , and faculty performed predetermined tasks on the model or cadaver , and then switched . Evaluation included h and motion analysis , task time , and blinded expert review . Results Sixteen subjects at various levels of training participated . Cadaver performance correlated well with level of training and previous experience with ESS . However , model performance did not demonstrate statistically significant correlation . Conclusion Our model was unable to demonstrate clear construct validity at this time . Material s and structural modifications are in progress . Pending further validation , its low-cost construction possesses potential for integration into otolaryngology residency curricula . Assessment of the simulator 's ability to improve surgical skill is also planned Purpose To develop a valid and reliable examination to assess the technical proficiency of family medicine residents ' performance of minor surgical office procedures . Method A multi-station OSCE-style examination using bench-model simulations of minor surgical procedures was developed . Participants were a r and omly selected group of 33 family medicine residents ( PGY-1 = 16 , PGY-2 = 17 ) and 14 senior surgical residents who functioned as a validation group . Examiners were qualified surgeons and family physicians who used both checklists and global rating scales to score the participants ' performances . Results When family medicine residents were evaluated by family physicians , interstation reliabilities were .29 for checklists and .42 for global ratings . When family medicine residents were evaluated by surgeons , the reliabilities were .53 for checklists and .75 for global ratings . Interrater reliability , measured as a correlation for total examination scores , was .97 . Mean scores on the examination were 60 % , 64 % , and 87 % for PGY-1 family medicine , PGY-2 family medicine , and surgery residents , respectively . The difference in scores between family medicine and surgery residents was significant ( p < .001 ) , providing evidence of construct validity . Conclusion A new examination developed for assessing family medicine residents ' skills with minor surgical office procedures is reliable and has evidence for construct validity . The examination has low reliability when family physicians serve as examiners , but moderate reliability when surgeons are the evaluators Background Mini-CEX scores assess resident competence . Rater training might improve mini-CEX score interrater reliability , but evidence is lacking . Objective Evaluate a rater training workshop using interrater reliability and accuracy . Design R and omized trial ( immediate versus delayed workshop ) and single-group pre/post study ( r and omized groups combined ) . Setting Academic medical center . Participants Fifty-two internal medicine clinic preceptors ( 31 r and omized and 21 additional workshop attendees).InterventionThe  workshop included rater error training , performance dimension training , behavioral observation training , and frame of reference training using lecture , video , and facilitated discussion . Delayed group received no intervention until after posttest . Measurements Mini-CEX ratings at baseline ( just before workshop for workshop group ) , and four weeks later using videotaped resident – patient encounters ; mini-CEX ratings of live resident – patient encounters one year preceding and one year following the workshop ; rater confidence using mini-CEX . Results Among 31 r and omized participants , interrater reliabilities in the delayed group ( baseline intraclass correlation coefficient [ ICC ] 0.43 , follow-up 0.53 ) and workshop group ( baseline 0.40 , follow-up 0.43 ) were not significantly different ( p = 0.19 ) . Mean ratings were similar at baseline ( delayed 4.9 [ 95 % confidence interval 4.6–5.2 ] , workshop 4.8 [ 4.5–5.1 ] ) and follow-up ( delayed 5.4 [ 5.0–5.7 ] , workshop 5.3 [ 5.0–5.6 ] ; p = 0.88 for interaction ) . For the entire cohort , rater confidence ( 1 = not confident , 6 = very confident ) improved from mean ( SD ) 3.8 ( 1.4 ) to 4.4 ( 1.0 ) , p = 0.018 . Interrater reliability for ratings of live encounters ( entire cohort ) was higher after the workshop ( ICC 0.34 ) than before ( ICC 0.18 ) but the st and ard error of measurement was similar for both periods . Conclusions Rater training did not improve interrater reliability or accuracy of mini-CEX scores . Clinical trials registration clinical trials.gov identifier PURPOSE To evaluate the effectiveness of binary content checklists in measuring increasing levels of clinical competence . METHOD Fourteen clinical clerks , 14 family practice residents , and 14 family physicians participated in two 15-minute st and ardized patient interviews . An examiner rated each participant 's performance using a binary content checklist and a global process rating . The participants provided a diagnosis two minutes into and at the end of the interview . RESULTS On global scales , the experienced clinicians scored significantly better than did the residents and clerks , but on checklists , the experienced clinicians scored significantly worse than did the residents and clerks . Diagnostic accuracy increased for all groups between the two-minute and 15-minute marks without significant differences between the groups . CONCLUSION These findings are consistent with the hypothesis that binary checklists may not be valid measures of increasing clinical competence This study compares the effects of data -driven assessor training with schema-driven assessor training and control training . The sample consisted of 229 industrial and organizational psychology students and 161 managers who were r and omly assigned to 1 of these training strategies . Participants observed and rated c and i date s in an assessment center exercise . The data -driven and schema-driven assessor training approaches outperformed the control training on all 3 dependent variables . The schema-driven assessor training result ed in the largest values of interrater reliability , dimension differentiation , and accuracy . Managers provided significantly more accurate ratings than students but distinguished less between the dimensions . Practical implication s regarding the design of assessor trainings and the composition of assessor teams are proposed Context Reliable methods for evaluating clinical competence of medical trainees are needed . Contribution This cluster r and omized trial involving 16 internal medicine programs evaluated a 4-day course that taught faculty direct observation methods for evaluating clinical competence . Eight months later , course participants reported greater comfort with direct observation to evaluate residents and rated videotaped clinical encounters between st and ardized residents and patients more stringently than did faculty not taking the course . Caution s Larger studies that use ratings of actual residents and that include resident feedback are needed to establish the transportability and efficacy of the program . The Editors Medical educators have a major responsibility to evaluate the clinical competence of medical students and residents and to provide them with timely , useful feedback to ensure continued progress and correction of deficiencies . Despite tremendous advances in technology , the clinical skills of interviewing , physical examination , and counseling remain essential to the successful care of patients . The Association of American Medical Colleges ( AAMC ) , Accreditation Council for Graduate Medical Education ( ACGME ) , and American Board of Internal Medicine ( ABIM ) strongly endorse the evaluation of students and residents in these clinical skills through direct observation ( 1 - 3 ) . Numerous studies continue to document substantial deficiencies in the clinical skills of medical interviewing , physical examination , communication , and counseling among students , residents , and practicing physicians ( 4 - 24 ) . For example , Mangione and Nieman ( 19 ) demonstrated that students and residents could successfully identify fewer than one third of 12 important cardiac sounds , and Braddock and colleagues ( 10 ) found that practicing physicians performed core elements of informed decision making in fewer than 10 % of patient encounters . Direct observation of a student or resident performing these skills is m and atory for reliable and valid assessment and is essential for providing formative feedback to improve these skills . Residency is the last structured experience to ensure that young physicians have sufficient clinical skills , but evaluation of these skills by faculty is often neglected . The AAMC , for example , visited 97 medical schools between 1993 and 1998 and found that faculty rarely observed student interactions with patients and that most of a student 's evaluation was based on faculty and resident impressions of student presentation skills and knowledge ( 3 ) . Similar findings have been reported for residents ( 25 - 27 ) . Furthermore , when faculty observe the clinical skills of trainees , the quality of the evaluation is often poor . In a study of faculty ratings using the long form of the clinical evaluation exercise ( CEX ) , faculty failed to detect 68 % of errors committed by a resident when observing a videotape scripted to depict marginal performance ( 28 ) . The use of checklists prompting faculty to look for specific skills increased error detection from 32 % to 64 % but did not improve overall accuracy ; approximately two thirds of faculty still rated the overall performance of the marginal resident as satisfactory or superior . Other studies have also attested to the low reliability of faculty observations ( 28 - 33 ) . Perhaps the most notable finding in these studies is that brief faculty training interventions ( for example , a 30-minute description of the CEX and its purpose ) failed to improve the quality of faculty evaluation ( 28 - 31 ) . Given the growing concerns over patient safety and quality of care , both public and professional organizations are calling for a renewed emphasis on the teaching and evaluation of clinical skills . To address these concerns , better methods for training faculty in evaluation of clinical competence are urgently needed . The purpose of our study was to evaluate a novel approach to training faculty in direct observation skillsdirect observation of competence trainingin 3 domains : faculty satisfaction with the training , change in comfort in performing direct observation , and changes in faculty rating behavior . Methods Study Design Our study was a cluster- design ed r and omized , controlled trial of an intensive 4-day faculty development course in evaluation of clinical competence ( 34 ) . Twenty-one programs were approached , and 16 were enrolled ( Figure ) . Invited programs were chosen from 2 regionsthe Northeast ( Connecticut , Massachusetts , and Rhode Isl and ) and the Mid-Atlantic ( Maryl and , Virginia , and the District of Columbia ) and were balanced to represent both university and community-based programs . Of the 5 excluded programs , 3 declined to participate , 1 could not identify at least 2 faculty members to participate , and 1 was in the process of closing . The final cohort consisted of 5 university and 11 community-based programs . R and omization was stratified by program type and location and was blinded by using sealed envelopes . One smaller university program in the Mid-Atlantic group was r and omly assigned along with the community-based programs because of the unbalanced number of university programs ( n = 3 ) in this region . Figure . Flow of participants through the study . Participants Forty faculty members participated in the study . Each program director was required to identify a minimum of 2 and a maximum of 4 faculty members before r and omization , and program directors were encouraged to participate . Choice of study participants was left to the discretion of the program directors , but the study guidelines asked directors to choose faculty who were active in teaching and evaluation and who the program director believed would be willing to serve as agents to promote change in their local programs ' evaluation practice s. Program directors were not informed of other institutional allocations before participation . The Yale University Human Investigation Committee and the Uniformed Services University of the Health Sciences Institutional Review Board approved the study . Participants gave informed consent on the morning of the baseline assessment and before any research activities . Evaluation Videotapes Two sets of 9 videotapes were specifically produced for assessment of direct observation skills , 1 set each for the baseline and follow-up assessment s. Scripts were written for st and ardized patients and st and ardized residents for each of 3 clinical skills : history taking , physical examination , and counseling . The baseline history skill videotapes depicted a male resident interviewing a 64-year-old woman presenting to the emergency department with acute shortness of breath and chest pain due to a pulmonary embolism . The physical examination skill videotapes depicted a male resident examining a 69-year-old man with progressive shortness of breath secondary to ischemic cardiomyopathy . The counseling skill videotapes portrayed a female resident counseling a 48-year-old man about treatment options for his recently diagnosed hypertension . The videotapes were scripted to demonstrate 3 levels of competence , and all contained some errors in clinical performance ; none were design ed to be a gold st and ard . Level 1 videotapes were scripted to represent unequivocally poor performance and contained the most errors of omission and commission . Level 3 videotapes depicted the fewest number of errors . For example , on the baseline level 1 videotape for history taking , the resident fails to introduce himself and fails to ask about key thromboembolic risk factors and the patient 's symptoms of leg swelling . In the physical examination videotapes , examples of errors include poor technique in pulmonary auscultation and failure to assess jugular venous distention . For each clinical skill , the average number of errors per videotape was 12 for level 1 videotapes , 6 for level 2 videotapes , and 2 for level 3 videotapes . The scripts were developed by 1 of the authors and were then review ed and edited independently by the other 2 authors . The scripts were revised until consensus was reached among the 3 authors . Scripts were then sent to an outside review er for additional comments before the final edits . The st and ardized resident and patient rehearsed the scenarios before the final videotapes were made . For the follow-up assessment , the medical interview videotapes depicted a male resident interacting with a 69-year-old man who presented to an emergency department with chest pain secondary to coronary artery disease . The physical examination videotapes showed a different male resident examining a 55-year-old man with cough and shortness 
    Output:
    
Checklists and GRSs usually had similar evidence for relations to other variables .
Checklist inter-rater reliability and trainee discrimination were more favourable than suggested in earlier work , but each task requires a separate checklist .
Compared with the checklist , the GRS has higher average inter-item and inter-station reliability , can be used across multiple tasks , and may better capture nuanced elements of expertise