***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 Current assessment s using the fundamentals of laparoscopic surgery ( FLS ) tasks are labour intensive and depend heavily on expert raters . H and motion analysis may offer an alternative method of objective evaluation of FLS performance . Purpose The aim of this study was to assess whether a correlation exists between the expert rated assessment s of the FLS tasks and computer-based assessment of motion efficiency using the Imperial College surgical assessment device ( ICSAD ) . Methods We recruited 26 volunteer subjects who were stratified into three experience groups : juniors ( PGY1–3 ) ( N = 13 ) , seniors ( PGY4,5 ) ( N = 7 ) and staff surgeons ( N = 6 ) . All subjects performed four FLS tasks : ( 1 ) peg transfer , ( 2 ) pattern cut , ( 3 ) endoloop and ( 4 ) intracorporeal suturing . Performance was assessed by both st and ard FLS expert rating and motion analysis using ICSAD . Group differences were analyzed using the Kruskal – Wallis test , and Spearman coefficient analyses were employed to compare FLS and ICSAD scores . Results FLS expert-derived scores discriminated effectively between experience groups for all tasks ( p < 0.05 ) . Motion efficiency scores discriminated between experience groups for tasks 1 , 3 and 4 for number of movements ( p < 0.05 ) , tasks 1 and 4 for total distance ( p < 0.05 ) and tasks 1 , 2 , 3 and 4 for total time ( p < 0.005 ) . There was a significant correlation between total FLS expert scores and the motion efficiency metrics of total distance , number of movements and total time ( Spearman coefficient and p values of 0.81 , < 0.001 ; 0.76 ; < 0.001 ; and 0.93 , < 0.001 , respectively ) . Conclusion There is a high correlation between FLS st and ard scoring and motion efficiency metrics . The use of ICSAD for the objective assessment of FLS tasks may in the future offer an adjunctive method of evaluation . ICSAD metrics are potentially less labour intensive due to the instant and fully automated computerized scoring that it provides Abstract Background : Laparoscopic skill was measured objective ly through a series of seven tasks in an inanimate laparoscopic simulator . Seven analogous skills were tested in an in vivo porcine model . These skills included transferring , cutting , clipping , placement of a ligating loop , mesh placement , and suturing with an intracorporeal and extracorporeal knot . Scoring of each task rewarded precision and speed . Methods : Twelve PGY3 residents were given a baseline evaluation in the simulator and in the animal model . They were then r and omized to either five practice sessions in the simulator ( group A ) or no practice ( group B ) . Each group was retested in the simulator and in the animal ( final test ) . Scores in vivo were compared by t-test for baseline versus final evaluation for each group . Linear regression analysis was used to correlate in vivo and in vitro scores for each task and for the total score ( sum of all scores ) . Results : Group A showed significant improvement in performance in vivo for cutting , clipping , mesh placement , and suturing with an intracorporeal and extracorporeal knot , as well as in the total score ( p < 0.05 ) . Group B showed significant improvement in suturing with an intracorporeal and extracorporeal knot , and in the total score . The magnitude of improvement from baseline to final evaluation was significantly greater for group A ( p < 0.05 ) . There was significant correlation between in vitro and in vivo total scores and the score for each task ( p < 0.05 ) except for placement of the ligating loop and mesh . Conclusions : Performance in an in vitro laparoscopic simulator correlated significantly with performance in an in vivo animal model . Practice in the simulator result ed in improved performance in vivo OBJECTIVE -To determine whether scores for basic laparoscopic skills were significantly associated with extent of laparoscopic experience and compare basic laparoscopic skill scores obtained before and after 2 laparoscopic training sessions incorporating a canine abdominal model . DESIGN -Evaluation study . SAMPLE POPULATION -8 experienced and 25 novice individuals . PROCEDURES -Novice participants were r and omly assigned to control ( n = 10 ) and training ( 15 ) groups . Individuals in the experienced and novice training groups were required to undergo 2 training sessions with a canine abdominal model .  Basic laparoscopic skills were assessed twice on the basis of 3 tasks included in the McGill Inanimate Simulator for Training and Evaluation of Laparoscopic Skills ( MISTELS ) . RESULTS -For the novice training group , laparoscopic skills scores were significantly higher after training than before , but for individuals in the novice control group , scores did not differ significantly between the first and second assessment s. The increase in score for the novice training group was significantly higher than increases for the experienced group and for the novice control group , but the increase in score for the experienced group was not significantly different from the increase in score for the novice control group . CONCLUSIONS AND CLINICAL RELEVANCE - Results suggested that basic laparoscopic skills scores obtained with the MISTELS were associated with extent of laparoscopic experience and that training with a canine abdominal model could increase skills scores for individuals without previous laparoscopic experience Objective : To assess the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills ( MISTELS ) physical laparoscopic simulator for construct and predictive validity and for its educational utility . Summary Background Data : MISTELS is the physical simulator incorporated by the Society of American Gastrointestinal and Endoscopic Surgeons ( SAGES ) in their Fundamentals of Laparoscopic Surgery ( FLS ) program . MISTELS ’ metrics have been shown to have high interrater and test-retest reliability and to correlate with skill in animal surgery . Methods : Over 200 surgeons and trainees from 5 countries were assessed using MISTELS in a series of experiments to assess the validity of the system and to evaluate whether practicing MISTELS basic skills ( transferring ) would result in skill acquisition transferable to complex laparoscopic tasks ( suturing ) . Results : Face validity was confirmed through question ing 44 experienced laparoscopic surgeons using global rating scales . MISTELS scores increased progressively with increasing laparoscopic experience ( n = 215 , P < 0.0001 ) , and residents followed over time improved their scores ( n = 24 , P < 0.0001 ) , evidence of construct validity . Results in the host institution did not differ from 5 beta sites ( n = 215 , external validity ) .  MISTELS scores correlated with a highly reliable vali date d intraoperative rating of technical skill during laparoscopic cholecystectomy ( n = 19 , r = 0.81 , P < 0.0004 ; concurrent validity ) . Novice laparoscopists were r and omized to practice /no practice of the transfer drill for 4 weeks . Improvement in intracorporeal suturing skill was significantly related to practice but not to baseline ability , career goals , or gender ( P < 0.001 ) . Conclusion : MISTELS is a practical and inexpensive inanimate system developed to teach and measure technical skills in laparoscopy . This system is reliable , valid , and a useful educational tool Introduction Simulators are being used more and more for teaching and testing laparoscopic skills . However , it has yet to be firmly established that simulator performance reflects operative laparoscopic skill . The study reported here was design ed to test the hypothesis that laparoscopic simulator performance predicts intraoperative laparoscopic skill . Methods A review of our prospect ively maintained data base identified 40 subjects who underwent Fundamentals of Lapraoscopic Surgery ( FLS ) skills testing and objective intraoperative assessment s within the same 6-month period . Subjects consisted of 22 novice ( postgraduate year [ PGY ] 1–2 ) , 10 intermediate ( PGY 3–4 ) , and 8 experienced ( PGY 5 , fellows , and attendings ) laparoscopic surgeons .  Laparoscopic performance was objective ly assessed in the operating room using the previously vali date d Global Operative Assessment of Laparoscopic Skill ( GOALS ) . Analysis of variance ( ANOVA ) was used to compare mean FLS scores and mean GOALS scores across experience levels . The relationship between individual FLS scores and GOALS scores was assessed with linear regression analysis . A multivariate analysis evaluated FLS score and surgeon experience as predictors of intraoperative GOALS score . A receiver-operator curve ( ROC ) was constructed in order to define an FLS cutoff score that predicts intraoperative performance at or above the level of experienced surgeons . Significance was defined as p < 0.05 . Results Mean FLS scores and mean GOALS scores increased with increasing experience . Individual FLS scores correlated significantly with intraoperative GOALS scores ( 0.77 , p < 0.001 ) . Multivariate analysis confirmed that FLS score is an independent predictor of intraoperative GOALS scores . The ROC identified an FLS cutoff score of 70 with optimal sensitivity ( 91 % ) and specificity ( 86 % ) for predicting a GOALS score at or above the level of experienced surgeons . Conclusions In this study sample , FLS simulator scores were independently predictive of intraoperative laparoscopic performance as measured by GOALS . More precisely , an FLS cutoff score of 70 optimized sensitivity and specificity for expert intraoperative performance . A larger prospect i ve study is justified to vali date these findings 
    Output:
    
Evidence nearly always supported the validity of FLS total scores .
However , the loop ligation task lacks discriminatory ability .
Conclusion Validity evidence confirms expected relations with other variables and acceptable inter-rater reliability , but other validity evidence is sparse .