***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 The hypothesis of this study is that working on the simulator without a structured feedback does not change performance ; hence , any effects shown after structured feedback would amount to useful learning of the procedure . The aim was to investigate the learning curve for the HT Immersion Medical Colonoscopy Simulator without any structured feedback . This could then be potentially applied to vali date the learning curve on the simulator when structured feedback is provided . There are no previous studies on this matter . Methods C and i date s were asked to perform colonoscopy on the HT Immersion Medical Colonoscopy Simulator . Modules 3 and 4 were used at r and om . In total , each c and i date was asked to perform five consecutive virtual colonoscopies on the same module . These five episodes were collectively referred to as one trial . A time result of 3,600 sec ( 1 h ) was used to denote perforation . No guidance or feedback was given to c and i date s before , during , or after each procedure . A total of 26 postgraduate doctors were recruited , including nine research fellows , five pre registration house officers , six specialist registrars , and six consultants . Fourteen c and i date s recorded five attempts each ( i.e. , one trial each ) on the same module of the colonoscopy simulator ( 14 trials over 70 episodes ) . Another 12 c and i date s recorded five attempts ( i.e. , one trial each ) on two modules of the colonoscopy simulator ( 24 trials over 120 episodes ) . Hence , 190 episodes were recorded in total , representing 38 trials . Results There was no improvement in performance on the simulator from first attempt to the fifth in the absence of feedback . If there was any initial gain in any measurable outcome , this was lost in subsequent attempts indicating lack of learning . The outcomes measured included time taken to complete the test , percentage of the mucosa visualized , depth of the instrument inserted , and the path length used . The results were statistically significant for all outcomes . Conclusions This study demonstrates that in the absence of feedback , it is not possible to improve performance on the HT Immersion Medical Colonoscopy Simulator . Thus , there is no learning curve for the machine . The information from this study is vital for using the simulators in training and assessment because any improvement in learning curves shown after training on simulators can be presumed to be due to learning the procedure and not the Background The Erlangen Active Simulator for Interventional Endoscopy ( EASIE ) using ex-vivo porcine organs was introduced in 1997 . The present study should analyze whether repeated EASIE simulator training in endoscopic hemostasis led to superior performance compared with a traditionally educated group . The results were compared with a similar project in New York . Methods Thirty-five French GI fellows were enrolled . Baseline skills evaluation was performed in four disciplines ( manual skills , injection/coagulation , clip application and variceal ligation ) using the compactEASIE-simulator equipped with an upper gastrointestinal organ package for bleeding simulation . The same , translated evaluation forms ( from the prior New York project ) were used . Subsequently , fellows were r and omized into group A ( n=17 , only clinical education ) and group B ( n=18 , additional three simulator trainings ) . Group B was trained the next day and after 4 and 7 months by experts of the French Society of Gastrointestinal Endoscopy . Both groups performed routine and emergency endoscopies at their home hospitals during the study period . Both groups were re-evaluated blindly after 9 months . Results The learning curve for group B showed a significant improvement in all disciplines ( P<0.004 ) whereas group A improved significantly in only two of four disciplines at blinded final evaluation ( manual skills P=0.02 , injection/coagulation P=0.013 ) . The direct comparison of groups B and A at blinded final evaluation showed significantly superior ratings for group B in all disciplines ( P<0.006 ) and significantly shorter performance times in two disciplines ( P=0.016 each ) . The comparison with the similar ‘ New York project ’ revealed that preexisting differences in skills were adjusted by the training . Conclusion Complementary trainings ( three workshops in 7 months ) in endoscopic hemostasis using the compactEASIE improved skills compared with a solely clinical education . The results of the ‘ New York project ’ were confirmed and benefits were independent from the medical educational system 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 AND STUDY AIMS The Erlangen Active Simulator for Interventional Endoscopy ( EASIE ) was introduced in 1997 as a training model for interventional endoscopy . Objective evidence of the benefits of training with this model has not previously been published . As part of two long-term projects , the benefits of a 1-day training course with the " compactEASIE " simulator were evaluated . MATERIAL S AND METHODS Fourteen American and 18 French gastroenterology fellows were enrolled . These fellows were participants in the intensive groups performing training in endoscopic hemostasis , with a total number of 28 fellows in New York and 36 in France . Gastrointestinal endoscopy faculty members in New York and France evaluated and timed the fellows in four disciplines to establish baseline skills ( manual skills ; injection and coagulation ; Hemoclip application ; and variceal ligation ) with the compactEASIE simulator . The trainees were reevaluated after an intensive 1-day course ( with two or three fellows and one instructor per station ) , also including preparation and assistance for each procedure . The assessment ( overall and parts ) was done by expert tutors using an ordinal scale ranging from 1 to 10 ( 1 = poorest , 10 = best ) , recording also mistakes and performance time . The compactEASIE simulator , equipped with an upper gastrointestinal organ package and an artificial blood perfusion system , was used as the training tool . RESULTS A highly significant improvement ( P < or = 0.001 ) was observed in the performance of all endoscopic techniques . A significant reduction in performance time was also observed with three of the four endoscopic techniques . Successful hemostasis was significantly improved in two out of three techniques . CONCLUSIONS A 1-day training course on endoscopic hemostasis using the compactEASIE simulator is capable of improving the performance of hemostasis procedures . Long-term effects of repeated training sessions are currently subject of collaborative studies in New York and France 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 AND STUDY AIMS Skills in gastrointestinal endoscopy mainly depend on experience and practice . Training on endoscopy simulators may decrease the time needed to reach competency in endoscopy . The purpose of the study was to determine whether the GI-Mentor , a virtual reality endoscopy simulator , can distinguish between beginners and experts in endoscopy and to assess whether training improves the performance of beginners . METHODS A total of 13 beginners and 11 experts ( more than 1,000 procedures ) in gastrointestinal endoscopy were included . The baseline assessment consisted of virtual endoscopies and skill tests . The beginners were r and omly allocated to receive training ( n = 7 ) or no training ( n = 6 ) . The training group was allowed to practice using the simulator for 2 hours per day . After 3 weeks participants were re-evaluated with two new virtual endoscopy cases and one virtual skill test .  Insertion time , correctly identified pathologies , adverse events and skill test performance were recorded . RESULTS The baseline assessment revealed significant differences favoring the experts for virtual endoscopies and skill tests . Significant differences in favor of experts were found for successful retroflection during esophagogastroduodenoscopy ( EGD ) ( P < 0.005 ) ; adverse events during colonoscopy ( P < 0.02 ) ; insertion time ( P < 0.001 ) ; correctly identified pathologies in gastroscopy and colonoscopy ( P < 0.02 ) ; and skill test performance ( P < 0.01 ) . The final evaluation showed significant differences between training and no-training groups , in favor of the training group , for the number of adverse events during virtual endoscopy ( P < 0.04 ) , for the insertion time during colonoscopy ( P < 0.03 ) ; and for skill test performance ( P < 0.01 ) . The training group improved its abilities on the simulator significantly . Differences between experts and the training group were no longer seen . CONCLUSION This virtual endoscopy simulator is capable of identifying differences between beginners and experts in gastrointestinal endoscopy . A 3-week training improves the performance of beginners significantly . This quite fast improvement in endoscopic skills certainly can not be seen in clinical practice ; no conclusions can be made about the impact of virtual simulator training on real-life endoscopy , and this must be evaluated OBJECTIVES : The impact of endoscopic retro grade cholangiopancreatography ( ERCP ) mechanical simulator ( EMS ) practice on trainee clinical performance is unknown . The hypothesis that trainees with EMS practice ( study group ( SG ) ) have improved clinical outcomes compared with those without such practice ( control group ( CG ) ) is tested . METHODS : This was a r and omized controlled trial involving six US academic centers . Sixteen trainees were r and omized after ERCP didactic teaching . SG ( n=8 ) participated in two sessions of EMS practice on selective cannulation ; CG ( n=8 ) did not undergo EMS practice . All participants ’ clinical performances were monitored in the subsequent 16 weeks . Intervention effects were assessed in multivariable regression models using generalizing estimating equations ( GEE ) to account for cluster r and omization of trainees . The primary outcome was successful biliary cannulation , and secondary outcomes were cannulation time and competency score . RESULTS : Cannulation success rate was 47.1 % for CG and 69.6 % for SG . SG had higher odds of successful cannulation ( adjusted odds ratio=3.01 , P=0.021 ) . SG trainees achieved faster cannulation time ( min ) ( 4.7±4.2 vs. 10.3±14.1 , P<0.001 ) . Trainee competency scores given by supervising physicians were comparable confirming adequate blinding of the trainers . Limitations included short observation period , small number of ERCPs performed by individual trainees , and variation in the number of ERCPs between trainees . CONCLUSIONS : In a prospect i ve multicenter r and omized controlled trial during early training , a significantly higher proportion of the biliary cannulations performed by trainees with EMS practice were successful and with faster cannulation time compared with those performed by trainees without such practice . The results provide objective evidence to support the continued evaluation of EMS practice to augment clinical 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 
    Output:
    
Virtual endoscopy simulator training might be effective for gastroscopy , but so far no data is available to support this for colonoscopy