***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 : We evaluated the effectiveness of five training methods -four structured and one unstructured-for teaching intracorporeal knot tying . Methods : Forty-three graduate students without prior laparoscopic experience were r and omly assigned to one of five training groups , and their performance in 10 intracorporeal knot tying trials was evaluated , using time to complete a knot as the outcome measure . Results : The average knot tying times for the four structured groups were significantly faster than the unstructured group ( p < 0.0001 ) . AMONG THE FOUR STRUCTURED GROUPS , THE MINIMALLY INVASIVE SURGICAL TRAINER-VIRTUAL REALITY ( MIST-VR ) AND THE BOX TRAINER DRILLS SHOWED THE MOST RAPID IMPROVEMENTS . THE MIST-VR IMPROVED AVERAGE SUTURING TIME FROM TRIAL ONE TO TRIAL TWO ( P = 0.05 ) , THE BOX TRAINER DRILLS GROUP IMPROVED FROM TRIAL ONE TO TRIAL FOUR ( P = 0.01 ) , AND THE OTHER TWO GROUPS SHOWED SLOWER IMPROVEMENTS . STATISTICALLY SIGNIFICANT CORRELATIONS WERE OBSERVED BETWEEN SCORES ON MIST-VR TASKS AND AVERAGE KNOT TYING TIMES ( R > 0.7 , p < 0.05 ) . Conclusion : Structured training can be useful for the development of laparoscopic skills . MIST-VR is a valuable part of this training , particularly in the objective evaluation of performance Purpose . To examine the effect of instructional format on medical students ' learning of ECG diagnosis .  Method . Two experiments employed different learning and practice methods . In the first , students were r and omly allocated to one of two instructional approaches , one organized around features ( e.g. , QRS voltage ) and the other around diagnostic categories ( e.g. , bundle branch blocks ) , followed by a practice phase . In the second experiment , the instruction was st and ardized , and students were r and omly allocated to one of two practice phases , either “ contrastive ” where examples from various categories are mixed together , or “ non-contrastive ” where all the examples in a single category are practice d in a single block . Results . In the first experiment , there was no significant differences in students ' diagnostic accuracy on novel ECG examples . In the second experiment , students exposed to the contrastive approach in the practice phase had superior diagnostic accuracy ( 46 % ) compared to 30 % accuracy for the non-contrastive session , p < 0.05 ) . Conclusion . These experiments highlight two important features in the design of instructional material s. First , learning around the features of the problem ( analogous to problem – based learning ) may have no advantages over learning the category . Second , the design and organization of deliberate practice can result in significant learning gain BACKGROUND We hypothesized that the Minimally Invasive Surgery Trainer ( MIST-VR ; VP Medical R , London , U.K. ) would be as effective as the Yale Laparoscopic Skills Course in improving laparoscopic intracorporeal suturing skills . MATERIAL S AND METHODS Each student made six attempts to tie a knot laparoscopically . Students were then r and omized to train on the MIST-VR for five sessions ( six skills/session ) or the Yale Skills  for five sessions ( three skills/session ) over 5 days . On completion of training , all students were evaluated by a test consisting of six attempts to tie a laparoscopic knot . RESULTS The percentage improvement in knot tying time did not differ significantly in the pelvic trainer group ( 30 + /- 21 % ) ( from 443 + /- 135 to 311 + /- 137 seconds ) and the MIST-VR group ( 39 + /- 21 % ) ( from 409 + /- 109 to 256 + /- 140 seconds ) ( P = 0.308 ) . CONCLUSIONS The MIST-VR is equivalent to the Yale Skills Course for training in the advanced laparoscopic skill of intracorporeal suturing CONTEXT A substantial proportion of medical students enter their intern year without any basic skills experience . Lack of experience is a significant source of stress for many junior doctors . OBJECTIVES To evaluate the effect of a basic procedural skills tutorial for Year 3 medical students on their competence in relevant skills at Year 5 . SUBJECTS The control group consisted of 93 medical students who completed Year 3 in 1996 . The intervention group consisted of 92 medical students who completed Year 3 in 1997 . The intervention group received a practical skills tutorial in Year 3 ; the control group did not . Both groups were assessed on their practical skills competence during Year 5 . METHODS A 3-hour practical tutorial on injection and suturing techniques was delivered to the intervention group . The effectiveness of the intervention was assessed by self-reported experience of giving injections , inserting sutures and sustaining needlestick injuries , and by teacher-rated competency in four basic procedural skills . RESULTS Students who received the Year 3 tutorial were significantly more likely to record a satisfactory assessment for their performance in all four basic skills compared with students who did not receive the tutorial . They were less likely than controls to refuse invitations to give injections , but not invitations to insert a suture , during Years 4 and 5 . CONCLUSIONS A single session of formalised teaching in procedural skills in the early stages of a medical degree can have long-term effectiveness in basic skills competence and may increase students ' confidence to practise their skills Scrubbing , gowning , gloving and aseptic technique are currently the only formal teaching 4th year medical students receive at the beginning of an 8-week surgery rotation . Teaching is often delegated to junior house staff and early bad habits are difficult to unlearn in post-graduate training . A study population of 4th year medical students from three hospitals were examined . At the beginning of an 8-week surgery rotation technical skills were tested with a simulation appendectomy model at the beginning and end of the surgery rotation . On day one , after a pre-test , a teaching intervention was alternated between two hospitals . A control group received only a post-test . The outcome measure was a cumulative score of the students ' performance in technical stations in the simulation model . A comparison was made of the mean post-test scores in the teaching , non-teaching and control groups . An analysis of variance of all post-test scores rejected the null hypothesis at the 0.05 level . Duncan 's multiple range test demonstrated a significant difference between the teaching and non-teaching group . Feedback from 25 students indicated the teaching model was practical and relevant . A formal teaching intervention of basic technical skills with 4th year medical students improved their performance on a simulated appendectomy model An interactive , self- study learning system for airway management instruction that utilizes a “ sensorized ” manikin head ( Actronics Inc. , Pittsburgh , PA ) was compared to didactic instruction from anesthesiologists during third-year medical student anesthesia rotations . Before students were allowed to participate in airway management on anesthetized patients , they were r and omly separated into two groups . One group received instruction from the learning system , and the other group was given a lecture with guided practice on a st and ard tracheal intubating manikin . Differences between groups were then assessed using 22 separate variables as all students performed actual airway management on patients undergoing general anesthesia . Anesthesia faculty , residents , and nurse anesthetists , blinded to group , served as assessors . There were 48 and 49 students in the didactic instruction and learning system groups , respectively . Beginning experience level of students with respect to airway management was similar between groups before the anesthesia rotations . There were 185 and 188 evaluation forms completed to assess the didactic instruction and learning system groups , respectively . Demographic data regarding patients were recorded . Patients in the learning system group on whom students performed airway management were older , had a larger average body mass index , and their airways more frequently received higher Mallampati classifications ( glottic structures more difficult to visualize ) . No difference in the quality of airway management efforts or in students ' appraisal of their own performances was seen between groups . Neither group demonstrated more rapid development of psychomotor skills . Students were equally satisfied with both methods of instruction . We conclude that the airway management self- study learning system is as efficacious as didactic instruction for pre clinical airway management instruction during third-year medical student anesthesia rotations Epistaxis is a common problem faced by primary care physicians . Typically , first-h and experience with this problem is not obtained in medical school . A computer learning module was developed to address practical management of epistaxis . It was evaluated by use of third-year clerks and compared with an interactive seminar based on the same material . Fifty-eight students doing their required otolaryngology rotations were r and omly separated into 3 groups : ( 1 ) doing a preinstruction test , ( 2 ) using the computer module , and ( 3 ) participating in a small-group seminar . All participants were tested with a short written test and a practical test that involved performing anterior nasal pack placement in a model patient . Percentage scores for the 2 groups were compared by use of t tests , and there was no significant difference between the written , practical , or combined scores at a level where P = 0.05 . This study shows that basic patient management and a simple procedure can be taught as effectively with a computer module as with a small-group interactive seminar AIM To assess the immediate effect on trauma-related knowledge of the trauma evaluation and management ( TEAM ) program applied to medical students in Australia . METHODS 73 final year medical students from Melbourne were r and omly assigned to two experimental groups ( E1 and E2 who completed the TEAM program after a 20 item MCQ pre-test on trauma resuscitation and a second MCQ exam after the TEAM program ) and two control groups ( C1 and C2 who completed the pre- and post-MCQ exams before completing the TEAM module ) . All 73 students completed an evaluation question naire . Paired and unpaired t-tests were used for within and between groups comparisons . RESULTS Groups C1 and C2 had similar mean scores in pre- and post-tests ranging from 57.2 to 60.5 % . Groups E1 and E2 had similar pre-test scores but increased their post-test scores ( pre-test range 53.8 - 57.1 % and post-test 68.8 - 77.4 % , P < 0.05 ) . On a scale of 1 - 5 with five being the highest , a score of four or greater was assigned by over 74 % of the students that the objectives were met , over 80 % that trauma knowledge was improved , 25 - 40 % that clinical skills were improved with over 74 % overall satisfaction . Over 75 % assigned a score of four or greater suggesting the module be m and atory . CONCLUSIONS After the TEAM program there was significant improvement in cognitive skills . The students strongly supported its introduction in the undergraduate curriculum PURPOSE To investigate the effectiveness of a st and ardized vascular clinic ( SVC ) in teaching diagnostic and management skills for common vascular problems , as compared with that of the traditional ambulatory setting . METHODS Third-year medical students participating in the required surgical clerkship participated in this study . Students were r and omly assigned to attend either a 4-hour SVC experience  ( group 1 , n = 64 ) or a 4-hour traditional ambulatory experience  ( group 2 , n = 60 ) . Students completed a satisfaction rating scale and a preencounter and postencounter self-efficacy rating scale at the end of the experience . Student t tests were used to compare the groups in the areas of knowledge acquisition , problem solving , clinical skills and satisfaction with the encounter . Analysis of covariance was used to compare the change between pre and post self-efficacy ratings . RESULTS Students in group 1 performed significantly higher than students in group 2 in the areas of problem solving , clinical skills , and student satisfaction . They also demonstrated a higher level of confidence in their vascular skills than students assigned to the traditional setting . CONCLUSION The SVC may be more effective in teaching problem-solving and clinical skills . It also may promote more student satisfaction with the experience and confidence in clinical skills than the traditional ambulatory setting BACKGROUND As case-based methods replaced lectures in a surgical clerkship , the influences of case structure and prior experience on learning were investigated . METHODS Early and late third-year students r and omly received different cases .  " Structured " cases had data presented and summarized . " Unstructured " cases required questions to faculty for information . Multiple choice tests and differential diagnosis activities were administered . An attitudinal question naire gauged student perceptions . RESULTS In both multiple choice and differential diagnosis activities , the late rotation , " unstructured " group scored higher than the " structured " group . Conversely , the early rotation , " unstructured " group scored lower than the " structured " group . Combined , rotation , and structure significantly affected both multiple choice and differential diagnosis activities ( ANOVA , P < or = 0.02 ) . Early rotation , " unstructured " students described a more enjoyable experience , despite lower evaluation scores . CONCLUSIONS Surgical clerkship case-based learning is profoundly affected by case structure and prior clinical experience . Case-based curriculum should be tailored to accommo date these interactions STUDY OBJECTIVE We conducted a prospect i ve , r and omized , controlled trial to test the hypothesis that a 34-minute video self-instruction ( VSI ) training program for adult CPR would yield comparable or better CPR performance than the current community st and ard , the American Heart Association Heartsaver course . METHODS Incoming freshman medical students were r and omly assigned to VSI or the Heartsaver CPR course .  Two to 6 months after training , we tested subjects to determine their ability to perform CPR in a simulated cardiac arrest setting . Blinded observers used explicit criteria to assess our primary outcome , CPR performance skill . In addition , we assessed secondary outcomes including sequential performance of individual skills , ventilation and chest compression characteristics , and written tests of CPR-related knowledge and attitudes . RESULT 
    Output:
    
CONCLUSIONS This systematic review assessed the quality of RCTs used in teaching undergraduates surgical and emergency skills .
Students varied in their skills , and most did not demonstrate optimal performance in any of the procedures .