***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: OBJECTIVE " Dry lab " facilities are integral to laparoscopy training , but access is often limited due to the high costs of video-laparoscopy equipment . We assessed the effectiveness of a cheap and simple training model compared to conventional video-laparoscopy for basic training using a r and omised , blinded study . METHODS Thirty-six third-year medical students without previous surgical skills were r and omised into two groups : group A students were taught basic laparoscopy skills using a conventional video-laparoscopy pelvic trainer and group B students were taught similar techniques using a cardboard box with a cut-out top to allow light and visualisation . Participants in group B had one eye obscured to reduce their stereoscopic vision . After eight sessions of training amounting to 24h , the two groups were assessed by a blinded adjudicator on set tasks using both the video-laparoscopy pelvic trainer and the cardboard box .  Accuracy , timing and depth perception were assessed and the results compared . RESULTS There was no significant difference in performance scores or times between the two groups in any of the parameters when tested on the cardboard box . However , when assessed on the video trainer , the cardboard box-trained group had significantly faster times with equivalent scores in the majority of tasks . CONCLUSION For basic laparoscopic training the cardboard box , costing nothing , is a simple and effective alternative , which can be used in conjunction with sophisticated video-laparoscopy equipment costing thous and s of dollars Background Laparoscopic suturing is one of the most difficult tasks in endoscopic surgery , requiring extensive training . The aim of this study was to determine the transfer validity of knot-tying training on a virtual-reality ( VR ) simulator to a realistic laparoscopic environment . Methods Twenty surgical trainees underwent basic eye – h and coordination training on a VR simulator  ( SIMENDO , DelltaTech , Delft , the Netherl and s ) until predefined performance criteria were met . Then , they were r and omized into two groups . Group A ( the experimental group ) received additional training with the knot-tying module on the simulator , during which they had to tie a double laparoscopic knot ten times . Group B ( controls ) did not receive additional manual training . Within a week the participants tied a double knot in the abdominal cavity of an anaesthetized porcine model . Their performance was captured on digital video and coded . Objective analysis parameters were : time taken to tie the knot and number of predefined errors made . Subjective assessment s were also made by two laparoscopic surgeons using a global rating list with a five-point Likert scale . Results Trainees in group A ( n = 9 ) were significantly faster than the controls ( n = 10 ) , with a median of 262 versus 374 seconds ( p = 0.034 ) . Group A made a significantly lower number of errors than the controls ( median of 24 versus 36 errors , p = 0.030 ) . Subjective assessment s by the laparoscopic experts did not show any significant differences in economy of movement and erroneous behavior between the two groups . ConclusionS urgical trainees who received knot-tying training on the VR simulator were faster and made fewer errors than the controls . The VR module is a useful tool to train laparoscopic knot-tying . Opportunities arose to improve simulator-based instruction that might enhance future training Background : The study aim was to compare the effectiveness of virtual reality and computer-enhanced video-scopic training devices for training novice surgeons in complex laparoscopic skills . Methods : Third-year medical students received instruction on laparoscopic intracorporeal suturing and knot tying  and then underwent a pretraining assessment of the task using a live porcine model . Students were then r and omized to objectives -based training on either the virtual reality ( n=8 ) or computer-enhanced ( n=8 ) training devices for 4 weeks , after which the assessment was repeated . Results : Posttraining performance had improved compared with pretraining performance in both task completion rate ( 94 % versus 18 % ; P<0.001 * ) and time [ 181±58 ( SD ) versus 292±24 * ] . Performance of the 2 groups was comparable before and after training . Of the subjects , 88 % thought that haptic cues were important in simulators . Both groups agreed that their respective training systems were effective teaching tools , but computer-enhanced device trainees were more likely to rate their training as representative of reality ( P<0.01 ) . Conclusions : Training on virtual reality and computer-enhanced devices had equivalent effects on skills improvement in novices . Despite the perception that haptic feedback is important in laparoscopic simulation training , its absence in the virtual reality device did not impede acquisition of skill Background Many laparoscopic simulation training systems exist and have been shown to transfer learning of surgical skills to the operating room . The manner in which the training is structured to maximize learning has not been examined . There are many aspects to the acquisition of laparoscopic skills during training , one of which is the availability of knowledge of results ( KR ) . Knowledge of results is information about the outcome of motor skill execution , usually provided to individuals at the end of the execution . The timing and nature of KR can affect how well people learn new motor skills . In addition , detailed instruction during learning can also affect skill acquisition . We studied the effects of KR and instruction on the learning curve of a suturing and knot-tying task . We hypothesized that KR was necessary for skill acquisition , and that detailed instruction would help trainees to learn to perform the task more correctly and reach a performance plateau earlier . In addition , the overall workload of a trainee during training would decrease as skills improved , especially when KR and coaching were provided . Methods Nine medical students with no previous laparoscopic surgical experience were r and omly and evenly divided into three groups with different KR conditions : ( 1 ) no KR , ( 2 ) KR , ( 3 ) KR + instruction . Each subject attended a training session for 1 h each day , 6 days a week for 4 consecutive weeks . Performance measures such as task time , smoothness of instrument , and path length were recorded for each trial . Workload was assessed using the NASA-TLX question naire . Results While KR was necessary for learning to suture , continual instruction had limited additional benefits . However , KR + instruction did reduce subjects ’ perceived overall workload . Conclusions Surgical training could be carried out effectively with only knowledge of results . These results have implication s for the staffing of surgical skills laboratories Background Training of skills in simulators is preferred over learning on patients so as to avoid undue injury to patients and to allow more efficient use of re sources . Most simulators are costly and require a dedicated space . The aim of this study was to evaluate a simple desktop simulator , the Mirror Trainer . Methods Thirty medical students were r and omly assigned to three groups . One group was taught laparoscopic suturing in the Mirror Trainer , the second group used a pelvic training box , while the third group served as a control group and did not receive any training . All suture attempts during training were recorded on video . A blinded , independent investigator analyzed the videos . At the completion of training , the suturing skills of each participant were evaluated in an animal model . Results Training with the Mirror Trainer required less time than with the pelvic trainer ( p < 0.001 ) . Compared with the control group , the Mirror Trainer group and the pelvic trainer group were significantly faster at creating three knots in the pig ( p = 0.001 and p = 0.004 , respectively ) . Both training groups performed equally well on the animal model ( p = 0.99 ) . Conclusion The Mirror Trainer and the pelvic trainer are equally effective in teaching laparoscopic suturing skills but training with the Mirror Trainer requires less time , can be done on any desktop , and is less costly BACKGROUND We carried out a prospect i ve , r and omized , 4-arm study including control arm , blinding of examiners to determine effectiveness of computer-based video instruction ( CBVI ) and different types of expert feedback ( concurrent and summary ) on learning of a basic technical skill . METHODS Using bench models , participants were pre-tested on a suturing and instrument knot-tying skill after viewing an instructional video . The students were subsequently assigned r and omly to 4 practice conditions : no additional intervention ( control ) , self study with CBVI , expert feedback during practice trials ( concurrent feedback ) , and expert feedback after practice trials ( summary feedback ) .  All participants underwent 19 trials of practice , over 1 hour , in their assigned training condition . The effectiveness of training was assessed both at an immediate post-test and 1 month later at a retention test . Performance was evaluated using both expert-based ( Global Rating Scores ) and computer-based assessment ( H and Motion Analysis ) . Data were analyzed using repeated- measures ANOVA . RESULTS There were no differences in GRS between groups at pre-test . The CBVI , concurrent feedback and summary feedback methods were equally effective initially for the instruction of this basic technical skill to naive medical students and displayed better performance than control ( control , 12.71 [ 10.79 to 14.62 ] ; CBVI , 16.39 [ 14.38 to 18.40 ] ; concurrent , 16.97 [ 15.79 to 18.15 ] ; summary , 16.09 [ 13.57 to 18.62 ] ; P < .001 each ) . At retention . however , only CBVI and summary feedback groups retained superior suturing and knot-tying performance versus control ( control , 8.13 [ 6.94 to 9.85 ] ; CBVI , 11.92 [ 10.19 to 14.99 ] P = .037 ; concurrent , 9.80 [ 8.55 to 13.45 ] P = .635 ; summary , 111.19 [ 10.27 to 14.29 ] P = .037 ) . H and motion data displayed a similar pattern of results . There were no group differences in the rate of learning ( P > .05 ) . CONCLUSION Our study showed that CBVI can be as effective as  summary expert feedback  in the instruction of basic technical skills to medical students . Thoughtfully incorporated into technical curricula , CBVI can make efficient use of faculty time and serve as a useful pedagogic adjunct for basic skills training . Additionally , our study provides evidence supporting an increased role of  summary feedback  to effectively train novices in technical skills BACKGROUND Based on prior success of virtual-reality ( VR ) trainers in imparting surgical skills , a r and omized and controlled study was design ed to determine whether VR training improves angled-telescope operative performance . METHODS Third-year medical students received instruction on the use of an angled laparoscope and subsequently underwent performance assessment of angled telescope navigational tasks in an anesthetized porcine model . Subjects were then r and omized to objective -based training with an angled-telescope simulator ( EndoTower ; Verefi Technologies , Elizabethtown , PA ) versus no training , followed by re assessment of performance . RESULTS Initially , there were no significant differences between VR-trained ( n = 9 ) and control ( n = 10 ) groups . After training , object visualization , scope orientation , and horizon error scores were significantly better in VR-trained than control groups ; subject-matched improvement in orientation score was 50.9 % versus 10.8 % ( P < .05 ) . CONCLUSIONS VR training in angled laparoscope use improves operative performance of novices . These data support growing evidence that VR training is highly effective in improving surgical skills outside of the clinical setting TOPIC The rapid development of advanced laparoscopic techniques is a strong challenge for the skills and competence of the paediatric surgeon . It is therefore m and atory that training must offer adequate preparation . The present experimental study investigates how surgical residents perform laparoscopic bowel biopsy  and defect repair after training with a pelvitrainer versus a rabbit model . METHODS New Zeal and white rabbits , 3 mm instruments , a 5 mm scope and a 6 - 0 prolene suture were used . Twelve surgical residents were r and omised into two groups . Their basic task was to take a seromuscular bowel biopsy laparoscopically and to repair the defect using an intracorporeal suture . Group I trained 8 times ( on 8 occasions ) with a pelvitrainer ( PT ) , group II trained similarly using a rabbit model ( RM ) . Each participant took a final test to demonstrate the operation in the rabbit . Operating time , suture time and perforation of the bowel were analysed . RESULTS In the PT group , mean operating times decreased from 11.18 ( + /- 5.04 ) min to 4.91 ( + /- 0.89 ) min ( p < 0.01 ) , however the final test procedure in the rabbit model lasted 9.62 ( + /- 5.11 ) min . In the RM group mean operating times also decreased from 10.04 ( + /- 3.39 ) min to 6.38 ( + /- 1.40 ) min ( p < 0.01 ) during the eight training operations . Within this group the final live operation lasted 5.45 ( + /- 0.67 ) min and was significantly faster than in the PT group 9.62 ( + /- 5.11 ) min ( p < 0.1 ) . The suture times showed a similar pattern . A significant difference with respect to the rate of perforation was not found . CONCLUSIONS Repetitive training in the rabbit provides superior skills for live operations . In paediatric surgical centres with advanced laparoscopic procedures , an animal model should be considered as an important step in training which may contribute to a beneficial outcome in patients BACKGROUND This study compares a laparoscopic skill training protocol without proficiency targets to the same protocol with explicit targets and notification of progress . METHODS Fourteen surgery interns were r and omized into 2 groups . The intervention group received task-specific proficiency criteria 
    Output:
    
Comparisons between different simulation interventions ( n = 79 studies ) clarified best practice s. For example , in comparison with virtual reality , box trainers have similar effects for process skills outcomes and seem to be superior for outcomes of satisfaction and skills time .
CONCLUSIONS  Simulation-based laparoscopic surgery training of health professionals has large benefits when compared with no intervention and is moderately more effective than nonsimulation instruction