***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 Most of the many computer re sources used in clinical teaching of dermatology and venereology for medical undergraduates are information-oriented and focus mostly on finding a " correct " multiple-choice alternative or free-text answer . We wanted to create an interactive computer program , which facilitates not only factual recall but also clinical reasoning . Methods Through continuous interaction with students , a new computerised interactive case simulation system , NUDOV , was developed . It is based on authentic cases and contains images of real patients , actors and healthcare providers . The student selects a patient and proposes questions for medical history , examines the skin , and suggests investigations , diagnosis , differential diagnoses and further management . Feedback is given by comparing the user 's own suggestions with those of a specialist . In addition , a log file of the student 's actions is recorded . The program includes a large number of images , video clips and Internet links . It was evaluated with a student question naire and by r and omising medical students to conventional teaching ( n = 85 ) or conventional teaching plus NUDOV ( n = 31 ) and comparing the results of the two groups in a final written examination . Results The question naire showed that 90 % of the NUDOV students stated that the program facilitated their learning to a large/very large extent , and 71 % reported that extensive working with authentic computerised cases made it easier to underst and and learn about diseases and their management . The layout , user-friendliness and feedback concept were judged as good/very good by 87 % , 97 % , and 100 % , respectively . Log files revealed that the students , in general , worked with each case for 60–90 min . However , the intervention group did not score significantly better than the control group in the written examination . Conclusion We created a computerised case simulation program allowing students to manage patients in a non-linear format supporting the clinical reasoning process . The student gets feedback through comparison with a specialist , eliminating the need for external scoring or correction . The model also permits discussion of case processing , since all transactions are stored in a log file . The program was highly appreciated by the students , but did not significantly improve their performance in the written final examination Introduction Physician empathy is a complex phenomenon known to improve illness outcomes ; however , few tools are available for deliberate practice of empathy . We used a virtual patient ( VP ) to teach empathic communication to first-year medical students . We then evaluated students ’ verbal empathy in a st and ardized patient ( SP ) interaction . Methods Seventy medical students , r and omly assigned to 3 separate study groups , interacted with ( 1 ) a control VP portraying depression , ( 2 ) a VP with a backstory simulating patient shadowing , or ( 3 ) a VP able to give immediate feedback about empathic communication ( empathy-feedback VP ) . Subsequently , the students interviewed an SP portraying a scenario that included opportunities to express empathy . All SP interviews were recorded and transcribed . The study outcomes were ( 1 ) the students ’ verbal response to the empathic opportunities presented by the SP , as coded by reliable assessors using the Empathic Communication Coding System , and ( 2 ) the students ’ responses as coded by the SPs , using a communication checklist . Results There were no significant differences in student demographics between groups . The students who interacted with the empathy-feedback VP showed higher empathy in the SP interview than did the students in the backstory VP and the control VP groups [ mean ( SD ) empathy scores coded on a 0–6 scale were 2.91 ( 0.16 ) vs. 2.20 ( 0.22 ) and 2.27 ( 0.21 ) , respectively ) . The difference in scores was significant only for the empathy-feedback VP versus the backstory VP group ( P = 0.027 ) . The SPs rated the empathy-feedback and the backstory VP groups significantly higher than the control VP group on offering empathic statements ( P < 0.0001 ) , appearing warm and caring ( P = 0.015 ) , and forming rapport ( P = 0.004 ) . Conclusions Feedback on empathy in a VP interaction increased students ’ empathy in encounters with SPs , as rated by trained assessors , whereas a simulation of patient shadowing did not . Both VP interventions increased students ’ empathy as rated by SPs , compared with the control VP group Objective To improve pain management practice s , we developed an online interactive continuing education ( CE ) program for primary care providers ( PCPs ) . This program follows the flow of clinical decision-making through simulated cases at critical pain treatment points along the pain treatment continuum . Design A r and omized controlled trial was conducted to test the efficacy of this program . Participants were r and omized to either the experimental condition or the control condition ( online , text-based CE program ) . Subjects A total of 238 primary care providers were recruited through hospitals , professional newsletters , and pain conferences . Results Participants in both conditions reported significantly improved scores on knowledge ( KNOW-PAIN 50 ) , attitudes ( CAOS ) , and pain practice behaviors ( PPBS ) scales over the four-month study . The experimental condition showed significantly greater change over time on the tamper-resistant formulations ( TRFs ) of opioids and dosing CAOS subscale compared with the control condition . Post hoc comparisons suggested that participants in the experimental condition were less likely to endorse use of opioid TRFs over time compared with the control condition . Exploratory analyses for potential moderators indicated a significant three-way interaction with time , condition , and discipline ( i.e. , physician vs other ) for the impediments and concerns attitudes subscale and the early refill behaviors subscale . Post hoc comparisons indicated that physicians in the experimental condition exhibited the greatest change in attitudes and the nonphysicians exhibited the greatest change in reported behaviors in response to requests for early refills . Conclusions Findings suggest online CE programs may positively impact PCPs ' knowledge , attitudes , and pain practice behaviors but provide minimal evidence for the value of including interactivity Background The concept of virtual patients ( VPs ) encompasses a great variety of predominantly case-based e-learning modules with different complexity and fidelity levels . Methods for effective placement of VPs in the process of medical education are sought . The aim of this study was to determine whether the introduction of a voluntary virtual patients module into a basic life support with an automated external defibrillator ( BLS-AED ) course improved the knowledge and skills of students taking the course . Methods Half of the students were r and omly assigned to an experimental group and given voluntary access to a virtual patient module consisting of six cases presenting BLS-AED knowledge and skills . Pre- and post-course knowledge tests and skills assessment s were performed , as well as a survey of students ' satisfaction with the VP usage . In addition , time spent using the virtual patient system , percentage of screen cards viewed and scores in the formative questions in the VP system throughout the course were traced and recorded . Results The study was conducted over a six week period and involved 226 first year medical students . The voluntary module was used by 61 ( 54 % ) of the 114 entitled study participants . The group that used VPs demonstrated better results in knowledge acquisition and in some key BLS-AED action skills than the group without access , or those students from the experimental group deliberately not using virtual patients . Most of the students rated the combination of VPs and corresponding teaching events positively . Conclusions The overall positive reaction of students and encouraging results in knowledge and skills acquisition suggest that the usage of virtual patients in a BLS-AED course on a voluntary basis is feasible and should be further investigated Objectives To compare medical students ’ and residents ’ knowledge retention of assessment , diagnosis and treatment procedures , as well as a learning experience , of patients with spinal trauma after training with either a Virtual Patient case or a video-recorded traditional lecture . Methods A total of 170 volunteers ( 85 medical students and 85 residents in orthopedic surgery ) were r and omly allocated ( stratified for student/resident and gender ) to either a video-recorded st and ard lecture or a Virtual Patient-based training session where they interactively assessed a clinical case portraying a motorcycle accident . The knowledge retention was assessed by a test immediately following the educational intervention and repeated after a minimum of 2 months . Participants ’ learning experiences were evaluated with exit question naires . A repeated- measures analysis of variance was applied on knowledge scores .  A total of 81 % ( n = 138 ) of the participants completed both tests . Results There was a small but significant decline in first and second test results for both groups ( F(1 , 135 ) = 18.154 , p = 0.00 ) . However , no significant differences in short-term and long-term knowledge retention were observed between the two teaching methods . The Virtual Patient group reported higher learning experience levels in engagement , stimulation , general perception , and expectations . Conclusions Participants ’ levels engagement were reported in favor of the VP format . Similar knowledge retention was achieved through either a Virtual Patient or a recorded lecture Background E-learning and blended learning approaches gain more and more popularity in emergency medicine curricula . So far , little data is available on the impact of such approaches on procedural learning and skill acquisition and their comparison with traditional approaches . Objective This study investigated the impact of a blended learning approach , including Web-based virtual patients ( VPs ) and st and ard pediatric basic life support ( PBLS ) training , on procedural knowledge , objective performance , and self- assessment . Methods A total of 57 medical students were r and omly assigned to an intervention group ( n=30 ) and a control group ( n=27 ) . Both groups received paper h and outs in preparation of simulation-based PBLS training . The intervention group additionally completed two Web-based VPs with embedded video clips . Measurements were taken at r and omization ( t0 ) , after the preparation period ( t1 ) , and after h and s-on training ( t2 ) . Clinical decision-making skills and procedural knowledge were assessed at t0 and t1 . PBLS performance was scored regarding adherence to the correct algorithm , conformance to temporal dem and s , and the quality of procedural steps at t1 and t2 . Participants ’ self- assessment s were recorded in all three measurements . Results Procedural knowledge of the intervention group was significantly superior to that of the control group at t1 . At t2 , the intervention group showed significantly better adherence to the algorithm and temporal dem and s , and better procedural quality of PBLS in objective measures than did the control group . These aspects differed between the groups even at t1 ( after VPs , prior to practical training ) . Self- assessment s differed significantly only at t1 in favor of the intervention group . Conclusions Training with VPs combined with h and s-on training improves PBLS performance as judged by objective measures PURPOSE To assess the performance of interprofessional teams of radiologists , technologists , and nurses trained with high-fidelity h and s-on ( HO ) simulation and computer-based ( CB ) simulation training  for contrast reaction management ( CR ) and teamwork skills ( TS ) . METHODS Nurses , technologists , and radiology residents were r and omized into 11 teams of three ( one of each ) . Six teams underwent HO training and five underwent CB training for CR and TS . Participants took written tests before and after training and were further tested using a high-fidelity simulation scenario . RESULTS HO and CB groups scored similarly on all written tests and each showed improvement after training ( P = .002 and P = .018 , respectively ) . During the final scenario test , HO teams tended to receive higher grade s than CB teams on CR ( 95 % versus 81 % , P = .17 ) and made fewer errors in epinephrine administration ( 0/6 versus 2/5 , P = .18 ) . HO and CB teams scored similarly on TS ( 51 % versus 52 % , P = .66 ) , but overall scores were lower for TS than for CR skills in both the HO ( P = .03 ) and CB teams ( P = .06 ) . HO training was more highly rated than CB as an effective educational tool ( P = .01 ) and for effectiveness at teaching CR and team communication skills ( P = .02 ) . CONCLUSIONS High-fidelity simulation can be used to both train and test interprofessional teams of radiologists , technologists , and nurses for both CR and TS and is more highly rated as an effective educational tool by participants than similar CB training . However , a single session of either type of training may be inadequate for mastering TS Aim The Virtual Ophthalmology Clinic ( VOC ) is an interactive web-based teaching module , with special emphasis on history taking and clinical reasoning skills . The purpose of this study was to determine the impact of VOC on medical students ’ learning . Methods A r and omised controlled trial ( RCT ) was conducted with medical students from the University of Sydney ( n=188 ) who were r and omly assigned into either an experimental ( n=93 ) or a control group ( n=95 ) . A pre- and post-test and student satisfaction question naire were administered . Twelve months later a follow-up test was conducted to determine the long-term retention rate of graduates . Results There was a statistically significant ( P<0.001 ) within-subject improvement pre- to post rotation in the number of correctly answered questions for both the control and experimental groups ( mean improvement for control 10 % , 95 % CI 1.3–2.6 , and for experimental 17.5 % , 95 % CI 3.0–4.0 ) . The improvement was significantly greater in the experimental group ( mean difference in improvement between groups 7.5 % , 95 % CI 0.8–2.3 , P<0.001 ) . At 12 months follow-up testing , the experimental group scored on average 1.6 ( 8 % ) ( 95%CI 0.4 to 2.7 , P=0.007 ) higher than the controls . Conclusion On the basis of a statistically significant improvement in academic performance and highly positive student feedback , the implementation of VOC may provide a means to address challenges to ophthalmic learning outcomes in an already crowded medical curriculum We intended to clarify the influence of student academic ability on the effectiveness of CAI  , using data of a study to assess the effectiveness of a new type of CAI software , cyberPatient ( CP ) , 
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Conclusions Low to modest and mixed evidence suggests that when compared with traditional education , virtual patients can more effectively improve skills , and at least as effectively improve knowledge .
The skills that improved were clinical reasoning , procedural skills , and a mix of procedural and team skills .
We found evidence of effectiveness in both high-income and low- and middle-income countries , demonstrating the global applicability of virtual patients .