***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 : To evaluate the viability and effectiveness of a simulation-based pediatric mock code program on patient outcomes , as well as residents ' confidence in performing resuscitations . A resident 's leadership ability is integral to accurate and efficient clinical response in the successful management of cardiopulmonary arrest ( CPA ) . Direct experience is a contributing factor to a resident 's code team leadership ability ; however , opportunities to gain experience are limited by relative infrequency of pediatric arrests and code occurrences when residents are on service . Design : Longitudinal , mixed- methods research design . Setting : Children 's hospital at an tertiary care academic medical center . Patients : Pediatric . Interventions : Clinicians responsible for pediatric resuscitations responded to mock codes r and omly called at increasing rates over a 48-month period , just as they would an actual CPA event . Events were recorded and used for immediate debriefing facilitated by clinical faculty to provide residents feedback about their performance . Measurements : Self- assessment data were collected from all team members . Hospital records for pediatric CPA survival rates were examined for the study duration . Results : Survival rates increased to approximately 50 % ( p = .000 ) , correlating with the increased number of mock codes ( r = .87 ) . These results are significantly above the average national pediatric CPA survival rates and held steady for 3 consecutive years , demonstrating the stability of the program 's outcomes . Conclusions : This study suggests that a simulation-based mock code program may significantly benefit pediatric patient CPA outcomes —applied clinical outcomes —not simply learner perceived value , increased confidence , or simulation-based outcomes . The use of mock codes as an integral part of residency programs could provide residents with the resuscitation training they require to become proficient in their practice . Future programs that incorporate transport scenarios , ambulatory care , and other outpatient setting s could further benefit pediatric patients in prehospital context Objective : To determine if high fidelity simulation based team training can improve clinical team performance when added to an existing didactic teamwork curriculum . Setting : Level 1 trauma center and academic emergency medicine training program . Participants : Emergency department ( ED ) staff including nurses , technicians , emergency medicine residents , and attending physicians . Intervention : : ED staff who had recently received didactic training in the Emergency Team Coordination Course ( ETCC ® )  also received an 8 hour intensive experience in an ED simulator in which three scenarios of graduated difficulty were encountered . A comparison group , also ETCC trained  , was assigned to work together in the ED for one 8 hour shift . Experimental and comparison teams were observed in the ED before and after the intervention . Design : Single , crossover , prospect i ve , blinded and controlled observational study . Teamwork ratings using previously vali date d behaviorally anchored rating scales ( BARS ) were completed by outside trained observers in the ED . Observers were blinded to the identification of the teams . Results : There were no significant differences between experimental and comparison groups at baseline . The experimental team showed a trend towards improvement in the quality of team behavior ( p = 0.07 ) ; the comparison group showed no change in team behavior during the two observation periods ( p = 0.55 ) . Members of the experimental team rated simulation based training as a useful educational method . Conclusion : High fidelity medical simulation appears to be a promising method for enhancing didactic teamwork training . This approach , using a number of patients , is more representative of clinical care and is therefore the proper paradigm in which to perform teamwork training . It is , however , unclear how much simulator based training must augment didactic teamwork training for clinical ly meaningful differences to become apparent OBJECTIVE Evaluate the impact of a team training curriculum for residents and multidisciplinary trauma team members on team communication , coordination and clinical efficacy of trauma resuscitation . DESIGN Prospect i ve , cohort intervention comparing pre- vs. post-training performance . The intervention was a human patient simulator (HPS)-based , in situ team training curriculum , comprising a one-hour web based didactic followed by HPS training in the emergency department ( ED ) . Teams were trained in multidisciplinary groups of 5 - 8 persons . Each HPS session included three fifteen minute scenarios with immediate video-enabled debriefing . Structured debriefing and teamwork assessment was performed with a modified NOTECHS scale for trauma ( T-NOTECHS ) . Teams were assessed for performance changes during HPS-based training , as well as in actual trauma resuscitations . SETTING The Queen 's Trauma Center ( Level II ) ; the primary teaching hospital for the University of Hawaii Surgical Residency . PARTICIPANTS 137 multidisciplinary trauma team members , including residents ( n = 24 ) , ED and trauma attending physicians , nurses , respiratory therapists , and ED technicians . RESULTS During HPS-based training sessions , significant improvements in teamwork ratings , and in clinical task speed and completion rates were noted between the first and the last scenario.244 real-life blunt trauma resuscitations were observed for six months before and after training . There was a significant improvement in mean teamwork scores from the pre-to post-training resuscitations . Moreover , there were significant improvements in the objective parameters of speed and completeness of resuscitation . This was manifest by a 76 % increase in the frequency of near-perfect task completion ( ≤ 1 unreported task ) , and a reduction in the mean overall ED resuscitation time by 16 % . CONCLUSIONS A relatively brief ( four-hour ) HPS-based curriculum can improve the teamwork and clinical performance of multidisciplinary trauma teams that include surgical residents . This improvement was evidence d both in simulated and actual trauma setting s , and across teams of varying composition . HPS-based trauma teamwork training appears to be an educational method that can impact patient care Problem : Advance cardiac life support ( ACLS ) training does not address coordination of team re sources to improve the ability of teams to deliver needed treatments reliably and rapidly . Our objective was to use a human simulation training educational environment to develop multidisciplinary team skills and improve medical emergency team ( MET ) performance . We report findings of a crisis team training course that is focused on organization . Setting : Large center for human simulation training at a university affiliated tertiary care hospital . Participants : Ten courses were delivered and 138 clinical ly experienced individuals were trained ( 69 critical care nurses , 48 physicians , and 21 respiratory therapists ) . All participants were ACLS trained and experienced in responding to cardiac arrest situations . Course design : Each course had four components : ( 1 ) a web based presentation and pretest before the course ; ( 2 ) a brief reinforcing didactic session on the day of the course ; ( 3 ) three of five different simulated scenarios ; each followed by ( 4 ) debriefing and analysis with the team . Three of five simulator scenarios were used ; scenario selection and order was r and om . Trainees did not repeat any scenario or role during the training . Participants were video recorded to assist debriefing . Debriefing focused on reinforcing organizational aspects of team performance : assuming design ated roles independently , completing goals ( tasks ) assigned to each role , and directed communication . Measures for improvement : Participants grade d their performance of specific organizational and treatment tasks within specified time intervals by consensus . Simulator “ survival ” depended on supporting oxygenation , ventilation , circulation within 60 seconds , and delivering the definitive treatment within 3 minutes . Effects of change : Simulated survival ( following predetermined criteria for death ) increased from 0 % to 89 % . The initial team task completion rate was 10–45 % and rose to 80–95 % during the third session . Lessons learnt : Training multidisciplinary teams to organize using simulation technology is feasible . This preliminary report warrants more detailed inquiry Background : Simulation-based training is useful in improving physicians ' skills . However , no r and omized controlled trials have been able to demonstrate the effects of simulation teaching in real-life patient care . This study aim ed to determine whether simulation-based training or an interactive seminar result ed in better patient care during weaning from cardiopulmonary bypass (CPB)—a high stakes clinical setting . Methods : This study was conducted as a prospect i ve , single-blinded , r and omized controlled trial . After institutional research board approval , 20 anesthesiology trainees , postgraduate year 4 or higher , inexperienced in CPB weaning , and 60 patients scheduled for elective coronary artery bypass grafting were recruited . Each trainee received a teaching syllabus for CPB weaning 1 week before attempting to wean a patient from CPB ( pretest ) . One week later , each trainee received a 2-h training session with either high-fidelity simulation-based training or a 2-h interactive seminar . Each trainee then weaned patients from CPB within 2 weeks ( posttest ) and 5 weeks ( retention test ) from the intervention . Clinical performance was measured using the vali date d Anesthesiologists ' Nontechnical Skills Global Rating Scale and a checklist of expected clinical actions . Results : Pretest Global Rating Scale and checklist performances were similar . The simulation group scored significantly higher than the seminar group at both posttest ( Global Rating Scale [ mean ± st and ard error ] : 14.3 ± 0.41 vs. 11.8 ± 0.41 , P < 0.001 ; checklist : 89.9 ± 3.0 % vs. 75.4 ± 3.0 % , P = 0.003 ) and retention test ( Global Rating Scale : 14.1 ± 0.41 vs. 11.7 ± 0.41 , P < 0.001 ; checklist : 93.2 ± 2.4 % vs. 77.0 ± 2.4 % , P < 0.001 ) . Conclusion : Skills required to wean a patient from CPB can be acquired through simulation-based training . Compared with traditional interactive seminars , simulation-based training leads to improved performance in patient care by senior trainees in anesthesiology Background : The debriefing process during simulation-based education has been poorly studied despite its educational importance . Videotape feedback is an adjunct that may enhance the impact of the debriefing and in turn maximize learning . The purpose of this study was to investigate the value of the debriefing process during simulation and to compare the educational efficacy of two types of feedback , oral feedback and videotape-assisted oral feedback , against control ( no debriefing ) . Methods : Forty-two anesthesia residents were enrolled in the study . After completing a pretest scenario , participants were r and omly assigned to receive no debriefing , oral feedback , or videotape-assisted oral feedback . The debriefing focused on nontechnical skills performance guided by crisis re source management principles . Participants were then required to manage a posttest scenario . The videotapes of all performances were later review ed by two blinded independent assessors who rated participants ' nontechnical skills using a vali date d scoring system . Results : Participants ' nontechnical skills did not improve in the control group , whereas the provision of oral feedback , either assisted or not assisted with videotape review , result ed in significant improvement ( P < 0.005 ) . There was no difference in improvement between oral and video-assisted oral feedback groups . Conclusions : Exposure to a simulated crisis without constructive debriefing by instructors offers little benefit to trainees . The addition of video review did not offer any advantage over oral feedback alone . Valuable simulation training can therefore be achieved even when video technology is not available Background and objective Fibreoptic intubation is an essential skill in anaesthesiology that is challenging to learn in the clinical setting . The goal of this study was to evaluate ‘ virtual fibreoptic intubation ’ ( VFI ) software as an adjunct to the traditional fibreoptic intubation teaching . Methods After informed consent , 42 undergraduate medical students were r and omized into two groups . The ‘ control group ’ was taught conventionally by an expert bronchoscopist with a 1 h lecture . In addition to the didactic lecture by the expert , the ‘ VFI group ’ was given the VFI CD-ROM , and students self-trained with the software until they felt competent performing a virtual fibreoptic bronchoscopy on the normal patient models . Students were evaluated 2 weeks later on their first orotracheal fibreoptic intubation of an airway manikin . The primary endpoint was success , as evaluated by a staff anaesthesiologist blinded to the group of teaching . Fibreoptic intubation ability was the secondary endpoint . Results The fibreoptic intubation success rate was significantly higher in the VFI group than in the control group ( 81 versus 52 % , P < 0.05 ) . Among 10 failures in the control group , nine were due to oesophageal intubation as compared with only one out of four in the VFI group . Among four failures in the VFI group , three were because of taking longer than 4 min as compared with only one out of 10 in the control group . The VFI group tended towards better ability in the procedural skills of fibreoptic intubation than the control group . Conclusion Self-training in fibreoptic intubation with the VFI software may improve the acquisition of fibreoptic intubation skills Objective : To compare the effectiveness of an interprofessional within-team debriefing with that of an instructor-led debriefing on  team performance during a simulated crisis . Background : Although instructor-led simulation debriefing is considered the “ gold st and ard ” in team-based simulation education , cost and logistics are limiting factors for its implementation . Within-team debriefing , led by the individuals of the team itself rather than an external instructor , has the potential to address these limitations . Methods : One hundred twenty subjects were grouped into 40 operating room teams consisting of 1 anesthesia trainee , 1 surgical trainee , and 1 staff circulating operating room nurse . All teams managed a simulated crisis scenario ( pretest ) . Teams were then r and omized to either a within-team debriefing group or an instructor-led debriefing group . In the within-team debriefing group , the teams review ed the video of their scenario by themselves . 
    Output:
    
In three of these studies , simulation-enhanced CRM training was found significantly more effective than no intervention or didactic teaching .
Conclusions Based on a small number of studies , this systematic review found that CRM skills learned at the simulation centre are transferred to clinical setting s , and the acquired CRM skills may translate to improved patient outcomes , including a decrease in mortality .
Dans trois de ces études , la formation à la CRM soutenue par des simulations s’est avérée significativement plus efficace que l’absence d’intervention ou un enseignement didactique .
Conclusions Reposant sur un petit nombre d’études , cette analyse systématique a trouvé que les habiletés en matière de CRM apprises au centre de simulations sont transférées dans des cadres cliniques et que les habiletés acquises de CRM peuvent se traduire par une amélioration de l’évolution , y compris une baisse de la mortalité