***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: CONTEXT Despite evidence that a variety of continuing medical education ( CME ) techniques can foster physician behavioral change , there have been no r and omized trials comparing performance outcomes for physicians participating in Internet-based CME with physicians participating in a live CME intervention  using approaches documented to be effective . OBJECTIVE To determine if Internet-based CME can produce changes comparable to those produced via live , small-group , interactive CME with respect to physician knowledge and behaviors that have an impact on patient care . DESIGN , SETTING , AND PARTICIPANTS R and omized controlled trial conducted from August 2001 to July 2002 . Participants were 97 primary care physicians drawn from 21 practice sites in Houston , Tex , including 7 community health centers and 14 private group practice s. A control group of 18 physicians from these same sites received no intervention .  INTERVENTIONS Physicians were r and omly assigned to an Internet-based CME intervention that could be completed in multiple sessions over 2 weeks , or to a single live , small-group , interactive CME workshop . Both incorporated similar multifaceted instructional approaches demonstrated to be effective in live setting s. Content was based on the National Institutes of Health National Cholesterol Education Program -- Adult Treatment Panel III guidelines . MAIN OUTCOME MEASURES Knowledge was assessed immediately before the intervention , immediately after the intervention , and 12 weeks later . The percentage of high-risk patients who had appropriate lipid panel screening and pharmacotherapeutic treatment according to guidelines was documented with chart audits conducted over a 5-month period before intervention and a 5-month period after intervention . RESULTS Both interventions produced similar and significant immediate and 12-week knowledge gains , representing large increases in percentage of items correct ( pretest to posttest : 31.0 % [ 95 % confidence interval { CI } , 27.0%-35.0 % ] ; pretest to 12 weeks : 36.4 % [ 95 % CI , 32.2%-40.6 % ] ; P<.001 for all comparisons ) . Chart audits revealed high baseline screening rates in all study groups ( > or = 93 % ) with no significant postintervention change . However , the Internet-based intervention was associated with a significant increase in the percentage of high-risk patients treated with pharmacotherapeutics according to guidelines ( preintervention , 85.3 % ; postintervention , 90.3 % ; P = .04 ) . CONCLUSIONS Appropriately design ed , evidence -based online CME can produce objective ly measured changes in behavior as well as sustained gains in knowledge that are comparable or superior to those realized from effective live activities Purpose To evaluate a five-year experience ( 1995–2000 ) developing and integrating computer cases into a required clerkship . Method In Study 1 , 54 volunteer students were r and omly assigned to study articles , a paper case  , or a  computer case on low back pain/kidney stones . Students were given an exam immediately after the exercise and one week later . In Study 2 , 325 clerkship students were asked to select and complete two computer cases or to prepare assignments on unrelated topics . Among the cases offered were two test cases on low back pain/kidney stones and pneumonia . Questions specific to the computer test cases ( CC ) and other noncomputer cases ( NCC ) were in the final exam . Exam scores related to CC questions and NCC questions were compared between the groups of students who did and did not complete the computer cases . Students also rated the  computer cases  on a question naire . Results In Study 1 , reading articles required the most time and received the most negative comments . The students who completed the computer case scored the best on the exam one week later . In Study 2 , the students who completed the two computer cases scored significantly higher on the CC questions than did students who studied only one or none of the computer cases ( p < .001 ) . There was no difference among groups for the NCC scores ( p = .76 ) . Students rated the computer cases  with a mean of 6 on a seven-point scale ( 7 = strongly agree ) . Conclusion Computer cases are effective learning tools , are well-received by students , and can be successfully integrated into existing clerkships INTRODUCTION The use of computer-generated 3-dimensional ( 3-D ) anatomical models to teach anatomy has proliferated . However , there is little evidence that these models are educationally effective . The purpose of this study was to test the educational effectiveness of a computer-generated 3-D model of the middle and inner ear . METHODS We reconstructed a fully interactive model of the middle and inner ear from a magnetic resonance imaging scan of a human cadaver ear . To test the model 's educational usefulness , we conducted a r and omised controlled study in which 28 medical students completed a Web-based tutorial on ear anatomy that included the interactive model , while a control group of 29 students took the tutorial without exposure to the model .  At the end of the tutorials , both groups were asked a series of 15 quiz questions to evaluate their knowledge of 3-D relationships within the ear . RESULTS The intervention group 's mean score on the quiz was 83 % , while that of the control group was 65 % . This difference in means was highly significant ( P < 0.001 ) . DISCUSSION Our findings st and in contrast to the h and ful of previous r and omised controlled trials that evaluated the effects of computer-generated 3-D anatomical models on learning . The equivocal and negative results of these previous studies may be due to the limitations of these studies ( such as small sample size ) as well as the limitations of the models that were studied ( such as a lack of full interactivity ) . Given our positive results , we believe that further research is warranted concerning the educational effectiveness of computer-generated anatomical models Background : Although animations may intuitively seem more effective than static graphics for teaching , there is no clear-cut evidence for the superiority of simple computer-based animations in medical education . Aims : We investigated whether simple animations are better than static graphics as an aid to medical students in learning home safety assessment , an important part of geriatric curriculum . Methods : We used two versions of an interactive online module , one that depicted common home safety issues in static graphics and the other in animations .  We r and omized first-year medical students who agreed to participate into two groups . After the module , students completed a cognitive burden scale and a st and ardized competency assessment test in which they had to identify the salient home safety issues and give recommendations based on the hazards . We also captured time spent on task . Results and conclusions : We found no significant differences between the groups in the cognitive burden level , competency assessment scores , and time spent on task . The much cheaper-to-produce static graphics were equally effective as simple animations in this medical education scenario BACKGROUND Video-based instructions for clinical procedures have been used frequently during the preceding decades . AIM To investigate in a r and omised controlled trial the learning effectiveness of fragmented videos vs. the complete sequential video and to analyse the attitudes of the user towards video as a learning aid . MATERIAL S AND METHODS An instructional video on surgical h and wash was produced . The video was available in two different forms in two separate web pages : one as a sequential video and one fragmented into eight short clips .  Twenty-eight dental students in the second semester were r and omised into an experimental ( n = 15 ) and a control group ( n = 13 ) . The experimental group used the fragmented form of the video and the control group watched the complete one . The use of the videos was logged and the students were video taped whilst undertaking a test h and wash . The videos were analysed systematic ally and blindly by two independent clinicians . The students also performed a written test concerning learning outcome from the videos as well as they answered an attitude question naire . RESULTS The students in the experimental group watched the  video significantly longer than the control group . There were no significant differences between the groups with regard to the ratings and scores when performing the h and wash . The experimental group had significantly better results in the written test compared with those of the control group . There was no significant difference between the groups with regard to attitudes towards the use of video for learning , as measured by the Visual Analogue Scales . Most students in both groups expressed satisfaction with the use of video for learning . CONCLUSION The students demonstrated positive attitudes and acceptable learning outcome from viewing CAL videos as a part of their pre- clinical training . Videos that are part of computer-based learning setting s would ideally be presented to the students both as a segmented and as a whole video to give the students the option to choose the form of video which suits the individual student 's learning style OBJECTIVE To determine the impact of adding audio-feed to an online lecture on screening given to medical students who were participating in an outpatient clerkship . DESIGN Prospect i ve , r and omised , controlled study . SETTING V and erbilt University School of Medicine , Nashville and Wake Forest Medical School , Winston-Salem . PARTICIPANTS A total of 59 Years 3 and 4 medical students . MAIN OUTCOME MEASURES Students ' use of time , satisfaction with the lecture experience , and knowledge . Educational intervention The online lecture was developed at V and erbilt University . At V and erbilt , 16 Year 4 medical students were r and omised to the lecture on screening with audio and 17 Year 4 medical students were r and omised to the same lecture without audio . At Wake Forest , 13 Year 3 medical students were r and omised to the lecture on screening with audio and 13 Year 3 students were r and omised to the same lecture without audio . RESULTS The audio lecture required 20 more minutes to complete than the non-audio lecture . Students in the audio group were more satisfied with their experience than students in the non-audio group . Students in the audio-feed group achieved a trend for higher post-intervention knowledge scores , with the difference attributed to the students at V and erbilt . CONCLUSION Audio narration is an important aspect of an online lecture . The distribution of online lectures to students at different sites and different training levels requires further study Purpose To determine whether internal medicine residents prefer learning from Web-based ( WB ) modules or printed material , and to compare the effect of these teaching formats on knowledge . Method The authors conducted a r and omized , controlled , crossover study in the internal medicine resident continuity clinics of the Mayo School of Graduate Medical Education during the 2002–03 academic year . Participants studied two topics of ambulatory medicine using WB modules and two topics using paper practice guidelines in r and omly assigned sequences . Primary outcomes were format preference ( assessed by an end-of-course question naire ) and score changes from pre- to postintervention tests of knowledge . Results A total of 109 consented and 75 ( 69 % ) completed the postintervention test . Fifty-seven of 73 ( 78 % “ 95 % CI , 67–86 % ” ) preferred the WB format ( p < .001 ) . Test scores improved for both formats ( 67.7 % to 75.0 % for WB , 66.0 % to 73.3 % for paper ) , but score change was not different between formats both before ( p = .718 ) and after ( p = .080 ) adjusting for topic , clinic site , study group , postgraduate year , and gender . Residents spent less time on WB modules ( mean = 47 ± 26 minutes ) than paper ( mean = 59 ± 35 , p = .024 ) . Difficulties with passwords limited their use of WB modules for 71 % ( 59–80 % ) of residents . Conclusion No difference was found between WB and paper-based formats in knowledge-test score change , but residents preferred learning with WB modules and spent less time doing so . Passwords appeared to impede use of WB modules . WB learning is effective , well accepted , and efficient . Research should focus on aspects of WB instruction that will enhance its power as a learning tool and better define its role in specific setting Multimedia instruction offers many potential advantages over traditional methods of instruction . Multimedia programs can interact with the learner , use graphic images , sound , and video , and keep track of progress . Students complete programs at their own pace while accessing material both at school and at home . Multimedia instruction can provide an interactive alternative to lectures and textbooks by quizzing the student over concepts as they are presented and requiring that the student think about the material before proceeding . While several studies have found that multimedia instruction can be more efficient by reducing instructor and classroom time , few have been able to show an increase in learning when compared with traditional methods of instruction . Santer and colleagues compared a multimedia textbook with a lecture presentation on the same material and found an increase in the post-test scores of the multimedia group , but no difference when they compared the multimedia group with a group using a printed textbook . Studies comparing multimedia and traditional approaches to learning in the areas of psychology and computer science instruction suggest an improvement in students ’ performances using the multimedia versions . Thus , there is a need for well- design ed studies to determine whether multimedia instruction more effectively facilitates students ’ learning — including medical students ’ learning — than do traditional methods . Multimedia instruction is particularly well suited to help students learn physical diagnosis . Sound , pictures , and movies augment the learning of examination skills and diagnosis findings by allowing students to hear heart and lung sounds , watch videos of physical examination procedures , and see more pictures of pathologic findings than can be included in a textbook or lecture . These visual and audio aids should increase students ’ recognition of these findings when encountered in patients . We wished to test whether a Web-based multimedia program using interactive learning and virtual reality would be more efficient and effective than traditional print-based self- study by medical students . To accomplish this , we design ed a course on physical examination of the eye and ear . Using this material , we conducted a controlled study of first-year medical students to determine whether having students use a multimedia version of the course result ed in a change in the time spent with the material and an increase in knowledge gained when compared with having students study a printed version of the same material OBJECTIVES A case-based , worked example approach was realised in a computer-based learning environment with the intention of facilitating medical students ' diagnostic knowledge . In order to enhance the effectiveness of the approach , two additional measures were implemented : erroneous examples and elaborated feedback . In the context of an experimental study , the two measures were varied experimentally . METHODS A total of 153 medical students were r and omly assigned to four experimental conditions of a 2 x 2-factor design ( errors versus no errors , elaborated feedback 
    Output:
    
Other studies revealed that audio narration , video clips , interactive models , and animations increase learning time but also facilitate higher knowledge and /or satisfaction .
Conclusions On average , Internet-based instruction and non-computer instruction require similar time .
Instructional strategies to enhance feedback and interactivity typically prolong learning time , but in many cases also enhance learning outcomes .
Isolated examples suggest potential for improving efficiency in Internet-based instruction