***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 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 BACKGROUND Developing technical skill is essential to surgical training , but using the operating room for basic skill acquisition may be inefficient and expensive , especially for laparoscopic operations . This study determines if laparoscopic skills training using simulated tasks on a video-trainer improves the operative performance of surgery residents . STUDY DESIGN Second- and third-year residents ( n= 27 ) were prospect ively r and omized to receive  formal laparoscopic skills training  or to a control group . At baseline , residents had a vali date d global assessment of their ability to perform a laparoscopic cholecystectomy based on direct observation by three evaluators who were blinded to the residents ' r and omization status . Residents were also tested on five st and ardized video-trainer tasks . The training group practice d the video-trainer tasks as a group for 30 minutes daily for 10 days . The control group received no formal training . All residents repeated the video-trainer test and underwent a second global assessment by the same three blinded evaluators at the end of the 1-month rotation . Within-person improvement was determined ; improvement was adjusted for differences in baseline performance . RESULTS Five residents were unable to participate because of scheduling problems ; 9 residents in the training group and 13 residents in the control group completed the study . Baseline laparoscopic experience , video-trainer scores , and global assessment s were not significantly different between the two groups . The training group on average practice d the video-trainer tasks 138 times ( range 94 to 171 times ) ; the control group did not practice any task . The trained group achieved significantly greater adjusted improvement in video-trainer scores ( five of five tasks ) and global assessment s ( four of eight criteria ) over the course of the four-week curriculum , compared with controls . CONCLUSIONS Intense training improves video-eye-h and skills and translates into improved operative performance for junior surgery residents . Surgical curricula should contain laparoscopic skills training Objective : To assess the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills ( MISTELS ) physical laparoscopic simulator for construct and predictive validity and for its educational utility . Summary Background Data : MISTELS is the physical simulator incorporated by the Society of American Gastrointestinal and Endoscopic Surgeons ( SAGES ) in their Fundamentals of Laparoscopic Surgery ( FLS ) program . MISTELS ’ metrics have been shown to have high interrater and test-retest reliability and to correlate with skill in animal surgery . Methods : Over 200 surgeons and trainees from 5 countries were assessed using MISTELS in a series of experiments to assess the validity of the system and to evaluate whether practicing MISTELS basic skills ( transferring ) would result in skill acquisition transferable to complex laparoscopic tasks ( suturing ) . Results : Face validity was confirmed through question ing 44 experienced laparoscopic surgeons using global rating scales . MISTELS scores increased progressively with increasing laparoscopic experience ( n = 215 , P < 0.0001 ) , and residents followed over time improved their scores ( n = 24 , P < 0.0001 ) , evidence of construct validity . Results in the host institution did not differ from 5 beta sites ( n = 215 , external validity ) .  MISTELS scores correlated with a highly reliable vali date d intraoperative rating of technical skill during laparoscopic cholecystectomy ( n = 19 , r = 0.81 , P < 0.0004 ; concurrent validity ) . Novice laparoscopists were r and omized to practice /no practice of the transfer drill for 4 weeks . Improvement in intracorporeal suturing skill was significantly related to practice but not to baseline ability , career goals , or gender ( P < 0.001 ) . Conclusion : MISTELS is a practical and inexpensive inanimate system developed to teach and measure technical skills in laparoscopy . This system is reliable , valid , and a useful educational tool This study examined the impact of virtual reality ( VR ) surgical simulation on improvement of psychomotor skills relevant to the performance of laparoscopic cholecystectomy BACKGROUND To determine prospect ively if simulator-based laparoscopic training could improve laparoscopic skills of gynecology residents . STUDY DESIGN Twenty-six gynecology residents were enrolled in a  laparoscopy training curriculum involving didactics , self-paced learning modules , and grade d simulator-based laparoscopic training modules . Six simulator tasks were developed to introduce incremental levels of difficulty . Residents were tested on bead/peg manipulation , passing of a specially design ed " key , " cutting of lines and circles on a two-layer latex glove , and laparoscopic suturing followed by both intra- and extracorporeal knot tying .  Times for each task and penalties for errors were assessed at baseline and after 3 months of training . RESULTS Twenty-six residents completed initial baseline and 3-month evaluations . Average summary time ( including 30-seconds penalties for each error ) at baseline was 64 minutes and 36 minutes at 3-month evaluation ( p < 0.001 ) . For PGY1 baseline summary times averaged 83 minutes compared with 50 minutes at 3 months ( p = 0.006 ) . For PGY4 baseline summary times averaged 49 minutes compared with 28 minutes at 3 months ( p = 0.05 ) . All individual tasks demonstrated substantial improvement ( p < 0.001 ) from baseline to 3-month evaluation . Baseline summary scores demonstrated correlation between PGY training year and overall score ( p < 0.001 ) consistent with earlier ability and training . Three-month scores demonstrated equalization of skill level across PGY2 through PGY4 . CONCLUSIONS A dedicated simulator-based laparoscopic training curriculum has the ability to improve basic laparoscopic skills in a gynecologic residency , as measured by timed and scored simulator tasks . Construct validity was demonstrated by measuring substantial improvement in performance with increasing residency training , and with practice Background : To vali date the usefulness of virtual reality surgical simulators , we investigated the transfer of skills achieved by their use to real tasks . Methods : Thirty medical students underwent a pretest using a real laparoscopic trainer . They were then r and omized to the following three groups : group I received no training ; group II received training using the Minimal Invasive Surgical Trainer in Virtual Reality ( MIST-VR ) ; and group III received training using conventional training exercises . Each group then underwent a posttest . Using the Imperial College Surgical Assessment Device ( ICSAD ) , scores were generated for time taken , distance traveled , number of movements made , and speed of instrument movement . Results : Significant changes between the MIST-VR group ( group II ) and the conventionally trained group ( group III ) , were observed in the speed of movement of the left h and and the numbers of movements taken by each h and , when compared to the untrained group ( group I ) . Conclusion : The training of novices using MIST-VR yields quantifiable changes in skill that are transferable to a simple real task and are similar to the results achieved with conventional training Background The content validity of currently available inanimate simulation models is question able , because some tasks seem too far from clinical reality . The aim of this study was to vali date a simulation model with six tasks commonly used in clinical practice ( 6-TSM ) for the acquisition of psychomotor skills in minimally invasive surgery ( MIS ) . Methods This was a prospect i ve r and omized trial comparing the 6-TSM to a previously described three-task training method ( 3-TTM ) .  All first , second , and third postgraduate year surgical residents were eligible . The 6-TSM included clipping and dividing of a vessel , excision of lesion , appendectomy , mesh repair , suturing perforation , and h and -sewn anastomosis . The outcome measures of 6-TSM included accuracy error , tissue damage , sliding knot , leak , operating time , and dangerous movements . After completion of training , 6-TSM and 3-TTN residents were tested by the Minimally Invasive Surgical Trainer — Virtual Reality ( MIST-VR ) . Criterion-related and construct validity , responsiveness , test – retest , and interrater reliability were assessed . Results During six months , 17 residents underwent training with the 6-TSM or the 3-TTM as allocated . The mean duration of training with 6-TSM and 3-TTM was similar ( 7.8 vs 8.1 h ) . The criterion-related validity of the 6-TSM was shown by significantly increased skill improvement in the 6-TSM residents , as compared with the 3-TTM residents at MIST-VR . Construct validity the of 6-TSM was shown by the finding that the experts ’ baseline was superior to the residents ’ baseline . The responsiveness of the 6-TSM was shown by the significantly increased skill improvement of the 6-TSM  residents in sliding knot , leak , and operating time . The test – retest reliability of the 6-TSM was good ( > 0.80 ) , except for accuracy error and dangerous movements ( Cronbach ’s intraclass correlation coefficient α : 0.57 , p < 0.0001 ; 0.62 , p < 0.0001 , respectively ) . The interrater reliability of the 6-TSM was good ( > 0.80 ) except for leak ( Kendall ’s concordance coefficient tau_b:0.76 , p = 0.06 for h and -sewn anastomosis ) and dangerous movements ( tau_b:0.72 , p = 0.08 for suturing perforation and tau_b:0.68 , p = 0.10 for h and -sewn anastomosis ) . The perresident cost for 6-TSM was $ 769 . Conclusions The 6-TSM is a valid and reliable learning tool for surgical residents ’ acquisition of laparoscopic motor skills Objective : To determine if prior training on the LapMentor ™ laparoscopic simulator leads to improved performance of basic laparoscopic skills in the animate operating room environment . Summary Background Data : Numerous influences have led to the development of computer-aided laparoscopic simulators : a need for greater efficiency in training , the unique and complex nature of laparoscopic surgery , and the increasing dem and that surgeons demonstrate competence before proceeding to the operating room . The LapMentor ™ simulator is expensive , however , and its use must be vali date d and justified prior to implementation into surgical training programs . Methods : Nineteen surgical interns were r and omized to training on the LapMentor ™ laparoscopic simulator ( n = 10 ) or to a control group ( no simulator training , n = 9 ) . Subjects r and omized to the LapMentor ™ trained to expert criterion levels 2 consecutive times on 6 design ated basic skills modules . All subjects then completed a series of laparoscopic exercises in a live porcine model , and performance was assessed independently by 2 blinded review ers . Time , accuracy rates , and global assessment s of performance were recorded with an interrater reliability between review ers of 0.99 . Results : LapMentor ™ trained interns completed the 30 ° camera navigation exercise in significantly less time than control interns ( 166 ± 52 vs. 220 ± 39 seconds , P < 0.05 ) ; they also achieved higher accuracy rates in identifying the required objects with the laparoscope ( 96 % ± 8 % vs. 82 % ± 15 % , P < 0.05 ) . Similarly , on the two-h and ed object transfer exercise , task completion time for LapMentor ™ trained versus control interns was 130 ± 23 versus 184 ± 43 seconds ( P < 0.01 ) with an accuracy rate of 98 % ± 5 % versus 80 % ± 13 % ( P < 0.001 ) . Additionally , LapMentor ™ trained interns outperformed control subjects with regard to camera navigation skills , efficiency of motion , optimal instrument h and ling , perceptual ability , and performance of safe electrocautery . Conclusions : This study demonstrates that prior training on the LapMentor ™ laparoscopic simulator leads to improved resident performance of basic skills in the animate operating room environment . This work marks the first prospect i ve , r and omized evaluation of the LapMentor ™ simulator , and provides evidence that LapMentor ™ training may lead to improved operating room performance Objective : The aim of this study was to compare learning curves for laparoscopic cholecystectomy ( LC ) after training on a proficiency based virtual reality ( VR 
    Output:
    
The typical validation study comes from a single institution with a small sample size , lacks clear justification for task selection , omits reliability reporting , and poses potential bias in study design .