***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 : We evaluated the effectiveness of five training methods -four structured and one unstructured-for teaching intracorporeal knot tying . Methods : Forty-three graduate students without prior laparoscopic experience were r and omly assigned to one of five training groups , and their performance in 10 intracorporeal knot tying trials was evaluated , using time to complete a knot as the outcome measure . Results : The average knot tying times for the four structured groups were significantly faster than the unstructured group ( p < 0.0001 ) . AMONG THE FOUR STRUCTURED GROUPS , THE MINIMALLY INVASIVE SURGICAL TRAINER-VIRTUAL REALITY ( MIST-VR ) AND THE BOX TRAINER DRILLS SHOWED THE MOST RAPID IMPROVEMENTS . THE MIST-VR IMPROVED AVERAGE SUTURING TIME FROM TRIAL ONE TO TRIAL TWO ( P = 0.05 ) , THE BOX TRAINER DRILLS GROUP IMPROVED FROM TRIAL ONE TO TRIAL FOUR ( P = 0.01 ) , AND THE OTHER TWO GROUPS SHOWED SLOWER IMPROVEMENTS . STATISTICALLY SIGNIFICANT CORRELATIONS WERE OBSERVED BETWEEN SCORES ON MIST-VR TASKS AND AVERAGE KNOT TYING TIMES ( R > 0.7 , p < 0.05 ) . Conclusion : Structured training can be useful for the development of laparoscopic skills . MIST-VR is a valuable part of this training , particularly in the objective evaluation of performance OBJECTIVE To evaluate construct and content validity as well as learners ' perceptions of CathSim , a virtual reality intravenous ( IV ) insertion simulator . METHODS A prospect i ve cohort study design was employed to determine construct validity , and a participant survey was used to ascertain content validity as well as user perceptions of CathSim .  Forty-one attendings , residents , and medical students in emergency medicine and anesthesia attempted five simulated IV insertions on CathSim .  Subject performances were scored by the computer , and subject perceptions of the simulator were measured using a Likert scale question naire ( 1 = worst rating ; 5 = best rating ) . The subjects were divided into three groups ( novices , intermediates , and experts ) based on previous IV experience . To determine construct validity , performances of the three groups were compared using one-way analysis of variance ( ANOVA ) . To determine content validity , the experts ' perceptions of the simulator 's realism and usefulness were assessed . Study subjects ' perceptions of the simulator 's ease of use and overall appeal were analyzed . RESULTS The experts scored better than the others in five of nine scoring parameters ( p < 0.05 ) . The experts rated the realism of CathSim 's four major simulation components at 3.85 , 3.46 , 3.69 , and 3.46 ; the overall realism of CathSim  at 2.93 ; and its utility for medical student training at 4.57 . The simulator 's ease of use was rated at 2.34 by all subjects . Novices reported a score of 4.59 regarding their likelihood to use the simulator . CONCLUSIONS CathSim demonstrated construct validity in five of nine internal scoring parameters and was judged to be adequately realistic and highly useful for medical student training . Despite being difficult to learn to use , it remained appealing to the users , especially the novices BACKGROUND We hypothesized that the Minimally Invasive Surgery Trainer ( MIST-VR ; VP Medical R , London , U.K. ) would be as effective as the Yale Laparoscopic Skills Course in improving laparoscopic intracorporeal suturing skills . MATERIAL S AND METHODS Each student made six attempts to tie a knot laparoscopically . Students were then r and omized to train on the MIST-VR for five sessions ( six skills/session ) or the Yale Skills  for five sessions ( three skills/session ) over 5 days . On completion of training , all students were evaluated by a test consisting of six attempts to tie a laparoscopic knot . RESULTS The percentage improvement in knot tying time did not differ significantly in the pelvic trainer group ( 30 + /- 21 % ) ( from 443 + /- 135 to 311 + /- 137 seconds ) and the MIST-VR group ( 39 + /- 21 % ) ( from 409 + /- 109 to 256 + /- 140 seconds ) ( P = 0.308 ) . CONCLUSIONS The MIST-VR is equivalent to the Yale Skills Course for training in the advanced laparoscopic skill of intracorporeal suturing An interactive , self- study learning system for airway management instruction that utilizes a “ sensorized ” manikin head ( Actronics Inc. , Pittsburgh , PA ) was compared to didactic instruction from anesthesiologists during third-year medical student anesthesia rotations . Before students were allowed to participate in airway management on anesthetized patients , they were r and omly separated into two groups . One group received instruction from the learning system , and the other group was given a lecture with guided practice on a st and ard tracheal intubating manikin . Differences between groups were then assessed using 22 separate variables as all students performed actual airway management on patients undergoing general anesthesia . Anesthesia faculty , residents , and nurse anesthetists , blinded to group , served as assessors . There were 48 and 49 students in the didactic instruction and learning system groups , respectively . Beginning experience level of students with respect to airway management was similar between groups before the anesthesia rotations . There were 185 and 188 evaluation forms completed to assess the didactic instruction and learning system groups , respectively . Demographic data regarding patients were recorded . Patients in the learning system group on whom students performed airway management were older , had a larger average body mass index , and their airways more frequently received higher Mallampati classifications ( glottic structures more difficult to visualize ) . No difference in the quality of airway management efforts or in students ' appraisal of their own performances was seen between groups . Neither group demonstrated more rapid development of psychomotor skills . Students were equally satisfied with both methods of instruction . We conclude that the airway management self- study learning system is as efficacious as didactic instruction for pre clinical airway management instruction during third-year medical student anesthesia rotations To determine the accuracy of the cardiovascular physical examination for the diagnosis of asymptomatic valvular heart disease ( VHD ) , we prospect ively studied 143 subjects , 68 apparent normal subjects and 75 patients with diseases known to produce VHD . All subjects underwent a complete physical examination with dynamic cardiac auscultation by a physician blinded to clinical data and compared with the results of transesophageal color Doppler echocardiography ( TEE ) . By TEE , 33 subjects ( 23 % ) , and by physical examination , 25 subjects ( 17 % ) had at least 1 form of VHD . Despite a high frequency of mild valve abnormalities and a 31 % prevalence of functional murmurs , the physical examination showed a sensitivity of 70 % , a specificity of 98 % ( confidence interval = 0.51 to 0.84 , and 0.94 to 0.99 , respectively ) , and a positive and negative predictive value of 92 % for the diagnosis of VHD . Only 2 of the 10 patients with VHD by TEE , but not by physical examination , had clinical ly important VHD . We conclude that the physical examination is a sensitive and highly specific method of screening for VHD in subjects without cardiac symptoms . Therefore , its use should be encouraged rather than the routine application of echocardiography INTRODUCTION The human patient simulator has proved to be an effective educational device for teaching physicians and paramedical personnel . METHODOLOGY To determine whether veterinary medicine students would benefit from similar educational sessions , 90 students each took a turn being the patient 's clinician as real-life scenarios were played out on the simulator . The students induced and maintained anesthesia on their patient and monitored vital signs . Several critical events were presented for the students to diagnose and treat as they occurred . All students su bmi tted a written evaluation of the course upon completion . The last 40 students were r and omly divided into two groups of 20 students each . The students in Group I experienced the simulator before their clerkship examination , and those in Group II took the examination before their simulator experience . RESULTS The students rapidly gained confidence in treating their simulated patient . This carried over to the clinical setting , where they appeared to be more confident when anesthetizing live patients . The simulator experience brought together much of the previous didactic material that they had been exposed to so they could appreciate its clinical relevance . The overwhelming response to the simulator experience was positive . The students in Group I had a significantly higher score on the clerkship examination dealing with concepts review ed by simulation than those in Group II , who engaged in self- study instead of the simulation exercise ( p < 0.001 ) . CONCLUSION We conclude that the human patient simulator was a valuable learning tool for students of veterinary medicine . It was exciting for the students to work with , made them deal with " real-life " scenarios , permitted them to learn without subjecting live patients to complications , enabled them to retrace their steps when their therapy did not correct the simulated patient 's problems , and facilitated correlation of their basic science knowledge with clinical data , thus accelerating their ability to h and le complex clinical problems in healthy and diseased patients Abstract Background : Laparoscopic skill was measured objective ly through a series of seven tasks in an inanimate laparoscopic simulator . Seven analogous skills were tested in an in vivo porcine model . These skills included transferring , cutting , clipping , placement of a ligating loop , mesh placement , and suturing with an intracorporeal and extracorporeal knot . Scoring of each task rewarded precision and speed . Methods : Twelve PGY3 residents were given a baseline evaluation in the simulator and in the animal model . They were then r and omized to either five practice sessions in the simulator ( group A ) or no practice ( group B ) . Each group was retested in the simulator and in the animal ( final test ) . Scores in vivo were compared by t-test for baseline versus final evaluation for each group . Linear regression analysis was used to correlate in vivo and in vitro scores for each task and for the total score ( sum of all scores ) . Results : Group A showed significant improvement in performance in vivo for cutting , clipping , mesh placement , and suturing with an intracorporeal and extracorporeal knot , as well as in the total score ( p < 0.05 ) . Group B showed significant improvement in suturing with an intracorporeal and extracorporeal knot , and in the total score . The magnitude of improvement from baseline to final evaluation was significantly greater for group A ( p < 0.05 ) . There was significant correlation between in vitro and in vivo total scores and the score for each task ( p < 0.05 ) except for placement of the ligating loop and mesh . Conclusions : Performance in an in vitro laparoscopic simulator correlated significantly with performance in an in vivo animal model . Practice in the simulator result ed in improved performance in vivo Abstract Background : The fulcrum effect of the body wall on instrument h and ling poses a major obstacle to the mastery of instrument coordination for junior laparoscopic surgeons . This study evaluated three types of laparoscopic simulator training to assess their ability to promote the user 's adaptation to the fulcrum effect . Methods : Thirty-two participants with no previous experience in laparoscopic surgery were r and omly assigned to one of four groups representing different training conditions . One group was assigned to use a virtual reality simulator ( MIST VR ) ; two others were given a laparoscopic Z or U maze-tracking task . The control group received no training . Subjects were asked to perform a 2-min laparoscopic cutting task under normal laparoscopic imaging conditions first before and then after training . Results : In the test trial , subjects who trained on MIST VR made significantly more correct incisions ( p < 0.0001 ) and fewer incorrect incisions ( p < 0.0001 ) . Conclusion : Training on a virtual reality simulator such as MIST VR helps laparoscopic novices adapt to the fulcrum effect faster OBJECTIVE To evaluate the effectiveness of an educational intervention on pediatric residents ' resuscitation fund of knowledge , technical skills , confidence , and overall performance . DESIGN Prospect i ve , nonconcurrent , controlled interventional trial . SETTING Urban pediatric tertiary care hospital . PARTICIPANTS An intervention group ( IG ) of 28 pediatric residents graduating in 1997 , and a control group ( CG ) of 30 pediatric residents graduating in 1996 . INTERVENTIONS Resuscitation course with didactic lectures and skills practice stations , as well as a minimum of 3 practice mock resuscitations with immediate feedback throughout postgraduate year 3 . MAIN OUTCOME MEASURES Fund of knowledge , using the Pediatric Advanced Life Support test and short answer test ; technical skills , using the Airway and Vascular Access Skills Assessment ; experience and confidence , using an anonymous survey ; and overall performance , evaluated using a videotaped mock resuscitation test . RESULTS The IG scored better on the short answer test ( P<.001 ) . A larger number of IG residents were successful in the completion of ancillary airway maneuvers and femoral vascular access ( P = .02 ) , as well as endotracheal intubation ( P = .004 ) and intraosseous access ( P = .002 ) . The IG was more confident in their leadership role ( P = .0001 ) and technical skills ( P = .05 ) . Trends toward improved overall performance were noted for the IG mock resuscitations . Residents in the IG were more likely to assess the airway in fewer 
    Output:
    
The weight of the best available evidence suggests that high-fidelity medical simulations facilitate learning under the right conditions .
CONCLUSIONS While research in this field needs improvement in terms of rigor and quality , high-fidelity medical simulations are educationally effective and simulation-based education complements medical education in patient care setting