***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 explore the effect of training on  patient-actor perception of care during simulated obstetric emergencies . Method : A sub analysis from a prospect i ve r and omised controlled trial in six UK hospitals and the Bristol Medical Simulation Centre , UK . Midwives and doctors working in participating hospitals were eligible for inclusion . 140 participants ( 22 junior and 23 senior doctors , 47 junior and 48 senior midwives ) were r and omised to one of four obstetric emergency training  interventions : 1-day course at local hospitals ; 1-day course at simulation centre ; 2-day course with teamwork training at local hospitals ; and 2-day course with teamwork training at simulation centre . Local training used patient-actors and low-fidelity part-task trainers whereas simulation centre training used  full-bodied computerised manikins and high-fidelity part-task trainers . Three weeks before and after the training , the participants managed three simulated obstetric emergencies . Patient-actors scored their care after each simulation using a patient-actor perception score ( communication , safety , respect ) . Results : The following numbers of scores were awarded : 139 and 132 participant and 46 and 48 team scenarios , before and after training , respectively . There was a significant improvement in all scores in all scenarios after the training ( p = 0.017 to > 0.001 ) . Perception of safety and communication during postpartum haemorrhage was significantly improved following training with patient-actors compared with training with manikins ( safety p = 0.048 , communication p = 0.035 ) . Teamwork training offered no additional benefit to patient-actors ’ perception of their care . Conclusions : All multiprofessional training improved patient-actor perception of care . Training using a patient-actor may be better at improving perception of safety and communication than training with a computerised manikin simulator Objectives To determine the effect of  training residents in interpersonal and communication skills  on women ’s satisfaction with doctor – woman relationship in labour and delivery rooms . Design A stepped wedge cluster r and omised trial . Setting 4 tertiary care teaching maternity hospitals in Damascus , Syria . Participants 2000 women who gave birth to a living baby in the four study hospitals and consented to participate in the intervention took part in the study . Women with difficult labour and high-risk pregnancies were excluded . All were interviewed at home after discharge . Interventions A specially design ed training package in communication skills was delivered to all resident doctors at the four hospitals . Primary outcome measures The main outcome measure was women ’s satisfaction with interpersonal relationships in labour and delivery rooms measured via a series of questions on a Likert scale modified from the Medical Interview Satisfaction Scale . Results At the individual level , the mean for the average satisfaction score was 3.23 ( SD 0.72 ) of a possible score of 5 in the control group and 3.42 ( SD 0.73 ) in the intervention group . Using generalised linear mixed models , we were unable to detect a difference between the mean for the average satisfaction score of women in the intervention arm and that of women in the control arm ; the 95 % CI associated with the effect of the intervention ranged from –0.08 to 0.15 . Conclusions Despite slight changes in the observed residents ’ communication skills , the training package in communication skills does not seem to be associated with higher satisfaction scores of women . This raises the question of whether training individuals without further structural changes in the delivery of care and without further reinforcement of the training can have an impact on improving the quality of doctor – patient communication . Trial Registration Number IS RCT Background To assess the student perspective on acceptability , realism , and perceived effect of communication training with peer role play ( RP ) and st and ardised patients ( SP ) . Methods 69 prefinal year students from a large German medical faculty were r and omly assigned to one of two groups receiving communication training with RP ( N = 34 ) or SP ( N = 35 ) in the course of their paediatric rotation . In both groups , training addressed major medical and communication problems encountered in the exploration and counselling of parents of sick children .  Acceptability and realism of the training as well as perceived effects and applicability for future parent-physician encounters were assessed using six-point Likert scales . Results Both forms of training were highly accepted ( RP 5.32 ± .41 , SP 5.51 ± .44 , n.s . ; 6 = very good , 1 = very poor ) and perceived to be highly realistic ( RP 5.60 ± .38 , SP 5.53 ± .36 , n.s . ; 6 = highly realistic , 1 = unrealistic ) . Regarding perceived effects , participation was seen to be significantly more worthwhile in the SP group ( RP 5.17 ± .37 , SP 5.50 ± .43 ; p < .003 ; 6 = totally agree , 1 = do n't agree at all ) . Both training methods were perceived as useful for training communication skills ( RP 5.01 ± .68 , SP 5.34 ± .47 ; 6 = totally agree ; 1 = do n't agree at all ) and were considered to be moderately applicable for future parent-physician encounters ( RP 4.29 ± 1.08 , SP 5.00 ± .89 ; 6 = well prepared , 1 = unprepared ) , with usefulness and applicability both being rated higher in the SP group ( p < .032 and p < .009 ) . Conclusions RP and SP represent comparably valuable tools for the training of specific communication skills from the student perspective . Both provide highly realistic training scenarios and warrant inclusion in medical curricula . Given the expense of SP , deciding which method to employ should be carefully weighed up . From the perspective of the students in our study , SP were seen as a more useful and more applicable tool than RP . We discuss the potential of RP to foster a greater empathic appreciation of the patient perspective 
    Output:
    
The study from Syria reported that a communication skills training intervention for resident doctors was not associated with higher satisfaction reported by women .
In the UK study , patient-actors ' ( experienced midwives ) perceptions of safety and communication significantly improved for postpartum haemorrhage scenarios after training with patient-actors in local hospitals , compared with training using manikins in simulation centres , but no differences were identified for other scenarios .
KEY CONCLUSIONS AND IMPLICATION S FOR PRACTICE the review identified a lack of evidence on impact of interventions to support effective communication between maternity care staff and healthy women during labour and birth .
Very low quality evidence was found on effectiveness of communication training of maternity care staff .