***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 Colonoscopy insertion is difficult to teach due to the inability of current training models to provide realistic tactile sensation with simultaneous three-dimensional ( 3D ) colonoscope display . Aims To assess the influence of a simulator consisting of a colon model coupled with 3D instrument visualization on trainee colonoscopy performance . Methods Pilot study using the simulator model with three trainees who were not proficient in colonoscopy . At r and om times over a 6-week period , trainees participated in an individualized half-day session using the Colonoscope Training Model and a colonoscope equipped with a 3D magnetic probe imaging system ( ScopeGuide ) in six st and ardized cases . A blinded supervising instructor grade d patient-based colonoscopy performance over the 6-week period , and we independently analyzed the 2-week period before and after the intervention . We also measured cecal intubation and withdrawal times and medication requirements . Results Trainees performed 86 patient-based colonoscopies . Following the intervention , the colonoscopy performance score improved from 4.4 ± 2.3 to 5.9 ± 2.4 ( p = 0.005 ) . Trainees had a 76 % cecal intubation rate following the session as compared to 43 % before training ( p = 0.004 ) , while utilizing less time , 14 ± 7 versus 18 ± 11 min ( p = 0.056 ) and less medication ( p > 0.05 ) . Conclusions Colonoscopy simulation using the Colonoscope Training Model and the ScopeGuide produced an immediate and large effect on trainee  colonoscopy performance BACKGROUND Little is known regarding the value of esophagogastroduodenoscopy ( EGD ) simulators in education . The purpose of the present paper was to vali date the use of computer simulation in novice EGD training . METHODS In phase 1 , expert endoscopists evaluated various aspects of simulation fidelity as compared to live endoscopy . Additionally , computer-recorded performance metrics were assessed by comparing the recorded scores from users of three different experience levels . In phase 2 , the transfer of simulation-acquired skills to the clinical setting was assessed in a two-group , r and omized pilot study . The setting was a large gastroenterology ( GI ) Fellowship training program ; in phase 1 , 21 subjects ( seven expert , intermediate and novice endoscopist ) , made up the three experience groups . In phase 2 , eight novice GI fellows were involved in the two-group , r and omized portion of the study examining the transfer of simulation skills to the clinical setting . During the initial validation phase , each of the 21 subjects completed two st and ardized EDG scenarios on a computer simulator and their performance scores were recorded for seven parameters . Following this , staff participants completed a question naire evaluating various aspects of the simulator 's fidelity . Finally , four novice GI fellows were r and omly assigned to receive 6 h of simulator-augmented training ( SAT group ) in EGD prior to beginning 1 month of patient-based EGD training . The remaining fellows experienced 1 month of patient-based training alone ( PBT group ) . Results of the seven measured performance parameters were compared between three groups of varying experience using a Wilcoxon ranked sum test . The staffs ' simulator fidelity survey used a 7-point Likert scale ( 1 , very unrealistic ; 4 , neutral ; 7 , very realistic ) for each of the parameters examined . During the second phase of this study , supervising staff rated both SAT and PBT fellows ' patient-based performance daily . Scoring in each skill was completed using a 7-point Likert scale ( 1 , strongly disagree ; 4 , neutral ; 7 , strongly agree ) . Median scores were compared between groups using the Wilcoxon ranked sum test . RESULTS Staff evaluations of fidelity found that only two of the parameters examined ( anatomy and scope maneuverability ) had a significant degree of realism . The remaining areas were felt to be limited in their fidelity . Of the computer-recorded performance scores , only the novice group could be reliably identified from the other two experience groups . In the clinical application phase , the median Patient Discomfort ratings were superior in the PBT group ( 6 ; interquartile range [ IQR ] , 5 - 6 ) as compared to the SAT group ( 5 ; IQR , 4 - 6 ; P = 0.015 ) . PBT fellows ' ratings were also superior in Sedation , Patient Discomfort , Independence and Competence during various phases of the evaluation . At no point were SAT fellows rated higher than the PBT group in any of the parameters examined . CONCLUSION This EGD simulator has limitations to the degree of fidelity and can differentiate only novice endoscopists from other levels of experience . Finally , skills learned during EGD simulation training do not appear to translate well into patient-based endoscopy skills . These findings suggest against a key element of validity for the use of this computer simulator in novice EGD training BACKGROUND The efficacy of an intensive h and s-on training in endoscopic hemostasis on the compactEASIE simulator has been previously demonstrated in a r and omized prospect i ve trial . In the current study , we evaluated how quickly and effectively  new tutors  , without simulator training experience , are able to acquire teaching skills in endoscopic hemostasis . METHODS Five tutors with prior Erlangen Active Simulator for Interventional Endoscopy ( EASIE ) teaching experience instructed 7 endoscopists without prior EASIE experience on how to teach when using the model . These new tutors then independently conducted a workshop for 8 fellows in 4 hemostasis techniques . Results were compared with a historical control trained similarly by experienced tutors . Two one-day workshops in endoscopic hemostasis on the compactEASIE ex vivo endoscopy simulator were conducted in a category A hospital in New York City , New York . Skill scores at the end of training were compared with baseline skills assessment s , and qualitative ratings of the new tutors were obtained from both the trainees and the experienced tutors . RESULTS Significant improvement was achieved by the fellows in all 4 skills areas . Both the expert tutors and the trainees consistently rated the teaching skill of the new tutors highly . Fellows ' skill acquisition using new tutors was of similar magnitude to that achieved in the prior EASIE trial using experienced trainers teaching the fellows . CONCLUSIONS It is feasible to conduct an effective EASIE train-the-trainer course in one day . Tutors trained in this manner are able to provide a similar educational experience with objective improvement in trainee skill to experts who have conducted many h and s-on workshops Background and Study Aims Esophageal stricture dilatation has a significant morbidity and mortality and training can be difficult to obtain . The aim of the study was to investigate the face validity of a novel stricture simulation and evaluate its utility for training in balloon-dilatation technique . Methods Single-use stricture simulations were used to adapt a mechanical model for use in esophageal stricture dilatation . Face validity was evaluated using a question naire survey following a 40-min h and s-on training session . Performance improvement was evaluated as part of a r and omized blinded controlled trial . Results Face validity was established , with all trainees and instructors rating it as good or excellent overall and as adequately realistic or better in appearance . About 74 % found it fairly or very realistic to dilate and 91 % found it fairly or very useful for learning balloon-dilatation technique . Significant improvements in performance compared with controls were found following use of the simulation in a training episode . Conclusions The novel esophageal stricture simulation had good face validity and has been shown to improve performance when used for training in balloon-dilatation technique . Its use allows practice without risk to patients or the need for animal cadavers Background The hypothesis of this study is that working on the simulator without a structured feedback does not change performance ; hence , any effects shown after structured feedback would amount to useful learning of the procedure . The aim was to investigate the learning curve for the HT Immersion Medical Colonoscopy Simulator without any structured feedback . This could then be potentially applied to vali date the learning curve on the simulator when structured feedback is provided . There are no previous studies on this matter . Methods C and i date s were asked to perform colonoscopy on the HT Immersion Medical Colonoscopy Simulator . Modules 3 and 4 were used at r and om . In total , each c and i date was asked to perform five consecutive virtual colonoscopies on the same module . These five episodes were collectively referred to as one trial . A time result of 3,600 sec ( 1 h ) was used to denote perforation . No guidance or feedback was given to c and i date s before , during , or after each procedure . A total of 26 postgraduate doctors were recruited , including nine research fellows , five pre registration house officers , six specialist registrars , and six consultants . Fourteen c and i date s recorded five attempts each ( i.e. , one trial each ) on the same module of the colonoscopy simulator ( 14 trials over 70 episodes ) . Another 12 c and i date s recorded five attempts ( i.e. , one trial each ) on two modules of the colonoscopy simulator ( 24 trials over 120 episodes ) . Hence , 190 episodes were recorded in total , representing 38 trials . Results There was no improvement in performance on the simulator from first attempt to the fifth in the absence of feedback . If there was any initial gain in any measurable outcome , this was lost in subsequent attempts indicating lack of learning . The outcomes measured included time taken to complete the test , percentage of the mucosa visualized , depth of the instrument inserted , and the path length used . The results were statistically significant for all outcomes . Conclusions This study demonstrates that in the absence of feedback , it is not possible to improve performance on the HT Immersion Medical Colonoscopy Simulator . Thus , there is no learning curve for the machine . The information from this study is vital for using the simulators in training and assessment because any improvement in learning curves shown after training on simulators can be presumed to be due to learning the procedure and not the Background The Erlangen Active Simulator for Interventional Endoscopy ( EASIE ) using ex-vivo porcine organs was introduced in 1997 . The present study should analyze whether repeated EASIE simulator training in endoscopic hemostasis led to superior performance compared with a traditionally educated group . The results were compared with a similar project in New York . Methods Thirty-five French GI fellows were enrolled . Baseline skills evaluation was performed in four disciplines ( manual skills , injection/coagulation , clip application and variceal ligation ) using the compactEASIE-simulator equipped with an upper gastrointestinal organ package for bleeding simulation . The same , translated evaluation forms ( from the prior New York project ) were used . Subsequently , fellows were r and omized into group A ( n=17 , only clinical education ) and group B ( n=18 , additional three simulator trainings ) . Group B was trained the next day and after 4 and 7 months by experts of the French Society of Gastrointestinal Endoscopy . Both groups performed routine and emergency endoscopies at their home hospitals during the study period . Both groups were re-evaluated blindly after 9 months . Results The learning curve for group B showed a significant improvement in all disciplines ( P<0.004 ) whereas group A improved significantly in only two of four disciplines at blinded final evaluation ( manual skills P=0.02 , injection/coagulation P=0.013 ) . The direct comparison of groups B and A at blinded final evaluation showed significantly superior ratings for group B in all disciplines ( P<0.006 ) and significantly shorter performance times in two disciplines ( P=0.016 each ) . The comparison with the similar ‘ New York project ’ revealed that preexisting differences in skills were adjusted by the training . Conclusion Complementary trainings ( three workshops in 7 months ) in endoscopic hemostasis using the compactEASIE improved skills compared with a solely clinical education . The results of the ‘ New York project ’ were confirmed and benefits were independent from the medical educational system INTRODUCTION Colonoscopic simulators offer the opportunity for skill acquisition in the pre clinical setting . Currently available simulators vary widely with respect to level of fidelity and technological sophistication . Despite the belief that more realistic is better , there is a paucity of evidence regarding the relative effectiveness of simulator fidelity ( high vs low ) on the acquisition of basic colonoscopic skills . We hypothesized that novice learners can acquire basic colonoscopic skills using simulators , however fidelity of the simulator does not make a difference . METHODS We r and omly assigned novice third-year and fourth-year medical students to practice on either a low-fidelity or high-fidelity colonoscopy model . The low-fidelity model used is described in the module 16 of the American College of Surgeons/Association of Program Directors in Surgery surgical skills curriculum for residents , Phase 1 : basic or core skills and tasks < http://elearning.facs.org/mod/re source /view.php?1d=450 > . The high-fidelity model was the AccuTouch colonoscopy simulator , Immersion Medical ( AccuTouch CS ) that has 6 different simulated scenarios for diagnostic colonoscopy ( level 1 - 6 ) . Both groups had 16 students and were given st and ard instruction by an expert with respect to the procedure and instrument h and ling on both models . Both groups were pretested and posttested on level 1 of the AccuTouch CS . The high-fidelity group practice d on level 2 and 4 of the AccuTouch CS , whereas the low-fidelity group practice d on the low-fidelity model for 2 sessions of 1 hour each . The computer-based evaluation parameters available on the AccuTouch CS were used to compare performances . RESULTS Both groups had similar demographics . There were no significant differences in the baseline performances of either group . Each group demonstrated significant improvement for insertion time and percentage of mucosa visualized . However , there were no significant differences between the groups on posttesting on any of the measured parameters . CONCLUSIONS Colonoscopic skill training on a low-fidelity model appears to be as effective as high-fidelity model training for basic endoscopic skill acquisition 
    Output:
    
Simulation-based education in gastrointestinal endoscopy is associated with improved performance in a test setting and in clinical practice , and improved patient outcomes compared with no intervention .