***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: & NA ; To increase cardiopulmonary arrest survival , the American Heart Association developed basic and advanced cardiac life support ( ACLS ) courses that expose participants to realistic learning situations . This experimental study compared results of two ACLS classes on measures of knowledge ( content exam ) and resuscitation skills ( performance exam ) .  Both the control and experimental groups consisted of physicians , nurses , emergency medical technicians , respiratory therapists , and advanced health care providers . The control group used low‐fidelity simulation ( LFS ) ; the experimental group was exposed to enhanced realism via high‐fidelity simulation ( HFS ) . The findings showed a positive correlation between enhanced practice and learning but no significant correlation between posttest and skills test scores for the LFS and HFS groups . The HFS group did score higher on both cognitive and behavioral tests , but the difference was not statistically significant . Participants from both groups indicated satisfaction with their forms of simulation experience and course design . In addition , participants ' self‐confidence to care for a victim of cardiopulmonary arrest was increased after completing their course ; profession and work experience had no effect on responses . The largest difference noted was in verbal responses to course satisfaction . The experimental group stated that learning using HFS was enjoyable and adamantly recommended that ACLS should only be taught using HFS . Further study is required to assess if practicing beyond the course enhances short‐ and long‐term retention of ACLS techniques Background Virtual reality ( VR ) simulators and Web-based instructional videos are valuable supplemental training re sources in surgical programs , but it is unclear how to optimally integrate them into minimally invasive surgical training . Methods Medical students were r and omized to proficiency-based training on  VR laparoscopy and endoscopy simulators by two different methods : proctored training ( automated simulator feedback plus human expert feedback ) or independent training ( simulator feedback alone ) . After achieving simulator proficiency , trainees performed a series of laparoscopic and endoscopic tasks in a live porcine model . Prior to their entry into the animal lab , all trainees watched an instructional video of the procedure and were r and omly assigned to either observe or not observe the actual procedure before performing it themselves . The joint effects of VR training method and procedure observation on time to successful task completion were evaluated with Cox regression models . Results Thirty-two students ( 16 proctored , 16 independent ) completed  VR training . Cox regression modeling with adjustment for relevant covariates demonstrated no significant difference in the likelihood of successful task completion for independent versus proctored training [ Hazard Ratio ( HR ) 1.28 ; 95 % Confidence Interval ( CI ) 0.96–1.72 ; p = 0.09 ] . Trainees who observed the actual procedure were more likely to be successful than those who watched the instructional video alone ( HR 1.47 ; 95 % CI 1.09–1.98 ; p = 0.01 ) . Conclusions Proctored VR training is no more effective than independent training with respect to surgical performance . Therefore , time-consuming human expert feedback during VR training may be unnecessary . Instructional videos , while useful , may not be adequate substitutes for actual observation when trainees are learning minimally invasive surgical procedures Background With increasing pressure to use operating room time efficiently , opportunities for residents to learn fiberoptic orotracheal intubation in the operating room have declined . The purpose of this study was to determine whether fiberoptic orotracheal intubation skills learned outside the operating room on a simple model could be transferred into the clinical setting . Methods First-year anesthesiology residents and first- and second-year internal medicine residents were recruited . Subjects were r and omized to a didactic-teaching-only group ( n = 12 ) or a model-training group ( n = 12 ) . The didactic-teaching group received a detailed lecture from an expert bronchoscopist . The model-training group was guided , by experts , through tasks performed on a simple model design ed to refine fiberoptic manipulation skills . After the training session , subjects performed a fiberoptic orotracheal intubation on healthy , consenting , anesthetized , paralyzed female patients undergoing elective surgery with predicted “ easy ” laryngoscopic intubations . Two blinded anesthesiologists evaluated each subject . Results After the training session , the model group significantly outperformed the didactic group in the operating room when evaluated with a global rating scale ( P < 0.01 ) and checklist ( P < 0.05 ) . Model-trained subjects completed the fiberoptic orotracheal intubation  significantly faster than didactic-trained subjects ( P < 0.01 ) . Model-trained subjects were also more successful at achieving tracheal intubation than the didactic group ( P < 0.005 ) . Conclusion Fiberoptic orotracheal intubation skills training on a simple model is more effective than conventional didactic instruction for transfer to the clinical setting . Incorporating an extraoperative model into the training of fiberoptic orotracheal intubation may greatly reduce the time and pressures that accompany teaching this skill in the operating room BACKGROUND This study compares a laparoscopic skill training protocol without proficiency targets to the same protocol with explicit targets and notification of progress . METHODS Fourteen surgery interns were r and omized into 2 groups . The intervention group received task-specific proficiency criteria to guide practice . The control group did not . After training , participants were evaluated by blinded faculty during laparoscopic cholecystectomy . RESULTS The control group met significantly fewer of the 7 LapSim ( Surgical Science Sweden AB , Gotëborg ) targets ( mean = 1.14 ) than the intervention group ( mean = 7.00 ; P = .001 ) and significantly fewer of the 5 video trainer targets ( mean = .86 ) than the intervention group ( mean = 5.00 ; P = .001 ) . Ratings of depth perception , bimanual dexterity , efficiency , tissue h and ling , autonomy , and overall competence were higher for the intervention group . Effect sizes ranged from medium to large ( .394-.981 ) , indicating an impact of the proficiency-based training protocol . CONCLUSIONS Delineation of proficiency targets with reporting of progress improves interns ' practice results , and appears to have a positive effect on their early operating room ( OR ) performance of laparoscopic cholecystectomy Training on a video trainer or computer-based minimally invasive surgery trainer leads to improved benchtop laparoscopic skill . Recently , improved operative performance from practice on a video trainer was reported . The purpose of this study was three fold : ( a ) to compare psychomotor skill improvement after training on a virtual reality ( VR ) system with that after training on a video-trainer , ( VT ) ( b ) to evaluate whether skills learned on the one training system are transferable to the other , and ( c ) to evaluate whether VR or VT training improves operative performance . For the study , 50 junior surgery residents completed baseline skill testing on both the VR and VT systems . These subjects then were r and omized to either a VR or VT structured training group . After practice , the subjects were tested again on their VR and VT skills . To assess the effect of practice on operative performance , all second-year residents ( n = 19 ) were evaluated on their operative performance during a laparoscopic cholecystectomy before and after skill training . Data are expressed as percentage of improvement in mean score/time . Analysis was performed by Student 's paired t-test . The VR training group showed improvement of 54 % on the VR posttest , as compared with 55 % improvement by the VT group . The VR training group improved more on the VT posttest tasks ( 36 % ) than the VT training group improved on the VR posttest tasks ( 17 % ) ( p < 0.05 ) . Operative performance improved only in the VR training group ( p < 0.05 ) . Psychomotor skillsimprove after training on both VR and VT , and skills may be transferable . Furthermore , training on a minimally invasive surgery trainer , virtual reality system may improve operative performance during laparoscopic cholecystectomy BACKGROUND We have previously shown that reaching expert performance on an fundamentals of laparoscopic surgery (FLS)-type simulator model for laparoscopic suturing results in measurable improvement during an actual operation ; trained novices , however , demonstrate inferior operative performance compared with experts . We hypothesized that simulator training under more difficult and realistic conditions would enhance the operative performance of novices . STUDY DESIGN Medical students ( n=32 ) participated in an IRB-approved , r and omized , controlled trial . All participants were pretested in laparoscopic suturing on a previously vali date d porcine Nissen model and were r and omized into three groups : group I ( n=6 ) received no training , group II ( n=13 ) trained on the FLS videotrainer model until a previously published proficiency score ( 512 ) was achieved on 2 consecutive and 10 additional attempts , group III ( n=13 ) trained to the same goal but had to practice in a constrained space , with a shorter suture , starting with a dropped needle , and listening to operating room noise . Training workload was measured with the vali date d NASA-TLX ( Task Load Index ) question naire after each training session . All groups were posttested on the porcine model . Results were compared using ANOVA ; p < 0.05 was considered significant . RESULTS All group II and III participants reached the training goal . At posttesting , group II and group III participants performed similarly , but substantially better than group I did ( 210+/-140 versus 218+/-139 versus 0+/-0 , respectively ; p < 0.001 ) . Compared with group II , group III participants trained longer ( 329+/-71 minutes versus 239+/-69 minutes , p < 0.001 ) , performed more repetitions ( 81+/-15 versus 59+/-14 , p < 0.001 ) , and their workload improved less by the end of training ( 5 % versus 23 % , p < 0.001 ) . CONCLUSIONS Proficiency-based simulator training reliably results in improved operative performance . Although increasing the level of training difficulty increased trainees ' workload , the strategy we used in this study did not enhance their operative performance . Other methods for curriculum optimization are needed 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 PURPOSE Repetitive practice of laparoscopic suturing and knot tying can facilitate surgeon proficiency in performing this reconstructive technique . We compared a silicone model and pelvic trainer to a virtual reality simulator in the learning of laparoscopic suturing and knot tying by laparoscopically naïve medical students , and evaluated the subsequent performance of porcine laparoscopic cystorrhaphy . MATERIAL S AND METHODS A total of 20 medical students underwent a 1-hour didactic session with video demonstration of laparoscopic suturing and knot tying by an expert laparoscopic surgeon . The students were r and omized to a pelvic trainer ( 10 ) or virtual reality simulator ( 10 ) for a minimum of 2 hours of laparoscopic suturing and knot tying training . Within 1 week of the training session the medical students performed lapar 
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Pretraining and additional practice improved outcomes but , again , took longer .
Limited evidence suggests that mastery learning SBME is superior to nonmastery instruction but takes more time