***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 compare the effectiveness of traditional and online teaching methods for educating anesthesiology residents in the principles and practice of difficult airway management . Design Prospect i ve , r and omized , controlled trial . Setting University hospital . Participants Two r and omly selected groups , each containing 28 physicians enrolled from among residents in Anesthesiology and Intensive Care Medicine in Italy . Interventions Residents in Group 1 took a traditional 5-h course on the principles and practice of airway management , which included lectures , slide projection , and dummy demonstrations . The same material was presented to Group 2 in an exclusively online format , which could be individually accessed for a period of 36 h. In the online course , student-instructor interaction was provided through threaded discussion forums during three 30-min real-time question - and -answer sessions . Measurements and results Differences in baseline and post-course scores on written tests and practical skills tests were measured . Knowledge gains in Group 2 were slightly , but not significantly , greater compared with Group 1 both in written ( P=0.228 ) and practical skills ( P=0.376 ) tests . Semi-quantitative ratings of learner satisfaction were significantly higher in the online group ( P=0.014 ) . Almost all online students ( 93 % ) were logged in for at least 45 of the 90 min of real-time question - and -answer sessions . The four instructors spent an average of 144±10 min preparing answers and interacting with online students . Conclusions Online teaching formats may be a valid alternative for teaching residents the principles and practice of difficult airway management . Interaction with instructors seems to be an important element , but it may require substantial time commitments by instructors OBJECTIVES Asynchronous e-learning allows for targeted teaching , particularly advantageous when bedside and didactic education is insufficient . An asynchronous e-learning curriculum has not been studied across multiple centers in the context of a clinical rotation . We hypothesize that an asynchronous e-learning curriculum during the pediatric emergency medicine ( EM ) rotation improves medical knowledge among residents and students across multiple participating centers . METHODS Trainees on pediatric EM rotations at four large pediatric centers from 2012 to 2013 were r and omized in a Solomon four-group design . The experimental arms received an asynchronous e-learning curriculum consisting of nine Web-based , interactive , peer- review ed Flash/HTML5 modules .  Postrotation testing and in-training examination ( ITE ) scores quantified improvements in knowledge . A 2 × 2 analysis of covariance ( ANCOVA ) tested interaction and main effects , and Pearson 's correlation tested associations between module usage , scores , and ITE scores . RESULTS A total of 256 of 458 participants completed all study elements ; 104 had access to asynchronous e-learning modules , and 152 were controls who used the current education st and ards .  No pretest sensitization was found ( p = 0.75 ) . Use of asynchronous e-learning modules was associated with an improvement in posttest scores ( p < 0.001 ) , from a mean score of 18.45 ( 95 % confidence interval [ CI ] = 17.92 to 18.98 ) to 21.30 ( 95 % CI = 20.69 to 21.91 ) , a large effect ( partial η(2 ) = 0.19 ) . Posttest scores correlated with ITE scores ( r(2 ) = 0.14 , p < 0.001 ) among pediatric residents . CONCLUSIONS Asynchronous e-learning is an effective educational tool to improve knowledge in a clinical rotation . Web-based asynchronous e-learning is a promising modality to st and ardize education among multiple institutions with common curricula , particularly in clinical rotations where scheduling difficulties , seasonality , and variable experiences limit in-hospital learning OBJECTIVE : To determine the effectiveness of a quality improvement program to improve pediatricians ' adherence to existing , evidence -based , attention-deficit/hyperactivity disorder ( ADHD ) practice guidelines . METHODS : Forty-nine community-based pediatricians at 8 practice s participated in a cluster-r and omized trial . Practice s were matched according to the numbers of pediatricians and the proportions of patients receiving Medicaid . The medical charts for a r and om sample of patients with ADHD for each of the participating pediatricians were examined at baseline and 6 months . All practice s participated in 4 sessions of training , including didactic lectures and office flow modification workshops . Practice s were then given access to an ADHD Internet portal that allowed parents , teachers , and pediatricians to input information ( eg , rating scales ) about patients , after which information was scored , interpreted , and formatted in a report style that was helpful for assessment and treatment of patients with ADHD . Physicians evaluated their practice behaviors quarterly and addressed underperforming areas . RESULTS : Pediatricians in the intervention group , compared with those in the control group , demonstrated significantly higher rates of many American Academy of Pediatrics – recommended ADHD care practice s , including collection of parent ( Cohen 's d = 0.69 ) and teacher ( d = 0.68 ) rating scales for assessment of children with ADHD , use of Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , criteria ( d = 0.85 ) , and use of teacher rating scales to monitor treatment responses ( d = 1.01 ) . CONCLUSION : A quality improvement intervention that can be widely disseminated by using Internet-based information technology significantly improved the quality of ADHD care in community-based pediatric setting BACKGROUND AND OBJECTIVES Cultural competency education is an important and required part of undergraduate medical education . The objective of this study was to evaluate whether an online cross-cultural communication module could increase student use of cross-cultural communication questions that assess the patient 's definition of the problem , the way the problem affects their life , their concerns about the problem , and what the treatment should be ( PACT ) . METHODS We used multi- method assessment of students assigned to family medicine clerkship blocks that were r and omized to receive online cultural competency and PACT training added to their st and ard curriculum or to a control group receiving the st and ard curriculum only .  Outcomes included comparison , via analysis of variance , of number of PACT questions used during an observed St and ardized Patient Exercise , end-of-year OSCE scores , and qualitative analysis of student narratives . RESULTS Students ( n=119 ) who participated in the online module ( n=60 ) demonstrated increased use of cross-cultural communication PACT questions compared to the control group ( n=59 ) and generally had positive themes emerge from their reflective writing . The module had the biggest impact on students who later went on to match in high communication specialties . CONCLUSIONS Online teaching of cross-cultural communication skills can be effective at changing medical student behavior OBJECTIVE To evaluate whether a consultation skills training ( CST ) program with oncologists and trainees would improve skills in detecting and responding to patient distress , thereby improving their patients ' emotional functioning and reducing psychological distress . METHODS R and omized-controlled trial with 29 medical and radiation oncologists from Australia r and omized to CST group ( n=15 ) or usual-care group ( n=14 ) . The CST consisted of a 1.5-day face-to-face workshop incorporating presentation of principles , a DVD modelling ideal behaviour and role-play practice , and four 1.5h monthly video-conferences . At the CST conclusion , patients of participating doctors were recruited ( n=192 in CST group , n=183 in usual-care group ) , completing telephone surveys at baseline , 1 week and 3 months to assess quality of life , anxiety , depression and unmet psychosocial needs . RESULTS Despite high patient functioning at baseline , anxiety significantly improved at 1-week follow-up in the CST group , compared to the control group . There were no statistically significant differences in emotional functioning , depression or unmet supportive care need between the groups . CONCLUSION Consistent trends for greater improvements were observed in intervention compared to control group patients , suggesting the CST program deserves wider evaluation . PRACTICE IMPLICATION S Video-conferencing after a short training course may be an effective strategy for delivering CST CONTEXT Despite evidence that a variety of continuing medical education ( CME ) techniques can foster physician behavioral change , there have been no r and omized trials comparing performance outcomes for physicians participating in Internet-based CME with physicians participating in a live CME intervention  using approaches documented to be effective . OBJECTIVE To determine if Internet-based CME can produce changes comparable to those produced via live , small-group , interactive CME with respect to physician knowledge and behaviors that have an impact on patient care . DESIGN , SETTING , AND PARTICIPANTS R and omized controlled trial conducted from August 2001 to July 2002 . Participants were 97 primary care physicians drawn from 21 practice sites in Houston , Tex , including 7 community health centers and 14 private group practice s. A control group of 18 physicians from these same sites received no intervention .  INTERVENTIONS Physicians were r and omly assigned to an Internet-based CME intervention that could be completed in multiple sessions over 2 weeks , or to a single live , small-group , interactive CME workshop . Both incorporated similar multifaceted instructional approaches demonstrated to be effective in live setting s. Content was based on the National Institutes of Health National Cholesterol Education Program -- Adult Treatment Panel III guidelines . MAIN OUTCOME MEASURES Knowledge was assessed immediately before the intervention , immediately after the intervention , and 12 weeks later . The percentage of high-risk patients who had appropriate lipid panel screening and pharmacotherapeutic treatment according to guidelines was documented with chart audits conducted over a 5-month period before intervention and a 5-month period after intervention . RESULTS Both interventions produced similar and significant immediate and 12-week knowledge gains , representing large increases in percentage of items correct ( pretest to posttest : 31.0 % [ 95 % confidence interval { CI } , 27.0%-35.0 % ] ; pretest to 12 weeks : 36.4 % [ 95 % CI , 32.2%-40.6 % ] ; P<.001 for all comparisons ) . Chart audits revealed high baseline screening rates in all study groups ( > or = 93 % ) with no significant postintervention change . However , the Internet-based intervention was associated with a significant increase in the percentage of high-risk patients treated with pharmacotherapeutics according to guidelines ( preintervention , 85.3 % ; postintervention , 90.3 % ; P = .04 ) . CONCLUSIONS Appropriately design ed , evidence -based online CME can produce objective ly measured changes in behavior as well as sustained gains in knowledge that are comparable or superior to those realized from effective live activities Background : Few interventions have proven effective in reducing the overuse of antibiotics for acute respiratory infections . We evaluated the effect of DECISION+2 , a shared decision-making training program , on the percentage of patients who decided to take  antibiotics  after consultation with a physician or resident . Methods : We performed a r and omized trial , clustered at the level of family practice teaching unit , with 2 study arms : DECISION+2 and control . The DECISION+2 training program included a 2-hour online tutorial followed by a 2-hour interactive seminar about shared decision-making . The primary outcome was the proportion of patients who decided to use antibiotics immediately after consultation . We also recorded patients ’ perception that shared decision-making had occurred . Two weeks after the initial consultation , we assessed patients ’ adherence to the decision , repeat consultation , decisional regret and quality of life . Results : We compared outcomes among 181 patients who consulted 77 physicians in 5 family practice teaching units in the DECISION+2 group , and 178 patients who consulted 72 physicians in 4 family practice teaching units in the control group . The percentage of patients who decided to use antibiotics after consultation was 52.2 % in the control group and 27.2 % in the DECISION+2 group ( absolute difference 25.0 % , adjusted relative risk 0.48 , 95 % confidence interval 0.34–0.68 ) . DECISION+2 was associated with patients taking a more active role in decision-making ( Z = 3.9 , p < 0.001 ) . Patient outcomes 2 weeks after consultation were similar in both groups . Interpretation : The shared decision-making program DECISION+2 enhanced patient participation in decision-making and led to fewer patients deciding to use antibiotics for acute respiratory infections . This reduction did not have a negative effect on patient outcomes 2 weeks after consultation . Clinical Trials.gov trial register no. NCT01116076 Background To reduce the spread of antibiotic resistance , there is a pressing need for worldwide implementation of effective interventions to promote more prudent prescribing of antibiotics for acute LRTI . This study is a process analysis of the GRACE/INTRO trial of a multifactorial intervention that reduced antibiotic prescribing for acute LRTI in six European countries . The aim was to underst and how the interventions were implemented and to examine effects of the interventions on general practitioners ’ ( GPs ’ ) and patients ’ attitudes . Methods GPs were cluster r and omised to one of three intervention groups or a control group . The intervention groups received web-based training in either use of the C-reactive protein ( CRP ) test , communication skills and use of a patient booklet , or training in both .  GP attitudes were measured before and after the intervention using constructs from the Theory of Planned Behaviour and a Website Satisfaction Question naire . Effects of the interventions on patients were assessed by a post-intervention question naire assessing patient enablement , satisfaction with the consultation , and beliefs about the risks and need for antibiotics . Results GPs in all countries and intervention groups had very positive perceptions of the intervention and the web-based training , and felt that taking part had helped them to reduce prescribing . All GP 
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Conclusions Empiric evidence showed that ODE and blended learning may be equivalent to self-directed/face-to-face learning for training practicing physicians .
Few other studies demonstrated that ODE and blended learning may significantly improve learning outcomes compared to self-directed/face-to-face learning .