***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: PURPOSE The study assesses potential for improving residents ' evidence -based medicine search ing skills in MEDLINE through real-time librarian instruction . SUBJECTS Ten residents on a rotation in a neonatal intensive care unit participated . METHODOLOGY Residents were r and omized into an instruction and a non-instruction group .  Residents  generated questions from rounds and search ed MEDLINE for answers . Data were collected through observation , search strategy analysis , and surveys . Librarians observed search es and collected data on questions , search ing skills , search problems , and the test group 's instruction topics . Participants performed st and ardized search es before , after , and six-months after intervention and were scored using a search strategy analysis tool ( 1 representing highest score and 5 representing lowest score ) . Residents completed pre- and post-intervention surveys to measure opinions about MEDLINE and search satisfaction . RESULTS Post-intervention , the test group formulated better questions , used limits more effectively , and reported greater confidence in using MEDLINE . The control group expressed less satisfaction with retrieval and demonstrated more errors when limiting . The test and control groups had the following average search scores respectively : 3.0 and 3.5 ( pre-intervention ) , 3.3 and 3.4 ( post-intervention ) , and 2.0 and 3.8 ( six-month post-intervention ) . CONCLUSION Data suggest that measurable learning outcomes were achieved . Residents receiving instruction improved and retained search ing skills six-months after intervention Objective To determine whether  fellowship training in critical care medicine with critical appraisal exercises improves the ability and confidence of fellows to evaluate the medical literature .  Design Prospect i ve , interventional pilot study . Setting Multidisciplinary critical care medicine training program at a large university hospital . InterventionFellows were given three didactic sessions covering study design , analysis , and critical appraisal techniques . During the course of the year , each fellow was required to review one article from the literature and present a critique of this article to the group and faculty ( Journal Club ) . Fellows were guided in the preparation of this presentation by one of the critical care medicine faculty . Finally , a written analysis and critique of the article was performed by each fellow . Measurements and Main Results A test was given to each fellow at the beginning and end of the academic year . This test consisted of two pairs of articles on therapy for acute lung injury . For the pretest , each fellow was assigned , at r and om , one pair of articles . Fellows were given 1 hr to review both articles and to fill out a six-point test to assess their ability and confidence to appraise each article . At the end of the year , each fellow was tested on the opposite pair , the tests were grade d in a blinded fashion and the results of each test were compared . Six fellows completed both pre- and posttests . These paired results were analyzed separately , whereas results for another six fellows were conducted as an unpaired analysis . Mean scores increased both for the paired analysis ( 4.1 ± 0.7 vs. 5.1 ± 0.5;p = .015 ) and for the unpaired analysis ( 4.3 ± 0.6 vs. 5.0 ± 0.5;p = .012 ) . Self-reported confidence in critical appraisal also increased ( 2.5 ± 0.5 vs. 3.9 ± 0.7;p = .004 and 2.6 ± 0.5 vs. 3.9 ± 0.6;p < .001 , respectively ) . Conclusion Critical appraisal exercises used in the training of critical care medicine fellows appear to improve both ability and confidence to appraise relevant medical literature STUDY OBJECTIVES To compare the performance of an evidence -based medicine ( EBM ) approach and a traditional approach to teaching critical appraisal skills to emergency medicine residents . METHODS This was a prospect i ve , case-controlled trial of 32 emergency medicine residents ( 16 control and 16 intervention ) . Intervention residents were exposed to a monthly , 1-hour journal club using an EBM approach to critical appraisal over the course of 1 year .  Control residents were exposed to a traditional , unstructured journal club , also monthly . Both groups were given a factitious article to evaluate in an essay format before and after the 12-month study period . The Wilcoxon rank sum test was used to compare mean improvement in test scores for each group . RESULTS The mean improvement in test scores was 1.80 for the control group and 1.53 for the intervention group ; these values were not significantly different ( P = .90 ) . The difference in mean change in test score between the 2 groups was.27 points . CONCLUSION Compared with a traditional approach , an EBM approach to teaching critical appraisal did not appear to improve the critical appraisal skills of emergency medicine residents . However , because of the small number of subjects studied , small differences in critical appraisal skill improvement can not be ruled out OBJECTIVES To measure the effectiveness of an educational intervention design ed to teach residents four essential evidence -based medicine ( EBM ) skills : question formulation , literature search ing , underst and ing quantitative outcomes , and critical appraisal . DESIGN Firm-based , controlled trial . SETTING Urban public hospital . PARTICIPANTS Fifty-five first-year internal medicine residents : 18 in the experimental group and 37 in the control group . INTERVENTION An EBM course , taught 2 hours per week for 7 consecutive weeks by senior faculty and chief residents focusing on the four essential EBM skills . MEASUREMENTS AND MAIN RESULTS The main outcome measure was performance on an EBM skills test that was administered four times over 11 months : at baseline and at three time points postcourse . Postcourse test 1 assessed the effectiveness of the intervention in the experimental group ( primary outcome ] ; postcourse test 2 assessed the control group after it crossed over to receive the intervention ; and postcourse test 3 assessed durability . Baseline EBM skills were similar in the two groups . After receiving the EBM course , the experimental group achieved significantly higher postcourse test scores ( adjusted mean difference , 21 % ; 95 % confidence interval , 13 % to 28 % ; P < .001 ) . Postcourse improvements were noted in three of the four EBM skill domains ( formulating questions , search ing , and quantitative underst and ing [ P < .005 for all ] , but not in critical appraisal skills [ P = .4 ] ) . After crossing over to receive the educational intervention , the control group achieved similar improvements . Both groups sustained these improvements over 6 to 9 months of follow-up . CONCLUSIONS A brief structured educational intervention produced substantial and durable improvements in residents ' cognitive and technical EBM skills BACKGROUND We performed a prospect i ve controlled trial of a monthly journal club to determine if it would increase pediatric residents ' knowledge of clinical epidemiology and biostatistics . METHODS  Intervention residents received two didactic sessions before the journal club started . Eight monthly journal club sessions followed . Pediatric residents at another institution served as controls .  Intervention and control  residents completed a pre- and post-test on clinical epidemiology and biostatistics . RESULTS Neither the intervention nor the control group showed a significant change in test scores over the 9-month period . CONCLUSION A more intensive and more structured approach is needed to effectively teach clinical epidemiology and biostatistics to residents Purpose To assess the utility and practicality of an evidence -based format in internal medicine attending rounds . Method Two r and omly selected teams of residents and medical students in the internal medicine program at the Montefiore Medical Center participated in “ Evidence -Based Medicine Attending Month .  ” The process entailed the development of patient-based , search able questions , a search for the evidence , the critical appraisal of the retrieved literature , and the application of the evidence to the care of the patient . At the last meeting , participants evaluated each case by answering three questions about whether the process ( 1 ) had changed the medical management of the patient during the admission , ( 2 ) had changed the way they would manage similar patients in the future , and ( 3 ) had informed them about the disease process in general . Results A total of 12 of 16 formal EBM questions were developed and assessed ( 75 % completion rate ) during the four-week period , in addition to the st and ard background literature review s usually performed . Twenty-two articles were retrieved and critically appraised . The evaluation demonstrated that 50 % of the participants felt the process had changed the active management of patients currently treated by the team , 75 % reported that the process would affect the care of future patients with comparable medical problems , and over 90 % believed the program had informed them about the disease process . Conclusions The formal EBM approach was conveniently implemented and enhanced the learning experience of the participants . It helped inform students ' and residents ' patient care at the time and their attitudes towards future patients . Hence , it is both practical and useful to perform formal EBM attending rounds OBJECTIVE To examine the evidence that the teaching of critical appraisal ( evidence -based medicine ) skills to undergraduate medical students or residents will result in significant gains in knowledge and increased use of the literature in clinical decision-making . DATA SOURCES Articles published from 1966 to 1995 , retrieved through a MEDLINE search supplemented by manual search es ; review of bibliographies maintained by individuals involved in teaching critical appraisal skills ; and a previous method ological review . STUDY SELECTION Articles were selected if the study involved some form of control group , although strict r and omization was not required , and a measure of performance followed the intervention . Articles were excluded if they simply reported the process of teaching critical appraisal skills or used some form of " happiness index . " DATA SYNTHESIS There were 10 studies of the impact of teaching critical appraisal skills  , 6 involving medical students and 4 involving residents . Results from 3 of the studies were nearly uninterpretable and thus were excluded ; the remaining 7 were method ologically acceptable . Analysis showed that interventions implemented in undergraduate programs result ed in significant gains in knowledge , as assessed by a written test ( mean gain 17.0 % ; st and ard deviation [ SD ] 4.0 % ) . Conversely , studies at the residency level consistently showed a small change in knowledge ( mean gain 1.3 % ; SD 1.7 % ) . Two studies that examined residents ' use of the literature were unable to demonstrate any positive changes . CONCLUSIONS Studies of the effect of teaching critical appraisal skills on gains in knowledge at the undergraduate level showed consistent improvement . By contrast , changes in knowledge at the residency level were small . Several suggestions from the educational literature are offered to increase effectiveness of critical appraisal interventions Purpose To investigate whether teaching an evidence -based medicine ( EBM ) curriculum increased the knowledge and use of EBM principles in residents ' continuity clinics . Method In 1999 , the authors performed a needs assessment with residents and faculty of Cascades East Family Practice Residency in Oregon and constructed a ten-session EBM workshop series that was introduced into the curriculum in 2000 . Resident – preceptor interactions during outpatient continuity clinic were tape-recorded prior to and six months following introduction of the curriculum . A 50-item , multiple-choice examination was administered before and after the workshop series . Residents at another FP residency at the same university served as a control group . The same assessment s were applied to the experimental and control groups . The tape recordings were analyzed for interactions that contained key EBM phrases or words . Results Pre-intervention multiple-choice test results were similar ( control mean 56 % , experimental 53 % , p > .22 NS ) . Post-intervention test scores for the experimental group were significantly improved ( mean 72 % , p < .001 ) . There was no significant improvement in test results among members of the control group ( p > .05 NS ) . In the recorded resident – preceptor interactions , a marked increase in the use of EBM terms indicated awareness and /or use of EBM in the experimental group . In 1,165 minutes recorded prior to the workshops , EBM terms were used in a total of ten events . In 735 minutes recorded after the workshops , EBM terms were recorded in 67 events . A reduced number of EBM terms were recorded in the control group . Conclusion Administering a structured EBM curriculum increased residents '  knowledge and use of EBM constructs during patient care The journal club is an established teaching modality in many house-staff training programs . To determine if a journal club improves house-staff reading habits , knowledge of epidemiology and biostatistics , and critical appraisal skills , we r and omized 44 medical interns to receive either a journal club or a control seminar series .  A test instrument developed by the Delphi method was administered before and after the interventions ( mean , five journal club sessions ) . By self-report , 86 % of the house staff in the journal club group improved their reading habits vs 0 % in the control group . Knowledge scores increased more in the journal club group than in the control group , and a trend was found toward more knowledge gained as more sessions were attended . Ability to appraise critically a test article increased slightly in each group , but there was no significant difference between the groups . We conclude that a journal club is a powerful motivator of critical house-staff reading behavior and can help teach epidemiology and biostatistics to physicians-in-training 
    Output:
    
RESULTS St and alone teaching improved knowledge but not skills , attitudes , or behaviour .
Clinical ly integrated teaching improved knowledge , skills , attitudes , and behaviour .