***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 Research into adverse events in hospitalized patients suggests that a significant number are preventable . The purpose of this r and omized , controlled study was to determine if simulation-based debriefing improved performance of practicing anaesthetists managing high-fidelity simulation scenarios . METHODS The anaesthetists were r and omly allocated to Group A : simulation debriefing ; Group B : home study ; and Group C : no intervention and secondary r and omization to one of two scenarios . Six to nine months later , subjects returned to manage the alternate scenario . Facilitators blinded to study group allocation completed the performance checklists ( dichotomously scored checklist , DSC ) and Global Rating Scale of Performance ( GRS ) . Two non-expert raters were trained , and assessed all videotaped performances . RESULTS Interim analysis indicated no difference between Groups B and C which were merged into one group . Seventy-four subjects were recruited , with 58 complete data sets available . There was no significant effect of group on pre-test scores . A significant improvement was seen between pre- and post-tests on the DSC in debriefed subjects ( pre-test 66.8 % , post-test 70.3 % ; F(1,57)=4.18 , P=0.046 ) . Both groups showed significant improvement in the GRS over time ( F(1,57)=5.94 , P=0.018 ) , but no significant difference between the groups . CONCLUSIONS We found a modest improvement in performance on a DSC in the debriefed group and overall improvement in both control and debriefed groups using a GRS . Whether this improvement translates into clinical practice has yet to be determined IMPORTANCE Resuscitation training programs use simulation and debriefing as an educational modality with limited st and ardization of debriefing format and content . Our study attempted to address this issue by using a debriefing script to st and ardize debriefings . OBJECTIVE To determine whether use of a scripted debriefing by novice instructors and /or simulator physical realism affects knowledge and performance in simulated cardiopulmonary arrests . DESIGN Prospect i ve , r and omized , factorial study design . SETTING The study was conducted from 2008 to 2011 at 14 Examining Pediatric Resuscitation Education Using Simulation and Scripted Debriefing ( EXPRESS ) network simulation programs . Interprofessional health care teams participated in 2 simulated cardiopulmonary arrests , before and after debriefing . PARTICIPANTS We r and omized 97 participants ( 23 teams ) to nonscripted low-realism ; 93 participants ( 22 teams ) to scripted low-realism ; 103 participants ( 23 teams ) to nonscripted high-realism ; and 94 participants ( 22 teams ) to scripted high-realism groups . INTERVENTION Participants were r and omized to 1 of 4 arms : permutations of scripted vs nonscripted debriefing and high-realism vs low-realism simulators . MAIN OUTCOMES AND MEASURES Percentage difference ( 0%-100 % ) in multiple choice question ( MCQ ) test ( individual scores ) , Behavioral Assessment Tool ( BAT ) ( team leader performance ) , and the Clinical Performance Tool ( CPT ) ( team performance ) scores postintervention vs preintervention comparison ( PPC ) . RESULTS There was no significant difference at baseline in nonscripted vs scripted groups for MCQ ( P = .87 ) , BAT ( P = .99 ) , and CPT ( P = .95 ) scores . Scripted debriefing showed greater improvement in knowledge ( mean [ 95 % CI ] MCQ-PPC , 5.3 % [ 4.1%-6.5 % ] vs 3.6 % [ 2.3%-4.7 % ] ; P = .04 ) and team leader behavioral performance ( median [ interquartile range ( IQR ) ] BAT-PPC , 16 % [ 7.4%-28.5 % ] vs 8 % [ 0.2%-31.6 % ] ; P = .03 ) . Their improvement in clinical performance during simulated cardiopulmonary arrests was not significantly different ( median [ IQR ] CPT-PPC , 7.9 % [ 4.8%-15.1 % ] vs 6.7 % [ 2.8%-12.7 % ] , P = .18 ) . Level of physical realism of the simulator had no independent effect on these outcomes . CONCLUSIONS AND RELEVANCE The use of a st and ardized script by novice instructors to facilitate team debriefings improves acquisition of knowledge and team leader behavioral performance during subsequent simulated cardiopulmonary arrests . Implementation of debriefing scripts in resuscitation courses may help to improve learning outcomes and st and ardize delivery of debriefing , particularly for novice instructors Background : Simulation-based training is useful in improving physicians ' skills . However , no r and omized controlled trials have been able to demonstrate the effects of simulation teaching in real-life patient care . This study aim ed to determine whether simulation-based training or an interactive seminar result ed in better patient care during weaning from cardiopulmonary bypass (CPB)—a high stakes clinical setting . Methods : This study was conducted as a prospect i ve , single-blinded , r and omized controlled trial . After institutional research board approval , 20 anesthesiology trainees , postgraduate year 4 or higher , inexperienced in CPB weaning , and 60 patients scheduled for elective coronary artery bypass grafting were recruited . Each trainee received a teaching syllabus for CPB weaning 1 week before attempting to wean a patient from CPB ( pretest ) . One week later , each trainee received a 2-h training session with either high-fidelity simulation-based training or a 2-h interactive seminar . Each trainee then weaned patients from CPB within 2 weeks ( posttest ) and 5 weeks ( retention test ) from the intervention . Clinical performance was measured using the vali date d Anesthesiologists ' Nontechnical Skills Global Rating Scale and a checklist of expected clinical actions . Results : Pretest Global Rating Scale and checklist performances were similar . The simulation group scored significantly higher than the seminar group at both posttest ( Global Rating Scale [ mean ± st and ard error ] : 14.3 ± 0.41 vs. 11.8 ± 0.41 , P < 0.001 ; checklist : 89.9 ± 3.0 % vs. 75.4 ± 3.0 % , P = 0.003 ) and retention test ( Global Rating Scale : 14.1 ± 0.41 vs. 11.7 ± 0.41 , P < 0.001 ; checklist : 93.2 ± 2.4 % vs. 77.0 ± 2.4 % , P < 0.001 ) . Conclusion : Skills required to wean a patient from CPB can be acquired through simulation-based training . Compared with traditional interactive seminars , simulation-based training leads to improved performance in patient care by senior trainees in anesthesiology Background The purpose of this study is to compare the cardiopulmonary resuscitation ( CPR ) team dynamics and performance between a conventional simulation training group and a script-based training group . Methods This was a prospect i ve r and omised controlled trial of educational intervention for CPR team training . Fourteen teams , each consisting of five members , were recruited . The conventional group ( C ) received training using a didactic lecture and simulation with debriefing , while the script group ( S ) received training using a resuscitation script . The team activity was evaluated with checklists both before and after 1 week of training . The videotaped simulated resuscitation events were compared in terms of team dynamics and performance aspects . Results Both groups showed significantly higher leadership scores after training ( C : 58.2±9.2 vs 67.2±9.5 , p=0.007 ; S : 57.9±8.1 vs 65.4±12.1 , p=0.034 ) . However , there were no significant improvements in performance scores in either group after training . There were no differences in the score improvement after training between the two groups in dynamics ( C : 9.1±12.6 vs S : 7.4±13.7 , p=0.715 ) , performance ( C : 5.5±11.4 vs S : 4.7±9.6 , p=0.838 ) and total scores ( C : 14.6±20.1 vs S : 12.2±19.5 , p=0.726 ) . Conclusion Script-based CPR team training result ed in comparable improvements in team dynamics scores  compared with conventional simulation training . Resuscitation scripts may be used as an adjunct for CPR team training BACKGROUND : Simulation experience alone without debriefing is insufficient for learning . St and ardized multimedia instruction has been shown to be useful in teaching surgical skills but has not been evaluated for use as an adjunct in crisis management training . Our primary purpose in this study was to determine whether st and ardized computer-based multimedia instruction is effective for learning , and whether the learning is retained 5 wk later . Our secondary purpose was to compare multimedia instruction to personalized video-assisted oral debriefing with an expert . METHODS : Thirty anesthesia residents were recruited to manage three different simulated resuscitation scenarios using a high-fidelity patient simulator .  After the first scenario , subjects were r and omized to either a computer-based multimedia tutorial or a personal debriefing of their performance with an expert and videotape review . After their respective teaching , subjects managed a similar posttest resuscitation scenario and a third retention test scenario 5 wk later . Performances were independently rated by two blinded expert assessors using a previously vali date d assessment system . RESULTS : Posttest ( 12.22 ± 2.19 , P = 0.009 ) and retention ( 12.80 ± 1.77 , P < 0.001 ) performances of nontechnical skills were significantly improved in the st and ardized multimedia instruction group compared with pretest ( 10.27 ± 2.10 ) . There were no significant differences in improvement between the two methods of instruction . CONCLUSION : Computer-based multimedia instruction is an effective method of teaching nontechnical skills in simulated crisis scenarios and may be as effective as personalized oral debriefing . Multimedia may be a valuable adjunct to centers when debriefing expertise is not available Background : The debriefing process during simulation-based education has been poorly studied despite its educational importance . Videotape feedback is an adjunct that may enhance the impact of the debriefing and in turn maximize learning . The purpose of this study was to investigate the value of the debriefing process during simulation and to compare the educational efficacy of two types of feedback , oral feedback and videotape-assisted oral feedback , against control ( no debriefing ) . Methods : Forty-two anesthesia residents were enrolled in the study . After completing a pretest scenario , participants were r and omly assigned to receive no debriefing , oral feedback , or videotape-assisted oral feedback . The debriefing focused on nontechnical skills performance guided by crisis re source management principles . Participants were then required to manage a posttest scenario . The videotapes of all performances were later review ed by two blinded independent assessors who rated participants ' nontechnical skills using a vali date d scoring system . Results : Participants ' nontechnical skills did not improve in the control group , whereas the provision of oral feedback , either assisted or not assisted with videotape review , result ed in significant improvement ( P < 0.005 ) . There was no difference in improvement between oral and video-assisted oral feedback groups . Conclusions : Exposure to a simulated crisis without constructive debriefing by instructors offers little benefit to trainees . The addition of video review did not offer any advantage over oral feedback alone . Valuable simulation training can therefore be achieved even when video technology is not available OBJECTIVE To test the hypotheses that classroom and simulation-based crew re source management ( CRM ) training interventions improve teamwork attitudes and behaviours of participants and that classroom training combined with simulation-based training provide synergistic improvements . DESIGN A r and omized controlled trial . SETTING Area Health Service in New South Wales , Australia . PARTICIPANTS A total of 157 doctors , nurses and midwives r and omized into one of four groups , consisting of three intervention groups and a control group . INTERVENTION One-day CRM-based classroom course ; one-day CRM style simulation-based training or classroom training followed by simulation-based training . MAIN OUTCOME MEASURES Pre- and post-test quantitative participant teamwork attitudes , and post-test quantitative trainee reactions , knowledge and behaviour . RESULTS Ninety-four doctors , nurses and midwives completed pre-intervention attitude question naires and 60 clinicians completed post-intervention assessment s. No positive changes in teamwork attitudes were found associated with classroom or simulation training . Positive changes were found in knowledge ( mean difference 1.50 , 95 % confidence interval ( CI ) 0.58 - 2.43 , P = 0.002 ) , self-assessed teamwork behaviour ( mean difference 2.69 , 95 % CI 0.90 - 6.13 , P = 0.009 ) and independently observed teamwork behaviour ( mean difference 2.30 , 95 % CI 0.30 - 4.30 , P = 0.027 ) when classroom-only trained group was compared with control ; however , these changes were not found in the group that received classroom followed by simulation training . CONCLUSIONS Classroom-based training alone result ed in improvements in participant knowledge and observed teamwork behaviour . The study found no additional impact of simulation training Objective : To compare the effectiveness of an interprofessional within-team debriefing with that of an instructor-led debriefing on  team performance during a simulated crisis . Background : 
    Output:
    
Acknowledging their limitations , these studies found that performance improved after self-led debrief , no debrief ( with experienced practitioners ) , st and ardised multimedia debrief or after review ing a DVD of the participants ’ own eye-tracking .