***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 Objectives : To assess the effect of high-fidelity simulation ( SIM ) on cognitive performance after a training session involving several mock resuscitations design ed to teach and reinforce Pediatric Advanced Life Support ( PALS ) algorithms . Methods : Pediatric residents were r and omized to high-fidelity simulation ( SIM ) or st and ard mannequin ( MAN ) groups . Each subject completed 3 study phases : ( 1 ) mock code exercises ( asystole , tachydysrhythmia , respiratory arrest , and shock ) to assess baseline performance ( PRE phase ) , ( 2 ) a didactic session review ing PALS algorithms , and ( 3 ) repeated mock code exercises requiring identical cognitive skills in a different clinical context to assess change in performance ( POST phase ) . SIM subjects completed all 3 phases using a high-fidelity simulator ( SimBaby , Laerdal Medical , Stavanger , Norway ) , and MAN subjects used SimBaby without simulated physical findings ( ie , as a st and ard mannequin ) . Performance in PRE and POST was measured by a scoring instrument design ed to measure cognitive performance ; scores were scaled to a range of 0 to 100 points . Improvement in performance from PRE to POST phases was evaluated by mixed modeling using a r and om intercept to account for within-subject variability . Results : Fifty-one subjects ( SIM , 25 ; MAN , 26 ) completed all phases . The PRE performance was similar between groups . Both groups demonstrated improvement in POST performance . The improvement in scores between PRE and POST phases was significantly better in the SIM group ( mean [ SD ] , 11.1 [ 4.8 ] vs. 4.8 [ 1.7 ] , P = 0.007 ) . Conclusions : The use of high-fidelity simulation in a PALS training session result ed in improved cognitive performance by pediatric house staff . Future studies should address skill and knowledge decays and team dynamics , and clearly defined and reproducible outcome measures should be sought Background . Video-assisted real-time simulation ( VARS ) offers the possibility of developing competence in acute medicine in a realistic and safe environment . We investigated the effectiveness of the VARS model and compared it with educational methods like Problem-Based Learning ( PBL ) and Pediatric Advanced Life Support ( PALS ) . Methods . 45 fourth-year medical students were r and omized for three educational methods .  Level of knowledge and self-efficacy were measured before and after intervention . Clinical performance was measured by a blinded observer using a video checklist of prescripted scenarios on a high-fidelity simulator . Results . Knowledge test and self-efficacy scores improved significantly ( P < 0.001 ) without differences between educational groups . The VARS group showed significantly ( P < 0.05 ) higher scores on both postintervention scenarios concerning structure and time . Conclusion . VARS training is an effective educational method teaching pediatric acute care skills in the undergraduate curriculum . When compared to PBL and PALS training , VARS training appears to be superior in enhancing short-term clinical performance OBJECTIVE : Poor communication and teamwork may contribute to errors during neonatal resuscitation . Our objective was to evaluate whether interns who received a 2-hour teamwork training intervention with the Neonatal Resuscitation Program ( NRP )  demonstrated more teamwork and higher quality resuscitations than control subjects . METHODS : Participants were noncertified 2007 and 2008 incoming interns for pediatrics , combined pediatrics and internal medicine , family medicine , emergency medicine , and obstetrics and gynecology ( n = 98 ) . Pediatrics and combined pediatrics/internal medicine interns were eligible for 6-month follow-up ( n = 34 ) . A r and omized trial was conducted in which half of the participants in the  team training  arm practice d NRP skills by using high-fidelity simulators ; the remaining practice d with low-fidelity simulators , as did control subjects . Blinded , trained observers viewed video recordings of high-fidelity – simulated resuscitations for teamwork and resuscitation quality . RESULTS : High-fidelity training ( HFT ) group had higher teamwork frequency than did control subjects ( 12.8 vs 9.0 behaviors per minute ; P < .001 ) . Intervention groups maintained more workload management ( control subjects : 89.3 % ; low-fidelity training [ LFT ] group : 98.0 % [ P < .001 ] ; HFT group : 98.8 % ; HFT group versus control subjects [ P < .001 ] ) and completed resuscitations faster ( control subjects : 10.6 minutes ; LFT group : 8.6 minutes [ P = .040 ] ; HFT group : 7.4 minutes ; HFT group versus control subjects [ P < .001 ] ) . Overall , intervention teams completed the resuscitation an average of 2.6 minutes faster than did control subjects , a time reduction of 24 % ( 95 % confidence interval : 12%–37 % ) . Intervention groups demonstrated more frequent teamwork during 6-month follow-up resuscitations ( 11.8 vs 10.0 behaviors per minute ; P = .030 ) . CONCLUSIONS : Trained participants exhibited more frequent teamwork behaviors ( especially the HFT group ) and better workload management and completed the resuscitation more quickly than did control subjects . The impact on team behaviors persisted for at least 6 months . Incorporating team training into the NRP curriculum is a feasible and effective way to teach interns teamwork skills . It also improves simulated resuscitation quality by shortening the duration 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 Objective : Despite completing accredited resuscitation training , neonatal trainees often feel unprepared to deal with real-life clinical emergencies . High-fidelity simulator ( HFS ) technology offers the potential of recreating a realistic stressful clinical environment to aid training and evaluation . To date , there are limited data examining the physiological impact of this training modality in comparison to less costly alternatives . The objective of this study was to compare the effects of low-fidelity simulator ( LFS ) versus HFS technology on performance levels , objective and subjective measures of stress in neonatal trainees . Study Design : Sixteen neonatal fellows were invited to participate in a prospect i ve r and omized study . Subjects were divided into pairs and r and omized to LFS or HFS for completion of scenario I. After an interval of 1 month , fellow teams crossed over to complete scenario II using the alternative simulator technology .  Technical and non-technical skills were assessed using vali date d resuscitation scoring tools . Participants recorded subjective stress at sequential time points before and after each simulation . Buccal cortisol was measured at each corresponding time point and comparison between HFS and LFS groups was made . Result : The mean overall resuscitation performance score was 75.8%±10 , but there was no difference in performance between HFS and LFS groups . There was also no significant difference in non-technical skills performance between groups . Salivary cortisol increased over the duration of the simulated experience , but there were no differences between the two groups ( P=0.001 , two-way repeated measures analysis of variance ) . We also identified changes in subjective measures of stress ( P<0.001 , analysis of variance ) over time , but again there were no differences between groups . Conclusion : Simulated neonatal resuscitations induce a significant stress response in neonatal trainees ; however , we were unable to identify any difference in stress measures between HFS and LFS . These data suggest that HFS technology offers no additional stress-inducing benefit The neonatal resuscitation program ( NRP ) has been developed to educate physicians and other health care providers about newborn resuscitation and has been shown to improve neonatal resuscitation skills . Simulation-based training is recommended as an effective modality for instructing neonatal resuscitation and both low and high-fidelity manikin simulators are used . There is limited research that has compared the effect of low and high-fidelity manikin simulators for NRP learning outcomes , and more specifically on teamwork performance and confidence . The purpose of this study was to examine the effect of using low versus high-fidelity manikin simulators in NRP instruction . A r and omized posttest-only control group study design was conducted . Third year undergraduate medical students participated in NRP instruction and were assigned to an experimental group ( high-fidelity manikin simulator ) or control group ( low-fidelity manikin simulator ) . Integrated skills station ( megacode ) performance , participant satisfaction , confidence and teamwork behaviour scores were compared between the study groups . Participants in the high-fidelity manikin simulator instructional group reported significantly higher total scores in overall satisfaction ( p = 0.001 ) and confidence ( p = 0.001 ) . There were no significant differences in teamwork behaviour scores , as observed by two independent raters , nor differences on m and atory integrated skills station performance items at the p < 0.05 level . Medical students ’ reported greater satisfaction and confidence with high-fidelity manikin simulators , but did not demonstrate overall significantly improved teamwork or integrated skills station performance .  Low and high-fidelity manikin simulators facilitate similar levels of objective ly measured NRP outcomes for integrated skills station and teamwork performance INTRODUCTION There are currently few studies describing the use of high-fidelity ( hi-fi ) simulation in teaching neonatal resuscitation . Traditionally , residents are certified in the neonatal resuscitation program ( NRP ) after successful completion of a multiple-choice written examination and demonstration of skills during a h and s-on ' mega-code ' . In the present study , the use of a hi-fi simulation mannequin was compared with a st and ard plastic man 
    Output:
    
Studies measuring skill performance at one year , skill performance between course conclusion and one year , and knowledge demonstrated no significant benefit for high fidelity manikins .
CONCLUSION The use of high fidelity manikins for advanced life support training is associated with moderate benefits for improving skills performance at course conclusion .