***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: CONTEXT Education in simulated learning environments ( SLEs ) has grown rapidly across health care professions , yet no substantive r and omised controlled trial ( RCT ) has investigated whether SLEs can , in part , substitute for traditional clinical education . METHODS Participants were physiotherapy students ( RCT 1 , n = 192 ; RCT 2 , n = 178 ) from six Australian universities undertaking clinical education in an ambulatory care setting with patients with musculoskeletal disorders . A simulated learning programme was developed as a replica for clinical education in musculoskeletal practice to replace 1 week of a 4-week clinical education placement . Two SLE models were design ed . Model 1 provided 1 week in the SLE , followed by 3 weeks in clinical immersion ; Model 2 offered training in the SLE in parallel with clinical immersion during the first 2 weeks of the 4-week placement . Two single-blind , multicentre RCTs ( RCT 1 , Model 1 ; RCT 2 , Model 2 ) were conducted using a non-inferiority design to determine if the clinical competencies of students part-educated in SLEs would be any worse than those of students educated fully in traditional clinical immersion . The RCTs were conducted simultaneously , but independently . Within each RCT , students were stratified on academic score and r and omised to either the SLE group or the control ( ' Traditional ' ) group , which undertook 4 weeks of traditional clinical immersion . The primary outcome measure was a blinded assessment of student competency conducted over two clinical examinations at week 4 using the Assessment of Physiotherapy Practice ( APP ) tool . RESULTS Students ' achievement of clinical competencies was no worse in the SLE groups than in the Traditional groups in either RCT ( Margin [ Δ ] ≥ 0.4 difference on APP score ; RCT 1 : 95 % CI - 0.07 to 0.17 ; RCT 2 : 95 % CI - 0.11 to 0.16 ) . CONCLUSIONS These RCTs provide evidence that clinical education in an SLE can in part ( 25 % ) replace clinical time with real patients without compromising students ' attainment of the professional competencies required to practise OBJECTIVE The purpose of this study was to investigate a quantitative biomechanical evaluation method for contact forces exerted during a manual examination and treatment technique used in a learning environment . The evaluation was based on three-dimensional ( 3D ) force component data . METHODS A h and -/palm-held computerized 3D force component measuring system was used during a simple feedback experiment involving 20 second-year university students of physiotherapy who delivered 5 sets of grade d perpendicular manual push forces on the sensor part of the system , which was placed on the padded surface of an examination/treatment table . In an effect study with a multiple time-series design , a r and omly chosen subgroup of subjects received concurrent visual 3D kinetic/dynamic force-time feedback . RESULTS The students delivered grade d perpendicular forces with good intrasubject consistency ( intraclass correlation coefficient [ 3 , 1 ] : mean , 0.80 ; range , 0.76 - 0.88 ) but with poor intersubject consistency ( intraclass correlation coefficient [ 2 , 1 ] : mean , 0.38 ; range , 0.15 - 0.74 ) . A temporary performance improvement in forward-backward force direction deviations from the perpendicular in the subgroup given feedback indicates that students are sensitive to feedback training . CONCLUSION An evaluation tool using 3D contact force component measurement enables the assessment of the overall magnitude of the manual contact force as well as its directional aspect . Compared with existing evaluations based on 1-dimensional force components , this 3D system allows for a more complete and , at the same time , more specific quantitative evaluation of the manual contact forces . Three-dimensional dynamic/kinetic augmented feedback has the additional potential of helping students and practitioners to improve their palpation and force delivery skills This study was design ed to investigate whether concurrent quantitative feedback of performance could improve the learning of a joint mobilization technique . A group of 110 physical therapy students had been r and omly divided into two groups for teaching purpose s. All students had previously learned mobilization of peripheral joints and were currently learning spinal mobilization .  From one of the groups , 22 students volunteered to comprise a control group , which was taught a spinal mobilization technique in the traditional way . Additional concurrent quantitative feedback of the level of force applied to the patient was given to 31 volunteers from the other group . These students formed the experimental group . A force plate was used for force measurement , and the feedback was given via an oscilloscope . The average force applied by the students ' instructors was taken as an " ideal " force . The oscilloscope showed both the applied force and the " ideal " force . Consistency was measured by the variance of the group 's performance . Accuracy was assessed by calculating the difference between the applied force and the " ideal " force . Results indicated that this feedback was associated with a significant improvement in accuracy and consistency in the application of the mobilizing force . This improvement was still present at a follow-up test conducted one week later . This result supports a greater use of such feedback in the teaching and practice of joint mobilization techniques , although the need for further research is emphasized Introduction Simulated learning environments ( SLEs ) are used worldwide in health professional education , including physiotherapy , to train certain attributes and skills . To date , no r and omized controlled trial ( RCT ) has evaluated whether education in SLEs can partly replace time in the clinical environment for physiotherapy cardiorespiratory practice . Methods Two independent single-blind multi-institutional RCTs were conducted in parallel using a noninferiority design . Participants were volunteer physiotherapy students ( RCT 1 , n = 176 ; RCT 2 , n = 173 ) entering acute care cardiorespiratory physiotherapy clinical placements . Two SLE models were investigated as follows : RCT 1 , 1 week in SLE before 3 weeks of clinical immersion ; RCT 2 , 2 weeks of interspersed SLE/ clinical immersion ( equivalent to 1 SLE week ) within the 4-week clinical placement . Students in each RCT were stratified on academic grade and r and omly allocated to an SLE plus clinical immersion or clinical immersion control group . The primary outcome was competency to practice measured in 2 clinical examinations using the Assessment of Physiotherapy Practice . Secondary outcomes were student perception of experience and clinical educator and patient rating of student performance . Results There were no significant differences in student competency between the SLE and control groups in either RCT , although students in the interspersed group ( RCT 2 ) achieved a higher score in 5 of 7 Assessment of Physiotherapy Practice st and ards ( all P < 0.05 ) . Students rated the SLE experience positively . Clinical educators and patients reported comparability between groups . Conclusions An SLE can replace clinical time in cardiorespiratory physiotherapy practice . Part education in the SLE satisfied clinical competency requirements , and all stakeholders were satisfied UNLABELLED The purpose of this study was to determine whether providing  physical therapy ( PT ) students with instructions in proper ultrasound ( US ) pressure application would result in more optimal pressures compared with pressures obtained by students who were not instructed . Previous research determined that for transmission to be adequate , optimal pressure must be 600 g. A sample of convenience of PT students in our program participated in this study . Students were divided into two groups : 31 first-year students who were instructed ( group 1 ) and 34 third-year students who were not instructed ( group 2 ) in US pressure application . METHODS The students who were trained in this new parameter did so as part of the electromodalities course and were compared with untrained third-year students . Group 1 received specific verbal instructions during laboratory , and then performed the US to a gel pad placed on top of a digital scale while observing the digital pressure readout for feedback . This group was retested 7 months later to determine retention of skill acquisition . For data collection , all students applied US for 5 minutes with pressures recorded every 30 seconds and were blinded to the readout . The group without instructions had a mean pressure of 321.92 g ( SD , 257.82 ) , and the group with instructions had a mean of 607.29 g ( SD , 145.52 ) 4 weeks after training . The difference between means was significant ( t[60.4 ] = 8.54 , p < 0.000 ) . Follow-up scores 7 months later for group 1 showed a mean of 587.23 g ( SD , 284.17 ) , not significantly different from the first measurements ( p = 0.807 ) . The results showed a significant difference between groups , whereby students who received instructions outperformed those who did not , overall were more accurate in their perception of US pressure , and showed good retention skills , reaffirming that feedback is a valuable learning tool . For US to be effective , proper pressure must be exerted , and this should be a parameter instructed in schools where US is taught to improve treatment effectiveness Background and Purpose Joint mobilization is a complicated task to learn and to teach and is characterized by great intersubject variability . This study 's purpose was to investigate whether quantitatively augmented feedback could enhance the learning of joint mobilization and , more specifically , to compare the effects of training with concurrent or terminal feedback by using a joint translation simulator ( JTS ) . Subjects Thirty-six undergraduate physical therapist students were r and omly assigned to control ( no feedback ) , concurrent feedback , and terminal feedback groups . Methods The JTS was design ed to simulate tissue resistance based on load-displacement relationships of glenohumeral joint specimens . Subjects applied specific mobilization grade s of force on the JTS while quantitative feedback was given to the feedback groups either during a trial ( ie , concurrent feedback ) or after a trial ( ie , terminal feedback ) . The skill acquisition phase lasted a total of 40 minutes , and a total of 75 repetitions were performed for each grade of each joint model . Pretest and no-feedback retention tests were conducted . Results During acquisition and retention , both feedback groups performed more accurately than did the control group . No obviously superior performance was shown by the terminal feedback group compared with concurrent feedback group during retention testing . Discussion and Conclusion Subjects who trained with augmented feedback had less variability , and thus more consistency , than the control group subjects who received no feedback . Augmented feedback provides the student with a reference force and the status of his or her performance . The effectiveness of the JTS feedback compared with no feedback was clearly demonstrated . Skill acquisition in mobilization can be enhanced by either concurrent or terminal feedback Purpose To evaluate the effectiveness of a novel , simulation-based educational model rooted in scaffolding theory that capitalizes on a systematic progressive sequence of simulators that increase in realism ( i.e. , fidelity ) and information content . Method Forty-five medical students were r and omly assigned to practice intravenous catheterization using high-fidelity training , low-fidelity training , or progressive training from low to mid to high fidelity . One week later , participants completed a transfer test on a st and ardized patient simulation . Blinded expert raters assessed participants ' global clinical performance , communication , procedure documentation , and technical skills on the transfer test . Participants ' management of the re sources available during practice was also recorded . Data were analyzed using multivariate analysis of variance . The study was conducted in fall 2008 at the University of Toronto . Results The high-fidelity group scored higher ( P < .05 ) than the low-fidelity group on all measures except procedure documentation . The progressive group scored higher ( P < .05 ) than other groups for documentation and global clinical performance and was equivalent to the high-fidelity group for communication and technical skills . Total practice time was greatest for the progressive group ; however , this group required little practice time on the re source -intensive high-fidelity simulator . Conclusions Allowing students to progress in their practice on simulators of increasing fidelity led to superior transfer of a broad range of clinical skills . Further , this progressive group was re source -efficient , as participants concentrated on lower fidelity and lower re source -intensive simulators . It is suggested that clinical training curricula incorporate exposure to multiple simulators to maximize educational benefit and potentially save educator time 
    Output:
    
While there were few r and omized controlled trials with vali date d outcome measures , some discoveries about simulation can positively affect the design of the PT entry-to- practice curricula .
Using simulators to provide specific output feedback can help students learn specific skills .
Computer simulations can also augment students ' learning experience .
Human simulation experiences in managing the acute patient in the ICU are well received by students , positively influence their confidence , and decrease their anxiety .
There is evidence that simulated learning environments can replace a portion of a full-time 4-week clinical rotation without impairing learning .
CONCLUSIONS Simulation-based learning activities are being effectively incorporated into PT curricula .