***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 Non-technical skills ( NTS ) , such as communication and professionalism , contribute to the safe and effective completion of procedures . NTS training has previously been shown to improve surgical performance . Moreover , increases in NTS have been associated with improved clinical endoscopic performance . Despite this evidence , NTS training has not been tested as an intervention in endoscopy . Objective The aim of this study is to evaluate the effectiveness of a simulation-based training ( SBT ) curriculum of NTS on novice endoscopists ’ performance of clinical colonoscopy . Methods Novice endoscopists were r and omized to 2 groups . The control group received 4 hours of interactive didactic sessions on colonoscopy theory and 6 hours of SBT . Hours 5 and 6 of the SBT were integrated scenarios , wherein participants interacted with a st and ardized patient and nurse , while performing a colonoscopy on the virtual reality ( VR ) simulator . The NTS ( intervention ) group received the same teaching sessions but the last hour was focused on NTS teaching . The NTS group also review ed a checklist of tasks relevant to NTS concepts prior to each integrated scenario case and was provided with dedicated feedback on their NTS performance during the integrated scenario practice . All participants were assessed at baseline , immediately after training , and 4 to 6 weeks post-training . The primary outcome measure is colonoscopy-specific performance in the clinical setting . Results In total , 42 novice endoscopists completed the study . Data collection and analysis is ongoing . We anticipate completion of all assessment s by August 2017 . Data analysis , manuscript writing , and subsequent su bmi ssion for publication is expected to be completed by December 2017 . Conclusions Results from this study may inform the implementation of NTS training into postgraduate gastrointestinal curricula . NTS curricula may improve attitudes towards patient safety and self-reflection among trainees . Moreover , enhanced NTS may lead to superior clinical performance and outcomes in colonoscopy . Trial Registration Clinical trial.gov NCT02877420 ; https://www . clinical trials.gov/ct2/show/NCT02877420 ( Archived by WebCite at http://www.webcitation.org/6rw94ubXX NCT02877420 Background : Training interdisciplinary trauma teams to work effectively together using simulation technology has led to a reduction in medical errors in emergency department , operating room , and delivery room context s. High-fidelity patient simulators (PSs)—the predominant method for training healthcare teams — are expensive to develop and implement and require that trainees be present in the same place at the same time . In contrast , online computer-based simulators are more cost effective and allow simultaneous participation by students in different locations and time zones . In this pilot study , the research ers created an online virtual emergency department ( Virtual ED ) for team training in crisis management , and compared the effectiveness of the Virtual ED with the PS . We hypothesized that there would be no difference in learning outcomes for graduating medical students trained with each method . Methods : In this pilot study , we used a pretest-posttest control group , experimental design in which 30 subjects were r and omly assigned to either the Virtual ED or the PS system .  In the Virtual ED each subject logged into the online environment and took the role of a team member . Four-person teams worked together in the Virtual ED , communicating in real time with live voice over Internet protocol , to manage computer-controlled patients who exhibited signs and symptoms of physical trauma . Each subject had the opportunity to be the team leader . The subjects ’ leadership behavior as demonstrated in both a pretest case and a posttest case was assessed by 3 raters , using a behaviorally anchored scale . In the PS environment , 4-person teams followed the same research protocol , using the same clinical scenarios in a Simulation Center . Guided by the Emergency Medicine Crisis Re source Management curriculum , both the Virtual ED and the PS groups applied the basic principles of team leadership and trauma management ( Advanced Trauma Life Support ) to manage 6 trauma cases — a pretest case , 4 training cases , and a posttest case . The subjects in each group were assessed individually with the same simulation method that they used for the training cases . Results : Subjects who used either the Virtual ED or the PS showed significant improvement in performance between pretest and posttest cases ( P < 0.05 ) . In addition , there was no significant difference in subjects ’ performance between the 2 types of simulation , suggesting that the online Virtual ED may be as effective for learning team skills as the PS , the method widely used in Simulation Centers . Data on usability and attitudes toward both simulation methods as learning tools were equally positive . Discussion : This study shows the potential value of using virtual learning environments for developing medical students ’ and resident physicians ’ team leadership and crisis management skills In this study the effects of virtual reality exposure therapy ( VRET ) were investigated in patients with acrophobia . Feelings of presence in VRET were systematic ally varied by using either a head-mounted display ( HMD ) ( low presence ) or a computer automatic virtual environment ( CAVE ) ( high presence ) . VRET in general was found to be more effective than no treatment . No differences were found in effectiveness between VRET using an HMD or CAVE . Results were maintained at 6 months follow-up . Results of VRET were comparable with those of exposure in vivo ( Cyberpsychology and Behavior 4 ( 2001 ) 335 ) . In treatment completers no relationship was found between presence and anxiety . Early drop-outs experienced less acrophobic complaints and psychopathology in general at pre-test . They also experienced less presence and anxiety in the virtual environment used in session one as compared to patients that completed VRET OBJECTIVE ( S ) Patient-specific simulated rehearsal ( PsR ) is a technological advance within the domain of endovascular virtual reality ( VR ) simulation . It allows incorporation of patient-specific computed tomography Digital Imaging and Communications in Medicine ( CT DICOM ) data into the simulation and subsequent rehearsal of real patient cases . This study aim ed to evaluate whether a part-task rehearsal ( PTr ) of a carotid artery stenting procedure ( CAS ) on a VR simulator is as effective as a full-task ( FTr ) preoperative run through . METHODS Medical trainees were trained in the CAS procedure and r and omised to a PTr or FTr of a challenging CAS case ( Type-II arch ) . PTr consisted of 30 min of repeated catheterisations of the common carotid artery ( CCA ) . Thereafter , both groups performed the CAS procedure in a fully functional simulated operating suite ( SOS ) with an interventional team . Technical performances were assessed using simulator-based metrics and expert ratings . Other aspects of performance were assessed using the Non-Technical Skills for Surgeons ( NOTSS ) scoring . RESULTS Twenty trainees were evenly r and omised to either PTr or FTr . No differences in performance were seen except for the total time the embolic protection device ( EPD ) was deployed ( 9.4 min for the PT vs. 8.1 min for the FT , p = 0.02 ) . Total time ( 26.3 vs. 25.5 min , p = 0.94 ) , fluoroscopy time ( 15.8 vs. 14.4 min , p = 0.68 ) , number of roadmaps ( 10.5 vs. 11.0 , p = 0.54 ) , amount of contrast ( 53.5 vs. 58.0 ml , p = 0.33 ) , time to deploy the EPD ( 0.9 vs. 0.8 min , p = 0.31 ) and time to catheterise the CCA ( 9.2 vs. 8.9 min , p = 0.94 ) were similar . Qualitative performances as measured by expert ratings ( score 24 vs. 24 , p = 0.49 ) and NOTSS ( p > 0.05 for all categories ) were also comparable . CONCLUSIONS Part- and full-task rehearsals are equally effective with respect to the operative performance of a simulated CAS intervention . This finding makes a patient-specific rehearsal more efficient and may increase the feasibility of implementation of this technology into medical practice Introduction Surgical performance is affected by distractors and interruptions to surgical workflow that exist in the operating room . However , traditional surgical simulators are used to train surgeons in a skills laboratory that does not recreate these conditions . To overcome this limitation , we have developed a novel , immersive virtual reality ( Gen2-VR © ) system to train surgeons in these environments . This study was to establish face and construct validity of our system . Methods and procedures The study was a within-subjects design , with subjects repeating a virtual peg transfer task  under three different conditions : Case I : traditional VR ; Case II : Gen2-VR © with no distractions and Case III : Gen2-VR © with distractions and interruptions . In Case III , to simulate the effects of distractions and interruptions , music was played intermittently , the camera lens was fogged for 10 s and tools malfunctioned for 15 s at r and om points in time during the simulation . At the completion of the study subjects filled in a 5-point Likert scale feedback question naire . A total of sixteen subjects participated in this study . Results Friedman test showed significant difference in scores between the three conditions ( p < 0.0001 ) . Post hoc analysis using Wilcoxon signed-rank tests with Bonferroni correction further showed that all the three conditions were significantly different from each other ( Case I , Case II , p < 0.0001 ) , ( Case I , Case III , p < 0.0001 ) and ( Case II , Case III , p = 0.009 ) . Subjects rated that fog ( mean 4.18 ) and tool malfunction ( median 4.56 ) significantly hindered their performance . Conclusion The results showed that Gen2-VR © simulator has both face and construct validity and that it can accurately and realistically present distractions and interruptions in a simulated OR , in spite of limitations of the current HMD hardware technology BACKGROUND  GI endoscopy simulation-based training augments early clinical performance ; however , the optimal manner by which to deliver training is unknown . OBJECTIVE We aim ed to vali date a simulation-based structured comprehensive curriculum ( SCC ) design ed to teach technical , cognitive , and integrative competencies in colonoscopy . DESIGN Single-blinded , r and omized , controlled trial . SETTING Endoscopic simulation course at an academic hospital . PARTICIPANTS AND INTERVENTIONS Thirty-three novice endoscopists were allocated to an SCC group or self-regulated learning ( SRL ) group . The SCC group received a curriculum consisting of 6 hours of didactic lectures and 8 hours of virtual reality simulation-based training with expert feedback . The SRL group was provided a list of desired objectives and was instructed to practice on the simulator for an equivalent time ( 8 hours ) . MAIN OUTCOME MEASUREMENTS Clinical transfer was assessed during 2 patient colonoscopies using the Joint Advisory Group Direct Observation of Procedural Skills ( JAG DOPS ) scale . Secondary outcome measures included differences in procedural knowledge , immediate post-training simulation performance , and delayed post-training ( 4 - 6 weeks ) performance during an integrated scenario test on the JAG DOPS communication and integrated scenario global rating scales . RESULTS There was no significant difference in baseline or post-training performance on the simulator task . The SCC group performed superiorly during their first and second clinical colonoscopies . Additionally , the SCC group demonstrated significantly better knowledge and colonoscopy-specific performance , communication , and global performance during the integrated scenario . LIMITATIONS We were unable to measure SRL participants ' effort outside of m and atory training . In addition , feedback metrics and number of available simulation cases are limited . CONCLUSIONS These results support integration of endoscopy simulation into a structured curriculum incorporating instructional feedback and complementary didactic knowledge as a means to augment technical , cognitive , and integrative skills acquisition , as compared with SRL on virtual reality simulators . ( CLINICAL TRIAL REGISTRATION NUMBER NCT01991522 . Background Current training modalities within ureteroscopy have been extensively vali date d and must now be integrated within a comprehensive curriculum . Additionally , non-technical skills often cause surgical error and little research has been conducted to combine this with technical skills teaching . This study therefore aim ed to develop and vali date a curriculum for semi-rigid ureteroscopy , integrating both technical and non-technical skills teaching within the programme . Methods Delphi methodology was utilised for curriculum development and content validation , with a r and omised trial then conducted ( n = 32 ) for curriculum evaluation . The developed curriculum consisted of four modules ; initially developing basic technical skills and subsequently integrating non-technical skills teaching .  Sixteen participants underwent the simulation-based curriculum  and were subsequently assessed , together with the control cohort ( n = 16 ) within a full immersion environment . Both technical ( Time to completion , OSATS and a task specific checklist ) and non-technical ( NOTSS ) outcome measures were recorded with parametric and non-parametric analyses used depending on the distribution of our data as evaluated by a Shapiro – Wilk test . Results Improvements within the intervention cohort demonstrated educational value across all technical and non-technical parameters recorded , including time to completion ( p < 0.01 ) , OSATS scores ( p < 0.001 ) , task specific checklist scores ( p = 0.011 ) and NOTSS scores ( p < 0.001 ) . Content validity , feasibility and acceptability were all demonstrated through curriculum development and post- study question naire results . Conclusions The current developed curriculum demonstrates that integrating both technical and non-technical skills teaching is both educationally valuable and feasible . Additionally , the curriculum offers a vali date d simulation-based training modality within ureteroscopy and a framework for the development of other simulation-based programmes BACKGROUND Advanced Cardiac Life Support ( ACLS ) is a series of team-based , sequential and time constrained interventions , requiring effective communication and coordination of activities that are performed by the care provider team on a patient undergoing cardiac arrest or respiratory failure . The state-of-the-art ACLS training is conducted in a face-to-face environment under expert supervision 
    Output:
    
Screen-based VR simulators or virtual worlds are the most frequently used systems .
The nontechnical skills addressed in VR simulation include mainly teamwork , communication , and situation awareness .
Most studies evaluate the usability and acceptability of VR simulation  , and few studies have measured the effects of VR simulation  on nontechnical skills development