***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: Objective : To assess the impact of warm-up on laparoscopic performance in the operating room ( OR ) . Background : Implementation of simulation-based training into clinical practice remains limited despite evidence to show that the improvement in skills is transferred to the OR . The aim of this study was to evaluate the impact of a short virtual reality warm-up training program on laparoscopic performance in the OP . Methods : Sixteen Laparoscopic Cholecystectomies were performed by 8 surgeons in the OR . Participants were r and omized to a group which received a preprocedure warm-up using a virtual reality simulator and no warm-up group . After the initial laparoscopic cholecystectomy all surgeons served as their own controls by performing another procedure with or without preoperative warm-up . All OR procedures were videotaped and assessed by 2 independent observers using the generic OSATS global rating scale ( from 7 to 35 ) . Results : There was significantly better surgical performance on the laparoscopic Cholecystectomy following preoperative warm-up , median 28.5 ( range = 18.5–32.0 ) versus median 19.25 ( range = 15–31.5 ) , P = 0.042 . The results demonstrated excellent reliability of the assessment tool used ( Cronbach 's & agr ; = 0.92 ) . Conclusion : This study showed a significant beneficial impact of warm-up on laparoscopic performance in the OP . The suggested program is short , easy to perform , and therefore realistic to implement in the daily life in a busy surgical department . This will potentially improve the procedural outcome and contribute to improved patient safety and better utilization of OR re sources Background  Surgical skills training outside the operating room is beneficial . The best methods have yet to be identified . The authors aim ed to document the predictive validity of simulation training in three different studies . Methods Study 1 was a prospect i ve , r and omized , multicenter trial comparing performance in the operating room after training on a laparoscopic simulator and after no training . The Global Operative Assessment of Laparoscopic Skills ( GOALS ) was used to evaluate operative performance . Study 2 retrospectively review ed the operative performance of junior residents before and after implementation of a laparoscopic skills training curriculum .  Operative time was the variable used to determine resident improvement . Study 3 was a prospect i ve , r and omized trial evaluating intern operative performance of laparoscopic cholecystectomy in a porcine model before and after training on a simulator .  Operative performance was assessed using GOALS . Results All three studies failed to demonstrate predictive validity . With GOALS used as the assessment tool , no difference was found between trained and untrained residents in studies 1 and 3 . In study 2 , the trained group took significantly longer to complete a laparoscopic cholecystectomy than the untrained group . Conclusions No correlation was found between the three types of training outside the operating room , and no improved operative performance was observed . Possible explanations include too few subjects , training introduced too late in the learning curve , and training criteria that were too easy . Additionally , simulator training focuses on precision , which may actually increase task time . Awareness of these issues can improve the design of future studies BACKGROUND This study compares a laparoscopic skill training protocol without proficiency targets to the same protocol with explicit targets and notification of progress . METHODS Fourteen surgery interns were r and omized into 2 groups . The intervention group received task-specific proficiency criteria to guide practice . The control group did not . After training , participants were evaluated by blinded faculty during laparoscopic cholecystectomy . RESULTS The control group met significantly fewer of the 7 LapSim ( Surgical Science Sweden AB , Gotëborg ) targets ( mean = 1.14 ) than the intervention group ( mean = 7.00 ; P = .001 ) and significantly fewer of the 5 video trainer targets ( mean = .86 ) than the intervention group ( mean = 5.00 ; P = .001 ) . Ratings of depth perception , bimanual dexterity , efficiency , tissue h and ling , autonomy , and overall competence were higher for the intervention group . Effect sizes ranged from medium to large ( .394-.981 ) , indicating an impact of the proficiency-based training protocol . CONCLUSIONS Delineation of proficiency targets with reporting of progress improves interns ' practice results , and appears to have a positive effect on their early operating room ( OR ) performance of laparoscopic cholecystectomy Training on a video trainer or computer-based minimally invasive surgery trainer leads to improved benchtop laparoscopic skill . Recently , improved operative performance from practice on a video trainer was reported . The purpose of this study was three fold : ( a ) to compare psychomotor skill improvement after training on a virtual reality ( VR ) system with that after training on a video-trainer , ( VT ) ( b ) to evaluate whether skills learned on the one training system are transferable to the other , and ( c ) to evaluate whether VR or VT training improves operative performance . For the study , 50 junior surgery residents completed baseline skill testing on both the VR and VT systems . These subjects then were r and omized to either a VR or VT structured training group . After practice , the subjects were tested again on their VR and VT skills . To assess the effect of practice on operative performance , all second-year residents ( n = 19 ) were evaluated on their operative performance during a laparoscopic cholecystectomy before and after skill training . Data are expressed as percentage of improvement in mean score/time . Analysis was performed by Student 's paired t-test . The VR training group showed improvement of 54 % on the VR posttest , as compared with 55 % improvement by the VT group . The VR training group improved more on the VT posttest tasks ( 36 % ) than the VT training group improved on the VR posttest tasks ( 17 % ) ( p < 0.05 ) . Operative performance improved only in the VR training group ( p < 0.05 ) . Psychomotor skillsimprove after training on both VR and VT , and skills may be transferable . Furthermore , training on a minimally invasive surgery trainer , virtual reality system may improve operative performance during laparoscopic cholecystectomy BACKGROUND Clinical outcomes after many complex surgical procedures vary widely across hospitals and surgeons . Although it has been assumed that the proficiency of the operating surgeon is an important factor underlying such variation , empirical data are lacking on the relationships between technical skill and postoperative outcomes . METHODS We conducted a study involving 20 bariatric surgeons in Michigan who participated in a statewide collaborative improvement program . Each surgeon su bmi tted a single representative videotape of himself or herself performing a laparoscopic gastric bypass . Each videotape was rated in various domains of technical skill on a scale of 1 to 5 ( with higher scores indicating more advanced skill ) by at least 10 peer surgeons who were unaware of the identity of the operating surgeon . We then assessed relationships between these skill ratings and risk-adjusted complication rates , using data from a prospect i ve , externally audited , clinical - outcomes registry involving 10,343 patients . RESULTS Mean summary ratings of technical skill ranged from 2.6 to 4.8 across the 20 surgeons . The bottom quartile of surgical skill , as compared with the top quartile , was associated with higher complication rates ( 14.5 % vs. 5.2 % , P<0.001 ) and higher mortality ( 0.26 % vs. 0.05 % , P=0.01 ) . The lowest quartile of skill was also associated with longer operations ( 137 minutes vs. 98 minutes , P<0.001 ) and higher rates of reoperation ( 3.4 % vs. 1.6 % , P=0.01 ) and readmission ( 6.3 % vs. 2.7 % ) ( P<0.001 ) . CONCLUSIONS The technical skill of practicing bariatric surgeons varied widely , and greater skill was associated with fewer postoperative complications and lower rates of reoperation , readmission , and visits to the emergency department . Although these findings are preliminary , they suggest that peer rating of operative skill may be an effective strategy for assessing a surgeon 's proficiency BACKGROUND The efficacy of laparoscopy simulators remains controversial . METHODS This was a comparative prospect i ve study that evaluated the impact of  simulator training  on technical competence during a real surgical procedure . Residents were divided into 3 groups : the Mcgill Inanimate System for Training and Evaluation of Laparoscopic Skills ( MISTELS ) group , training on a simple simulator ; LAP Mentor group , training on a virtual simulator ; and control group . An initial evaluation was made by a vali date d score during a laparoscopic cholecystectomy . Each resident was then trained for 1 month . A second evaluation was then performed . RESULTS Before/after scores were significantly improved in the MISTELS ( P = .042 ) and LAP Mentor ( P = .026 ) groups . It was not the case in the control group . There was a better progression in the MISTELS ( P = .026 ) and LAP Mentor ( P = .007 ) groups than in the control group . There was no significant difference between the MISTELS and LAP Mentor groups . CONCLUSIONS Simulator training provides a more rapid acquisition of competence in surgical technique Objective : To assess the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills ( MISTELS ) physical laparoscopic simulator for construct and predictive validity and for its educational utility . Summary Background Data : MISTELS is the physical simulator incorporated by the Society of American Gastrointestinal and Endoscopic Surgeons ( SAGES ) in their Fundamentals of Laparoscopic Surgery ( FLS ) program . MISTELS ’ metrics have been shown to have high interrater and test-retest reliability and to correlate with skill in animal surgery . Methods : Over 200 surgeons and trainees from 5 countries were assessed using MISTELS in a series of experiments to assess the validity of the system and to evaluate whether practicing MISTELS basic skills ( transferring ) would result in skill acquisition transferable to complex laparoscopic tasks ( suturing ) . Results : Face validity was confirmed through question ing 44 experienced laparoscopic surgeons using global rating scales . MISTELS scores increased progressively with increasing laparoscopic experience ( n = 215 , P < 0.0001 ) , and residents followed over time improved their scores ( n = 24 , P < 0.0001 ) , evidence of construct validity . Results in the host institution did not differ from 5 beta sites ( n = 215 , external validity ) .  MISTELS scores correlated with a highly reliable vali date d intraoperative rating of technical skill during laparoscopic cholecystectomy ( n = 19 , r = 0.81 , P < 0.0004 ; concurrent validity ) . Novice laparoscopists were r and omized to practice /no practice of the transfer drill for 4 weeks . Improvement in intracorporeal suturing skill was significantly related to practice but not to baseline ability , career goals , or gender ( P < 0.001 ) . Conclusion : MISTELS is a practical and inexpensive inanimate system developed to teach and measure technical skills in laparoscopy . This system is reliable , valid , and a useful educational tool This study examined the impact of virtual reality ( VR ) surgical simulation on improvement of psychomotor skills relevant to the performance of laparoscopic cholecystectomy Background : This study was undertaken to investigate operating room performance of surgical residents , after participating in the Eindhoven virtual reality laparoscopic cholecystectomy training course . This course is the first formal surgical resident trainings course , using a variety of complementary virtual reality ( VR ) skills training simulation in order to prepare surgical residents for their first laparoscopic cholecystectomy . The course was granted EAES certification . Methods : The four-day course is based on multimedia and multimodality approach . A variety of increasingly difficult simulation training sessions , next to intimate focus-group “ knowledge sessions ” are included . Both basic and procedural VR simulation is featured , using MIST-VR and the Xitacts ' LapChol simulation software . The operating room performance of twelve surgical residents who participated in the course and twelve case-control counterparts were compared . The case-control grup was matched for clinical number laparoscopic cholecystectomy performance ( maximum of 4 procedures ) . Two observers analyzed a r and omly mixed videotape , featuring the part of the “ clip- and -cut ” procedure of the laparoscopic cholecystectomy , and were blinded for participants ' group status . Structured question naires including multiple observation scales were used to assess performance . Results : Residents of both the experimental and control group did not differ in demographic parameters , except for number of laparoscopic cholecystectomies in favor of the control group ( p-value 0.008 ) . Both observers judge the experimental group to perform significantly better ( p-value 0.004 and 0.013 ) . Experimental group residents valued their course highly in terms of their laparoscopic surgical skills improvement and the use of VR simulators in the surgical curiculum . Conclusions : The Eindhoven Virtual Reality laparoscopic cholecyctectomy training course improves surgical skill in the operating room above the level of residents trained by a variety of other training methods BACKGROUND Laparoscopic surgery has changed the face of medical care forever . The benefits of laparoscopic open surgery have been demonstrated in virtually all major abdominal surgical procedures . Laparoscopy has introduced a new skill set that must be mastered and requires dedicated training . The teaching of laparoscopic operative skills in the clinical setting is constrained by the complexity of procedures , medicolegal and ethical concerns , fiscal and time limitations . This has created the need for formal training outside the operating room . Simulator-based training holds great promise in enhancing surgical education and providing a safe , 
    Output:
    
Conclusions The most commonly reported validity evidence was inter-rater reliability and relationships to other known variables .