***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 Colonoscopy insertion is difficult to teach due to the inability of current training models to provide realistic tactile sensation with simultaneous three-dimensional ( 3D ) colonoscope display . Aims To assess the influence of a simulator consisting of a colon model coupled with 3D instrument visualization on trainee colonoscopy performance . Methods Pilot study using the simulator model with three trainees who were not proficient in colonoscopy . At r and om times over a 6-week period , trainees participated in an individualized half-day session using the Colonoscope Training Model and a colonoscope equipped with a 3D magnetic probe imaging system ( ScopeGuide ) in six st and ardized cases . A blinded supervising instructor grade d patient-based colonoscopy performance over the 6-week period , and we independently analyzed the 2-week period before and after the intervention . We also measured cecal intubation and withdrawal times and medication requirements . Results Trainees performed 86 patient-based colonoscopies . Following the intervention , the colonoscopy performance score improved from 4.4 ± 2.3 to 5.9 ± 2.4 ( p = 0.005 ) . Trainees had a 76 % cecal intubation rate following the session as compared to 43 % before training ( p = 0.004 ) , while utilizing less time , 14 ± 7 versus 18 ± 11 min ( p = 0.056 ) and less medication ( p > 0.05 ) . Conclusions Colonoscopy simulation using the Colonoscope Training Model and the ScopeGuide produced an immediate and large effect on trainee  colonoscopy performance BACKGROUND Little is known regarding the value of esophagogastroduodenoscopy ( EGD ) simulators in education . The purpose of the present paper was to vali date the use of computer simulation in novice EGD training . METHODS In phase 1 , expert endoscopists evaluated various aspects of simulation fidelity as compared to live endoscopy . Additionally , computer-recorded performance metrics were assessed by comparing the recorded scores from users of three different experience levels . In phase 2 , the transfer of simulation-acquired skills to the clinical setting was assessed in a two-group , r and omized pilot study . The setting was a large gastroenterology ( GI ) Fellowship training program ; in phase 1 , 21 subjects ( seven expert , intermediate and novice endoscopist ) , made up the three experience groups . In phase 2 , eight novice GI fellows were involved in the two-group , r and omized portion of the study examining the transfer of simulation skills to the clinical setting . During the initial validation phase , each of the 21 subjects completed two st and ardized EDG scenarios on a computer simulator and their performance scores were recorded for seven parameters . Following this , staff participants completed a question naire evaluating various aspects of the simulator 's fidelity . Finally , four novice GI fellows were r and omly assigned to receive 6 h of simulator-augmented training ( SAT group ) in EGD prior to beginning 1 month of patient-based EGD training . The remaining fellows experienced 1 month of patient-based training alone ( PBT group ) . Results of the seven measured performance parameters were compared between three groups of varying experience using a Wilcoxon ranked sum test . The staffs ' simulator fidelity survey used a 7-point Likert scale ( 1 , very unrealistic ; 4 , neutral ; 7 , very realistic ) for each of the parameters examined . During the second phase of this study , supervising staff rated both SAT and PBT fellows ' patient-based performance daily . Scoring in each skill was completed using a 7-point Likert scale ( 1 , strongly disagree ; 4 , neutral ; 7 , strongly agree ) . Median scores were compared between groups using the Wilcoxon ranked sum test . RESULTS Staff evaluations of fidelity found that only two of the parameters examined ( anatomy and scope maneuverability ) had a significant degree of realism . The remaining areas were felt to be limited in their fidelity . Of the computer-recorded performance scores , only the novice group could be reliably identified from the other two experience groups . In the clinical application phase , the median Patient Discomfort ratings were superior in the PBT group ( 6 ; interquartile range [ IQR ] , 5 - 6 ) as compared to the SAT group ( 5 ; IQR , 4 - 6 ; P = 0.015 ) . PBT fellows ' ratings were also superior in Sedation , Patient Discomfort , Independence and Competence during various phases of the evaluation . At no point were SAT fellows rated higher than the PBT group in any of the parameters examined . CONCLUSION This EGD simulator has limitations to the degree of fidelity and can differentiate only novice endoscopists from other levels of experience . Finally , skills learned during EGD simulation training do not appear to translate well into patient-based endoscopy skills . These findings suggest against a key element of validity for the use of this computer simulator in novice EGD training BACKGROUND AND AIMS The advantages of using a computer-based simulator during colonoscopy training are debated . We aim ed to explore its usefulness in objective ly measuring trainees ' competence in colonoscopy . METHODS Twelve colonoscopy trainees ( fully trained in upper GI endoscopy ) were evaluated using a computer-based simulator ( GI-Mentor , Symbionix ) before and during h and s-on training ( i.e. after 60 colonoscopies ) ; the controls were 15 experts ( > 90 % of caecal intubation ) . Both trainees and experts performed two " screening " simulations ( easy and difficult ) in a r and omised order , and the time to reach the caecum and withdrawal time was assessed . RESULTS The percentage of caecal intubation progressively increased during h and s-on training . All of the trainees intubated the caecum during the easy and difficult simulations , both before and during h and s-on training . The median time ( interquartile range ) to reach the caecum upon easy simulation was the only variable influenced by h and s-on training : 2.7 min ( 2.1 - 3.2 ) before and 1.9 min ( 1.6 - 2 ) during training ( p<0.01 ) . Withdrawal time was ≥6 min in the case of five trainees before training , and three during h and s-on training . Computer-based simulator performance did not correlate with h and s-on training performance . CONCLUSIONS The computer-based simulator was not found to be useful in evaluating competence during h and s-on training in colonoscopy Background Virtual reality ( VR ) simulators and Web-based instructional videos are valuable supplemental training re sources in surgical programs , but it is unclear how to optimally integrate them into minimally invasive surgical training . Methods Medical students were r and omized to proficiency-based training on  VR laparoscopy and endoscopy simulators by two different methods : proctored training ( automated simulator feedback plus human expert feedback ) or independent training ( simulator feedback alone ) . After achieving simulator proficiency , trainees performed a series of laparoscopic and endoscopic tasks in a live porcine model . Prior to their entry into the animal lab , all trainees watched an instructional video of the procedure and were r and omly assigned to either observe or not observe the actual procedure before performing it themselves . The joint effects of VR training method and procedure observation on time to successful task completion were evaluated with Cox regression models . Results Thirty-two students ( 16 proctored , 16 independent ) completed  VR training . Cox regression modeling with adjustment for relevant covariates demonstrated no significant difference in the likelihood of successful task completion for independent versus proctored training [ Hazard Ratio ( HR ) 1.28 ; 95 % Confidence Interval ( CI ) 0.96–1.72 ; p = 0.09 ] . Trainees who observed the actual procedure were more likely to be successful than those who watched the instructional video alone ( HR 1.47 ; 95 % CI 1.09–1.98 ; p = 0.01 ) . Conclusions Proctored VR training is no more effective than independent training with respect to surgical performance . Therefore , time-consuming human expert feedback during VR training may be unnecessary . Instructional videos , while useful , may not be adequate substitutes for actual observation when trainees are learning minimally invasive surgical procedures Background The hypothesis of this study is that working on the simulator without a structured feedback does not change performance ; hence , any effects shown after structured feedback would amount to useful learning of the procedure . The aim was to investigate the learning curve for the HT Immersion Medical Colonoscopy Simulator without any structured feedback . This could then be potentially applied to vali date the learning curve on the simulator when structured feedback is provided . There are no previous studies on this matter . Methods C and i date s were asked to perform colonoscopy on the HT Immersion Medical Colonoscopy Simulator . Modules 3 and 4 were used at r and om . In total , each c and i date was asked to perform five consecutive virtual colonoscopies on the same module . These five episodes were collectively referred to as one trial . A time result of 3,600 sec ( 1 h ) was used to denote perforation . No guidance or feedback was given to c and i date s before , during , or after each procedure . A total of 26 postgraduate doctors were recruited , including nine research fellows , five pre registration house officers , six specialist registrars , and six consultants . Fourteen c and i date s recorded five attempts each ( i.e. , one trial each ) on the same module of the colonoscopy simulator ( 14 trials over 70 episodes ) . Another 12 c and i date s recorded five attempts ( i.e. , one trial each ) on two modules of the colonoscopy simulator ( 24 trials over 120 episodes ) . Hence , 190 episodes were recorded in total , representing 38 trials . Results There was no improvement in performance on the simulator from first attempt to the fifth in the absence of feedback . If there was any initial gain in any measurable outcome , this was lost in subsequent attempts indicating lack of learning . The outcomes measured included time taken to complete the test , percentage of the mucosa visualized , depth of the instrument inserted , and the path length used . The results were statistically significant for all outcomes . Conclusions This study demonstrates that in the absence of feedback , it is not possible to improve performance on the HT Immersion Medical Colonoscopy Simulator . Thus , there is no learning curve for the machine . The information from this study is vital for using the simulators in training and assessment because any improvement in learning curves shown after training on simulators can be presumed to be due to learning the procedure and not the Background The Erlangen Active Simulator for Interventional Endoscopy ( EASIE ) using ex-vivo porcine organs was introduced in 1997 . The present study should analyze whether repeated EASIE simulator training in endoscopic hemostasis led to superior performance compared with a traditionally educated group . The results were compared with a similar project in New York . Methods Thirty-five French GI fellows were enrolled . Baseline skills evaluation was performed in four disciplines ( manual skills , injection/coagulation , clip application and variceal ligation ) using the compactEASIE-simulator equipped with an upper gastrointestinal organ package for bleeding simulation . The same , translated evaluation forms ( from the prior New York project ) were used . Subsequently , fellows were r and omized into group A ( n=17 , only clinical education ) and group B ( n=18 , additional three simulator trainings ) . Group B was trained the next day and after 4 and 7 months by experts of the French Society of Gastrointestinal Endoscopy . Both groups performed routine and emergency endoscopies at their home hospitals during the study period . Both groups were re-evaluated blindly after 9 months . Results The learning curve for group B showed a significant improvement in all disciplines ( P<0.004 ) whereas group A improved significantly in only two of four disciplines at blinded final evaluation ( manual skills P=0.02 , injection/coagulation P=0.013 ) . The direct comparison of groups B and A at blinded final evaluation showed significantly superior ratings for group B in all disciplines ( P<0.006 ) and significantly shorter performance times in two disciplines ( P=0.016 each ) . The comparison with the similar ‘ New York project ’ revealed that preexisting differences in skills were adjusted by the training . Conclusion Complementary trainings ( three workshops in 7 months ) in endoscopic hemostasis using the compactEASIE improved skills compared with a solely clinical education . The results of the ‘ New York project ’ were confirmed and benefits were independent from the medical educational system INTRODUCTION Colonoscopic simulators offer the opportunity for skill acquisition in the pre clinical setting . Currently available simulators vary widely with respect to level of fidelity and technological sophistication . Despite the belief that more realistic is better , there is a paucity of evidence regarding the relative effectiveness of simulator fidelity ( high vs low ) on the acquisition of basic colonoscopic skills . We hypothesized that novice learners can acquire basic colonoscopic skills using simulators , however fidelity of the simulator does not make a difference . METHODS We r and omly assigned novice third-year and fourth-year medical students to practice on either a low-fidelity or high-fidelity colonoscopy model . The low-fidelity model used is described in the module 16 of the American College of Surgeons/Association of Program Directors in Surgery surgical skills curriculum for residents , Phase 1 : basic or core skills and tasks < http://elearning.facs.org/mod/re source /view.php?1d=450 > . The high-fidelity model was the AccuTouch colonoscopy simulator , Immersion Medical ( AccuTouch CS ) that has 6 different simulated scenarios for diagnostic colonoscopy ( level 1 - 6 ) . Both groups had 16 students and were given st and ard instruction by an expert with respect to the procedure and instrument h and ling on both models . Both groups were pretested and posttested on level 1 of the AccuTouch CS . The high-fidelity group practice d on level 2 and 4 of the Accu 
    Output:
    
Simulation-based training , as compared with no training , generally appears to provide participants with some advantage over their untrained peers as measured by composite score of competency , independent procedure completion , performance time , independent insertion depth , overall rating of performance or competency error rate and mucosal visualization .
Alternatively , there was no conclusive evidence that simulation-based training was superior to conventional patient-based training , although data were limited .
The results of this systematic review indicate that virtual reality endoscopy training can be used to effectively supplement early conventional endoscopy training ( apprenticeship model ) in diagnostic oesophagogastroduodenoscopy , colonoscopy and /or sigmoidoscopy for health professions trainees with limited or no prior endoscopic experience .