***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 " Dry lab " facilities are integral to laparoscopy training , but access is often limited due to the high costs of video-laparoscopy equipment . We assessed the effectiveness of a cheap and simple training model compared to conventional video-laparoscopy for basic training using a r and omised , blinded study . METHODS Thirty-six third-year medical students without previous surgical skills were r and omised into two groups : group A students were taught basic laparoscopy skills using a conventional video-laparoscopy pelvic trainer and group B students were taught similar techniques using a cardboard box with a cut-out top to allow light and visualisation . Participants in group B had one eye obscured to reduce their stereoscopic vision . After eight sessions of training amounting to 24h , the two groups were assessed by a blinded adjudicator on set tasks using both the video-laparoscopy pelvic trainer and the cardboard box .  Accuracy , timing and depth perception were assessed and the results compared . RESULTS There was no significant difference in performance scores or times between the two groups in any of the parameters when tested on the cardboard box . However , when assessed on the video trainer , the cardboard box-trained group had significantly faster times with equivalent scores in the majority of tasks . CONCLUSION For basic laparoscopic training the cardboard box , costing nothing , is a simple and effective alternative , which can be used in conjunction with sophisticated video-laparoscopy equipment costing thous and s of dollars Background Many laparoscopic simulation training systems exist and have been shown to transfer learning of surgical skills to the operating room . The manner in which the training is structured to maximize learning has not been examined . There are many aspects to the acquisition of laparoscopic skills during training , one of which is the availability of knowledge of results ( KR ) . Knowledge of results is information about the outcome of motor skill execution , usually provided to individuals at the end of the execution . The timing and nature of KR can affect how well people learn new motor skills . In addition , detailed instruction during learning can also affect skill acquisition . We studied the effects of KR and instruction on the learning curve of a suturing and knot-tying task . We hypothesized that KR was necessary for skill acquisition , and that detailed instruction would help trainees to learn to perform the task more correctly and reach a performance plateau earlier . In addition , the overall workload of a trainee during training would decrease as skills improved , especially when KR and coaching were provided . Methods Nine medical students with no previous laparoscopic surgical experience were r and omly and evenly divided into three groups with different KR conditions : ( 1 ) no KR , ( 2 ) KR , ( 3 ) KR + instruction . Each subject attended a training session for 1 h each day , 6 days a week for 4 consecutive weeks . Performance measures such as task time , smoothness of instrument , and path length were recorded for each trial . Workload was assessed using the NASA-TLX question naire . Results While KR was necessary for learning to suture , continual instruction had limited additional benefits . However , KR + instruction did reduce subjects ’ perceived overall workload . Conclusions Surgical training could be carried out effectively with only knowledge of results . These results have implication s for the staffing of surgical skills laboratories Background Training of skills in simulators is preferred over learning on patients so as to avoid undue injury to patients and to allow more efficient use of re sources . Most simulators are costly and require a dedicated space . The aim of this study was to evaluate a simple desktop simulator , the Mirror Trainer . Methods Thirty medical students were r and omly assigned to three groups . One group was taught laparoscopic suturing in the Mirror Trainer , the second group used a pelvic training box , while the third group served as a control group and did not receive any training . All suture attempts during training were recorded on video . A blinded , independent investigator analyzed the videos . At the completion of training , the suturing skills of each participant were evaluated in an animal model . Results Training with the Mirror Trainer required less time than with the pelvic trainer ( p < 0.001 ) . Compared with the control group , the Mirror Trainer group and the pelvic trainer group were significantly faster at creating three knots in the pig ( p = 0.001 and p = 0.004 , respectively ) . Both training groups performed equally well on the animal model ( p = 0.99 ) . Conclusion The Mirror Trainer and the pelvic trainer are equally effective in teaching laparoscopic suturing skills but training with the Mirror Trainer requires less time , can be done on any desktop , and is less costly INTRODUCTION Modernisation of Medical Careers dictates a shortening of the training required to achieve consultant status . Precisely what type of work these consultants could be expected to accomplish , and be trained to do , is not clear . The objective of this study was to demonstrate a method of stratifying urological workload so as to determine what a urological trainee , undergoing shortened training  , might be expected to do as a consultant and to use this stratification to help manpower planning within the specialty . PATIENTS AND METHODS A cohort study of all urological activity undertaken over a 3-year period in a single teaching hospital in the UK was performed . All out-patient , in-patient or day-case activity within the urological department was analysed in the years 2000 - 2002 . Urological activity was stratified according to the absolute numbers of patients presenting for different types of out-patient consultation , the grade of complexity of any surgical intervention undertaken , and the theatre re source consumed by the study population . RESULTS Utilising prospect ively collected data , it was possible to aggregate information about the contributions generalist and sub-specialty activity made to the overall workload of a urological unit . Whilst the majority of out-patient activity , and almost 88 % of the surgical workload , could be accomplished by consultants undergoing shortened training , 11.9 % of specialised urological activity , consuming nearly 43 % of the available theatre re source , was outwith the remit of such a specialist . CONCLUSIONS Shortened training seems able to satisfy the service delivery needs of the majority of out-patient and day-case urological activity . It will not , however , fulfil the need for subspecialty-based training required to cope with the large minority of patients necessitating complex surgical intervention . Specialist training programmes , promoting advanced operative skills , need to be evolved in parallel to shortened training so as to ensure global urological service provision for the future Background Laparoscopic camera navigation ( LCN ) is vital for the successful performance of laparoscopic operations , yet little time is spent on training . This study aim ed to develop an inexpensive LCN simulator , to design a structured curriculum , and to determine the transferability of skills acquired . Methods In this study , 0 ° and 30 ° LCN simulators were developed for use on a videotrainer platform . Transferability was tested by enrolling 20 medical students in an institutional review board-approved , r and omized , controlled , blinded protocol . Subjects viewed a video tutorial and were pretested in LCN on a porcine Nissen model . Procedures were videotaped and the LCN performance was scored by a blinded rater according to the number of st and ardized verbal cues required and the percentage of time an optimal surgical view ( % OSV ) was obtained . Procedure time also was recorded . Subjects were stratified and r and omized . The trained group practice d on the LCN simulator until competency was demonstrated . The control group received no training . Both groups were posttested on the porcine Nissen model . Results The constructed simulators required 35 man hours for development , cost $ 25 per board for material s , and proved to be durable . The trained group demonstrated significant improvement in verbal cues ( p = 0.001 ) , % OSV ( p < 0.001 ) , and procedure time ( p = 0.001 ) , whereas the control group showed improvement only in verbal cues ( p < 0.02 ) . At posttesting , the training group demonstrated significantly better scores for verbal cues ( 2.1 vs 8.0 ; p = 0.02 ) and % OSV ( 64 % vs 45 % p = 0.01 ) than the control group . Conclusion These data suggest that the LCN simulator is cost effective and provides trainees with skills that translate to the operating room OBJECTIVES The objectives of this study were ( 1 ) to compare different methods of learning basic laparoscopic skills using box trainer ( BT ) , virtual reality simulator ( VRS ) and mental training ( MT ) ; and ( 2 ) to determine the most effective method of learning laparoscopic skills . DESIGN R and omized controlled trial . SETTING King 's College , London . METHODS 41 medical students were included in the study . After r and omization , they were divided into 5 groups . Group 1 was the control group without training ; group 2 was box trained ; group 3 was also box trained with an additional practice session ; group 4 was VRS trained ; and group 5 was solely mentally trained . The task was to cut out a circle marked on a stretchable material . All groups were assessed after 1 week on both BT and VRS . Four main parameters were assessed , namely time , precision , accuracy , and performance . RESULTS Time : On BT assessment , the box-trained group with additional practice group 3 was the fastest , and the mental-trained group 5 was the slowest . On VRS assessment , the time difference between group 3 and the control group 1 was statistically significant . Precision : On BT assessment , the box-trained groups 2 and 3 scored high , and mental trained were low on precision . On VRS assessment , the VRS-trained group ranked at the top , and the MT group was at the bottom on precision . Accuracy : On BT assessment , the box-trained group 3 was best and the mental-trained group was last . On VRS assessment , the VRS-trained group 4 scored high closely followed by box-trained groups 2 and 3 . Performance : On BT assessment , the box-trained group 3 ranked above all the other groups , and the mental-trained group ranked last . On VRS assessment , the VRS group 4 scored best , followed closely by box-trained groups 2 and 3 . CONCLUSIONS The skills learned on box training were reproducible on both VRS and BT . However , not all the skills learned on VRS were transferable to BT . Furthermore , VRS was found to be a reliable and the most convenient method of assessment . MT alone can not replace conventional training R and omized controlled clinical trials are conducted to determine whether differences of clinical importance exist between selected treatment regimens . When statistical analysis of the study data finds a P value greater than 5 % , it is convention to deem the assessed difference nonsignificant . Just because convention dictates that such study findings be termed nonsignificant , or negative , however , it does not necessarily follow that the study found nothing of clinical importance . Subject sample s used in controlled trials tend to be too small . The studies therefore lack the necessary power to detect real , and clinical ly worthwhile , differences in treatment . Freiman et al. found that only 30 % of a sample of 71 trials published in the New Engl and Journal of Medicine in 1978 - 79 with a P value greater than 10 % were large enough to have a 90 % chance of detecting even a 50 % difference in the effectiveness of the treatments being compared , and they found no improvement in a similar sample of trials published in 1988 . It is therefore wrong and unwise to interpret so many negative trials as providing evidence of the ineffectiveness of new treatments . One must instead seriously question whether the absence of evidence is a valid justification for inaction . Efforts must be made to look for quantification of an association rather than just a P value , especially when the risks under investigation are small . The authors cite a recent trial comparing octreotide and sclerotherapy in patients with variceal bleeding  , as well as the overview of clinical trials evaluating fibrinolytic treatment for preventing reinfa rct ion after acute myocardial infa rct ion as examples PURPOSE Many sophisticated and expensive trainers have been developed to assist surgeons in learning basic laparoscopic skills . We developed an inexpensive trainer and evaluated its effectiveness . MATERIAL S AND METHODS The webcam laparoscopic training device is composed of a webcam , cardboard box , desk lamp and home computer . This homemade trainer was evaluated against 2 commercially available systems , namely the video Pelvitrainer ( Karl Storz Endoscopy , Culver City , California ) and the dual mirror Simuview ( Simulab Corp. , Seattle , Washington ) . The Pelvitrainer consists of a fiberglass box , single lens optic laparoscope , fiberoptic light source , endoscopic camera and video monitor , while the Simuview trainer uses 2 offset , facing mirrors and an uncovered plastic box . A total of 42 participants without prior laparoscopic training were enrolled in the study and asked to execute 2 tasks , that is peg transfer and pattern cutting . Participants were r and omly assigned to 6 groups with each group representing a different permutation of trainers to be used . The time required for participants to complete each task was recorded and differences in performance were calculated . Paired t tests , the Wilcoxon signed rank test and ANOVA were performed to analyze the statistical difference in performance times for all conditions . RESULTS Statistical analyses of the 2 tasks showed no significant difference for the video and webcam trainers . However , the mirror trainer gave significantly higher outcome values for tasks 1 and 2 compared to the video ( p = 0.01 and < 0.01 ) and webcam ( p = 0.04 and < 0.01 , respectively ) methods . ANOVA indicated no overall difference for tasks 1 and 2 across the orderings ( p = 0.36 and 0.99 , respectively ) . However , by attempt 3 the time required to complete the skill tests decreased significantly for all 3 trainers ( each p < 0.01 ) . CONCLUSIONS Our homemade webcam system is comparable in function to the more elaborate video trainer but superior to the dual mirror trainer . For novice laparoscopists we believe that the webcam system is an inexpensive and effective 
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AUTHORS ' CONCLUSIONS There is insufficient evidence to determine whether laparoscopic box model training reduces mortality or morbidity .
There is very low quality evidence that it improves technical skills compared with st and ard surgical training in trainees with limited previous laparoscopic experience .
It may also decrease operating time and increase the proportion of patients who were discharged as day-surgery in the first total extraperitoneal hernia repair after box model training .