***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 Internet education is increasingly provided to health professionals , but little is known about the most effective strategies for delivering the content . The purpose of this study is to compare four strategies for delivering an Internet-based ( e- ) curriculum on clinicians ' knowledge ( K ) , confidence ( CONF ) , and communication ( COMM ) about herbs and other dietary supplements ( HDS ) . Methods This national r and omized 2 × 2 factorial trial included physicians , pharmacists , nurses , nutritionists and trainees in these fields . Participants were r and omly assigned to one of four curriculum delivery strategies for 40 brief modules about HDS : a ) delivering four ( 4 ) modules weekly over ten ( 10 ) weeks by email ( drip-push ) ; b ) modules accessible on web site with 4 reminders weekly for 10 weeks ( drip-pull ) ; c ) 40 modules delivered within 4 days by email ( bolus-push ) ; and d ) 40 modules available on the Internet with one email informing participants of availability ( bolus-pull ) . Results Of the 1,267 enrollees , 25 % were male ; the average age was 40 years .  The completion rate was 62 % , without significant differences between delivery groups . There were statistically significant improvements in K , CONF and COMM scores after the course ( P<0.001 for all ) , although the difference in COMM was small . There were no significant differences in any of the three outcomes by delivery strategy , but outcomes were better for those who paid for continuing education credit . Conclusion All delivery strategies tested similarly improved K , CONF , COMM scores about HDS . Educators can use the strategy that is most convenient without diminishing effectiveness . Additional curricula may be necessary to make substantial changes in clinicians ' communication practice Purpose To determine the effect of self- assessment questions on learners ’ knowledge and format preference in a Web-based course , and investigate associations between learning styles and outcomes . Method The authors conducted a r and omized , controlled , crossover trial in the continuity clinics of the Mayo-Rochester internal medicine residency program during the 2003–04 academic year .  Case-based self- assessment questions were added to Web-based modules covering topics in ambulatory internal medicine . Participants completed two modules with questions and two modules without questions , with sequence r and omly assigned . Outcomes included knowledge assessed after each module , format preference , and learning style assessed using the Index of Learning Styles . Results A total of 121 of 146 residents ( 83 % ) consented . Residents had higher test scores when using the question format ( mean ± st and ard error , 78.9 % ± 1.0 ) than when using the st and ard format ( 76.2 % ± 1.0 , p = .006 ) . Residents preferring the question format scored higher ( 79.7 % ± 1.1 ) than those preferring st and ard ( 69.5 % ± 2.3 , p < .001 ) . Learning styles did not affect scores except that visual-verbal “ intermediate ” learners ( 80.6 % ± 1.4 ) and visual learners ( 77.5 % ± 1.3 ) did better than verbal learners ( 70.9 % ± 3.0 , p = .003 and p = .033 , respectively ) . Sixty-five of 78 residents ( 83.3 % , 95 % CI 73.2–90.8 % ) preferred the question format . Learning styles were not associated with preference ( p > .384 ) . Although the question format took longer than the st and ard format ( 60.4 ± 3.6 versus 44.3 ± 3.3 minutes , p < .001 ) , 55 of 77 residents ( 71.4 % , 60.0–81.2 % ) reported that it was more efficient . Conclusions Instructional methods that actively engage learners improve learning outcomes . These findings hold implication s for both Web-based learning and “ traditional ” educational activities . Future research , in both Web-based learning and other teaching modalities , should focus on further defining the effectiveness of selected instructional methods in specific learning context OBJECTIVE The purpose of this study is to compare whether students '  learning outcomes would be better in a design ed learning environment ( WebCT ) than in a conventional web site ( WWW ) with similar course material but without special learning tools . CONTEXT Third-year medical students in an introductory course on medical informatics at the University of Helsinki , Finl and . METHODS Students were r and omly assigned to a WebCT group ( n=39 ) and a WWW group ( n=46 ) . The students in the WebCT group utilized the course material in general discussion groups , special discussion s about lectures , quizzes and students ' own notes . The WWW group had access only to the course material . The learning outcome was assessed by administering an on-line examination and the learning experience of the students was assessed by an on-line quiz . RESULTS The course grade was significantly higher in the WebCT group as compared to the WWW group . This finding was more prominent among females . The students of the WebCT group also experienced significantly more improvement in collaboration with the use of computers than the students in the WWW group . CONCLUSIONS Based on our results , web-based learning seems to be more effective when students are provided with specially design ed learning tools PURPOSE This study is an assessment of the acceptability and short-term educational efficacy of interactive spaced education compared to web based teaching cases within the compact time frame of a clinical clerkship . MATERIAL S AND METHODS All 237 third-year students completing their 3-month surgery clerkships at 2 medical schools were asked to complete a urology online-education program covering 4 core topics of benign prostatic hyperplasia , erectile dysfunction , prostate cancer and screening with prostate specific antigen . Students were stratified by clinical site and r and omized to 1 of 2 cohorts . Students in cohort A received interactive spaced education on prostate cancer/prostate specific antigen and web based teaching on benign prostatic hyperplasia/erectile dysfunction . Students in cohort B received interactive spaced education on benign prostatic hyperplasia/erectile dysfunction and web based teaching on prostate cancer/prostate specific antigen . A vali date d 28-item test on all 4 topics was administered at the end of the 10-week program . RESULTS No statistically significant differences in end-of-program test scores were observed between cohorts in the topics of prostate cancer/prostate specific antigen with 87.6 % ( SD 12.9 ) for cohort A ( interactive spaced education ) and 82.4 % ( SD 19.6 ) for cohort B ( web based teaching ) ( p = 0.25 ) . Similarly there was also no statistically significant difference in test scores in the topics of benign prostatic hyperplasia/erectile dysfunction with 79.5 % ( SD 15.9 ) for cohort A ( web based teaching ) and 82.1 % ( SD 14.7 ) for cohort B ( interactive spaced education , p = 0.28 ) . When students were asked which format they would prefer if they were to receive all their urology online education in a single format , 55 % of students ( 109 of 198 respondents ) preferred interactive spaced education while 45 % ( 89 of 109 ) preferred web based teaching ( p = 0.16 ) . CONCLUSIONS Within the compact time frame of a clinical clerkship interactive spaced education is equivalent to web based teaching in short-term learning gains and in acceptability by medical students The use of the Internet makes it possible to bring together learners and teachers from rural areas and academic centers and to deliver well-accepted educational material s quickly and effectively . The objective of this study was to determine feasibility and the effectiveness of a problem-based small-group learning ( PBSGL ) intervention conducted via the Internet in a r and omized controlled trial . A group of 23 family physicians from rural Northern Ontario practice s and across Canada were r and omly assigned to a study group ( n = 11 ) and a control group ( n = 12 ) . The study group spent two months discussing the topic of depression in the elderly with the help of a facilitator and two geriatric psychiatrists . The control group was given similar educational re sources via the Internet but without the benefit of the small-group interaction . Outcome measures included qualitative feedback from the learners and teachers as well as a Multiple Choice Questions ( MCQ ) test before and after the study . The study provided important insight into the feasibility , keys to success , utility of Internet-assisted education from an education and evaluation perspective . Although the MCQ testing used revealed no significant differences between the study group and the control group , the usefulness of the measure is considered within the context of the educational approach . It is unclear whether this method of continuing medical education ( CME ) represents an effective way to conduct such activities PURPOSE We investigated whether an online educational program based on spacing effect principles could significantly improve the acquisition and retention of medical knowledge . MATERIAL S AND METHODS In this r and omized , controlled trial involving urology residents in the United States and Canada participants r and omized to cohort 1 ( bolus education )  were  e-mailed  a vali date d set of 96 study questions on 4 urology topic areas in June 2005 . Residents in cohort 2 ( spaced education )  were sent daily educational e-mails during 27 weeks ( June to December 2005 ) , each of which contained 1 or 2 study questions presented in a repeating , spaced pattern . In November 2005 participants completed the Urology In-Service Examination . Participants were also r and omized to 1 of 5 outcome cohorts , which completed a 32-item online test at staggered time points ( 1 to 14 weeks ) after completion of the spaced education program . RESULTS Of 537 participants 400 ( 74 % ) completed the online staggered tests and 515 ( 96 % ) completed the In-Service Examination .  Residents in the spaced education cohort demonstrated significantly greater online test scores than those in the bolus cohort ( ANOVA p < 0.001 ) . One-way ANOVA with trend analysis revealed that online test scores for the spaced education cohort remained stable with no significant differences with time , while test scores in the bolus cohort demonstrated a significant linear decrease ( p = 0.007 ) . The specific learning gains attributable to Spaced Education were robust when controlling for use of the study material s but they did not generalize to higher scores on the In-Service Examination . CONCLUSIONS Online spaced education improves the acquisition and retention of clinical knowledge PURPOSE Medical knowledge learned by trainees is often quickly forgotten . How can the educational process be tailored to shift learning into longer-term memory ? We investigated whether ' spaced education ' , consisting of weekly e-mailed case scenarios and clinical questions , could improve the retention of students ' learning . METHODS During the 2004 - 5 surgery clerkships , 3rd-year students completed a m and atory 1-week clinical rotation in urology and vali date d web-based teaching programme on 4 core urology topics .  Spaced educational e-mails were constructed on all 4 topics based on a vali date d urology curriculum . Each consisted of a short clinical ly relevant question or clinical case scenario in multiple-choice question format , followed by the answer , teaching point summary and explanations of the answers . Students were r and omised to receive weekly e-mailed case scenarios in only 2 of the 4 urology topics upon completion of their urology rotation . Students completed a vali date d 28-item test ( Cronbach 's alpha = 0.76 ) on all 4 topics prior to and after the rotation and at the end of the academic year . RESULTS A total of 95 of 133 students ( 71 % ) completed the end-of-year test . There were no significant differences in baseline characteristics between r and omised cohorts . Spaced education significantly improved composite end-of-year test scores ( P < 0.001 , paired t-test ) . The impact of the spaced educational e-mails was largest for those students who completed their urology education 6 - 8 and 9 - 11 months previously ( Cohen 's effect sizes of 1.01 and 0.73 , respectively ) . CONCLUSION Spaced education consisting of clinical scenarios and questions distributed weekly via e-mail can significantly improve students ' retention of medical knowledge BACKGROUND Web-based technologies are increasingly being used to create modes of online learning for nurses but their effect has not been assessed in nurse education . OBJECTIVES Assess whether participation in face-to-face discussion seminars or online asynchronous discussion groups had different effects on educational attainment in a web-based course . DESIGN Non-r and omised or quasi-experimental design with two groups-students choosing to have face-to-face discussion seminars and students choosing to have online discussion s. SETTING The Core Methods module of a postgraduate research methods course . PARTICIPANTS All 114 students participating in the first 2 yr during which the course teaching material was delivered online . OUTCOME Assignment mark for Core Methods course module . METHODS Background details of the students , their choices of modules and assignment marks were collected as part of the routine course administration . Students ' online activities were identified using the student tracking facility within WebCT . Regression models were fitted to explore the association between available explanatory variables and assignment mark . RESULTS Students choosing online discussion s had a higher Core Methods assignment mark ( mean 60.8/100 ) than students choosing face-to-face discussion s ( 54.4 ) ; the difference was statistically significant ( t=3.13 , df=102 , p=0.002 ) , although this ignores confounding variables . Among online discussion students , assignment mark was significantly correlated with the numbers of discussion messages read ( Kendall 's tau(b)=0.22 , p=0.050 ) and posted ( Kendall 's tau(b)=0.27 , p=0.017 ) ; among 
    Output:
    
Interactivity , practice exercises , repetition , and feedback seem to be associated with improved learning outcomes , although inconsistency across studies tempers conclusions .
Evidence for other instructional variations remains inconclusive