human
***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 investigate whether a force application of a novel motor skill was simple or complex and to determine the appropriate level of feedback during training . The objective was to determine the effects of various amounts of knowledge of results ( KR ) on learning a novel skill that is frequently taught in chiropractic for the assessment of vertebral motor unit dysfunction . METHODS Thirty-five active subjects were taught the novel skill of spring testing to a particular force range through 9 or 10 teaching sessions over a 2-week period ( a school holiday limited some to only 9 sessions ) . To determine the particular force range , an initial phase of the study involved a licensed and practicing clinician performing motion palpation spring testing of the thoracic spine of a prone subject . The data from a total of 47 pushes throughout the thoracic spine were recorded , and the mean force and st and ard deviation were calculated . The second phase of the study used the obtained mean and st and ard deviation for teaching the force of prone thoracic spine motion palpation to 35 active subjects by administering spring testing to 35 passive subjects . The active subjects were r and omly divided into 4 groups , with each receiving a varying amount of verbal feedback to move toward the target force of their learned skill . Each passive subject was laid prone on an instrumented adjusting table . Group 1 received the least amount of feedback while learning the novel skill . Groups 2 and 3 received more frequent , intermittent feedback while learning the skill , and group 4 received constant , frequent feedback during each of the 10 teaching sessions . All subjects returned within 2 weeks for 2 retention trials to determine the efficacy of the learned skill . RESULTS The mean force determined was 143 N with a st and ard deviation of 14 N. Each subject was taught spring testing within this target range . The 2 final retention trials showed group 3 to have demonstrated the most targeted retention of the learned motor skill . These subjects exhibited the closest force range to the target for the motor skill learned and fewer changes in st and ard deviation compared with their acquisition trials and thus the highest retention . Group 4 , receiving 100 % feedback , demonstrated the most accurate spring testing during the acquisition trials , but the subjects did not effectively demonstrate when compared on acquisition and retention trials . CONCLUSION The results of this study show data to be consistent with the guidance hypothesis in learning a novel motor skill . The constant KR feedback is beneficial for learning when used to reduce error during practice but detrimental when relied upon for retention and learning . These data suggest the necessity of using motor skill development learning theory in the teaching of chiropractic 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 INTRODUCTION The " 4-stage approach " has been widely accepted for practical skill training replacing the traditional 2 stages ( " see one , do one " ) . However , the superior effectiveness of the 4-stage approach was never proved . OBJECTIVES To evaluate whether skill training with the 4-stage approach results in shorter performance time needed for a successful percutaneous needle-puncture cricothyroidotomy  , and consequently in a reduced number of attempts needed to perform the skill in < 60s compared to traditional teaching . TRIAL DESIGN R and omized controlled single-blinded parallel group study at the University Hospital Bern . METHODS With IRB approval and informed consent 128 undergraduate medical students were r and omized in four groups : traditional teaching , no stage 2 , no stage 3 , and 4-stage approach for the training of cricothyroidotomy .  Everyone watched a video of the cricothyroidotomy as stage 1 followed by skill training in the respective teaching group .  Participants had to perform the cricothyroidotomy 10 times on skin-covered pig larynxes . Performance time was measured from skin palpation to trachea ventilation . Study participants filled out a self-rating on competency during the training . RESULTS Performance time for each attempt was comparable in all groups and improved similarly to reach a performance time of < 60 s. Self-rating revealed that all groups felt equally competent throughout . CONCLUSIONS Even if the 4-stage approach is widely accepted and used as a didactic method for skill teaching we could not find evidence that its use or omitting stage 2 or 3 results in superior learning of an emergency skill compared to traditional teaching Practice of complex tasks can be scheduled in several ways : as whole-task practice or as practice of the individual skills composing the task in either a blocked or a r and om order . The authors used those 3 schedules to study 18 participants ' learning of an orthopedic surgical task .  They assessed learning by obtaining expert evaluation of performance and objective kinematic measures before , immediately after , and 1 week after practice ( transfer test ) . During acquisition , the blocked group showed superior performance for simple skills but not for more complex skills . For the expert-based measures of performance , all groups improved from pretest to posttest and remained constant from posttest to transfer . Measures of the final product showed that the whole- practice group 's outcomes were significantly better than those of the r and om group on transfer . All groups showed better efficiency of motions in the posttest than in the pretest . Those measures were also poorer on the transfer test than on the posttest . The present evidence does not support the context ual interference effect — hypothetically , because of the inherent cognitive effort effect associated with some of the component skills . The authors recommend that surgical tasks composed of several discrete skills be practice d as a whole . The results of this study demonstrate the importance of critically appraising basic theories in applied environments BACKGROUND Mental practice ( MP ) is defined as the ' symbolic rehearsal of a physical activity in the absence of any gross-muscular movements ' and has been used in sport and music to enhance performance . In healthcare , MP has been demonstrated to improve technical skill performance of surgical residents . However , its effect on crisis re source management ( CRM ) skills has yet to be determined . We aim ed to investigate the effect of warm-up with MP on CRM skill performance during a simulated crisis scenario . METHODS Following ethics board approval , 40 anaesthesia residents were r and omized . The intervention group performed 20 min of MP of a script based on CRM principles . The control group received a 20 min didactic teaching session on an unrelated topic . Each subject then managed a simulated cardiac arrest . Two CRM experts rated the video recordings of each performance using the previously vali date d Ottawa GRS . The time to start chest compressions , administer epinephrine , and give blood was recorded . RESULTS There was no significant difference between the intervention and control groups : total Ottawa GRS score was 24.50 ( 18.63 - 28.88 [ 6.50 - 34.50 ] ) ( median ( inter-quartile range [ range ] ) vs 20.50 ( 13.00 - 29.13 [ 6.50 - 34.50 ] ) ( P=0.53 ) ; the time to start chest compressions 146.0 s ( 138.0 - 231.0 [ 115.0 - 323.0 ] ) vs 162.5 s ( 138.0 - 231.0 [ 100.0 - 460.0 ] ) ( P=0.27 ) , the time to epinephrine administration 163.0 s ( 151.0 - 187.0 [ 111.0 - 337.0 ] ) vs 187.0 s ( 164.0 - 244.0 [ 115.0 - 310.0 ] ) ( P=0.09 ) , and the time to blood administration 220.5 s ( 130.8 - 309.0 [ 92.0 - 485.0 ] ) vs 252.5 ( 174.5 - 398.8 [ 65.0 - 527.0 ] ) ( P=0.48 ) . CONCLUSION Unlike technical skills , warm-up with MP does not seem to improve CRM skills in simulated crisis scenarios INTRODUCTION The ability to mentally rotate an object in 3 dimensions has been shown with an individual 's score on the V and enberg and Kuse Mental Rotations Test . The was to determine whether this Mental Rotations Test could be used to predict performance complex surgical skill - the tying of a 1-h and ed surgical reef knot . In addition , we learning a spatially complex surgical skill could be achieved more effectively via a computer-based selfdirected learning approach than with a didactic lecture-based teaching method . METHODS preclerkship medical students at the University of Western Ontario were r and omized into computer-based self-directed learning group and a didactic lecture-style learning group . administration of the Mental Rotations Test , the students were taught how to tie a reef knot via the learning modality assigned to their respective group . RESULTS Students Mental Rotations Test scores were able to tie more surgical knots in the allocated time Students learning how to tie the surgical knot via the computer-based self-directed showed improvement on their knot tying abilities more rapidly than their didactically trained colleagues . CONCLUSION The ability to mentally rotate an object in 3 dimensions played an important initial learning of a spatially complex surgical technical skill . Our data demonstrated learning was as effective and more practical than traditional lecture-based learning BACKGROUND CONTEXT Spinal manipulation is a widely accepted therapeutic approach in the treatment of  back pain .  In st and ard training programs , feedback on student performances is provided by an instructor based on teaching and clinical experience . Systematic study of the type of augmented feedback provided and skill learning is lacking in the literature . PURPOSE The goal of this investigation is to compare the performance of two groups of chiropractic students , one receiving traditional training from experienced instructors , and the other , augmented feedback on specific biomechanical aspects of spinal manipulation therapy using an instrumented manikin . STUDY DESIGN R and omized controlled study . PATIENT SAMPLE Thirty-one fourth-year students from the Department of Chiropractic of Université du Québec à Trois-Rivières participated in this study . OUTCOME MEASURES Kinetic parameters ( force-time curves ) of spinal manipulation were evaluated . METHODS Spinal manipulation parameters were measured before and after a 5-week training period in which one group received st and ard chiropractic training while a second group received augmented feedback about specific biomechanical parameters of spinal manipulation . For both groups , practice scheduling and time duration were similar and consisted of a weekly practice session of 90 minutes for five consecutive weeks . Both groups had to practice thoracic spine manipulation throughout the training period . RESULTS Both groups showed a decrease in peak force applied , with a diminution in the number of trials where a downward incisural point was present in preload force . Participants in the feedback training group significantly reduced their peak force variability and significantly increased their preload force . No significant difference was observed for time to peak force . CONCLUSIONS The results of this study highlight the merits of practicing with an instrumented manikin or other instrumented training aids . Such a device can provide specific feedback on specific parameters of the task during learning ; it can also serve as a tool to assess the progress of students and eliminate the risks relating to repetitive spinal manipulative therapy practice on student colleagues GOAL Isolate and evaluate the impact of mental imagery on the acquisition of an emergency surgical technique . METHOD We studied 44 first-year medical students performing a cricothyrotomy on a mannequin to determine the impact of teaching using mental imagery ( MI ) and /or kinesiology ( KG ) compared to the st and ard Adv and ec Trauma Life Support ( ATLS ) approach . Students were r and omly assigned to one of three groups : MI and KG , KG alone or control ( ATLS ) . Two weeks after the one-hour teaching session , they were evaluated with an OSCE testing the performance of the different steps of the technique , the time required and its fluidity . RESULTS Total results ( maximum : 25 marks ) are as follows : KG + MI = 20.3 + /- 1.5 ; KG = 19.3 + /- 2.9 ; ATLS = 18.2 + /- 2.5 . The only statistically significant difference for total results was in the use of MI and KG compared to the control group . Kinesiology alone or with mental imagery improved the fluidity of the performance . CONCLUSION Many factors influence the acquisition of a surgical technique . This study showed that acquisition and performance of an emergency procedure ( cricothyrotomy ) was improved when mental imagery and kinesiology were combined to teach it Background : Part task training ( PTT ) focuses on dividing complex tasks into components followed by intensive concentrated training on individual components . Variable priority training ( VPT ) focuses on optimal distribution 
    Output:
    
agent
***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 investigate whether a force application of a novel motor skill was simple or complex and to determine the appropriate level of feedback during training . The objective was to determine the effects of various amounts of knowledge of results ( KR ) on learning a novel skill that is frequently taught in chiropractic for the assessment of vertebral motor unit dysfunction . METHODS Thirty-five active subjects were taught the novel skill of spring testing to a particular force range through 9 or 10 teaching sessions over a 2-week period ( a school holiday limited some to only 9 sessions ) . To determine the particular force range , an initial phase of the study involved a licensed and practicing clinician performing motion palpation spring testing of the thoracic spine of a prone subject . The data from a total of 47 pushes throughout the thoracic spine were recorded , and the mean force and st and ard deviation were calculated . The second phase of the study used the obtained mean and st and ard deviation for teaching the force of prone thoracic spine motion palpation to 35 active subjects by administering spring testing to 35 passive subjects . The active subjects were r and omly divided into 4 groups , with each receiving a varying amount of verbal feedback to move toward the target force of their learned skill . Each passive subject was laid prone on an instrumented adjusting table . Group 1 received the least amount of feedback while learning the novel skill . Groups 2 and 3 received more frequent , intermittent feedback while learning the skill , and group 4 received constant , frequent feedback during each of the 10 teaching sessions . All subjects returned within 2 weeks for 2 retention trials to determine the efficacy of the learned skill . RESULTS The mean force determined was 143 N with a st and ard deviation of 14 N. Each subject was taught spring testing within this target range . The 2 final retention trials showed group 3 to have demonstrated the most targeted retention of the learned motor skill . These subjects exhibited the closest force range to the target for the motor skill learned and fewer changes in st and ard deviation compared with their acquisition trials and thus the highest retention . Group 4 , receiving 100 % feedback , demonstrated the most accurate spring testing during the acquisition trials , but the subjects did not effectively demonstrate when compared on acquisition and retention trials . CONCLUSION The results of this study show data to be consistent with the guidance hypothesis in learning a novel motor skill . The constant KR feedback is beneficial for learning when used to reduce error during practice but detrimental when relied upon for retention and learning . These data suggest the necessity of using motor skill development learning theory in the teaching of chiropractic 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 INTRODUCTION The " 4-stage approach " has been widely accepted for practical skill training replacing the traditional 2 stages ( " see one , do one " ) . However , the superior effectiveness of the 4-stage approach was never proved . OBJECTIVES To evaluate whether skill training with the 4-stage approach results in shorter performance time needed for a successful percutaneous needle-puncture cricothyroidotomy  , and consequently in a reduced number of attempts needed to perform the skill in < 60s compared to traditional teaching . TRIAL DESIGN R and omized controlled single-blinded parallel group study at the University Hospital Bern . METHODS With IRB approval and informed consent 128 undergraduate medical students were r and omized in four groups : traditional teaching , no stage 2 , no stage 3 , and 4-stage approach for the training of cricothyroidotomy .  Everyone watched a video of the cricothyroidotomy as stage 1 followed by skill training in the respective teaching group .  Participants had to perform the cricothyroidotomy 10 times on skin-covered pig larynxes . Performance time was measured from skin palpation to trachea ventilation . Study participants filled out a self-rating on competency during the training . RESULTS Performance time for each attempt was comparable in all groups and improved similarly to reach a performance time of < 60 s. Self-rating revealed that all groups felt equally competent throughout . CONCLUSIONS Even if the 4-stage approach is widely accepted and used as a didactic method for skill teaching we could not find evidence that its use or omitting stage 2 or 3 results in superior learning of an emergency skill compared to traditional teaching Practice of complex tasks can be scheduled in several ways : as whole-task practice or as practice of the individual skills composing the task in either a blocked or a r and om order . The authors used those 3 schedules to study 18 participants ' learning of an orthopedic surgical task .  They assessed learning by obtaining expert evaluation of performance and objective kinematic measures before , immediately after , and 1 week after practice ( transfer test ) . During acquisition , the blocked group showed superior performance for simple skills but not for more complex skills . For the expert-based measures of performance , all groups improved from pretest to posttest and remained constant from posttest to transfer . Measures of the final product showed that the whole- practice group 's outcomes were significantly better than those of the r and om group on transfer . All groups showed better efficiency of motions in the posttest than in the pretest . Those measures were also poorer on the transfer test than on the posttest . The present evidence does not support the context ual interference effect — hypothetically , because of the inherent cognitive effort effect associated with some of the component skills . The authors recommend that surgical tasks composed of several discrete skills be practice d as a whole . The results of this study demonstrate the importance of critically appraising basic theories in applied environments BACKGROUND Mental practice ( MP ) is defined as the ' symbolic rehearsal of a physical activity in the absence of any gross-muscular movements ' and has been used in sport and music to enhance performance . In healthcare , MP has been demonstrated to improve technical skill performance of surgical residents . However , its effect on crisis re source management ( CRM ) skills has yet to be determined . We aim ed to investigate the effect of warm-up with MP on CRM skill performance during a simulated crisis scenario . METHODS Following ethics board approval , 40 anaesthesia residents were r and omized . The intervention group performed 20 min of MP of a script based on CRM principles . The control group received a 20 min didactic teaching session on an unrelated topic . Each subject then managed a simulated cardiac arrest . Two CRM experts rated the video recordings of each performance using the previously vali date d Ottawa GRS . The time to start chest compressions , administer epinephrine , and give blood was recorded . RESULTS There was no significant difference between the intervention and control groups : total Ottawa GRS score was 24.50 ( 18.63 - 28.88 [ 6.50 - 34.50 ] ) ( median ( inter-quartile range [ range ] ) vs 20.50 ( 13.00 - 29.13 [ 6.50 - 34.50 ] ) ( P=0.53 ) ; the time to start chest compressions 146.0 s ( 138.0 - 231.0 [ 115.0 - 323.0 ] ) vs 162.5 s ( 138.0 - 231.0 [ 100.0 - 460.0 ] ) ( P=0.27 ) , the time to epinephrine administration 163.0 s ( 151.0 - 187.0 [ 111.0 - 337.0 ] ) vs 187.0 s ( 164.0 - 244.0 [ 115.0 - 310.0 ] ) ( P=0.09 ) , and the time to blood administration 220.5 s ( 130.8 - 309.0 [ 92.0 - 485.0 ] ) vs 252.5 ( 174.5 - 398.8 [ 65.0 - 527.0 ] ) ( P=0.48 ) . CONCLUSION Unlike technical skills , warm-up with MP does not seem to improve CRM skills in simulated crisis scenarios INTRODUCTION The ability to mentally rotate an object in 3 dimensions has been shown with an individual 's score on the V and enberg and Kuse Mental Rotations Test . The was to determine whether this Mental Rotations Test could be used to predict performance complex surgical skill - the tying of a 1-h and ed surgical reef knot . In addition , we learning a spatially complex surgical skill could be achieved more effectively via a computer-based selfdirected learning approach than with a didactic lecture-based teaching method . METHODS preclerkship medical students at the University of Western Ontario were r and omized into computer-based self-directed learning group and a didactic lecture-style learning group . administration of the Mental Rotations Test , the students were taught how to tie a reef knot via the learning modality assigned to their respective group . RESULTS Students Mental Rotations Test scores were able to tie more surgical knots in the allocated time Students learning how to tie the surgical knot via the computer-based self-directed showed improvement on their knot tying abilities more rapidly than their didactically trained colleagues . CONCLUSION The ability to mentally rotate an object in 3 dimensions played an important initial learning of a spatially complex surgical technical skill . Our data demonstrated learning was as effective and more practical than traditional lecture-based learning BACKGROUND CONTEXT Spinal manipulation is a widely accepted therapeutic approach in the treatment of  back pain .  In st and ard training programs , feedback on student performances is provided by an instructor based on teaching and clinical experience . Systematic study of the type of augmented feedback provided and skill learning is lacking in the literature . PURPOSE The goal of this investigation is to compare the performance of two groups of chiropractic students , one receiving traditional training from experienced instructors , and the other , augmented feedback on specific biomechanical aspects of spinal manipulation therapy using an instrumented manikin . STUDY DESIGN R and omized controlled study . PATIENT SAMPLE Thirty-one fourth-year students from the Department of Chiropractic of Université du Québec à Trois-Rivières participated in this study . OUTCOME MEASURES Kinetic parameters ( force-time curves ) of spinal manipulation were evaluated . METHODS Spinal manipulation parameters were measured before and after a 5-week training period in which one group received st and ard chiropractic training while a second group received augmented feedback about specific biomechanical parameters of spinal manipulation . For both groups , practice scheduling and time duration were similar and consisted of a weekly practice session of 90 minutes for five consecutive weeks . Both groups had to practice thoracic spine manipulation throughout the training period . RESULTS Both groups showed a decrease in peak force applied , with a diminution in the number of trials where a downward incisural point was present in preload force . Participants in the feedback training group significantly reduced their peak force variability and significantly increased their preload force . No significant difference was observed for time to peak force . CONCLUSIONS The results of this study highlight the merits of practicing with an instrumented manikin or other instrumented training aids . Such a device can provide specific feedback on specific parameters of the task during learning ; it can also serve as a tool to assess the progress of students and eliminate the risks relating to repetitive spinal manipulative therapy practice on student colleagues GOAL Isolate and evaluate the impact of mental imagery on the acquisition of an emergency surgical technique . METHOD We studied 44 first-year medical students performing a cricothyrotomy on a mannequin to determine the impact of teaching using mental imagery ( MI ) and /or kinesiology ( KG ) compared to the st and ard Adv and ec Trauma Life Support ( ATLS ) approach . Students were r and omly assigned to one of three groups : MI and KG , KG alone or control ( ATLS ) . Two weeks after the one-hour teaching session , they were evaluated with an OSCE testing the performance of the different steps of the technique , the time required and its fluidity . RESULTS Total results ( maximum : 25 marks ) are as follows : KG + MI = 20.3 + /- 1.5 ; KG = 19.3 + /- 2.9 ; ATLS = 18.2 + /- 2.5 . The only statistically significant difference for total results was in the use of MI and KG compared to the control group . Kinesiology alone or with mental imagery improved the fluidity of the performance . CONCLUSION Many factors influence the acquisition of a surgical technique . This study showed that acquisition and performance of an emergency procedure ( cricothyrotomy ) was improved when mental imagery and kinesiology were combined to teach it Background : Part task training ( PTT ) focuses on dividing complex tasks into components followed by intensive concentrated training on individual components . Variable priority training ( VPT ) focuses on optimal distribution 
    Output:
    