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: 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 Objective : To investigate the impact of instructor feedback versus no instructor feedback when training a complex operational task on a laparoscopic virtual reality simulator . Background : Simulators are now widely accepted as a training tool , but there is insufficient knowledge about how much feedback is necessary , which is useful for sustainable implementation . Methods : A r and omized trial complying with CONSORT Statement . All participants had to reach a predefined proficiency level for a complex operational task on a virtual reality simulator . The intervention group received st and ardized instructor feedback a maximum of 3 times . The control group did not receive instructor feedback .  Participants were senior medical students without prior laparoscopic experience ( n = 99 ) . Outcome measures were time , repetitions , and performance score to reach a predefined proficiency level . Furthermore , influence of sex and perception of own surgical skills were examined . Results : Time ( in minutes ) and repetitions were reduced in the intervention group ( 162 vs 342 minutes ; P < 0.005 ) and ( 29 vs 65 repetitions ; P < 0.005 ) . The control group achieved a higher performance score than the intervention group ( 57 % vs 49 % ; P = 0.004 ) . Men used less time ( in minutes ) than women ( P = 0.037 ) , but no sex difference was observed for repetitions ( P = 0.20 ) . Participants in the intervention group had higher self-perception regarding surgical skills after the trial ( P = 0.011 ) . Conclusions : Instructor feedback increases the efficiency when training a complex operational task on a virtual reality simulator ; time and repetitions used to achieve a predefined proficiency level were significantly reduced in the group that received instructor feedback compared with the control group . Trial registration number : NCT01497782 BACKGROUND As surgical training is evolving and operative exposure is decreasing , new , effective , and experiential learning methods are needed to ensure surgical competency and patient safety . Video coaching is an emerging concept in surgery that needs further investigation . DESIGN In this r and omized controlled trial conducted at a single teaching hospital , participating residents were filmed performing a  side-to-side intestinal anastomosis  on cadaveric dog bowel for baseline assessment . The Surgical Video Coaching ( SVC ) group then participated in a one-on-one video playback coaching and debriefing session with a surgeon , during which constructive feedback was given . The control group went on with their normal clinical duties without coaching or debriefing . All participants were filmed making a second intestinal anastomosis . This was compared to their first anastomosis using a 7-category-vali date d technical skill global rating scale , the Objective Structured Assessment of Technical Skills . A single independent surgeon who did not participate in coaching or debriefing to the SVC group review ed all videos . A satisfaction survey was then sent to the residents in the coaching group . SETTING Department of Surgery , HôpitalMaisonneuve-Rosemont , tertiary teaching hospital affiliated to the University of Montreal , Canada . PARTICIPANTS General surgery residents from University of Montreal were recruited to take part in this trial . A total of 28 residents were r and omized and completed the study . RESULTS After intervention , the SVC group ( n = 14 ) significantly increased their Objective Structured Assessment of Technical Skills score ( mean of differences 3.36 , [ 1.09 - 5.63 ] , p = 0.007 ) when compared to the control group ( n = 14 ) ( mean of differences 0.29 , p = 0.759 ) . All residents agreed or strongly agreed that video coaching was a time-efficient teaching method . CONCLUSIONS Video coaching is an effective and efficient teaching intervention to improve surgical residents ' technical skills BACKGROUND There is evidence that preoperative practice prior to surgery can improve trainee performance , but the optimal approach has not been studied . OBJECTIVE We sought to determine if preoperative practice by surgical trainees paired with instructor feedback improved surgical technique , compared to preoperative practice or feedback alone . METHODS We conducted a r and omized controlled trial of obstetrics-gynecology trainees , stratified on a simulator-assessed surgical skill . Participants were r and omized to preoperative practice on a simulator with instructor feedback ( PPF ) , preoperative practice alone ( PP ) , or feedback alone ( F ) . Trainees then completed a laparoscopic salpingectomy , and the operative performance was evaluated using an assessment tool . RESULTS A total of 18 residents were r and omized and completed the study , 6 in each arm . The mean baseline score on the simulator was comparable in each group ( 67 % for PPF , 68 % for PP , and 70 % for F ) . While the median score on the assessment tool for laparoscopic salpingectomy in the PPF group was the highest , there was no statistically significant difference in assessment scores for the PPF group ( 32.75 ; range , 15 - 36 ) compared to the PP group ( 14.5 ; range , 10 - 34 ) and the F group ( 21.25 ; range , 10.5 - 32 ) . The interrater correlation between the video review ers was 0.87 ( 95 % confidence interval 0.70 - 0.95 ) using the intraclass correlation coefficient . CONCLUSIONS This study suggests that a surgical preoperative practice with instructor feedback may not improve operative technique compared to either preoperative practice or feedback alone BACKGROUND Constructive feedback plays an important role in learning during surgical training .  St and ard feedback is usually given verbally following direct observation of the procedure by a trained assessor . However , such feedback requires the physical presence of expert faculty members who are usually busy and time-constrained by clinical commitments . We aim to evaluate  electronic feedback ( e-feedback ) after video observation of surgical suturing in comparison with st and ard face-to-face verbal feedback . METHODS A prospect i ve , blinded , r and omized controlled trial comparing e-feedback with st and ard verbal feedback was carried out in February 2015 using a vali date d pro formas for assessment . The study participants were 38 undergraduate medical students from the University of Sheffield , UK . They were recorded on video performing the procedural skill , completed a self-evaluation form , and received e-feedback on the same day ( group 1 ) ; observed directly by an assessor , invited to provide verbal self-reflection , and then received st and ard verbal feedback ( group 2 ) . In both groups , the feedback was provided after performing the procedure . The participants returned 2 days later and performed the same skill again . Post study question naire was used to assess the acceptability of each feedback among the participants . RESULTS Overall , 19 students in group 1 and 18 students in group 2 completed the study . Although there was a significant improvement in the overall mean score on the second performance of the task for all participants ( first performance mean 11.59 , second performance mean 15.95 ; p ≤ 0.0001 ) , there was no difference in the overall mean improvement score between group 1 and group 2 ( 4.74 and 3.94 , respectively ; p = 0.49 ) . The mean overall scores  for the e-feedback group at baseline recorded by 2 independent investigators showed good agreement ( mean overall scores of 12.84 and 11.89 ; Cronbach α = 0.86 ) . Post study question naire demonstrated that both e-feedback and st and ard verbal feedback achieved high mean Likert grade s as recorded by the participants ( 4.42 [ range : 2 - 5 ] and 4.71 [ range : 4 - 5 ] , respectively ; p = 0.274 ) . CONCLUSION e-Feedback after watching a video recording appears to be acceptable and is not quantitatively different than st and ard feedback in improving suturing skills among novice trainees . Video assessment of procedural skills is reliable OBJECTIVES The aim of the study was to determine whether individualized coaching improved surgical technical skill in the operating room to a higher degree than current residency training . BACKGROUND Clinical training in the operating room is a valuable opportunity for surgeons to acquire skill and knowledge ; however , it often remains underutilized . Coaching has been successfully used in various industries to enhance performance , but its role in surgery has been insufficiently investigated . METHODS This r and omized controlled trial was conducted at one surgical training program . Trainees undergoing a minimally invasive surgery rotation were r and omized to either  conventional training ( CT ) or comprehensive surgical coaching ( CSC ) . CT included ward and operating room duties , and regular departmental teaching sessions . CSC comprised performance analysis , debriefing , feedback , and behavior modeling . Primary outcome measures were technical performance as measured on global and procedure-specific rating scales , and surgical safety parameters , measured by error count . Operative performance was assessed by blinded video analysis of the first and last cases recorded by the participants during their rotation . RESULTS Twenty residents were r and omized and 18 completed the study . At posttraining the CSC group ( n = 9 ) scored significantly higher on a procedure-specific skill scale compared with the CT group ( n = 9 ) [ median , 3.90 ( interquartile range , 3.68 - 4.30 ) vs 3.60 ( 2.98 - 3.70 ) , P = 0.017 ] , and made fewer technical errors [ 10 ( 7 - 13 ) vs 18 ( 13 - 21 ) , P = 0.003 ] . Significant within-group improvements for all skill metrics were only noted in the CSC group . CONCLUSIONS Comprehensive surgical coaching enhances surgical training and results in skill acquisition superior to conventional training OBJECTIVES The objective of this prospect i ve learning research study is to examine the impact of structured elaborative feedback in practical skills teaching of visual and digital shade matching . MATERIAL S AND METHODS A total of 60 pre clinical dental students participated in the study . The mean average age was 23 years , of which 37 were female ( 61.7 % ) and 23 male ( 38.3 % ) . The participants were r and omly divided into a study and control group ( n = 30 each ) . Recording of shade matching  was carried out on the phantom patient using clinical ly simulated setting s with elaborative feedback in the study group ( T1 ) . Nine items were recorded for  visual shade matching  and six items for  digital shade-taking .  The errors were coded . The lower the total ( max . 30 points ) , the fewer the errors made by students during shade determination . The subject labeled the tooth color using VITA 3D-Master and VITA Easyshade ( Vita Zahnfabrik , Bad Säckingen , Germany ) . RESULTS On comparing the two groups , the study group and the control group showed a similar mean error value at reference time T1 . After intervention ( T2 ) it was possible to achieve a clear improvement in the rate of errors for study group . In the study group there was a significant difference between the ΔE values from time T1 and T2 of visual shade matching ( p < 0.05 ) . The digital ΔE values show in total no significant changes . CONCLUSION Elaborative feedback in conjunction with st and ardized checklists can lead to a substantial improvement among students in terms of visual shade matching . CLINICAL SIGNIFICANCE Correctly determining the tooth shade is an essential treatment step in esthetic reconstructive dentistry . Color is probably one of the most important determinants of esthetics in dentistry . Factors such as lighting conditions , gender , age , experience , and color vision impairment affect the process of shade matching . With an elaborative feedback in conjunction with st and ardized checklists can lead to a substantial improvement among students in terms of visual shade matching . ( J Esthet Restor Dent 28:277 - 286 , 2016 ) BACKGROUND Medical educators have indicated that feedback is one of the main catalysts required for performance improvement . However , medical students appear to be persistently dissatisfied with the feedback that they receive . The purpose of this study was to evaluate learning outcomes and perceptions in students who received feedback compared to those who received general compliments . METHODS All subjects received identical instruction on two-h and ed surgical knot-tying .  Group  
    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: 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 Objective : To investigate the impact of instructor feedback versus no instructor feedback when training a complex operational task on a laparoscopic virtual reality simulator . Background : Simulators are now widely accepted as a training tool , but there is insufficient knowledge about how much feedback is necessary , which is useful for sustainable implementation . Methods : A r and omized trial complying with CONSORT Statement . All participants had to reach a predefined proficiency level for a complex operational task on a virtual reality simulator . The intervention group received st and ardized instructor feedback a maximum of 3 times . The control group did not receive instructor feedback .  Participants were senior medical students without prior laparoscopic experience ( n = 99 ) . Outcome measures were time , repetitions , and performance score to reach a predefined proficiency level . Furthermore , influence of sex and perception of own surgical skills were examined . Results : Time ( in minutes ) and repetitions were reduced in the intervention group ( 162 vs 342 minutes ; P < 0.005 ) and ( 29 vs 65 repetitions ; P < 0.005 ) . The control group achieved a higher performance score than the intervention group ( 57 % vs 49 % ; P = 0.004 ) . Men used less time ( in minutes ) than women ( P = 0.037 ) , but no sex difference was observed for repetitions ( P = 0.20 ) . Participants in the intervention group had higher self-perception regarding surgical skills after the trial ( P = 0.011 ) . Conclusions : Instructor feedback increases the efficiency when training a complex operational task on a virtual reality simulator ; time and repetitions used to achieve a predefined proficiency level were significantly reduced in the group that received instructor feedback compared with the control group . Trial registration number : NCT01497782 BACKGROUND As surgical training is evolving and operative exposure is decreasing , new , effective , and experiential learning methods are needed to ensure surgical competency and patient safety . Video coaching is an emerging concept in surgery that needs further investigation . DESIGN In this r and omized controlled trial conducted at a single teaching hospital , participating residents were filmed performing a  side-to-side intestinal anastomosis  on cadaveric dog bowel for baseline assessment . The Surgical Video Coaching ( SVC ) group then participated in a one-on-one video playback coaching and debriefing session with a surgeon , during which constructive feedback was given . The control group went on with their normal clinical duties without coaching or debriefing . All participants were filmed making a second intestinal anastomosis . This was compared to their first anastomosis using a 7-category-vali date d technical skill global rating scale , the Objective Structured Assessment of Technical Skills . A single independent surgeon who did not participate in coaching or debriefing to the SVC group review ed all videos . A satisfaction survey was then sent to the residents in the coaching group . SETTING Department of Surgery , HôpitalMaisonneuve-Rosemont , tertiary teaching hospital affiliated to the University of Montreal , Canada . PARTICIPANTS General surgery residents from University of Montreal were recruited to take part in this trial . A total of 28 residents were r and omized and completed the study . RESULTS After intervention , the SVC group ( n = 14 ) significantly increased their Objective Structured Assessment of Technical Skills score ( mean of differences 3.36 , [ 1.09 - 5.63 ] , p = 0.007 ) when compared to the control group ( n = 14 ) ( mean of differences 0.29 , p = 0.759 ) . All residents agreed or strongly agreed that video coaching was a time-efficient teaching method . CONCLUSIONS Video coaching is an effective and efficient teaching intervention to improve surgical residents ' technical skills BACKGROUND There is evidence that preoperative practice prior to surgery can improve trainee performance , but the optimal approach has not been studied . OBJECTIVE We sought to determine if preoperative practice by surgical trainees paired with instructor feedback improved surgical technique , compared to preoperative practice or feedback alone . METHODS We conducted a r and omized controlled trial of obstetrics-gynecology trainees , stratified on a simulator-assessed surgical skill . Participants were r and omized to preoperative practice on a simulator with instructor feedback ( PPF ) , preoperative practice alone ( PP ) , or feedback alone ( F ) . Trainees then completed a laparoscopic salpingectomy , and the operative performance was evaluated using an assessment tool . RESULTS A total of 18 residents were r and omized and completed the study , 6 in each arm . The mean baseline score on the simulator was comparable in each group ( 67 % for PPF , 68 % for PP , and 70 % for F ) . While the median score on the assessment tool for laparoscopic salpingectomy in the PPF group was the highest , there was no statistically significant difference in assessment scores for the PPF group ( 32.75 ; range , 15 - 36 ) compared to the PP group ( 14.5 ; range , 10 - 34 ) and the F group ( 21.25 ; range , 10.5 - 32 ) . The interrater correlation between the video review ers was 0.87 ( 95 % confidence interval 0.70 - 0.95 ) using the intraclass correlation coefficient . CONCLUSIONS This study suggests that a surgical preoperative practice with instructor feedback may not improve operative technique compared to either preoperative practice or feedback alone BACKGROUND Constructive feedback plays an important role in learning during surgical training .  St and ard feedback is usually given verbally following direct observation of the procedure by a trained assessor . However , such feedback requires the physical presence of expert faculty members who are usually busy and time-constrained by clinical commitments . We aim to evaluate  electronic feedback ( e-feedback ) after video observation of surgical suturing in comparison with st and ard face-to-face verbal feedback . METHODS A prospect i ve , blinded , r and omized controlled trial comparing e-feedback with st and ard verbal feedback was carried out in February 2015 using a vali date d pro formas for assessment . The study participants were 38 undergraduate medical students from the University of Sheffield , UK . They were recorded on video performing the procedural skill , completed a self-evaluation form , and received e-feedback on the same day ( group 1 ) ; observed directly by an assessor , invited to provide verbal self-reflection , and then received st and ard verbal feedback ( group 2 ) . In both groups , the feedback was provided after performing the procedure . The participants returned 2 days later and performed the same skill again . Post study question naire was used to assess the acceptability of each feedback among the participants . RESULTS Overall , 19 students in group 1 and 18 students in group 2 completed the study . Although there was a significant improvement in the overall mean score on the second performance of the task for all participants ( first performance mean 11.59 , second performance mean 15.95 ; p ≤ 0.0001 ) , there was no difference in the overall mean improvement score between group 1 and group 2 ( 4.74 and 3.94 , respectively ; p = 0.49 ) . The mean overall scores  for the e-feedback group at baseline recorded by 2 independent investigators showed good agreement ( mean overall scores of 12.84 and 11.89 ; Cronbach α = 0.86 ) . Post study question naire demonstrated that both e-feedback and st and ard verbal feedback achieved high mean Likert grade s as recorded by the participants ( 4.42 [ range : 2 - 5 ] and 4.71 [ range : 4 - 5 ] , respectively ; p = 0.274 ) . CONCLUSION e-Feedback after watching a video recording appears to be acceptable and is not quantitatively different than st and ard feedback in improving suturing skills among novice trainees . Video assessment of procedural skills is reliable OBJECTIVES The aim of the study was to determine whether individualized coaching improved surgical technical skill in the operating room to a higher degree than current residency training . BACKGROUND Clinical training in the operating room is a valuable opportunity for surgeons to acquire skill and knowledge ; however , it often remains underutilized . Coaching has been successfully used in various industries to enhance performance , but its role in surgery has been insufficiently investigated . METHODS This r and omized controlled trial was conducted at one surgical training program . Trainees undergoing a minimally invasive surgery rotation were r and omized to either  conventional training ( CT ) or comprehensive surgical coaching ( CSC ) . CT included ward and operating room duties , and regular departmental teaching sessions . CSC comprised performance analysis , debriefing , feedback , and behavior modeling . Primary outcome measures were technical performance as measured on global and procedure-specific rating scales , and surgical safety parameters , measured by error count . Operative performance was assessed by blinded video analysis of the first and last cases recorded by the participants during their rotation . RESULTS Twenty residents were r and omized and 18 completed the study . At posttraining the CSC group ( n = 9 ) scored significantly higher on a procedure-specific skill scale compared with the CT group ( n = 9 ) [ median , 3.90 ( interquartile range , 3.68 - 4.30 ) vs 3.60 ( 2.98 - 3.70 ) , P = 0.017 ] , and made fewer technical errors [ 10 ( 7 - 13 ) vs 18 ( 13 - 21 ) , P = 0.003 ] . Significant within-group improvements for all skill metrics were only noted in the CSC group . CONCLUSIONS Comprehensive surgical coaching enhances surgical training and results in skill acquisition superior to conventional training OBJECTIVES The objective of this prospect i ve learning research study is to examine the impact of structured elaborative feedback in practical skills teaching of visual and digital shade matching . MATERIAL S AND METHODS A total of 60 pre clinical dental students participated in the study . The mean average age was 23 years , of which 37 were female ( 61.7 % ) and 23 male ( 38.3 % ) . The participants were r and omly divided into a study and control group ( n = 30 each ) . Recording of shade matching  was carried out on the phantom patient using clinical ly simulated setting s with elaborative feedback in the study group ( T1 ) . Nine items were recorded for  visual shade matching  and six items for  digital shade-taking .  The errors were coded . The lower the total ( max . 30 points ) , the fewer the errors made by students during shade determination . The subject labeled the tooth color using VITA 3D-Master and VITA Easyshade ( Vita Zahnfabrik , Bad Säckingen , Germany ) . RESULTS On comparing the two groups , the study group and the control group showed a similar mean error value at reference time T1 . After intervention ( T2 ) it was possible to achieve a clear improvement in the rate of errors for study group . In the study group there was a significant difference between the ΔE values from time T1 and T2 of visual shade matching ( p < 0.05 ) . The digital ΔE values show in total no significant changes . CONCLUSION Elaborative feedback in conjunction with st and ardized checklists can lead to a substantial improvement among students in terms of visual shade matching . CLINICAL SIGNIFICANCE Correctly determining the tooth shade is an essential treatment step in esthetic reconstructive dentistry . Color is probably one of the most important determinants of esthetics in dentistry . Factors such as lighting conditions , gender , age , experience , and color vision impairment affect the process of shade matching . With an elaborative feedback in conjunction with st and ardized checklists can lead to a substantial improvement among students in terms of visual shade matching . ( J Esthet Restor Dent 28:277 - 286 , 2016 ) BACKGROUND Medical educators have indicated that feedback is one of the main catalysts required for performance improvement . However , medical students appear to be persistently dissatisfied with the feedback that they receive . The purpose of this study was to evaluate learning outcomes and perceptions in students who received feedback compared to those who received general compliments . METHODS All subjects received identical instruction on two-h and ed surgical knot-tying .  Group  
    Output:
    