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  Laparoscopic simulator training translates into improved operative performance . Proficiency-based curricula maximize efficiency by tailoring training to meet the needs of each individual ; however , because rates of skill acquisition vary widely , such curricula may be difficult to implement . We hypothesized that psychomotor testing would predict baseline performance and training duration in a proficiency-based laparoscopic simulator curriculum . METHODS Residents ( R1 , n = 20 ) were enrolled in an IRB-approved prospect i ve study at the beginning of the academic year . All completed the following : a background information survey , a battery of 12 innate ability measures ( 5 motor , and 7 visual-spatial ) , and baseline testing on 3 vali date d simulators ( 5 videotrainer [ VT ] tasks , 12 virtual reality [ minimally invasive surgical trainer-virtual reality , MIST-VR ] tasks , and 2 laparoscopic camera navigation [ LCN ] tasks ) . Participants trained to proficiency , and training duration and number of repetitions were recorded . Baseline test scores were correlated to skill acquisition rate . Cutoff scores for each predictive test were calculated based on a receiver operator curve , and their sensitivity and specificity were determined in identifying slow learners . RESULTS Only the Cards Rotation test correlated with baseline simulator ability on VT and LCN . Curriculum implementation required 347 man-hours ( 6-person team ) and 795,000 dollars of capital equipment . With an attendance rate of 75 % , 19 of 20 residents ( 95 % ) completed the curriculum by the end of the academic year . To complete training , a median of 12 hours ( range , 5.5 - 21 ) , and 325 repetitions ( range , 171 - 782 ) were required . Simulator score improvement was 50 % . Training duration and repetitions correlated with prior video game and billiard exposure , grooved pegboard , finger tap , map planning , Rey Figure Immediate Recall score , and baseline performance on VT and LCN . The map planning cutoff score proved most specific in identifying slow learners . CONCLUSIONS Proficiency-based laparoscopic simulator training provides improvement in performance and can be effectively implemented as a routine part of resident education , but may require significant re sources . Although psychomotor testing may be of limited value in the prediction of baseline laparoscopic performance , its importance may lie in the prediction of the rapidity of skill acquisition . These tests may be useful in optimizing curricular design by allowing the tailoring of training to individual needs Background Many factors are known to influence the performance of surgeons within the operating theater , including tiredness , previous experience , and stress levels . The effects of mental rehearsal and cognitive visualization on microsurgical skills have not been assessed . Methods Thirty-six subjects recruited from the Northwick Park Microsurgery Skills Course were r and omized into three groups ; ( 1 ) a control group ( C ) with no mental rehearsal script , ( 2 ) a visual anastomosis group ( VA ) , with a detailed rat anastomosis script , and ( 3 ) a visual relaxation ( VR ) group with a relaxation script , unrelated to the anastomosis . Participants ran through relevant scripts from day 2 to 5 and were assessed through recorded arterial rat anastomosis , scored using the structured assessment of microsurgery skills . Results Results were analyzed by double-blinded assessors . No statistical significance was found on Monday and Tuesday ( first day post intervention ) , p = 0.326 ( VA vs. C ) and p = 0.283 ( VR vs. C ) . A statistically significant difference was noted at the end of day 4 ; p < 0.001 ( VA vs. VR ) and p = 0.001 ( VA vs. C ) . Further analysis demonstrated that domains within the global rating scoring system showed statistical significance for ( 1 ) dexterity : VA versus VR , p = 0.001 , ( 2 ) visuospatial skills : VA versus VR , p = 0.001 , and VA versus C , p = 0.002 , and ( 3 ) operative flow : VA versus VR , p = 0.044 , and VA versus C , p = 0.026 . Conclusion The benefits of cognitive visualization and mental rehearsal in microsurgery may result in fewer complications from errors and thus lead to enhanced patient safety and better operative outcomes 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 OBJECTIVE To analyze the relationship between visuospatial ability and simulated laparoscopy performed by consultants in obstetrics and gynecology ( OBGYN ) . STUDY DESIGN This was a prospect i ve cohort study carried out at two community hospitals in Sweden . Thirteen consultants in obstetrics and gynecology were included . They had previously independently performed 10 - 100 advanced laparoscopies .  Participants were tested for visuospatial ability by the Mental Rotations Test version A ( MRT-A ) . After a familiarization session and st and ardized instruction , all participants subsequently conducted three consecutive virtual tubal occlusions followed by three virtual salpingectomies . Performance in the simulator was measured by Total Time , Score and Ovarian Diathermy Damage . Linear regression was used to analyze the relationship between visuospatial ability and simulated laparoscopic performance . The learning curves in the simulator were assessed in order to interpret the relationship with the visuospatial ability . RESULTS Visuospatial ability correlated with Total Time ( r=-0.62 ; p=0.03 ) and Score ( r=0.57 ; p=0.05 ) in the medium level of the virtual tubal occlusion . In the technically more advanced virtual salpingectomy the visuospatial ability correlated with Total Time ( r=-0.64 ; p=0.02 ) , Ovarian Diathermy Damage ( r=-0.65 ; p=0.02 ) and with overall Score ( r=0.64 ; p=0.02 ) . CONCLUSIONS Visuospatial ability appears to be related to the performance of gynecological laparoscopic procedures in a simulator . Testing visuospatial ability might be helpful when design ing individual training programs Objective To compare innate spatial awareness skills , using the MIST‐VR system ( Ethicon Ltd , Edinburgh , a computer‐based virtual reality system that objective ly tests spatial awareness ) among three groups of people ( consultant urologists , urological trainees and controls who were not surgeons ) , because urological surgeons require spatial awareness for endoscopic and laparoscopic surgery , but trainees are selected by academic prowess rather than surgical aptitude BACKGROUND The introduction of noninvasive laparoscopic surgery has raised concerns about appropriate teaching techniques for medical students considering surgery as a specialization . The principal aim of this study was to determine the effect , between the sexes , of cognitive imaging as a teaching method in the context of learning a surgical technique . METHODS A r and omized treatment-control sample of 42 medical student volunteers was used to test the effect of cognitive imaging on performance and on traditional instructional techniques to help medical students acquire suturing skills specific to laparoscopic surgery . RESULTS Repeated- measures analysis of variance showed no significant effect for the use of cognitive imaging ( F1,40 = 0.97 , p > 0.05 ) . Males tended to perform better than females in completing tasks that required the use of visual-spatial manipulation of the instruments within a simulated laparoscopic environment ( F1,40 = 5.08 , p < 0.05 ) . CONCLUSIONS These results , which are in concordance with other research findings , indicate that females generally have lower visual-spatial abilities than males . Enhanced performance for both sexes , however , increases rapidly with practice . Other than verbal one-on-one instruction , males on average rank instructional approaches that are applied and visual higher than do females PURPOSE Endovascular therapy has had a major effect on vascular surgery ; surgeons perform tasks in three dimensions ( 3D ) while viewing two-dimensional ( 2D ) displays . This fundamental change in how surgeons perform operations has educational implication s related to learning curves and patient safety . We studied the effects of experience , training , and visual-spatial ability on 3D perception of 2D angiographic images of abdominal aortic aneurysms ( AAA ) . METHODS A novel computer-based method was developed to produce 3D depth maps based on subjects ' interpretations of 2D images . Seven experts ( certified vascular surgeons ) and 20 novices ( medical or surgical trainees ) were presented with a 2D AAA angiographic image .  With software specifically design ed for this study , a depth map representing each subject 's 3D interpretation of the 2D angiogram was produced . The novices were then r and omized into a control group and a treatment group , who received a 5-minute AAA anatomy educational session . All subjects repeated the exercise on a second AAA image . Finally , all novices were given tests of visual-spatial ability , including the Surface Development Test and the Mental Rotations Test . Comparisons between experts and novices were made with depth map comparison , a subject 's perception of overall object contour . RESULTS The depth maps were significantly different ( depth map comparison , P < .001 ) between the expert and both novice groups for the first image . After the educational intervention , the control group and the treatment group exhibited significantly different depth maps ( depth map comparison , P < .001 ) , with treatment group depth maps more similar to those of the expert group . There were no significant correlations between the visual-spatial tests and the novice depth map comparison with the expert group . CONCLUSIONS This is the first study to examine perception of endovascular images in an educational context . Perception of overall surface contour of 3D structures from 2D angiographic images is affected by experience and training . With application of methods of vision science to an important problem in surgery , this research represents a first step in underst and ing the nature of visual perceptual processes involved in execution of an increasingly common clinical task . These results have implication s for underst and ing and study ing the endovascular learning curve . CLINICAL RELEVANCE This research represents a unique collaboration in an effort to underst and and solve one of the greatest problems facing surgical educators and surgeons . This research uses applied tools in vision science to underst and the perceptual constraints involved in minimally invasive surgery . Specifically , we examined the mental three-dimensional maps experts use when viewing two-dimensional displays . Furthermore , we compared experts with novices in an effort to assist surgical trainees Background : Performing minimally invasive surgery requires training and visual-spatial intelligence . The aim of our study was to examine the impact of visual-spatial perception and additional mental training on the simulated laparoscopic knot-tying task performed by surgical novices . Methods : A total of 40 medical students r and omly assigned to two groups underwent two sessions of laparoscopic basic training on a VR simulator  ( SimSurgery ® , Oslo , Norway ) . The variables time and tip trajectory ( total path length of the instrument tip trajectory ) were used to assess the performance of the intracorporeal knot-tying task using a laparoscopic Nissen fundoplication model . The experimental group completed additional mental practice during the interval between the two training sessions . All performed a cube subtest of a st and ard intelligence test ( I-S-T 2000 R ) to evaluate visual-spatial ability . Results : All participants achieved an improvement in time ( t = 9.861 ; p < 0.001 ) and tip trajectory ( t = 6.833 ; p < 0.001 ) in the second training session . High scores on the visual-spatial test correlated with a faster performance ( r = −0.557 ; p < 0.001 ) and more precise movements ( r = −0.377 ; p = 0.016 ) . Comparison of the two groups did not show any statistical significant differences in the parameters time and tip trajectory . Conclusions : Visual-spatial intelligence tested by a cube test correlated with simulated laparoscopic knot-tying skills in surgical novices . Additional mental practice did not improve the overall knot-tying performance . Further studies are therefore required to determine whether mental practice might be beneficial for experienced laparoscopic surgeons or for more complex tasks BACKGROUND The visual overlay technique for surgical planning is difficult to apply to spatially complex fractures . Virtual reality can be applied by virtual fracture carving to adapt the visual overlay technique to three-dimensional ( 3D ) images . In this study , we evaluated whether virtual fracture carving is a useful exercise by performing two experiments comparing trainees ' underst and ing of a complex fracture with the application of either current preoperative techniques or the use of the Virtual-Fracture-Carving Simulator . METHODS Forty-eight participants -senior medical students and residents in post 
    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  Laparoscopic simulator training translates into improved operative performance . Proficiency-based curricula maximize efficiency by tailoring training to meet the needs of each individual ; however , because rates of skill acquisition vary widely , such curricula may be difficult to implement . We hypothesized that psychomotor testing would predict baseline performance and training duration in a proficiency-based laparoscopic simulator curriculum . METHODS Residents ( R1 , n = 20 ) were enrolled in an IRB-approved prospect i ve study at the beginning of the academic year . All completed the following : a background information survey , a battery of 12 innate ability measures ( 5 motor , and 7 visual-spatial ) , and baseline testing on 3 vali date d simulators ( 5 videotrainer [ VT ] tasks , 12 virtual reality [ minimally invasive surgical trainer-virtual reality , MIST-VR ] tasks , and 2 laparoscopic camera navigation [ LCN ] tasks ) . Participants trained to proficiency , and training duration and number of repetitions were recorded . Baseline test scores were correlated to skill acquisition rate . Cutoff scores for each predictive test were calculated based on a receiver operator curve , and their sensitivity and specificity were determined in identifying slow learners . RESULTS Only the Cards Rotation test correlated with baseline simulator ability on VT and LCN . Curriculum implementation required 347 man-hours ( 6-person team ) and 795,000 dollars of capital equipment . With an attendance rate of 75 % , 19 of 20 residents ( 95 % ) completed the curriculum by the end of the academic year . To complete training , a median of 12 hours ( range , 5.5 - 21 ) , and 325 repetitions ( range , 171 - 782 ) were required . Simulator score improvement was 50 % . Training duration and repetitions correlated with prior video game and billiard exposure , grooved pegboard , finger tap , map planning , Rey Figure Immediate Recall score , and baseline performance on VT and LCN . The map planning cutoff score proved most specific in identifying slow learners . CONCLUSIONS Proficiency-based laparoscopic simulator training provides improvement in performance and can be effectively implemented as a routine part of resident education , but may require significant re sources . Although psychomotor testing may be of limited value in the prediction of baseline laparoscopic performance , its importance may lie in the prediction of the rapidity of skill acquisition . These tests may be useful in optimizing curricular design by allowing the tailoring of training to individual needs Background Many factors are known to influence the performance of surgeons within the operating theater , including tiredness , previous experience , and stress levels . The effects of mental rehearsal and cognitive visualization on microsurgical skills have not been assessed . Methods Thirty-six subjects recruited from the Northwick Park Microsurgery Skills Course were r and omized into three groups ; ( 1 ) a control group ( C ) with no mental rehearsal script , ( 2 ) a visual anastomosis group ( VA ) , with a detailed rat anastomosis script , and ( 3 ) a visual relaxation ( VR ) group with a relaxation script , unrelated to the anastomosis . Participants ran through relevant scripts from day 2 to 5 and were assessed through recorded arterial rat anastomosis , scored using the structured assessment of microsurgery skills . Results Results were analyzed by double-blinded assessors . No statistical significance was found on Monday and Tuesday ( first day post intervention ) , p = 0.326 ( VA vs. C ) and p = 0.283 ( VR vs. C ) . A statistically significant difference was noted at the end of day 4 ; p < 0.001 ( VA vs. VR ) and p = 0.001 ( VA vs. C ) . Further analysis demonstrated that domains within the global rating scoring system showed statistical significance for ( 1 ) dexterity : VA versus VR , p = 0.001 , ( 2 ) visuospatial skills : VA versus VR , p = 0.001 , and VA versus C , p = 0.002 , and ( 3 ) operative flow : VA versus VR , p = 0.044 , and VA versus C , p = 0.026 . Conclusion The benefits of cognitive visualization and mental rehearsal in microsurgery may result in fewer complications from errors and thus lead to enhanced patient safety and better operative outcomes 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 OBJECTIVE To analyze the relationship between visuospatial ability and simulated laparoscopy performed by consultants in obstetrics and gynecology ( OBGYN ) . STUDY DESIGN This was a prospect i ve cohort study carried out at two community hospitals in Sweden . Thirteen consultants in obstetrics and gynecology were included . They had previously independently performed 10 - 100 advanced laparoscopies .  Participants were tested for visuospatial ability by the Mental Rotations Test version A ( MRT-A ) . After a familiarization session and st and ardized instruction , all participants subsequently conducted three consecutive virtual tubal occlusions followed by three virtual salpingectomies . Performance in the simulator was measured by Total Time , Score and Ovarian Diathermy Damage . Linear regression was used to analyze the relationship between visuospatial ability and simulated laparoscopic performance . The learning curves in the simulator were assessed in order to interpret the relationship with the visuospatial ability . RESULTS Visuospatial ability correlated with Total Time ( r=-0.62 ; p=0.03 ) and Score ( r=0.57 ; p=0.05 ) in the medium level of the virtual tubal occlusion . In the technically more advanced virtual salpingectomy the visuospatial ability correlated with Total Time ( r=-0.64 ; p=0.02 ) , Ovarian Diathermy Damage ( r=-0.65 ; p=0.02 ) and with overall Score ( r=0.64 ; p=0.02 ) . CONCLUSIONS Visuospatial ability appears to be related to the performance of gynecological laparoscopic procedures in a simulator . Testing visuospatial ability might be helpful when design ing individual training programs Objective To compare innate spatial awareness skills , using the MIST‐VR system ( Ethicon Ltd , Edinburgh , a computer‐based virtual reality system that objective ly tests spatial awareness ) among three groups of people ( consultant urologists , urological trainees and controls who were not surgeons ) , because urological surgeons require spatial awareness for endoscopic and laparoscopic surgery , but trainees are selected by academic prowess rather than surgical aptitude BACKGROUND The introduction of noninvasive laparoscopic surgery has raised concerns about appropriate teaching techniques for medical students considering surgery as a specialization . The principal aim of this study was to determine the effect , between the sexes , of cognitive imaging as a teaching method in the context of learning a surgical technique . METHODS A r and omized treatment-control sample of 42 medical student volunteers was used to test the effect of cognitive imaging on performance and on traditional instructional techniques to help medical students acquire suturing skills specific to laparoscopic surgery . RESULTS Repeated- measures analysis of variance showed no significant effect for the use of cognitive imaging ( F1,40 = 0.97 , p > 0.05 ) . Males tended to perform better than females in completing tasks that required the use of visual-spatial manipulation of the instruments within a simulated laparoscopic environment ( F1,40 = 5.08 , p < 0.05 ) . CONCLUSIONS These results , which are in concordance with other research findings , indicate that females generally have lower visual-spatial abilities than males . Enhanced performance for both sexes , however , increases rapidly with practice . Other than verbal one-on-one instruction , males on average rank instructional approaches that are applied and visual higher than do females PURPOSE Endovascular therapy has had a major effect on vascular surgery ; surgeons perform tasks in three dimensions ( 3D ) while viewing two-dimensional ( 2D ) displays . This fundamental change in how surgeons perform operations has educational implication s related to learning curves and patient safety . We studied the effects of experience , training , and visual-spatial ability on 3D perception of 2D angiographic images of abdominal aortic aneurysms ( AAA ) . METHODS A novel computer-based method was developed to produce 3D depth maps based on subjects ' interpretations of 2D images . Seven experts ( certified vascular surgeons ) and 20 novices ( medical or surgical trainees ) were presented with a 2D AAA angiographic image .  With software specifically design ed for this study , a depth map representing each subject 's 3D interpretation of the 2D angiogram was produced . The novices were then r and omized into a control group and a treatment group , who received a 5-minute AAA anatomy educational session . All subjects repeated the exercise on a second AAA image . Finally , all novices were given tests of visual-spatial ability , including the Surface Development Test and the Mental Rotations Test . Comparisons between experts and novices were made with depth map comparison , a subject 's perception of overall object contour . RESULTS The depth maps were significantly different ( depth map comparison , P < .001 ) between the expert and both novice groups for the first image . After the educational intervention , the control group and the treatment group exhibited significantly different depth maps ( depth map comparison , P < .001 ) , with treatment group depth maps more similar to those of the expert group . There were no significant correlations between the visual-spatial tests and the novice depth map comparison with the expert group . CONCLUSIONS This is the first study to examine perception of endovascular images in an educational context . Perception of overall surface contour of 3D structures from 2D angiographic images is affected by experience and training . With application of methods of vision science to an important problem in surgery , this research represents a first step in underst and ing the nature of visual perceptual processes involved in execution of an increasingly common clinical task . These results have implication s for underst and ing and study ing the endovascular learning curve . CLINICAL RELEVANCE This research represents a unique collaboration in an effort to underst and and solve one of the greatest problems facing surgical educators and surgeons . This research uses applied tools in vision science to underst and the perceptual constraints involved in minimally invasive surgery . Specifically , we examined the mental three-dimensional maps experts use when viewing two-dimensional displays . Furthermore , we compared experts with novices in an effort to assist surgical trainees Background : Performing minimally invasive surgery requires training and visual-spatial intelligence . The aim of our study was to examine the impact of visual-spatial perception and additional mental training on the simulated laparoscopic knot-tying task performed by surgical novices . Methods : A total of 40 medical students r and omly assigned to two groups underwent two sessions of laparoscopic basic training on a VR simulator  ( SimSurgery ® , Oslo , Norway ) . The variables time and tip trajectory ( total path length of the instrument tip trajectory ) were used to assess the performance of the intracorporeal knot-tying task using a laparoscopic Nissen fundoplication model . The experimental group completed additional mental practice during the interval between the two training sessions . All performed a cube subtest of a st and ard intelligence test ( I-S-T 2000 R ) to evaluate visual-spatial ability . Results : All participants achieved an improvement in time ( t = 9.861 ; p < 0.001 ) and tip trajectory ( t = 6.833 ; p < 0.001 ) in the second training session . High scores on the visual-spatial test correlated with a faster performance ( r = −0.557 ; p < 0.001 ) and more precise movements ( r = −0.377 ; p = 0.016 ) . Comparison of the two groups did not show any statistical significant differences in the parameters time and tip trajectory . Conclusions : Visual-spatial intelligence tested by a cube test correlated with simulated laparoscopic knot-tying skills in surgical novices . Additional mental practice did not improve the overall knot-tying performance . Further studies are therefore required to determine whether mental practice might be beneficial for experienced laparoscopic surgeons or for more complex tasks BACKGROUND The visual overlay technique for surgical planning is difficult to apply to spatially complex fractures . Virtual reality can be applied by virtual fracture carving to adapt the visual overlay technique to three-dimensional ( 3D ) images . In this study , we evaluated whether virtual fracture carving is a useful exercise by performing two experiments comparing trainees ' underst and ing of a complex fracture with the application of either current preoperative techniques or the use of the Virtual-Fracture-Carving Simulator . METHODS Forty-eight participants -senior medical students and residents in post 
    Output:
    