title: The impact of feedback of intraoperative technical performance in surgery: a systematic review.
abstract: OBJECTIVE
  Increasing patient demands, costs and emphasis on safety, coupled with reductions in the length of time surgical trainees spend in the operating theatre, necessitate means to improve the efficiency of surgical training. In this respect, feedback based on intraoperative surgical performance may be beneficial. Our aim was to systematically review the impact of intraoperative feedback based on surgical performance.
  
  
  METHODS
  MEDLINE, Embase, PsycINFO, AMED and the Cochrane Database of Systematic Reviews were searched. Two reviewers independently reviewed citations using predetermined inclusion and exclusion criteria. 32 data-points per study were extracted.
  
  
  METHODS
  The search strategy yielded 1531 citations. Three studies were eligible, which comprised a total of 280 procedures by 62 surgeons.
  
  
  RESULTS
  Overall, feedback based on intraoperative surgical performance was found to be a powerful method for improving performance. In cholecystectomy, feedback led to a reduction in procedure time (p=0.022) and an improvement in economy of movement (p<0.001). In simulated laparoscopic colectomy, feedback led to improvements in instrument path length (p=0.001) and instrument smoothness (p=0.045). Feedback also reduced error scores in cholecystectomy (p=0.003), simulated laparoscopic colectomy (p<0.001) and simulated renal artery angioplasty (p=0.004). In addition, feedback improved balloon placement accuracy (p=0.041), and resulted in a smoother learning curve and earlier plateau in performance in simulated renal artery angioplasty.
  
  
  CONCLUSIONS
  Intraoperative feedback appears to be associated with an improvement in performance, however, there is a paucity of research in this area. Further work is needed in order to establish the long-term benefits of feedback and the optimum means and circumstances of feedback delivery.
authors.affiliation: Medical Sciences Division, University of Oxford, Oxford, UK.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Trehan
authors.affiliation: Imperial College London, London, UK.
authors.forename: Ashton
authors.initials: A
authors.lastname: Barnett-Vanes
authors.affiliation: Harvard Medical School, Boston, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Carty
authors.affiliation: Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: McCulloch
authors.affiliation: Imperial College London, London, UK.
authors.forename: Mahiben
authors.initials: M
authors.lastname: Maruthappu
mesh_terms: D000800:Angioplasty, Balloon / Q000592:standards*; D002983:Clinical Competence; D013505:Digestive System Surgical Procedures / Q000592:standards*; D004526:Efficiency; D005246:Feedback; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000592:standards*; D019300:Medical Errors / Q000517:prevention & control; D061646:Operative Time; D013663:Teaching / Q000379:methods*
keywords: Feedback; Quality improvement; performance