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Two authors (MM, AT) independently examined all retrieved articles for inclusion. Any disagreements over inclusion or exclusion were resolved by discussion between authors. References in relevant papers were also reviewed in order to identify any additional studies that may have been missed by the search strategy. Data extraction Thirty two data-points per study were [http://www.selleckchem.com/products/AZD6244.html AZD6244 manufacturer] extracted using a predesigned data collection form including: first author, year of publication, study aim, study type, study design (eg, prospective, retrospective, experimental, observational, cross-sectional, longitudinal), study population, population setting (eg, hospital), surgical specialty, surgical procedure analysed, number of surgeons, types of feedback dissemination, content of feedback, frequency of feedback, measured outcomes and interventions following feedback. The full data extraction  from the studies can be found in online supplementary appendix 2. Results Study identification and selection Our search yielded 1531 citations, of which 1185 articles were excluded. After detailed evaluation of the 346 remaining articles, three studies remained eligible, which comprised of a total  of 280 procedures by 62 surgeons.13�C15 A flow diagram of the search results is illustrated in figure 1. Figure?1 Summary of search strategy for identification of relevant studies. Study characteristics All three studies were performed on surgical trainees, one involving live cholecystectomy cases, one involving simulated laparoscopic colectomy and one involving simulated renal artery angioplasty. Two studies were two-armed RCTs (with one arm receiving feedback and the control arm receiving no feedback),13 15 while one study was a three-armed RCT (with one arm receiving  expert feedback, another arm receiving non-expert feedback and one arm receiving no feedback).14 The studies included in this review are shown in table 1, and their basic characteristics are summarised in table 2. Table?1 Overview of studies included and impact of feedback on performance Table?2 Basic characteristics of studies included Feedback dissemination In all studies, feedback was delivered orally after each procedure.13�C15 No written feedback was provided in any of the studies and one study required participants to self-assess their performance after each case in addition to receiving oral feedback.13 One study utilised video footage in facilitating feedback.15 Feedback contents The two examined studies involving simulation provided participants with feedback relevant to the exercise, including standard instrument metrics, procedural time and errors, accompanied with a description of correct methods where necessary.