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One means by which surgical skills acquisition could be enhanced is via the dissemination of feedback on intraoperative performance. Studies in medical students performing basic surgical skills such as suturing, knot tying and basic laparoscopic tasks, have demonstrated that feedback can improve skill acquisition.8�C10 Additionally, [http://www.selleckchem.com/products/MDV3100.html find more] proficiency in simulated laparoscopic salpingectomy is accelerated in medical students when they receive instructor feedback,11 and feedback improves colonoscopy performance in gastroenterologists.12 Thus, provision of feedback on intraoperative  surgical performance to surgical trainees may also be associated with improved performance and/or a more rapid acquisition of skills, and hence formalised feedback should potentially serve as a key component of future surgical training programmes. Although feedback of intraoperative skill and technique can be a common occurrence in the operating theatre, the impact of this on performance and requirements for optimal training have thus far not been reviewed. We therefore conducted a systematic review to evaluate the impact of feedback of technical skill in the operating theatre and in the context of  simulation. For the purpose of this study, feedback was defined as the provision of information pertaining to the operator's surgical performance with the aim of improving subsequent performance. Methods Data sources and search strategy The systematic review was conducted in accordance with PRISMA guidelines. A comprehensive search was undertaken to determine the impact of feedback on surgical performance via the Ovid SP interface. The following databases were searched from inception to February 2013: MEDLINE, Embase, PsycINFO, AMED and the Cochrane Database of Systematic Reviews. We used two different domains of MeSH-terms and key words combined by ��AND��, and within each domain the terms were combined by ��OR��. The first domain contained terms related to surgical skill and performance, while the second contained terms  related to the impact of feedback. A detailed search strategy can be found in online supplementary appendix 1. The search was limited to English publications with no other restrictions. Study selection Two reviewers independently reviewed citations and selected eligible studies based on predetermined inclusion and exclusion criteria. Publications were selected for review if they satisfied the following inclusion criteria: the article was published in a peer-reviewed journal; the article described a study involving surgical patients or simulation; the article investigated the impact of feedback of intraoperative surgical performance; the article used a statistical unit that was patient-focused or procedure-focused.