All three studies were randomised controlled trials, however, two of these three involved simulated, as opposed to live, procedures.13 14 Future studies should look to further assess the impact of feedback related to live surgery such that the broader implications of feedback can be appreciated. The impact of feedback on long-term skill acquisition was not studied; all studies only assessed surgical performance with between one and five procedures after the first feedback was provided. Thus, studies
taking place over a longer time scale are necessary. It is also important to establish the clinical significance of feedback; none of the studies included assessed whether the improvement in technical skill was associated with an improvement in clinical outcomes, although one might suspect it would, particularly in light of recent findings that technical skills rated by experts based on video footage correlate with surgical outcomes.7 In one study, feedback included a review of a videotape recording and a 60?min structured feedback session with a senior surgeon.15 Although extensive feedback sessions have been suggested (but not shown) to be effective,21 provision of feedback in this manner may be resource intensive and hence cost- and time-effectiveness must also be considered. The finding from a study involving simulation that non-expert delivered
feedback is still effective14 may broaden options for educationalists and time-pressed senior surgeons, although one must be careful not to implement counter-productive feedback initiatives. Although there are a few studies on this subject, all studies included in our analysis were randomised controlled trials. Given the consistent benefit of feedback demonstrated, this supports further research on this topic and implementation of structured intraoperative feedback initiatives. The small number of studies included in this review highlights the need for more substantive research in this area in order to establish the optimum means and circumstances of feedback dissemination
such that standardised methods for future widespread implementation can be MDV3100
attained, and future studies should consider the effect of the following study variables Source (oral/written), facilitator (expert/non-expert), frequency (every procedure/once daily/weekly/monthly) and duration of feedback (months/years). Surgeon involvement in feedback (either active or passive), standardised means of assessing surgical performance (which may be both generic and procedure-specific), content of feedback, timing of feedback relative to the procedure (intraoperatively/postoperatively), and the opportunities available for discussion, correction and learning. Benchmarking (relative to peers as well as to literature data) and feedback based on intraoperative recordings reviewed at a later time point. Other interventions utilised, such as guidelines, education and review of instructional videos.