Educational Impact of Automated Feedback Systems in Surgical Training: A Systematic Review With Quantitative Synthesis.

OBJECTIVE: To evaluate the impact of automated feedback systems (AFS) on technical surgical skill acquisition in individuals undergoing surgical skills training. DESIGN: PRISMA-guided systematic review of studies published between May 2013 and December 2024. Four databases were searched. Eligible studies compared AFS with no feedback or assessed the impact of AFS on technical skill. Risk of bias was assessed using ROB-2 and ROBINS-I, and certainty of evidence with GRADE. The review was prospectively registered with PROSPERO (CRD420251058650). SETTING: Simulation-based training environments, including bench models and virtual reality simulators. PARTICIPANTS: Fourteen studies involving 814 trainees were included. RESULTS: All studies reported improvement in technical skills with AFS; 9 demonstrated significant within-group gains, with a mean improvement of 38.1% (p = 0.0046). Six studies contributed to pooled analysis, showing a moderate-to-large benefit (Hedges' g = 0.81, 95% CI: 0.45-1.00, p < 0.0001). Secondary outcomes consistently favored AFS: learner satisfaction increased by 60% (MD = 1.16, 95% CI: 0.65-1.67, p < 0.01), path length decreased by 41% (95% CI: 10.3%-71.7%, p = 0.02), speed improved by 9.4% (MD = 3.1 mm/s, 95% CI: 0.4-5.8, p = 0.04), and applied force was reduced by 11.8% (95% CI: 4.5%-19.2%, p = 0.01). CONCLUSIONS: AFS are associated with moderate-to-large improvements in technical performance, particularly for foundational repetitive surgical tasks. While gains are often task-specific and largely confined to simulation settings, evidence supports AFS as a valuable adjunct to early surgical training. Integration into structured programmes, alongside expert oversight and contextual teaching, is essential to maximize benefit and ensure safe transferability to clinical practice. Small study numbers, task-specific designs, and heterogeneity limit interpretation.