Past studies have demonstrated the impact of stress on surgeons' performance in both technical and non-technical aspects of their work. This systematic review analyzed 22 studies that evaluated the relationship between intraoperative stress and surgical performance. Although the current evidence is limited by study heterogeneity, the authors did find that laparoscopic procedures trigger stress and poor technical performance and that expert surgeons experienced less stress and less impaired performance than novice surgeons. The other primary finding suggested that stress also seems to impact non-technical skills, such as communication and decision-making. All of these findings provide greater opportunities for targeted training interventions, including the use of simulation. A past AHRQ WebM&M perspective discussed the role of simulation in improving patient safety.