Intra-operative consultation: The benefits and optimization of asking for second surgical opinions

Abstract

Background

Intra-operative consultation (IOC) presents an opportunity for successful collaboration around direct patient care in an unanticipated fashion. Besides technical performance and cognitive guidance, successful IOC benefits from incorporating a blend of non-technical skills (NTS) such as communication, teamwork, and decision-making during the ideally supportive episode. Failure to use such skills may lead to untoward consequences for the surgeon who requests IOC despite successful patient rescue.

Objective

This narrative review explores the role of NTS within the context of IOC, particularly focusing on the dynamics between the surgeon seeking assistance and the surgeon providing aid.

Methods

A comprehensive literature search was performed using PubMed and OVID Medline, covering publications up to January 2024. Search terms included “non-technical skills,” “intra-operative consultation,” “conflict management in surgery,” and “surgical teamwork.” Manuscript selection was based on relevance to NTS within the context of IOC. The findings were synthesized to craft a narrative review of the importance of NTS during IOCs.

Results

IOC setting variability reflects consulting surgeon experience, case complexity, intra-operative events, resource availability, and responding surgeon specialty. Essential expectations for both the consulting and responding surgeon include embracing a collegial, non-judgmental approach that prioritizes patient safety and team cohesion. Strategies for conflict management—effective communication, active listening, and appropriate non-verbal cues—are readily leveraged to establish a supportive environment during IOC. Additionally, cultural elements - such as the reluctance to seek help due to fear of potential reputational damage - stand as barriers to viewing requesting IOC as a hallmark of maturity and professional practice.

Conclusions

NTS supports effective and successful IOC, positioning it as a valuable tool for ongoing professional development. By fostering a culture of consultation and collaboration, the surgical community can enhance both patient care and surgeon well-being. Incorporating NTS into surgical training is one means by which to adaptively overcome existing cultural barriers which impede IOC and may asymmetrically impact early career surgeons.