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

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.