Determinants of collaborative reasoning in physician-to-physician teleconsultations: a qualitative study

OBJECTIVE: Teleconsultation has become a vital component of modern healthcare delivery, within which clinical reasoning is a critical determinant of care quality, directly impacting patient outcomes. This qualitative study aimed to explore and validate the key components that constitute effective (accurate, timely and safe) physician-physician clinical reasoning in teleconsultations. DESIGN AND SETTING: We employed a qualitative design using directed content analysis. The study was conducted within Iran's national 'Moein Program', a structured teleconsultation service providing specialist support for obstetrics and gynaecology. Data collection was conducted between 2023 and 2024. PARTICIPANTS: Semistructured interviews were conducted with 16 purposively sampled obstetrician-gynaecologists (both specialists and residents) who had direct teleconsultation experience. Data collection continued until theoretical saturation was achieved. ANALYSIS: The data analysis process was guided by an initial conceptual framework derived from a literature review, and the study's rigour was ensured through Lincoln and Guba's trustworthiness criteria, including triangulation and member checking. RESULTS: The analysis validated and refined the initial framework, culminating in five key components influencing clinical reasoning in teleconsultations: (1) Data collection and sharing, (2) Situation analysis, (3) Ethical and emotional factors, (4) Collaborative decision-making and (5) Resource-related factors. CONCLUSIONS: The study concludes that successful teleconsultation relies not merely on technological infrastructure but critically on a complex interplay of human, cognitive and ethical factors. These findings underscore the necessity for developing integrated teleconsultation systems that are explicitly designed to support both the technical and the collaborative cognitive dimensions of clinical reasoning.