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.

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.

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.

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.

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.

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.

Teleconsultation has gained significant traction due to advancements in information and communication technologies. While much attention has been given to physician-to-patient teleconsultation, the factors influencing physician-to-physician teleconsultation remain underexplored.

This scoping review aims to map and synthesise the existing evidence on the factors influencing physician-to-physician teleconsultation.

We included publications of all methodological designs that specifically addressed factors affecting physician-to-physician teleconsultation. Studies focusing primarily on physician-to-patient teleconsultation without sufficient detail on physician-to-physician components were excluded. The search was limited to articles published in English and Persian between 2014 and 2024.

Eight electronic databases (PubMed, Scopus, Web of Science, etc) were searched from January 2014 to June 2024.

Data extraction was performed by two independent reviewers using a standardised form. Extracted data included study characteristics, key factors influencing teleconsultation and main findings.

From 12 included studies, five key influencing components were identified: ‘patient-related factors’, ‘medical team competencies’, ‘infrastructure and technology’, ‘timing factors’ and ‘planning and programme evaluation’. Among these, infrastructure and technology were the most frequently reported factors across the studies, while patient-related factors were less commonly addressed.

This review identifies a comprehensive set of factors that influence physician-to-physician teleconsultation. The findings provide a foundation for developing effective teleconsultation programmes and highlight the need for more research in diverse healthcare settings.