Considerations for a two-surgeon model of care – Clinical practice point

MAY 2025

The VPCC has reviewed a number of cases of mortality in which early career surgeons have proceeded with complex cases without the clinical support of more a more experienced surgeon. Catastrophic intraoperative events have occurred in both high-risk cases and cases where a change to an initial surgical plan has been instigated. The outcomes have been traumatic for families but also for the clinicians involved. 

Recommendations arising from such reviews, and supported by VPCC, include:

1. Institution of a two-surgeon model for higher risk cases and cases where volume of practice may be low.
2. Case based discussions and planning, multi and intra disciplinary, for high-risk surgery and/or co-morbid patients
3. Use of risk stratification indices for determining a specific procedure and model of care. 
4. Determine defined triggers for intra-operative escalation of care and particularly the need for assistance (e.g. second experienced surgeon).
5. Tiered credentialling should be considered in facilities where low frequency, complex cases are performed.
6. Implementation of robust mentoring for early career surgeons which also assists in building unit capability.