Decision Making on the Labor Floor: Assessment of Obstetrician–Gynecologists’ Expertise Amidst Uncertainty [ID 885]

INTRODUCTION: Decision making in obstetrics often occurs under clinical uncertainty, particularly in determining the mode of delivery. This study explores how practicing obstetrician–gynecologists navigate such decisions and evaluates a novel assessment tool utilizing clinical vignettes to identify individual decision-making tendencies. METHODS: An explanatory sequential mixed-methods design was employed. Fifty ob-gyns completed a 25-item vignette-based assessment, rating their likelihood of cesarean versus vaginal delivery on a 4-point scale. Quantitative analysis included descriptive statistics, ordinal logistic regression to evaluate demographic predictors of cesarean preference, and assessment of internal consistency (Cronbach’s alpha). Fourteen ob-gyns were purposively sampled for semistructured interviews exploring contextual influences on decision making and reactions to the assessment. Thematic analysis was utilized for qualitative data, and integration occurred through a connecting strategy through which assessment results guided qualitative sampling and interpretation. RESULTS: Quantitative data revealed variation in systematic preferences for mode of delivery in uncertain scenarios. Ordinal regression showed no single demographic factor consistently predicted decision tendency. Qualitative themes clustered into three major domains influencing decision making: physician (training, experience, personality, risk tolerance), patient (clinical and personal factors), and context (practice environment, resources, team dynamics, policies). Participants reported that the assessment was valuable as it prompted self-awareness and professional reflection. CONCLUSIONS/IMPLICATIONS: Navigating clinical ambiguity is a defining feature of professional expertise. Decision making is shaped by the dynamic interplay of physician characteristics, patient factors, and contextual influences. A structured, decision-aligned assessment offers a promising tool for uncovering systemic tendencies and promoting reflective learning. This model has potential applications in continuing certification, simulation, and professional development.