title: The relationship between obstetricians' cognitive and affective traits and their patients' delivery outcomes.
abstract: OBJECTIVE
  The objective of the study was to investigate the relationship between physician coping skills, need for cognition, tolerance of ambiguity, and anxiety and their patients' mode of delivery.
  
  
  METHODS
  Ninety-four obstetricians were surveyed using 5 standardized psychometric scales: Reflective Coping, Proactive Coping, Multiple Stimulus Types Ambiguity Tolerance-II, Need for Cognition (measures learner motivation and engagement in cognitive efforts), and State-Trait Anxiety Inventory. Psychometric test scores were analyzed by quartile. Data regarding route of delivery were collected on 3488 nulliparous, term, cephalic, nonanomalous singleton deliveries performed by participating physicians. χ(2) tests and random-effects logistic regression analyses were used to examine the relationship between the obstetrician cognitive traits and type of delivery.
  
  
  RESULTS
  Sixty-one percent of the women were delivered by spontaneous vaginal delivery, 15.5% by operative vaginal delivery, and 23.5% by cesarean delivery. Random-effects multivariable logistic regression adjusting for patient characteristics demonstrated that physicians with the most reflective coping (ie, highest quartile) were significantly less likely (adjusted odds ratio, 0.70; 95% confidence interval, 0.50-0.98) to perform operative vaginal delivery. However, lower anxiety and higher ambiguity tolerance were associated with an increased risk of chorioamnionitis and postpartum hemorrhage, respectively. There were no identified differences in adverse neonatal outcomes by physician cognitive or affective traits.
  
  
  CONCLUSIONS
  There is a decreased risk of operative vaginal delivery for patients delivered by providers with better adaptive decision-making traits. Other cognitive and affective traits were associated with a greater chance of chorioamnionitis and hemorrhage. Further work is required to elucidate whether training in these cognitive and affective traits can alter obstetric outcomes.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL. Electronic address: lynn.yee@northwestern.edu.
authors.forename: Lynn M
authors.initials: LM
authors.lastname: Yee
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: Lilly Y
authors.initials: LY
authors.lastname: Liu
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: William A
authors.initials: WA
authors.lastname: Grobman
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001007:Anxiety; D001291:Attitude of Health Personnel; D002585:Cesarean Section / Q000706:statistics & numerical data; D002821:Chorioamnionitis / Q000453:epidemiology*; D003071:Cognition; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005113:Extraction, Obstetrical / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D009774:Obstetrics; D016017:Odds Ratio; D006473:Postpartum Hemorrhage / Q000453:epidemiology*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D012189:Retrospective Studies
keywords: mode of delivery; obstetrician cognitive traits; physician coping skills