Volume 48 | Number 2pt2 | April 2013

Abstract List

Navid Ghaffarzadegan Ph.D., M.B.A., Andrew J. Epstein, Erika G. Martin Ph.D.


To simulate physician‐driven dynamics of delivery mode decisions (scheduled cesarean delivery [] vs. vaginal delivery [] vs. unplanned after labor), and to evaluate a behavioral theory of how experiential learning leads to emerging toward more and across obstetricians.

Data Sources/Study Setting

Hospital discharge data on deliveries performed by 300 randomly selected obstetricians in Florida who finished obstetrics residency and started practice after 1991.

Study Design

We develop a system dynamics simulation model of obstetricians' delivery mode decision based on the literature of experiential learning. We calibrate the model and investigate the extent to which the model replicates the data.

Principal Findings

Our learning‐based simulation model replicates the empirical data, showing that physicians are more likely to schedule as they practice longer. Variation in rates is related to the way that physicians learn from outcomes of past decisions and accumulate experience.


The repetitive nature of medical decision making, learning from past practice, and accumulating experience can account for increases in decisions and practice variation across physicians. Policies aimed at improving medical decision making should account for providers' feedback‐based learning mechanisms.