title: [Validation of a questionnaire to evaluate the experience and self-confidence on emergency assistance in vaginal delivery.]
abstract: OBJECTIVE
  To validate a questionnaire to be applied in order to learn and describe the perceptions of specialists in obstetrics and gynecology about their experience and self-confidence in the emergency care for vaginal delivery.
  
  
  METHODS
  This was a prospective study for the validation of an instrument that contains statements about emergency obstetrical care: breech delivery (n=23), shoulder dystocia (n=20), postpartum haemorrhage (n=24), forceps delivery (n=32), and vacuum extractor (n=5). Participants gave their opinions on each item by applying the Likert scale (0=strongly disagree, 1=partially disagree, 2=indifferent, 3=partially agree and 4=strongly agree). The questionnaire was applied to 12 specialists in obstetrics and gynecology and it was expected to be found a level of comprehension exceeding 80%. A five-point scale was used to assess the understanding of each question (from 0=did not understand anything to 5=understood perfectly and I have no doubt). A score above 4 was considered to indicate sufficient understanding. The instrument used was specially designed to suit the specific demands. The analysis of internal reliability was done using the Cronbach alpha coefficient. For external validation, we calculated the proportion of items with full understanding for each subscale. For research purposes, the alpha should be greater than 0.7.
  
  
  RESULTS
  Participants had a mean age of 33.3 years, with 5.0 standard deviation (SD), and an average interval time since graduation from medical school of 5.8 years (SD=1.3 years). All were specialists with residency in obstetrics and gynecology. The mean proportion of participants who fully understood the items in each emergency was 97.3% for breech delivery, 96.7% for shoulder dystocia, 99.7% for postpartum hemorrhage, 97.4% for forceps delivery, and 98.3% for the use of a vacuum extractor. The results of Cronbach's alpha for the items in each emergency studied were: 0.85 for breech delivery, with 0.72 lower limit of 95% confidence interval ((%%CI), 0.74 for shoulder dystocia (lower limit of 95%CI=0.51), 0.79 for postpartum hemorrhage (lower limit of 95%CI=0.61), 0.96 for forceps delivery (lower limit of 95%CI=0.92), and 0.90 for the vacuum extractor (lower limit of 95%CI=0.79).
  
  
  CONCLUSIONS
  The validated questionnaire is useful for learning and describing the perception of physicians about their experience and self-confidence in emergency care for vaginal births.
authors.affiliation: Departamento de Obstetrícia, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil.
authors.forename: Roseli Mieko Yamamoto
authors.initials: RM
authors.lastname: Nomura
authors.affiliation: Curso de Graduação em Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil.
authors.forename: Victoria Arruga Novoa Y
authors.initials: VA
authors.lastname: Novoa
authors.affiliation: Curso de Graduação em Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil.
authors.forename: Bruna Sanches Ozane
authors.initials: BS
authors.lastname: Pimenta
authors.affiliation: Departamento de Obstetrícia, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil.
authors.forename: Mary Uchiyama
authors.initials: MU
authors.lastname: Nakamura
authors.affiliation: Departamento de Obstetrícia, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil.
authors.forename: Antono Fernandes
authors.initials: AF
authors.lastname: Moron