Checkout Procedure, Airway Practices, Video Based Feedback

Video-assisted feedback (VAF) is an educational method used by educators in various areas of medicine. It is possible to gain technical and non-technical skills for practical applications such as cardiopulmonary resuscitation and surgical procedures . VAF is an objective proof of an individual's performance because by giving feedback it provides non debatable, accurate, real-time data. By allowing awareness on certain issues it helps correcting the mistakes . Studies have shown improvement in clinical skills after VAF .

Inaccurate or incomplete control of anesthesia equipment before use is associated with serious postoperative morbidity and mortality risk. For this reason, a number of control methods have been developed before the anesthesia application. This is one of these methods that checklists are created and repeated in intermittent periods.

American society of anesthesiologists (ASA) published a guideline to improve patient safety in 2008 . This guideline is summarized as mentioned below.

ASA Checklist:

1.Verify Auxiliary Oxygen Cylinder and Self-inflating Manual Ventilation Device are Available \& Functioning 2: Verify patient suction is adequate to clear the airway 3: Turn on anesthesia delivery system and confirm that ac power is available 4: Verify availability of required monitors, including alarms. 5: Verify that pressure is adequate on the spare oxygen cylinder mounted on the anesthesia machine 6: Verify that the piped gas pressures are ≥ 50 psig 7: Verify that vaporizers are adequately filled and, if applicable, that the filler ports are tightly closed. 8: Verify that there are no leaks in the gas supply lines between the flowmeters and the common gas outlet 9: Test scavenging system function. 10: Calibrate, or verify calibration of, the oxygen monitor and check the low oxygen alarm.

11: Verify carbon dioxide absorbent is not exhausted 12: Breathing system pressure and leak testing. 13: Verify that gas flows properly through the breathing circuit during both inspiration and exhalation.

14: Document completion of checkout procedures. 15: Confirm ventilator settings and evaluate readiness to deliver anesthesia care. (ANESTHESIA TIME OUT)

Ten anesthesia residents will be included in this study. Preoperative evaluation in terms of general anesthesia will be completed for a patient before anesthesia induction. After receiving informed consent from the patient resident will complete the preparations by checking the above-mentioned list (anesthesia machine, operating room desk, monitorization methods, aspirator systems, operating room gas systems, waste systems and other anesthesia equipment) then induction will be started. All these steps will be recorded with a camera system. Once the anesthetic application is completed and all stages are recorded, the video records will be evaluated in terms of ASA guideline. Before the second phase of the study, the resident will be informed about the guideline by a staff. Then induction of general anesthesia in another patient will be recorded at all stages. Once the anesthesia application is complete, the camera record will be monitored. Differences and developments or possible similar mistakes between the records will be discussed. After evaluating the records -twice for each resident- the applicability and effectiveness of the VAF training course will be investigated in the direction of the results of 20 records, before and after VAF.

The aim of the study is to assess the compliance of anesthesiology and reanimation residents with the ASA guideline in Kocaeli Derince Training and Research Hospital.