An Assessment of Students’ and Health Professional’ Abilities to Site Stomas Accurately on Human Cadavers

A stoma is a surgically constructed opening created to treat disease or damage in a patient. Common examples include colostomies and ileostomies. Macdonald et al. (2003) previously indicated that stoma nurses were superior to surgeons at identifying stoma sites, potentially reducing post-operative complications and preventing stoma failure. However, that study did not assess these healthcare professionals under the same conditions, potentially skewing the conclusions.We aimed to investigate the accuracy of siting stomas between specialist stoma nurses compared with trainee surgeons, students and non-clinical academics with some anatomical background. All groups would site stomas under the same conditions using human cadavers.Ethical approval was granted by UoA CLSM Ethical Review Board. Students (BSc n=39, MBChB=28), non-clinical academic staff(n=14), stoma nurses (n=3) and surgeons (n=8) were recruited. Each participant assessed stoma locations on ten anonymised cadavers.A3 Acetate sheets with 1cm2 grids indicating XY coordinates covered each cadaver’s abdomen. Participants marked the locations of their proposed ileostomy and a colostomy on these acetates. Mean coordinates obtained from different participant groups were compared against a ‘gold standard’ established by a group of experienced senior colorectal surgeons/nurses. Statistical analysis using Student’s unpaired t-test between sets of coordinates was undertaken to assess whether there were any differences between the ‘ideal stoma location’ and the mean X and Y coordinates identified by participants. Participants were also asked how they identified their sites and their confidence when doing so.There was a significant difference between the x coordinates for siting an ileostomy (<0.001) and colostomy (<0.05), but there was no significant difference for the y coordinates when comparing stoma nurses and surgeons. Stoma nurses were nearest the pre-determined ‘gold standard’ locations. Confusion regarding the height of stoma location on the abdomen dominated when non-clinical academics were assessed, but with physiology staff demonstrating superior accuracy to anatomy faculty. There was no significant difference between the X and Y coordinates for siting both an ileostomy and a colostomy when comparing science and medical students as cohorts.Participant responses indicated that confidence in siting a stoma was no indication of accuracy. Other comments indicated that those who were most likely to site a stoma accurately had considered how the person would function in real life (i.e. how they would walk, where fat masses would move when upright etc) as well as their anatomy. Those who did less well tended to only observe anatomical landmarks to make their decisions.Surgical training involving stoma nurses where anatomy, physiology and lifestyle are considered may improve stoma siting technique and post-operative outcomes for patients.