EP800 - Closing the Gap in Ostomy Care: A Structured Curriculum Improves General Surgery Resident Competence in Preoperative Stoma Site Marking

Purpose/Background: Proper preoperative stoma site marking is a critical predictor of long-term ostomy success and patient quality of life. Poorly positioned stomas lead to higher rates of skin breakdown, appliance leakage, hernia formation, and psychosocial distress. At our hospital, many ostomy procedures do not receive preoperative site marking, and general surgery residents lack formal training in this essential skill. This quality improvement project aims to address this educational gap by implementing a structured teaching session to improve surgical resident knowledge and confidence in preoperative stoma site marking, with the goal of establishing a sustainable educational module within the residency program.

Methods/Interventions: General surgery residents participated in a structured teaching session led by a board-certified general surgeon and a certified Wound, Ostomy, and Continence Nurse (WOCN). The session included a didactic component, informative pamphlets, and hands-on practice with manikins in the GME simulation lab. Resident knowledge and confidence were assessed using a 10-question pre- and post-quiz. The quiz utilized a Likert scale to measure resident comfort with principles of site selection, patient factors, and collaboration with a WOCN. The primary outcome was a measurable improvement in resident knowledge and confidence.

Results/Outcomes: Twelve general surgery residents completed the teaching session and the associated assessments. A Wilcoxon signed-rank test showed the QI project did elicit a statistically significant change in the post-test evaluation (Z = -3.062, p = .002). All twelve GME participants had higher scores after the QI project. The median pre-test score was 27.00 and the median post-test score was 48.00. Furthermore, low scores were effectively eliminated: while the pre-test contained scores as low as 1, the minimum score on the post-test was 4 across all questions and participants, demonstrating that every resident achieved at least a "Confident" rating.

Conclusion/Discussion: The lack of formal resident training in preoperative stoma site marking is a barrier to achieving optimal ostomy outcomes. This quality improvement initiative successfully demonstrated that a brief, structured teaching session led by a multidisciplinary team (surgeon and WOCN) can significantly increase surgical resident confidence and knowledge in preoperative stoma site marking. The substantial and consistent rise in scores, with all residents achieving at least a "Confident" rating post-intervention, validates the immediate efficacy of this educational model. Incorporating this validated, simulation-based curriculum into the standard general surgery residency training program may prove valuable in improving patient quality of life, reducing ostomy related complications, and standardizing care practices in line with established guidelines.