Undescended testis? How best to teach the physical examination

• Published in: Journal of pediatric urology Vol. 12; no. 6; pp. 406.e1 - 406.e6
• Main Authors: Zundel, S, Blumenstock, G, Herrmann-Werner, A, Trueck, M, Schmidt, A, Wiechers, S
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.12.2016
• Subjects: Cryptorchidism - diagnosis; Education, Medical - methods; Humans; Infant, Newborn; Male; Medical students; Pediatrics; Pediatrics - education; Physical Examination; Teaching; Undescended testicle; Urology; Medical students; Undescended testicle; Physical examination; Teaching
• ISSN: 1477-5131; 1873-4898
• DOI: 10.1016/j.jpurol.2016.07.003

Summary Background Undescended testis in boys is common. To lower the risks of subfertility and testicular carcinoma, international guidelines recommend surgical treatment between the ages of 6 months and 2 years; nevertheless, orchidopexy is frequently performed at later ages. One reason is the belated diagnosis due to a perceived difficulty in the physical examination and correct localization of the testis. Objectives The present study aimed to find an alternate method for teaching the physical examination of the testis in a child, as using pediatric standardized patients or patient volunteers presents an ethical challenge. Study design A curriculum was designed using Kern’s recommendations. An interdisciplinary team developed the teaching sessions, including an educational video and a simulator. Year-3 medical students from the University of Tuebingen, Germany ( n =133) were randomized into three groups: self-study only, video, and video and simulator. The sessions were carried out and quantitative feedback was collected from the teachers and students. The learning achievements of the different groups were assessed with an objective structured clinical examination (OSCE). The differences in mean OSCE results between all three groups were tested using one-way analysis of variance (ANOVA). For multiple pairwise comparisons, a closed testing procedure was performed using unpaired t -tests. The level of statistical significance was set at P <0.05. Results The self-study only group acquired the poorest results in the OSCE, with a mean score of 5.1 out of 10. The video-only-group reached a mean of 6.7, and the video-and-simulator group performed best with a mean score of 8.5. The differences between all three groups were found to be statistically significant, with P =0.007. The attached figure illustrates this data. If analyzed in pairs, this difference was particularly apparent between the groups self-study only vs video and simulator, with P =0.002. Qualitative feedback revealed doubtful effectiveness for educational videos, but positive reactions to training on a simulator. Discussion Detailed and structured development of the teaching session proved essential to define learning goals, teaching methods and assessment. The poor results of the self-study-only group were in accordance with the literature, where textbook learning was found not to increase OSCE results. The effectiveness of video tutorials remains doubtful; studies focusing on this teaching method are divergent and the present students’ feedback supports this data. The effective teaching with the simulator has been proven for other skills (i.e. ultrasound skills). The analyzed cohort for this study was small, and the study should be repeated at different institutions and with later numbers of students to assure generalizability. Conclusions Low-fidelity pediatric simulators with palpable testis are available and are able to improve examining skills in medical students. It is hoped that the present data inspire medical educators in pediatrics to commence teaching the physical examination (PE) of pediatric testis.