Simulation-based education of the male infant genitourinary physical exam and management of undescended testis

Abstract

Introduction Undescended Testicle (UDT) is one of the most common congenital anomalies of the genitourinary system. Concern for UDT is one of the most common reasons for referral to Pediatric Urologists. Pediatricians provide initial assessment and referral of boys with UDT but receive little training in pediatric genitourinary physical exam (GUPE) and may not be familiar with guidelines for UDT management. Objective We hypothesized that asynchronous didactics and simulation-based learning would improve pediatrician confidence, comfort, and skill performing the GUPE and increase knowledge on UDT management. Study design We developed a novel manikin that permits simulated GUPE for normal scrotal testicle, palpable UDT, nonpalpable UDT, and retractile testicle. Education sessions consisted of at-home video on UDT guidelines and GUPE technique, followed by in-person simulation sessions. Participants were scored on GUPE technique and feedback was provided until mastery was achieved. In this nonrandomized prospective performance evaluation with longitudinal extension, a baseline survey, immediate post-intervention survey, and three-month follow-up survey were used to assess outcomes. Results 28 residents and 27 attendings completed the baseline survey, of whom 22 and 21 completed the education. At baseline, 22 % were “very comfortable” in GUPE skill, 11 % with UDT identification, and none with UDT guidelines. Participants achieved GUPE mastery in median of two attempts. After training, over 90 % were more confident in all areas. 79 % felt the hands-on simulation training was the most useful education component. Participant knowledge on management improved significantly on most measures. Findings persisted on the three-month survey. Conclusions Standardized education involving an at-home video and in-person simulation using a novel manikin is effective at increasing confidence, comfort, physical exam skill, and UDT knowledge in both the immediate and long term. Simulation with the novel manikin played a key role in the education. The educational strategy could be expanded to other institutions and extend to other provider types. Future studies may include quality improvement initiatives to study how participation can change patient outcomes.