Teaching testicular self-examination: education and practices in pediatric residents

Although testicular cancer is the most common cancer among 15- to 35-year-old male individuals, physicians seldom conduct testicular self-examination (TSE) education, thus potentially missing opportunities for early detection. Pediatric residents should be learning TSE skills training and be encouraged to incorporate them into routine practice. There are no published studies addressing the medical education and practices of pediatric residents regarding testicular cancer and TSE. The purpose of this study was to determine the prevalence of pediatric residents who teach TSE to their adolescent patients, and significant factors related to teaching TSE.

A cross-sectional study was conducted of all pediatric residents at 2 pediatric residency programs during the 2000 to 2001 academic year. A self-administered, 37-item Internet-based questionnaire was developed, pilot-tested, and then used. Statistical analyses included frequency distributions, univariate analysis, correlation coefficient, and logistic regression.

A total of 129 (61%) of the eligible pediatric residents participated. Fourteen (29%) of the male residents reported performing TSE on themselves at least once a month, and 30 (61%) reported performing TSE at least every 3 months. The most frequent reason cited for not performing TSE monthly was "know how, but forget to do it" (97%). Forty (40%) of all residents reported teaching TSE to their 12- to 21-year-old male patients during a routine annual physical examination. The 2 most common reasons for not teaching TSE were "never thought about including it" (36%) and "lack of time" (29%). The senior-level residents reported teaching TSE to their male patients during a routine annual physical examination more often (51%) than the first-year pediatric residents (21%; odds ratio [OR]: 3.99; 95% confidence interval [CI]: 1.5-10.5). There was no difference in teaching TSE between the male residents who report performing TSE (43%) and those who do not perform TSE (37%; OR: 1.27; 95% CI: 0.36-4.5) and between male and female residents (OR: 0.9; 95% CI: 0.44-1.9). There was no association between knowledge of TSE and testicular cancer with teaching TSE or practicing TSE. In a logistic regression model, confidence in testicular examination (OR: 3.1; 95% CI: 1.2-7.9), confidence teaching TSE (OR: 3.6; 95% CI: 1.2-10.9), and knowing someone with testicular cancer (OR: 2.4; 95% CI: 1.0-5.8) were associated with residents' teaching TSE to their patients.

Fewer than half of the pediatric residents teach TSE to their adolescent patients. Confidence in performing a testicular examination, confidence in teaching TSE, and knowing someone with testicular cancer were the most important factors related to teaching TSE. This information could be used to design an educational intervention to increase physician promotion of TSE and ultimately increase young males' TSE practices. Additional studies are recommended to determine the generalizability of these results.