Improving Male Genital Examinations in Adolescent Patients: Creation and Preliminary Validation of an Assessment Tool

Providers cite lack of training and knowledge as reasons for omitting male genitourinary (GU) examinations. Also, no standard tools exist for assessment of male GU exams despite instruments for female pelvic exams. The objective of this project was to create and validate a male GU assessment instrument to evaluate trainee skill level.

A first-author created 18-item assessment instrument (addressing preparation, exam, communication) was reviewed by a seven-member expert panel of adolescent medicine providers who reviewed items using a 4-point Likert scale. Adolescent medicine faculty completed the instrument (n = 48) for trainees, and differences in assessments were analyzed utilizing chi-square (SPSS, v. 24.0 p < .05). Exempt status was granted by the Institutional Review Board.

Nineteen trainees (13 female, 6 male) completed the instrument; no significant differences existed in assessments by gender. Trainees who completed the assessment > 2 times inspected the glans/meatus (p = .045), palpated the inguinal canals (p = .02), and informed of exam steps (p = .04) well compared to their first assessment. There were differences between provider assessments washing hands (p = .001); inspecting pubic hair (p = .000), glans (p = .001), and penis shaft (p = .002); palpating inguinal canals (p = .000); explaining exam steps (p = .000); being professional (p = .000); and explaining exam findings (p = .000). Excluding the creator, only professionalism was rated differently among providers (p = .023).

The male genital exam assessment tool was preliminarily validated as highly relevant to the male GU exam, was not affected by learner gender, and showed learner improvement over time. There are differences between faculty, indicating individual perception of exam items and need for increased discussion before implementing the assessment instrument into practice.