162. Male Genitourinary Exam Assessment: A Tool Validation

Abstract

Providers often cite lack of training and knowledge as primary reasons for omitting the male genitourinary (GU) examination during routine visits. Therefore, male patients are typically not engaged in their sexual and reproductive health. Also, no standard tools exist for assessment of male genitourinary exams although multiple instruments for female pelvic examinations are readily available. The objective of our study was to create and validate a male GU examination assessment instrument to evaluate resident knowledge and skill level. An original first-author created 18-item assessment instrument was reviewed by a 7-member expert panel of Adolescent Medicine providers with the instruction to review each item based on relevance to the subject matter using a 4-point Likert scale (1=not relevant; 4 highly relevant). The edited tool was subsequently piloted in a learner-based Adolescent Medicine clinic. Adolescent faculty/senior fellows completed the instrument (n=48) for residents and fellows conducting male genitourinary exams; multiple instruments could be completed for each learner. The instrument addressed preparation (washing hands, using gloves), examination steps (e.g. inspecting pubic hair, inspecting and palpating testes, palpating inguinal canals for hernias with Valsalva maneuver), communication/interpersonal skills (e.g. displaying concern for patient’s comfort, avoiding jargon, and explaining exam findings). Differences in exam conduct were analyzed utilizing chi-square (SPSS, v. 24.0 p<.05). Exempt status was granted by the Institutional Review Board. Nineteen residents and fellows (13 female, 6 male) completed the instrument one or more times with six assessing providers. There were no significant assessment differences between male and female learners. Learners who completed the assessment two or more times inspected the glans/meatus (chi-sq[df] = 6.2[2]; p=.045), palpated the inguinal canals (chi-sq[df] = 7.8[2]; p=.02) and informed the steps of the exam (chi-sq[df] = 6.7[2]; p=.04) well compared to first assessment. There were differences between how providers assessed learners on several items: washing hands(chi-sq[df] =, 23[6]; p=.001), inspecting pubic hair (chi-sq[df] = 66.8[12]; p=.000), glans (chi-sq[df] =31.8[12]; p=.001), penis shaft (chi-sq[df] =30.7[12]; p=.002), palpating inguinal canals (chi-sq[df] =39.3[12]; p=.000), explaining exam steps (chi-sq[df] =52.8[12]; p=.000), being professional (chi-sq[df] =48[12]; p=.000), and explaining exam findings (chi-sq[df] =40[12]; p=.000). The assessment creator rated washing hands (chi-sq[df] =5.6[1]; p=.018), inspecting pubic hair (chi-sq[df] =8.6[2]; p=.013) and glans (chi-sq[df] =9.4[2]; p=.009) as done well higher than other providers; palpating inguinal canal (chi-sq[df] = 8.0[2]; p=.018) and explaining exam findings (chi-sq[df] =12.8[2]; p=.002) were rated done well less often. With the assessment creator excluded, only professionalism was rated differently among providers (chi-sq[df] =13[5]; p=.023); inspecting pubic hair (chi-sq[df] =16.9[10]; p=.07), explaining exam steps (chi-sq[df] =17.3[10]; p=.07) were marginally significant. The male GU exam assessment was validated by an expert panel as highly relevant to the exam itself. Assessment is not affected by learner gender and shows learner improvement over time. Differences between providers underline increased discussion and agreement should be established if using the instrument for global learner instruction. Male genital health is a vital component of adolescent care, and a universal screening tool could be essential to improving provider skill and subsequent clinical outcomes for our adolescent patients.