Teaching Testicular Self-Examination: Education and Practices in Pediatric Residents Joel S. Brenner, MD, MPH*; Albert C. Hergenroeder, MD‡; Claudia A. Kozinetz, PhD, MPH§; and Steven H. Kelder, PhD, MPH ABSTRACT. Objective. 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 encour- aged 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 deter- mine the prevalence of pediatric residents who teach TSE to their adolescent patients, and significant factors re- lated to teaching TSE. Methods. A cross-sectional study was conducted of all pediatric residents at 2 pediatric residency programs during the 2000 to 2001 academic year. A self-adminis- tered, 37-item Internet-based questionnaire was devel- oped, pilot-tested, and then used. Statistical analyses in- cluded frequency distributions, univariate analysis, correlation coefficient, and logistic regression. Results. A total of 129 (61%) of the eligible pediatric residents participated. Fourteen (29%) of the male resi- dents 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 pediat- ric residents (21%; odds ratio [OR]: 3.99; 95% confidence interval [CI]: 1.5–10.5). There was no difference in teach- ing TSE between the male residents who report perform- ing 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 asso- ciation between knowledge of TSE and testicular cancer with teaching TSE or practicing TSE. In a logistic regres- sion 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. Conclusion. Fewer than half of the pediatric residents teach TSE to their adolescent patients. Confidence in performing a testicular examination, confidence in teach- ing 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. Addi- tional studies are recommended to determine the gener- alizability of these results. Pediatrics 2003;111:e239 –e244. URL: http://www.pediatrics.org/cgi/content/full/111/3/ e239; cancer, testicular, education, self-examination, Inter- net survey, residency training. ABBREVIATIONS. TSE, testicular self-examination; HBM, health belief model; BSE, breast self-examination; SD, standard deviation; OR, odds ratio; CI, confidence interval. T esticular self-examination (TSE) instruction is not emphasized in residency training. 1 No studies have addressed the medical education and practices of residents regarding testicular cancer and TSE. Increased physician training regarding TSE has been recommended. 2 Barriers to providing TSE training to patients may include a lack of physician/ nurse time and a lack of knowledge, skill, or comfort level in teaching TSE to patients. If barriers can be identified, then an educational intervention can be developed to attempt to overcome the barriers. Testicular cancer accounts for 20% of cancer diag- noses in male individuals 15 to 35 years of age, making it the most common cancer in male individ- uals within this age group. 3,4 The incidence of testic- ular cancer has risen 42% in the past 25 years and is 5 times higher in whites compared with blacks. 4 The incidence rate for male individuals 15 to 34 years of age is 8.8 cases per 100 000. The risk of developing testicular cancer varies geographically. The highest risk is in the United States, United Kingdom, and Northern Europe and the lowest in Africa, Asia, and Puerto Rico. 5 Secondary to improved treatment, the mortality rate for male individuals who are younger than 65 years has decreased 70% in the past 25 years with an estimated annual decrease of 5%. 4 Mortality for From the *General Pediatrics and Adolescent Medicine Division, Depart- ment of Pediatrics, and Sports Medicine Section, Department of Orthope- dics, Medical College of Georgia, Augusta, Georgia; ‡Adolescent and Sports Medicine Section, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; §Academic General Pediatrics Section, Department of Pe- diatrics, Baylor College of Medicine, Houston, Texas; and University of Texas Health Science Center at Houston School of Public Health, Houston, Texas. Presented in part at the annual meeting of the Society for Adolescent Medicine, March 7, 2002, Boston, Massachusetts. Received for publication May 3, 2002; accepted Nov 21, 2002. Reprint requests to (J.S.B.) Medical College of Georgia Sports Medicine Center, 937 15th St, Augusta, GA 30912. E-mail: jbrenner@mail.mcg.edu PEDIATRICS (ISSN 0031 4005). Copyright © 2003 by the American Acad- emy of Pediatrics. http://www.pediatrics.org/cgi/content/full/111/3/e239 PEDIATRICS Vol. 111 No. 3 March 2003 e239