THE EFFECTS OF A COMBINED FLIPPED CLASSROOM AND SIMULATION-BASED EDUCATION SESSION OF MALE INFANT GENITOURINARY EXAM ON PEDIATRIC RESIDENT AND ATTENDING COMFORT, CONFIDENCE, PERFORMANCE, AND KNOWLEDGE

Abstract

Introduction and Objective: Pediatricians provide initial assessment and referral of boys with undescended testis (UDT) but receive little training in pediatric genitourinary physical exam (GUPE) and may not be familiar with guidelines for UDT management. We hypothesized that an educational strategy combining asynchronous didactics and simulation-based learning would improve pediatrician confidence, comfort, and skill performing the GUPE and increase knowledge on UDT management. Methods: We developed a novel manikin that permits realistic simulated GUPE for normal scrotal testicle, palpable UDT, nonpalpable UDT, and retractile testicle. Pediatricians (residents and attendings) participated in an educational session consisting of an asynchronous video on UDT guidelines and GUPE technique, followed by an in-person simulation session using the manikin. Participants were scored on GUPE technique and immediate deliberate feedback was performed until mastery was achieved. Participants completed a baseline survey, immediate post-intervention survey, and three-month follow up survey to assess comfort, confidence, and practice changes. Results: 28 residents and 27 attendings completed the baseline survey, of whom 22 and 21 completed the simulation session. At baseline, only 22% were very comfortable in GUPE skill, 11% were very comfortable with identification of UDT, and none were very comfortable 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 with the novel manikin was the most useful component of the education. Participant knowledge on management improved significantly on most measures, with few participants opting for imaging prior to referral after completing the education. Findings persisted on the three-month follow up survey, with 91.7% of respondents reporting modifying their GU physical exam technique due to the education. Conclusions: Standardized education involving an asynchronous 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.