Brian S. Aprill, MD; Rodney D. Michaels, MD; K.M. Mohamed Shakir, MD
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Aprill BS, Michaels RD, Shakir KM. Underestimation of Testicular Size by Medical Students and Housestaff. Ann Intern Med. 1996;125:942. doi: 10.7326/0003-4819-125-11-199612010-00027
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Published: Ann Intern Med. 1996;125(11):942.
TO THE EDITOR:
Recent reports [1, 2] have addressed deficiencies in medical education, especially education for physical examination. Improper examination techniques, omissions, detection failures, and errors in interpreting physical findings can often affect diagnosis . This is particularly true for testicular examination, where identifying small size can lead to the clinical diagnosis of hypogonadism and its important treatable causes (such as pituitary disease) and sequelae (including osteoporosis, anemia, and infertility).
We questioned 81 third- and fourth-year medical students and internal medicine housestaff at four major teaching hospitals in the Washington, D.C., area about testicular examination. By examining a Prader orchidometer (which consists of 12 ellipsoids that vary in volume from 1 to 25 cm3), the students and housestaff were asked to identify the ellipsoid that best represented normal adult testicular size. Normal testicular size was defined as larger than 15 cm3 on the basis of data that correlated testicular size, as measured by orchidometer, with testicular function . Estimates of normal testicular size had a wide range. Residents in internal medicine were less accurate (4 of 24 [17%] made correct estimates) than were interns (9 of 24 [37%]) or medical students (9 of 33 [27%]). Eight of 81 (10%) participants regarded prepubertal testes as normal for an adult, but only 27% (22 of 81) identified testes larger than 15 cm3 as normal.
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