LETTER
Underestimation of Testicular Size by Medical Students and Housestaff
Brian S. Aprill, MD;
Rodney D. Michaels, MD; and
K.M. Mohamed Shakir, MD
1 December 1996 | Volume 125 Issue 11 | Page 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 [3]. 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 [4]. 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.
To improve education in physical examination skills, the nature and frequency of errors must be determined [1]. We found that most internal medicine housestaff and students could not identify normal adult testicular size. We recommend that attending physicians question a reported normal testicular size at least once during rounds and show normal size either at the bedside or through use of an orchidometer. Increased attention to testicular examination and wider availability of orchidometers would promote awareness of normal testicular size and should result in more frequently correct clinical diagnosis of hypogonadism.
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Author and Article Information
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National Naval Medical Center, Bethesda, MD 20889-5600.
Note: The views expressed in this letter are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. Government.
1. Johnson JE, Carpenter JL. Medical housestaff performance in physical examination. Arch Intern Med. 1986; 146:937-41.
2. Wray NP, Friedland JA. Detection and correction of housestaff error in physical diagnosis. JAMA. 1983; 249:1035-7.
3. Weiner S, Nathonson M. Physical examination—frequently observed errors. JAMA. 1976; 236:852-5.
4. Takihara H, Costentino MJ, Sakatoko J, Cochett AT. Significance of testicular size measurement in andrology. II. Correlation of testicular size with testicular function. J Urol. 1987; 137:416-9.
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