Frequency and Variability of Advice Given to Parents on the Care of the Uncircumcised Penis by Pediatric Residents: A Need to Improve Education
Neha Malhotra, MD1, Ilina Rosoklija, MPH2, Rachel Shannon, BA2, Dennis B. Liu, MD, FAAP, FACS2.
1University of Illinois at Chicago College of Medicine, Chicago, IL, USA, 2Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
The American Academy of Pediatrics (AAP) Task Force on Circumcision recommends that regardless of circumcision status “parents of newborn boys should be instructed in the care of the penis”. However, there is no current standard as to what this instruction should be. We sought to understand the preparedness of pediatric residents and the advice they are providing families in regard to care of the uncircumcised penis, an increasingly important issue in early childhood.
An IRB-approved, anonymous survey was sent to the pediatric residents in 5 urban-based training programs in both electronic and paper form. Descriptive statistics were used to analyze clinical and demographic data. Fisher’s exact test was used for comparative analysis.
Surveys were completed by 83/244 residents (34%). The majority of the respondents were female (75%). Of those reporting their PGY (71/83), 30% were PGY 1, 34% PGY 2, 34% PGY 3, and 2% greater than PGY 3. Those surveyed estimated that 34% of their patients were uncircumcised. Only 45% of those surveyed were likely to offer advice on care of the uncircumcised penis, while 55% were neutral, unlikely or extremely unlikely to offer advice. While 49% of residents reported never formally learning appropriate care of the uncircumcised penis, those who had formal training were more likely to provide advice to parents than those who had not (67% vs 23%, p < 0.001, Fisher’s exact test). 38% of respondents advised parents to begin retracting the foreskin based on age, 28% based on toilet training status, and 57% did not offer advice to parents on when to begin retraction. In pre-toilet trained boys, 22% advised parents not to retract the foreskin, 6% with each diaper change, 31% with baths and 40% offered no advice. In toilet-trained boys, 9% recommended never retracting the foreskin, 11% with each void, 41% with baths, and 40% still offered no advice. On a scale of 0-100, the median level of confidence of residents to offer advice to parents was 48 (IQR 30-52).
As circumcision rates have decreased in the United States, it is vital that pediatricians are well-prepared to advise parents on the care of the uncircumcised penis. This study demonstrates that pediatric residents currently receive inadequate training in care of the uncircumcised penis and thus, are unlikely to offer advice to parents. When offered, the advice given is highly variable and the resident’s confidence in their advice to parents is low. This study emphasizes the need for increased education of pediatric residents and further investigation to establish evidence-based best practices for the care of the uncircumcised penis.
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