A single center, pilot study to compare the efficacy of an instructional male genital exam video to No prior education in the quality of telemedicine consultations in pediatric urology.

Abstract

Background: Telemedicine (TM) has already been implemented into healthcare. TM visits are associated with shorter wait times, decreased missed work/school and less financial strain on families. Although high satisfaction has been reported with TM, studies suggest limitations with the physical exam (PE).

Objective: If sending an instructional video to parents before their TM appointment teaching them how to perform a genital exam on a male child leads to greater parental comfortability during the visit and an increase in physician perception of PE adequacy in diagnosis.

Secondary outcomes: parental PE knowledge, image quality, and physician perspective of caregiver comfortability/preparedness.

Study design: This blinded randomized study had two groups each with 9 individual parents with a total of 3 pediatric urology physicians covering all 18 patients each for a 1:1 distribution: Video group: Received a pre-recorded video before appointment teaching parents how to perform PE on a male child. No-Video Group: Did not receive a video and physician instructed parents how to perform PE in real-time during visit. After each TM visit, a satisfaction questionnaire with five possible answers on the Likert scale with 1 being strongly disagree and 5 being strongly agree was administered to parents and the treating physician.

Results: Parents who received the educational video prior to their TM visit felt more comfortable performing the PE (p < 0.005) and were able to capture on camera what the physician wanted to see better than the no video group (p < 0.05). Parents who received the educational video felt it was helpful in explaining the PE demonstrating clinical significance, but this was not statistically significant (p = 0.061). Physicians believed the parents who received the education video had a more adequate PE to aid in their diagnosis (p < 00.05), and were more prepared (p < 0.05), and more comfortable during the PE (p < 0.05).

Discussion: This single institution study is limited by the small sample of exclusively male pediatric patients, unvalidated subjective survey use, and confounding factors such as internet speed. This study to our knowledge is the first to report upon a method to improve the PE portion of a pediatric urology TM visit.

Conclusion: Primary study aims of increasing parental comfortability and physician diagnostic use of PE were met with statistical significance. Secondary aims of parental knowledge about the PE were clinically increased but not statistically. Physicians believed the parents who received the education video were more prepared and comfortable and had better image quality.