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Licensed Unlicensed Requires Authentication Published by De Gruyter November 11, 2020

Training using a simulation-based workshop reduces inaccuracies in estimations of testicular volume

Jessica N. Craig, Megan R. Sharman, Ciara G. Fitzgerald, Dominic Wigg, Beth S. Williams, Ellen E. Wilkinson, Neil P. Wright, Joe Langley and Charlotte J. Elder ORCID logo



Measuring testicular volume (TV) by orchidometer is routine in the clinic when staging male puberty. We have developed a simulation model for TV estimation and investigated whether training medical students, using a workshop with simulation models, could improve the accuracy and reliability of TV estimation.


All participating medical students watched a video representing standard undergraduate training in male pubertal assessment. Volunteers were then randomised directly to assessment or to attend a workshop consisting of a further video and four stations contextualising and practising the skills required for TV estimation, prior to assessment. Three child mannequins displaying testes of 3 mL, 4 mL (twice), 5, 10 and 20 mL were used for assessment. Participants were asked to return a fortnight later for repeat assessment to assess intra-observer reliability, the effect of repeated examinations on accuracy and time on skill retention.


Ninety students participated (55F), 46 attended the workshop and were considered “trained”. There was no difference between the groups in numbers of correct estimations (29% trained, 27% untrained, p=0.593). However, the trained group’s estimations were closer to the true volume, with more from the trained group one bead away (p=0.002) and fewer more than three beads away from the true volume (p<0.001), compared to the untrained group. Trained participants were more accurate at the second assessment (n=80) (p<0.001) and had greater intra-observer reliability (p=0.004).


Overall TV estimation accuracy was poor. Workshop-style training improved accuracy, reliability and retention of skill acquisition and could be considered as a useful learning tool.

Corresponding author: Dr. Charlotte J. Elder, Senior Lecturer in Paediatric Endocrinology Academic Unit of Child Health, Sheffield Children’s NHS Foundation Trust, Sheffield, UK, Phone: +44 (0) 114 2260716, E-mail:
Joe Langley and Charlotte J Elder are joint senior authors.

  1. Research funding: None declared.

  2. Author contributions: CJE and NPW had the original idea for the study. BW and EW designed the workshop and undertook the pilot study. JL and DW designed and produced simulation models. NPW provided educational material for the workshops. JC, MS and CF conducted the study, analysed the data and drafted the initial manuscript. CJE revised the manuscript. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  3. Competing interests: The funding organisation(s) played no role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

  4. Statement of Ethics: Ethical approval was not required for this study. All participants recruited were willing and consented prior to taking part.


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Received: 2020-05-28
Accepted: 2020-09-21
Published Online: 2020-11-11
Published in Print: 2021-01-27

© 2020 Walter de Gruyter GmbH, Berlin/Boston

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