title: Educational survey of regional general practitioner's management of paediatric patients with undescended testis.
abstract: BACKGROUND
  Recent recommendations have lowered the ideal age of surgery for undescended testis (UDT) to 3-6 months of age. However, many publications demonstrate that age at surgery is still above the recommended age of 1 year as originally suggested in 1996.
  
  
  OBJECTIVE
  Through a web-based educational survey, we aimed to combine questions regarding General Practioner's (GPs) management of these patients with educational slides with advice to update them with current recommendations.
  
  
  METHODS
  The regional GPs were invited by email and letter to undertake the web-based questionnaire devised using SurveyMonkey(®). Educational slides were shown after each questionnaire slide. Feedback was immediate and a one-page summary was emailed to the GP on completion. A pre- and post-educational intervention audit was undertaken to ascertain the change in age of referral for patients <5 years of age.
  
  
  RESULTS
  144 (36%) of 401 GPs undertook this survey. 84% were happy assessing infants (<1year) with UDT. 16% were unhappy discussing management with parents for palpable UDT. 52% were happy discussing malignant risk with parents. 80% thought that ultrasonography was routinely used. Optimal referral time was thought to be 6-12 months (42%) and time of surgery was 1-2 years (50%). 72% would refer a patient with palpable UDT after 6 months of age. Only 41% were happy to assess testicular size at puberty. 98% found this format of an educational survey was helpful. The average age of referral for patients <5 years improved significantly after educational intervention from 2.8 years in 2010 to 1.25 years in 2013 (p < 0.01).
  
  
  CONCLUSIONS
  With an interactive survey, we were able assess and also educate the regional GPs with regard to management of paediatric patients with UDT. There is a varied range of knowledge and practice demonstrated which we hoped to standardise and thereby increase efficiency and decrease the age of referral. A large majority would refer patients with UDT after 6 months of age that would make the target of surgery <6 months unachievable unless they are aware of current recommendations. This study is limited by a 36% response rate but that is comparable to other surveys. Also, referrals come from other sources that were not included. The causal effect of the educational survey is hypothesised.
  
  
  CONCLUSIONS
  This educational survey has confirmed the varied management by GPs. The referral age was demonstrated to be reduced after this intervention and this process was widely accepted by GPs that undertook the educational survey.
authors.affiliation: Department of Paediatric Surgery, Norfolk & Norwich University Hospital, Norwich, UK. Electronic address: alexcho@doctors.net.uk.
authors.forename: Alexander
authors.initials: A
authors.lastname: Cho
authors.affiliation: University of East Anglia, Norwich, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Ball
authors.affiliation: University of East Anglia, Norwich, UK.
authors.forename: Katherine
authors.initials: K
authors.lastname: Read
authors.affiliation: University of East Anglia, Norwich, UK.
authors.forename: Pavithira
authors.initials: P
authors.lastname: Tharmapoopathy
authors.affiliation: Department of Paediatric Surgery, Norfolk & Norwich University Hospital, Norwich, UK.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Ross
authors.affiliation: Department of Paediatric Surgery, Norfolk & Norwich University Hospital, Norwich, UK.
authors.forename: Azad
authors.initials: A
authors.lastname: Mathur
authors.affiliation: Department of Paediatric Surgery, Norfolk & Norwich University Hospital, Norwich, UK.
authors.forename: Ashish
authors.initials: A
authors.lastname: Minocha
authors.affiliation: Department of Paediatric Surgery, Norfolk & Norwich University Hospital, Norwich, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Tsang
authors.affiliation: Department of Paediatric Surgery, Norfolk & Norwich University Hospital, Norwich, UK.
authors.forename: Milind
authors.initials: M
authors.lastname: Kulkarni
mesh_terms: D000367:Age Factors; D002675:Child, Preschool; D003194:Computer-Assisted Instruction; D003456:Cryptorchidism / Q000601:surgery*; D058006:General Practice / Q000193:education; D006801:Humans; D007223:Infant; D008297:Male; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D057566:Self Report
keywords: Age; GP; Management; Survey; Undescended testis