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Teaching Society for Fetal Urology (SFU) Grading of Pediatric Hydronephrosis Is Significantly Improved by Utilizing Structured Online Learning: A Prospective Multi-Institutional and Multi-Specialty Trial
Dennis B. Liu, MD1, Blake W. Palmer, MD2, CD Anthony Herndon, MD3, Max Maizels, MD1.
1Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA, 2University of Oklahoma Medical Center, Oklahoma City, OK, USA, 3University of Virginia School of Medicine, Charlottesville, VA, USA.

BACKGROUND: SFU grading of pediatric hydronephrosis has been the mostly widely cited method of grading for more than 2 decades. Traditionally, methods to teach residents to grade are casual through immersion learning or unstructured self-study. Because these casual teaching methods do not utilize a structured plan, learning could be inconsistent. Herein we research if structuring learning as online access to standardized content could improve current teaching to grade pediatric hydronephrosis.
METHODS: The study design was a prospective pre-and post-test comparison. First, the authors built online learning to SFU grading of hydronephrosis. The learning material was standardized according to CEVL (Computer Enhanced Visual Learning) methods: presenting background knowledge as static text and pictures, interactives to create mental concepts of the component parts of an ultrasound image, and a self-test to promote confidence to grade. Second, intake data on fund of knowledge was obtained by surveying members of multiple specialties (i.e., Urology, Nephrology, and Radiology) at six institutions and the Society for Fetal Urology membership. Data points included respondents’ background on what method was used to learn to grade hydronephrosis, and their confidence to grade hydronephrosis (Likert scores). Additionally, their skill to grade was assessed by assigning SFU grading to 15 renal ultrasounds. Respondents then accessed standardized learning material via the online CEVL module. After CEVL learning, exit surveys were completed in which the respondents re-took the same test. The number of correct answers pre and post CEVL training were compared. Respondents were also asked to assess their experience with CEVL learning.
RESULTS: A total of 57 respondents completed the intake survey. There were 24 residents (42%), 12 fellows (21%), 14 attendings (25%), and 7 others (12%). The most common method of learning was identified as casual learning during training
(48%). The group of 24 respondents who provided both the intake and study data showed improved confidence in SFU grading (mean Likert score 3.13 vs. 3.92) (p=0.003, CI 0.29, 1.289) and to identify the correct grade of hydronephrosis (8.4 (55.8%) to 10.1
(67.3%)) (p=0.006, CI 0.55, 2.86). A total of 23 (96%) respondents indicated they would recommend CEVL for learning SFU grading of hydronephrosis, and 19 (79%) indicated CEVL learning was superior to other methods of learning.
CONCLUSIONS: Structuring learning to SFU grading of hydronephrosis using the CEVL method significantly improves both the confidence and accuracy of ultrasound grading of hydronephrosis over traditional learning methods. We believe providing learners the opportunity to choose to study during off-duty hours, privately, or in a group setting enhances the effectiveness of the method.

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