title: Teaching of the Society for Fetal Urology grading system for pediatric hydronephrosis is improved by e-Learning using Computer Enhanced Visual Learning (CEVL): A multi-institutional trial.
abstract: BACKGROUND
  It is unclear how clinicians learn to grade pediatric hydronephrosis (HN) and how effective their training has been. We sought to: 1. Assess how clinicians learn to grade HN and their confidence in their training and abilities and 2. To assess Computer Enhanced Visual Learning (CEVL) e-Learning to learn the Society for Fetal Urology (SFU) grading system for pediatric HN.
  
  
  METHODS
  A multi-institutional online survey was distributed to pediatric urologists, nephrologists, and radiologists. Respondents used a 6-point Likert scale (0 = not confident to 5 = very confident) to assess their confidence in knowledge of the criteria, indications, and ability to grade HN, and how they learned to grade. Participants assigned SFU grades to 15 neonatal ultrasounds (US). A CEVL module on the SFU grading system was accessed and a post-CEVL survey completed. Changes in confidence and accuracy of grading were compared before and after CEVL e-Learning.
  
  
  RESULTS
  The most common method of learning was "casually during training" (44.5%). Significant increases in confidence in knowledge of criteria, indications, and ability to grade, as well as the accuracy of grading were seen following CEVL e-Learning (Figure A and B).
  
  
  CONCLUSIONS
  Although the SFU grading system is considered the predominant grading system for HN, its application in clinical practice has been inconsistent. While this may be due to the grading system itself, it is possible that deficient training and confidence are the root causes. Our data supports this by demonstrating that most clinicians receive only casual training and accordingly, report low confidence in their knowledge and ability to grade HN. Therefore, we conclude that there exists a strong need to improve the teaching of the SFU grading system. e-Learning has been shown to be effective in teaching difficult topics and skills. We demonstrate that e-Learning with CEVL is effective in increasing both the confidence and accuracy of SFU grading of pediatric HN. Limitations of our study include a small sample size, low response rate, and discrepant participation. Furthermore, we did not assess the extent to which the CEVL module was used or include a control group learning through traditional means. Therefore, we were unable to evaluate the efficiency of learning or be certain that the improvements seen were derived exclusively from CEVL.
  
  
  CONCLUSIONS
  Current training in SFU grading of HN is mostly unstructured and inaccurate grading is common. Learners who use CEVL show improvements in their confidence and ability to SFU grade HN.
authors.affiliation: Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Box 24, Chicago, IL 60611, USA. Electronic address: dbliu@luriechildrens.org.
authors.forename: Dennis B
authors.initials: DB
authors.lastname: Liu
authors.affiliation: Department of Urology, University of Oklahoma Health Science Center, 920 Stanton L. Young Blvd, W.P. 3150, Oklahoma City, OK 73104, USA. Electronic address: blake-palmer@ouhsc.edu.
authors.forename: Blake
authors.initials: B
authors.lastname: Palmer
authors.affiliation: Division of Pediatric Urology, University of Virginia School of Medicine, P.O. Box 800422 Charlottesville, VA 22908, USA. Electronic address: cah7cc@hscmail.mcc.virginia.edu.
authors.forename: C D Anthony
authors.initials: CD
authors.lastname: Herndon
authors.affiliation: Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Box 24, Chicago, IL 60611, USA. Electronic address: max.maizels@gmail.com.
authors.forename: Max
authors.initials: M
authors.lastname: Maizels
mesh_terms: D002648:Child; D003162:Competency-Based Education / Q000379:methods*; D003194:Computer-Assisted Instruction / Q000379:methods*; D004501:Education, Medical / Q000379:methods*; D004521:Educational Measurement; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D006869:Hydronephrosis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D020407:Internet; D007396:Internship and Residency / Q000379:methods*; D008297:Male; D012955:Societies, Medical; D013663:Teaching / Q000379:methods; D016216:Ultrasonography, Prenatal; D014481:United States; D014572:Urology / Q000193:education*
keywords: CEVL; Education; Hydronephrosis; Society for Fetal Urology; Ultrasound; e-Learning