The effects of proficiency and bias on residents' interpretation of the microscopic urinalysis.
OBJECTIVE
This study aims to determine whether residents are influenced by clinical information when interpreting microscopic urinalysis (UA) and estimating the probability of a urinary tract infection (UTI), and to determine the accuracy and reliability of UA readings.


METHODS
Residents estimated the UA white blood cell count and the probability of a UTI in vignettes using a fractional factorial design, varying symptoms, gender, and the white blood cell count on preprepared urine slides.


RESULTS
Individual-level results indicated a clinical information bias and poor accuracy. Seventeen of 38 residents increased the white blood cell count in response to female gender; 14 increased the white blood cell count in response to UTI symptoms. Forty-nine percent of the readings were inaccurate; agreement ranged from 50% to 67% for white and red blood cells and bacteria.


CONCLUSIONS
Many residents gave inaccurate UA readings, and many readings varied with clinical information. A significant portion of residents needs assistance in objectively and accurately interpreting the UA.
Flach
Stephen D
SD
Department of Internal Medicine, University of Nebraska Medical Center College of Medicine, Omaha, USA. stephen-flach@uiowa.edu
Canaris
Gay J
GJ
Tape
Thomas G
TG
Huntley
Kathryn M
KM
Wigton
Robert S
RS
D001431:Bacteriological Techniques / Q000191:economics; D001437:Bacteriuria / Q000175:diagnosis / Q000382:microbiology; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D007958:Leukocyte Count / Q000706:statistics & numerical data*; D008297:Male; D009329:Nebraska; D011237:Predictive Value of Tests; D011379:Prognosis; D012737:Sex Factors; D016482:Urinalysis / Q000592:standards*; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000209:etiology; D014556:Urine / Q000737:chemistry / Q000382:microbiology*