title: The effects of proficiency and bias on residents' interpretation of the microscopic urinalysis.
abstract: 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.
authors.affiliation: Department of Internal Medicine, University of Nebraska Medical Center College of Medicine, Omaha, USA. stephen-flach@uiowa.edu
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Flach
authors.forename: Gay J
authors.initials: GJ
authors.lastname: Canaris
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Tape
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Huntley
authors.forename: Robert S
authors.initials: RS
authors.lastname: Wigton
mesh_terms: 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*