title: The combined influence of knowledge, training and experience when grading contact lens complications.
abstract: OBJECTIVE
  A study was conducted to evaluate the influence of knowledge, training and experience (clinical skills set) when assessing the severity of contact lens complications.
  
  
  METHODS
  Nine optometrists (who were in possession of a relevant clinical skills set) and nine 'non-optometrists' (subjects without the clinical skills set) were each invited to grade - to the nearest 0.1 increment - an image of each of 16 contact lens complications using Efron Grading Scales for Contact Lens Complications. This procedure was repeated 2 weeks later, yielding a total data base comprising 576 individual grading estimates.
  
  
  RESULTS
  The mean of the test and retest grading estimates was the same for the optometrists (2.8 +/- 0.7) and the non-optometrists (2.6 +/- 0.9) (F1,15,1 = 1.3, p = 0.26); that is, non-optometrists can grade accurately. Median grading reliability for optometrists (+/-0.41) was lower than (i.e. superior to) that for non-optometrists (+/-0.67) (p = 0.001). Non-optometrists tended to display a reluctance to grade by interpolation and to less reliably grade subtle clinical signs.
  
  
  CONCLUSIONS
  When averaged over several attempts, non-optometrists will arrive at similar estimates of severity to optometrists when grading ocular complications of contact lens wear; however, they will do so less reliably. The relative contribution of the three attributes of the clinical skills set to grading performance is presently unclear.
authors.affiliation: Department of Optometry and Neuroscience, UMIST, Manchester, UK. n.efron@umist.ac.uk
authors.forename: Nathan
authors.initials: N
authors.lastname: Efron
authors.forename: Philip B
authors.initials: PB
authors.lastname: Morgan
authors.forename: Ritu
authors.initials: R
authors.lastname: Jagpal
mesh_terms: D002983:Clinical Competence; D003261:Contact Lenses / Q000009:adverse effects*; D003951:Diagnostic Errors; D005128:Eye Diseases / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D009907:Optometry / Q000193:education; D012680:Sensitivity and Specificity