Can internal medicine residents master microscopic urinalysis? Results of an evaluation and teaching intervention.
OBJECTIVE
Although microscopic urinalysis (micro UA) is commonly used in clinical practice, and residents are trained in micro UA, proficiency in this procedure has not been studied.


METHODS
In 1996-97, 38 residents in the University of Nebraska Medical Center's internal medicine (IM) residency program were evaluated on their technical ability to perform micro UA, and on their cognitive skills in recognizing common micro UA findings. After identifying deficits in the residents' cognitive competency, two educational interventions were applied and residents were tested after each intervention.


RESULTS
A total of 24 residents (63%) correctly prepared the specimen for analysis (the technical portion). On the cognitive portion, only one of the 38 residents correctly identified 80% of all micro UA findings in the urinary sediment, although 11 (29%) residents identified UA findings specific to urinary tract infection (UTI). The first educational intervention did little to improve residents' performance. A second more intensive intervention resulted in 10 (45%) residents identifying 80% of all micro UA findings, and 19 (86%) residents correctly identifying UTI findings.


CONCLUSIONS
Many residents were not proficient in performing micro UA, even after intensive educational interventions. Although micro UA is a simple procedure, residents' mastery cannot be assumed. Residency programs should assess competency in this procedure.
Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198-3331, USA. gcarnis@unmc.edu
Gay J
GJ
Canaris
Stephen D
SD
Flach
Thomas G
TG
Tape
Kathyrn M
KM
Stierwalt
David A
DA
Haggstrom
Robert S
RS
Wigton
D000328:Adult; D001431:Bacteriological Techniques; D001437:Bacteriuria / Q000175:diagnosis / Q000382:microbiology; D016009:Chi-Square Distribution; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency / Q000592:standards*; D007958:Leukocyte Count / Q000706:statistics & numerical data; D008297:Male; D009329:Nebraska; D011237:Predictive Value of Tests; D011379:Prognosis; D016482:Urinalysis / Q000592:standards*; D014552:Urinary Tract Infections / Q000175:diagnosis*; D014556:Urine / Q000737:chemistry / Q000382:microbiology*