The effects of proficiency and bias on residents' interpretation of the microscopic urinalysis

Stephen D. Flach, Gay J. Canaris, Thomas Gerald Tape, Kathryn M. Huntley, Robert Swift Wigton

Research output: Contribution to journalArticle

6 Scopus citations


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. Design. 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. Conclusion. 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.

Original languageEnglish (US)
Pages (from-to)318-325
Number of pages8
JournalMedical Decision Making
Issue number4
StatePublished - Jan 1 2002



  • Accuracy
  • Clinical information bias
  • Microscopic urinalysis
  • Probability estimates
  • Residents
  • Urinary tract infection

ASJC Scopus subject areas

  • Health Policy

Cite this