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Residents' Perceptions and Performance

Lee H. Hilborne, MD; Neil S. Wenger, MD; Robert K. Oye, MD

JAMA. 1990;264(3):382-386.

Abstract
Primary care physicians perform simple laboratory tests in clinical practice, frequently with little formal training. To determine the frequency of tests that are performed and evaluate house officer laboratory skills, we surveyed house officer attitudes and tested their ability to perform four common laboratory tests. We received 193 responses from 254 house officers at one university teaching hospital. While most perceived the need to use ward laboratories (ie, self-service laboratories located on patient care wards), 67% used them infrequently. Barriers included poor laboratory condition, inadequate time, accuracy, and infectious exposure concerns. Twenty-four percent felt they did not know or were unsure if they knew how to perform simple tests. Forty-seven house officers completed the practical examination. Most accurately reported a spun hematocrit and correctly identified white blood cell findings on a blood smear. Only 50% counted 100 cells. Urinary dipstick interpretation was generally acceptable but the microscopic examination was less accurate. Twenty-three percent failed to identify gram-negative rods on a slide with both gram-positive cocci and gram-negative rods. If physicians are to perform selected laboratory tests, these data suggest, at least in one institution, more formal training, practice, and evaluation are necessary to ensure their performance with adequate proficiency.

(JAMA. 1990;264:382-386)

Author Affiliations
From the Departments of Pathology and Laboratory Medicine (Dr Hilborne) and Medicine (Drs Wenger and Oye), University of California, Los Angeles School of Medicine.

Footnotes
The opinions and conclusions are those of the authors and do not necessarily represent those of the Robert Wood Johnson Foundation.

Reprint requests to Department of Pathology and Laboratory Medicine, University of California, Los Angeles School of Medicine, 10833 Le Conte Ave, Los Angeles, CA 90024-1732 (Dr Hilborne).

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