A two-year study of microscopic urinalysis competency using the urinalysis-review computer program

Background: The microscopic examination of urine sediment is one of the mos t commonly performed microscope-based laboratory tests, but despite its wid espread use, there has been no detailed study of the competency of medical technologists in performing this test. One reason for this is the lack of a n effective competency assessment tool that can be applied uniformly across an institution. Methods: This study describes the development and implementation of a compu ter program, Urinalysis-Review(TM), which periodically tests competency in microscopic urinalysis and then summarizes individual and group test result s. In this study, eight Urinalysis-Review exams were administered over 2 ye ars to medical technologists (mean, 58 technologists per exam; range, 44-77 ) at our academic medical center. The eight exams contained 80 test questio ns, consisting of 72 structure identification questions and 8 quantificatio n questions. The 72 structure questions required the identification of 134 urine sediment structures consisting of 63 examples of cells, 25 of casts, 18 of normal crystals, 8 of abnormal crystals, and 20 of organisms or artif acts. Results: Overall, the medical technologists correctly identified 84% of cel ls, 72% of casts, 79% of normal crystals, 65% of abnormal crystals, and 81% of organisms and artifacts, and correctly answered 89% of the quantificati on questions. The results are probably a slight underestimate of competency because the images were analyzed without the knowledge of urine chemistry results. Conclusions: The study shows the feasibility of using a computer program fo r competency assessment in the clinical laboratory. In addition, the study establishes baseline measurements of competency that other laboratories can use for comparison, and which we will use in future studies that measure t he effect of continuing education efforts in microscopic urinalysis. (C) 19 99 American Association for Clinical Chemistry.