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Ann R Coll Surg Engl. 2000 September; 82(5): 336–338.
PMCID: PMC2503602

The influence of experience and specialisation on the reliability of a common clinical sign.


OBJECTIVES: To explore the influence of experience and specialisation on clinical judgement by comparing accuracy in diagnosing anaemia between a consultant general surgeon, a consultant ophthalmologist and their registrars. PATIENTS AND METHODS: Conjunctival inspection of 101 patients, subsequent correlation with haemoglobin concentration. MAIN OUTCOME MEASURES: Number of correct and incorrect diagnoses of anaemia. RESULTS: 54 patients were anaemic and 47 were not. Overall accuracy in diagnosing anaemia ranged from 0.61-0.69, sensitivity 0.52-0.65 and specificity 0.62-0.83. Agreements between pairs of examiners were 0.68-0.81, with kappa values of 0.36-0.60 when adjusted for chance agreement. CONCLUSIONS: Neither experience nor specialisation significantly influenced our ability to diagnose anaemia, based on conjunctival inspection. Without critical analysis of clinical signs, we are unaware of their diagnostic limitations.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977 Mar;33(1):159–174. [PubMed]
  • Gjørup T, Bugge PM, Hendriksen C, Jensen AM. A critical evaluation of the clinical diagnosis of anemia. Am J Epidemiol. 1986 Oct;124(4):657–665. [PubMed]
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  • Koran LM. The reliability of clinical methods, data and judgments (second of two parts). N Engl J Med. 1975 Oct 2;293(14):695–701. [PubMed]
  • Ghosh S, Mohan M. Screening for anaemia. Lancet. 1978 Apr 15;1(8068):823–823. [PubMed]

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