The ability to read music fluently is fundamental for undergraduate music study yet the training of sight-reading is often neglected. This study compares approaches to sight-reading and accompanying by students with extensive sight-reading experience to those with limited experience, and evaluates the importance of this skill to advanced pianists and the type of strategies they use when sight-reading. Analysis of 74 survey-interviews highlights the importance of sight-reading, and indicates underdeveloped sight-reading skills and a substantial lack of experience in sight-reading and accompanying in advanced pianists. Significant differences in accompanying practice emerged between the groups with no/little and extensive sight-reading experience. The analysis of a number and the type of strategies used during sight-reading suggests individual approaches and distinct paths in the development of the skill. The findings emphasise the need for a new approach in the development of sight-reading curricula for higher education.