Teaching Internal Medicine Residents to Critically Appraise the Role of Race in Pulmonary Function Testing

Race-specific equations for spirometry reference values are one example of race-specific algorithms traditionally used in medicine. The American Thoracic Society now recommends use of race-neutral reference equations instead of race-specific equations. However, no published curricula on interpretation of spirometry using race-based compared to race-neutral reference equations exist. We developed a curriculum for internal medicine residents to address this gap and equip providers to interpret spirometry in a race-conscious fashion.

An internal medicine resident and an attending in pulmonary medicine developed the curriculum and invited other experts to review and edit the material. The internal medicine resident delivered an hour-long, interactive, slide-based, didactic presentation during a weekly, residency-wide videoconference to 45 participants. The presentation included the following components: (1) history of spirometry and race, (2) race-specific equations, (3) race-neutral equations, and (4) clinical implications. The presentation opened with a clinical case and small-group discussions. We conducted pre- and posttest surveys; the posttest survey was designed using the Kirkpatrick model to assess reaction, learning, and anticipated behavioral change. Mean score differences were evaluated for level 2 questions using Cohen's d effect size.

Thirty-eight respondents completed the pretest survey, and 24 completed the posttest survey. Test scores significantly improved after session participation, with Cohen's d ranging from 0.27 to 1.17.

This curriculum was successful in engaging participants in critically appraising race-based interpretations of pulmonary function testing. The structure of the curriculum could be repurposed to create didactic content on other examples of race-based clinical algorithms.