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

Abstract

Introduction: 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.

Methods: 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.

Results: 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.

Discussion: 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.