Baugh Aaron D, Bhakta Nirav R, Adamson Rosemary
Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Francisco, San Francisco, California.
Pulmonary, Critical Care and Sleep Medicine Section, Puget Sound Veterans Affairs Healthcare System, Seattle, Washington; and.
ATS Sch. 2025 Jun;6(2):232-251. doi: 10.34197/ats-scholar.2024-0042HT.
Race has been used in medical algorithms, including reference equations for spirometry, following the assumption that race is a biological concept due to the finding that Black American and Asian populations have lower lung function (i.e., forced expiratory volume in 1 second and forced vital capacity) than White populations. Recognizing that race is a social construct and its use in medical algorithms may contribute to health disparities, this practice has been questioned. This inquiry, combined with recent evidence, led the American Thoracic Society to recommend using race-neutral reference equations for spirometry in 2023. In this article, we share our approach to teaching spirometry interpretation, focusing on the factors that determine lung function and the effects of using race-based or race-neutral reference equations. We explicitly define race as a social construct and review the likely reasons for the differences in lung function found between racial groups. We use an interactive and case-based approach to facilitate learning. As part of our interactive approach, we incorporate strategies to enhance psychological safety for the learners. This is particularly important for this topic because discussions of race and health inequities can be contentious and uncomfortable and have the potential to exacerbate the difficulties faced by learners from groups that are underrepresented in medicine. Our approach is intended for a small group of graduate medical learners and could be presented during formal didactic instruction or informally during clinical teaching.
种族已被应用于医学算法中，包括肺功能测定的参考方程，这是基于这样一种假设，即种族是一个生物学概念，因为研究发现美国黑人和亚洲人群的肺功能（即一秒用力呼气量和用力肺活量）低于白人人群。鉴于认识到种族是一种社会建构，且其在医学算法中的使用可能导致健康差距，这种做法受到了质疑。这一质疑，再加上近期的证据，促使美国胸科学会在2023年建议使用不考虑种族的肺功能测定参考方程。在本文中，我们分享我们教授肺功能测定解读的方法，重点关注决定肺功能的因素以及使用基于种族或不考虑种族的参考方程的影响。我们明确将种族定义为一种社会建构，并审视不同种族群体之间肺功能差异的可能原因。我们采用互动式和基于案例的方法来促进学习。作为我们互动方法的一部分，我们纳入了增强学习者心理安全感的策略。对于这个主题而言，这一点尤为重要，因为关于种族和健康不平等的讨论可能具有争议性且令人不适，并且有可能加剧医学领域中代表性不足群体的学习者所面临的困难。我们的方法针对一小群医学研究生学习者，可以在正式的理论教学中呈现，也可以在临床教学中非正式地进行讲解。
