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A Framework for Antiracist Curriculum Changes in Nephrology Education

      Addressing persistent racial health disparities in cases of kidney disease will first require significant investment in examining how structural racism has influenced our clinical practice and medical education. Improving how we understand and articulate race is critical for achieving this goal. This work begins with ensuring that race's mention within nephrology literature and curricular materials for medical trainees is thoroughly rooted in evidence-based rationale—not to serve as a proxy for polygenic contributions, social determinants of health, or systemic health care barriers. While many institutions are increasingly recognizing the importance of instituting such changes on behalf of the systematically marginalized patient populations who are most affected by these disparities, there is a paucity of guidance on how to critically appraise and revise decades of pathophysiological and epidemiological findings through an antiracist lens. In this article, we propose an inquiry-based framework with case-study examples to help readers recognize improper use of race within nephrology, assess personal and institutional readiness to introduce changes to said content, and generate materials that center evidence-based findings and reject harmful misinterpretations of race.

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      References

        • Crews D.C.
        • Bello A.K.
        • Saadi G.
        World Kidney Day Steering Committee. Burden, Access, and Disparities in Kidney Disease..
        Kidney Int Rep. 2019; 4: 372-379
        • Nicholas Susanne
        • Kalantar-Zadeh Kamyar
        • Norris Keith
        Racial disparities in kidney disease outcomes.
        Semin Nephrol. 2013; 33: 409-415
        • Rostand S.G.
        • Kirk K.A.
        • Rutsky E.A.
        • Pate B.A.
        Racial differences in the Incidence of treatment for end-stage renal disease.
        N Engl J Med. 2010; 306: 1276-1279
        • Washington Harriet
        Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present.
        Harlem Moon, New York2006
        • Wynter Sylvia
        No Humans involved: an Open Letter to My Colleagues.
        in: 1st. Knowledge for the 21st ed Century. 1. Institute N.H.I., Stanford, CT1994: 42-73
        • Deyrup Andrea
        • Graves Joseph
        Racial Biology and Medical Misconceptions.
        N Engl J Med. 2022; 386: 501-503
        • Roberts Dorothy
        What’s Wrong with race-based medicine?.
        Minn J L Sci Technol. 2011; 12: 1-21
        • Tsai Jennifer
        • Cerdena Jessica
        • Goedel William
        • et al.
        Evaluating the Impact and Rationale of Race-Specific Estimations of Kidney Function: Estimations from U.S. NHANES, 2015-2018.
        EClinicalMedicine. 2021; 42
        • Argueza Bianca
        • Saenz Samuel
        • McBride Dannielle
        From Diversity and Inclusion to Antiracism in Medical Training Institutions.
        Acad Med J Assoc Am Med Coll. 2021; 96: 798-801
        • Roberts E, Dorothy
        Abolish race correction.
        Lancet. 2021; 397: 17-18
        • Prochaska J.O.
        • Velicer W.F.
        The transtheoretical model of health behavior change.
        Am J Health Promot AJHP. 1997; 12: 38-48
        • Torralba Karina
        • Jose Donna
        • Byrne John
        Psychological safety, the hidden curriculum, and ambiguity in medicine.
        Clin Rheumatol. 2020; 39: 667-671
        • Bynum William
        • Teunissen Pim
        • Varpio Lara
        In the “Shadow of shame”: a Phenomenological Exploration of the Nature of Shame Experiences in Medical Students.
        Acad Med. 2021; 96: S23-S30
        • Perkins H.W.
        • Berkowitz A.D.
        Perceiving the community norms of alcohol use among students: some research implications for campus alcohol education programming.
        Int J Addict. 1986; 21: 961-976
      1. Amuzie, Adaure U., and Justin L. Jia. “Supporting Students of Color: Balancing the Challenges of Activism and the Minority Tax.” Academic Medicine 96, no. 6 (June 2021): 773. https://doi.org/10.1097/ACM.0000000000004052.

      2. Johnson, Tyrone. “The Minority Tax: An Unseen Plight of Diversity in Medical Education.” in-Training: the agora of the medical student community, December 12, 2017. https://in-training.org/minority-tax-unseen-plight-diversity-medical-education-intern-piece-features-15570.

      3. Rodríguez, José E, Kendall M. Campbell, and Linda H. Pololi. “Addressing Disparities in Academic Medicine: What of the Minority Tax?” BMC Medical Education 15, no. 1 (February 1, 2015): 6. https://doi.org/10.1186/s12909-015-0290-9.

        • Weiner Bryan
        A theory of organizational readiness for change.
        Implement Sci. 2009; 4
        • Blanchard F.A.
        • Crandall C.
        • Brigham J.
        • et al.
        Condemning and condoning racism: A social context approach to interracial settings.
        J Appl Psychol. 1994; 79: 993-997
        • Rusly Fariza
        • Corner James
        • Sun Peter
        Positioning change readiness in knowledge management research.
        J Knowl Manag. 2012; 16: 329-355
        • USMLE
        USMLE review focuses on patient individuality.
        https://www.usmle.org/usmle-review-focuses-patient-individuality
        Date: 2019
        Date accessed: September 29, 2022
        • Delgado Cynthia
        • Baweja Mukta
        • Crews Deidra
        • et al.
        A Unifying Approach for GFR Estimation: Recommendations of the NKF-ASN Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease.
        Am J Kidney Dis. 2021; 79: 268-288
        • Braun Lundy
        • Wentz Anna
        • Baker Reuben
        • et al.
        Racialized algorithms for kidney function: Erasing social experience.
        Soc Sci Med. 2021; 268: 113548
        • Levey A.S.
        • Bosch J.P.
        • Lewis J.B.
        • et al.
        A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group.
        Ann Intern Med. 1999; 130: 461-470
        • Grubbs V.
        Precision in GFR reporting: Let’s Stop playing the race card.
        Clin J Am Soc Nephrol. 2020; 15: 1201-1202
        • Fujimura Joan
        • Rajagopalan Ramya
        Different differences: the use of ‘genetic ancestry’ versus race in biomedical human genetic research.
        Soc Stud Sci. 2011; 41: 5-30
        • Levey A.S.
        • Stevens L.A.
        • Schmid C.H.
        • et al.
        A new equation to estimate glomerular filtration rate.
        Ann Intern Med. 2009; 150: 604-612
        • Ahmed S.
        • et al.
        Examining the potential impact of race Multiplier Utilization in estimated glomerular filtration rate calculation on African-American care outcomes.
        J Gen Intern Med. 2021; 36: 464-471
        • Zelnick Leila
        • Leca Nicolae
        • Young Bessie
        • et al.
        Association of the Estimated Glomerular Filtration Rate With vs Without a Coefficient for Race with Time to Eligibility for kidney transplant.
        JAMA Netw Open. 2021; 4: e2034004
        • Yap Ernie
        • Prysyazhnyuk Yelyzaveta
        • Ouyang Jie
        • et al.
        The Implication of Dropping race from the MDRD Equation to Estimate GFR in an African American-only Cohort.
        Int J Nephrol. 2021; 2021: 1880499
        • Rednor Samuel
        • Ross Michael
        Molecular mechanisms of Injury in HIV-associated nephropathy.
        Front Med. 2018; 5: 177
        • Freedman Barry
        • Limou Sophie
        • Ma Lijun
        • et al.
        APOL1-Associated Nephropathy: A Key Contributor to Racial Disparities in CKD.
        Am J Kidney Dis. 2018; 72: S8-S16
        • Nobakht Ehsan
        • Cohen Scott
        • Rosenberg Avi
        • et al.
        HIV-associated immune complex kidney disease.
        Nat Rev Nephrol. 2016; 12: 291-300
        • Thomson Russell
        • Genovese Giulio
        • Canon Chelsea
        • et al.
        Evolution of the primate trypanolytic factor APOL1.
        Proc Natl Acad Sci. 2014; 111: E2130-E2139
        • Tez Mesut
        • Yildiz Baris
        How Reliable are Medical Textbooks?.
        J Grad Med Educ. 2017; 9: 550
        • Wing Edwart
        • Schiffman Fred
        Glomerular Diseases.
        Cecil Essentials Of Medicine. 10th ed. Elsevier, Philadelphia, PA2021
        • Kumar V.
        • Abbas A.K.
        • Aster J.C.
        • et al.
        The Kidney.
        Robbins & Cotran Pathologic Basis of Disease. 10th ed. Elsevier, Philadelphia, PA2021
        • Partin Alan
        • Dmochowski Roger
        • Kavoussi Louis
        • et al.
        Renal Physiology and Pathophysiology.
        Campbell Walsh Wein Urology. 12th ed. Elsevier, Philadelphia, PA2020
        • Bogart Laura
        • Ransome Yusuf
        • Allen Wanda
        HIV-Related Medical Mistrust, HIV Testing, and HIV Risk in the National Survey on HIV in the Black Community.
        Behav Med. 2019; 45: 134-142
        • Agyemang C.
        • Bhopal R.
        • Bruijnzeels M.
        Negro, Black, Black African, African Caribbean, African American or what? Labelling African origin populations in the health arena in the 21st century.
        J Epidemiol Community Health. 2005; 59: 1014-1018
        • Amutah Christina
        • Greenidge Kaliya
        • Mante Adjoa
        • et al.
        Misrepresenting Race — the Role of Medical Schools in Propagating Physician Bias.
        N Engl J Med. 2021; 384: 872-878
        • Hoffman Kelly
        • Trawalter Sophie
        • Axt Jordan
        • et al.
        Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites.
        Proc Natl Acad Sci. 2016; 113: 4296-4301
        • Hall William
        • Chapman Mimi
        • Lee Kent
        • et al.
        Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: a Systematic Review.
        Am J Public Health. 2015; 105: e60-e76