For educators, training program directors, program coordinators, fellows, and anyone else.
In the United States, kidney failure rates are 3.5 times greater in Black and African Americans, 2.7 times greater in Native Hawaiians and Pacific Islanders, 1.5 times greater in Latinx people, and 1.4 times greater in Native Americans when compared to White Americans (1). These individuals are also less likely than White Americans to receive kidney care before kidney failure, to receive a kidney transplant, and to be treated with home dialysis (1). Black and African Americans in particular are less likely to be placed on the kidney transplant waiting list and have disproportionately high rates of transplant failure, compared to White Americans (1). The populations most at risk for and overburdened with kidney diseases also face inequitable social conditions—they "are less likely to have health insurance, have less access to health care, and experience lower-quality care when they do have access." (1)
In order to address these comprehensive social determinants of health, systemic racism in medical education and health care must be identified and eliminated. The American Society of Nephrology made a commitment in June 2020 to work towards dismantling systemic racism (2, 3). The society invites all kidney health professionals to join in efforts to reduce the adverse impact of racism in medicine.
Using This Toolkit
These resources are intended to guide nephrology training programs and other individuals in addressing topics such as better understanding systemic racism, recognizing unconscious bias, eliminating disparities in health care, approaching patient encounters with cultural humility, improving recruitment practices, and more. If you have any suggestions for improvements to this webpage, please email email@example.com.
1. Gadegbeku, Crystal A., Tod Ibrahim, Anupam Agarwal, and Susan
E. Quaggin. " Identifying, Confronting, and Addressing Systemic Racism in
US Nephrology", Kidney News 13, 6 (2021): 12-13, accessed Dec 14, 2021, https://www.kidneynews.org/view/journals/kidney-news/13/6/article-p12_5.xml.
2. "ASN Statement Against Racism." ASN Society News. The American Society of Nephrology, 2020. https://www.asn-online.org/news/item.aspx?ID=173.
3. "Dismantling Systemic Racism in Nephrology". In Dismantling Systemic Racism in Nephrology, (20 Apr. 2021) accessed Dec 14, 2021, https://www.kidneynews.org/view/post/clinical-15/dismantling-systemic-racism-in-nephrology.xml.
Cultural Competency Role-Playing Scenarios and Facilitator Guide
Facilitators are strongly encouraged to consume some of the resources below to help prepare for this activity.
Click on this link to access a PDF of the guide.
Click on this link to access a PowerPoint version of the guide (abridged).
Relevant ASN Initiatives
- ASN Loan Mitigation Pilot Program
- The NKF-ASN Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease
- Network of Minority Health Researcher Investigators (NMRI) Travel Support
- ASN-Harold Amos Medical Faculty Development Program Award
- Video Recording of the ASN Training Program Town Hall: Addressing Racism in Kidney Care and Training
- Slides from a relevant presentation held at the ASN Training Program Town Hall: Expanding and Diversifying the Workforce
- Going Beyond the Statement: Dismantling Systemic Racism in Nephrology (YouTube)
- Racism Defined
- Discussion of Racist Laws, Policies, and Legislation
- Social Exclusion: The Decisions and Dynamics That Drive Racism
- The UNESCO Courier Against Racism
- Fallacies of Racism Exposed: UNESCO Publishes Declaration by World's Scientists
- Levels of Racism: A Theoretic Framework and a Gardener's Tale (American Journal of Public Health)
- Confronting Institutionalized Racism
- Rethinking Racism: Toward a Structural Interpretation (American Sociological Review)
- 5 Keys to Challenging Implicit Bias
- Reckoning with Histories of Medical Racism and Violence in the USA (The Lancet)
- Race, Medicine, and Health Care in the United States: A Historical Survey (Journal of the National Medical Association)
- Combating Racism and Place-ism in Medicine (YouTube)
- Responses to 10 Common Criticisms of Anti-racism Action in STEMM
- Health Inequities and the Inappropriate Use of Race in Nephrology (Nature Reviews Nephrology)
- Dismantling Structural Racism as a Root Cause of Racial Disparities in COVID-19 and Transplantation (American Journal of Transplantation)
- Structural Racism and Health Inequities in the USA: Evidence and Interventions (The Lancet)
- When Does a Difference Become a Disparity? Conceptualizing Racial and Ethnic Disparities in Health (Health Affairs)
- Social Determinants of Racial Disparities in CKD (Journal of the American Society of Nephrology)
- Using Quality Improvement to Eliminate Health Disparities
- CKD in Native Hawaiians and Pacific Islanders (CJASN)
- ACGME Equity Matters
- New competencies on diversity, equity, and inclusion for medical education across the continuum
- Health Disparities Collaborative, Alliance for Academic Internal Medicine, Subgroup 2: Implicit Bias
There are many useful resources in this toolkit, but there is an especially good section on implicit bias which includes a downloadable PowerPoint presentation titled, "An Introduction to Implicit Bias" and a toolkit to address methods of combating bias in medicine titled, "Addressing Bias Through Mitigation". This includes the PAUSE framework, ERASE framework, PRISM® Toolkit, and WELL Toolkit. This linked toolkit will provide access to materials to address recruitment and increasing diversity (Subgroup 5: Recruitment). AAIM often hosts relevant webinars, which can be accessed through this same webpage.
- Anti-Racism and Race Literacy: A Primer and Toolkit for Medical Educators
A comprehensive source providing background on why this discussion on anti-racism is important, the vocabulary to understand the discussion, and a toolkit to develop anti-racism education at your institution. This provides a detailed "suggested reading" section directing readers to sources (podcasts, websites, videos, books, and academics on Twitter) focusing on health equity and race.
- Words Matter: An Antibias Workshop for Health Care Professionals to Reduce Stigmatizing Language
The site provides materials to hold a 90-minute workshop with the following learning objectives:
1. Explain the impact of providers' language on creating biases on patient care
2. Describe strategies that can be used to mitigate providers' language biases
3. Apply strategies from the Mindful Language Toolkit to address stigmatizing language
(Cases can be modified to be nephrology-centric.)
- Six Words: 'You've Got to Be Taught' Intolerance (8-minute listen)
- How to Talk About Race and Racism (60-minute listen)
- Brené Brown with Ibram X. Kendi on How to Be an Antiracist (60-minute listen)
- Be Antiracist Podcast by Ibram X. Kendi in collaboration with Pushkin Industries and iHeartRadio
- Antiracism in Medicine Podcast Series from The Clinical Problem Solvers
A series of monthly podcasts addressing topics regarding racism in medicine. The following episodes may be of interest:
- Episode 188: Antiracism in Medicine Series – Episode 10 – Counterspaces in Medicine: Creating Safe Spaces and Redefining Value (7/14/2021)
- Episode 181: Antiracism in Medicine Series – Episode 9 – Moving Towards Antiracism in Medical Education (6/10/2021)
- Episode 176: Antiracism in Medicine Series – Episode 8 – Towards Justice and Race Conscious Medicine (5/10/2021)
- Episode 169: Antiracism in Medicine Series – Episode 7 – Antiracism, Global Health Equity, and the COVID-19 Response (4/1/2021)
- Episode 162: Antiracism in Medicine Series – Episode 6 – Racism, Trustworthiness, and the COVID-19 Vaccine (2/25/2021)
- Episode 155: Antiracism in Medicine Series – Episode 5 – Racism, Power, and Policy: Building the Antiracist Health Systems of the Future (1/19/2021)
- Episode 148: Antiracism in Medicine Series Episode 4 – Dismantling Race-Based Medicine Part 2: Clinical Perspectives (12/16/2020)
- Episode 145: Antiracism in Medicine Series Episode 3 – Structural Inequities and the Pandemic's Winter Surge (12/2/2020)
- Episode 141: Antiracism in Medicine Series Episode 2 – Dismantling Race-Based Medicine Part 1: Historical and Ethical Perspectives with Edwin Lindo (11/17/2020)
- Episode 120: Antiracism in Medicine Series Episode 1 – Racism, Police Violence, and Health (8/25/2020)
- Kirwan Institute for the Study of Race & Ethnicity's Implicit Bias Module Series
This course will introduce you to insights about how our minds operate and help you understand the origins of implicit associations. You will also uncover some of your own biases and learn strategies for addressing them. Each module is divided into a short (2-5 minutes) series of lessons.
- Module 1: Understanding Implicit Bias
- Module 2: Real Word Implications
- Module 3: Understanding Your Own Biases
- Module 4: Mitigating Unwanted Biases
- How Microaggressions Are like Mosquito Bites
- How to Overcome Our Biases? Walk Boldly toward Them
- Are You Biased? I Am
- How to Outsmart Your Own Unconscious Bias
- Just Belonging: Finding the Courage to Interrupt Bias
- Allegories on Race and Racism
- How Racism Makes Us Sick
- Combating Racism and Place-ism in Medicine
- Tackling Ethnic Health Disparities
- Race – the Power of an Illusion
- Multiple Stress Factors & Social Indicators of Health
- From the documentary series, Unnatural Causes
- How Can Providers Reduce Unconscious Bias?
- A Call to Action for Addressing Disparities and Increasing Diversity in Academic Nephrology (CJASN)
- Naming and Eliminating Systemic and Institutional Racism in Nephrology Training (Kidney News Online)
- Holistic Application Review
"Holistic Review" refers to mission-aligned admissions or selection processes that take into consideration applicants' experiences, attributes, and academic metrics as well as the value an applicant would contribute to learning, practice, and teaching. Holistic review allows admissions committees to consider the whole applicant, rather than disproportionately focusing on any one factor. The core principles of holistic review are outlined on the linked webpage.
- Improving Diversity in Pediatric Residency Selection: Using an Equity Framework to Implement Holistic Review (Journal of Graduate Medical Education)
- Looking Beyond the Numbers: Increasing Diversity and Inclusion Through Holistic Review in General Surgery Recruitment (Journal of Surgical Education)
- Reimagining Merit and Representation: Promoting Equity and Reducing Bias in GME Through Holistic Review (Academic Psychiatry)
- Bridging the Gap: Holistic Review to Increase Diversity in Graduate Medical Education (Journal of the Association of American Medical Colleges)
- Keeping Our Promise: Supporting Trainees from Groups That Are Underrepresented in Medicine (The New England Journal of Medicine)
- Addressing Implicit Bias in Virtual Interviews (a video from the AAMC)
- Mentoring Across Differences – an Interactive Workshop (MedEdPORTAL)
- "A-Ha" Activities for Unconscious Bias Training
This webpage outlines varies group activities to stimulate discussions of unconscious bias.
- Implicit Bias Assessment
AcknowledgmentsSpecial thanks to the following contributors to the content on this webpage:
Abinet Mathias Aklilu, MD
Jason Cobb, MD
Sarah L. Elfering, MD
Scott J. Gilbert, MD, FASN
Rachel Hilburg, MD
Koyal Jain, MD, MPH, FASN
Cynthia Miracle, MD
Ebele M. Umeukeje, MD, MPH, FASN
Also, special thanks to the ASN Diversity, Equity, and Inclusion Committee; ASN Health Care Justice Committee; and ASN Workforce and Training Committee for their support.