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I wanted to follow-up yesterday's discussion of @UWMedicine's announcement that they will stop using the MDRD with race coefficient to answer some questions and also give insight to how this change came to be in addition to highlighting work by others. This is a
First and foremost, I want to again acknowledge that it is the many black students past and present at UW who pushed tirelessly for change in our curriculum and medical practices at great personal sacrifice that made this possible.
It is through numerous protests led by students that the Anti-Racism Action Committee (ARAC) was created and continues to have influence at our school. You can read more about their work via the link. @lizstein_ plays a crucial role in their work. http://cedi-web01.s.uw.edu/arac-testpage/
I want to recognize that student work led to this change because most of these people are not on Twitter, but I think it's important to make it clear that nobody did this alone. @endywen was among those students that came before us to make their voices heard.
We also have to recognize that while this was a student driven initiative over the course of years, change came from collaboration with faculty and departments within the school @EdwinLindo @UWNephrology @UWDeptMedicine among others
UW will now be using the CKD-EPI equation which is based on serum creatinine, age, and sex. This is more accurate for estimating GFR as the MDRD equation is known to underestimate GFR in many individuals.
There are many papers discussing issues with the MDRD, it's racist implications, and it's impact on both patient care and medical education. Here are just two samplings. One in JAMA by Dr. Nwamaka Denise Eneanya MD/MPH and the other by myself and colleagues in Academic Medicine.
JAMA paper: https://jamanetwork.com/journals/jama/article-abstract/2735726
Academic Medicine paper:
https://journals.lww.com/academicmedicine/Abstract/9000/Changing_How_Race_Is_Portrayed_in_Medical.97189.aspx
@lizstein_ @BriChristophers
Academic Medicine paper:
https://journals.lww.com/academicmedicine/Abstract/9000/Changing_How_Race_Is_Portrayed_in_Medical.97189.aspx
@lizstein_ @BriChristophers
So how did we make this change? We made it by questioning lecturers when the MDRD was taught. We did it by not letting the issue go and continuing to push discussions in class about the use of this equation.
We did it by having meetings with teaching faculty, sending articles to them like the one in JAMA, forcing discussions in small group sessions, and making use of the advocacy framework that we built via ARAC.
We did it by pushing for global curriculum changes to make it more anti-racist. @lizstein_ has great threads about this work, detailing everything
https://twitter.com/lizstein_/status/1265071486638800897
and https://twitter.com/lizstein_/status/1244075355922563072
https://twitter.com/lizstein_/status/1265071486638800897
and https://twitter.com/lizstein_/status/1244075355922563072
Others have done similar work, notably UCSF, led by @MonicaHahnMD, @Sprichmond2, and @thenephrologist. An AMAZING discussion was led by students @bernielim, @NoorChadha , @zh_angela as they launched their Institute for Healing and Justice in Medicine
You can read about their brilliant work at https://www.instituteforhealingandjustice.org/ where you can also find the link to watch their interdisciplinary discussion with physicians, students, and activists. I watched this live and was awe-struck.
Lastly, I want to make a call to action for all of #Meded, #medtwitter, and #MedStudentTwitter . The burden of educating our peers and educators should not be placed solely on the backs of students of color, particularly black students.
It is both draining and traumatic to have to constantly be responsible for fighting against lessons that pathologize our bodies and our communities and see first hand how and why the care we receive is lesser. We need allies.
We need allies that lift our voices, support our work, and use the privilege that protects them to shield us too. We need allies that recognize the coded language and policies that dictate professionalism and see that it is often used as a trap to silence POC.
We need you to recognize that the burden of this work most often falls on us. @laurendolsen wrote a great piece on this very issue https://www.instituteforhealingandjustice.org/
And we need you to realize that we have to work twice as hard for half of the respect and recognition of our peers. This is most clearly seen in clinical grading and is the subject of a study conducted at UW https://www.tandfonline.com/doi/full/10.1080/10401334.2019.1597724
Lastly, I want to say thank you to all of those who have reached out and supported us and remind students again that your voices matter. You may be called loud, unprofessional or even pushy, but your voice matters. We changed an entire institution because we didn't back down.
