Revamping the KRESCENT Core Curriculum: The KRESCENT 2.0 Program Report

2017-2018 KRESCENT Curriculum Revamp

For the past 20 years, feedback from trainees, invited speakers and other workshop participants has been collected biannually, after each workshop (de-identified and collected by a third party not involved in running the program). Feedback has dynamically driven curricular evolution since program inception. This has been a crucial safeguard, ensuring KRESCENT best serves trainee needs within a rapidly evolving research climate and larger dynamic cultural milieu. Periodic formal curriculum evaluations have also been performed. The first formal review conducted from 2017 to 2018 was led by the incoming director and curriculum chair. Ms Lis Fowler, Kidney Foundation of Canada (KFoC) national director at the time, and Ms Chantal Boucher, KFoC administrative assistant, both provided indispensable strategic and logistical support.

As an initial step of the review, the curriculum chair conducted phone interviews with current and past trainees who responded to the invitation to provide feedback on the core curriculum. During interviews, 60 current and former KRESCENT trainees (out of a total of 65 awardees) shared their personal experiences while in KRESCENT as well as the perceived value of KRESCENT training in their professional lives. Interviewees discussed (i) what curricular elements had been helpful or unhelpful and why and (ii) what additional curricular elements would have been helpful and why. KRESCENT graduates who had continued in academia also discussed elements of their training experience in KRESCENT that in hindsight had been particularly helpful for them in navigating their early career path. Vital insights arising from this interview process led to the 2018 KRESCENT Mission and Values statements (Table 1), and a corresponding major reshaping of the curriculum. In addition to retiring some curriculum exercises and updating others, major changes were made to the curriculum to prioritize trainee mental health and well-being, patient-oriented research (POR), leveraging lived experience, and advancing cultural competence.

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Table 1.

2018 KRESCENT Mission and Value Statements.

Mission	To encourage and support early career kidney research scientists and trainees in multiple disciplines, who will reinvent the future of kidney health research in Canada. We will do so by facilitating collaboration between and across disciplines, fostering the next generation of leaders, and by honoring both equity and diversity.
Values	1. People: It is from and through people that hypotheses are generated, tested and refuted or upheld. At the core of our values is the respect for others, including the diversity of Canadians and our Indigenous peoples.
	2. Integrity: Conclusions drawn from scientific research inform clinical decision-making, public policy and individual life choices. It is therefore paramount that the methodology employed, means of collecting data and dissemination of data occurs with the highest integrity. This includes ensuring all work performed, including negative studies is deposited in the scientific literature.
	3. Collaboration: We appreciate that we all have something to contribute to research into kidney health and disease. We all appreciate that we are not experts in all areas of kidney health and disease. We therefore acknowledge and embrace the opportunity to collaborate with other experts in and across our field of research.
	4. Community: Kidney science does not occur in a vacuum. Central to this are the societies and organizations, which raise funds for and communicate the knowledge generated by ourselves the researchers. For this community to function optimally everyone must contribute their part. This includes a commitment to quality peer review (both grants and papers), the dissemination of information to scientific, lay and clinical audiences and the participation of members in meetings of the societies.
	5. Excellence: We are committed to life-long learning and innovation. Our work aims to contribute the highest quality experiments thereby promoting kidney health through excellence in research.

2022-2024 Curriculum Review

In 2021, the Canadian Institutes of Health Research (CIHR) launched its pilot Health Research Training Platform (HRTP) program. Under the leadership of then KRESCENT director, Dr R. Alexander, the KRESCENT 2.0 HRTP application was awarded a six-year grant to ensure continuation of this capacity building program in Canada. ⁴ Following the notification of this award in 2022, KRESCENT initiated a second formal evaluation and redesign of the core curriculum, resulting in the KRESCENT 2.0 core curriculum. Led by the KRESCENT curriculum chair, director and senior consultant, a small pan-Canadian working group representing multiple disciplines and jurisdictions in the kidney research community was assembled. In tandem, KRESCENT hired equity consultants Mr Ike Okafor and Ms Nadia MacLaren, of Bridge to Corporate Social Responsibility (B-CSR) Consultancy, representing Black, Indigenous, and People of Colour (BIPOC) communities. B-CSR performed an environmental scan of the entire KRESCENT program from application process to curriculum, and in their report provided concrete recommendations to increase the number of Black and Indigenous kidney researchers in Canada (Supplemental File 1). Also in 2022, KRESCENT organized a patient partner summit. At this meeting, existing patient partnership within the KRESCENT curriculum was formalized through establishment of the Patient Community Advisory Network (PCAN) with five founding members: Ms Nancy Verdin, Ms Tania Woodlock, Ms Anne MacPhee, Ms Mary Beaucage, and Dr Sunny Hartwig (chair). The newly formed PCAN team was tasked with providing curriculum recommendations to prioritize POR, including suggestions for new didactic sessions on POR, and incorporation of POR into training exercises.

In summary, formal curriculum recommendations for updating the KRESCENT 1.0 curriculum into KRESCENT 2.0 came from the curriculum working group, B-CSR consultation and PCAN over a two-year period between 2022 and 2023 (Table 2). A KRESCENT leadership retreat was held in 2023 to discuss recommendations and to finalize the curriculum. Although it is founded upon the original KRESCENT curriculum (ie, KRESCENT 1.0) and faithful to its mission and values,^2,3 the new KRESCENT 2.0 core curriculum described in this program report, rolled out over a span of two years (2024-2025), nevertheless incorporates significant changes in curriculum format and delivery. ¹

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Table 2.

Comparison of KRESCENT 1.0 and 2.0 Program Elements.

Note. CIHR = Canadian Institutes of Health Research; CJKHD = Canadian Journal of Kidney Health and Disease; NI = new investigator; PDF = post-doctoral fellow; POR = patient-oriented research; RISE-LMS = Raising Interdisciplinary Scientist Excellence Learning Management System; TDR = transdisciplinary research challenge.

Curriculum Revamp Workflow

Priority areas to be addressed in the remodeled KRESCENT 2.0 curriculum that were previously identified during the HRTP application process ⁴ included:

Many of these priority areas were straightforward to address through increased emphasis of existing curricular elements in the workshops themselves (items three to six). In the sections below, we highlight additions to the curriculum to create new opportunities for Black and Indigenous kidney researchers, greater patient involvement in the curriculum, enhancing mental health and wellness, as well as changes to workshop exercises deemed “make-work” projects by the revamp committee (summarized in Table 3).

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Table 3.

Priority Areas and Actionable Items for the KRESCENT 2.0 Curriculum.

Priority area	General description	Actionable item(s)
1. Recruitment of Black and Indigenous scholars	Increased support for research that supports the kidney health and care of Black and Indigenous communitiesIncreased recruitment of Black and Indigenous kidney researchers	Establish a targeted KRESCENT fellowship to support a trainee doing research supporting kidney health and care in Black and Indigenous communities in CanadaLaunch a summer studentship program to support kidney research opportunities for Black and Indigenous students
2. Greater incorporation of POR across the CIHR themes	Integrate patient partners into research programsDeeper integration of the lived experience voice into the curriculumCreate a patient/mentor program for traineesEstablish novel relationships with hospitals and volunteers	Establishment of the KRESCENT PCAN teamIncreasing participation of PCAN beyond patient stories at workshops toward practical mentorship in improved lay communication (mentorship in writing lay abstracts led by PCAN, and willingness to provide one-on-one mentorship for interested trainees)PCAN members participate in the TDR exercise with trainees and share co-authorship on the resulting manuscript
3. Increased training on sex and gender in health research	Enhanced training in sex and gender within curriculumAddressing gender equityGoing beyond traditional sex and gender; incorporation of non-binaryOpportunities to link with interest groups and content experts	Additional mandatory online modules for sex and gender trainingIn-person didactic lectures on sex and gender training incorporated into KRESCENT core curriculumEstablishing a dedicated KRESCENT fellowship seat for sex and gender kidney researchHighlighting online training modules available on the RISE-LMS platformFor example, women in transplantation
4. Exposure to novel techniques	Incorporate didactic training in novel techniques into the curriculumInvolve experts in unique novel techniques to participate in workshops and online modules a Add elective component into curriculum for specialized techniquesProvide funding for trainees to travel and learn new techniques	In-person didactic lectures with a focus on cutting-edge techniques in kidney researchAll invited speakers are tasked with highlighting innovations in their field as part of their lectureHighlighting online training modules available on the RISE-LMS platform
5. Increased attention to trainee mental health	Increased emphasis on trainee well-being	Greater investment of health and wellness modules in KRESCENT workshops (eg nature as medicine, forest bathing, mindfulness, group outings to art galleries, and didactic lectures)Invited speakers tasked with sharing ways they have navigated overall well-being during their careerHighlighting online training modules available on the RISE-LMS platform and other resources (eg KidneyLink)
6. Industry partnerships and mentorship in non-academic career paths	Greater exposure to non-academic career pathways	Guidance on alternate career pathways incorporated into KRESCENT curriculumHelping trainees connect with mentors within industryConnect with KRESCENT alumni who chose a non-academic pathway

Note. CIHR = Canadian Institutes of Health Research; KRESCENT = Kidney Research Scientist Core Education and National Training; NPA = nominated principal applicant; PA = principal applicant; PCAN = patient council advisory network; POR = patient-oriented research; RISE-LMS = Raising Interdisciplinary Scientist Excellence Learning Management System; TDR = transdisciplinary research challenge.

a

Prioritization of inviting Canadian content experts (vs international speakers) to participate in KRESCENT workshops provides important networking opportunities for trainees with senior Canadian researchers in a small group setting.

Creation of Opportunities for Black and Indigenous Kidney Researchers

A targeted initiative of KRESCENT 2.0 was to increase Black and Indigenous representation in kidney research by supporting training for Black and Indigenous scholars. In addition, KRESCENT seeks to increase support for research on racialized groups disproportionately affected by kidney disease.^5-11

Recognizing that disparities in access to academic exposure and research experience affect Black and Indigenous students long before post-doctoral training, KRESCENT retained EDI consultants Mr Ike Okafor and Ms Nadia McLaren, who represent these communities, to rigorously scrutinize the existing KRESCENT curriculum and advise how to support students identifying as Black or Indigenous who are interested in pursuing kidney research. Recommendations from their report fell into three main categories: (1) communication, nomenclature, and language/terminology (eg, applications and trainee feedback surveys); (2) policies (including trainee selection criteria, mentorship models, research supervisory, and trainee expectations); and (3) cultural humility and relationship building (Table 4). A Black Health Equity expert, Ms Lydia-Joi Marshall, was subsequently retained as an ongoing consultant for KRESCENT to ensure continued operational safety of the program for Black scholars. Responsibilities of the Black Health Equity expert are highlighted in Table 5. In-person anti-Black racism training was formally introduced to the KRESCENT 2.0 core curriculum in 2024 as a result.

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Table 4.

EDI Consultancy Recommendations.

Surveys
Suggestion	Rationale
Adjust question regarding raceRemove the term “visible minority”	Visible minority is an outdated term
Add question on self-identifying race
Add question on socioeconomic status and country of birth	To ensure equality and fairness in the recruitment processTo statistically monitor the demographics of KRESCENT applicants
Trainee selection process
Suggestion	Rationale
Incorporate Black and Indigenous community members into the selection process. Include Elders, knowledge keepers, professors, and educators. Compensate fairly	To encourage equity in the selection process to provide an EDI lens in decision-making.
	To involve communities most affected by kidney disease, yet least represented in medical establishments to the health care systemMembers of Black and Indigenous communities can adequately view and value experiences of candidates which may otherwise go unrecognized
KRESCENT website
Suggestion	Rationale
Add multiple statements about EDI on KRESCENT website including EDI principles in the program, and the aim to increase the number of Black and Indigenous community scholars in kidney research	To demonstrate willingness to include Black and Indigenous communities in kidney science and researchTo revolutionize EDI principles into health care for a greater degree of health and wellness for underserved populations
Cultural safety
Suggestion	Rationale
Support for applicants Childminding offeringsFlexibility for BIPOC community holidays and responsibilitiesCommunity engagement Building and strengthening pathways between KRESCENT members and Indigenous communitiesCreation of a network and resource list of health-focused Indigenous and Black organizationsCreation of a network for Indigenous Elders and knowledge keepersEstablish an Indigenous councilElder engagement Incorporate Elders as staff in the KFoC underKRESCENTTrain staff on Elder protocolsHire Indigenous Elders through relationships and connections	Offers support to trainees who are parents of young childrenTo encourage community strengthening and celebrationsPromote security and validation for members of Black and Indigenous communitiesTo encourage further participation from Indigenous communities: “one of our own” peopleTo strengthen Indigenous community healthcare supportTo move beyond cultural competency into cultural fluencyTo discourage formal job postings; relational hire more significant and important for Black and Indigenous communities
Mentorship
Suggestion	Rationale
Recruit Indigenous and Black mentors	Mentors provide a layer of protection and sense of belonging to the traineesBlack and Indigenous mentors will bring a unique lens through which to appreciate lived experiences
New awards
Suggestion	Rationale
A new award for Black and Indigenous trainees with a drive for innovationBlack and Indigenous trainees must still be eligible for applying for other awards within the KRESCENT program	With a high prevalence of KD in Black and Indigenous communities, researchers representing underserved communities can help drive innovation and change within the healthcare system
Policies
Suggestion	Rationale
Incorporate a statement of commitment regarding truth and reconciliationCompose the statement under the guidance of Indigenous Elders and community leadersIncorporate an anti-Black racism statement	To ensure progress toward peace and reconciliation with Indigenous peoplesIndigenous reconciliation and anti-Black racism are crucial components to the KRESCENT programTo reduce racial disparities in health researchTo acknowledge and contest against systemic racism against Blacks embedded in society to treat all with respect and dignity

Note. EDI = equity, diversity, and inclusion; KD = kidney disease; KFoC = Kidney Foundation of Canada; KRESCENT = Kidney Research Scientist Core Education and National Training program.

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Table 5.

Roles and Responsibilities of Black Health Equity Champion.

Description	Purpose
Engage potential Black and Indigenous applicants in an equitable manner with a Black mentor outside of the KRESCENT program	To provide Black and Indigenous applicants the opportunity to connect with a Black (female) mentor for the program
Support current trainees and mentors through workshops and discussions regarding cultural safety and inclusion	To ensure KRESCENT mentors provide an inclusive and safe environment for incoming Black and Indigenous scholars
Create educational resources on anti-Black racism in kidney care in the core curriculum (eg, create Black Health Awareness module)	To prevent racial bias within program documentation; to educate potential mentors on challenges Black and Indigenous communities experience in health care settings
Build relationships with Black KRESCENT trainees and summer students	To facilitate thriving and provide community support and safety for Black students with their mentors and peers
Ongoing program support and resource recommendations	To ensure program documentation and curriculum elements are presented in a fair, equitable, and open manner to Black and Indigenous communities

Summer Studentship Program

A major outcome of anti-racism consultancy was the creation of the KRESCENT Summer Studentship award for outstanding undergraduate students or medical students who identify as Black or Indigenous (Supplemental File 2). The program is incentivized through a competitive student salary ($750/week for up to 16 weeks) to complete a summer student research position in an approved Canadian kidney research laboratory (Table 6). KRESCENT also provides stipend support to supervisors who are selected by the program. Barriers preventing students from applying were identified via consultation with the EDI champion and anti-racism consultants. These barriers were reduced within the application process. Research projects are carried out in-lab over a period of 12 to 16 weeks in Canada under the supervision of a kidney researcher who has undergone anti-Black racism training.

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Table 6.

KRESCENT Summer Studentship.

Description	Purpose
Black and Indigenous undergraduate students engage in research in a culturally safe and supported environment	To promote Black and Indigenous scholars in undergraduate degrees to explore kidney researchTo increase and support Black and Indigenous representation in kidney research
Supervisors are required by KRESCENT to complete cultural safety and sensitivity trainingNetworking opportunities with other summer students during the summerMentorship meetings with KRESCENT curriculum chair and Black equity consultant during the summer	Ensure a culturally safe environment for traineesCommunity-building and networkingTrack research progress and address any trainee concerns
Laboratory research projects are conducted for 12 to 16 weeks at a competitive summer salary of $750/week	Goal of producing a unit of research that contributes to a publication or presentation
Students present their research project at the fall KRESCENT workshop and receive feedback from KRESCENT curriculum chair	Cultivate oral and written scientific communication skills, exposure to in the academic milieu
Students submit abstracts to the annual meeting of the Canadian Society of Nephrology	Cultivate oral and written scientific communication skills, exposure to in the academic milieu

Opportunities for networking with fellow students in the program are provided via a moderated online platform (discussed below). In addition to the local supervisor, mentorship is provided by the KRESCENT curriculum chair and the equity consultant. Ongoing communication between the KRESCENT chair, equity consultant, trainees, and supervisors throughout the summer ensures a culturally safe environment for trainees, as well as tracking of research progress. Key research findings are presented at the following fall KRESCENT workshop, allowing for formalized experience-building exercises. To provide further opportunities for networking and exposure to the academic milieu, trainees are encouraged to submit abstracts to the Canadian Society of Nephrology (CSN) annual meeting. Since its inception in 2024, three Black medical students and three fourth-year Black undergraduate students have participated in the summer studentship to date, and three trainees have presented posters at the CSN annual meeting. No person identifying as Indigenous has yet applied.

Feedback from trainees has been singularly positive. KRESCENT is currently seeking to increase the number of mentors to better support outstanding scholars from racialized communities in accessing kidney research opportunities across Canada. The foremost metric of success of the summer studentship is defined by trainee satisfaction with their research experience, rather than an expression of intent to pursue further kidney research opportunities.

Increased Emphasis on Patient-Oriented Research

Over the past decade, patient engagement in research has emerged as a vital strategy to improve the quality, relevance, and impact of health research, leading to improved kidney care and outcomes. ¹² Notwithstanding, for many researchers, there remains limited understanding of how to meaningfully engage with patients in the research milieu. In 2016, the Canadian kidney research community established a national POR network to overcome barriers to patient engagement, Canadians Seeking Solutions and innovations to overcome chronic kidney disease (Can-SOLVE CKD), which puts patients at the center of kidney health research. ¹³

Building on this foundation, the first POR modules were introduced to KRESCENT in 2017. Patient partners were invited to share their lived experience stories at workshops, thereby embedding lived experience as an essential dimension of scientific development. Over the past eight years, KRESCENT has continued to expand patient partnership in kidney research, pioneering the inclusion of patient partners as co-educators, leaders, and mentors in kidney research training. This evolution reflects reciprocal learning: trainees gain early exposure to patient-centered perspectives, cultivate their oral and written communications for diverse audiences, and increase their confidence in engaging patients in research. In tandem, patient partners develop mentorship skills and confidence in shaping research directions.

In 2022, formal integration of patient partners as mentors and leaders was achieved through the creation of PCAN, a team comprised patients, caregivers, and organ donors. Patient Community Advisory Network members attend biannual workshops and educate trainees on the lived experience of kidney disease. They provide hands-on mentorship for trainees in lay abstract writing for grant applications and manuscripts. PCAN members are compensated hourly and receive an annual honorarium. All conference travel expenses are covered. PCAN mentorship has raised the overall quality and relevance of KRESCENT, positioning trainees for maximum success by increasing the likelihood that their research will result in meaningful change for patients.

Mental Health and Wellness

The COVID-19 pandemic had a disastrous and sustained effect on mental health and wellness, globally. Health care professionals in particular were severely impacted by increased workplace demands, and stress associated with increased health risks to their own lives and of their families during this time. ¹⁴ In response to trainee feedback, mental health and wellness sessions were formalized into the KRESCENT curriculum in 2020, to help trainees cultivate well-being best practices. Didactic and interactive workshop modules included mindfulness, breath work, nature as medicine, and forest bathing (Table 3). Once in-person workshops resumed in late 2022, group outings were formalized into the KRESCENT 2.0 curriculum, including excursions to art galleries and other places of cultural interest at the completion of each workshop.

Raising Interdisciplinary Scientist Excellence Learning Management System Platform

The online virtual training hub Raising Interdisciplinary Scientist Excellence Learning Management System (RISE-LMS) platform was launched in 2022. RISE-LMS represents more than 2 years of collaboration between multiple HRTPs, spearheaded by Dr Susan Samuel, director of the Empowering Next-Generation Researchers in Perinatal and Child Health (ENRICH) HRTP, and administered through the SickKids Hospital Research Institute. Raising Interdisciplinary Scientist Excellence Learning Management System is a centralized, open-source training platform repository for the sharing of learning tools between HRTPs, allowing trainees across multiple health research disciplines to access to a plethora of common learning resources (eg, Indigenous cultural safety training, sex, and gender certificate training module). As part of the CIHR HRTP program mandate, all individual funded training bodies, to varying degrees, contribute to the RISE-LMS platform. Trainees from any HRTP can log into RISE and access these common training modules on their own time (asynchronous learning).

RISE-LMS also provides infrastructure support for curriculum delivery for multiple HRTPs. The KRESCENT program manager was instrumental in transitioning KRESCENT 2.0 curriculum administration to RISE-LMS over a period of two years. KRESCENT trainees now access mandatory modules asynchronously on RISE-LMS, such as San’yas Indigenous cultural safety and First Nations principles of Ownership, Control, Assess, and Possession (OCAP^®) certificate training modules. San’yas training is an introductory course for health care professionals seeking to enhance their knowledge, awareness, and skills when working with Indigenous people. This module explores the history of colonization and specific ways individuals can combat anti-Indigenous racism in the health care system; OCAP^® training provides guidance for clinicians and researchers seeking to utilize patient data from First Nations communities. Upon completion, certificates for these and other assignments are uploaded onto the server, enabling curriculum deliverables to be tracked. RISE-LMS also serves as a user-friendly centralized submission portal for trainee curriculum vitae (CVs), CIHR individual development plans (IDPs), progress reports, travel reimbursements, and other program-specific documents. With the steady increase in the number and complexity of CIHR requirements for continued funding of KRESCENT 2.0, RISE-LMS infrastructure support has been operationally essential for program administration and delivery.

Reimagining Existing Training Elements: Transdisciplinary Research Challenge and Mock Manuscript Exercises

The transdisciplinary research challenge (TDR) is designed to help first-year KRESCENT trainees collaborate with each other and to learn to approach research from an interdisciplinary mindset. In small groups of four to six, trainees work with members of PCAN to write a narrative review on a major issue in kidney disease and health (eg, hemodialysis and nephrotic syndrome) that includes at least three of the four CIHR themes: (1) biomedical research, (2) clinical research, (3) health services research, and (4) social, cultural, environmental, and population health research (https://cihr-irsc.gc.ca/e/53146.html). ¹⁵ The review articles are intended to inform research strategies, develop priority areas of interest, and provide innovative, transdisciplinary solutions for the problem at hand. KRESCENT mentors provide internal peer review of the manuscript prior to submission to CJKHD. TDR manuscripts are supported through the publication process with a publication waiver. Trainees therefore produce a publication as a tangible outcome metric and CV line item as part of this exercise. To date, trainees have published 13 TDR articles in CJKHD.

The curriculum revamp process identified several issues with the existing TDR format. Because the TDR topic was predetermined by the annual theme for each workshop, an unequal share of the workload typically fell on 1 trainee whose area of expertise coincided with the annual workshop theme. This generally made the TDR a costly “make-work” project for 1 trainee, and an easy publication for the rest of the trainees involved in the exercise. Another related concern was that the publication conferred greater value to trainees whose content expertise aligned with the topic area. Other issues with the TDR related to time-management and varying work ethics amongst group members. The KRESCENT 2.0 TDR has since been modified to address trainee concerns. Increased guidance is provided throughout the exercise timelines, with monthly check-ins by the curriculum chair to the team, to ensure equitable workload distribution and timely deadline adherence. Importantly, trainees are now free to choose any topic in nephrology. Based on trainee feedback (2023-2024), this change has led to a fairer workload distribution amongst participating trainees, and has increased the perceived value of the TDR exercise (Table 3).

Historically, trainees have submitted a manuscript for mock peer review. This mock manuscript exercise from the original KRESCENT curriculum was intended to provide mentorship in manuscript writing and valuable peer review feedback. A key logistical issue with this exercise related to timing: trainees were at different stages of their research at the time of the mock manuscript submission deadline. Consequently, the quality of submissions varied tremendously, limiting the benefit of peer review for most manuscripts. There was strong consensus in the curriculum committee to eliminate this exercise and instead replace it with a journal club exercise. Specific comments relating to the mock manuscript exercise are summarized in Table 3.