# Addressing Ethnicity in the Design and Evaluation of an Educational Intervention on Interindividual Variation in Pharmacokinetics

## TL;DR

This study explores how students understand ethnicity and genetic differences in drug metabolism and finds that education can reduce misconceptions about genetic causes for ethnic differences.

## Contribution

The paper introduces an educational intervention that reduces students' tendency to assume genetic causes for ethnic differences in drug metabolism.

## Key findings

- Students initially expect genetic mechanisms for ethnic differences in drug metabolism, but this expectation decreases after the intervention.
- The educational intervention had no effect on students' views about ethnicity in the context of hypertension.
- Students associate ethnicity with culture and origin, while pharmacological literature equates it with racial groups.

## Abstract

Interindividual variation in pharmacokinetics can occur due to diet, environmental or lifestyle factors, underlying pathology, and gene variants, typically single nucleotide polymorphisms (SNPs). Genetic mechanisms have received the most attention in research and education about ethnic differences in pharmacokinetics. Making this connection between genetics and ethnicity is problematic because it could reinforce the erroneous idea that there is a biological basis to ethnicity. The aim of this work was to design an educational intervention about interindividual variation in pharmacokinetics, explore how students perceive ethnicity and genetic differences prior to the educational intervention, and then assess the impact of the intervention and whether it could influence any misconceptions students might have about ethnicity and genetic similarity. Through the use of questionnaires and focus groups, we found that students typically refer to ethnicity to mean culture and place of origin, whereas in the pharmacological literature, ethnicity is synonymous with racial groups, that is, Black, White, and Asian. Prior to the educational intervention, students tended to expect a genetic mechanism for ethnic differences in drug metabolism and this was reduced after the intervention when a range of other nongenetic mechanisms were presented for interindividual variation. However, students' views about possible underlying mechanisms for ethnic differences in hypertension and about ethnicity more generally were unaffected by the intervention. This highlights the importance of reevaluating the way ethnicity is presented across the medical and medical sciences curriculums to be clear that ethnicity is socially constructed and avoid implying a biological basis.

Students show confusion about ethnicity and genetic similarity and tend to suggest genetic mechanisms for proposed ethnic differences. Teaching reduces this but has no effect on ethnicity in other medical contexts. This has important implications for the wider curriculum to avoid inadvertently promoting a biological basis for ethnicity when it is socially constructed.