Cultural competence in skin of colour
Education on cultural matters will help dermatology residents treat people, not diseases (1,500 words, 7 minutes)
The Skin Spectrum Weekly e-newsletter is supported by an unrestricted grant from Bausch Health Canada.
Physicians practicing anywhere in Canada should be comfortable diagnosing and counselling patients of all backgrounds and all skin types, said Dr. Bolu Ogunyemi during the 7th annual Skin Spectrum Summit on Nov. 6.
Dr. Ogunyemi is a dermatologist and the Assistant Dean of Social Accountability and a Clinical Assistant Professor of Medicine in the Faculty of Medicine at Memorial University in St. John’s, Newfoundland & Labrador.
He stressed the importance of addressing the lack of diversity in undergraduate medical education.
“The undergraduate curriculum is a clear way to expose all future physicians to skin of colour dermatology and different cultural issues and how they reflect dermatology,” he said.
Canada's changing demographics make this education even more essential, he said.
Dr. Ogunyemi referred to a recent study from the University of Toronto (Journal of Cutaneous Medicine and Surgery, July 1, 2021; 25(4):409-417) that examined skin of colour representation in undergraduate dermatologic education materials and whether there was a link to diagnostic ability and confidence.
Findings from that study included:
In the first-year curriculum, 3.7% of images were of skin of colour
In the third year, 6.1% of images were of skin of colour
Students showed similar diagnostic accuracy when examining pictures of White skin or skin of colour
Students were less confident about their answers for skin of colour
Dr. Ogunyemi also stressed the issue is not just diagnostic accuracy.
“We treat people, not just diseases,” said Dr. Ogunyemi. “Culturally competent care is a lot more than having seen a lot of images of different dermatoses in skin of colour.” He said that true cultural competence includes meeting people where they are, understanding why a patient is seeking treatment, and considering demographic factors in disease presentation, care, and counselling.
Bottom Line: There is a definite lack of representation of skin of colour in undergraduate medical education, which can make doctors less confident about diagnosing patients of colour and may ultimately affect diagnostic accuracy. To treat all patients anywhere in Canada, physicians need more exposure to skin of colour patients in training. But cultural competence also requires understanding the patient beyond just their dermatological issues.
From the literature on cultural competency in dermatology
Evaluating skin of colour education in dermatology residency programs: Data from a national survey
In this study, dermatology residents across the United States were surveyed anonymously about skin of colour (SOC) education in their residency program. The students were asked about their satisfaction with SOC education, their opinions on improving SOC education, and their perspective on cultural competence.
Of the 125 respondents, 63.2% reported their program provides SOC-related didactics; 44.0% had a rotation where residents primarily saw patients with SOC, although only 11.2% had a dedicated SOC rotation. While more than 60% of residents reported being satisfied or very satisfied with their SOC education, residents' satisfaction with their knowledge of diseases primarily seen in SOC was the lowest (56.8%) of all categories.
The researchers identified four major themes for the improvement of SOC education. These were curricular reform, clinical exposure, emphasizing determinants of health, and opportunities to learn from faculty with diverse interests and expertise about SOC.
Observing cultural competence of healthcare professionals: A systematic review of observational assessment instruments
The authors of this paper note that observational instruments are preferred for assessing cultural competence. They aimed to identify and evaluate observational tools used to assess cultural competence in healthcare providers.
The investigators selected six articles on five instruments using a systematic literature review. The chosen tools were directed toward health professionals and counsellors. Four tools were designed for face-to-face communications, and one used verbal responses to videotaped simulated interactions.
There was a significant variation in the content of the tools. Most focused on attitude, and there was little content on knowledge and skills. The authors write that the measurement properties were suboptimal.
Improving cultural competency and practicing cultural humility in dermatologic training: Skin of colour education and board certification
The authors of this paper discuss shortcomings related to skin of colour education they identify in the current U.S. dermatology residency programs.
In particular, they note that only 52% of chief residents in a U.S. survey reported didactics on skin of colour, and more than 50% of residents felt that more than one month of dedicated training is required to learn about skin of colour.
“The lack of cultural humility in the training paradigm prevents dermatologists from effectively treating darker-skinned patients and perpetuates patients' historically rooted fears of exploitation,” they write.
To address some of these limitations in skin of colour didactics, the authors suggest that all training programs should have a skin of colour core. Measures could involve recruiting darker-skinned standardized patients, inviting guest lecturers on skin of colour topics, and coordinating resident rotations at institutions with ample skin of colour caseloads.
They also recommend dedicated training on cultural humility and people of colour be required for residents in the Accreditation Council for Graduate Medical Education-certified programs.
The authors write that board certification exams should also assess what is “essential” to know related to skin of colour.
VIDEO: Psoriasis in Skin of Colour
Dr. Seemal Desai offers tips on how to diagnose and treat psoriasis in skin of colour and shares resources dermatologists can use to feel more confident providing care to these patients. He is President and Medical Director for Innovative Dermatology, PA, in Plano, Texas, and Clinical Assistant Professor of Dermatology at the University of Texas Southwestern in Dallas.
At the intersection of skin and society
Toronto City Council recently voted to celebrate Canada’s first two Black doctors by installing a pair of plaques close to where they lived, studied, and practiced.
The news outlet notes that Drs. Alexander Augusta and Anderson Abbott lived in Toronto in the 19th century.
“Our mission as a charity is to share these stories, to tell these stories, to tell the important stories that people need to know because they haven’t really been shared widely in the past,” Chris Bateman, plaques program manager at Heritage Toronto, is quoted saying.
He notes that Drs. Abbott and Augusta have different but legitimate claims to the title of first Black doctor in Canada.
Dr. Augusta was born in the U.S. but could not study medicine there, so travelled to Canada for education and worked as a pharmacist on Yonge St. in Toronto.
The other physician, Dr. Abbott, was born in Toronto in 1837. His parents had immigrated from Alabama three years earlier after a store they operated was ransacked. Dr. Abbott apprenticed in medicine under Dr. Augusta and was licensed in 1862, making him the first Canadian-born Black doctor.
Both physicians also participated in the U.S. civil war, enlisting with the Union army—being two of eight Black doctors who did so.
After that war, Dr. Abbott returned to Canada, married and moved to Chatham, Ont. and became that area’s first Black coroner. He also became a Black community advocate and campaigned against racially segregated schools in Canada. In 1894 Dr. Abbott returned to the U.S., becoming the Surgeon-in-Chief at Chicago’s Provident Hospital, the first Black-owned hospital in that country.
Eventually, he returned to Toronto, where he continued to practice medicine while also writing for local publications on a variety of subjects until passing away in 1913.
The two plaques are to be installed by the end of 2022. Dr. Abbott’s plaque is expected to be erected near the intersection of College Street and Spadina Avenue, close to where he once lived. Dr. Augusta’s plaque will be installed at the northwest corner of College Street and University Avenue.
June is National Indigenous History Month in Canada
June 1 is Global Day of Parents
June 5 is World Environment Day
Something to think about in the week ahead. . .
In our next edition, we cover a talk given by Dr. Jaishree Sharad on microneedling in skin of colour. Dr. Sharad is a cosmetic dermatologist in Mumbai, India and a past Vice President of the Cosmetic Dermatology Society of India. She presented her work at the 2021 annual meeting of the American Academy of Dermatology.
Indigenous Skin Spectrum Summit
Registration is open for the 2022 Indigenous Skin Spectrum Summit which will be held on Sat. June 11, 10:00 AM to 2:00 PM EDT.
First held in March 2021, the Indigenous Skin Spectrum Summit is a special session of the Skin Spectrum Summit addressing specific challenges in treating Canada’s Indigenous community.
The second Indigenous Skin Spectrum Summit will be held during National Indigenous History Month in Canada. As we recognize the history, heritage and diversity of First Nations, Inuit and Métis peoples in Canada, we must also acknowledge the persistent health gaps that these communities experience.
Learning objectives for the event are:
Be able to identify skin disorders in richly pigmented skin and recognize prevalent dermatologic diseases in Indigenous populations
Improve diagnosis of dermatologic conditions in First Nations, Inuit, and Métis patients
Understand how historical and systemic factors contribute to health gaps for Indigenous people
Understand how NIHB program coverage works for treating skin conditions
Adopt an experience-based approached to more effectively manage Indigenous patients and the unique treatment challenges they may face
Register for the 2022 Indigenous Skin Spectrum Summit here: