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Improving educational representation with AI
A new system automates measuring the representation of skin tones in dermatology education documents (1,400 words, 7 minutes)
Artificial intelligence could be used to automate the process of detecting unequal representation of skin tone in medical educational materials.
“Unfairness in the teaching materials equates to unfairness in society,” said Roxana Daneshjou, a dermatologist and biomedical data scientist at Stanford University, in a press release.
Dr. Daneshjou and her colleagues recently authored a study introducing the Skin Tone Analysis for Representation in EDucational materials (STAR-ED) framework that uses machine learning to assess bias in skin tones in frequently used medical training materials.
According to the paper, STAR-ED extracts text, images, and table entities from documents, identifies images containing skin, segments the skin-containing parts of those images, and estimates the skin tone.
“We’re turning the AI-bias storyline on its head a little bit,” Dr. Daneshjou said. “There’s lots of news out there of bias in AI models, but in this case, we’ve trained an AI model that detects human bias.”
STAR-ED was developed using the Fitzpatrick17k dataset, an annotated collection of 16,577 clinical images sourced from two dermatology atlases that are labelled with Fitzpatrick skin type.
When Dr. Daneshjou and the other researchers tested STAR-ED on four commonly used medical textbooks, they found the system had a strong performance in detecting skin and classifying skin tones.
The system showed that in the four tested textbooks, Brown and Black skin tones (Fitzpatrick V-VI) images constituted only 10.5% of all skin images.
“We envision STAR-ED helping medical educators, publishers, clinicians, and even students quickly and more easily assess their educational materials for skin-tone bias,” Dr. Daneshjou said.
Bottom line: Artificial intelligence has the potential to automate the process of screening medical educational materials for a balanced representation of skin tones. More balanced educational materials could translate to earlier, more frequent, more accurate dermatologic diagnoses for underserved populations.
From the literature on skin of colour dermatology education
The power of representation in educational materials: Teaching cutaneous lupus across skin tones in an interactive module
The authors of this paper note clinicians report having low confidence in assessing cutaneous lupus erythematosus (CLE) lesions, especially for patients who identify as Black, Indigenous, and People of Color (BIPOC), who have not been well represented in medical educational materials.
This paper describes the development of an online, interactive module for teaching an approach to assessing CLE across skin tones, and the measurement of its impact on medical knowledge and confidence. The developed module uses a case-based approach to introduce an approach to CLE, common mimicking rashes, and tips for photographing cutaneous lesions in BIPOC.
Graduate medical trainees from five academic institutions completed the module. Using surveys and pre-post testing, researchers assessed changes in medical knowledge and clinical confidence along with learner satisfaction among the trainees. The authors also assessed the module's representation of light, medium, and dark skin tones.
Of the 102 images representing light, medium, and dark skin tones, 79 (77.5%) were novel images from authors' personal libraries.
Ninety-four participants completed the post-module test and evaluation survey.
Investigators found there was a significant improvement in medical knowledge identifying serologic studies associated with subacute CLE and describing how to photograph rashes. Participants reported improved confidence across all learning objectives after module completion.
Mitigating diagnostic performance bias in a skin-tone balanced dermatology curriculum
This study was conducted to see if a skin-tone balanced dermatology curriculum would help mitigate diagnostic performance bias related to skin tone.
Researchers conducted a prospective, randomized intervention study over two weeks in 2020 at a Canadian medical school, choosing a convenience sample (167) from all first-year medical students, of which 92 participated.
In week 1, all participants had access to dermatology podcasts and were randomly allocated to receive non-analytic training (NAT) involving online patient 'cards' on either skin of colour (SOC) cases or light skin (LS) cases. In week 2, all participants received combined training (CT) with both NAT and analytic training through workshops on how to apply dermatology diagnostic rules for all skin tones.
After week 1, both students trained on SOC or LS cards had a lower diagnostic performance on SOC. The researchers observed a significant decrease in mean skin tone difference in both groups after week 2. Five students participated in a post-study survey in 2023, and all found the curriculum enhanced their diagnostic skills in SOC.
In their conclusion, the investigators write that SOC performance biases of medical students disappeared after CT in a skin tone-balanced dermatology curriculum.
Anogenital skin of colour images are underrepresented in dermatology, gynecology, and urology educational textbooks
The authors of this paper note even in high-risk skin cancer clinics, genitalia is often excluded from skin examinations, and this exclusion is particularly relevant for skin of colour (SOC) patients, where melanoma more frequently involves the anogenital region.
To evaluate anogenital images and representation of SOC in commonly used residency textbooks the authors evaluated anogenital SOC images in nine educational textbooks often utilized by dermatology, gynecology, and urology residents, as well as in a genital dermatology atlas.
Researchers classified all photographs as light (Fitzpatrick skin types [FST] I–IV), dark (V or VI), or indeterminate when the classification was not possible. They excluded duplicate, black-and-white, and inconclusive images. Supplementary online images were included. Two of the authors independently reviewed all images, with discrepancies resolved by senior authors.
Overall, investigators found anogenital images in SOC patients were lacking. STIs were overrepresented in SOC images, including a genital dermatology atlas. The authors write that these discrepancies may create implicit bias in learners and lead to an erroneous diagnosis of STIs in SOC patients with anogenital inflammatory or neoplastic dermatoses.
“Increased efforts to expand SOC images in medical textbooks should also focus on the inclusion of SOC anogenital images, with a particular emphasis on non-infectious genital conditions including inflammatory dermatoses as well as pigmented lesions,” they write.
Improving diagnostic accuracy in skin of colour using an educational module
This study was conducted to evaluate the effectiveness of a focused educational module for improving diagnostic accuracy and confidence in the treatment of patients with SOC among interprofessional healthcare providers.
The investigators created a module involving a pretest, 15-minute lecture, immediate post-test, and three-month post-test.
Interprofessional health care providers including medical students, residents or fellows, attending physicians, advanced practice providers, and nurses practicing across various medical specialties at The University of Texas at Austin Dell Medical School and Ascension Medical Group were invited to participate in the study.
In all, 100 participants completed the pretest and immediate posttest; 36 of them also completed the three-month post-test.
The authors write that their results suggest that a focused educational module may provide long-term improvements in diagnostic accuracy and confidence for conditions.
VIDEO: Leaders in dermatology on diversity in research and technology
Maryam Sadeghi, PhD, CEO & Co-founder, MetaOptima Technology Inc. and Cheryl M. Burgess, Assistant Clinical Professor at Georgetown University and The George Washington University discuss the importance of diversity and inclusion in clinical research, trials and development of emerging technologies in dermatology with Bloomberg’s Duane Wright
At the intersection of skin and society
The 2023 Legacy Awards, honouring outstanding domestic and global achievements of Black Canadians, will be available on CBC and CBC Gem on Sunday, Sept. 24, 2023, at 8:00 p.m. EST.
These awards recognize Black Canadians in the fields of arts, entertainment and sports, with special awards highlighting excellence in business and entrepreneurship, fashion and design, science and technology, philanthropy and humanitarian endeavours.
In a press release, Building A Legacy in Acting, Cinema and Knowledge (B.L.A.C.K.) Canada announced the first four recipients of the 2023 Legacy Awards: Canadian screen industry “godmother” Tonya Williams, filmmaker Julien Christian Lutz (also known as Director X), platinum-selling artist Jully Black, and singer-songwriter LU KALA.
B.L.A.C.K. Canada is a community-based not-for-profit organization with the goal of facilitating the development of young and emerging Black talent in the entertainment industry.
“Honouring Jully, Tonya, X, and LU is a no-brainer for The Legacy Awards,” said Shamier Anderson, co-founder of The Black Academy and executive producer of The Legacy Awards, in the release. “This year’s recipients all perfectly embody what we stand for: they epitomize Black excellence and are at the top of their game in their respective fields.”
“Our priority is to showcase Black talent and to share the remarkable achievements of our community with the entire country—especially young Canadians—so that they can be inspired by these exceptional role models,” said Stephan James, co-founder of The Black Academy and executive producer of The Legacy Awards.
Sept. 18 to 22 is Fungal Disease Awareness Week
September is Sexual Health Month in the U.S.
September is Childhood Cancer Awareness Month
Something to think about in the week ahead. . .
—David Brinkley, U.S. journalist, [1920-2003]
Events of interest: GLIDE 5.0
Drs. Perla Lansang and Neil Shear announce the 2023 edition of Great Lakes Immunodermatology Exchange (GLIDE 5.0) in which we will focus on new concepts, therapeutic options, and real-world practice issues in immunodermatology. Immune diseases and immune-based therapies continue to evolve, and the new landscape — and challenges — are exciting.
The faculty includes leading Canadian and international immunodermatology experts. There will be ample opportunity for audience participation, discussion and networking with faculty and other participants.
The meeting organizers ask you to mark your calendars for October 27-28, 2023 at the Queen’s Landing Hotel in Niagara-on-the-Lake, Ont.
Los Angeles-based dermatologist Dr. Sanusi Umar, head of the scalp and hair disorder section at Harbor-UCLA's dermatology division, and his colleagues have identified a shared precursor condition between acne keloidalis nuchae and primary cicatricial alopecias. This finding could be important for the diagnosis and treatment of these conditions.
If you like Skin Spectrum Weekly, why not check out Chronicle’s other publications, podcasts, and portal?
Established in 1995, The Chronicle of Skin & Allergy is a scientific newspaper print providing news and information on practical therapeutics and clinical progress in dermatologic medicine. The latest issue features:
Drs. Lisa Kellett (Toronto), Michal Martinka (Calgary), and Jaggi Rao (Edmonton) discuss strategies for optimizing the management rosacea.
In a therapeutic update, Drs. Marcie Ulmer (Vancouver), Jen Lipson (Ottawa), and Sonya Cook (Toronto), detail current and upcoming advances in acne treatments.
An essay from Dr. Nickoo Merati (Montreal) submitted to the 2022 Dermatology Industry Taskforce on Inclusion, Diversity and Equity (DiTiDE) short essay contest. Dr. Merati wrote about the importance of people with skin of colour to “see” their community members represented at decision-making tables to rise to their full potentials. The essay also touches on efforts by Canadian medical students to improve the representation of skin of colour in dermatology education materials.
Plus regular features, including the popular column “Vender on Psoriasis” by Hamilton, Ont. dermatologist Dr. Ron Vender
Read a recent digital edition of The Chronicle of Skin & Allergy here. To apply for a complimentary* subscription or to receive a sample copy, please email firstname.lastname@example.org with your contact information.
The Women in Dermatology e-newsletter updates new findings concerning dermatologic issues that affect women and the female dermatologists who care for them. Read the current issue here.
Season two of the Yadav on Acne podcast with Dr. Geeta Yadav has launched. Listen to the new season here. In episode one, Dr. Yadav comments on recent research into managing moderate-to-severe acne using isotretinoin.
And if you’re looking for a web destination for all things derm, visit derm.city, “Where Dermatology Lives.” Please like, rate, review, and share it with your colleagues.