Skin of colour diagnosis by medical students remains poor
Survey reveals second-year students lack ability and confidence in dermatology diagnosis in darker skin (1,300 words, 6 minutes)
Findings from a survey of first- and second-year medical students exploring their ability and confidence in diagnosing dermatologic conditions in White skin and skin of colour (SOC) show a need for changes in the preclinical dermatology curriculum to improve diagnostic ability and representation of SOC images in educational resources.
The survey findings were published online before print in Skin Health and Disease (Sept. 3, 2024).
Through email, investigators recruited first- and second-year medical students at the University of Arizona College of Medicine-Phoenix (UACOMP), gathered demographic data, and presented the students with a quiz. The quiz included 15 multiple-choice questions assessing dermatologic diagnostic ability and three Likert-Scale questions asking participants to rate their confidence level in identifying dermatologic conditions in SOC and the diversity of dermatologic resources.
All diagnoses in the quiz are taught in the first six months of the UACOMP curriculum and include Lyme disease, acne, atopic dermatitis, psoriasis, varicella, folliculitis, tinea versicolour, melanoma, hypertrophic scar, urticaria, impetigo, molluscum contagiosum, café au lait maculae, neurofibroma, and port wine stain.
The investigators also assessed the SOC content of the preclinical lectures at UACOMP, finding that 15% of the total images were SOC.
Overall, the students performed similarly well on the White and SOC image surveys, with a mean percentage of correct answers of 61.73% and 66.20% (p=0.28). When the researchers conducted sub-group analyses, there were no statistically significant differences between the White and the SOC image surveys for students who identified as persons of colour (POC) versus those who did not.
Students were more likely to identify psoriasis (p=0.004), varicella zoster (p=0.004), and melanoma (p=0.01) on White skin and neurofibroma (p=0.004) and tinea versicolour (p=0.004) on SOC. Second-year medical students scored better than first-year medical students overall (p=0.01) and on the White image survey scores (p=0.02) but not on POC image survey scores (p=0.09).
The students largely agreed they were more comfortable identifying dermatologic diagnoses on White skin (Likert scale = 4.05) and that more opportunities to identify common skin lesions on SOC would enhance their medical education (Likert scale = 4.56).
Bottom line: The overall low scores support the need for re-exposure to dermatology presentations in all skin types during the preclinical curriculum. The study findings also support the need for changes in the preclinical dermatology curriculum to improve diagnostic ability. Second-year students performed better at diagnosing dermatologic conditions overall and on White skin compared to SOC at the end of their didactic years. This may be due to an underrepresentation of SOC images in institutional and outside educational resources.
From the literature on dermatology in skin of colour
A scoping review of reporting gaps in U.S. FDA-approved AI medical devices
Researchers conducted a scoping review on the 692 U.S. FDA-approved artificial intelligence/machine-learning-enabled medical devices approved from 1995-2023 to examine transparency, safety reporting, and sociodemographic representation.
They found that only 3.6% of approvals reported race or ethnicity, and 99.1% provided no socioeconomic data. Also, 81.6% did not report the age of study subjects. Only 46.1% provided comprehensive, detailed results of performance studies; just 1.9% included a link to a scientific publication with safety and efficacy data. Only 9.0% contained a prospective study for post-market surveillance.
The authors conclude that U.S. FDA reporting data remains inconsistent despite the growing number of market-approved medical devices. Demographic and socioeconomic characteristics are underreported, exacerbating the risk of algorithmic bias and health disparity.
Popular skin-of-colour dermatology social media hashtags on TikTok from 2021 to 2022: Content analysis
Findings from a longitudinal analysis of skin of colour (SOC)–related TikTok hashtags from 2021 to 2022 suggest that non-dermatologist influencers continue to dominate content creation.
This study's investigators compiled 61 SOC-related hashtags from multiple reputable sources, including SOC journal literature, SOC-focused, peer-reviewed social media research, and the Skin of Color Society. They then searched each hashtag on TikTok in Aug. 2022 and compared the findings to previous results from a search in 2021.
Content sources included self-identified U.S. board-certified dermatologists, estheticians, non-U.S. physicians, other healthcare providers, patients, and influencers.
Two independent raters with medical education and dermatology experience categorized each post’s content: “educational” if clearly disseminating medical information, “promotional” if advertising a service or product, and “personal” for all other content.
Self-identified, board-certified dermatologists posted educational content as expected, garnering views and engagement comparable to promotional and personal posts from other sources. Still, they comprised a small fraction of popular TikTok content generators. The study authors say their findings highlight the need for more participation from board-certified dermatologists to actively counter misinformation and address potential disparities in skin-of-color health care.
A retrospective cross-sectional analysis of gender and racial/ethnic diversity trends in dermatology chairs
This cross-sectional study utilizes self-reported demographic data of department chairs by specialty from the Association of American Medical Colleges’ Faculty Roster annual reports from 2000 to 2020. Investigators compared the demographics of dermatology chairs to those of primary and specialty care chairs.
Their findings showed women and underrepresented in medicine physicians were underrepresented among chairs of all specialties. Women were most underrepresented among specialty care chairs but were similarly represented among dermatology and primary care chairs. Black race was represented less among chairs in dermatology than in primary care, but similarly in specialty care. Latinx ethnicity was more represented among dermatology chairs than primary and specialty care. American Indian, Alaska Native, Native Hawaiian, and Pacific Islander chairs were underrepresented across all specialties, but even more so in dermatology.
From 2000 to 2020, the representation of women chairs trended upward in dermatology. However, representation of Latinx ethnicity or Black race among dermatology chairs remained unchanged. The authors say the low overall representation of American Indian/Alaska Native/Native Hawaiian/Pacific Islander chairs precluded any trend analysis of these groups.
VIDEO: Pigment, perception, and rash decision. Dermatology in skin of colour
In this video Grand Rounds presented at the Ottawa Hospital Department of Emergency Medicine, emergency medicine resident Dr. Mejbel Alazemi discusses the importance of cultural competence in dermatology and provides guidance on recognizing common rashes that present in emergency departments in skin of colour.
At the intersection of skin and society
A Federal Court hearing got underway on Oct. 28, 2024, to determine whether a group of Black public servants can proceed with a class-action lawsuit alleging discrimination in the federal government, reports MSN.
The certification hearing, which is happening in Toronto, could last up to 12 days.
According to the news report, the class action comprises approximately 45,000 people who worked for the government from 1970 to the present. They are asking for $2.5 billion in damages for lost salaries and pensions.
The plaintiffs allege widespread discrimination in the public service, citing reports of anti-Black racism at the Canadian Human Rights Tribunal and an internal report on discrimination at the Privy Council Office.
This week
Nov. 3 to 9 is National Pain Awareness Week in Canada
Nov. 4 to 10 is National Pathology Week in the U.K.
Nov. 10 is World Science Day for Peace and Development
Something to think about in the week ahead . . .
—John F. Kennedy, 35th U.S. President (1917 to 1963)
Next week
As part of a presentation at the 4th annual Indigenous Skin Spectrum Summit, Barrie, Ont.-based dermatologist Dr. Megan MacGillivray discusses dermatologic medications covered by Canada’s Non-Insured Health Benefits program for First Nations and Inuit peoples.
If you value Skin Spectrum Weekly, why not check out the Chronicle’s other publications, podcasts, and portal?
Established in 1995, The Chronicle of Skin & Allergy is a scientific newspaper providing news and information on practical therapeutics and clinical progress in dermatologic medicine. The latest issue features:
Dr. Jennifer Beecker (Ottawa) discusses the treatment of alopecia areata, including a range of therapies recently approved in Canada.
Dr. Cathryn Sibbald (Toronto) reviews the treatment of atopic dermatitis in children, with special attention to the biologics and other systemic agents approved in Canada for use in young patients.
Drs. Jenn Tran (Toronto), Jennifer Lipson (Ottawa), Jessica Asgarpour (Toronto), and Maxwell Sauder (Toronto) provide an overview of essential news in acne therapy, including a new topical hormonal therapy and new combination treatments.
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Season three of the Vender on Psoriasis podcast with Dr. Ron Vender has begun. Listen to the new season here. In episode five, Dr. Vender discusses whether vitamin D influences psoriasis severity, sex differences in psoriatic inflammation itch, and the risk of psychiatric disorders associated with acitretin.
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