Abstract
Being a good physician means having the ability to recognize diseases in all kinds of individuals. This is especially true for skin lesions (e.g., acne, cancer), which present differently based on skin color and tone. Developing skin-tone-dependent diagnosing skills depends on the medical education (e.g., lectures, medical textbooks, and online board certification prep resources) and hands-on clinical experiences doctors receive. We find it alarming that medical students' gold standard resources overrepresent light skin and underrepresent dark skin to the point where many medical students can recognize a lesion on white skin but fail to recognize a similar lesion on dark skin. This lack of representation perpetuates race as a social determinant of health, leading to missed diagnoses and diagnosis at a later/worse stage in people of color. To combat this underrepresentation within medical education, we propose the Liaison Committee on Medical Education (LCME) amend Accreditation Standard 7: Curricular Content, Subsection 7.6: Cultural Competence and Health Care Disparities. The amendment is to include 1 of the 2 following policy changes, with preference for the top-down mandate: 1) Top-down Mandate: An objective measure and subsequent goal (1:1 representation) for the representation of skin of color within a school's medical lectures, which is evaluated by an LCME-approved curriculum committee and mandated for schools wishing to continue to be LCME accredited. 2) Bottom-up Individualized Institutional Goals: A requirement for schools to choose their own goal, create their committee, and evaluate their progress. These progress reports will be submitted to the LCME annually.
Highlights
Dermatological health disparities disproportionately affect patients with skin of color (SoC) leading to delayed treatment courses and increased morbidity and mortality, e.g., finding skin cancer too late and at a worse stage (Fourniquet et al 2019, 06.18; Tripathi et al 2018, 1286–91; Buster et al 2012, 53–viii)
Executive Summary: Being a good physician means having the ability to recognize diseases in all kinds of individuals. This is especially true for skin lesions, which present differently based on skin color and tone
We find it alarming that medical students' gold standard resources overrepresent light skin and underrepresent dark skin to the point where many medical students can recognize a lesion on white skin but fail to recognize a similar lesion on dark skin
Summary
Dermatological health disparities disproportionately affect patients with skin of color (SoC) leading to delayed treatment courses and increased morbidity and mortality, e.g., finding skin cancer too late and at a worse stage (Fourniquet et al 2019, 06.18; Tripathi et al 2018, 1286–91; Buster et al 2012, 53–viii). Of the many factors that contribute to this disparity, one factor that is education-dependent and physiciandependent is a lack of familiarity with disease presentation in patients with SoC (Wang et al 2015; Ezenwa et al 2021) This lack of familiarity stems from a lack of representation of SoC within books that teach dermatology, resources for board exam preparation, and school lectures. This point is driven home by studies showing that medical students are less accurate in diagnosing dermatological conditions such as squamous cell carcinoma, atopic dermatitis, and urticaria in patients with SoC (Fenton et al 2020, 957–58). In the light of demographic trends, we recognize an absolute need for diversity in skin www.sciencepolicyjournal.org images used during medical school and propose an approach that we believe would be both realistic and effective
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