Impact of Diversity in Training Resources on Self-Confidence in Diagnosing Skin Conditions Across a Range of Skin Tones: An International Survey.

Danilo Buonsenso,Damian Roland,Jo-Fen Liu,Tessa Davis,Dhurgshaarna Shanmugavadivel

doi:10.3389/fped.2022.837552

Abstract

BackgroundMedical images are invaluable in facilitating recognition of clinical signs. Recent studies highlight a lack of diversity of skin tone images used within medical education. However, there is a paucity of data on the impact of this on patient care.AimsTo investigate diversity in training resources used by users of an International online teaching platform and self-confidence in diagnosing skin conditions in all skin tones.MethodsUsers of an online teaching platform (www.dftbskindeep.com) were invited to participate in a survey evaluating key points including geographical location, ethnicity, profession, specialty, years of experience, training resources and confidence in diagnosing skin conditions. Data analyses were performed using SPSS. Categorical variables were presented as proportions. Chi-squared or Fisher's exact tests were used to compare the distribution between groups as appropriate.ResultsOf 600 participants, 74% reported training resources featuring predominantly white skin. Participants were “generally uncertain” in 43% cases, “sometimes uncertain but clinically safe” (52%), and “confident across a range of skin tones” in a minority (5%). Self-confidence was associated with location [higher in Africa (29%) and Latin America (11%), (p < 0.001)]; diversity of training resources [higher with a mix (10%) or darker tones (20%) (p < 0.001)]; clinical experience [6–10 (5%) or >10 years of practice (11%) (p < 0.001)] and specialty [highest in dermatologists (53%, p < 0.001)]. Self-confidence was lowest among pediatricians, emergency medicine and pediatric emergency medicine specialists (<5%).ConclusionsThese data provide preliminary evidence that training resources used by healthcare professionals on a global scale may lack enough diversity on representation of skin images, and a lack of self-confidence in diagnosing pediatric skin conditions. Further work is needed to understand the impact on knowledge and patient care to ensure equitable healthcare for all.

Highlights

Race, a recognized social determinant of health, has a profound impact on the health status of children, adolescents, emerging adults, and their families1,2
Inequalities extend from education to research with evidence that children with darker skin tones have a lower probability of inclusion in clinical trials [8]
Whilst evidence shows that Afro-Carribean and Asian patients experience a more severe illness course from COVID-19 [9], a systematic literature review demonstrated that articles describing the cutaneous manifestations of COVID-19 almost exclusively used clinical images from patients with light skin tones, with no single published images of darker skin tones (Fitzpatrick type V or VI) [10]

Summary

Introduction

A recognized social determinant of health, has a profound impact on the health status of children, adolescents, emerging adults, and their families. Whilst evidence shows that Afro-Carribean and Asian patients experience a more severe illness course from COVID-19 [9], a systematic literature review demonstrated that articles describing the cutaneous manifestations of COVID-19 almost exclusively used clinical images from patients with light skin tones, with no single published images of darker skin tones (Fitzpatrick type V or VI) [10]. This has the potential implication that patients, including children, with darker skin tones are more likely to experience a delayed or incorrect diagnosis compared to their lighter skin tone counterparts. There is a paucity of data on the impact of this on patient care

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Conclusion