Integrating skin of color and sexual and gender minority content into dermatology residency curricula: A prospective program initiative

Abstract

To the Editor: The integration of skin of color (SOC) and sexual and gender minority (SGM) content in dermatology residency curricula has been limited and inconsistent.1Nijhawan R.I. Jacob S.E. Woolery-Lloyd H. Skin of color education in dermatology residency programs: does residency training reflect the changing demographics of the United States?.J Am Acad Dermatol. 2008; 59: 615-618Google Scholar,2Jia J.L. Nord K.M. Sarin K.Y. Linos E. Bailey E.E. Sexual and gender minority curricula within US dermatology residency programs.JAMA Dermatol. 2020; 156: 593-594Google Scholar Poor exposure to SOC and SGM content may lead to cognitive biases in clinical practice and may inadequately prepare dermatology residents to care for diverse patient populations.2Jia J.L. Nord K.M. Sarin K.Y. Linos E. Bailey E.E. Sexual and gender minority curricula within US dermatology residency programs.JAMA Dermatol. 2020; 156: 593-594Google Scholar, 3Alvarado S.M. Feng H. Representation of dark skin images of common dermatologic conditions in educational resources: a cross-sectional analysis.J Am Acad Dermatol. 2021; 84: 1427-1431Google Scholar, 4Lester J.C. Taylor S.C. Chren M.M. Under-representation of skin of colour in dermatology images: not just an educational issue.Br J Dermatol. 2019; 180: 1521-1522Google Scholar, 5Fenton A. Elliott E. Shahbandi A. et al.Medical students' ability to diagnose common dermatologic conditions in skin of color.J Am Acad Dermatol. 2020; 83: 957-958Google Scholar Dermatology residency programs acknowledge the importance of education on such topics and needs assessment data suggest that longitudinal integration is preferable to stand-alone lectures.2Jia J.L. Nord K.M. Sarin K.Y. Linos E. Bailey E.E. Sexual and gender minority curricula within US dermatology residency programs.JAMA Dermatol. 2020; 156: 593-594Google Scholar From July 2019 to June 2020, Stanford dermatology residency leadership sought to improve longitudinal didactic exposure to SOC and SGM content. Faculty invitations for resident didactics included language about goals to improve SOC and SGM content and encouraged faculty to make changes to their lectures. The faculty were then surveyed within 4 weeks of their lecture to understand changes made and barriers to change. Of the 66 faculty lecturers surveyed, 59 (89%) responded. Twenty-five (42.4%) faculty lecturers reported adjustments to improve SOC and SGM curricula. Of the 25 who made changes, 21 (84.0%) reported adding SOC images and 9 (36.0%) reported adding topics (7 SOC and 2 SGM). All respondents who made changes described it as “not burdensome at all (score of 1)” or “slightly burdensome (score of 2)” on a 5-point Likert scale, with 5 being “most burdensome.” Faculty lecturers who described the change as “slightly burdensome” highlighted access to images as a barrier. Thirty-four (57.6%) faculty lecturers did not make changes, although 11 (32.3%) reported that they had previously made applicable additions. Others reported reasons for no changes, which included the absence of relevant topics (12; 35.3%) and images (7; 20.6%) and the lack of access to images (10; 29.4%). Of the 29 faculty lecturers who offered qualitative perspectives, 2 themes emerged: faculty recognize the importance of improving trainee exposure to SOC and SGM content and access to resources remains a critical barrier to topic integration. The faculty are willing to improve SOC and SGM content and image diversity in residency education. Over half of the faculty lecturers had previously included SOC and SGM topics and images or had made efforts to do so once it was recommended to them. Offering accessible content and image resources to faculty may further reduce the most commonly identified barrier to implementation. We have collated a table of SOC and SGM content and image-based atlases, as well as cultural training resources, which faculty may find helpful when designing educational material and teaching these topics to trainees (available upon request). Table I also contains topics related to SOC and SGM that may guide the efforts of program leadership to include this information in curricula, although this represents only a partial list.Table IPotential skin of color and sexual and gender minority health curricular topics∗This partial list of potential topics is based on educational material from the Skin of Color Society and past needs assessment survey data of residency program curricula.1,2 We recommend that faculty members consider opportunities to integrate SOC and SGM content in all lecture preparations to encourage inclusion throughout the curriculum.SOC topics Alopecias and hair pathologies in patients with SOC Autoimmune diseases epidemiology and presentation in SOC (including vitiligo, etc) Cosmetic procedures and skin renewal treatments for SOC Dermatologic diagnoses presenting more commonly in SOC (including melasma, lichen planus pigmentosus, postinflammatory hyperpigmentation, keloids, etc) Invasive and noninvasive treatment options for hyperpigmentation and scarring in SOC Photoprotection for SOC Presentation of common dermatoses in patients with SOC (including acne, psoriasis, eczema, etc) Skin cancer risk in patients with skin of colorSGM topics Cosmetic procedures and injectables for transitioning patients Dermatologic concerns related to HIV/AIDS Gender-affirming surgeries and related dermatologic concerns Hormone therapies and related dermatologic concerns in SGM populations Pronoun use and appropriate SGM-oriented history taking/physical examination Puberty blockers and associated dermatologic concerns Skin cancer risk in SGM populationsSGM, Sexual and gender minority; SOC, skin of color.∗ This partial list of potential topics is based on educational material from the Skin of Color Society and past needs assessment survey data of residency program curricula.1Nijhawan R.I. Jacob S.E. Woolery-Lloyd H. Skin of color education in dermatology residency programs: does residency training reflect the changing demographics of the United States?.J Am Acad Dermatol. 2008; 59: 615-618Google Scholar,2Jia J.L. Nord K.M. Sarin K.Y. Linos E. Bailey E.E. Sexual and gender minority curricula within US dermatology residency programs.JAMA Dermatol. 2020; 156: 593-594Google Scholar We recommend that faculty members consider opportunities to integrate SOC and SGM content in all lecture preparations to encourage inclusion throughout the curriculum. Open table in a new tab SGM, Sexual and gender minority; SOC, skin of color. Interested faculty may also wish to join the Skin of Color Society and the American Academy of Dermatology Expert Resource Group on LGBTQ (lesbian, gay, bisexual, transgender, and queer) and SGM health, where faculty share educational best practices and resources. The American Academy of Dermatology has recently announced efforts to build a centralized SOC curriculum for residents, which may help programs meet this need. Study limitations include potential recall bias and single institution design. Improving resident education by integrating SOC and SGM content is an important step toward mitigating disparities and improving care for the patients we serve. Author Jia is a member of the American Academy of Dermatology Expert Resource Group on LGBTQ/Sexual and Gender Minority Health. Drs Gordon, Lester, Linos, Nord, and Bailey have no conflicts of interest to declare.