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Topic Racial Bias: If you graduated medical students and they could not.......

  • 1.  Topic Racial Bias: If you graduated medical students and they could not.......

    Posted 07-21-2020 08:55

    Would we (or should we) graduate a medical student if they could not perform an adequate (hopefully excellent) exam of the heart and lungs, or abdomen, or the neurologic system?  Then why are most medical students unable to perform the physical exam of the skin and describe it's physical exam features well? And in particular a rash in a patient with deeply pigmented skin?

     

    In 2006 we wrote in the Journal of the American Academy of Dermatology  (JAAD) the attached "Disparities in Dermatology Educational Resources" (https://pubmed.ncbi.nlm.nih.gov/17010750/ )  regarding disparities in knowledge in the dermatology textbooks and meetings. We showed how underrepresented images of skin of color were in the leading resources and meetings and discussed how important it is to perform the skin exam well in a patient of color as many serious inflammatory and infectious  diseases  are first diagnosed by a skin clue.  In June,  Hao Feng MD at U Conn published in the JAAD "Representation of dark skin images of common dermatologic conditions in educational resources: a cross-sectional analysis" https://pubmed.ncbi.nlm.nih.gov/32565205/ and showed our group's progress in this area relative to other resources, and how the textbooks were mostly still lagging behind.    It should be noted that there is a rich history of dermatologists have been authoring wonderful textbooks and journal articles specifically for improving diagnosis in skin of color but these textbooks are not mainstream (but should be!). 

     

    Many on this list know that improving diagnosis is not a financial priority of our health system.  Improving diagnosis in skin of color has been even less so.

     

    This generation of students and residents are demanding impactful actions rather than just words of solidarity.  In our work over the past two decades what we have seen is that a few Deans of Education, hospital CMO's, CMIO's, CQO's have made equity in knowledge a priority,  but many others have simply not.   

     

    Here is an OpEd published yesterday on this topic  https://www.statnews.com/2020/07/20/to-begin-addressing-racial-bias-in-medicine-start-with-the-skin/

     

    Any educators that would like to learn more about our work on this and is interested in impact please contact me off the list serv.  Thanks.

     

    Best

    Art

     

    Art Papier MD

    CEO VisualDx

     

    Associate Professor of Dermatology and Medical Informatics

    University of Rochester College of Medicine

     

     

     



  • 2.  RE: Topic Racial Bias: If you graduated medical students and they could not.......

    Posted 07-21-2020 09:29
    Dr. Papier,

    Thank you for raising all of these important points.

    When my physical therapist wanted to show me a muscle group recently, he hauled out his "A.D.A.M"  book of anatomy-a book featuring white men's anatomy only.  
    For so many of us alienated from a health are system that sometimes seems unable to even perceive our difficulties, the book of A.D.A.M. seemed like one more reason for this failure.

    Time to update and write new texts to include the rest of humanity?



    Sherrill Franklin
    129 E. Harmony Road
    West Grove, PA 19390
    610.869.4234











  • 3.  RE: Topic Racial Bias: If you graduated medical students and they could not.......

    Posted 07-21-2020 15:02
    Thanks Art,

    There are so many issues that need addressing which may be far more important than any diagnostic bias we discuss.

    I strongly believe that any committee/body making recommendations in medicine should have adequate representatives from the intended group of people being discussed.

    That does not always exist.

    With medical education are medical students adequately represented in any proposed changes to medical  education?

    Rob Bell, M.D.







  • 4.  RE: Topic Racial Bias: If you graduated medical students and they could not.......

    Posted 07-22-2020 12:26
    Awesome op-ed, Art. Ensuring equity within medical knowledge itself is at the heart of the matter and we can no longer afford or continue on ignorance here. It's exciting to see more educational resources being created for future generations of physicians to be able to adequately and accurately see disease as it expresses across phenotypes, which of course is the starting point for reliably contributing to care rather than harm for all humans. I continue to update my own curricula on observation in medicine and would love to learn more about what you're working on as well as others in this group so as to collaborate on impact.




    -----------------------

    Alexa Miller, M.A.









  • 5.  RE: Topic Racial Bias: If you graduated medical students and they could not.......

    Posted 07-23-2020 07:45

    Alexa,

    Thanks for your message.  We placed some images at in the middle of this page.  https://www.visualdx.com/diversity 

    We are working with the Skin of Color Society https://skinofcolorsociety.org/  on a lecture series and other programs.  More to come soon! 

    Best

    Art