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.
Art Papier MD
Associate Professor of Dermatology and Medical Informatics
University of Rochester College of Medicine
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!