Skin Color Representation in Teaching Photographs: One Institution's Approach to Addressing Visual Racism in Medical Education

Academic Health Sciences Library Develops Novel Online Teaching and Learning Resource for Dermatology

Primary care providers and medical students often receive limited dermatologic education, leading to delayed diagnosis and treatment for patients with cutaneous conditions. Additionally, dermatology education has historically focused on light skin, neglecting skin of color, which exacerbates diagnostic delays and treatment disparities. The University of Utah's Eccles Health Sciences Library and Department of Dermatology, along with Oregon Health & Science University, developed Utah Dermatology Education Resources & Modules (UtahDERM) to address these educational gaps. UtahDERM features a custom-built slide-viewer platform with clinical dermatology images, diagnoses, clinical characteristics, and textbook references, along with a quick reference tool for core dermatology diagnoses.

Skin of Colour Education Initiatives Among Dermatology Residents: A Narrative Review

BACKGROUND

Achieving comprehensive education in skin of colour (SoC) dermatology presents a multifaceted challenge for dermatology trainees. Exposure to diverse skin tones in didactic curricula and clinical encounters varies greatly based on geographic location and institution and, as a whole, remains disparate. While SoC education initiatives for medical students and residents have increased in recent years, the characteristics and outcomes of initiatives specifically tailored to dermatology residents have not been summarized.

OBJECTIVES

(1) Outline the demographic features of participants; (2) summarize intervention characteristics and the metrics by which educational impact was defined.

METHODS

MEDLINE, Embase, and PubMed were searched for SoC education interventions aimed at dermatology trainees.

RESULTS

Five studies were selected for inclusion. Two hundred thirty-seven dermatology residents participated from institutions across the United States, United Kingdom, Australia, and Botswana. Most interventions were didactics based, assessed changes in subjective confidence, and employed identical pre- and posttest questions. Confidence increased for didactic-only interventions, decreased with multimodal interventions, and was incongruent with objective knowledge or diagnostic scores. Single-format interventions or assessments with identical pre- and posttest questions may provide an inflated sense of confidence through recall bias or other heuristics. Conversely, the cognitive synthesis afforded by multimodal interventions or new (but equivalent) assessment questions may lead to low confidence ratings despite improved knowledge scores.

CONCLUSIONS

When designing SoC learning initiatives in postgraduate dermatology education, multimodal formats, and paired objective and subjective assessments that employ both identical and different pre- and post-intervention questions may give a more relevant and accurate reflection of impact in clinical practice settings.

Interventions addressing systemic racism in the US: A scoping review

Previous studies have reported on the health impact of systemic racism among historically oppressed populations. In fact, there is an emerging body of literature, including systematic reviews, which describe the negative health consequences of systemic racism among racial/ethnic minoritized groups in the US. Less is known, however, about effective intervention strategies to address systemic racism and the resulting health inequities. This scoping review was conducted to synthesize the published literature on U.S.-based interventions designed to improve health equity by addressing systemic racism. The Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review (PRISMA-ScR) checklist was used to report this review. We searched six databases (MEDLINE, CINAHL, PsycINFO, Sociological Abstracts, Web of Science Core Collection, and Scopus) to examine the intervention studies. A total of 172 articles were included in review. These interventions were classified by typology which included healing-centered approaches, community-based interventions targeting health disparities, diversity, equity, inclusion (DEI) efforts, anti-racism training interventions, and policy interventions. The findings from this review have important implications for the development, testing, and scaling of interventions designed to addressed systemic racism.

An Analysis of the Diversity of Skin Colour Representation in Paediatric Nursing Practitioner Textbooks

AIMS

Our study aims to analyse 8 commonly used textbooks to determine how diverse skin tones are represented in paediatric nursing practitioner education.

DESIGN

Literature reviewed from 2016 to 2024 demonstrated that the lack of darkly pigmented skin colour representation in health science education leads to diminished patient outcomes for these populations. Our study sought to study representation teaching images and eight commonly referenced nursing textbooks were chosen for this study, given their use in paediatric nurse practitioner education. Of the eight textbooks selected, five were analysed based on inclusion criteria.

METHODS

Two investigators trained in skin prototyping coded each textbook for skin colour representation and coded during 2023-2024. Coders used the widely accepted prototyping scale, the Fitzpatrick Scale (range I-VI, with I being the lightest colour skin and VI the darkest). Teaching photographs were defined as all photos used to provide insight into a disease or diagnostic technique that included human skin. Two individual coders coded and documented data, ensuring each coder was blinded to the overall results.

RESULTS

Our analysis of 5 textbooks revealed that 2112 images met the criteria as teaching images. Of the 2112 teaching images, 593.5 included images of type IV-VI skin (darkly pigmented skin), resulting in a 28% representation of dark skin tone images. Additionally, 2 of the 82 total illustrations included patients with dark skin tones, indicating a representation of 2.5%. However, chapters addressing conditions of child abuse/neglect (55.95%) and stigmatised social issues (infectious disease, 54.88%) displayed a disproportionate representation of patients from these demographics.

CONCLUSIONS

Our results highlight the importance of enhancing equitable representation in educational resources for nursing practitioners.

IMPLICATIONS FOR THE PROFESSION/ PATIENT CARE

There is room to collaborate with other health science institutions to establish clear guidelines for future improvement in expanding teaching images to include diversity representation in education.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Breast Pain Differential: Mondor's Disease of the Breast

Breast pain is a common concern among women in primary care clinics. A rare cause of breast pain is Mondor's disease (MD), which can present as an acute, painful, erythematous, cord-like induration on the breast or anterior chest wall. The disorder is caused by sclerosing superficial thrombophlebitis of the anterolateral thoracoabdominal wall veins. There does not appear to be a racial or ethnic propensity for this condition; however, it is important to understand that it may be more difficult to see in darker skin types (Fitzpatrick skin types IV-VI) and requires close attention on physical exam. The cause of MD is poorly understood but may be related to direct trauma, strenuous exercise, or hormone changes. We review a case of a 54-year-old woman who presented with an anterior chest wall palpable cord, better visualized with adequate lighting and skin traction, ultimately diagnosed as MD based on clinical findings and imaging studies. Mondor's disease often resolves spontaneously with supportive care, as in this patient's case; however, clinicians should be aware of this rare cause of breast pain and its association with hypercoagulable state, vasculitis, and breast cancer.