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Bridging The Gap: Demanding 1-1 Representation of Dark-Light Skin Tones Within Medical Lectures/Resources

Dr.Farouk, CC BY 2.0, via Wikimedia Commons
Journal of Science Policy & Governance | Volume 18, Issue 04 | September 27, 2021

Policy Memo Competition First Place Winner

Policy Memo: Bridging The Gap: Demanding 1-1 Representation of Dark-Light Skin Tones Within Medical Lectures/Resources

Delice Kayishunge*, Mason Belue*
University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR

*Authors contributed equally

Corresponding author: dkayishunge@uams.edu or mbelue@uams.edu
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https://doi.org/10.38126/JSPG180412
Keywords: skin of color; medical education; dermatology; healthcare disparities; socioeconomic

Executive Summary: Being a good physician means having the ability to recognize diseases in all kinds of individuals. This is especially true for skin lesions (e.g., acne, cancer), which present differently based on skin color and tone. Developing skin-tone-dependent diagnosing skills depends on the medical education (e.g., lectures, medical textbooks, and online board certification prep resources) and hands-on clinical experiences doctors receive. We find it alarming that medical students' gold standard resources overrepresent light skin and underrepresent dark skin to the point where many medical students can recognize a lesion on white skin but fail to recognize a similar lesion on dark skin. This lack of representation perpetuates race as a social determinant of health, leading to missed diagnoses and diagnosis at a later/worse stage in people of color. To combat this underrepresentation within medical education, we propose the Liaison Committee on Medical Education (LCME) amend Accreditation Standard 7: Curricular Content, Subsection 7.6: Cultural Competence and Health Care Disparities. The amendment is to include 1 of the 2 following policy changes, with preference for the top-down mandate: 1) Top-down Mandate: An objective measure and subsequent goal (1:1 representation) for the representation of skin of color within a school's medical lectures, which is evaluated by an LCME-approved curriculum committee and mandated for schools wishing to continue to be LCME accredited. 2) Bottom-up Individualized Institutional Goals: A requirement for schools to choose their own goal, create their committee, and evaluate their progress. These progress reports will be submitted to the LCME annually.

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References

  1. Adelekun, Ademide, Ginikanwa Onyekaba, and Jules B. Lipoff. 2021. “Skin Color in Dermatology Textbooks: An Updated Evaluation and Analysis.” Journal of the American Academy of Dermatology 84 (1): 194–96. https://doi.org/10.1016/j.jaad.2020.04.084.
  2. Buster, Kesha J., Erica I. Stevens, and Craig A. Elmets. 2012. “Dermatologic Health Disparities.” Dermatologic Clinics 30 (1): 53–viii. https://doi.org/10.1016/j.det.2011.08.002.
  3. Colby, Sandra L., and Jennifer M. Ortman. 2015. Projections of the Size and Composition of the U.S. Population: 2014 to 2060. Population Estimates and Projections. Current Population Reports. P25-1143. US Census Bureau. US Census Bureau. https://eric.ed.gov/?id=ED578934.
  4. Ebede, Tobechi, and Art Papier. 2006. “Disparities in Dermatology Educational Resources.” Journal of the American Academy of Dermatology 55 (4): 687–90. https://doi.org/10.1016/j.jaad.2005.10.068.
  5. Ezenwa, Ekene, and Kesha Buster. "Health Disparities And Skin Cancer In People Of Color - Practical Dermatology". 2021. Practical Dermatology. https://practicaldermatology.com/articles/2019-apr/health-disparities-and-skin-cancer-in-people-of-color.
  6. Fenton, Anne, Erika Elliott, Ashkan Shahbandi, Ekene Ezenwa, Chance Morris, Justin McLawhorn, James G. Jackson, Pamela Allen, and Andrea Murina. 2020. “Medical Students’ Ability to Diagnose Common Dermatologic Conditions in Skin of Color.” Journal of the American Academy of Dermatology 83 (3): 957–58. https://doi.org/10.1016/j.jaad.2019.12.078.
  7. Fourniquet, Sophie Elise, Kristen Garvie, and Kaylin Beiter. 2019. “Exposure to Dermatological Pathology on Skin of Color Increases Physician and Student Confidence in Diagnosing Pathology in Patients of Color.” The FASEB Journal 33 (S1): 606.18-606.18. https://doi.org/10.1096/fasebj.2019.33.1_supplement.606.18.
  8. Jones, Virginia A., Kayla A. Clark, Morinola T. Shobajo, Adriana Cordova, and Maria M. Tsoukas. 2020. “Skin of Color Representation in Medical Education: An Analysis of Popular Preparatory Materials Used for United States Medical Licensing Examinations.” Journal of the American Academy of Dermatology, August. https://doi.org/10.1016/j.jaad.2020.07.112.
  9. “LCME Accreditation.” AAMC. Accessed July 12, 2021. https://www.aamc.org/services/first-for-financial-aid-officers/lcme-accreditation.
  10. Louie, Patricia, and Rima Wilkes. 2018. “Representations of Race and Skin Tone in Medical Textbook Imagery.” Social Science & Medicine 202 (April): 38–42. https://doi.org/10.1016/j.socscimed.2018.02.023.
  11. Tripathi, Raghav, Konrad D. Knusel, Harib H. Ezaldein, Jeffrey F. Scott, and Jeremy S. Bordeaux. 2018. “Association of Demographic and Socioeconomic Characteristics With Differences in Use of Outpatient Dermatology Services in the United States.” JAMA Dermatology 154 (11): 1286–91. https://doi.org/10.1001/jamadermatol.2018.3114.
  12. Wang, Stephanie, Lynda Shadrake, Pauline Scott, Hajwa Kim, and Claudia Hernandez. 2015. “Medical Student Melanoma Detection Rates in White and African American Skin Using Moulage and Standardized Patients.” Clinical Research in Dermatology Open Access 2 (1). DOI: http://dx.doi.org/10.15226/2378-1726/2/1/00

Delice Kayishunge is a third-year medical student at the University of Arkansas for Medical Sciences (UAMS). She received her bachelor’s degree in Biology from Lyon College and a master’s degree in Information Quality from the University of Arkansas at Little Rock (UALR). Her clinical interest is in academic dermatology and the pursuit of health and social justice for all. Beyond research and medicine, she serves in a combat support hospital unit in the Army Reserves. Outside of educational and career interests, she enjoys spending time with her friends and loved ones, cooking, traveling, and exercising. 
 
Mason Belue is a third-year medical student at the University of Arkansas for Medical Sciences (UAMS). Belue received their bachelor’s degree in biomedical engineering from the University of Arkansas Fayetteville and wishes to pursue a career as a clinician-scientist with a focus on molecular imaging and artificial intelligence. 

DISCLAIMER: The findings and conclusions published herein are solely attributed to the author and not necessarily endorsed or adopted by the Journal of Science Policy and Governance. Articles are distributed in compliance with copyright and trademark agreements.

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