DISCUSSION
Previous studies have identified a clear gap in dermatology residents’ exposure to both formal and informal education on skin of color.7–9 In one study examining dermatology residents’ exposure to skin of color education, of 59 dermatology chief residents, only half (52.4%) endorsed a lecture or didactic session on skin of color during their residency.8 In another study from Australia, a country with a diversifying population, only 18% of 56 residents surveyed indicated participating in a lecture focused on skin of color in the preceding 12 months.7
In addition to residents, patients themselves have expressed a desire for dermatologists who are knowledgeable and comfortable treating patients with skin of color. In one qualitative study examining black patients’ perceptions on their dermatologic care, subjects expressed frustration with providers who seemed uncomfortable or uninformed regarding their hair and skin conditions.10
Additionally, recent events nationwide have prompted a renewed focus on the history of systemic racism in the United States. The impact of systemic racism in the house of medicine and specifically dermatology has become more apparent and it’s resolution more urgent.11
The results of this pilot study demonstrate that residents’ overall confidence in managing individual conditions and treating patients of color was improved by the focused curriculum. Participants felt that dermatology residents at-large would benefit from a similar curriculum implemented annually.
Limitations include the small sample size with all subjects from the same residency program. We recognize that reproducibility is dependent on a multitude of institutional-related factors including availability of lecturers with expertise in skin of color as well as prioritizing didactic time for this content. Additionally, we did not use a standardized objective measure to assess residents’ knowledge gains as such a tool does not yet exist.
This pilot curriculum covered a portion of the topics that could be included in a skin of color didactic curriculum. Further steps include the creation of a comprehensive curriculum on skin of color which could be disseminated broadly to both dermatology residents and practicing providers. Importantly, didactic lectures are not a substitute for in-person clinical exposure to patients of all skin types. We encourage dermatology residency programs to continue to seek out a diverse patient population for trainees to care for and learn from. We hope that this curriculum may serve as a model for other institutions to begin improving skin of color education.
In addition to residents, patients themselves have expressed a desire for dermatologists who are knowledgeable and comfortable treating patients with skin of color. In one qualitative study examining black patients’ perceptions on their dermatologic care, subjects expressed frustration with providers who seemed uncomfortable or uninformed regarding their hair and skin conditions.10
Additionally, recent events nationwide have prompted a renewed focus on the history of systemic racism in the United States. The impact of systemic racism in the house of medicine and specifically dermatology has become more apparent and it’s resolution more urgent.11
The results of this pilot study demonstrate that residents’ overall confidence in managing individual conditions and treating patients of color was improved by the focused curriculum. Participants felt that dermatology residents at-large would benefit from a similar curriculum implemented annually.
Limitations include the small sample size with all subjects from the same residency program. We recognize that reproducibility is dependent on a multitude of institutional-related factors including availability of lecturers with expertise in skin of color as well as prioritizing didactic time for this content. Additionally, we did not use a standardized objective measure to assess residents’ knowledge gains as such a tool does not yet exist.
This pilot curriculum covered a portion of the topics that could be included in a skin of color didactic curriculum. Further steps include the creation of a comprehensive curriculum on skin of color which could be disseminated broadly to both dermatology residents and practicing providers. Importantly, didactic lectures are not a substitute for in-person clinical exposure to patients of all skin types. We encourage dermatology residency programs to continue to seek out a diverse patient population for trainees to care for and learn from. We hope that this curriculum may serve as a model for other institutions to begin improving skin of color education.
DISCLOSURES
The authors have nothing to disclose.
ACKNOWLEDGMENT
We thank analyst Jen Yeh for her contribution to data analysis.
REFERENCES
1. Taylor SC, Kelly AP, Serrano AM, Lim HW. Taylor and Kelly’s Dermatology for Skin of Color. 2e. New York, NY: McGraw-Hill; 2008.
2. US Census Bureau Applications Development and Services Division W. US Census Bureau. https://www.census.gov/population/projections/nation/ summary/np-t5-g.pdf. Accessed June 25, 2019.
3. Xierali IM, Nivet MA. The racial and ethnic composition and distribution of primary care physicians. J Health Care Poor Underserved. 2018;29:556-570.
4. Linos E, Wintroub B, Shinkai K. Diversity in the dermatology workforce: 2017 status update. Cutis. 2017;100:352-353.
5. Pandya AG, Alexis AF, Berger TG, Wintroub BU. Increasing racial and ethnic diversity in dermatology: A call to action. J Am Acad Dermatol. 2016; 74:584-587.
6. Pritchett EN, Pandya AG, Ferguson NN, Hu S, Ortega-Loayza AG, Lim HW. Diversity in dermatology: Roadmap for improvement. J Am Acad Dermatol. 2018;79:337-341.
7. Wee E, Gilmore S, Rodrigues M. Australian trainee dermatologists’ opinions on skin of colour education: Does it reflect changing demographics of the population? Australas J Dermatol. 2018;59:e239-e240.
8. Nijhawan RI, Jacob SE, 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;59:615-618.
9. Cline A, Winter RP, Kourosh S, Taylor SC, Stout M, Callender V, McMichael AJ. Multiethnic training in residency: A survey of dermatology residents. Cutis. 2020;105:310-313.
10. Gorbatenko-Roth K, Prose N, Kundu RV, Patterson S. Assessment of Black patients’ perception of their dermatology care. JAMA Dermatol. 2019; 155:1129-1134.
11. Nolen L. How medical education is missing the bull’s-eye. N Engl J Med. 2020;382:2489-2491.
2. US Census Bureau Applications Development and Services Division W. US Census Bureau. https://www.census.gov/population/projections/nation/ summary/np-t5-g.pdf. Accessed June 25, 2019.
3. Xierali IM, Nivet MA. The racial and ethnic composition and distribution of primary care physicians. J Health Care Poor Underserved. 2018;29:556-570.
4. Linos E, Wintroub B, Shinkai K. Diversity in the dermatology workforce: 2017 status update. Cutis. 2017;100:352-353.
5. Pandya AG, Alexis AF, Berger TG, Wintroub BU. Increasing racial and ethnic diversity in dermatology: A call to action. J Am Acad Dermatol. 2016; 74:584-587.
6. Pritchett EN, Pandya AG, Ferguson NN, Hu S, Ortega-Loayza AG, Lim HW. Diversity in dermatology: Roadmap for improvement. J Am Acad Dermatol. 2018;79:337-341.
7. Wee E, Gilmore S, Rodrigues M. Australian trainee dermatologists’ opinions on skin of colour education: Does it reflect changing demographics of the population? Australas J Dermatol. 2018;59:e239-e240.
8. Nijhawan RI, Jacob SE, 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;59:615-618.
9. Cline A, Winter RP, Kourosh S, Taylor SC, Stout M, Callender V, McMichael AJ. Multiethnic training in residency: A survey of dermatology residents. Cutis. 2020;105:310-313.
10. Gorbatenko-Roth K, Prose N, Kundu RV, Patterson S. Assessment of Black patients’ perception of their dermatology care. JAMA Dermatol. 2019; 155:1129-1134.
11. Nolen L. How medical education is missing the bull’s-eye. N Engl J Med. 2020;382:2489-2491.
AUTHOR CORRESPONDENCE
Julia Mhlaba MD julia.mhlaba@nm.org
