Visual Learning Equity Initiative Enhances Preclinical Dermatologic Image Representation: A Cross-Sectional Study

July 2024 | Volume 23 | Issue 7 | 519 | Copyright © July 2024


Published online June 24, 2024

doi:10.36849/JDD.7992

Janeth R. Campbell MD MSa*, Brenda Umenita Imo MSa*, Christina Asare BSa, Umayr R. Shaikh MPHa, Daniella Jaguan BSa, Sach Thakker BSa, Benjamin E. Swaby MD MSa, Mia Jenkins MD MSa, Adaora Ewulu MDa, Randy Amibang MD MSa, Stephanie Roberts MSa, Sarah Kureshi MD MPHa, Michael Cardis MDb, Olga Rodriguez MD PhDa

aGeorgetown University School of Medicine, Washington, DC 
bDepartment of Dermatology, MedStar Georgetown University Hospital/MedStar Washington Hospital Center, Washington, DC

*Co-first Authors

Abstract
Despite growing diversity in the United States population, studies show that medical education lacks representation of conditions in darker skin tones. Given that medical conditions present differently in different skin tones, limited exposure to images of darker tones in medical training may contribute to incorrect or delayed diagnoses, perpetuating health inequities. This study examines the preclinical curriculum at the Georgetown University School of Medicine (GUSOM) to report on its image representation with respect to skin tone and to assess the impact of a student-driven initiative in achieving visual learning equity (VLE). Of 1050 preclinical images, 58.2% depicted conditions in light/white skin tones, 31.3% in medium/brown, and 10.5% in dark/black. The microbiology and pathology courses had the highest percentages of dark/black and medium/brown images. Infectious disease images made up 36.3% of all images with 54.6% light/white, 31.5% medium/brown, and 13.9% dark/black. Overall, the first images representing conditions were 63.5% light/white, 30.0% medium/brown, and 6.6% dark/black. When dark/black images were presented first, 64.3% were of infectious diseases, compared to 35.1% for medium/brown and only 28.4% for white/light first images that were infectious diseases. A significant increase in images of conditions in darker skin tones was observed in the IRD course 2022 compared to the IRD course 2020 (P<.001). Our study highlights an underrepresentation of darker skin tones compared to lighter skin tones in the GUSOM preclinical curriculum. A student-led initiative significantly increased the representation of darker skin tones in dermatologic images, demonstrating the potential impact of such efforts in achieving VLE in medical education.

J Drugs Dermatol. 2024;23(7):519-524.  doi:10.36849/JDD.7992

INTRODUCTION

The United States (US) population is becoming increasingly more diverse. According to the 2020 US Census, all racial or ethnic groups experienced population increases, apart from the non-Hispanic White population, which declined by approximately 0.03%.1 It is expected that no single ethnic group will comprise greater than 50% of the US population by 2024.2 Despite this growing diversity, studies have shown that medical education lacks sufficient images of conditions in skin of color (SOC) patients. A recent study that analyzed the content of textbooks assigned at top medical schools reported that skin tone representation favored light skin tones while darker skin tones were underrepresented.3 When evaluating dermatology textbooks, Passby et. al found that around 89% of photographs in the six top best-selling dermatology textbooks were of white skin.4 Given that medical conditions may present differently in different skin tones, limited exposure to images of darker tones in medical training may contribute to incorrect or delayed diagnoses, perpetuating health inequities. 

Several academic institutions have launched initiatives aimed at addressing the aforementioned lack of representation, coined Visual Learning Equity (VLE). Researchers at the University of Pittsburgh School of Medicine (UPSOM) created a course auditing system to assess the proportion of brown and black skin images in medical school curricula versus images depicting white skin.5 At our institution, the Georgetown University School of Medicine (GUSOM), a 2020 student-led open letter addressed to the school administration called for racial justice reform at multiple levels. This letter prompted the creation of the Racial Justice Committee for Change (RJCC). To address curriculum concerns outlined in the letter, a Curricular Reform Subcommittee was created. Through diversity,