Student led initiative improves skin of color inclusion in educational dermatologic images

Key takeaways:

• Only 10.5% and 31.3% of preclinical images depicted dark/black and medium/brown skin tones.
• A student-led initiative requesting to increase visual equity in the curriculum increased the amount of images by 8%.

While skin of color continues to be underrepresented in dermatologic images used in educational curriculums, a student-led initiative showed that action makes a difference, according to a study.

“The United States population is becoming increasingly more diverse,” Janeth R. Campbell, MD, MS, of Georgetown University School of Medicine, and colleagues wrote. “Despite this growing diversity, studies have shown that medical education lacks sufficient images of conditions in skin of color patients.”

As an example, this study examined the skin tone diversity in the preclinical curriculum at Georgetown University School of Medicine. The researchers used the Massey-Martin New Immigrant Survey Skin Color Scale, defining skin tones of 1 to 2 as light/white, 3 to 5 as medium/brown and 6 to 10 as dark/black.

Of 1,050 images, which were taken from 24 preclinical Georgetown University School of Medicine courses comprised of 566 lectures, only 10.5% and 31.3% depicted dark/black and medium/brown skin tones, respectively, whereas 58.2% depicted light/white skin tones.

Of 293 microbiology course images, 38 (13%) were dark/black and 98 (33.5%) were medium/brown, with the remainder classified as light/white (53.6%). Of 342 pathology course images, the vast majority again were light/white (57%), whereas 35 (10.2%) were dark/black and 112 (32.8%) were medium/brown.

According to the study, when multiple images were used for a condition, the images that were used first were light/white 63.5% of the time, medium/brown 30% of the time and dark/black 6.6% of the time. When images that were categorized as dark/black were presented first, 64.3% of the time it was to represent an infectious disease vs. 35.1% of the time for medium/brown images and 28.4% of the time for light/white images.

On the other hand, the authors did find that the number of images featuring individuals with skin of color in immunology, rheumatology and dermatology lecture materials did increase from 42% of 176 images in 2020 to 50% of 269 images in 2022 (P < .001). According to the authors, the significant increase over the 2 years was attributed to the efforts of a student-led initiative that requested an increase in image representation of different skin tones from course directors.

“Our study demonstrates an underrepresentation of darker skin tones in the preclinical curriculum at the [Georgetown University School of Medicine] when compared to white/light skin tones,” the authors wrote. “We reveal that a simple, student-driven initiative can lead to a significant increase in the representation of darker skin tones in dermatologic images.”