Dark skin tones in rheumatology educational images up 40% since 2020
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Key takeaways:
- The study follows a 2021 analysis that found darker skin tones were underrepresented in major rheumatology resources.
- Diversity in medical images fosters improved care for people of color, the researchers wrote.
The share of images depicting dark skin tones in commonly referenced rheumatology educational materials has grown 40.6% since 2020, according to data published in Arthritis Care & Research.
“Medical education materials, including rheumatology-specific resources, underrepresent people with skin of color in their clinical images,” Lisa Zickuhr, MD, MHPE, of the Washington University School of Medicine in St. Louis, and colleagues wrote. “As a result, clinicians report decreased confidence and demonstrate reduced skill identifying rashes among [people with skin of color], fostering disparate health outcomes and medical mistrust.”
Zickuhr and colleagues followed up on a 2021 study, published by Strait and colleagues in Arthritis Care & Research, that found darker skin tones were “significantly underrepresented” in four major rheumatology resources: the American College of Rheumatology Image Library, the ninth edition of Kelley’s Textbook of Rheumatology, The New England Journal of Medicine and UpToDate. In the current analysis, the researchers analyzed the 10th edition of Kelley’s Textbook of Rheumatology; surveyed ACR and New England Journal of Medicine images through Oct. 31, 2022; and reviewed UpToDate clinical images on Jan. 31, 2024, using the same subscription access as the original study.
The skin color in each image was rated as “light,” “dark” or “indeterminate” using Fitzpatrick’s skin phototypes score. Findings of “dark” skin tones were compared with the original study using one-way Z tests.
Overall, 19.2% of the images demonstrated “dark” skin tones, 80.1% showed “light,” and 0.6% were classified as “indeterminate.” According to the researchers, there was a significant 40.6% rise in the proportion of “dark” tones (P < .0001) across all texts from 2020 to 2024.
The researchers additionally noted that Kelley’s Textbook of Rheumatology had a 90.1% increase in the proportion of dark skin tones, with 18 images of dark skin tones published between 2022 and 2024, compared with 11 images published in 2020. Each of the other three resources also saw an increased proportion of dark skin tone representation compared with 2020 — 41.9% for ACR, 31% for UpToDate and 28.2% for the New England Journal of Medicine.
“Action to enact change follows awareness, and, 24 to 39 months after [the original study], our study demonstrates that publishers are improving representation of [people of skin of color] in focused attempts to increase equity within rheumatology educational materials,” Zickuhr and colleagues wrote.
“This analysis encourages medical education publishers to continue on this path, iteratively enhancing diversity in their images and striving towards equitable representation,” they added. “In doing so, rheumatology educators will provide clinicians with the resources needed to care for [people with skin of color].”
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