This article is the second of a 2-part feature on skin of color in medical education and dermatology practice. Check out part 1 of this feature series.

In this second article of a 2-part series on skin of color (SoC), we interviewed several experts who are actively involved in ethnic skin centers across the United States. These experts discussed unmet needs and disparities in dermatology practice and potential initiatives to reduce racial/ethnic disparities in clinical practice.

Education and Residency: Increasing Exposure to Diverse Populations

Residency training and continuing education represent primary avenues through which clinicians improve their knowledge of disease and treatment; however, dermatology training has historically lacked robust representation of, and exposure to, racially/ethnically diverse skin types.1 Physicians specializing in SoC are therefore calling for increased focus on education regarding darker skin tones in an effort to better address challenges involved in care of dermatologic disorders in diverse populations.


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“The dermatology community must assess means of providing residents and dermatologists with specialized training opportunities to meet the needs of the growing minority population in the United States,” Neelam A. Vashi, MD, director of the Boston University Center for Ethnic Skin, told us. “The lack of diversity in the dermatology workforce also plays an important role in current knowledge and cultural gaps as there are complexities and nuances for ethnic skin and hair.”

Shadi Kourosh, MD, assistant professor of dermatology at Harvard Medical School and Director of Dermatology at the Massachusetts General Hospital, said that the main challenges in the care of patients with SoC are partially driven by individual dermatologists’ experience and exposures they received during residence training. According to Dr Kourosh, many medical doctors do not receive adequate exposure to diverse populations.

“I had the privilege of training in county hospitals that served very diverse patient populations, in terms of their ethnic and socioeconomic backgrounds, and had the benefit of seeing how the same dermatologic condition can present and appear on diverse skin types,” added Dr Kourosh. “Because our job is to be able to recognize and treat skin conditions in diverse skin types, appreciating the nuances of how the same condition can appear differently on different skin types is an integral part of that training.”

Henriette De La Garza, MD, a research fellow in the Boston University  Ethnic Skin Center, said that dermatology residents should ideally be exposed to different types of patients during training and be provided with elective opportunities to rotate at other institutions where they can get greater exposure to patients with SoC. “Inviting experts in ethnic skin as guest lecturers for grand rounds and incorporating skin of color images to didactics, textbooks, and peer-reviewed literature can also help prepare residents to correctly identify and treat conditions in skin of color,” said Dr De La Garza.

The SoC Society, an organization in which Dr Kourosh is a member, seeks to fill many of the identified educational gaps among dermatologists and other physicians, she explained. “One of our missions is to improve the standard of dermatology education nationwide and raise that standard for everyone,” she said. Before the organization’s initiative, it would be largely “more piecemeal in terms of what a person’s opportunities for education might be depending on what the circumstances of their training program were,” she related.

Ethnic Skin Centers: Current Initiatives to Reduce Disparities

Several initiatives have been implemented within large hospital systems and ethnic skin centers across the United States to help bridge the gap between evidence-based care and SoC needs.

Dr Kourosh, who began her career at Massachusetts General Hospital, noticed early on a significant lack of clinics dedicated to SoC. To meet this need, Dr Kourosh founded and was appointed Director of the Pigmentary Disorder and Multi-Ethnic Skin Clinic at Massachusetts General Hospital. “I set out to establish an ethnic skin clinic and make sure that our hospital was at the forefront of meeting the needs of patients with diverse skin types and also treating conditions focusing on the academic study and best practice treatment of skin conditions that disproportionately affect darker skin types,” she said.

Other dermatologists across the country have also devoted their practices to elevating the level of care for patients with SoC within specialized clinics. Diane Jackson-Richards, MD, for example, is a Henry Ford Health System dermatologist and leads the Henry Ford’s Multicultural Dermatology Clinic as the clinic’s director. In an effort to address current disparities in care, Dr Jackson-Richards told us that her center exposes their “residents to a diverse patient population by providing lectures that address SoC needs and continue to encourage diversity in the field of dermatology.”

Continuing education has been a prime target for improving awareness of dermatologic issues in SoC care as well as increasing dermatologists’ knowledge of how to treat skin disorders in racial/ethnic minority patients. Dr Kourosh noted that she has recently worked with her mentor Susan C. Taylor, MD, the founder of the SoC Society, to develop a set of curricula for the American Academy of Dermatology on SoC. For her part, Dr Kourosh worked on a subsection on cultural competency and anti-racism and health policy.

Dr Kourosh added that she has also created an MGH Massachusetts General Hospital International SoC online lecture series “which is going to be an online virtual conference where we are going to be teaching SoC dermatology to dermatologists and health care providers of all backgrounds all around the world, virtually.” Speakers for the series will comprise dermatology professionals from nearly every continent. The series will launch February 7th, 2022.3

In addition to continuing education, Dr Kourosh urges dermatologists to join organizations that provide relevant education on SoC management, such as the SoC Society. “I think participation and membership with these societies can be invaluable because it gives a person a community of experts that have both formal and informal mentorship,” she said.

Dr Vashi suggests centers should also seek to recruit underrepresented minority dermatologists who better understand special considerations in SoC patients, as this may help drive down health care disparities experienced by these populations. “The goal is to have a workforce that more closely reflects the diversity of our patient population,” she said. “Dermatologists with cross-cultural competence, confidence, and skill to treat patients from diverse backgrounds can ameliorate health care disparities and improve care for all patients.”

References

  1. Perlman KL, Williams NM, Egbeto IA, Gao DX, Siddiquee N, Park JH. Skin of color lacks representation in medical student resources: A cross-sectional studyInt J Womens Dermatol. 2021;7(2):195-196. doi:10.1016/j.ijwd.2020.12.018
  2. American Association of Medical Colleges Diversity in medicine: facts and figures. Website. Accessed February 3, 2022. Available from: https://www.aamc.org/data-reports/workforce/data/table-12-practice-specialty-females-race/ethnicity-2018
  3. Massachusetts General Hospital. International skin of color lecture series & specialty modules. Website. Accessed February 3, 2022. Available from: https://www.massgeneral.org/dermatology/news/skin-of-color-series