Increasing skin of color (SOC) content in a first-year medical school dermatology course may improve student satisfaction and interest in dermatology, according to findings from a study published in the Journal of the American Academy of Dermatology.
Researchers sought to quantify and enhance the representation of diverse skin tones in a first-year medical school course and assess student and faculty experiences in an intervention-modified course.
In the Dermatology IDD Image Verification Ensuring Representation of Skin of Color (DIIVERS) initiative, investigators reviewed materials, under faculty guidance, for a medical school course from October through December 2020 involving dermatology, rheumatology, and immunology. They used the Massey-Martin skin color scale to define light (1-2), intermediate (3-5), and dark (6-10) skin tones. Course images were assessed, and preintervention ratios of SOC images were calculated. New images were added from clinical databases and online materials to achieve a target of 40% light, 30% intermediate, and 30% dark skin images per session. Postcourse surveys on course satisfaction and SOC representation were completed by students and faculty members.
Before the initiative, 367 images from 22 course sessions were found to be 59.9% light, 19.9% intermediate, and 20.2% dark skin. After the initiative, 427 images were included in the medical course of 40.5% light, 29.5% intermediate, and 30% dark skin (χ2=29.8; P <.001).
A total of 73 students (44% response rate, 67% female, 60% non-White) and 10 dermatologist faculty members (59% response rate, 30% non-White) completed the postcourse surveys. Interest in a dermatology career increased significantly (P <.01), and postcourse proportions were comparable according to race and sex. SOC images were associated with an increased interest in dermatology across subgroups.
Discussions on racial healthcare disparities resulting from the SOC images occurred more frequently in White students (85.7% White vs 63.6% non-White, P <.001), although overall satisfaction with SOC presentation was not different between the race-stratified groups. A significantly greater proportion of non-White students believed that SOC representation remained inadequate (6.9% White vs 29.5% non-White, P =.02). Of the 10 faculty members, 9 were satisfied with the SOC presentation, and 5 believed that the SOC images stimulated discussion about racial healthcare disparities. “We emphasize the importance of these racial differences because the voices of non-White students are essential in discussions on race-based disparities,” researchers wrote.
“Although most non-White students felt satisfied with the SOC representation, they were more likely to report a perception of persistently inadequate representation and less frequently reported that SOC images stimulated disparity discussions, highlighting additional areas for future inquiry,” noted the study authors. “We emphasize the importance of these racial differences because the voices of non-White students are essential in discussions on race-based disparities.”
Study limitations include the single-institutional setting and absence of preintervention data. Also, the sample size precluded more specific stratification according to race and ethnicity.
“The DIIVERS initiative may serve as a model for increasing SOC images within medical educational material to prepare future physicians to care for diverse patient populations,” stated the researchers.
Kassamali B, Lee MS, Linggonegoro D, et al. Increasing skin of color representation in a medical school dermatology course through student and faculty engagement: the Dermatology IDD Image Verification Ensuring Representation of Skin of Color initiative. J Am Acad Dermatol. 2023;88(2):437-440. doi:10.1016/j.jaad.2022.05.028