In the past couple of years, researchers raised the issue of the lack of skin of colour in dermatology training, which has inspired the medical school at the University of Calgary and elsewhere to revamp their programs. 

Dermatology is the second-least diverse field in medicine in terms of practitioners behind orthopaedic surgery, explained Dr. Jenny Murase, one of the lead researchers of a study that outlined a lack of skin of colour in dermatology journals. 

“Considering that we’re the physicians of the skin and hair, that’s really not good,” she said. 

University of Calgary 

Inspired by increasing calls for diversifying the dermatology field, the University of Calgary has revamped its dermatology program to include more representation of skin of colour. 

“In the last three years, we’ve almost entirely revamped the dermatology course with equal representation of all skin conditions,” said Dr. Jori Hardin, clinical assistant professor at the Cumming School of Medicine at the U of C. 

Dr. Jenny Murase is one of the lead researchers who looked into the lack of skin of colour in dermatology literature. PHOTO COURTESY: Jenny Murase.

Along with Hardin, Dr. Laurie Michelle Parsons (the other course chair) and a group in the undergraduate medical education office created the new curriculum to increase diversity within the dermatology course. 

Hardin explained that the course now has equal representation of skin of colour in their workshops and lectures. She said that this was an important move because dermatology is a very visual program. 

She said that the program now uses an “amazing resource” that has given them the ability to access a database of images on various types of skin of colour. 

The platform is called VisualDx and it is one of the only places that has “robust pictures of Black skin,” she said. VisualDX is a service that is used by several medical schools in Canada,  providing medical images of a large variety of skin of colour.

“It’s made it much easier because traditionally one of the problems was that even if somebody wanted to update their lecture, there weren’t even pictures available of skin conditions in patients with Black and Brown skin,” Hardin explained. 

The University of Calgary program was not only revamped but the students have also been involved with some research studies as well. 

Pityriasis rosea is a skin rash that presents differently on Black and white skin. PHOTO COURTESY: of VisualDX.

For the class of 2020, Hardin had her students participate in a study that measured their performance on all skin types. Hardin said that they created flashcards that had decks of skin of colour and decks of white skin and presented it to each student to determine the diagnosis. 

The results were that the cards themselves didn’t change the students’ performance but at the end of the course, students had a significantly better diagnosis on both white and Black skin. It was even noted that there was also a bigger jump of their recognition of Black skin using both decks of cards. 

The study is currently in the works to be published soon.  

Hardin also noted that the new program has updated their podcast that they use to teach in their courses to include dedicated episodes on skin of colour, and has invited Black dermatologists as guest speakers to teach their students about personal experiences, addressing areas of anti-racism. 

“There’s a bunch of work nationally across the country with dermatology programs [that are] working together to try to improve this lack of representation of skin of colour. So Calgary’s program is not in isolation to try to diversify the materials and provide more comprehensive education,” she explained. 

The importance of including a range of skin tones 

The trend in diversifying dermatology programs is increasing because of the rise in awareness to provide medical students with the proper tools to treat all skin types. 

Britney Wilson will be graduating with a medical degree by May 2022, at the Rutgers New Jersey Medical School. PHOTO COURTESY: Britney Wilson

Britney Wilson, a medical student out of the Rutgers New Jersey Medical School who has been studying the lack of diversity in dermatology, noted that it is important to include all skins of colour in training because “it’s very hard for you to know how to treat all people and recognize different morphologies on different skin colours if you’re only seeing a Caucasian person in your textbooks,” she said in a interview with the Calgary Journal. 

Wilson gave the example that in dermatology, rashes can be described as a reddish colour but in a person of colour it can look more of a purplish colour. 

“So if you don’t teach medical students this information early on, later in their careers, they can misdiagnose or overlook different skin disorders in people of colour,” she said. 

Due to the lack of skin of colour representation in the field, students like Wilson are also recognizing this gap in dermatology. 

Trends in diversifying dermatology 

Iku Nwosu, a student at Queen’s University and chair of Black Medical Students’ Association of Canada, noticed that most of the lectures that were taught at her school mainly included images of white people, she said in a February webinar with in collaboration with VisualDX.

So she and several students at Queen’s University decided to call on their school administrators to allow them to create a curriculum review to outline where more skin of colour needs to be included. 

Some 120 students volunteered to audit the library and found out that of 168 teaching materials that showed skin presentations, 131 only showed white skin. 

In order to address this issue, the students suggested the administration purchase a licence from VisualDX to increase skin-of-colour images in their training. “At the end of the day VisualDX was truly the only option that could fill the gaps in our curriculum” Nwosu stated in the webinar.

Images of Lyme disease present on white skin vs. Black skin, that is used by VisualDX to teach students and doctors about how different diseases look on different skins of colour. PHOTO COURTESY: VisualDX. 

“So many of my classmates have mentioned how much they love using the [VisualDX] app in hospitals, in clinics, and how much it has helped them with consolidating their learning when they do see patients of colour” she said. 

Nwosu also stated that if institutions want to teach skin of colour effectively and have skin of colour images in lecture slides, that having a resource like VisualDX is really important. 

“It’s important to me and my community and to Black medical students to see ourselves in these lectures and to see ourselves in our curriculum” she stated. 

With the rise of awareness around the lack of skin of colour in dermatology, Murase explained that some of the dermatology field is really embracing the issue and calls to action. 

“I’m honestly incredibly proud to be a dermatologist right now.” 

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