Skin of color lacks representation in medical student resources: A cross-sectional study

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A cross-sectional studyDear Editors,Visual diagnostic skills and pattern recognition in different skin tones are necessary for accurate diagnoses of dermatologic conditions in diverse patient populations.Prior studies have demonstrated large disparities between the representation of skin types among dermatology training materials (Alvarado and Feng, 2020;Ebede and Papier, 2006).Images of skin of color (SoC) are underrepresented in American Academy of Dermatology (AAD) annual meetings, medical textbooks, medical school curricular material, and web-based medical resources (Adelekun et al., 2021;Alvarado and Feng, 2020;Ebede and Papier, 2006).Furthermore, medical students lack training on how cutaneous pathology presents in different skin tones and are not as skilled in diagnosing dermatologic manifestations in darker skin compared with lighter skin (Alvarado and Feng, 2020;Adelekun et al., 2021;Fenton et al., 2020).Over the last decade, there has been an increase in the use of supplementary learning tools in medical school.Therefore, we sought to investigate the diversity of dermatology images among these commonly used medical school resources.The following resources were comprehensively searched for photographs of dermatologic lesions: Amboss, Boards and Beyond, Firecracker, First Aid, Pathoma, and the AAD Basic Dermatology Curriculum.Images without a clear background skin type were excluded.One author classified each image as non-SoC (white to beige skin tones, corresponding to Fitzpatrick skin types I-III) or SoC (brown to black skin tones, corresponding to Fitzpatrick skin types IV-VI), and extracted information on the disease process based on the photo caption.A second author repeated this process in 10% of images randomly selected from each source, and interrater reliability was calculated using Cohen's kappa, which indicated almost perfect agreement (j = 0.94-1.0).