Images in Rheumatology Educational Materials Do Not Depict All Patients

Action Needed

Medical publishers can correct the underrepresentation of SOC in their materials, addressing one root cause for health inequity. Strait et al. call for improved representation of all skin tones in educational resources.⁵

The ACR dedicated this year’s Image Competition to SOC to increase representation and enhance practitioner learning.¹⁰ This initiative, combined with online modules focused on cutaneous findings in a variety of skin tones, begins to address providers’ educational needs.¹¹

The development of SOC atlases has expanded practitioners’ access to images, and current initiatives seek to integrate SOC images in all educational texts, thereby standardizing their publication in resources.^6,12

The delivery of high-quality care to all patients enhances clinical learning. In response to documented gaps in training and disparate comfort levels caring for patients across a spectrum of skin colors, dermatologists have created clinics dedicated to SOC.¹³ These clinics work toward improving health outcomes for patients, as well as augmenting the educational experience. When practitioners and educators partner with providers with expertise diagnosing and treating patients with SOC, they build relationships that reinforce the medical profession’s commitment to equitable patient care.

Bottom Line

The underrepresentation of SOC in medical resources hinders practitioners’ knowledge and clinical skills, perpetuating the marginalized status of vulnerable patients. Medical education contributes to these health disparities, but it also represents a way to help remedy them.

Lisa Zickuhr, MD, is an assistant professor of medicine, director of the rheumatology curricula and associate director of the medicine clerkship at Washington University School of Medicine, St. Louis, Mo.

Amaad Rana, MD, is a first-year rheumatology fellow at Washington University School of Medicine.

Heather A. Jones, MD, is an assistant professor of medicine and associate program director of the Dermatology Training Program at Washington University School of Medicine.

References

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2. Louie P, Wilkes R. Representations of race and skin tone in medical textbook imagery. Soc Sci Med. 2018 Apr;202:38–42.
3. Adelekun A, Onyekaba G, Lipoff JB. Skin color in dermatology textbooks: An updated evaluation and analysis. J Am Acad Dermatol. 2021;84(1):194–196.
4. Massie JP, Cho DY, Kneib CJ, et al. Patient representation in medical literature. Plast Reconstr Surg Glob Open. 2019 Dec 26;7(12):e2563.
5. Strait A, Graf J, Margaretten M, et al. Race, ethnicity and disparities in rheumatology educational materials. Arthritis Care Res (Hoboken). 2021 Mar 25.
6. Rana A, Witt A, Jones H, et al. The representation of skin colors in images of patients with lupus erythematosus. Arthritis Care Res (Hoboken). 2021 May 31. Epub ahead of print.
7. Rodrigues MA, Ross AL, Gilmore S, Daniel BS. Australian dermatologists’ perspective on skin of colour: Results of a national survey. Australas J Dermatol. 2018 Feb;59(1):e23–e30.
8. Gorbatenko-Roth K, Prose N, Kundu RV, Patterson S. Assessment of Black patients’ perception of their dermatology care. JAMA Dermatology. 2019;155(10):1129–1134.
9. Nolen LS. How medical education is missing the bull’s-eye. N Engl J Med. 2020 Jun 25;382(26):2489–2491.
10. Image Competition. American College of Rheumatology.
11. Elston CA, Elston DM. Identifying lesions on skin of color. Medscape. 2021 May 10.
12. Kelly AP, Taylor SC, Lim HW, Serrano AMA. Taylor and Kelly’s Dermatology for Skin of Color, 2nd ed. New York: McGraw-Hill Education; 2016.
13. Tull RZ, Kerby E, Subash JJ, McMichael AJ. Ethnic skin centers in the United States: Where are we in 2020? J Am Acad Dermatol. 2020 Dec;83(6):1757–1759.