Exposure to Dermatological Pathology on Skin of Color Increases Physician and Student Confidence in Diagnosing Pathology in Patients of Color

Fourniquet, Sophie; Garvie, Kristen; Beiter, Kaylin

doi:10.1096/fasebj.2019.33.1_supplement.606.18

Cited by 9 publications

(8 citation statements)

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“…Previous research has shown that curricular modules can improve clinicians' confidence in diagnosing rashes in P-SOC. 7 In our study, educational tools from practitioners' training predicted confidence in the univariate model but were not associated with confidence in the multivariate model. This implies that educational materials dispensed during an initial training period insufficiently prepare clinicians for treating lupus-related rashes in P-SOC in longterm practice.…”

Section: Discussioncontrasting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

“…6 These resources and learning experiences prepare practitioners to care for patients, and they impart unconscious biases while creating deficiencies in clinical skills when they exclude P-SOC. 7,8 This can delay diagnosis for patients, can expose them to misdiagnosis, and can promote their distrust in the health care system. 9 Given the importance of recognizing lupus among P-SOC and the consequences of biases in education, we investigated practitioners' confidence assessing lupus-related rashes in P-SOC.…”

Section: Introductionmentioning

confidence: 99%

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Health care practitioners’ confidence assessing lupus-related rashes in patients of color

Kannuthurai

Murray

Chen

et al. 2021

Lupus

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Background: Patients with skin of color (P-SOC) are disproportionately burdened by lupus and often have worse disease outcomes than white patients. This is partly because educational materials underrepresent P-SOC, thereby promoting unconscious bias and clinical deficiencies among practitioners. Purpose: We sought to measure providers' confidence in diagnosing the cutaneous manifestations of lupus (i.e., lupus-related rashes) in P-SOC and to assess which factors influenced their confidence. Research Design: We created and distributed a survey that gathered information about participants' personal characteristics, clinical specialty, training, and current practice as well as measuring their confidence assessing lupus-related rashes in various skin tones. Study Sample: Practitioners from the fields of rheumatology, dermatology, and internal medicine in the greater St. Louis area (Missouri, USA) participated in the survey. Analysis: We compared practitioners' mean confidence levels assessing lupus-related rashes in patients with fair skin and P-SOC with a linear mixed effects model and used univariate and multivariate linear regression models to determine if the aforementioned factors correlated with confidence. Results: Participants' mean confidence in diagnosing lupus-related rashes in P-SOC was significantly lower than assessing such findings in patients with fair skin ( p = .009). Several factors correlated with confidence level at a univariate level; however, the multivariate model revealed experience as the only factor significantly associated with confidence ( p = .001). Conclusions: Providers report significantly less confidence assessing lupus-related rashes in P-SOC than in patients with fair skin. Our analysis demonstrates that experience positively correlates with confidence and suggests that interventions which enhance practitioners' exposure to and experience with these rashes in P-SOC can improve clinical confidence as well as patient outcomes.

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Section: Discussioncontrasting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Health care practitioners’ confidence assessing lupus-related rashes in patients of color

Kannuthurai

Murray

Chen

et al. 2021

Lupus

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“…29 This observation implies an interaction between the perception of clinical features and the application of clinical rules to the perceived abnormalities 38 (both of which are interrelated elements with an illness script) and suggests that learning outcomes-including diagnostic performance on different skin tones-may be enhanced by additional training in areas where the perception of clinical abnormalities is more challenging. 39 The success of students diagnosing melanoma on SoC increased, but still appears to be lower than diagnosing melanoma of LS.…”

Section: Discussionmentioning

confidence: 99%

Mitigating diagnostic performance bias in a skin‐tone balanced dermatology curriculum

Hardin,

Mourad,

Desy

et al. 2023

The Clinical Teacher

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IntroductionIndividuals with skin of colour (SoC) have delayed diagnosis and poorer outcomes when presenting with some dermatologic conditions when compared to individuals with light skin (LS). The objective of this study was to determine if diagnostic performance bias can be mitigated by a skin‐tone balanced dermatology curriculum.MethodologyA prospective randomised intervention study occurred over 2 weeks in 2020 at a Canadian medical school. A convenience sample of all first‐year medical students (n = 167) was chosen. In week 1, all participants had access to dermatology podcasts and were randomly allocated to receive non‐analytic training (NAT; online patient ‘cards’) on either SoC cases or LS cases. In week 2, all participants received combined training (CT; NAT and analytic training through workshops on how to apply dermatology diagnostic rules for all skin tones). Participating students completed two formative assessments after weeks 1 and 2.ResultsNinety‐two students participated in the study. After week 1, both groups had a lower diagnostic performance on SoC (p = 0.0002 and p = 0.002 for students who trained on LS ‘cards’ and SoC ‘cards’, respectively). There was a significant decrease in mean skin tone difference in both groups after week 2 (initial training on SoC: 5.8% (SD 12.2) pre, −1.4% (14.7) post, p = 0.007; initial training on LS: 7.8% (15.4) pre, −4.0% (11.8%) post, p = 0.0001). Five students participated in a post‐study survey in 2023, and all found the curriculum enhanced their diagnostic skills in SoC.ConclusionsSoC performance biases of medical students disappeared after CT in a skin tone‐balanced dermatology curriculum.

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“…This was somewhat surprising given that our previous findings showed that the use of more inclusive resources positively correlated with increased confidence. This is reflected in the literature: a study looking at confidence in medical students before and after completing a dermatology education module with diverse skin tones showed that increased exposure to darker skin tones increased confidence in diagnosing conditions such as eczema ( p = 0.006) and psoriasis ( p = 0.028) [ 15 ]. Knowledge, however, was not objectively tested in our study.…”

Section: Discussionmentioning

confidence: 99%

Assessing Healthcare Professionals’ Identification of Paediatric Dermatological Conditions in Darker Skin Tones

et al. 2022

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The impacts of the lack of skin tone diversity in medical education images on healthcare professionals (HCPs) and patients are not well studied. The aim of this study was to assess the diagnostic knowledge of HCPs and correlate this with confidence and training resources used. An online multiple choice quiz was developed. The participants’ demographics, training resources and self-confidence in diagnosing skin conditions were collected. The differences in the results between the subgroups and the correlations between the respondents’ experience, self-reported confidence and quiz results were assessed. The mean score of 432 international participants was 5.37 (SD 1.75) out of a maximum of 10 (highest score). Eleven percent (n = 47) reached the 80% pass mark. Subanalysis showed no difference by the continent (p = 0.270), ethnicity (p = 0.397), profession (p = 0.599), training resources (p = 0.198) or confidence (p = 0.400). A significance was observed in the specialty (p = 0.01). A weak correlation between experience and confidence (Spearman’s ρ = 0.286), but no correlation between scores and confidence or experience (ρ = 0.087 and 0.076), was observed. Of diagnoses, eczema was recognised in 40% and meningococcal rash in 61%. This is the first study assessing the identification of paediatric skin conditions in different skin tones internationally. The correct identification of common/important paediatric conditions was poor, suggesting a possible difference in knowledge across skin tones. There is an urgent need to improve the representation of all skin tones to ensure equity in patient care.

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Exposure to Dermatological Pathology on Skin of Color Increases Physician and Student Confidence in Diagnosing Pathology in Patients of Color

Cited by 9 publications

References 0 publications

Health care practitioners’ confidence assessing lupus-related rashes in patients of color

Health care practitioners’ confidence assessing lupus-related rashes in patients of color

Mitigating diagnostic performance bias in a skin‐tone balanced dermatology curriculum

Assessing Healthcare Professionals’ Identification of Paediatric Dermatological Conditions in Darker Skin Tones

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