Visual representation of racial diversity in aesthetic surgery literature

Cho, Daniel; Kneib, Cameron J.; Massie, Jonathan P.; Sobol, Danielle L.; Crowe, Christopher S.; Shakir, Afaaf; Burns, Jill; Lane, Megan; Morrison, Shane D; Sabin, Janice A.; Sousa, Janelle D.

doi:10.1016/j.bjps.2020.05.048

Cited by 10 publications

(18 citation statements)

References 1 publication

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“…This can be further amplified and affect how physicians and surgeons interpret published visual materials and, in turn, impact their delivery of patient care. 22,28 Given that health care providers will likely be exposed to an overwhelming amount of patient images with White skin, this may further perpetuate racial biases when they provide care for minority patients. It is important that the racial distribution of patients in medical literature reflects the patient demographics of the disease or procedure.…”

Section: Discussionmentioning

confidence: 99%

An Analysis of Racial Diversity in the Breast Reconstruction and Aesthetic Surgery Literature

Chawla

Shihadeh

Patel

2022

Plastic and Reconstructive Surgery - Global Open

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Background: Racial disparities in the visual representation of patients in the plastic surgery literature can contribute to health inequities. This study evaluates racial diversity in photographs published in the aesthetic and breast reconstruction literature. Methods: A photogrammetric analysis of plastic surgery journals from the USA, Canada, and Europe was performed. Color photographs depicting human skin, pertaining to breast reconstruction and aesthetic surgery in 2000, 2010, and 2020, were categorized as White (1–3) or non-White (4–6) based on the Fitzpatrick scale. Results: All journals demonstrated significantly more White skin images than non-White for all procedures (P < 0.05) except blepharoplasty and rhinoplasty. Blepharoplasty was the only procedure with more non-White images (P = 0.02). When examining USA journals, significant differences were not found in blepharoplasty, rhinoplasty, and male chest surgery. European journals published a greater proportion of non-White images than USA journals (P < 0.0001). There was a decreasing rate of change in diversity with 15.5% of images being non-White in 2000, 32.7% in 2010, and 40.7% in 2020 (P < 0.01). Percentage of non-White images varied by geographical region and ranged from 3.6% in Oceania to 93.5% in Asia (P < 0.01). Conclusions: Diversity of patient populations depicted in plastic surgery literature has increased over the past two decades. Despite this improvement, the racial diversity seen in photographs published in the literature does not adequately reflect this demographic for aesthetic and breast procedures. Equitable visual representation may promote cultural competency and improve care for the populations we serve.

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Section: Discussionmentioning

confidence: 99%

An Analysis of Racial Diversity in the Breast Reconstruction and Aesthetic Surgery Literature

Chawla

Shihadeh

Patel

2022

Plastic and Reconstructive Surgery - Global Open

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“…A similar underrepresentation of darker skin tone was reported in training textbooks in Canada and US, respectively (2, 3). Furthermore, in two studies assessing images in plastic surgery, only 20% of images represented darker skin tones (6,7). Recently, another study showed that darker skin phenotypes are underrepresented in the UWorld Step 2 QBank, a popular study tool for medical students seeking US residencies (15).…”

Section: Discussionmentioning

confidence: 99%

“…An example is demonstrated by skin color. Studies assessing diversity of skin representation among textbooks in the United States (US), Canada (2,3) and in major scientific journals (4)(5)(6)(7) have shown that the majority of images used within these educational materials are of light skin tones (defined in the oxford English dictionary as the color of the surface of someone's skin). Furthermore, descriptors of dermatological features also lack diversity; many descriptions of rashes focus on redness, pallor, purpura and cyanosis all of which are more difficult to recognize in darker skin tones or may not be present at all.…”

Section: Introductionmentioning

confidence: 99%

Impact of Diversity in Training Resources on Self-Confidence in Diagnosing Skin Conditions Across a Range of Skin Tones: An International Survey

et al. 2022

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BackgroundMedical images are invaluable in facilitating recognition of clinical signs. Recent studies highlight a lack of diversity of skin tone images used within medical education. However, there is a paucity of data on the impact of this on patient care.AimsTo investigate diversity in training resources used by users of an International online teaching platform and self-confidence in diagnosing skin conditions in all skin tones.MethodsUsers of an online teaching platform (www.dftbskindeep.com) were invited to participate in a survey evaluating key points including geographical location, ethnicity, profession, specialty, years of experience, training resources and confidence in diagnosing skin conditions. Data analyses were performed using SPSS. Categorical variables were presented as proportions. Chi-squared or Fisher's exact tests were used to compare the distribution between groups as appropriate.ResultsOf 600 participants, 74% reported training resources featuring predominantly white skin. Participants were “generally uncertain” in 43% cases, “sometimes uncertain but clinically safe” (52%), and “confident across a range of skin tones” in a minority (5%). Self-confidence was associated with location [higher in Africa (29%) and Latin America (11%), (p < 0.001)]; diversity of training resources [higher with a mix (10%) or darker tones (20%) (p < 0.001)]; clinical experience [6–10 (5%) or >10 years of practice (11%) (p < 0.001)] and specialty [highest in dermatologists (53%, p < 0.001)]. Self-confidence was lowest among pediatricians, emergency medicine and pediatric emergency medicine specialists (<5%).ConclusionsThese data provide preliminary evidence that training resources used by healthcare professionals on a global scale may lack enough diversity on representation of skin images, and a lack of self-confidence in diagnosing pediatric skin conditions. Further work is needed to understand the impact on knowledge and patient care to ensure equitable healthcare for all.

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“…For one, the wide skin tone spectrum is categorized into a binary white (Fitzpatrick I-III) versus nonwhite skin tones (Fitzpatrick IV-VI) in order to answer the question about whether nonwhite skin tones are being included in literature. Although the Fitzpatrick scale 17 is not perfect, it has been utilized and accepted in multiple studies spanning multiple specialties 15,16,26,27 . Given the retrospective nature of the study, the authors are unable to classify each image into a more specific, complex racial profile and thus skin tone was used as a surrogate.…”

Section: Discussionmentioning

confidence: 99%