Journal of Cutaneous Medicine and Surgery | 2021
Author Comment on “Diversity in Dermatology: Curriculum Reform in Undergraduate Medical Education at the University of Toronto”
Abstract
Our manuscript titled “Diversity in Dermatology? An Assessment of Undergraduate Medical Education” revealed that less than 7% of images in the previous preclerkship dermatology curriculum at the University of Toronto represented skin of color (SoC) (Fitzpatrick III-\xadVI),\xadand\xadthat\xadmedical\xadstudents’\xadself-\xadrated\xadconfidence\xadin\xad their\xaddiagnoses\xadof\xadskin\xadconditions\xadwas\xadsignificantly\xadgreater\xad in white skin compared with SoC.1 Physician\xadknowledge\xadgaps\xadand\xadlack\xadof\xaddiagnostic\xadconfidence leads to delays in diagnosis, and inferior care for racialized patients. Besides the direct disparities in health outcomes, this also fosters mistrust in the health care system in already marginalized populations, where building trust is paramount in best care practices.2 Canada is one of most diverse countries in the OECD and Toronto arguably the most diverse City in the world.3 Every physician in Canada needs to be competent in recognizing and treating skin conditions in both SoC and white skin and for this we need broad educational reform. Now. At UofT, informed by the results of our study, we have started to make sweeping changes to the undergraduate curriculum. This is what we have done so far: Improve visibility of SoC in the curriculum by increasing representation of SoC (Fitzpatrick IIIIV) images to 50% in large group lectures. Addition of new learning objectives focusing on recognizing\xad dermatologic\xad conditions\xad across\xad different\xad skin\xad types, identifying skin disease presentations unique to SoC, and appreciating how sociomedial experiences can differ\xadin\xadracialized\xadpopulations. Interweave themes of Equity, Diversity, and Inclusion (EDI) in Small group Teaching by revamping small group sessions to add themes around variability in presentation of skin disease in SoC, delay to diagnosis experienced disproportionately by patients with SoC, and the\xad psychosocial\xad impacts\xad of\xad post-\xadinflammatory\xad pigmentary changes, more prevalent in SoC. Model Diversity in Leadership by promoting diverse representation among lecturersrepresenting BIPOC, LGBTQ, gender diversity. Provide adequate resources as easily accessible supplemental\xad reference\xad material\xad specific\xad to\xad SoC—available\xad for\xadstudent’s\xadthat\xadfind\xadthe\xadmainstream\xadtextbooks\xadand\xadonline\xad resources’ SoC material inadequate. Traditional morphological “kodachrome” dermatologic descriptions are primarily based on presentations in white skin and disparities still exist in the most commonly used dermatology textbooks with low representation of dark skin phototype images.4,5 In progress initiatives include updating emodules and rerecording of old prerecorded video lectures to increase SoC representation, further expanding small group teaching EDI material, parallel clerkship course improvements, UofT family medicine residency program SoC in dermatology education expansion, and partnering with the EDI and AntiOppression Curriculum leads to further improve small group content and tutor support. There is much more work to be done. This is just the start. Most importantly we will continue to take responsibility for changing previously ingrained unjust patterns, listen to our student’s feedback, and work together to improve and evolve the curriculum. I am extremely grateful to Emily Bellicoso, Kennedy Ayoo,\xadand\xadSofia\xadOke,\xadwhose\xadobservations,\xadgentle-\xadapproach\xad inquiry, hard work, and dedication initiated this work, as well as to Gagandeep Singh, Drs Renee Beach, and Marissa Joseph for their invaluable ongoing contributions.