Diversity in Dermatology Undergraduate Medical Education

A lack of representation of skin of colour in dermatology curricula is well-documented across many North American medical schools presenting a potential barrier to equitable and comprehensive undergraduate medical education. Toronto is one of the most multicultural cities in the world with nearly 50% of its population identifying as a visible minority. Educational resources with equal representation of different skin types, reflective of the city’s inhabitants, are needed for the University of Toronto’s burgeoning physicians.   

A needs assessment study was undertaken at the University of Toronto Medical School to examine diversity representation in dermatologic educational materials in the undergraduate medical education curriculum and to assess student diagnostic ability and self-rated confidence in diagnosing dermatologic conditions in skin of colour compared to white skin. 

An anonymous, voluntary survey of multiple-choice questions was administered to first- and third-year medical students to assess diagnostic accuracy and self-rated confidence in diagnosing five common skin conditions in white skin (skin phototype I-III) and skin of colour (skin phototype IV-VI). An audit was also performed on the University of Toronto Dermatology Undergraduate Medical Education curriculum to examine the percentage photographic representation of dermatologic conditions in skin of colour compared to white skin. 

Results demonstrated diagnostic accuracy was fair for students diagnosing skin conditions in both white skin and skin of colour, but students’ self-rated confidence was significantly lower with making dermatologic diagnoses in skin of colour when compared with diagnoses in white skin (P=0.0002). The curriculum audit showed that <7% of all images of skin disease in the curriculum were representative of skin of colour. 

Informed by this study, curriculum improvement initiatives are currently underway to improve skin of colour teaching in dermatology undergraduate medical teaching at the University of Toronto. Corrective work is needed, both at our institution and beyond, to address this gap and ensure that the next generations of Canadian physicians are able to accurately, equitably and confidently treat patients of all skin types. 

Manuscript in process. Diversity in Dermatology: An Assessment of Undergraduate Medical Education. Kennedy Ayoo BScH, Emily Bellicoso BScH, Sofia Oke Quick MSc, Renée A. Beach MD FRCPC, Marissa Joseph MD FRCPC, and Erin Dahlke MD FRCPC