Addressing the pressing need for enhanced inclusivity in medical education, Black and Brown Skin; National Health Service (NHS); and Pastest are leading transformative initiatives to diversify clinical practice.

According to a groundbreaking global survey, which included 600 healthcare professionals, a mere 5% expressed confidence in diagnosing dermatology conditions across a range of skin tones. This statistic highlights a critical disparity in dermatological understanding and the urgent need for change.

BMJ Author and Paediatrician, Dr Zeshan Qureshi, highlights the lack of representation of ethnic minority groups in medical education. He describes attending a two-day course on managing acutely unwell children, where it "became obvious that the course’s guidance was almost entirely predicated on treating patients with white skin". The course materials included no images of patients with darker skin, and every mannequin used was white. Despite pointing out this issue, the problem was not addressed until a later course update was released. But why wasn't the issue addressed sooner?

"Anti-racist medicine is multifaceted."

- Dr Zeshan Qureshi

Racism in healthcare is not a singular issue with a simple solution but rather a complex problem embedded within various aspects of medical practice, education, policy, and societal attitudes. In essence, "Anti-racist medicine is multifaceted" suggests that tackling racism in healthcare requires a comprehensive strategy that addresses its root causes and manifestations across different areas of medical practice and society.

In response, Black and Brown Skin, a renowned advocate for diversity in healthcare, is leading the Mind the Gap initiative. This groundbreaking effort aims to bridge the gap in medical education by providing comprehensive resources and training modules that authentically depict diverse skin tones and conditions. By empowering healthcare professionals with the knowledge and skills needed to deliver culturally competent care,

Black and Brown Skin seeks to eradicate systemic biases and promote health equity.

Simultaneously, the NHS has taken proactive steps to overhaul medical training by revolutionising how skin symptoms are presented and taught. Embracing inclusive design principles, the NHS is committed to developing educational materials that accurately reflect the diverse spectrum of skin tones and pathologies encountered in clinical practice, ensuring more comprehensive and culturally sensitive care.

In 2021, the NHS team began a project auditing their website to see the levels of diversity within their Health A to Z topics to help the public identify their illnesses. They found:

• Only 7 out of 75 pages about skin problems described various skin tones

• Only 3 out of 61 pages with images included an image of non-white skin

• Many other pages about health conditions described how to identify symptoms on white skin only.

The NHS is working on rectifying this issue through funding the UWE Bristol's REFRAME initiative, which aims to create a library of digital images showing various skin conditions across individuals with diverse skin tones. Making it accessible at no cost to clinicians, educators, and the general public.

The alignment between these initiatives is a testament to an unyielding commitment to fostering cultural competency in medical education. While each initiative operates independently, collectively, they represent a powerful stride towards achieving comprehensive health equality.

Here at Pastest, as an esteemed provider of medical exam preparation resources, we had to contribute to this momentum, and spearheaded an extraordinary project titled 'Dermatology for Dark Skin'. This groundbreaking initiative aspires to combat the scarcity of diverse imagery in dermatology education by curating a vast collection of images that showcase skin conditions across different dark skin tones and age groups.

When speaking with Ampley Narayanan, former Medical Editor at Pastest and project lead, she emphasised, "The lack of description and depiction of dermatological conditions affecting darker skin tones in textbooks and by education platforms used by medical professionals worldwide has inevitably led to health inequalities including misdiagnosis and delayed diagnosis in affected patients. The issue is slowly being recognised, and its great to see that Pastest is proactively addressing this within their educational materials. I’m delighted to hear that the first phase of the 'Dermatology for Dark Skin' project, initiated by my colleague Adele Martin and myself during my former role at Pastest, is now complete."

Adele, Content Editor at Pastest and current project lead, also expressed her enthusiasm, "I'm so pleased to be able to contribute to increasing visibility for diverse populations in medical exam revision. I hope this project will contribute to more robust diagnostic training for all our users," she said.

Integrated into various Pastest medical exam preparation products, including Med Students, MRCP, MRCPCH, MSRA, MRCS A, PLAB 1, Primary FRCA, and MRCGP (AKT). This collection offers medical students and doctors a holistic understanding of dermatological conditions in diverse patient populations via Qbanks, Spot Diagnosis and Extended Matching Questions (EMQs).

Currently, the Pastest project is in its launch stage. However, to enhance its impact, we seek to expand its collection of photos. If you would like to contribute to this groundbreaking initiative or offer your insights, please email us at enquiries@pastest.com

As these pioneering initiatives gain traction, stakeholders across the healthcare spectrum are poised to embrace a future characterised by diversity and inclusivity in medical education. With a shared commitment to challenging systemic biases and fostering cultural competence, Black and Brown Skin; the NHS; and Pastest are at the forefront of propelling healthcare towards a more equitable future.

Get involved: If you would like to contribute to the Pastest Dermatology for Dark Skin project or provide valuable input, please reach out to us via email enquiries@pastest.com

Sources:

Medical education is still complicit in poor healthcare outcomes for ethnic minority patients | The BMJ

Mind the Gap — Black & brown skin (blackandbrownskin.co.uk)

Making content about skin symptoms more inclusive - NHS England Digital

Project to tackle lack of diversity in photographs of medical conditions | UWE Bristol