Division of Plastic Surgery, Department of Surgery, University of Washington. Seattle, WA.
Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine at Northwestern University, Chicago, IL.
J Craniofac Surg. 2022;33(1):76-80. doi: 10.1097/SCS.0000000000007972.
Implicit bias can lead to discrimination of certain populations within healthcare. Representation in medical literature is no exception and it is hypothesized that images with lighter skin tone are more prevalent than darker skin tones in craniofacial literature. Clinical photographs and figure graphics from 5 journals were examined for pre-defined years. Annals of Plastic Surgery, Aesthetic Surgery Journal, Journal of Craniofacial Surgery, Journal of Plastic, Reconstructive and Aesthetic Surgery, and Plastic and Reconstructive Surgery journals were reviewed. All craniofacial-focused articles containing at least one color image depicting human skin were included. 10,477 images and 627 graphics were evaluated using the Fitzpatrick scale as a guide. Most journals trended toward broader inclusion of nonwhite photographs and graphics over time. In 2016, 47% of articles published in Journal of Craniofacial Surgery included nonwhite images compared to Annals of Plastic Surgery (16%), Aesthetic Surgery Journal (40%), Journal of Plastic, Reconstructive and Aesthetic Surgery (25%), and Plastic and Reconstructive Surgery (7%). Comparison of domestic and international publications demonstrated that author's country of origin impacted the percentage of nonwhite clinical photographs for most journals. Comparisons of publications by country demonstrated increased diversity in Asia and the Middle East for clinical photographs but not graphics. The frequency of nonwhite figure graphics was staggeringly low, identified in only 18 articles across all journals and years. Craniofacial literature more commonly reflects white skin tones. The trend over time suggests increasing inclusion of racial diversity in clinical photographs; however, figure graphics remain less racially diverse. Time, country of origin, and publishing journal appear to play a role.
隐性偏见可能导致医疗保健领域对某些人群的歧视。医学文献中的代表性也不例外，有人假设在颅面文献中，肤色较浅的图像比肤色较深的图像更为常见。检查了 5 种期刊的预定义年份的临床照片和图形。回顾了《整形外科学年鉴》、《美容外科学杂志》、《颅面外科学杂志》、《整形再造与美容外科学杂志》和《整形与重建外科学杂志》。纳入了所有包含至少一张描绘人类皮肤的彩色图像的颅面焦点文章。使用 Fitzpatrick 量表作为指南，评估了 10477 张图像和 627 张图形。大多数期刊在时间推移中，逐渐扩大了对非白色照片和图形的收录范围。2016 年，《颅面外科学杂志》发表的文章中，有 47%的文章包含非白色图像，而《整形外科学年鉴》（16%）、《美容外科学杂志》（40%）、《整形再造与美容外科学杂志》（25%）和《整形与重建外科学杂志》（7%）则较少。对国内外出版物的比较表明，作者的原籍国影响了大多数期刊的非白色临床照片的比例。对国家出版物的比较表明，亚洲和中东的临床照片多样性增加，但图形的多样性则没有增加。非白色图形的频率非常低，仅在所有期刊和年份的 18 篇文章中有所发现。颅面文献更常反映白色肤色。随着时间的推移，这种趋势表明临床照片中种族多样性的纳入逐渐增加；然而，图形的种族多样性仍然较低。时间、原籍国和出版期刊似乎都发挥了作用。
