Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Division of General Internal Medicine, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Clin Teach. 2023 Dec;20(6):e13613. doi: 10.1111/tct.13613. Epub 2023 Aug 30.
Individuals with skin of colour (SoC) have delayed diagnosis and poorer outcomes when presenting with some dermatologic conditions when compared to individuals with light skin (LS). The objective of this study was to determine if diagnostic performance bias can be mitigated by a skin-tone balanced dermatology curriculum.
A prospective randomised intervention study occurred over 2 weeks in 2020 at a Canadian medical school. A convenience sample of all first-year medical students (n = 167) was chosen. In week 1, all participants had access to dermatology podcasts and were randomly allocated to receive non-analytic training (NAT; online patient 'cards') on either SoC cases or LS cases. In week 2, all participants received combined training (CT; NAT and analytic training through workshops on how to apply dermatology diagnostic rules for all skin tones). Participating students completed two formative assessments after weeks 1 and 2.
Ninety-two students participated in the study. After week 1, both groups had a lower diagnostic performance on SoC (p = 0.0002 and p = 0.002 for students who trained on LS 'cards' and SoC 'cards', respectively). There was a significant decrease in mean skin tone difference in both groups after week 2 (initial training on SoC: 5.8% (SD 12.2) pre, -1.4% (14.7) post, p = 0.007; initial training on LS: 7.8% (15.4) pre, -4.0% (11.8%) post, p = 0.0001). Five students participated in a post-study survey in 2023, and all found the curriculum enhanced their diagnostic skills in SoC.
SoC performance biases of medical students disappeared after CT in a skin tone-balanced dermatology curriculum.
与浅色皮肤（LS）个体相比，有色人种（SoC）个体在出现某些皮肤病时诊断延迟且预后较差。本研究旨在确定肤色均衡皮肤科课程是否可以减轻诊断性能偏差。
这是一项 2020 年在加拿大一所医学院进行的前瞻性随机干预研究。选择了所有一年级医学生（n=167）的便利样本。在第 1 周，所有参与者都可以访问皮肤科播客，并随机分配接受非分析性培训（NAT；在线患者“卡片”），要么针对 SoC 病例，要么针对 LS 病例。在第 2 周，所有参与者都接受了综合培训（CT；通过关于如何为所有肤色应用皮肤病诊断规则的研讨会进行 NAT 和分析性培训）。参与学生在第 1 周和第 2 周后完成了两次形成性评估。
92 名学生参与了这项研究。第 1 周后，两组对 SoC 的诊断性能均降低（分别训练 LS 卡片和 SoC 卡片的学生，p=0.0002 和 p=0.002）。第 2 周后，两组的平均肤色差异均显著降低（初始 SoC 训练：5.8%（SD 12.2）预，-1.4%（14.7）后，p=0.007；初始 LS 训练：7.8%（15.4）预，-4.0%（11.8%）后，p=0.0001）。2023 年，有 5 名学生参与了一项研究后调查，他们都认为该课程提高了他们对 SoC 的诊断技能。
在肤色均衡的皮肤科课程中，经过 CT 后，医学生对 SoC 的表现偏见消失了。
