Resolution: F-20-3: INCLUSION OF MEDIUM AND DARK SKIN TONES IN MEDICAL EDUCATION AND EVALUATION

[Valerie Lile]

1  WHEREAS, 36.8% United States population identified with medium and dark skin tones as
2  reported by a recent study, on average only 22.2% of medical textbooks depicted black patients and
3  no images depicted people of color1-2; and
4  WHEREAS, only 63.4% of the United States population identified with light skin as reported in a
5  recent study, one of the most assigned medical textbooks at top North American medical schools,
6  “Atlas of Human Anatomy (2014),” was noted to depict 99.7% white skin1; and
7  WHEREAS, Latino, Asian, and black patients report a lower quality of care from physicians
8  relative to white patients1, 3-4; and
9  WHEREAS, studies show that people of color receive little or no education from their doctors
10  concerning the risks and prevention of skin cancer7, 10; and
11  WHEREAS, COVID-19 disproportionately affects patients of color, a 2020 study reported no
12  published images of cutaneous manifestations on dark skin8-9; and
13  WHEREAS, studies show there is limited research on skin cancer in people of color as compared
14  to an abundance of research on skin cancer in white skin7-8, 10; and
15  WHEREAS, 47% of dermatologists reported a lack of exposure to darker skinned patients during
16  their medical training, and identical symptom patients were reported to receive a difference in
17  treatment based on racial differences only1, 9; and
18  WHEREAS, the white population is the primary victim of skin cancer, a recent epidemiological
19  review showed that the 5-year survival rate for non-white populations is 70%, which is significantly
20  lower than that of white populations7; and
21  WHEREAS, an analysis of case study examples provided in medical education revealed language
22  linking ethnicity to risk factors, while no such correlating language was present for case studies
23  presenting white patients11; and
24  WHEREAS, the underrepresentation of people of color in medical education imagery conditions
25  physicians to look for disease symptoms in white patients only, which is complicit in the late-stage
26  diagnosis of patients of color1, 4-6, 9-10, 12; now, therefore, be it
27  RESOLVED, that the Student Osteopathic Medical Association, the American Osteopathic
28  Association, and all associated training institutions acknowledge the underrepresentation of
29  medium and dark skin tones in medical education in the United States; and, be it further
30  RESOLVED, that the Student Osteopathic Medical Association and the American Osteopathic
31  Association shall support the adoption of policies and practices that ensure the improved inclusion

1  and population-based representation of medium and dark skin tones in medical education
2  curriculum and evaluations in pre-clinical, clinical, and support programs that are promoted by,
3  accredited by, endorsed by, or otherwise funded by the Student Osteopathic Medical Association
4  and the American Osteopathic Association.

Relevant Existing Policies:

SOMA Policy:

Policy of Other Organizations Named in the Resolved Statements (AOA/AMA/etc): AOA Policy #H215-A/17

AOA Policy #H433-A/15 AOA Policy #H406-A/19 AMA Policy #D-275.963 AMA Policy #D-295.963 AMA Policy #H-350.974

References:

1. Louie, P., & Wilkes, R. (2018, February 23). Representations of race and skin tone in medical textbook imagery. Retrieved September 19, 2020, from https://www.sciencecom/science/article/pii/S0277953618300790
2. The American National Election Studies (ANES) (2016, May 17). ANES 2012 Time Series Study. Retrieved September 19, 2020, from https://doi.org/10.3886/ICPSR35157.v1
3. Ngo-Metzger, Q., Legedza, A., & Phillips, R. (2004, February). Asian Americans’ reports of their health care experiences. Results of a national survey. Retrieved September 19, 2020, from https://www.ncbi.nlm.nih.gov/pubmed/15009790
4. Nelson, B. (2020, January 06). How dermatology is failing melanoma patients with skin of color. Retrieved September 19, 2020, from https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncy.22229
5. Turbes, S., Krebs, E., & Axtell, S. (2002, March). The hidden curriculum in multicultural medical education: The role of case examples. Retrieved September 19, 2020, from https://www.ncbi.nlm.nih.gov/pubmed/11891157
6. Karnieli-Miller, O., Vu, T., Frankel, R., Holtman, M., Clyman, S., Hui, S., & Inui, T. (2011, March). Which experiences in the hidden curriculum teach students about professionalism? Retrieved September 19, 2020, from https://www.ncbi.nlm.nih.gov/pubmed/21248599
7. Gupta, A. G., Bharadwaj, M. B., & Mehrotra, R. M. (2016). Skin Cancer Concerns in People of Color: Risk Factors and Prevention. https://Www.Ncbi.Nlm.Nih.Gov/. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5454668/
8. Tori L. Cowger, M. (2020, July 28). Use of Population Data to Assess Inequities in COVID- 19 Deaths by Race/Ethnicity Reported by the CDC. Retrieved September 20, 2020, from https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2768722
9. Lester, J., Jia, J., Zhang, L., Okoye, G., & Linos, E. (2020, July 16). Absence of images of skin of colour in publications of COVID‐19 skin manifestations. Retrieved September 20, 2020, from https://onlinelibrary.wiley.com/doi/full/10.1111/bjd.19258
10. Nelson, B. (2020, January 06). How dermatology is failing melanoma patients with skin of color. Retrieved September 20, 2020, from https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncy.22229
11. Turbes, S., Krebs, E., Axtell, S. (2002). The hidden curriculum in multicultural medical education: The role of case examples. Retrieved September 20, 2020, from https://pubmed.ncbi.nlm.nih.gov/11891157/
12. Mukwende, M., Tamony, P., & Turner, M.. (2020, August 12). Mind the Gap: A handbook of clinical signs in Black and Brown skin. St George’s, University of London.. Retrieved September 20, 2020, from https://sgul.figshare.com/articles/online_resource/Mind_the_Gap_A_handbook_of_clinical_signs_in_Black_and_Brown_skin/12769988/1

Submitted by:

Zehra Rizvi, OMS I – Dr. Kiran C. Patel College of Osteopathic Medicine
Nitya Kumaran, OMS I – Dr. Kiran C. Patel College of Osteopathic Medicine

Action Taken: [Leave Blank. Will be Approved by the House of Delegates or Not Approved.]
Date: [Leave Blank. Date submitted to National Vice President and the National Office.]
Effective Time Period: Ongoing

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