JMIR Publications

ABSTRACT

Research has highlighted clinicians’ lack of confidence in safely diagnosing and managing dermatological disease in patients with skin of colour (SOC).The imagery and language surrounding skin colour in medical education often presents a narrow spectrum of individual experiences and the undergraduate voice appears to be lacking from these discussions. We aimed to capture the descriptors which medical students use in relation to their own skin and how this relates to their education, to better understand how we can diversify the language used, for the benefit of the patient and future clinician. An ethically-approved, digital survey was distributed to all UK medical schools between October 1st and December 31st 2024. Participants were asked to describe their skin type at baseline, when inflamed, and in relation to the Fitzpatrick scale; rate preparedness to examine and discuss differences in skin conditions in SOC; suggest how best to describe SOC when ethnicity is unknown; and describe any experiences of unacceptable SOC terminology used in the context of medical education. The survey generated 367 responses from 21 different medical schools. Self-ascribed ethnicity included: White British/Irish/White other (48%), Black/African/Caribbean/Black British (10%), Asian/Asian British (30%) and Mixed White/Black/Asian (7%) and Other (5%). The responses demonstrated that neither the pictorial nor text versions of the Fitzpatrick scale adequately represent how medical students consider their own skin, with 56% positioning themselves outside of the six images. The top descriptors of skin colour reflected that most participants self-identified as: brown (125 mentions), pale (123) and white (116). For inflamed skin, the terms red or reddish (337) were most frequently used, followed by pink (97) and brown (27). There were differing views on the use of ethnicity-related terminology where patient ethnicity is unknown. A total of 71% and 75% of participants felt between neutral and unprepared in relation to seeing patients with diverse skin tones and discussing differences in the presentation of dermatoses in SOC with patients, respectively. Our findings suggest that skin descriptors and imagery in medical education needs to encompass greater variation in skin tone. We recommend further involvement of medical students in the diversification of undergraduate curricula, and for educators to consider the language they use to improve comprehension and preparation for clinical practice.