Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Nov 15;9(11):1749.
doi: 10.3390/children9111749.

Assessing Healthcare Professionals' Identification of Paediatric Dermatological Conditions in Darker Skin Tones

Dhurgshaarna Shanmugavadivel  1 , Jo-Fen Liu  1 , Danilo Buonsenso  2   3   4 , Tessa Davis  5   6 , Damian Roland  7   8
Affiliations

Assessing Healthcare Professionals' Identification of Paediatric Dermatological Conditions in Darker Skin Tones

Dhurgshaarna Shanmugavadivel et al. Children (Basel). .

Abstract

The impacts of the lack of skin tone diversity in medical education images on healthcare professionals (HCPs) and patients are not well studied. The aim of this study was to assess the diagnostic knowledge of HCPs and correlate this with confidence and training resources used. An online multiple choice quiz was developed. The participants' demographics, training resources and self-confidence in diagnosing skin conditions were collected. The differences in the results between the subgroups and the correlations between the respondents' experience, self-reported confidence and quiz results were assessed. The mean score of 432 international participants was 5.37 (SD 1.75) out of a maximum of 10 (highest score). Eleven percent (n = 47) reached the 80% pass mark. Subanalysis showed no difference by the continent (p = 0.270), ethnicity (p = 0.397), profession (p = 0.599), training resources (p = 0.198) or confidence (p = 0.400). A significance was observed in the specialty (p = 0.01). A weak correlation between experience and confidence (Spearman's ρ = 0.286), but no correlation between scores and confidence or experience (ρ = 0.087 and 0.076), was observed. Of diagnoses, eczema was recognised in 40% and meningococcal rash in 61%. This is the first study assessing the identification of paediatric skin conditions in different skin tones internationally. The correct identification of common/important paediatric conditions was poor, suggesting a possible difference in knowledge across skin tones. There is an urgent need to improve the representation of all skin tones to ensure equity in patient care.

Keywords: child health; dermatology; ethics; medical education; paediatrics.

PubMed Disclaimer

Conflict of interest statement

Tessa Davis and Damian Roland are executive committee members of Don’t Forget the Bubbles. The remaining authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Example of images from the quiz. (a) Eczema; (b) Infected eczema; (c) Meningococcal septicalemia; (d) Kawasaki disease.
Figure 2
Figure 2
Example of a multiple choice question (a) and the distribution of the quiz scores (b).
Figure 3
Figure 3
Quiz scores by demographics and professional background, experience, skin tone representation in training resources and self-reported confidence in diagnoses across a range of skin tones. The dotted line represents the group mean of 5.37, and open dots indicate subgroups with n < 10.
Figure 4
Figure 4
Percentages of correctness for common diagnoses.
See this image and copyright information in PMC

References

    1. Buonsenso D., Roland D., Abela N., Shanmugavadivel D., Platt R., Davis T. Time to improve the diversity of paediatric skin images. Lancet Child Adolesc. Health. 2020;4:e44. doi: 10.1016/S2352-4642(20)30303-5. - DOI - PubMed
    1. Lester J.C., Taylor S.C., Chren M.-M. Under-representation of skin of colour in dermatology images: Not just an educational issue. Br. J. Dermatol. 2019;180:1521–1522. doi: 10.1111/bjd.17608. - DOI - PubMed
    1. Massie J.P., Cho D.Y., Kneib C.J., Sousa J.D., Morrison S.D., Friedrich J.B. A Picture of modern medicine: Race and visual representation in medical literature. J. Natl. Med. Assoc. 2021;113:88–94. doi: 10.1016/j.jnma.2020.07.013. - DOI - PubMed
    1. Louie P., Wilkes R. Representations of race and skin tone in medical textbook imagery. Soc. Sci. Med. 2018;202:38–42. doi: 10.1016/j.socscimed.2018.02.023. - DOI - PubMed
    1. Cho D.Y., Kneib C.J., Massie J.P., Sobol D.L., Crowe C.S., Shakir A., Burns J.R., Lane M., Morrison S.D., Sabin J., et al. Visual representation of racial diversity in aesthetic surgery literature. J. Plast. Reconstr. Aesthet. Surg. 2021;74:223–243. doi: 10.1016/j.bjps.2020.05.048. - DOI - PubMed

LinkOut - more resources