Assessing Implicit Bias in Dermatology

Abstract

Background: Patients with skin of color (SOC), defined as Fitzpatrick skin types IV to VI, and of varying ethnicities are under-represented in dermatology. This includes practitioners, trainees, dermatologic teaching materials, and clinical studies.  Methods: Online survey study to assess dermatologists’ perceptions that could impact patient care. Participants were screened for providers that spent ≥80% of their time in direct patient care; managed ≥100 unique patients per month; and had ≥20% aesthetic patients.

Results: A total of 220 dermatologists participated; 50 with SOC, 152 non-SOC, and 18 other. SOC dermatologists had a more diverse patient population by racial/ethnic background, but there was no difference in proportion of patients by Fitzpatrick skin phototype categories. While race/ethnicity is not considered a primary factor in clinical decision making, Fitzpatrick skin type is for many dermatologists. Most dermatologists agree that more diversity in medical training for dermatologic conditions would be beneficial. Dermatologists report that adding before and after photos of different skin types in educational materials and increasing training on cultural competency are likely to be the most effective strategies for improvement.

Conclusions: Although racial/ethnic diversity shows differences based on location of practice and the race of dermatologists, diversity of skin type based on Fitzpatrick scale is virtually identical across practices, illustrating the challenge of categorizing patients by this scale alone. Beer J, Downie J, Noguiera A, et al. Assessing implicit bias in dermatology. J Drugs Dermatol. 2023;22(7):635-640. doi:10.36849/JDD.7435.