Throughout their first two years of medical school, a group of students at Queen’s University noticed that class after class, slide after slide, most of the images their instructors added were of white people.
And when it came to their dermatology classes, the lack of diversity was especially “frightening.”
“That’s where you would expect to see diverse skin tones because it’s a skin-focused specialty,” said third-year student Iku Nwosu. “But we still saw entire lectures of entirely white skin.”
Students rely a lot on images to see examples of what conditions look like, while they’re training. And with Queen’s University located in Kingston, Ont., a predominately white city, it wasn’t a guarantee that their in-field clerkship learning would fill the gap.
So Nwosu, along with two classmates created a plan to make sure that examples of diverse skin tones and races would be included in their learning.
For dermatology in particular, a lack of diversity in education can drastically change treatment for races with darker skin.
While some skin diseases can present with redness on pale skin, they will look different on more melanated skin.
And while some skin conditions are benign, like acne, more serious ailments like Kawasaki disease in children and melanoma have higher stakes.
A 2016 study from the U.S. found that skin cancer is rarer among people of colour than white people, but people of colour were more likely to die from the disease because it’s not caught until it is already advanced. An author of the study said both the public and many physicians are not aware Black people can get skin cancer.
Nwosu said it was “bothersome” to think that she wasn’t being trained to properly diagnose herself or her family members, and nor were her fellow students.
And once students start practising, they can wind up anywhere.
“Anyone can walk into your door,” said third-year student Aquila Akingbade. “You’re not providing your students the tools to be culturally competent, and to service an ever increasing proportion of the Canadian population.”
So, classmates Nwosu, Akingbade and Eric Zhang gathered support from the student body and wrote an open letter to school administrators asking them to approve their project — a curriculum review for all of their classes.
Over 120 students volunteered to audit the library of course materials and together they went through over 900 learning events. They came across 168 teaching materials that showed skin presentations and of those, 131 only showed examples of conditions on white skin.
With the support of faculty, Nwosu, Akingbade and Zhang worked on a solution.
Most instructors use images they’ve taken personally to avoid copyright issues. The students instead found VisualDx, a service that includes a medical image library with a variety of skin tones, and administration purchased a licence for the entire health science department.
Nwosu said they’ve created packages for their professors with suggested updates.
Student volunteers then went back to the materials they flagged, and linked an image that could be added, either from VisualDx or the book Mind the Gap, a book created by a student and two professors in the U.K. to address the same problem.
Since proposing these changes to the Queen’s curriculum, Nwosu said they have shared the framework they followed with students at other schools — including McGill University, Université de Montréal and Northern Ontario School of Medicine — who have reached out and are looking to make a similar change.
“We found that this issue was not something that was unique to Queen’s University, this is something that was actually quite prevalent in the entirety of North America,” Akingbade said.
At McGill University, student Victoire Kpadé is working to make these changes as well as have curriculum added on the history of racism in medicine, critical race theory and effective allyship.
“We’ve had diverse populations in (Canada) and medicine in general for decades at this point,” Nwosu said. “We didn’t really understand why these gaps were still there and they’re definitely fillable.”
Story by Angelyn Francis, The Toronto Star, for the Local Journalism Initiative.