DT05: Is skin of colour appropriately represented in undergraduate resources for dermatological conditions covered in the new national medical licensing assessment?

Katie Creamer,¹ Shagayegh Javadzadeh,¹ Leila Ferguson,¹ Vanessa Pinder² and Zainab Jiyad¹

¹St George’s University Hospital and ²Epsom and St Helier University Hospital, London, UK

The General Medical Council is introducing the Medical Licensing Assessment (MLA), which UK medical students graduating in 2024–25 are required to pass before joining the medical register. This is the first time there will be a national dermatology undergraduate curriculum. Teaching clinical presentations in all skin types is crucial and it is increasingly reported that skin of colour is under-represented in dermatology educational resources. The introduction of the MLA represents a unique opportunity for medical schools to review learning resources and ensure skin of colour is represented. We evaluated commonly used resources to determine skin of colour representation. An online survey was sent to clinical medical students at a large UK university to identify the most commonly used dermatology resources, with 31 responses. The three most commonly used, freely available (either online or via the library) resources were evaluated (DermNetNZ, BMJ Best Practice and the Oxford Handbook of Medical Dermatology). The proportion of pictures that represented type V–VI skin for each of the dermatology conditions listed in the MLA curriculum was collected using two assessors in a consistent environment. In total, 4374 images were reviewed. Only 140 of these images represented patients with type V–VI skin, a proportion of 3·2% overall (2·7% DermNetNZ; 3·6% Oxford Handbook; 9·1% BMJ Best Practice). Across the MLA conditions, a range of 0–25% (DermNetNZ), 0–33% (BMJ Best Practice) and 0–14% (Oxford Handbook) of pictures were of type V–VI skin. The findings of our study highlight that there is still significant under-representation of type V–VI skin across commonly used dermatology resources, and the introduction of the MLA provides a valuable opportunity to improve this. With 40·2% of our study area population identifying as nonwhite, there is a clear need to ensure resources used in undergraduate training adequately represent the diversity of populations and differences in dermatological manifestations. While in certain conditions (such as skin malignancy) differences in representation may signify epidemiological variation, there was a striking under-representation of inflammatory conditions such as psoriasis (0–1% of photos). Furthermore, our findings may represent other important issues such as cultural disparities in seeking medical help, or difficulties obtaining consent for photography for medical education. Finally, despite the increasing prevalence of skin of colour resources, students are not using these, possibly owing to their relative brevity or a lack of awareness that these resources exist.