Medical students launch plan to improve skin tone diversity in course material

A group of students at Queen's University noticed a problem when they were sitting through a dermatology lecture: most of the photos of medical conditions appeared on white skin. And that, they say, could have consequences when it comes to making the right diagnosis.

Skin conditions, cancers appear differently on brown, black skin

Varies conditions and infections, like shingles, can manifest differently on darker skin tones versus lighter ones. (brownskinmatters/Instagram)

A group of medical students at Queen's University noticed a problem when they were sitting through a dermatology lecture — most of the photos of medical conditions appeared on white skin. 

"When I saw those slides, that didn't really include diverse skin tones, my first thought after was 'How would this [condition] look on me? How would this look on my family members, my community, my loved ones?'" Iku Nwosu, a third-year medical student at the Kingston, Ont., university, told CBC Radio's All In A Day.

"And I felt like I couldn't provide as good care to them as I could for other populations."

Liver disease, heart valve disease, and certain cancers can all manifest in skin conditions, and those conditions can look very different depending on someone's skin tone.

As a result, Nwosu and two other medical students, Aquila Akingbade and Eric Zhang, set out to find how deep the problem went — and are now working to ensure other medical students across the country have access to a wider, more diverse range of images.

Iku Nwosu, a third-year Queen's University medical student, has been working with her colleagues to ensure Canadian universities teach how medical conditions appear on a variety of skin tones, not just lighter ones. (Submitted by Iku Nwosu)

90% of images were of white skin

With a team of more than 100 volunteers, the three students reviewed the learning materials for the first two years of medical school at Queen's.

They found that out of 900 lectures, roughly one in five dealt with skin conditions, and more than 90 per cent of those only used images of white skin.

"When we talk about upholding systemic racism in medicine, that begins at the level of a learner, and the definition of a white person as a standard in health care and everyone else being a deviant off of that," Nwosu said.

The future doctors wondered how they could treat a significant — and growing — portion of the population, given they weren't learning how diseases appeared on anyone who didn't have light skin. 

According to Statistics Canada's 2016 census, more than 22 per cent of Canadians identified as belonging to a visible minority. That number is projected to increase to upwards of 30 per cent by 2036.

"The fact that, you know, three-tenths of the population are not being covered in the lecture is quite disturbing to me," said Akingbade.

Many studies have shown Black patients are more likely to be diagnosed with later stages of skin cancer, Nwosu said, compared to people with lighter skin tones. 

And that can have implications, she added,  for a patient's quality of life.

The group brought their findings to the faculty's attention, and discovered that professors weren't showing images of a variety of skin tones because they didn't have access to them.

Zhang said part of the problem is that often images are copyright and difficult to obtain, so professors tend to rely on the images they have access to. In less diverse communities, that can mean fewer skin tones to choose from.

So Nwosu, Akingbade, and Zhang found an online resource with images of a variety of skin tones, and they're now working to make sure other medical students have access to them. They're sharing their project through social media and providing strategies for other students to approach their school's administration and request they acquire the database.

"Now we have this framework that other schools can use and apply to their own curriculum to review their content for skin of colour and also really for other topics of equity, diversity and inclusion," said Nwosu.


For more stories about the experiences of Black Canadians — from anti-Black racism to success stories within the Black community — check out Being Black in Canada, a CBC project Black Canadians can be proud of. You can read more stories here.

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With files from CBC Radio's All In A Day

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