Turning Diversity Aspirations Into Action
By Julie V. Schaffer, M.D.*
Since June 2020, the American Board of Dermatology has posted several statements unequivocally condemning racism, prejudice, and intolerance both within and outside of our specialty. We affirmed our objective to ensure dermatologists demonstrate the ethics and professionalism as well as knowledge and skills needed to improve the health of all.
During this time, the ABD established a Diversity Committee, chaired by Mercedes E. Gonzalez, M.D., of the University of Miami and Medical Director at Pediatric Dermatology of Miami, to turn these aspirations into action. We are very grateful to her, ABD staff member Sanettra Ferguson, the entire committee, and others who have offered ideas and support.
For dermatologists, issues of race are not only about equity and justice, but also about competently practicing our specialty. To provide effective patient care, dermatologists must have broad knowledge and skills to serve a diverse patient population, including individuals with skin of color, varied racial/ethnic groups, and sexual and gender minorities.
In my own pediatric dermatology practice, I see examples on a daily basis of the critical need for dermatologists to have expertise in diagnosing and managing skin disease in diverse patients. I am currently caring for a 16-year-old African American girl who has been dealing with significant hair loss and scalp tenderness since she was 13. She was previously followed by several other dermatologists, who had diagnosed her with alopecia areata. The patient and her mother were very distressed that her condition showed no signs of response to treatment and had continued to progress. I recognized (and confirmed via biopsy) that she had central centrifugal cicatricial alopecia (CCCA), which occurs almost exclusively in Black women (and occasionally adolescents). We won’t be able to fully reverse the scarring, but we can work to halt the progression. My other recent and all-too-common experiences range from post inflammatory hypopigmentation in a Hispanic boy previously misinterpreted as vitiligo, to erythrodermic atopic dermatitis in a South Asian teenager unrecognized in the emergency department due to the more subtle appearance of erythema in her darker skin.
We all want to avoid the kind of heartbreak and frustration my patient with CCCA felt, and the frustration that I’m sure her other dermatologists also experienced when they were unable to correctly diagnose and treat her condition. It is crucial for dermatologists to feel comfortable with skin diseases and issues pertinent to patients with skin of color and other diverse patient groups. As visual diagnosis is essential to the practice of dermatology, dermatologists also need to be familiar with the appearance of the full spectrum of cutaneous disease in different skin tones.
To provide optimal patient care, we must have opportunities to learn. That’s where the ABD can make a difference. If we make diversity a central part of our certification exams and CertLink, then these topics will be emphasized in dermatology training and education.
For those reasons, one of our primary goals is to ensure that our exam development focuses appropriately on skin of color and other diverse patient groups. Our intent is to reflect U.S. Census data and depict skin of color in at least 20%-25% of images in all ABD exams and new items.
Significant progress is being made:
- We have assessed our item and image banks and are developing additional items (1) covering specific disorders/issues pertinent to patients with skin of color and other diverse patient groups; and (2) depicting skin of color in a broad range of dermatologic diagnoses.
- We have added item-writers who have medical, pediatric, surgical, and cosmetic expertise as well as an interest in skin of color/diversity to develop items that build the item bank and fill gaps.
- We have designated a “diversity advocate” on each exam content development committee to keep us on target toward our goals.
- We are tracking overall performance of diversity items on exams so we can determine what the knowledge gaps are, and what kind of additional study opportunities would be beneficial.
- We have reached out to ~30 dermatology training programs, asking for images depicting skin of color. We plan to expand this request for images soon. (If you currently have a photo you believe would be useful, though, please contact us at email@example.com for more information.)
Of course, there is more to do. We want the ABD Board of Directors and item writing committees to reflect the diversity of the population. We want to listen to the needs and goals of dermatologists treating patients with skin of color and find ways to support them as they build their knowledge and skills. And we want to better understand the diversity of our own diplomates and candidates for certification.
We look forward to continuing to work with you to find solutions that will benefit all dermatologists and our diverse patients. Please share your ideas with us at Feedback@abderm.org.
*About the Author
Dr. Schaffer is the ABD Associate Executive Director for Exam Development, as of July 1, 2021. As President of the ABD Board of Directors in 2020, she worked to establish the diversity committee and set diversity as a priority for the board.
Dr. Schaffer also is a pediatric dermatologist in the Division of Pediatric Dermatology and Department of Pediatrics at the Hackensack University Medical Center (HUMC) in Hackensack, NJ. She is a professor of pediatrics at the Hackensack Meridian School of Medicine and director of the HUMC Pediatric Dermatology Fellowship.