There is a lack of representation of clinical pathologies on individuals of darker complexions across educational modalities. This lack of representation contributes to the existing disparity in the recognition of various medical conditions on darker skin tones, which then contributes to inequity in health care—which may influence health outcomes among patients of color.
To address this gap in medical knowledge and advance racial equity in gynecologic and gender-based medicine, medical students in Districts IV and VII have created In Plain Sight: Normalizing Diverse Clinical Presentations in Obstetrics and Gynecology. This guidebook provides clinical photographs of various pathologies seen commonly in obstetrics and gynecology. By sharing this information and highlighting the existing gaps in knowledge, the creators of this guidebook hope to ignite discussions around this important knowledge and share awareness and resources with a broader audience of educators and trainees.
Interrupting Health Disparities through Medical Education
Racial health care disparities dissipate when patients interact with health care professionals trained in equitable provision of health care, a finding that emphasizes the importance of incorporating principles of anti-racism in medical training1. Recognition and management of medical conditions in people of color is not well embedded in medical curriculum and can delay appropriate care. Prior research has demonstrated a lack of representation of patients of color in educational resources.3,5 In fact, a 2018 study showed that less than 5% of general medicine textbooks have images of dark skin tones.6 Interestingly, sexually transmitted infections are more frequently shown on dark skin tones as opposed to white skin tones, which are used to depict more common and less stigmatizing diagnoses.5
Combating Systemic Roots of Health Disparities
People of color have disproportionately worse gynecologic and gender-based health outcomes than white patients. Today, we see that Black obstetric and gynecologic patients have significantly worse perinatal outcomes—and proportionally more deaths due to gynecologic and breast cancer—when compared with white patients.2,4
The causes of these health care disparities are multifactorial, and the Institute of Medicine divides them into three broad categories: patient, health care professional, and systemic factors.1,3 Patient factors include education, geographical access to health care, financial and insurance status, cultural beliefs and values, and other social factors. Systemic factors influence the delivery and receipt of health care services themselves and include location and available resources. Health care professional factors include prior medical knowledge, expectations or beliefs, implicit bias, and the racial or ethnic background of the health care professional.
While it is relatively simple to divide causes of health care disparities into categories on paper, these factors have significant interplay in real-world application. Our digital guidebook addresses the need to ensure that future health care professionals have access to educational material that is diverse in its representation of pathology in obstetrics and gynecology to promote and foster the provision of equitable care.
- Collins, Y., Holcomb, K., Chapman-Davis, E., Khabele, D., Farley, J.H., (2014). Gynecologic cancer disparities:A report from the Health Disparities Taskforce of the Society of Gynecologic Oncology. Gynecologic Oncology 133, 353–361. doi:10.1016/j.ygyno.2013.12.039
- Gwan et al. (2022). Equity in visual representation of vulvar conditions in major gynecology textbooks. Journal of the National Medical Association.,114(3), 314.
- Nelson A. (2002). Unequal treatment: confronting racial and ethnic disparities in health care. Journal of the National Medical Association, 94(8), 666–668.
- Jatoi, I., Sung, H., Jemal, A., (2022). The Emergence of the Racial Disparity in U.S. Breast Cancer Mortality. New England Journal of Medicine 386, 2349– 2352. doi:10.1056/nejmp2200244
- Kaundinya, T., & Kundu, R. V. (2021). Diversity of Skin Images in Medical Texts: Recommendations for Student Advocacy in Medical Education. Journal of medical education and curricular development, 8, 23821205211025855. https://doi.org/10.1177/23821205211025855
- Louie, P., & Wilkes, R. (2018). Representations of race and skin tone in medical textbook imagery. Social science & medicine (1982), 202, 38–42. https://doi.org/10.1016/j.socscimed.2018.02.023