By Chonglu Huang
Writer
With support from the Faculty of Medicine, uOttawa medical students advocated for more skin colour representation in their dermatology studies and created an official new module for the MD curriculum that addresses skin colour diversity in diagnosing and treating dermatoses.
The fully bilingual self-learning module (SLM) on skin of colour dermatology will coincide with the dermatology unit offered during second-year pre-clerkship and is available to MD students beginning this May.
“I have had a longstanding interest in skin of colour since the start of medical school and this was solidified during my attendance at the Skin Spectrum Summit hosted by the Canadian Conference on Ethnodermatology in 2019,” said Selam Ogbalidet, a third-year MD student in the English Stream.
“Upon completing the dermatology unit, I noticed that there was a gap in the skin types represented in lectures with those seen in the clinical setting. To that end, I thought that the opportunity was ripe for medical students to mobilize and advocate for curricular development with the goal of promoting cultural competency and patient safety,” she added.
As a senior executive of the uOttawa Dermatology Interest Group (DIG), Ogbalidet reached out to her MD classmates Mina Boshra, Farhan Mahmood, Linda Mardiros, Victoria Lanoë and Alexandra Finstad to work on an initiative to bring more equality to their medical education curriculum.
“We’re all passionate about dermatology and we want to see inclusivity in something we love,” said Boshra, who also is a member of the DIG and does research on educational design. “Often, presentations in western medical textbooks will show mostly fair to light skin types.”
Boshra explained that, in medicine, there is the Fitzpatrick scale for defining common skin-tones ranging from one to six with increasing melanin pigments along that scale, and yet our textbooks tend to focus on one portion of the scale.
“The biggest challenge for people of colour is that their skin manifestations for certain diseases are not widely studied and shown,” added Boshra. “As a result, according to literature reviews, there is a longer delay between the first time a patient of colour presents with a skin disease and their time of diagnosis. For example, in melanoma, a deadly type of skin cancer, there is a misconception that it is extremely common in fair skin, but doesn’t happen at all in people of colour. In actuality, there are specific subtypes of melanoma that appear more commonly in people of colour and aren’t often recognized early enough as a result of biases.”
Furthermore, the French language component of this module was also crucial to its success. Mardiros, who is a second-year MD student in the French stream, voiced her interest in this curriculum project to help ensure that the content is accessible in both official languages.
“I wanted to touch on the bilingualism portion of the project and ensure that the initial survey for student input was offered in both English and French to allow for greater inclusivity and access to the dialogue. We are extremely thankful to have support from the Faculty, who assured us that the module would be available in both official languages. Ultimately, by receiving this training in their preferred language, students will be able to better serve their diverse patient population,” said Mardiros.
As a junior executive of the Dermatology Interest Group, Mahmood is a second-year MD student who is not only involved with this initiative, but is also a member of a uOttawa MD curriculum reform working group mandated to promote social accountability and anti-racism in medical education.
“As someone who is passionate about equity, diversity, and inclusivity, I strongly believe that skin of colour representation is essential to provide better care to the Canadian population,” said Mahmood. “Medical students should be well-equipped to care for diverse populations and should be aware of the differences that exist amongst their skin conditions.”
He added that the Canadian population is diversifying; by 2031, around 30% of the population will be Black, Indigenous, or People of Colour (BIPOC).
“There persists a mistrust towards the health care system amongst the Black and Indigenous communities and many health disparities exist for BIPOC patients; not training medical students and health care providers about the unique health conditions faced by these patients will further perpetuate disparities and the mistrust,” Mahmood expressed.
The Dermatology Interest Group also connected with student leaders at other Canadian medical schools on improving skin of colour representation in medical education overall.
“It became apparent that this issue is by no means unique to the University of Ottawa,” said Finstad, a third-year MD student and a senior executive of the DIG, who specifically worked on outreach efforts on provincial and national levels. “There was a collective drive amongst students across our nation to address this gap.”
Lanoë, who is graduating this year and is continuing her training in family medicine, said that it was her drive for social advocacy that led her to this project. “We go into medicine hoping to help improve care for our own patients one day. Future students taking this self-learning module to expand their understanding of race and diversity in medicine will ultimately serve their patients better.”
It’s an incredible achievement for a team of six medical students who developed this learning module over a period of 12 months with guidance from dermatologists and family physicians including Dr. Sophia Colantonio, Dr. Amin Bahubeshi, Dr. Isabel Arroyo, Dr. Craig Campbell and Dr. Stefan de Laplante.
In addition, Dr. Ewurabena Simpson, who is the Black health theme lead for the MD program, provided counsel on ensuring equity, diversity and inclusion. Finally, the module also received IT support from Medtech’s instructional designer Jennifer Jifu He who assisted with the technical aspects of the self-learning module.
“My colleagues and I are so proud of the collaborative process that allowed this transformative initiative to come to fruition,” said Ogbalidet. “Together, we have effectively played a role in leaving the dermatology curriculum in a better place for future generations of medical trainees than we found it.
