Bridging racial differences in the clinical encounter: How implicit bias and stereotype threat contribute to health care disparities in the dermatology clinic

Skin of Color Is Underrepresented on Instagram: Assessing South Jersey Skin Talk as an Educational Tool to Increase Awareness

Background Instagram, a widely used social media platform with over two billion active users, has the potential to propagate dermatologic health information within the public sphere. However, there is a lack of representation of people of color (POC), making it crucial to share accurate and inclusive posts to increase awareness about dermatologic conditions. It is also necessary to address the misconceptions about skin diseases and other hereditary conditions within various ethnic groups. To combat this, a group of medical students created South Jersey Skin Talk (SJST), an initiative aimed to improve dermatologic health literacy in skin-of-color communities, particularly in underserved areas like Camden County, NJ. Using reliable sources to prevent the spread of misinformation, SJST's accessible Instagram page explains skin conditions, especially emphasizing appearances and manifestations in POC. The hypothesis being investigated by this group is that the implementation of SJST as a community intervention is expected to improve dermatologic health literacy in POC. Methods A 13-question survey was conducted via Qualtrics (Seattle, Washington) and was distributed on social media (Instagram, Facebook, Reddit, Twitter, TikTok, and GroupMe). It remained open for eight weeks during which users 18 years or older were invited to participate. The survey was divided into four sections: demographics, Instagram usage, knowledge of dermatology, and inclusion and diversity on SJST's page. A total of 184 total responses were collected, which were compared using chi-squared analyses on Qualtrics software. Results POC felt less represented on social media compared to White respondents prior to visiting SJST on Instagram (p < 0.00001). However, after viewing SJST, 87.5% of White participants and 88% of POC reported feeling represented on the page. Additionally, both groups of respondents indicated that they felt more knowledgeable about their primary skin concern after viewing the SJST's posts. Furthermore, 86.8% of POC reported that they would feel more confident participating in a conversation with their dermatologist regarding their primary dermatologic concern. Conclusion SJST is a community outreach organization focused on improving health literacy for POC and bridging the gap in healthcare disparities between White and POC populations. The results from this survey confirm the hypothesis and illustrate that community interventions targeted at education for POC increase health literacy and patient autonomy. These results also show that there is a need for more representation and diversity in medical dermatology on social media. Further studies should be done to investigate other disparities affecting adequate representation for POC.

Unconscious Bias

Unconscious biases (also known as implicit biases) are involuntary stereotypes or attitudes held about certain groups of people that may influence our behaviors, understandings, and actions, often with unintended detrimental consequences. Implicit bias appears in multiple facets of medical education, training, and promotion with negative effects on diversity and equity efforts. Notable health disparities exist among minority groups in the United States, which may partly be attributable to unconscious biases. Although there is little evidence supporting the effectiveness of current bias/diversity training programming, standardization and blinding may be helpful, evidence-based methods to reduce implicit bias.

A new model for categorizing cognitive biases and debiasing strategies in dermatology

Cognitive biases are a significant cause of medical error. They arise from "system 1" thinking, which depends on heuristics to make quick decisions in complex situations. Heuristics make us "predictably irrational," distorting our ability to accurately assess probabilities in clinical scenarios. It is well reported in the literature that metacognition, the art of reflecting on one's thought processes, is the optimal way to deal with cognitive biases. However, it is unclear how this can be consistently implemented in dermatological practice. Our debiasing attempts thus far have been sporadic at best. This article categorizes important cognitive biases according to each stage of the doctor-patient interaction (history taking, clinical examination, investigations, diagnosis, and management). We hope that providing this clinically relevant framework can foster metacognition and a platform for algorithmic debiasing. This will enable us to engage "system 2" (analytical thinking) in a targeted way, thereby avoiding excessive cognitive load. Organization-level interventions should also be implemented to free up the cognitive capacity of an individual and to enable them to employ system 2 thinking more regularly.

Art of prevention: Atopic dermatitis in women and families of color-prevalence, recognition, and prevention

Atopic dermatitis (AD) is one of the most common skin conditions encountered by dermatologists. Skin of color (SOC) patients, in particular, are 50% more likely to visit a dermatologist for AD than non-SOC patients. While the misdiagnosis of AD in SOC patients is rare, the misinterpretation of severity or undertreatment of disease experienced by this patient population is a common occurrence. Herein, we present this Art of Prevention piece focused on the epidemiology, presentation, treatment, and management of AD in skin of color patients.