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• W3204406792 abstract "To the Editor: We laud Meckley et al1Meckley A.L. Presley C.L. Szeto M.D. et al.Skin of color representation in medical education: an analysis of National Board of Medical Examiners’ self-assessments and popular question banks.J Am Acad Dermatol. 2022; 86: e57-e59Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar for expanding upon our findings from our study “Skin of color representation in medical education: An analysis of popular preparatory materials used for United States Medical Licensing Examinations” (USMLE).2Jones V.A. Clark K.A. Shobajo M.T. Cordova A. Tsoukas M.M. Skin of color representation in medical education: an analysis of popular preparatory materials used for United States Medical Licensing Examinations.J Am Acad Dermatol. 2021; 85: 773-775Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar Their analysis of skin of color (SoC) images in AMBOSS Step 1, Kaplan Step 1, USMLERx Step 1 Qmax, and self-assessment examinations provided by the National Board of Medical Examiners (NBME) is undoubtedly an enormous addition to our original findings and to the contributions by Mitello et al.3Militello M. Presley C.L. Meckley A.L. Szeto M.D. Dellavalle R.P. Reply to “Skin of color representation in medical education: an analysis of popular preparatory materials used for United States Medical Licensing Examinations”: underrepresentation in additional popular resources.J Am Acad Dermatol. 2021; 85: e255-e256Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar Analysis of the limitations to these resources is paramount to improving medical education. In their study, Meckley et al1Meckley A.L. Presley C.L. Szeto M.D. et al.Skin of color representation in medical education: an analysis of National Board of Medical Examiners’ self-assessments and popular question banks.J Am Acad Dermatol. 2022; 86: e57-e59Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar reached the same conclusion regarding the lack of SoC images in commonly used USMLE preparatory resources. Given the importance of the additional 23 dermatologic diagnoses identified with at least 1 SoC image in the Meckley et al1Meckley A.L. Presley C.L. Szeto M.D. et al.Skin of color representation in medical education: an analysis of National Board of Medical Examiners’ self-assessments and popular question banks.J Am Acad Dermatol. 2022; 86: e57-e59Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar question bank analysis, our team would like to contribute an updated analysis of the original data from our study.2Jones V.A. Clark K.A. Shobajo M.T. Cordova A. Tsoukas M.M. Skin of color representation in medical education: an analysis of popular preparatory materials used for United States Medical Licensing Examinations.J Am Acad Dermatol. 2021; 85: 773-775Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar Using our initial methodology,2Jones V.A. Clark K.A. Shobajo M.T. Cordova A. Tsoukas M.M. Skin of color representation in medical education: an analysis of popular preparatory materials used for United States Medical Licensing Examinations.J Am Acad Dermatol. 2021; 85: 773-775Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar images from the dermatology sections of the UWorld question bank for USMLE Step 1 and the UWorld question bank for USMLE Step 2 CK (Clinical Knowledge) were assessed to include updated data. Two authors (K.C., M.M.) rated by the Fitzpatrick skin phototype scale. Ratings of Fitzpatrick types I -III were designated as “non-SOC” and types IV-VI were designated as “SOC.” Discrepancies in responses were resolved by a third author (V.J.). Duplicate and “indeterminate” images were excluded. Of the additional 23 diagnoses assessed, only 7 of these conditions were depicted by SoC images across both resources. These include bacillary angiomatosis, bullous impetigo, keloids, pellagra, and pityriasis versicolor alba in UWorld Step 1 and bacillary angiomatosis, congenital dermal melanocytosis, keloids, pityriasis versicolor alba, and pseudofolliculitis barbae in UWorld Step 2 CK (Table I). Concordant with Meckley et al,1Meckley A.L. Presley C.L. Szeto M.D. et al.Skin of color representation in medical education: an analysis of National Board of Medical Examiners’ self-assessments and popular question banks.J Am Acad Dermatol. 2022; 86: e57-e59Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar our updated analysis demonstrates the underrepresentation of dermatologic conditions in popular resources used by medical students. Furthermore, we agree that requiring the NBME to provide SoC representation that mirrors the population of the United States as a core concept can aid in increasing representation of SoC images in content created for the NBME.1Meckley A.L. Presley C.L. Szeto M.D. et al.Skin of color representation in medical education: an analysis of National Board of Medical Examiners’ self-assessments and popular question banks.J Am Acad Dermatol. 2022; 86: e57-e59Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar Our hope is that a SoC core concept may motivate question bank creators and medical educators to emulate this initiative and establish SoC representation as a core concept in medical education.Table ICommon dermatologic diagnoses and diagnoses represented in skin of color in popular question banks (adapted from Jones et al2Jones V.A. Clark K.A. Shobajo M.T. Cordova A. Tsoukas M.M. Skin of color representation in medical education: an analysis of popular preparatory materials used for United States Medical Licensing Examinations.J Am Acad Dermatol. 2021; 85: 773-775Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar and Meckley et al1Meckley A.L. Presley C.L. Szeto M.D. et al.Skin of color representation in medical education: an analysis of National Board of Medical Examiners’ self-assessments and popular question banks.J Am Acad Dermatol. 2022; 86: e57-e59Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar)Dermatologic diagnoses (26 diagnoses with SoC images)UWorld Step I question bankSoC/total images†Values are reported as Fitzpatrick phototypes IV-VI; the number of SoC images versus the total number of images (SoC/total images) for each of the dermatologic diagnoses cited in column 1.UWorld Step 2 CK question bankSoC/total images†Values are reported as Fitzpatrick phototypes IV-VI; the number of SoC images versus the total number of images (SoC/total images) for each of the dermatologic diagnoses cited in column 1.AMBOSS Step I question bankSoC/total images†Values are reported as Fitzpatrick phototypes IV-VI; the number of SoC images versus the total number of images (SoC/total images) for each of the dermatologic diagnoses cited in column 1.Kaplan Step I question bankSoC/total images†Values are reported as Fitzpatrick phototypes IV-VI; the number of SoC images versus the total number of images (SoC/total images) for each of the dermatologic diagnoses cited in column 1.USMLERx Step I question bankSoC/total images†Values are reported as Fitzpatrick phototypes IV-VI; the number of SoC images versus the total number of images (SoC/total images) for each of the dermatologic diagnoses cited in column 1.NBME self-assessmentsSoC/total images†Values are reported as Fitzpatrick phototypes IV-VI; the number of SoC images versus the total number of images (SoC/total images) for each of the dermatologic diagnoses cited in column 1.TotalSoC/total images†Values are reported as Fitzpatrick phototypes IV-VI; the number of SoC images versus the total number of images (SoC/total images) for each of the dermatologic diagnoses cited in column 1.Total question bank images (#)128299124171837623Soc images (number)287216329130SoC images (%)21.9%24.1%12.9%17.6%11.1%24.3%20.9% Acne vulgaris0/32/50/10/00/00/22/11 = 18% Atopic dermatitis2/40/60/30/10/20/12/17 = 12% Contact dermatitis∗Common dermatologic diagnoses from Jones et al2 that did not have any images representing the respective diagnosis in SoC.0/30/110/20/00/00/10/17 = 0% Psoriasis4/122/120/40/00/00/06/28 = 21% Seborrheic dermatitis∗Common dermatologic diagnoses from Jones et al2 that did not have any images representing the respective diagnosis in SoC.0/10/50/10/00/00/00/7 = 0% Acanthosis nigricans0/21/20/32/20/00/03/9 = 33% Bacillary angiomatosis1/11/11/20/00/00/03/4 = 75% Bullous impetigo1/10/20/01/10/00/02/4 = 50% Congenital dermal melanocytosis0/01/10/00/01/10/02/2 = 100% Digital clubbing0/00/01/10/00/00/11/2 = 50% Ganglion cyst0/00/00/00/00/01/11/1 = 100% Genital herpes0/10/20/00/00/01/21/5 = 20% Granuloma inguinale0/00/01/10/00/00/01/1 = 100% Hereditary angioedema0/00/01/20/00/00/01/2 = 50% Kaposi sarcoma0/11/31/20/00/21/13/9 = 33% Keloids2/21/11/10/00/00/04/4 = 100% Lymphocutaneous sporotrichosis0/11/21/10/00/00/02/4 = 50% Pellagra1/10/01/10/00/01/13/3 = 100% Pemphigus vulgaris0/20/21/30/00/00/01/7 = 14% Pityriasis versicolor alba1/11/31/30/00/01/14/8 = 50% Pseudofolliculitis barbae0/01/11/10/00/00/02/2 = 100% Scabies0/10/22/40/00/00/12/8 = 25% Shingles1/30/11/20/00/21/13/9 = 33% Stevens-Johnson syndrome0/01/20/00/01/10/02/3 = 67% Strawberry hemangiomas0/10/21/10/00/00/11/5 = 20% Tinea capitis0/12/30/00/00/02/24/6 = 67% Tinea corporis0/15/90/00/00/01/16/11 = 55% Vitiligo2/24/51/10/00/10/07/9 = 77%CK, Clinical knowledge; NBME, National Board of Medical Examiners; SoC, skin of color; USMLE, United States Medical Licensing Examinations.∗ Common dermatologic diagnoses from Jones et al2Jones V.A. Clark K.A. Shobajo M.T. Cordova A. Tsoukas M.M. Skin of color representation in medical education: an analysis of popular preparatory materials used for United States Medical Licensing Examinations.J Am Acad Dermatol. 2021; 85: 773-775Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar that did not have any images representing the respective diagnosis in SoC.† Values are reported as Fitzpatrick phototypes IV-VI; the number of SoC images versus the total number of images (SoC/total images) for each of the dermatologic diagnoses cited in column 1. Open table in a new tab CK, Clinical knowledge; NBME, National Board of Medical Examiners; SoC, skin of color; USMLE, United States Medical Licensing Examinations. It remains our mission to advocate for the inclusion of SoC imagery in medical school curricula, question banks, textbooks, examinations, and journal publications.2Jones V.A. Clark K.A. Shobajo M.T. Cordova A. Tsoukas M.M. Skin of color representation in medical education: an analysis of popular preparatory materials used for United States Medical Licensing Examinations.J Am Acad Dermatol. 2021; 85: 773-775Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar,4Clark K.A. Jones V.A. Shobajo M.T. Tsoukas M.M. Expanding the horizon: skin of color in medical education—reply to letter to the editor regarding: “Skin of color representation in medical education: an analysis of popular preparatory materials used for United States medical licensing examinations”.J Am Acad Dermatol. 2021; 85: e257-e258Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar While these changes are underway, we believe the commitment to reduce disparities in medicine and increase SoC imagery in medical education by established entities in dermatology, such as the American Academy of Dermatology, Skin of Color Society, National Medical Association, Dermatology Section, and VisualDx's project IMPACT, will continue to play a pivotal role in improving future medical education content. Finally, we ask medical educators to examine their educational materials with a critical eye and encourage collaboration with SoC experts within their institutions or the above-listed organizations to improve medical education curricula and resources. None disclosed. Skin of color representation in medical education: An analysis of National Board of Medical Examiners' self-assessments and popular question banksJournal of the American Academy of DermatologyVol. 86Issue 2PreviewTo the Editor: We applaud Jones's1 and Militello's2 examinations of skin of color (SoC) image underrepresentation in United States Medical Licensing Examination (USMLE) preparatory resources. Our analysis of popular question banks (AMBOSS Step 1, Kaplan Step 1, and USMLERx Step 1 Qmax) utilized by approximately one third of medical students in board preparation3 and our survey of the self-assessment exams provided by the National Board of Medical Examiners (NBME), which authors USMLE exams, are crucial additions to this work. Full-Text PDF" @default.
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