Skin Tone Analysis for Representation in Educational Materials (STAR-ED) using machine learning.
NPJ digital medicine
2023; 6 (1): 151
Images depicting dark skin tones are significantly underrepresented in the educational materials used to teach primary care physicians and dermatologists to recognize skin diseases. This could contribute to disparities in skin disease diagnosis across different racial groups. Previously, domain experts have manually assessed textbooks to estimate the diversity in skin images. Manual assessment does not scale to many educational materials and introduces human errors. To automate this process, we present the Skin Tone Analysis for Representation in EDucational materials (STAR-ED) framework, which assesses skin tone representation in medical education materials using machine learning. Given a document (e.g., a textbook in .pdf), STAR-ED applies content parsing to extract text, images, and table entities in a structured format. Next, it identifies images containing skin, segments the skin-containing portions of those images, and estimates the skin tone using machine learning. STAR-ED was developed using the Fitzpatrick17k dataset. We then externally tested STAR-ED on four commonly used medical textbooks. Results show strong performance in detecting skin images (0.96±0.02 AUROC and 0.90±0.06 F1 score) and classifying skin tones (0.87±0.01 AUROC and 0.91±0.00 F1 score). STAR-ED quantifies the imbalanced representation of skin tones in four medical textbooks: brown and black skin tones (Fitzpatrick V-VI) images constitute only 10.5% of all skin images. We envision this technology as a tool for medical educators, publishers, and practitioners to assess skin tone diversity in their educational materials.
View details for DOI 10.1038/s41746-023-00881-0
View details for PubMedID 37596324
- Anchoring bias and heuristics can perpetuate disparities in dermatology. Journal of the American Academy of Dermatology 2022
Review of the Molecular Genetics of Basal Cell Carcinoma; Inherited Susceptibility, Somatic Mutations, and Targeted Therapeutics.
2021; 13 (15)
Basal cell carcinoma (BCC) is a significant public health concern, with more than 3 million cases occurring each year in the United States, and with an increasing incidence. The molecular basis of BCC is complex, involving an interplay of inherited genetic susceptibility, including single nucleotide polymorphisms and genetic syndromes, and sporadic somatic mutations, often induced by carcinogenic exposure to UV radiation. This review outlines the currently known germline and somatic mutations implicated in the pathogenesis of BCC, including the key molecular pathways affected by these mutations, which drive oncogenesis. With advances in next generation sequencing and our understanding of the molecular genetics of BCC, established and emerging targeted therapeutics are offering new avenues for the non-surgical treatment of BCC. These agents, including Hedgehog pathway inhibitors, immune modulators, and histone deacetylase inhibitors, will also be discussed.
View details for DOI 10.3390/cancers13153870
View details for PubMedID 34359772
- Integrating Skin of Color and Sexual and Gender Minority Content in Dermatology Residency Curricula: A Prospective Program Initiative. Journal of the American Academy of Dermatology 2021
- Direct-to-Consumer Genetic Risk Scoring for Melanoma Improves Adherence to Sun-Protective Behaviors Among Increased-Risk Groups: Results from a Prospective U.S. Cohort Study. Journal of the American Academy of Dermatology 2021
Supporting Underrepresented in Medicine (UIM) and non-UIM Trainees Applying into Dermatology: A Qualitative Analysis.
Journal of drugs in dermatology : JDD
2021; 20 (7): 795-797
Recently, there have been calls to improve diversity among the dermatology workforce, with emphasis placed on the resident selection process and trainee pipeline. However, there is limited data on the perspectives of dermatology applicants, especially among UIM trainees, and the support that they need and want to successfully apply in dermatology.To assess trainee perspectives, we disseminated a survey to medical students, interns (matched into dermatology), and dermatology residents asking how dermatology residency programs can best support trainees through the dermatology application process. We developed a codebook drawing upon grounded theory methodology, and consensus coded all qualitative responses.We received 224 qualitative responses from underrepresented in medicine (UIM) (65, 29.0%) and non-UIM trainees (159, 70.9%). UIM trainees were more likely to mention diversity and inclusion initiatives (46.2% vs 3.8%, P<0.001), transparency in program information (40.0% vs 24.5%, P=0.021), holistic review (30.8% vs 6.3%, P<0.001), UIM student outreach/pipeline programs (23.1% vs 0.6%, P<0.001), and mentorship (21.5% vs 8.2%, P=0.009).Improving programmatic efforts to address unique challenges UIM trainees face when applying into dermatology is instrumental to mitigating barriers. We highlight opportunities for dermatology residency programs to create a more fair and equitable dermatology application process and support a more diverse pipeline of future dermatologists. J Drugs Dermatol. 2021;20(7):795-797. doi:10.36849/JDD.6043.
View details for DOI 10.36849/JDD.6043
View details for PubMedID 34231995
- Supporting Students of Color: Balancing the Challenges of Activism and the Minority Tax. Academic medicine : journal of the Association of American Medical Colleges 2021; 96 (6): 773
Journal attitudes and outcomes of preprints in dermatology.
The British journal of dermatology
The use of preprints, manuscripts that can be uploaded to a public server and made almost immediately available for public dissemination without peer review, is becoming increasingly common.1 Preprint servers are not typically associated with established peer-reviewed journals and often operate independently. Proponents of preprints point toward improved rapid dissemination of results and opportunities for crowdsourced feedback before submission to peer-reviewed journals.1 Conversely, inconsistent upload criteria among preprint servers (such as lack of guidance for reporting conflict of interest or image manipulation),1 and the risk for widespread discourse of non-peer reviewed results by news media may impinge on research integrity.2 As members of the public may not understand the difference between preprints and traditionally peer-reviewed articles, preprints have the potential to cause widespread confusion and mistrust.2 Use of preprints may also make publication of results in traditional journals more difficult, as the results may be perceived to be less novel. Despite controversy, the number of preprints continue to rise.3 There is limited understanding of how dermatology journals view and consider preprints. In this study, we explore dermatology journal policies toward the submission of preprint articles for publication, and corresponding publication outcomes of dermatology articles previously uploaded to a large clinically oriented preprint server.
View details for DOI 10.1111/bjd.20065
View details for PubMedID 33742455
- Skin of Color Article Representation in Dermatology Literature 2009-2019: Higher Citation Counts and Opportunities for Inclusion. Journal of the American Academy of Dermatology 2021
- Characteristics of dermatology clinical trials 2007-2018: Insights from a systematic analysis of ClinicalTrials.gov. Journal of the American Academy of Dermatology 2021
- Encouraging the Next Generation of Skin of Color Researchers: Funding Skin of Color Research in Medical School and Residency. Journal of the American Academy of Dermatology 2020
Paucity of COVID-19 Dermatology Literature from Low- and Middle-Income Countries.
The British journal of dermatology
Since emerging in December 2019, COVID-19 has become a global pandemic with community transmission now reported in most World Health Organization (WHO) regions. As the pandemic progresses, there have been a growing number of reports of cutaneous manifestations and discussions of how COVID-19 has impacted clinical practice. We hypothesised that many such dermatology publications may be authored from high-income countries, raising questions about case representation and the generalisability and comprehensiveness of COVID-19 related insights, discourse, and guidance in our field.
View details for DOI 10.1111/bjd.19505
View details for PubMedID 32866992
Absence of Skin of Colour Images in Publications of COVID-19 Skin Manifestations.
The British journal of dermatology
There are now over 1 million confirmed cases of COVID-19 globally with more than 270,000 recorded deaths to date. COVID-19 has been shown to disproportionately impact people of colour both in the United Kingdom and in the United States where blacks make up 13.4% of the population but 30% of COVID-19 cases. Mounting evidence shows that COVID-19 impacts several organ systems, including the skin.
View details for DOI 10.1111/bjd.19258
View details for PubMedID 32471009
Ways to Improve Care for LGBT Patients in Dermatology Clinics.
2020; 38 (2): 269–76
Lesbian, Gay, Bisexual, and Transgender (LGBT) patients face significant dermatologic health disparities. LGBT patients are often discriminated against, refused healthcare, or otherwise have negative healthcare experiences that may deter future utilization of professional care. While a number of factors may mitigate these negative experiences, the present article focuses on improving organizational and institutional drivers specific to individual dermatology clinics. Clinic workflow and operations, emerging technologies and EHRs, clinic culture, clinic environment and resource availability, and provider and staff education are all characteristics of healthcare clinics that can be improved to better facilitate high-quality dermatologic care for LGBT patients.
View details for DOI 10.1016/j.det.2019.10.012
View details for PubMedID 32115137
- Sexual and Gender Minority Curricula Within US Dermatology Residency Programs. JAMA dermatology 2020
- Fitzpatrick Phototype Disparities in Identification of Cutaneous Malignancies by Google Reverse Image. Journal of the American Academy of Dermatology 2020
- Improving Information Transparency Between Dermatology Residency Programs and Trainees: Report from the Association of Professors of Dermatology Work Group on Transparency. Journal of the American Academy of Dermatology 2020
Gamification improves melanoma visual identification among high school students: Results from a randomized study.
Identification of melanoma or worrisome moles is often taught as an important part of routine skin checks. We sought to evaluate the efficacy of gamified education vs. traditional ABCDEs education on melanoma identification and self-confidence in identifying worrisome moles. We report that in our cohort (n = 271), participants randomized to the gamified intervention were more likely to correctly identify melanoma and non-melanoma skin lesions than those randomized to the ABCDE control cohort (74.2% vs 63.5% correct, P < .0001) and perceived confidence in self-identifying worrisome lesions was slightly higher in the gamified group than the traditional group, though the trend was not significant. These novel findings have significant implications on improved ways to educate young patients on the visual identification of melanoma and worrisome moles.
View details for DOI 10.1111/pde.14158
View details for PubMedID 32266730
- Cutaneous Manifestations of COVID-19: A Preliminary Review. Journal of the American Academy of Dermatology 2020
- Patient Crowdfunding for the Treatment of Cutaneous Malignancies. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] 2020
Waiting it out: Consultation delays prolong in-patient length of stay
Postgraduate Medical Journal
View details for DOI 10.1136/postgradmedj-2018-136269
Improving Shared Decision Making For Asian American Pacific Islander Sexual and Gender Minorities.
Asian American Pacific Islander (AAPI) sexual and gender minorities (SGM) face unique challenges in mental health and accessing high-quality health care.The objective of this study was to identify barriers and facilitators for shared decision making (SDM) between AAPI SGM and providers, especially surrounding mental health.Interviews, focus groups, and surveys.AAPI SGM interviewees in Chicago (n=20) and San Francisco (n=20). Two focus groups (n=10) in San Francisco.Participants were asked open-ended questions about their health care experiences and how their identities impacted these encounters. Follow-up probes explored SDM and mental health. Participants were also surveyed about attitudes towards SGM disclosure and preferences about providers. Transcripts were analyzed for themes and a conceptual model was developed.Our conceptual model elucidates the patient, provider, and encounter-centered factors that feed into SDM for AAPI SGM. Some participants shared the stigma of SGM identities and mental health in their AAPI families. Their AAPI and SGM identities were intertwined in affecting mental health. Some providers inappropriately controlled the visibility of the patient's identities, ignoring or overemphasizing them. Participants varied on whether they preferred a provider of the same race, and how prominently their AAPI and/or SGM identities affected SDM.Providers should understand identity-specific challenges for AAPI SGM to engage in SDM. Providers should self-educate about AAPI and SGM history and intracommunity heterogeneity before the encounter, create a safe environment conducive to patient disclosure of SGM identity, and ask questions about patient priorities for the visit, pronouns, and mental health.
View details for DOI 10.1097/MLR.0000000000001212
View details for PubMedID 31567862
- Comparing Online Engagement and Academic Impact of Dermatology Research: An Altmetric Attention Score and PlumX Metrics Analysis. Journal of the American Academy of Dermatology 2019
Assessment of readability and content of patient-initiated google search results for epidermolysis bullosa.
Epidermolysis bullosa describes a group of conditions commonly characterized by fragile skin and blistering of the mucosal membranes. Due to the complex and rare nature of the disease, we sought to evaluate the quality and readability of epidermolysis bullosa information available online. Analysis of the top 50 search results on Google demonstrated that information by non-dermatologists was of a lower reading level and more accessible when compared to information by dermatologists, even though dermatologist written information was more likely to be useful and medically comprehensive. There is an increasing need for dermatologists to provide useful and medically comprehensive EB information that is accessible to patients and patient families.
View details for DOI 10.1111/pde.13975
View details for PubMedID 31468562
Emerging technologies for health information in dermatology: opportunities and drawbacks of web-based searches, social media, mobile applications, and direct-to-consumer genetic testing in patient care.
Seminars in cutaneous medicine and surgery
2019; 38 (1): E57–E53
Emerging technology is fundamentally changing how individuals interact with the health care system. Web-based searches, mobile applications, social media, and directto- consumer genetic testing companies are facilitating information exchange at a higher rate than ever before, creating a macroscopic shift in the mechanisms by which individuals seek health information. The visual nature of skin disease enables individuals to browse, share, and search based on images, adding another dimension to how dermatological information is transferred. These trends carry important implications on user health care behavior, and so it is vital for health care professionals to stay attuned to the morphing characteristics of their patients' health management in order to continue to provide high-quality, patient-centered care.
View details for PubMedID 31051025
- Navigating Controversy: A Critical Element of Medical Education ACADEMIC MEDICINE 2018; 93 (12): 1750
Navigating Controversy: A Critical Element of Medical Education.
Academic medicine : journal of the Association of American Medical Colleges
2018; 93 (12): 1750
View details for PubMedID 30489297
Shared Decision Making Among Clinicians and Asian American and Pacific Islander Sexual and Gender Minorities: An Intersectional Approach to Address a Critical Care Gap
2016; 3 (5): 327-334
Shared decision making (SDM) is a model of patient-provider communication. Little is known about the role of SDM in health disparities among Asian American and Pacific Islander (AAPI) sexual and gender minorities (SGM). We illustrate how issues at the intersection of AAPI and SGM identities affect SDM processes and health outcomes. We discuss experiences of AAPI SGM that are affected by AAPI heterogeneity, SGM stigma, multiple minority group identities, and sources of discrimination. Recommendations for clinical practice, research, policy, community development, and education are offered.
View details for DOI 10.1089/lgbt.2015.0143
View details for Web of Science ID 000384689500002
View details for PubMedID 27158858
Addressing Barriers to Shared Decision Making Among Latino LGBTQ Patients and Healthcare Providers in Clinical Settings
2016; 3 (5): 335-341
Effective shared decision making (SDM) between patients and healthcare providers has been positively associated with health outcomes. However, little is known about the SDM process between Latino patients who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ), and their healthcare providers. Our review of the literature identified unique aspects of Latino LGBTQ persons' culture, health beliefs, and experiences that may affect their ability to engage in SDM with their healthcare providers. Further research needs to examine Latino LGBTQ patient-provider experiences with SDM and develop tools that can better facilitate SDM in this patient population.
View details for DOI 10.1089/lgbt.2016.0014
View details for Web of Science ID 000384689500003
View details for PubMedID 27617356