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The impact of patient skin colour on diagnostic ability and confidence of medical students.

Published version
Peer-reviewed

Type

Article

Change log

Authors

Dodd, Rebecca V 
Rafi, Damir 
Stackhouse, Ashlyn A 
Brown, Celia A 
Westacott, Rachel J 

Abstract

Previous literature has explored unconscious racial biases in clinical education and medicine, finding that people with darker skin tones can be underrepresented in learning resources and managed differently in a clinical setting. This study aimed to examine whether patient skin colour can affect the diagnostic ability and confidence of medical students, and their cognitive reasoning processes. We presented students with 12 different clinical presentations on both white skin (WS) and non-white skin (NWS). A think aloud (TA) study was conducted to explore students' cognitive reasoning processes (n = 8). An online quiz was also conducted where students submitted a diagnosis and confidence level for each clinical presentation (n = 185). In the TA interviews, students used similar levels of information gathering and analytical reasoning for each skin type but appeared to display increased uncertainty and reduced non-analytical reasoning methods for the NWS images compared to the WS images. In the online quiz, students were significantly more likely to accurately diagnose five of the 12 clinical presentations (shingles, cellulitis, Lyme disease, eczema and meningococcal disease) on WS compared to NWS (p < 0.01). With regards to students' confidence, they were significantly more confident diagnosing eight of the 12 clinical presentations (shingles, cellulitis, Lyme disease, eczema, meningococcal disease, urticaria, chickenpox and Kawasaki disease) on WS when compared to NWS (p < 0.01). These findings highlight the need to improve teaching resources to include a greater diversity of skin colours exhibiting clinical signs, to improve students' knowledge and confidence, and ultimately, to avoid patients being misdiagnosed due to the colour of their skin.

Description

Keywords

Cognitive processing methods, Diagnostic ability, Diagnostic confidence, Educational resources, Medical education, Mixed methods, Racial bias, Think aloud

Journal Title

Adv Health Sci Educ Theory Pract

Conference Name

Journal ISSN

1382-4996
1573-1677

Volume Title

Publisher

Springer Science and Business Media LLC
Sponsorship
National Institute for Health Research (IS-BRC-1215-20014)