PM2073: Assessing Resident Understanding of Common Pediatric Rashes on Skin of Color

Background: The lack of representation of skin of color (SOC) in medical education has contributed to long-standing systemic racism and health inequity. Though the ACGME requires residents to understand healthcare disparities and attempt to reduce them, there is still a deficit in exposure and education regarding dermatology on SOC, including in residency training, medical study resources, medical journals, and, most recently, in articles showing COVID-19 findings.

Methods: The aims of this study include gaining an understanding of the current state of comfort with diagnosis regarding common pediatric skin rashes on skin of color (SOC) in a pediatric residency and assessing comfort of diagnosis after a lecture series. This study was approved by Hurley Medical Center IRB. The pediatric residents participated in a two-part lecture series during their didactics on common pediatric rashes on SOC. The lectures focused on background and importance, a review of skin layers and basic melanin biology, and pediatric rashes on SOC, including comparison with White skin. A pre-and post-survey, using a five-point Likert scale, was administered to residents to assess their previous education and knowledge, comfort with diagnosis and treatment, and clinical exposure to skin pathologies in SOC.

Results: The surveys had a 77% response rate, with a total of 7 residents completing both. The impact was larger, with 15 residents and 2 attending physicians participating in the lecture. The pre-survey revealed a lack of dermatology exposure, with most reporting “not much” or “some” during medical school (77%) and residency (100%). With regards to SOC, a lack of education and exposure was found. 100% reported that they have seen “not much” or “some” rashes on SOC during lectures and 89% reported seeing “not much” or “some” comparisons between rashes on SOC and White skin. In the clinical setting, 88% reported seeing “some”, “a lot”, or “a sufficient amount” SOC rashes. Pre-surveys indicated a lack of comfort with diagnosing SOC rashes. After the lecture there was a 49% increase in those that felt “fairly” comfortable diagnosing pediatric rashes on SOC, and the rest (29%) reported they felt “very” comfortable. Additionally, post-lecture, the categories “somewhat” and “not very” were eliminated in regard to comfort with diagnosis.

Conclusion: The compiled data is consistent with the literature, revealing that though clinical exposure is significant, there is a lack of training and comfort with diagnosis in common pediatric rashes on SOC. Though this study showed improved comfort levels post-lecture, mastery can only be achieved through longitudinal training and exposure. Limitations include small sample size, lack of generalizability, and possible recall bias. Early training and exposure to SOC pathologies is recommended at medical school and residency levels to improve diagnostic and treatment competencies of pediatric rashes on SOC and to work toward health equity.