From the Journals

Dermatologists lack training about skin of color

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Results should reflect call to action

The study by Gorbatenko-Roth et al. will hopefully serve as a spring board for the field of dermatology to improve physicians’ cultural competence and eliminate persistent knowledge gaps that exist in the treatment of black skin and hair, according to Susan C. Taylor, MD, of the department of dermatology at the University of Pennsylvania, Philadelphia.

Susan C. Taylor, MD, Perelman School of Medicine, University of Pennsylvania, Philadelphia

Dr. Susan C. Taylor

In an accompanying editorial in JAMA Dermatology (2019 Aug 21. doi: 10.1001/jamadermatol.2019.1963), Dr. Taylor wrote that the analysis yields insight into the importance of recognizing and understanding that differences exist in the skin and hair of black patients, compared with those of white patients.

“Implicit in this statement is that black skin color, biology, disease, reactions, presentation, diagnosis, and treatment as well as hair types, texture, tensile strength, shape, diameter, growth pattern, follicular configuration, diseases, and treatments are different than those of whites and require the dermatologist to have an expanded knowledge base and cultural sensitivity when evaluating and treating black patients,” Dr. Taylor wrote.

Another important finding is the overall preference by black patients for a race-concordant dermatologist, Dr. Taylor wrote, noting that the ability to fulfill these preferences is limited. In 2016, black dermatologists constituted only 3% of all dermatologists in the United States, while the overall black population in the United States at the time was 12.8%.

“Although this was a small study, the authors have demonstrated the great need for improvement and opportunities for the field of dermatology, including enhanced residency training, lifelong education in skin of color, culturally sensitive and competent care, and greater diversity in the dermatology workforce,” Dr. Taylor wrote. “Let us use this article as a call to action to serve all patients, regardless of race or ethnicity, with equal excellence.”

Dr. Taylor is an associate professor of dermatology at the University of Pennsylvania, Philadelphia, and creator and inaugural director of the Skin of Color Center, St. Luke’s Roosevelt Hospital Center, New York (currently Mount Sinai St Luke’s Medical Center). She reported no disclosures other than her association with the Skin of Color Center.



Black patients’ satisfaction with dermatologic care would increase if more dermatologists underwent enhanced training in skin of color, cultural competency, and empathic communication skills, a small study in JAMA Dermatology suggests.


Lead author Kristina Gorbatenko-Roth, PhD, of the department of psychology at University of Wisconsin-Stout, Menomonie, Wis., and colleagues analyzed the perceptions of 19 black, adult patients who had received treatment in a skin of color clinic (SOCC). Patients were asked about their perspectives and experiences inside and outside of the clinic as it pertained to dermatologists’ interaction style, cultural awareness, and overall treatment. Two focus groups consisted of patients seen by a race-concordant dermatologist, and two focus groups consisted of patients seen by a race-discordant dermatologist. The patients also responded to a survey.

Of 19 adult black patients who participated in the study, 18 respondents were women, and the mean age was 50 years. Compared with non-SOCC dermatology treatment experiences, patients experienced higher levels of overall satisfaction with SOCC dermatologists, reporting that SOCC dermatologists were better trained to care for black patients, showed greater respect and dignity, and were more trustworthy, according to the study published Aug 21.

Care satisfaction appeared most related to doctors’ interpersonal style and specialized knowledge of black skin and hair, according to the study. Investigators gleaned nine major themes during the analysis, five of which included dermatologist behaviors: interaction style, knowledge, partnering with patients in focusing on outcomes, economic sensitivity, and shared life experiences. Four themes were specific to patients: comfort, confidence, education, and concordance preference. Across all participants, a dermatologist’s interaction style was identified as the most important factor, elements of which included oral communication, body language, and physical examination performance.

Regarding experiences outside the SOCC, participants reported that some providers performed only a cursory skin examination and appeared to avoid physical contact, which some patients interpreted as a sign of disrespect and a lack of racial sensitivity. Participants also expressed frustration with dermatologists outside the clinic who seemed to lack knowledge about black skin and hair disorders. Of all respondents, 71% reported they would prefer a black (or race concordant) dermatologist, including 91% of the race-concordant group and 33% of the race-discordant group.

The investigators wrote the findings underscore a number of needed changes to enhance the care of black dermatology patients, including enhanced dermatology residency and workforce education about treatment of skin of color and more training on culturally aware communication skills. Perceptions of racial and cost-of-care insensitivities identified by the study population also suggest the need for training in cultural competency and implicit bias, delivery of cost conscious care, and the social determinants of health.

As far as they know, the authors noted that, before this study, “little was known regarding black patients’ perceptions of their dermatology care, either within or external to an SOCC,” and that the study “appears to be the first to investigate and provide preliminary findings for addressing this knowledge gap.”

SOURCE: Gorbatenko-Roth K et al. JAMA Dermatol. 2019 Aug 21. doi: 10.1001/jamadermatol.2019.2063.

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