New course helps members overcome unintended bias in practice

Nov. 2, 2023

The AAD recently launched a comprehensive new course, Medicine Without Barriers: Overcoming Unintended Bias in Practice, designed and curated to help members provide excellent, equitable, and compassionate patient care.  

Members of the AAD can access this course for free.  

In this exclusive DermWorld Academy Insider interview, Sacharitha Bowers, MD, FAAD, and Klint Peebles, MD, FAAD, two members of the AAD’s Diversity Committee, explain why the course was developed, what’s unique about it, and why members should participate.  

DermWorld: Why was this course developed? 

Dr. Bowers: Health disparities have been worsening and dermatology is no exception to this. The COVID-19 pandemic shone a spotlight on the drastic inequity present in our health care system. Over the last few years, there has been a dramatic and much needed increase in the data around dermatologic disparities. Review of this literature as well as listening to patients’ experiences gives us critical insight into the health needs of marginalized and minoritized communities, including racial and ethnic minority and LGBTQIA+ populations, as well as the educational needs of underrepresented in medicine trainees. 

Dermatology has been so fortunate to have pioneers in our field who have been at the forefront of care for populations who experience these disparities, such as our patients with skin of color. But we also know that it will take more than just a fraction of dermatologists to address the health care needs of all patients. This set of educational resources allows our dermatology community to gain the knowledge and skills necessary to provide excellent care to all patients, regardless of their skin color, ethnic and cultural background, gender, sexual orientation, socioeconomic barriers, physical ability, etc. It is up to all of us to ensure that no patients are left behind in the care of their dermatologic needs and that all patients receive the excellent, comprehensive, and culturally sensitive care they deserve. Since dermatology training traditionally has not addressed the breadth and depth of issues affecting populations who experience health disparities, this course was developed to fill these gaps in knowledge and ensure that our dermatology workforce can provide inclusive and equitable care to all patients. 

Dr. Peebles: The Academy has long recognized the importance of mitigating the disparities that have historically hindered our collective efforts to provide excellent dermatologic care to all patients regardless of background, circumstance, or lived experience. Numerous sociocultural inflection points and conversations over the last few years have catalyzed innovative solutions, heartfelt discussions, and intentional work designed to help the specialty on the path forward. This course is but a single, yet notable product of the Academy’s commendable initiatives to ensure that its members are equipped with not only the tools to engage in equitable health care delivery but also to better navigate their own personal journeys of self-awareness, insight, and cultural humility with thought-provoking and challenging content.    

DermWorld: What are some highlights of the course? What’s unique about it? 

Dr. Bowers: There are many features that are unique to this course, including the following: 

1. It was conceived out of extensive and open dialogue between a diverse group of dermatologists across the country, including those in academia and private practice, with concentrations spanning the medical, surgical, pediatric, and dermatopathology realms, all of whom are well-versed and active in the health equity space. Many, if not all, of these individuals, have been influential in developing curricula at their own programs, creating and/or running specialty Skin of Color clinics, recruiting a more diverse dermatology workforce, and conducting research on topics around dermatologic health disparities.  

2. It is diverse in its own right and utilizes educational resources from a variety of sources, including the expert-led ACGME Equity Matters curriculum, which is being utilized nationally by medical schools and in graduate medical education.  

3. It is structured in a way that allows for navigation based on the learner’s own starting point and baseline knowledge. Through this manner, it can be tailored to an individual's knowledge level and pace. 

Dr. Peebles: One of the strengths of this course is its admirable foundation, structure, and framework. The health care we provide does not exist in a vacuum, and it’s clear that the education of the health care workforce cannot rest solely on skills of diagnosis and management of disease. While such skills are obviously critically important, a holistic approach to understanding our patients’ individual life journeys while treating them with grace and dignity requires additional skillsets and knowledge. Unlike many other courses similar in theme, Medicine Without Barriers emphasizes fundamental concepts, including historical context, social determinants of health, structural barriers, terminology, and deeper explorations of cultural humility and intersectionality. Equally important is the inherent goal of the course to invoke reflection and an intra- and interpersonal awareness of how we fit into the social fabric of our patients’ communities and the opportunities we have to learn from them. Quite simply, equity is more than an outcome — it’s also a deeply meaningful personal journey of growth and maturity that occurs across the entirety of our lifespan as physicians and human beings. But it’s up to each of us on an individual and group level to intentionally engage in that journey, and this course facilitates just that. The course also presents a customizable experience for each learner in which one can assess their own knowledge gaps and accordingly prioritize the content with which they choose to engage. While the course provides opportunities for learners to establish foundations and to think critically about basic concepts, there are also opportunities for more seasoned learners to move beyond basic concepts and engage with active advocacy and leadership.  

Moreover, the course takes a comprehensive view of inclusion, highlighting numerous aspects of identity and dimensions of the human experience. Learners will have opportunities to reflect on the role of race and ethnicity in health care and social determinants of health as well as issues of gender identity and sexual orientation. Human beings do not have a single identity, and communities are not monolithic. All of us have multiple unique dimensions of identity and varying degrees to which each are salient at any given time. The way in which these identities come together on a personal and broader society level invokes themes of intersectionality, which informs us that human identities are complex and directly impact how individuals experience health care. The manner in which we understand these identities directly impacts how we navigate care delivery for our patients and the relationships we develop with them — whether we realize it or not. 

DermWorld: A recent research letter in JAAD found that “factors beyond race, such as interpersonal connection and communication, may play a role in dissipating minority groups’ mistrust” of health care. Why is it important for members to take this new course? 

Dr. Bowers: As dermatologists, we see patients of all skin tones, cultural backgrounds, genders, socioeconomic statuses, and other differentiating factors. It is imperative that we are knowledgeable about the variable presentations of skin disease in differing skin tones, the way external factors such as the social determinants of health and structural racism impact our patients’ dermatologic health and access to care, and the impact of our own blind spots in providing excellent and culturally sensitive care to all people. Dermatology textbooks continue to have underrepresentation of cutaneous pathology in diverse skin tones and undergraduate and graduate medical education for many of us did not cover topics that uniquely affect marginalized populations. Because there has been an explosion of knowledge in these areas in recent years, it can be confusing and even overwhelming to know how to navigate all the available resources. By having a course that has a wide variety of learning resources in one place, it is much more feasible for dermatologists to feel confident about providing excellent, compassionate, and comprehensive care to all our patients. 

Dr. Peebles: All of us have blind spots and knowledge gaps. More importantly, we have an implicit understanding in medicine that learning is a lifelong process, and our understanding of other people, cultures, and ways of life is a similarly lifelong journey. It is incumbent upon all of us to reaffirm our commitment to caring for and empowering all patients. While it is certainly true that our dermatology workforce should ideally mirror the populations we serve, there is also evidence that patients recognize, and in many cases prioritize, physicians’ ability to communicate and connect with them on a deeper level, suggesting the value of building trust in a relationship founded on cultural humility regardless of the physician’s identity.