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January 13, 2021

Resisting Racism in Dermatology: A Call to Action

Author Affiliations
  • 1Department of Dermatology, University of California, San Francisco
  • 2Perelman School of Medicine, Department of Dermatology, University of Pennsylvania, Philadelphia
JAMA Dermatol. 2021;157(3):267-268. doi:10.1001/jamadermatol.2020.5029

We have watched and been deeply disturbed by the tragic events that have unfolded in the US. We share the collective trauma, rage, and pain that our country is experiencing while we attempt to come to terms with the senseless killings of Black citizens by police—George Floyd, Breonna Taylor, Ahmaud Arbery, and Tony McDade, to name a few. The foundation of these events is rooted in structural racism and inequality, which have a long history in our country. Structural racism describes institutionalized policies, procedures, and systems that create adverse outcomes for Black, Latinx, and Indigenous people. Importantly, these structures exist beyond interpersonal relationships and create imbalances in power that contribute to inequalities despite the intentions of individuals. An example of structural inequity in dermatology is residential segregation and pediatric atopic dermatitis. Recent research indicates that Black children with atopic dermatitis are more likely to live in highly segregated communities and in rented homes,1 which can be associated with disease severity. Structural racism and the way it manifests within the health care system, as well as the communities where we practice, should be of concern to every physician because of the implications on public health.2

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    1 Comment for this article
    Selection Criteria for Dermatology Residency Candidates
    Binh Ngo, M.D. | Keck USC School of Medicine, Department of Dermatology
    At the University of Southern California, our institution is committed to recruit and retain students, residents, and faculty of diverse backgrounds. This is particularly important in dermatology where skin of color, be it African American, Asian, or Latinx, clearly confers different risk patterns and can call for alternative treatments. The article by Lester and Taylor points out many potential avenues to achieve the goal of expanding minority representation in dermatology. We want to point out that selection criteria for dermatology training programs represent a realistic issue affecting access. Typically dermatology residency applicants have top standardized testing scores, are AOA members at the top of their medical school class, and have participated in productive research programs. That does not mean that minority applicants cannot compete. At Keck USC, we have been successful in recruiting many top level residents and faculty. Yet, it would be useful to acknowledge the need to address skin of color in Dermatology by developing specific programs to increase representation. One approach could be to develop a pathway to enroll experienced and capable minority trainees in other specialties such as Internal Medicine, Pediatrics and Family Medicine into dermatology residencies as added representatives. This would require expansion of the dermatology residency pool and added funding but could alleviate the concern that current selection standards are being ignored.