Áù¾ÅÉ«ÌÃ

As with other areas of healthcare, there is data suggesting that individuals with black and brown skin have delayed diagnosis and poorer outcomes when presenting with skinÌýdisease, compared to patients with white skin^[1]. Colonialism and systemic racism are the underpinnings of health disparities that persist for Indigenous and Black peoples inÌýCanada^[2]. The division of Dermatology acknowledges its role in perpetuating racism and using the Truth and Reconciliation Committees calls to action as a guide, has sought toÌýredesign medical education at the UME and PGME levels and provide trauma-informed and culturally safe dermatologic care within Indigenous communities.

Re-creating the UME CurriculumÌý

Starting in 2020, Dr. Laurie Parsons and Dr. Jori Hardin, co-chairs of the undergraduate medical dermatologyÌýcurriculum, recreated the dermatology content with a focus on teaching skin disease on black and brown skin.ÌýThey sought the expertise of Indigenous and Black dermatologists from across the country. The default that whiteÌýskin is normal was intentionally challenged, with workshops and lectures designed to explain that race is a socialÌýconstruct and then further to present equal numbers of clinical images showing skin disease in all skin types.ÌýSafe spaces were created for students to explore their own stories, contexts, and exposure to dermatology with aÌýlens towards reconciliation and allyship. For each year of these changes, a research project has been conductedÌýaround medical student learning in black, brown, and white skin, and then exploring the impact of implicit bias onÌýdiagnosing skin disease. With the introduction of the RIME curriculum, these changes will not only persist but beÌýintegrated meaningfully.

PGME Anti-Racism EDI Curriculum & Implicit Bias

The dermatology residency program has also made meaningful changes to its curriculum. Starting with theÌýCaRMS application process, the dermatology residency program broadened its selection criteria to intentionallyÌýinclude a more holistic view of applicants, turning away from the traditional meritocracy of medicine. ResidentsÌýenter the program and complete implicit bias training, bystander training, and Indigenous cultural competencyÌýtraining. These workshops are supplemented with a lecture from Dr. Rachel Asiniwasis, an Indigenous dermatologistÌýin Regina. The dermatology program wants to encourage curiosity about patient values and the narrative ofÌýtheir patient’s life. Residents are provided articles regarding the levels of racism in medicine and reflect on theirÌýown role in perpetuating racism. When traveling to the Siksika Nation Health Center with Dr. Hardin, residentsÌýare asked to engage is critical self-reflection of their biases and read the work by Dr. Stephanie Nixon on the CoinÌýmodel of privilege^[3]. They are asked to review the TRC calls to action and select a call to focus on for the day ofÌýclinic. Perhaps most obviously, dermatology cases presented at rounds and academic half day are more balancedÌýwith a focus on manifestations of skin disease on black and brown skin.

Division and Faculty Development

The division of dermatology is also engaged in providingÌýcompassionate and culturally safe care to all patients inÌýsouthern Alberta. Dr. Hardin travels to the Siksika NationÌýhealth center and the Alex Community Health Center andÌýDr. Michele Ramien travels to the Stoney Health Centre.ÌýDrs Hardin and Ramien have relished the opportunity toÌýwork within these resilient interconnected communitiesÌýand strive to provide the same access to exceptional careÌýthat we expect in our tertiary carecentres. They haveÌýboth become proficient at navigating Non-insured healthÌýbenefits and seek to increase access to dermatologicÌýtherapies. They strive to create trust within the communitiesÌýthey serve, in ways that respect patient autonomy andÌýagency.Ìý

Dr. Hardin has also been involved with the University ofÌýCalgary’s Office of Indigenous Engagement and helpedÌýdeliver the first two-day Anti-Indigenous Racism workshopÌýseries.

Ìý

^{References
1) Williams DR, Cooper LA. Reducing Racial Inequities in Health: Using What WeÌýAlready Know to Take Action. Int J Environ Res Public Health. 2019;16(4):606.Ìýdoi:10.3390/ijerph16040606
2) Stuber, J., Meyer, I. H., & Link, B. (2008). Stigma, prejudice, discrimination andÌýhealth. Social Science and Medicine, 67(3), 351-357.Ìý
3) Nixon, S.A. The coin model of privilege and critical allyship: implications for health.ÌýBMC Public Health 19, 1637 (2019). https://doi.org/10.1186/s12889-019-7884-9}