Dermatology Clinical and Education Programs

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 skin disease, compared to patients with white skin^[1]. Colonialism and systemic racism are the underpinnings of health disparities that persist for Indigenous and Black peoples in Canada^[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 to redesign medical education at the UME and PGME levels and provide trauma-informed and culturally safe dermatologic care within Indigenous communities.

Re-creating the UME Curriculum 

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

PGME Anti-Racism EDI Curriculum & Implicit Bias

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

Division and Faculty Development

The division of dermatology is also engaged in providing compassionate and culturally safe care to all patients in southern Alberta. Dr. Hardin travels to the Siksika Nation health center and the Alex Community Health Center and Dr. Michele Ramien travels to the Stoney Health Centre. Drs Hardin and Ramien have relished the opportunity to work within these resilient interconnected communities and strive to provide the same access to exceptional care that we expect in our tertiary care centres. They have both become proficient at navigating Non-insured health benefits and seek to increase access to dermatologic therapies. They strive to create trust within the communities they serve, in ways that respect patient autonomy and agency. 

Dr. Hardin has also been involved with the University of Calgary’s Office of Indigenous Engagement and helped deliver the first two-day Anti-Indigenous Racism workshop series.

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