by Mercedes E Gonzalez, MD, Medical Director at Pediatric Skin Research, Coral Gables, Fla.
As a bilingual Hispanic physician, I have experienced firsthand the detrimental health disparities that face many minority non-English speaking patients and their families. I recently treated a six-year-old girl from a Spanish speaking Hispanic family living in rural Florida with limited access to a dermatologist. She was treated aggressively with biologics and potent topical steroids for presumed severe atopic dermatitis. The many physicians who treated her did not speak her language and had limited conversations with her. When she was able to communicate the details of her acute presentation and failed treatments in her native tongue it became clear that she had a severe scabies infestation and not severe atopic dermatitis. She and her family members were treated appropriately, and her skin disease resolved without recurrence.
A misdiagnosis or delayed diagnosis is a common scenario for patients from racial and ethnic minorities especially when there is language or cultural incongruency between the patient and medical provider. These experiences fuel my commitment to champion DEI efforts within the American Board of Dermatology (ABD), whose Board of Directors (BOD) I have served on since 2021.
Representing ABD, I had the privilege of serving on the American Board of Medical Specialties’ (ABMS) Diversity, Equity and Inclusion (DEI) Task Force for 12 months, working with colleagues representing other ABMS Member Boards and ABMS staff.
The Task Force was given five charges:
- Determine whether ABMS should request or require that Member Boards include in their certification programs education and assessment content and improvement activities intended to address equity and disparities as an improvement goal.
- Provide guidance to ABMS regarding inclusivity (as it relates to language, culture, end users, and diversity definitions).
- Create a comprehensive inventory of ABMS and Member Board DEI-related initiatives currently underway.
- Make a recommendation regarding research-related needs and goals.
- Make a recommendation regarding the need for dedicated structures and functions to support ABMS’ and the Member Boards’ DEI efforts.
The Task Force was divided into smaller groups to work on the charges and then solidify the final recommendations to present to the ABMS BOD, which we did in February.
I am most enthused about the recommendation to create a repository of DEI resources that Member Boards can use to further DEI work within our respective boards, including sharing recommendations for testable DEI-related concepts that cross all medical specialties. In addition, we recommended establishing a standing DEI Committee within ABMS that would be the guardian of this repository and continuously work within ABMS to further advance DEI efforts.
Learning so much about the work other Member Boards are doing to address and help improve health disparities has prompted me to lead similar work within ABD.
ABD is planning a DEI working session during which the BOD and administrative staff will develop guiding principles to help raise awareness, and weave DEI across all aspects of the organization. We are off to a good start — as part of our recent strategic planning, we set four main goals, one of which is to support diplomates’ ability to compassionately and effectively treat patients of all backgrounds.
The development of DEI guiding principles will further ABD’s commitment to:
- Investigate implicit bias in our examinations and policies.
- Ensure that the item bank, exams, and CertLink® questions appropriately represent skin of color and assess the ability to treat skin diseases in all patient populations.
- Incorporate DEI concepts that carry implications for patient care in practice improvement modules and article-based CertLink items.
- Obtain images of a broad range of dermatologic disease presentations in different skin colors and diverse patient populations to enhance exam and continuing certification resources.
- Partner with relevant organizations to leverage our collective DEI efforts.
As part of our DEI working session, we plan to develop goals for increasing diversity among ABD staff and volunteers, determine more ways to assess our exams and continuing certification activities for bias and stereotype, and continue to review and enhance our current policies to remove barriers and promote equality. ABD has already improved and broadened our image databank to ensure that test items include images representing disease across all skin types and consistently reviews exams to ensure adequate representation of skin disease in skin of color.
My work on the ABMS DEI Task Force has fueled my determination to invigorate the ABD’s efforts to commit to and continuously improve its DEI efforts. Tracking our progress will help ensure that our efforts become ingrained in our exams, assessments, and practices – moving beyond a checkbox marked complete.
“Learning so much about the work other Member Boards are doing to address and help improve health disparities has prompted me to lead similar work within ABD.”
© 2024 American Board of Medical Specialties
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