'No skin is either white or black': a national exploration of medical students' views surrounding skin colour terminology in undergraduate education

Research has highlighted clinicians’ lack of confidence in safely diagnosing and managing dermatological disease in patients with skin of colour (Hutchison E, Yoseph R, Wainman H. Skin of colour: essentials for the non-dermatologist. Clin Med 2023; 23: 2–8). The imagery and language surrounding skin colour in medical education often present a narrow spectrum of individual experiences and the undergraduate voice appears to be lacking from these discussions (Lax SJ, Roberts A, Cliffe E et al. Public views are needed for skin colour scales. Br J Dermatol 2023; 189: 623–4). We aimed to capture the descriptors that medical students use in relation to their own skin and how this relates to their education, to better understand how we can diversify the language used, for the benefit of the patient and future clinician. An ethically approved, digital survey was distributed to all UK medical schools between 1 October and 31 December 2024. Participants were asked to describe their skin type at baseline, when inflamed, and in relation to the Fitzpatrick scale; to rate preparedness to examine and discuss differences in skin conditions in skin of colour; to suggest how best to describe skin of colour when ethnicity is unknown; and to describe any experiences of unacceptable terminology used for skin of colour in the context of medical education. The survey generated 367 responses from 21 different medical schools. Self-ascribed ethnicity included White British/Irish/White other (48%), Black/African/Caribbean/Black British (10%), Asian/Asian British (30%), mixed White/Black/Asian (7%) and other (5%). The responses demonstrated that neither the pictorial nor text the versions of the Fitzpatrick scale adequately represent how medical students consider their own skin, with 56% positioning themselves outside of the six images. The top descriptors of skin colour reflected that most participants self-identified as brown (125 mentions), pale (123) and white (116). For inflamed skin, the terms red or reddish (337) were most frequently used, followed by pink (97) and brown (27). There were differing views on the use of ethnicity-related terminology where patient ethnicity is unknown. In total 71% and 75% of participants felt between neutral and unprepared, respectively, in relation to seeing patients with diverse skin tones and discussing differences in the presentation of dermatoses in skin of colour with patients. Our findings suggest that skin descriptors and imagery in medical education need to encompass greater variation in skin tone. We recommend further involvement of medical students in the diversification of undergraduate curricula, and for educators to consider the language they use to improve comprehension and preparation for clinical practice.