Power of Representation in Educational Materials: Teaching Cutaneous Lupus Across Skin Tones in an Interactive Module

Clinicians report low confidence assessing cutaneous lupus erythematosus (CLE) lesions, especially for patients who identify as Black, Indigenous, and People of Color (BIPOC) who are historically excluded from educational materials. To address this, we created an online, interactive module teaching an approach to assessing CLE across skin tones and measured its impact on medical knowledge and confidence.

Our team created a module with case-based methods to introduce an approach to CLE, common mimicking rashes, and tips for photographing cutaneous lesions in BIPOC. Graduate medical trainees from five academic institutions completed the module. Using surveys and pre-post testing, we assessed changes in medical knowledge and clinical confidence along with learner satisfaction, comparing responses using Wilcoxon-signed rank tests and chi square analysis. We assessed the module's representation of light, medium, and dark skin tones with chi square analysis.

The module represented light, medium, and dark skin tones (χ² = 4.788, P = 0.091) among 102 images (77.5%, n = 79) were novel images from authors' personal libraries. Ninety-four participants completed the postmodule test and evaluation survey. Analyses revealed significant improvement in medical knowledge identifying serologic studies associated with subacute CLE (χ² = 14.035, P < 0.001) and describing how to photograph rashes (χ² = 38.211, P < 0.001). Participants reported improved confidence across all learning objectives after module completion (P < 0.001).

This module is the first to introduce an approach to assessing CLE across skin tones, effectively increasing medical knowledge and confidence among graduate medical trainees.