Skin tone representation on United States medical school websites: A cross-sectional content analysis

In the United States, certain racial and ethnic groups are systemically underrepresented in the physician workforce. This underrepresentation perpetuates health disparities among corresponding underserved populations. On medical residency websites, representation has a demonstrated impact on applicant and matriculant demographics. However, visual representation on American medical school websites has not previously been independently studied.

A cross-sectional content analysis of all United States medical school websites (n=192) was conducted, including up to nine images per school (n=1042). Skin tone was evaluated using the 10-point Massey-Martin scale. Institutional characteristics (e.g. location, tuition, and proportion of students from groups underrepresented in medicine or URiM) were collected when included in school-level applicant-facing data.

Individuals of darker skin tones were represented in a lower proportion of images on medical school websites (r=-0.94). Most images represented multiple skin tones. Of images that depicted only one skin tone (n=403), the majority (80%, n=322) depicted lighter skin-toned individuals only. Schools located in urban environments were more likely to represent darker skin tones in images on their websites (t(233)=2.90, p=0.004). Other applicant facing metrics (e.g. tuition, program-reported URiM proportions) were not significantly associated with visual representation.

United States medical schools underrepresent darker skin tones in images on their websites. This may signal exclusion to applicants from marginalized backgrounds, influencing recruitment and perceptions of belonging in this population. Medical schools have a responsibility to critically assess whether their online imagery aligns with their commitments to equity and inclusion.