The Development of a “Diverse Skin Images Database” at Hackensack Meridian School of Medicine

In the spring of 2021, a group of Hackensack Meridian School of Medicine (HMSOM) students contacted the Interprofessional Health Sciences Library about a project to increase the racial diversity of images presented in their lectures. Working with HMSOM faculty, the students identified 75 skin conditions that had previously only been presented to them on light skin and sought IHS Library support to locate images showing the conditions on darker skin tones.

In response to this request, the IHS Library suggested several dermatology textbooks to the students and, finding gaps in our collection, purchased several additional textbooks for this mission. We then created a LibGuide or “toolkit” called “Representation in Medicine,” which listed these texts and other resources (https://library.shu.edu/representation). We also took this opportunity to include texts on cultural competence, LGBTQIA+ health, and medical racism.

Working with the IHS librarians on search strategy and citation style, the students then searched the textbooks and other outside literature, saving the images to a Google Drive folder and citing the image sources in a spreadsheet. To date, they have located 76 images depicting conditions including cellulitis, Kawasaki Disease, Livedo Reticularis, and Seborrhoeic Dermatitis on non-white skin.

Originally meant to remain a Google Drive folder, the library suggested uploading the images and citations into a dedicated Libguide so that HMSOM faculty and students could easily download the images and use them in class presentations.

With the students’ support, the library created the “Diverse Skin Images Database,” uploading the images and corresponding citations to the LibGuide (Figure 1). Due to the use of copyrighted content in the database, the LibGuide had to be password protected. The password was then broadly shared with students and faculty at the HMSOM.

Students, faculty, and HMSOM administrators have been thrilled with this student-led, collaborative project and its outcomes.

“Our amazing and socially conscious students pointed out that medical images in our courses were lacking in images of people of color. [R]ashes and other findings look different in people of color and our students were not learning how to recognize physical findings in a large segment of our population,” said Dr. Jeffrey Boscamp, Interim Dean at HMSOM.

The database, which we hope to keep expanding, has allowed for the teaching faculty to incorporate more diverse images into the course material. “A great outcome engineered by our students!” concluded Boscamp.

Megan Decker, who spearheaded the project as an M1 and is now an M2, agrees.

“The database has been an immense help to my colleagues and I as we learn about the skin manifestations of diseases on skin of color. Having all the resources available in one location saves us time and clicks to access the desired information. With this knowledge available at our fingertips, we are better equipped to diagnose and treat our future patients,” said Decker.

This medical student initiative around access to diverse skin images is just one of many such initiatives taking place in medical schools both nationally and internationally. For example, Mind the Gap: A handbook of clinical signs in Black and Brown skin, which is included in HMSOM’s “Representation in Medicine” toolkit, was initiated by a medical student at St George’s, University of London. In highlighting our school’s response to this issue, we hope that more medical schools, with the support of their institutional libraries, will engage in the push to bolster diverse skin image libraries.