An assessment of racial diversity in vascular surgery educational resources

Abstract

Objective

Cutaneous findings are vital for developing differential diagnoses in vascular surgery and are visually distinct based on skin tone. Studies show that non-White patients with vascular disease may be subject to delays in diagnosis, present with more advanced disease, and have worse outcomes. The ability to recognize cutaneous manifestations of vascular disease in various skin tones may contribute to these disparities in care. Thus, we aim to assess if there is equal representation of White vs non-White skin tones in vascular surgery educational materials. To our knowledge, this is the first assessment of racial diversity in vascular surgery resources.

Methods

We included 369 images from 11 commonly utilized vascular surgery resources and assessed for skin tone via the Fitzpatrick scale (ratings 1-3 classified as White, ratings 4-6 classified as non-White). Images without vascular pathology depiction were excluded. One rater examined all the pictures. A subsequent rater rated 60 photos to assess inter-rater reliability.

Results

The Cohen kappa score was 0.86, demonstrating strong inter-rater reliability. Of the photos, 93% (n = 344 photos) were classified as White, and 7% (n = 25) were classified as non-White. The images were then stratified by disease process: arterial (26/28 White), venous, lymphatic, edema (159/169 White), vasculitis (48/50 White), diabetes and ulcers (62/68 White), and other (49/54 White).

Conclusions

Ninety-three percent of images analyzed had a White skin tone, demonstrating unequal racial representation of vascular pathologies in educational resources. A lack of diverse representation of vascular pathology in educational resources may decrease trainee exposure and contribute to delays in diagnosis and disparities in outcomes. Further research is needed to answer this question. Regardless, the disparity should be addressed to provide adequate exposure to trainees and optimize patient care.