• Jonathan P Massie, Daniel Y Cho, Cameron J Kneib, Janelle D Sousa, Shane D Morrison, and Jeffrey B Friedrich.
• Division of Plastic Surgery, Department of Surgery, Northwestern University, Chicago, IL, USA.
• J Natl Med Assoc. 2021 Feb 1; 113 (1): 88-94.

BackgroundThere has been a recent focus on the impact of race on health equity, which has revealed unsettling results. Multiple studies have shown that the underrepresentation of minorities in medical education such as course slides, pre-clinical lecture material, case studies, and textbooks impedes racial equity in the practice of medicine.Aim Of StudyIn this study, we aimed to survey the landscape of published imaging in modern medicine to understand the degree of racial diversity represented in current biomedical literature.MethodsWe performed a photogrammetric analysis of medical images from the New England Journal of Medicine representing various medical fields and geographic regions to examine implicit biases with regards to human skin color.ResultsOverall, 18% of images depicted non-white skin tone but there was considerable heterogeneity in the percentage of non-white medical images published from different geographic regions and specialties (ranging from 0% to 67%).ConclusionsUnfortunately, these results suggest that there is an underlying implicit racial bias in published images from medical literature with an underrepresentation of minorities compared to the general population, which could also contribute to inequities in health care. It is critical that health care providers, educators, and trainees promote cultural competency and work to understand the multifaceted influence of race and culture on the daily experience of patients in the modern healthcare system. We hope this study will encourage authors to critically evaluate their medical images for implicit bias so that documented photography in scientific literature may better reflect the populations we serve.Copyright © 2020 National Medical Association. Published by Elsevier Inc. All rights reserved.

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