An Evaluation of Racial Diversity in Craniofacial Surgery Literature

Sobol, Danielle L.; Cho, Daniel; Massie, Jonathan P.; Burns, Jill; Crowe, Christopher S.; Kneib, Cameron J.; Lane, Megan; Shakir, Afaaf; Morrison, Shane D; Ettinger, Ruth A.

doi:10.1097/scs.0000000000007972

Cited by 9 publications

(9 citation statements)

References 26 publications

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“…24 These study results are consistent with previous studies. 18,19,22,25 The proportion of White skin images published in Canada are considerably fewer than the White Canadian demographic. 26 We also note that blepharoplasty was the only global aesthetic procedure which had a significantly higher proportion of non-White skin images than White skin.…”

Section: Discussionmentioning

confidence: 99%

“…This methodology has been previously validated. 18,19,22,25 Third, this analysis was limited in only using procedural data from the United States. Detailed procedural statistics from Canada and throughout Europe were not available to allow for a region-specific analysis.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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An Analysis of Racial Diversity in the Breast Reconstruction and Aesthetic Surgery Literature

Chawla

Shihadeh

Patel

2022

Plastic and Reconstructive Surgery - Global Open

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Background: Racial disparities in the visual representation of patients in the plastic surgery literature can contribute to health inequities. This study evaluates racial diversity in photographs published in the aesthetic and breast reconstruction literature. Methods: A photogrammetric analysis of plastic surgery journals from the USA, Canada, and Europe was performed. Color photographs depicting human skin, pertaining to breast reconstruction and aesthetic surgery in 2000, 2010, and 2020, were categorized as White (1–3) or non-White (4–6) based on the Fitzpatrick scale. Results: All journals demonstrated significantly more White skin images than non-White for all procedures (P < 0.05) except blepharoplasty and rhinoplasty. Blepharoplasty was the only procedure with more non-White images (P = 0.02). When examining USA journals, significant differences were not found in blepharoplasty, rhinoplasty, and male chest surgery. European journals published a greater proportion of non-White images than USA journals (P < 0.0001). There was a decreasing rate of change in diversity with 15.5% of images being non-White in 2000, 32.7% in 2010, and 40.7% in 2020 (P < 0.01). Percentage of non-White images varied by geographical region and ranged from 3.6% in Oceania to 93.5% in Asia (P < 0.01). Conclusions: Diversity of patient populations depicted in plastic surgery literature has increased over the past two decades. Despite this improvement, the racial diversity seen in photographs published in the literature does not adequately reflect this demographic for aesthetic and breast procedures. Equitable visual representation may promote cultural competency and improve care for the populations we serve.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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An Analysis of Racial Diversity in the Breast Reconstruction and Aesthetic Surgery Literature

Chawla

Shihadeh

Patel

2022

Plastic and Reconstructive Surgery - Global Open

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“…Prior studies have examined diversity in craniofacial surgery from the overall perspective of the international community, representation in published clinical photographs, speakers at national meetings, and authorship in peer-reviewed reconstructive journals, but the literature has yet to explore a broad analysis of leadership ranging from fellowship program faculty positions, editorial boards of major journals, and prominent national societies at a specific point in time or a single investigation. 6,[8][9][10] The additional granularity provided by our study examines possible regional differences and the time period that formal training was completed, providing future studies an opportunity to examine sex trends from a more temporospatial and quantitative perspective. Having multiple avenues to assess the diversity of craniofacial surgery across these important leadership roles can offer an effective method of reviewing progress toward the goal of equitable representation.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Sex Diversity Among Craniofacial Academic Faculty

Rivera

Hauc

Juan

et al. 2022

Journal of Craniofacial Surgery

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Sex diversity among plastic surgery and its subspecialties faculties lags behind many medical specialties. Despite the significant evidence in favor of diversity in leadership, female presence in high-ranking positions in medicine is lacking across multiple specialties. In this study, we aim to evaluate sex disparity among faculty across craniofacial fellowship programs by comparing the disparities among total number of faculty, program directors, years in practice, and academic rank. Our sample included 354 individuals including 193 craniofacial surgery journal editorial board members, 130 craniofacial surgery academic faculty members, and 31 craniofacial surgery association board members. A significant difference (P-value <0.0001) was seen among male and female craniofacial surgery faculty with 84.6% males. Faculty members were further subdivided by academic rank. A significant difference was found between the number of male and female faculty members at all academic positions (P-value =0.043). Of 41 full professors, 2.4% were female. There were 42 associate professors queried with 14.3% female. Similarly, 43 assistant professors were identified with 32.0% female. Years in practice after completing terminal training were analyzed across the academic faculty. There was a significant difference in the number of male and female faculty members across all experience levels (P-value =0.0037). Among the faculty with <10 years since completion of terminal training, 32.4 % were female. For faculty with 10 to 20 years after post-terminal training, 19.6% were female. For those with 20 to 30 years of experience, 0% were female. Finally, for the faculty with over 30 years since graduation, 5.9% were female. Board membership in 2 craniofacial surgery organizations was analyzed: the American Cleft Palate-Craniofacial Association and the American Society of Maxillofacial Surgeons. Among the 17 board members of the American Cleft Palate-Craniofacial Association, 8 (47.1%) were female. For the American Society of Maxillofacial Surgeons, 5 (35.7%) were female. Data were collected for 193 editorial board members from 2 craniofacial surgery journals. There was a significant difference between the number of male and female members across both journals (χ2 value: 33.3570; P-value <0.0001). Among 56 editorial board members from Cleft Palate-Craniofacial Journal, 26 (46.4%) members were female. In comparison, Journal of Craniofacial Surgery has 24.8% female editorial board members. Sex diversity among faculty members is really important and should be brought into light to highlight and improve areas of particular importance and of tremendous potential impact. Given our results, surgical residencies and fellowship programs should begin to show concrete commitment and increase their efforts to recruit and retain a diverse faculty not only for the educational benefit but more importantly to achieve a higher level of care for all.

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“…Current medical research and education lacks a robust understanding of skin color as an objective variable, making it difficult to quantify its impact as both a social and physical determinant of health. 1–4 Physical colorimeters or spectrophotometers are the current gold standard to objectively quantify skin color independently from race or ethnicity. 5–7 These tools, however, must be used in person with the patient present.…”

Section: The App: the Skin Analyzermentioning

confidence: 99%

A Novel Method to Determine Patient Skin Type: The Skin Analyzer

Mohamed,

Koussayer,

Randolph

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Summary: Measuring skin color for medical research in an objective and nonbiased manner usually requires expensive equipment such as spectrophotometry and requires the subject to be present in person. We present a novel method to measure skin color from photographs using the Skin Analyzer application as a more effective, accessible, and efficient alternative. A desktop application, the Skin Analyzer, was developed to convert skin samples collected from digital images to the L*a*b color space and uses those values to calculate an individual typology angle that correlates to a Fitzpatrick skin type. To assess accuracy in variable lighting, six known colors representing the six Fitzpatrick skin types were printed and photographed in 15 separate locations within the hospital. To account for user variability in sample selection, interrater reliability was calculated with data generated by 13 untrained users testing the app on six subjects. The accuracy of measuring known values, which is the classification accuracy, was calculated to be 80%. Krippendorff alpha test was used to evaluate interrater reliability. The obtained alpha of 0.84 indicates a high interrater reliability. The high accuracy and reliability make the Skin Analyzer a suitable method of objectively determining Fitzpatrick skin type from images. The app may be used to investigate the effects of skin tone in various areas of interest, especially in retrospective studies where skin colorimeters cannot be used.

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An Evaluation of Racial Diversity in Craniofacial Surgery Literature

Cited by 9 publications

References 26 publications

An Analysis of Racial Diversity in the Breast Reconstruction and Aesthetic Surgery Literature

An Analysis of Racial Diversity in the Breast Reconstruction and Aesthetic Surgery Literature

Assessment of Sex Diversity Among Craniofacial Academic Faculty

A Novel Method to Determine Patient Skin Type: The Skin Analyzer

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