Sex and race visual representation in emergency medicine textbooks and the hidden curriculum

Abstract

Introduction: In addition to formal training, informal training often occurs through a hidden curriculum. As the hidden curriculum shapes the knowledge and values held by learners, we must consider its role in implicit bias. One example is through the selection of images used in formal instruction. This study aimed to examine the representation of sex and race among images in two textbooks in emergency medicine (EM). Methods: We performed a cross-sectional study of the sex and race representation of figures in Rosen's Emergency Medicine: Concepts and Clinical Practice 9th Edition and Tintinalli's Emergency Medicine: A Comprehensive Study Guide 9th Edition. Two reviewers screened all images for inclusion, with disagreements resolved by a third reviewer.Images were excluded if they did not include visualized skin. Two reviewers independently reviewed each image and assessed the sex, race, and roles in the image. A third reviewer resolved any disagreements.Results: A total of 959 images (Rosen's n = 377; Tintinalli's n = 582) met inclusion criteria. Race was estimated in 877 cases (91.3%). Of those, White individuals comprised 77.6% (95% confidence interval [CI] 75.0%-80.2%). Sex was estimated in 362 cases (37.7%). Of those images, males comprised 70.2% (95% CI 65.4%-74.9%), and females comprised 29.8% (95% CI 25.1%-34.6%). Conclusion:There is a male sex and White race predominance in visual representation among two EM textbooks. We propose a call to action for the mindful selection of images in formal education to represent diversity, equity, and inclusion and close the gap between the formal and hidden curriculum.

Weighing the gold standard: The breadth of emergency medicine core content covered by textbooks

“…In this observational cross-sectional study, we evaluated the content of two widely used EM textbooks: Rosen's Emergency Medicine: Concepts and Clinical Practice 10th Edition (Rosen's) and Tintinalli's Emergency Medicine: A Comprehensive Study Guide 9th Edition (Tintinalli's). [8][9][10] Our methodology aligned with the Strengthening the Reporting of Observational Studies in Epidemiology guidelines and was classified as non-human subjects research by the Stanford University Institutional Review Board. 11 Our core objective was to compare the coverage of EM topics in these textbooks against the American Board of Emergency Medicine's 2019 Model of the Clinical Practice of Emergency Medicine (MCPEM).…”

Anatomy's missing faces: An assessment of representation gaps in atlas and textbook imagery

“…Race or skin tone audits of dermatology educational materials are relatively common, likely due to the high importance of visual diagnosis in this field. [36][37][38][39][40][41][42][43] However, other areas of medicine, such as surgery, 28,29,31,44,45 gynecology, 46 rheumatology, [47][48][49] ophthalmology, 50 and emergency medicine 51 have lately followed suit in conducting their own similar studies. Despite anatomy's foundational importance for most clinical fields, investigations of race representation in the anatomy reference materials used across medical curricula are somewhat limited.…”

“…Race or skin tone audits of dermatology educational materials are relatively common, likely due to the high importance of visual diagnosis in this field 36–43 . However, other areas of medicine, such as surgery, 28,29,31,44,45 gynecology, 46 rheumatology, 47–49 ophthalmology, 50 and emergency medicine 51 have lately followed suit in conducting their own similar studies.…”