Revisiting Race, Ethnicity, and Disparities in Rheumatology Educational Materials: An Update since 2020.

OBJECTIVE: In 2020, Strait and colleagues raised awareness that the clinical images in rheumatology educational materials underrepresent people with skin of color (P-SOC). Since then, publishers of rheumatology educational materials have focused on addressing this shortcoming. This study investigates the change in representation of P-SOC following Strait's review.

METHODS: We used Strait's methods to collect images from commonly referenced rheumatology educational materials and categorized the skin tones within them as "light" or "dark." We calculated the proportional change in images depicting "dark" skin tones between 2020 and 2022 from the American College of Rheumatology (ACR) Image Library, Kelley's Textbook of Rheumatology, and New England Journal of Medicine (NEJM) as well as between 2020 and 2024 from rheumatology articles within UpToDate. We compared results using one-sided Z tests.

RESULTS: Overall, the proportion of images depicting "dark" skin tones increased 40.6% (p<0.0001). Kelley's Textbook of Rheumatology most significantly increased inclusion of P-SOC (90.1%, p=0.0039), with ACR Image Library, UpToDate, and NEJM also enhancing representation (41.9%, p=<0.0001; 31.0%, p=0.0083; 28.2%, p=0.3046, respectively).

CONCLUSION: This study assesses the progress of rheumatology educational materials towards equitable representation of P-SOC. It demonstrates that awareness coupled with focused efforts from educational publishers can enhance the proportion of images depicting "dark" skin tones, thereby enriching the quality of foundational knowledge relayed to rheumatology providers with the goal of improving health experiences and outcomes for P-SOC with rheumatic diseases.