Integrating skin of colour into generalist dermatology education: A metacognitive framework.

Teaching skin of colour (SOC) is essential to equitable dermatologic care. Historically dermatology teaching has favoured lighter skin tones - fostering inequitable care of patients. Although significant advancements in teaching SOC have been made, these are predominantly addended to curricula. Limited dedicated contact time in dermatology and competing study needs may lead to undergraduate medical students and generalists deprioritising adjunctive SOC training. Using a metacognitive framework, we propose SOC should be embedded across all teaching materials for medical students and generalists, that is, skin in colour. Each common dermatosis should be illustrated using a triptych of clinical images: one each from approximate Fitzpatrick I/II, III/IV and V/VI skin tones. When learners encounter a clinical pattern across multiple skin tones, they must compare what is shared and what differs. Nuanced morphological teaching and multiple examples of the same condition allow for in-built repetition of key features of each disease, while the skin tone interleaving solidifies students' ability to identify dermatoses in all skin tones. Clinical pattern recognition across all skin tones is thereby linked to hierarchical schema of differential diagnoses and management - allowing students to subsequently access all these components simultaneously in clinical practice. We acknowledge that this approach only addresses ability to recognise clinical signs and diagnose conditions already included in teaching materials. Cultural competence and regional epidemiology are essential to an inclusive curriculum.