{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:03:40Z","timestamp":1785402220077,"version":"3.56.0"},"reference-count":24,"publisher":"AOSIS","issue":"1","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Teaching skin of colour (SOC) is essential to equitable dermatologic care. Historically dermatology teaching has favoured lighter skin tones \u2013 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\u2019 ability to identify dermatoses in all skin tones. Clinical pattern recognition across\u00a0all\u00a0skin tones is thereby linked to hierarchical schema of differential diagnoses and management \u2013 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.<\/jats:p>","DOI":"10.4102\/jcmsa.v4i1.347","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T07:52:12Z","timestamp":1783497132000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Integrating skin of colour into generalist dermatology education: A metacognitive framework"],"prefix":"10.4102","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6219-5515","authenticated-orcid":false,"given":"Husna","family":"Moola","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05bk57929","id-type":"ROR","asserted-by":"publisher"}],"name":"Stellenbosch University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2701-4632","authenticated-orcid":false,"given":"Willem I.","family":"Visser","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05bk57929","id-type":"ROR","asserted-by":"publisher"}],"name":"Stellenbosch University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Taylor SC. Skin of color: Biology, structure, function, and implications for dermatologic disease. J Am Acad Dermatol. 2002;46(2 Suppl Understanding):S41\u2013S62. https:\/\/doi.org\/10.1067\/mjd.2002.120790","DOI":"10.1067\/mjd.2002.120790"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Desir N, Encarnacion IN, Hamid A, et al. The first 20 years of skin of color dermatology: An era of advancements in skin, hair, and nail disorders. JAAD Rev. 2025;4:69\u201382. https:\/\/doi.org\/10.1016\/J.JDRV.2025.03.003","DOI":"10.1016\/j.jdrv.2025.03.003"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Syder NC, Omar D, McKenzie S, Brown-Korsah JB, Taylor SC, Elbuluk N. Gaps in medical education curricula on skin of color in medical school, residency, and beyond: Part 1. J Am Acad Dermatol. 2023;89(5):885\u2013892. https:\/\/doi.org\/10.1016\/j.jaad.2022.03.053","DOI":"10.1016\/j.jaad.2022.03.053"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Arza A, Sejdiu Z, Viveiros M, James A, Weingarten M, Giordano C. Beyond the surface: Unveiling gaps in medical education through eyes of diverse learners. Arch Dermatol Res. 2024;316(5):187. https:\/\/doi.org\/10.1007\/s00403-024-02963-9","DOI":"10.1007\/s00403-024-02963-9"},{"key":"ref4","unstructured":"Statistics South Africa. Census 2022 population count results [homepage on the internet]. Statistics South Africa. Stats SA; 2023 [cited 2026 May 23]. Available from: https:\/\/www.statssa.gov.za\/?p=16716"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Glazer AM, Rigel DS. Analysis of trends in geographic distribution of US dermatology workforce density. JAMA Dermatol. 2017;153(5):472\u2013473. https:\/\/doi.org\/10.1001\/JAMADERMATOL.2016.6032","DOI":"10.1001\/jamadermatol.2016.6032"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"De Jager RS, Gray NA, Visser WI. Waiting time to see a dermatologist in South Africa: A cross-sectional survey. J Coll Med S Afr. 2026;4(1):359. https:\/\/doi.org\/10.4102\/JCMSA.V4I1.359","DOI":"10.4102\/JCMSA.v4i1.359"},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"Phillips WR, Herbert CP. What makes family doctors the leaders we need in health care? Can Fam Physician. 2022;68(11):801. https:\/\/doi.org\/10.46747\/CFP.6811801","DOI":"10.46747\/cfp.6811801"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Emahiser J, Nguyen J, Vanier C, Sadik A. Study of live lecture attendance, student perceptions and expectations. Med Sci Educ. 2021;31(2):697. https:\/\/doi.org\/10.1007\/S40670-021-01236-8","DOI":"10.1007\/s40670-021-01236-8"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Gupta A, Saks NS. Exploring medical student decisions regarding attending live lectures and using recorded lectures. Med Teach. 2013;35(9):767\u2013771. https:\/\/doi.org\/10.3109\/0142159X.2013.801940","DOI":"10.3109\/0142159X.2013.801940"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"Sturman N, Mitchell B, Cameron R, Thomas H, Kelly M, King D. Online teaching materials and medical student impressions of general practice: Lots of rules and guidelines? Aust J Gen Pract. 2025;54(4):229\u2013233. https:\/\/doi.org\/10.31128\/AJGP-05-24-7253","DOI":"10.31128\/AJGP-05-24-7253"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"LaMonica LC, Hester T, Thomas R, Wang F. Skin of colour dermatology education in US primary care residency programmes: A nationwide cross-sectional survey of programme directors. Skin Health Dis. 2025;5(1):9\u201313. https:\/\/doi.org\/10.1093\/skinhd\/vzae001","DOI":"10.1093\/skinhd\/vzae001"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"Lujan HL, DiCarlo SE. The paradox of knowledge: Why medical students know more but understand less. Med Sci Educ. 2025;35(3):1761. https:\/\/doi.org\/10.1007\/S40670-025-02379-8","DOI":"10.1007\/s40670-025-02379-8"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"Stanton JD, Sebesta AJ, Dunlosky J. Fostering metacognition to support student learning and performance. CBE Life Sci Educ. 2021;20(2):fe3. https:\/\/doi.org\/10.1187\/CBE.20-12-0289","DOI":"10.1187\/cbe.20-12-0289"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"Peterknecht E, Reid E, Cheung K, Rajasekaran A. Improving recognition among undergraduate and postgraduate trainees of dermatological conditions in skin of colour: A cross-sectional quality improvement project. Clin Exp Dermatol. 2022;47(12):2261\u20132264. https:\/\/doi.org\/10.1111\/CED.15374","DOI":"10.1111\/ced.15374"},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"Guida A, Gobet F, Tardieu H, Nicolas S. How chunks, long-term working memory and templates offer a cognitive explanation for neuroimaging data on expertise acquisition: A two-stage framework. Brain Cogn. 2012;79(3):221\u2013244. https:\/\/doi.org\/10.1016\/J.BANDC.2012.01.010","DOI":"10.1016\/j.bandc.2012.01.010"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"Zimmerman BJ. Becoming a self-regulated learner: An overview. Theory Pract. 2002;41(2):64\u201370. https:\/\/doi.org\/10.1207\/S15430421TIP4102_2","DOI":"10.1207\/s15430421tip4102_2"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"Flavell JH. Metacognition and cognitive monitoring: A new area of cognitive-developmental inquiry. Am Psychol. 1979;34(10):906\u2013911. https:\/\/doi.org\/10.1037\/0003-066X.34.10.906","DOI":"10.1037\/0003-066X.34.10.906"},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"Schraw G, Moshman D. Metacognitive theories. Educ Psychol Rev. 1995;7(4):351\u2013371. https:\/\/doi.org\/10.1007\/BF02212307\/METRICS","DOI":"10.1007\/BF02212307"},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"Dunlosky J, Rawson KA, Marsh EJ, Nathan MJ, Willingham DT. Improving students\u2019 learning with effective learning techniques: Promising directions from cognitive and educational psychology. Psychol Sci Public Interest. 2013;14(1):4\u201358. https:\/\/doi.org\/10.1177\/1529100612453266","DOI":"10.1177\/1529100612453266"},{"key":"ref20","doi-asserted-by":"crossref","unstructured":"Gobet F. Chunking models of expertise: Implications for education. Appl Cogn Psychol. 2005;19(2):183\u2013204. https:\/\/doi.org\/10.1002\/ACP.1110","DOI":"10.1002\/acp.1110"},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"Xu H, Ang BWG, Soh JY, Ponnamperuma GG. Methods to improve diagnostic reasoning in undergraduate medical education in the clinical setting: A systematic review. J Gen Intern Med. 2021;36(9):2745. https:\/\/doi.org\/10.1007\/S11606-021-06916-0","DOI":"10.1007\/s11606-021-06916-0"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"Rohrer D, Dedrick RF, Hartwig MK, Cheung CN. A randomized controlled trial of interleaved mathematics practice. J Educ Psychol. 2020;112(1):40\u201352. https:\/\/doi.org\/10.1037\/EDU0000367","DOI":"10.1037\/edu0000367"},{"key":"ref23","doi-asserted-by":"crossref","unstructured":"Kassamali B, Lee MS, Linggonegoro D, et al. Increasing skin of color representation in a medical school dermatology course through student and faculty engagement: The dermatology IDD image verification ensuring representation of skin of color initiative. J Am Acad Dermatol. 2023;88(2):437\u2013440. https:\/\/doi.org\/10.1016\/j.jaad.2022.05.028","DOI":"10.1016\/j.jaad.2022.05.028"}],"container-title":["Journal of the Colleges of Medicine of South Africa"],"original-title":[],"link":[{"URL":"https:\/\/jcmsa.org.za\/index.php\/jcmsa\/article\/view\/347\/1090","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T07:52:57Z","timestamp":1783497177000},"score":1,"resource":{"primary":{"URL":"https:\/\/jcmsa.org.za\/index.php\/jcmsa\/article\/view\/347"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,9]]},"references-count":24,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,1]]}},"URL":"https:\/\/doi.org\/10.4102\/jcmsa.v4i1.347","relation":{},"ISSN":["3105-4331","2960-110X"],"issn-type":[{"value":"3105-4331","type":"print"},{"value":"2960-110X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,9]]},"article-number":"a347"}}