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Session: ePoster: Education, Training Assessment, and Practice Management 2 (Mon1015)

EP718 - A Lack of Anorectal Pathology Image Diversity in Colorectal Surgery Textbooks

Monday, May 12, 2025

10:20 AM – 10:25 AM PT

ePoster Presenter(s)

Yeonjoo Cho, MD

General Surgery Resident
Maimonides Medical Center
Brooklyn, NY, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

CP

Christopher Prien, MD, MS

General Surgery Resident
Maimonides Medical Center
Brooklyn, New York, United States

Disclosure information not submitted.
PD

Peace Deh, BS

Medical Student
SUNY Downstate College of Medicine
Brooklyn, New York, United States

Disclosure information not submitted.
JT

Jennifer Tapley, MD

General Surgery Resident
Maimonides Medical Center
Brooklyn, New York, United States

Disclosure information not submitted.
ES

Elie Sutton, MD

Attending, Colon and Rectal Surgery
Maimonides Medical Center
Brooklyn, New York, United States

Disclosure information not submitted.

Senior Author(s)

RR

Rebecca Rhee, MD, FACS, FASCRS

Division Chief, Colon and Rectal Surgery
Maimonides Medical Center
New York, New York, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Yeonjoo Cho, MD: This individual has no financial relationships with ineligible companies.

Rebecca Rhee, MD, FACS, FASCRS: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: We sought to evaluate the representation of different skin tones depicted in images of anorectal pathology found in colorectal surgery textbooks.

Methods/Interventions: Non-illustrated images depicting anorectal pathology were identified and analyzed from colorectal surgery textbooks. Images were classified based on category and pathology. The Fitzpatrick skin phenotype scale and constitutive skin color scale were used to evaluate each image. Fitzpatrick phototypes I – III represented skin of noncolor and phototypes IV – VI represented skin of color. The skin tone distribution was assessed over time and compared to the distribution of the general population.

Results/Outcomes: A total of 744 images from 13 textbooks were included. Textbooks were published from 2003 – 2022. Images were categorized as: diagnostic (78%), surgical (18.7%), postoperative (2.6%), or anatomic (0.7%). There were 466 (62.6%) images depicting benign/non-infectious pathology, 181 (24.4%) of infectious pathology, and 97 (13%) of malignant pathology. Based on the Fitzpatrick scale, most (84.7%) images depicted skin of noncolor. Similarly, using the constitutive scale, 86.9% of images depicted “light or fair” skin tones and only 13.1% depicted “medium or dark” skin tones. Across all pathological categories, noncolor skin was the most prevalent skin tone depicted. Compared to the distribution of skin tones in the general population, the proportion of textbook images depicting skin of color was significantly (p=0.0001) decreased. Over time, the proportion of images depicting noncolor skin has not significantly changed.

Conclusion/Discussion: Across all image categories and diagnoses, anorectal pathology is significantly underrepresented on skin of color in colorectal surgery textbook images.