starting off with the introduction. When we first start our first year's osteopathic education, we learn what a somatic dysfunction is, which in simple terms is any impaired or altered function of related different components of the body system. So in order for us to diagnose a somatic dysfunction, there's different steps that are needed to be done. We learn that the first thing we need to do is visualize the skin. That means visualizing for any abnormal hair growth, any scarring or any lesions. We then move on to palpating the different layers of the skin, starting off very superficially, working our way down to the fascia, the muscle, and eventually even the bone. We then do any special diagnostic tests that need to be done. So if that means a patient that has carpal tunnel, we would do Phelan's or Tunnell's test. Next, we would make our diagnosis based off our visualization, palpation, and any diagnostic tests that were done. And then we set the patient up and treat them. We learn early on in our first year that there are four components of diagnosing a somatic dysfunction, and there's four criteria. And of those four criteria, two of the criteria need to be met in order for us to have a somatic dysfunction. That acronym that we all know is called T.A.R.T. T stands for tissue texture changes. We then have A of T.A.R.T., which is asymmetry. Next, we have the R in T.A.R.T., which is restriction of motion. And lastly, we have tenderness. So two out of four of these components must be met for us to have a somatic dysfunction. So what Red Reflex is, is also called the erythema friction rub, is done when we are assessing the tissue texture changes. So if we feel that a patient has any fogginess or tightness in their muscles, we can basically run our fingers pretty roughly throughout that area of the skin a couple of times. And usually after we wait a couple of seconds, that area will become red. And that's indicative of some type of somatic dysfunction or disruption in our normal skin system. So what's the problem here? The problem is with different skin tones, it's very difficult to identify the Red Reflex consistently. And the aim is that through enhancements in medical student education, we can embrace a more comprehensive spectrum of skin tone that can eventually lead us to an improved education system that will be more diverse and inclusive for the forthcoming generation of osteopathic physicians. So how was this project conducted? What I did was I created a survey for both first and second year medical students at my institution. And this survey included questions that assessed the student's confidence on being able to palpate, but also assessed whether students felt that the school had enough diversity. And if we were taught how diversity and different skin tones can play a role in our diagnosis of somatic dysfunction. So these surveys were conducted and overall there were two major conclusions and results that were seen here. The first being that students in the second year class were more confident in their palpation skills and they felt that they were able to diagnose the somatic dysfunction more confidently than the first year students. The other conclusion that was from the survey was that the students in both classes felt that they were aware that different skin tones can play a role in the somatic dysfunction diagnosis, but overall it's not very educated on. It's kind of more like a fact that was mentioned and brushed over. And furthermore, our resources and our textbooks don't educate us on the differences that skin tones can play. So what I did was I found different students in my class who had a upper thoracic somatic dysfunction. And I tried to do the erythema friction rub on each of these seven students. And as you can see in this figure, the students that were more fair had a much more red or pink undertone of their skin after the red reflex was done. Comparatively to the darker skin individuals, you can see that the color was harder to see and it could easily be missed when trying to diagnose somatic dysfunction. The color that appeared very red and pink on the fair skinned individuals looked a little more violacious in color in those darker skinned individuals. So a little bit of a discussion. So the last question in the survey asked, how do you think our education system can be bettered and how can we improve our education system specifically as first year DO students? How can we bring diversity into the education system? Many students discussed including examples of different skin tones when we learn about skin-related disorders and using OMIM for that. And many students discussed that we can start practicing more on different skin tones and that will help us diagnose a lot better and we'll be more confident in our diagnosing as we work our way through our medical education. Some limitations that I had when doing this project was one, this project was confined to my medical school. And next, when I did do the upper thoracic red reflex on the seven individuals in my class, it was pretty difficult to find the exact same diagnoses when I was trying to do the red reflex. So overall they had upper thoracic dysfunction, but it was hard to find whether somebody had an extension rotation, a group dysfunction, whether it was more of a paraspinal muscle dysfunction. To conclude, palpation is taught very early in our osteopathic medical education and it's a very essential component in the layer-by-layer tissue texture changes that is a part of diagnosing somatic reflexes and somatic dysfunctions. So overall the data shows that not only does skin tone affect the appearance of the erythema friction rub or red reflex, but it's a very big area of improvement that's needed in our education system. When I looked back at two essential textbooks, such as the Foundations of Osteopathic Medicine and the Atlas of Osteopathic Techniques, two big textbooks that are used around the country in different medical schools for all of them, there were very little, if not any, photos of describing what erythema friction rub was. And one photo I did find was on a very fair skin tone. So this shows that it's not very spoken about and these changes in differences in skin tone is very apparent in the world today. So as our patient demographic is increasingly becoming more nearing to the general population and more diverse, it's vital to undergo training to provide these patients with empathy and expertise. And I think that this is the first step in helping us get to a point where we can implement diversity, inclusion, and equity in osteopathic medicine. Thank you.

osteopathic medical education

somatic dysfunctions

skin tone diversity

T.A.R.T. criteria

educational inclusivity