Mind the Gap handbook now freely available online

Published: 24 August 2020

Mind the Gap, a handbook of clinical signs and symptoms in black and brown skin, is now available to be downloaded online.

Designed as part of a student-staff partnership project, Mind the Gap was created by medical student, Malone Mukwende, Senior Lecturer in Diversity and Medical Education, Margot Turner, and Clinical Lecturer in Clinical Skills, Dr Peter Tamony. The booklet can now be downloaded as an ebook on the Black and Brown Skin website, created separately by Malone.

The project began after Malone recognised that the images being shown in clinical skills sessions weren’t representative of people with darker skin tones. As a result, Malone approached his personal tutor, and Mind the Gap was born.

Since the announcement of the project, Malone has featured in multiple interviews, appearing in news stories around the globe, sharing his vision to change the medical curriculum. With the handbook now widely available, it is hoped that more doctors and patients will be able to benefit from the content.

“Mind the Gap has allowed for the discussion of issues of representation in clinical teaching,” says Malone. “I hope to see the content of our handbook and similar tools become an integral part of medical school learning.

“If the doctors of tomorrow are better equipped to deal with how signs and symptoms present on black and brown skin, this will improve patient care and reduce the healthcare disparities that exist today.”

Malone has just started his third year of medicine at St George’s, but still has his eyes on growing the content of the handbook and his newly developed website. Malone’s website has been set up for people to submit their own images or personal stories anonymously, growing a portfolio of images and raising awareness of issues in healthcare.

“It will be a one-stop-shop of resources and pictures of how clinical signs and symptoms present on black and brown skin,” adds Malone. “The pictures will be isolated to different parts of the body, so for example, people will be able to see what chicken pox looks like on darker skin tones on the head and neck, or on the arms.”

The booklet has already been added to the recommended reading list of more than eight medical schools across the UK, and has led to equality and diversity training for clinical skills peer tutors at St George’s.

Senior Lecturer in Diversity and Medical Education and co-author, Margot Turner, said: “Now we’ve set the project in motion, it’s really important to see staff and students working together on this. Mind the Gap has started the journey, and we need to keep going with broader collaborative efforts.

“For this first version, we focused on conditions where we thought we’d be able to have the most impact. But looking ahead, we want to see even further progress in equality and diversity training and have it embedded in ways of working between staff and students.”

Overall, the project is seen as an opportunity to change the way medicine is taught and bring more people on board with raising awareness of racial bias in healthcare.

Professor Jane Saffell, Deputy Principal for Education, said: “I’m delighted that, thanks to a student-staff partnership collaboration with our clinical skills team, Malone’s mission to improve teaching about clinical signs on darker skin tones has been advanced by publication of the Mind the Gap handbook.

“Its integration into clinical teaching at St George’s and other medical schools in the UK and beyond means generations of healthcare professionals will be better able to recognise clinical signs on patients and improve healthcare for all.

"Our aim at St George’s is to develop students who will make a difference in the world.  Malone epitomises this quality and I hope his example will inspire and empower others to voice and take forward their ideas.”