The current state of representation in medical school anatomy lectures: A quality improvement project

Representation within medical education has important implications for diagnostic accuracy, cultural competency, and equitable patient care. Historically, anatomical teaching materials have disproportionately depicted lighter skin tones and smaller body types, potentially reinforcing bias and limiting trainees’ exposure to the diversity of patient populations. This study aimed to examine the representation of skin tone and body habitus within anatomy lecture materials across multiple medical programs and one physician assistant program. A cross-institutional analysis was conducted on anatomy lecture slides from Albany Medical College (MD and PA programs, 2022–2024), Duke University School of Medicine (2023–2024), and Howard University College of Medicine (2023–2024). Images depicting human anatomy were evaluated for skin tone using the Monk Skin Tone (MST) scale and for body habitus using the BIA-O scale. Two independent annotators scored each image, and descriptive statistics with chi-square analysis were used to evaluate trends in representation. Images were also categorized as “content” or “filler” based on educational utility. Descriptive statistics and chi-square analyses were performed. A total of 2,504 images were analyzed. Most depicted lighter skin tones, with approximately 70–80% corresponding to MST values 1–3, while darker tones accounted for fewer than 10% of images, with only two images rated MST 10. Of 627 images eligible for body habitus analysis, 93% depicted underweight-to-normal body sizes, with almost no representation of overweight bodies and none depicting obesity. Male bodies appeared more frequently than female bodies (73% vs. 27%). Anatomy lecture materials across institutions demonstrate persistent underrepresentation of darker skin tones and larger body habitus in anatomy lecture materials across institutions. These findings highlight measurable gaps in foundational medical education resources and underscore the need for more intentional de-homogenization of instructional materials. • 2,504 anatomy images analyzed across 3 medical schools and 1 PA program • 70–80% of images showed light skin tones; <10% depicted darker tones • 93% of body habitus images were underweight–normal; none showed obesity • Male bodies were overrepresented (73%) compared to female (27%) • MST and BIA-O scales applied to quantify diversity in anatomy education