Visualizing diversity: the Oregon Health & Science University Educational Use Photo Diversity Repository




diversity, inclusion, cultural humility, health science education


Background: Health science education needs images that represent both the diversity of patients served and the diversity of its students and clinicians. To begin to address this need, a nurse educator and librarian collaborated to launch the Oregon Health & Science University (OHSU) Educational Use Photo Diversity Repository. This online resource provides educators of health professional students with access to photos of pathophysiological conditions in skin of various colors so their students can increase their awareness of issues related to health and diversity and prepare themselves for more effective clinical work with their future patients.

Case Presentation: The OHSU Educational Use Photo Diversity Repository became a university-wide project, leveraging the thoughts of an image advisory board, clinicians, faculty members, administrators, and students. Key considerations were given to the workflows used to submit photos as well as the controlled vocabulary for submitting images. The repository was started with photos already in existence, with future plans to have images taken specifically for the repository.

Conclusions: This repository is playing an important role as OHSU and the health sciences in general reflect on the role of systemic racism in health care and clinical education. Negotiating issues of consent, patient health information, and privacy around using different technologies to take photos is a complex and ongoing process. The repository provides opportunities for closely examining these processes and creating improvements that result in more equitable education.

Author Biographies

Pamela Pierce, Oregon Health & Science University

OHSU Library, Digital Scholarship and Repository Librarian

Linda Felver, Oregon Health & Science University

Associate Professor, OHSU School of Nursing


Abrishami D. The need for cultural competency in health care. Radiol Technol. 2018 May;89(5),441–8.

Murray-García JL, Garcia JA. The institutional context of multicultural education: what is your institutional curriculum? Acad Med. 2008;83(7):646–52. DOI:

Agner J. Moving from cultural competence to cultural humility in occupational therapy: a paradigm shift. Am J Occup Ther. 2020 July/Aug;74(4):7404347010. DOI:

Sprik P, Gentile D. Cultural humility: a way to reduce LGBTQ health disparities at the end of life. Am J Hosp Palliat Care. 2020 Jun;37(6):404–8. DOI:

Maldonado ME, Fried ED, DuBose TD, Nelson C, Breida M. The role that graduate medical education must play in ensuring health equity and eliminating health care disparities. Ann Am Thorac Soc. 2014;11(4), 603–7. DOI:

Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's principles of internal medicine. 18th ed. New York, NY: McGraw-Hill; 2012.

Everett JS, Budescu M, Sommers MS. Making sense of skin color in clinical care. Clin Nurs Res. 2012;21:495–516. DOI:

Aby J. Stanford medicine: newborn nursery at Lucile Packard Children’s Hospital [Internet]. [cited 19 Jan 2021]. Available from: <>.

Jacobs D. Standing up against structural racism [Internet]. Portland, OR: Oregon Health & Science University; 31 May 2020 [cited 7 Aug 2020]. Available from: <>.

Oregon Health & Science University fact book [Internet]. [cited 20 Dec 2020]. Available from: <>.

Page S. A medical student couldn't find how symptoms look on darker skin. He decided to publish a book about it. [Internet]. Washington Post; 22 July 2020 [cited 15 Aug 2020]. Available from: <>.

Geddes L. Covid-19 skin rash website criticised for lack of BAME examples. The Guardian. 28 Sept 2020. Available from: <>.

Van der Rijt R, Stuart AH. Ethical considerations of clinical photography in an area of emerging technology and smartphones. J Med Ethics. 2014;40(3):211–2. DOI:

Dumestre DO, Frulin FOG. Balancing the need for clinical photography with patient privacy issues: The search for a secure smart phone application to take and store clinical photographs. Plast Surg (Oakv). Nov 2017;25(4):255–60. DOI:

Prevention and treatment of pressure ulcers: quick reference guide [Internet]. Washington, DC: National Pressure Ulcer Advisory Panel. [cited 30 December 2018]. Available from: <>.

Byrd WM, Clayton LA. An American health dilemma: a medical history of African Americans and the problem of race: beginnings to 1900. London, UK: Taylor & Francis Group; 2000. 192 p.

Ifekwunigwe JO, Wagner JK, Yu JH, Harrell TM, Bamshad MJ, Royal CD. A qualitative analysis of how anthropologists interpret the race construct. Am Anthropol. 2017;119:422–34. DOI:

Bigby M, Thaler D. Describing patients’ “race” in clinical presentations should be abandoned. J Am Acad Dermatol. 2006;54:1074–6. DOI:

Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K, eds. Fitzpatrick’s dermatology in general medicine. 8th ed. New York, NY: The McGraw-Hill Companies; 2012.

Ware OR, Dawson JE, Shinohara MM, Taylor SC. Racial limitations of Fitzpatrick skin type. Cutis. 2020;105(2):77–80.

Pimentel MA. Comment on racial limitations of Fitzpatrick skin type. Cutis. 2020;105(6):319–20.

Robinson J, Porter M, Montalvo Y, Peden CJ. Losing the wait: improving patient cycle time in primary care. BMJ Open Qual. 2020;9(2):e000910. DOI:

MIT graduate student council executive committee. Email to MIT graduate students: Black lives matter, in solidarity [Internet]. [cited 21 Jan 2021]. Available from: <>.

Espinal I, Sutherland T, Roh C. A holistic approach for inclusive librarianship: decentering whiteness in our profession. Library Trends. Summer 2018;67(1):147–62. DOI:


Additional Files





Case Report