Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: It is not known whether skin color influences inclusion of substance use on medical students’ differential diagnoses for a simulated cardiac arrest. Our objective in this study was to investigate whether the presence of a dark-skinned or light-skinned manikin in the lab correlated with their decision to include substance use on the differential as a possible cause of cardiac arrest.

Methods: In this study at a single institution, all fourth-year medical students in an emergency medicine course participated in a manikin-based cardiac arrest simulation case. The simulation sessions alternated between the use of a light-skinned and a dark-skinned manikin. Both were adult sized. After the first shock was delivered, students individually documented their differential diagnosis for the cause of the cardiac arrest on deidentified, free-text research forms. We excluded forms if they were blank, had been completed by a non-medical student, or could not be associated with the skin color of the manikin used. The primary outcome measure was how often students included substance use as a cause of cardiac arrest anywhere in their differential diagnoses. We compared the relationship between manikin skin color and the students’ consideration of substance use as a cause of cardiac arrest, using the Fisher exact test. 

Results: Of 270 eligible participants, 271 surveys were returned; 75 (27.7%) were excluded. Of the remaining 196 surveys, 96 were associated with the light-skinned and 100 with the dark-skinned manikin. Among the 100 respondents using the dark-skinned manikin, one student (1%) listed substance use as the leading diagnosis, while none (0%) of the students using the light-skinned manikin listed substance use as the leading diagnosis. In each group, only 20% of students (n = 39 total) listed substance use anywhere on the differential diagnosis (P = 1.00). 

Conclusion: Among fourth-year medical students participating in a simulated cardiac arrest, we found no correlation between manikin skin color and the inclusion of substance use on their differential for cardiac arrest. Overall, their decision to include substance use in their differentials was low regardless of skin color, suggesting the need to improve their awareness of substance use as a potential cause of cardiac arrest.