To the Editor:
Exclusionary language and images in academic medicine are common 1 and harmful. 2,3 Sexist jokes are frequent during medical school lectures. 2 Of over 4,000 images in medical school lectures, 61% depicted men and 78% portrayed White patients. 1 Stigmatizing language also occurs; it worsens self-management of disease and increases bias. 3,4
A culture of inclusion requires shifting the language and images used in academic medicine. Inclusive language is “free of bias and avoids perpetuating prejudicial beliefs,” 5 and inclusive images represent patients’ diversity.
We developed the Inclusive Language and Images Policy 6 (ILIP) to facilitate changing culture at our institution, using relevant literature reviews and stakeholders’ views. The ILIP applies to lectures, email signatures, and institutional documents.
The components of ILIP are:
- Introduction to inclusive language and imagery,
- Statement of leadership support,
- Explanation of principles of inclusive language and imagery with resources and examples, 1
- Guidance for email signatures, and
- Inclusive and diversity disclosure statement for presentations.
The benefits of inclusive language and imagery are supported by evidence. 4,7 Inclusive language often uses person-first and strengths-based wordings rather than using a medical illness as a noun (e.g., “person with diabetes” rather than “a diabetic”). Inclusive language is nonjudgmental, facts-based, mentions personal characteristics only when medically relevant, nonstigmatizing, and uses the singular “they.” Many national societies provide population-specific guidelines. The American Psychology Association’s style guide discussions of bias-free language can guide presentations and writing. However, individual preferences of appropriate language should take precedence over established principles in one-on-one interactions.
The ILIP is dynamic and should be adapted when necessary—for example, to acknowledge the history of the institution: its policies, celebrated figures, land, and achievements. We have added an Indigenous land acknowledgment to presentations as a local adaptation to support guidelines concerning truth and reconciliation.
Uses of the ILIP should be monitored for adherence; one option is to include questions about inclusion on presenter evaluations. Continuing education may be needed to support faculty as they implement ILIP policies. Shifting the culture of medicine requires role modeling by faculty, and the ILIP can provide this framework.
References
1. Martin GC, Kirgis J, Sid E, Sabin JA. Equitable imagery in the preclinical medical school curriculum: Findings from one medical school. Acad Med. 2016;91:1002–1006.
2. Larsson C, Hensing G, Allebeck P. Sexual and gender-related harassment in medical education and research training: Results from a Swedish survey. Med Educ. 2003;37:39–50.
3. Lloyd CE, Wilson A, Holt RIG, Whicher C, Kar P; Language Matters Group. Language matters: A UK perspective. Diabet Med. 2018;35:1635–1641.
4. Ashford RD, Brown AM, Curtis B. The language of substance use and recovery: Novel use of the Go/No-Go Association Task to measure implicit bias. Health Commun. 2019;34:1296–1302.
5. American Psychological Association. Bias-free language guidelines. In: Publication Manual of the American Psychological Association. 2019:7th ed. Washington, DC: APA; 131–152.
6. University of Calgary, Cumming School of Medicine. Inclusive language and images policy. 2020 Office of Professionalism, Equity and Diversity; [internal document].
7. Dickinson JK, Guzman SJ, Maryniuk MD, et al. The use of language in diabetes care and education. Diabetes Care. 2017;40:1790–1799.
