Yale School of Medicine (YSM) trainees, faculty, and staff have access to a new resource intended to facilitate learning across the school: the Inclusive Language Initiative & Glossary (“ILI & Glossary”). The introductory message on the ILI & Glossary webpage (located on the MD Curriculum website) describes how YSM’s Office of Curriculum, in conjunction with the Health Equity Thread, “is striving to create an inclusive learning environment where students, faculty, and staff feel recognized and respected. In communities where inclusion and belonging are priorities, the words that we use are important and can help achieve these goals.”
The aim “is to embrace inclusive language recognizing that it is integral to the teaching process, important for our learners as they grow professionally, and ultimately essential for delivering patient-centered care to the diverse population we serve.” Inclusive Language Committee Co-chair Beverley Sheares, MD, MS, associate professor of pediatrics (pulmonology) and leader, Health Equity Thread, says that the glossary is intended to be a resource in every space where trainees are learning, from the classroom, to clinical care, to research.
An inclusive, collaborative approach
A committee of more than 35 faculty, staff, students, and community partners—co-chaired by Jaideep S. Talwalkar, MD, associate professor of internal medicine (general medicine) and of pediatrics and director of Clinical Skills, and Sheares — collaborated for over a year to create the glossary. There was faculty representation from across the curriculum. The glossary builds on other YSM efforts. For example, the Dean’s Advisory Council on LGBTQI+ Affairs has created a glossary of LGBTQIA+ identity and health terms as a classroom resource.
The ILI & Glossary, at least initially, focuses on six areas: disability, LGBTQIA+, patient-centered language, poverty, race & ethnicity, and sex & gender— acknowledging the “intersectionality” of these categories. For each of these areas, the glossary provides information about a relevant set of words and phrases, including alternative updated terms, explanations of the origins of some outdated terms and phrases, and links to other resources.
A strength of the guide, Talwalkar and Sheares say, is that it does not provide absolutes that tell readers to use this word, but not that word. Rather, it outlines contextual factors and historical considerations for words and phrases. They believe this background information will help people better understand how terminology is changing and why certain words are most appropriate in the context of medical education. For example, the glossary explains that “sexual preference” is an outdated term, because “while people do have sexual preferences, using ‘sexual preference’ to describe someone’s sexual orientation is offensive as it implies that one’s sexual orientation is a choice, as opposed to something innate. In addition to being scientifically inaccurate, framing sexual orientation as a choice opens the door for interventions such as conversion therapy which lack scientific credibility and clinical utility. Additionally, there is evidence that such interventions are harmful.”
Michael Schwartz, PhD, associate dean for curriculum and director of innovation in medical education, praised the thoughtful, inclusive, and collaborative approach that Talwalkar and Sheares used to recruit the participants for this project and how they identified the areas of focus. He shared that in addition to this project reinforcing the use of accurate and inclusive language in the school’s educational programs, it provides students and faculty with a useful lens for understanding the limitations of research studies based upon the precision of language used to identify subject populations.
The glossary initially only is available to the Yale community, which aligns with the intent to create a resource for the school based on local needs. This internal rollout also provides an opportunity for feedback from the YSM community, enabling improvements to be incorporated. The website is structured to encourage feedback/suggestions, so that like language, the glossary will be ever evolving.
Opening up about the language we use when talking among colleagues and to our patients offers a chance for everyone to learn.
Nora O'Neill, third-year MD/PhD student
Significantly, the glossary is intended for use in medical education and clinical care. It is not designed to address the many outdated terms or phrases used in society at large. The ILI & Glossary introduction shares the vision that “members of the YSM community will review terms and concepts before, during, and after engaging with relevant curricular content.” Talwalkar already has used the glossary to guide teaching with his inpatient care team; "We had an engaging, nuanced discussion about terms we hear every day on rounds—homeless, facility, 'Red man' syndrome—and the importance of considering more precise explanations."
Optimism about Impact
Third-year MD/PhD student Nora O'Neill wanted to join the Disability Working Group because of her personal experience. She grew up with a twin brother with intellectual and physical disabilities and witnessed how physicians would “stumble over words when describing his abilities or diagnoses.” At YSM, O’Neill noticed “disability was often talked around rather than talked about. I think that stems from many physicians not knowing the language that people with disabilities use to describe themselves and the professional language that mirrors it.” The diagnostic term "mental retardation" appears in the curriculum, even though, as O’Neill states, “it is now outdated and offensive to many.”
O’Neill is hopeful about the glossary’s impact. “Opening up about the language we use when talking among colleagues and to our patients offers a chance for everyone to learn. This is particularly important because the social meanings of words change all the time! As a living document, the glossary will try to keep up to date with changing scholarship and community activism.”
Third-year MD student Darius Mostaghimi describes himself as “very sensitive to the power that words have, that they can easily be used incorrectly, which can accidentally lead to imprecise communication or make people feel excluded.” Race and ethnicity being erroneously biologized, both inside and outside the medical field, is especially concerning to him. Being part of the ILI & Glossary project, Mostaghimi says, “gave me an outlet to turn these frustrations into a force for positive change.”
Mostaghimi says the glossary will allow students to “more confidently open a conversation with their professor by pointing to this resource, facilitating a productive two-way exchange where everyone learns.” Additionally, he believes it provides “institutional direction for how researchers, clinicians, and instructors can conscientiously approach complicated and misunderstood subjects such as disability and race.” He hopes it will help them “become aware of and confront unconscious assumptions that they may not know they have. Through these processes, I hope that they will communicate more clearly, conscientiously, and compassionately with students and patients, which will create a more trusting and nurturing environment for all.”
Sheares also is hopeful about the Glossary’s potential impact. Language, she explains, “is another mechanism to achieve equity. The sharing of inclusive language among all of us in the medical community helps to bring about the transformation needed as we work to ultimately achieve equity in health care.”