Words as Windows: Using Language to Move Toward an Inclusive Environment.

Abstract

In health care, language simultaneously has the potential to liberate and leave out. The words we choose to use or not use shape our institutional environments and identities. When considering the language of diversity, equity, and inclusion (DEI), it can be challenging to understand and endorse concepts that are constantly evolving. For example, it is becoming more common to share pronouns during introductions and use phrases such as stereotype threat, code switching, tone policing, minority tax, and emotional labor. Language signals our values, communicates norms, and creates feelings of exclusion or inclusion.1 In short, language drives culture. The challenge is how to examine the language we use in our programs, to create a more inclusive climate.Language influences learners' feelings of belonging, resilience, identity, self-efficacy, and achievement.2 Consider the amplification cascade. While certain individuals gain from the accumulation of privilege, others may find barriers compounded by words used in successive narrative assessments, letters of recommendations, and Clinical Competency Committees (CCCs), each negatively building on the prior assessment.3 Language use is also affected by the shift to virtual meetings, which may sacrifice the rich language of gestures and facial expressions.Language is dynamic: meaning and structure constantly shift within and across communities. When language understanding is not shared, we can alienate learners, patients, and colleagues. Consider a physician who refers to a patient as “he” or “she” when the patient identifies as “they”—this misgendering can shut down the working alliance and set a tone of exclusion. Examining word use can lead to changes in all program activities, from orientations to CCCs. Through a process of learning and reflection, we can consciously adopt words, adapt ideas, and alter our language to enhance the learning environment.Understanding of DEI language issues will be based on our unique contexts and experiences. Concurrently, we must develop a shared understanding and vision of what terms and concepts mean within the varied settings of academic medicine.