The American College of Surgeons has a long-standing commitment to the principles of diversity, equity, and inclusion (DEI). In alignment with that commitment, the ACS DEI and Antiracism Lexicon was designed to serve as a practical resource for ACS members, staff, and others who engage with any aspect of DEI and antiracism (DEI&A) in surgical and healthcare settings. This Lexicon offers a common language and understanding of how ACS defines key terms that are most relevant to DEI&A topics in the surgical sphere. Read more.
Development of the DEI&A Lexicon required a comprehensive, collaborative approach. Read more.
Sincere appreciation is extended to the ACS leaders, contributors, and reviewers who invested in developing this Lexicon. Read more.
The American College of Surgeons has a long-standing commitment to the principles of diversity, equity, and inclusion (DEI). In alignment with that commitment, the ACS DEI and Antiracism Lexicon was designed to serve as a practical resource for ACS members, staff, and others who engage with any aspect of DEI and antiracism (DEI&A) in surgical and healthcare settings. This Lexicon offers a common language and understanding of how ACS defines key terms that are most relevant to DEI&A topics in the surgical sphere. The ACS DEI&A Lexicon was also developed to promote critical reflection on language and word choice. As part of the ACS DEI&A Resource and Implementation Toolkit, this Lexicon was crafted with cultural humility to raise awareness, generate dialogue, and activate collaborative change that contributes to surgical excellence.
In fulfilling its commitment to DEI, the College has sought to address all areas of marginalization and underrepresentation, including sexism, homophobia, ableism, and xenophobia. This Lexicon continues the College’s multifaceted DEI commitment while also placing a focus on racial considerations. This focus aligns with a comparable decision made by the ACS Regental Task Force on Racial Issues, as stated in its November 2020 Report and Recommendations, that “current national attention provides an opportunity to make great progress on the issue of structural racism in the ACS and in the profession of surgery.” The Task Force concluded: “We believe the practices that will improve our performance on the issues of race will improve those [DEI]-related issues as well, and today’s environment provides an opportunity to focus on race. As such, our recommendations are focused on antiracism.”
Development of the DEI&A Lexicon required a comprehensive, collaborative approach. Prior to the launch of the ACS Office of DEI in August 2021, the ACS Board of Governors’ Diversity Pillar and the ACS Staff Addressing Racism Task Force (ACS-START) had each began work that informed the initial phases of the Lexicon’s development. Building upon that work, the Office of DEI conducted a thorough literature review of DEI&A terminology and usage in healthcare, surgical settings, association management, and other relevant disciplines. The Bibliography includes the literature that served as a resource for developing the Lexicon. In August/September 2022, the Lexicon Advisory Council, consisting of ACS Fellows and staff, provided input on preliminary drafts of the Lexicon; in early 2023, the Lexicon Beta Review Team offered insights on the final draft. A final review team consisting of a broad range of ACS surgeon-leaders assisted with completing the production process of the Lexicon.
The Lexicon’s structure is designed to facilitate efficient use of its content. Related terms are grouped together; for example, the term bias includes references to implicit bias and unconscious bias. This Lexicon is not designed as an exhaustive encyclopedia of all DEI-related terms. Only terms that are most germane to DEI&A in the College and the House of Surgery are included. The Lexicon does not include terms whose common definitions, as found in a standard dictionary, are comparable to how the terms are used in ACS. Where appropriate, the Lexicon does include some historical, social, or cultural context to serve users by providing insights and nuances that extend beyond the scope of a standard definition. Most terms in the Lexicon, however, do not provide lengthy background, context, or usage considerations, which are addressed in the ACS DEI and Antiracism Resource and Implementation Toolkit.
Colloquial and formal language continually evolves. Context plays a critical role in appropriate use of terms and concepts. Terms that may be appropriate in some settings may be totally inappropriate in other settings. Thus, this Lexicon cannot be used as a static checklist for “correct/incorrect” wording or a definitive, all-encompassing guidebook. This Lexicon is a dynamic resource that will be frequently reviewed and updated. Lexicon users are encouraged to offer feedback to ensure continual improvement of this resource. Please email ACS-DEI@facs.org with any comments or questions.
Sincere appreciation is extended to the numerous ACS leaders, contributors, and reviewers who invested in developing this Lexicon, including the following: ACS Board of Governors’ Diversity Pillar and Regental Anti-Racism Committee; David B. Hoyt, MD, FACS, past-Executive Director of the ACS, for initiating this project; Patricia L. Turner, MD, MBA, FACS, for her ongoing support since she began as ACS Executive Director and CEO; the ACS Fellows and staff who served on the Lexicon Advisory Council and Beta Review Team; and the ACS-START participants. Most importantly, thank you to each user of this Lexicon for learning and applying information that ultimately contributes to fulfilling ACS’s mission “To Heal All with Skill and Trust.”
American Academy of Pediatrics. Words Matter: AAP Guidance on Inclusive, Anti-Biased Language. Available at: https://www.aap.org/en/about-the-aap/american-academy-of-pediatrics-equity-and-inclusion-efforts/words-matter-aap-guidance-on-inclusive-anti-biased-language/. Accessed March 20, 2023.
American College of Surgeons Board of Governors Diversity Pillar: Communication/Advocacy Subcommittee. ACS Bulletin Brief. May 4, 2021. Available at: https://web.archive.org/web/20210505050551/https:/www.facs.org/publications/bulletin-brief/050421/clinical#top_bog_dei. Accessed March 20, 2023.
American Medical Association and the Association of American Medical Colleges. Advancing Health Equity: A Guide to Language, Narrative and Concepts. 2021. Available at: https://www.ama-assn.org/system/files/ama-aamc-equity-guide.pdf. Accessed March 20, 2023.
Association of American Medical Colleges. Addressing and eliminating racism at the AAMC and beyond. June 1, 2021. Available at: https://www.aamc.org/addressing-and-eliminating-racism-aamc-and-beyond. Accessed March 20,2023.
Association of American Medical Colleges. Diversity, equity, and inclusion Competencies Across the Learning Continuum. 2022. Available at: https://www.aamc.org/data-reports/report/diversity-equity-and-inclusion-competencies-across-learning-continuum. Accessed March 20, 2023.
Beagan BL. A Critique of Cultural Competence: Assumptions, Limitations, and Alternatives. In: Frisby C, O'Donohue W, (eds) Cultural Competence in Applied Psychology. Champaign, IL: Springer International Publishing, 2018.
Centers for Disease Control and Prevention. CDC’s Health Equity Guiding Principles for Inclusive Communication. Available at: https://www.cdc.gov/healthcommunication/Health_Equity.html (website); https://www.cdc.gov/healthcommunication/HealthEquityGuidingPrinciples.pdf. Accessed March 20, 2023.
Centers for Disease Control and Prevention. Organizational Strategic Plan to Embed Racial Justice and Advance Health Equity 2021-2023. Available at: https://www.ama-assn.org/system/files/2021-05/ama-equity-strategic-plan.pdf. Accessed March 20, 2023.
Centers for Disease Control and Prevention. Resources & Style Guides for Framing Health Equity & Avoiding Stigmatizing Language. Available at: https://www.cdc.gov/healthcommunication/Resources.html. Accessed March 20,2023.
Global ERG Network. DEI key terms and definitions. Available at: https://globalergnet.com/wp-content/uploads/2022/01/diversity-equity-inclusion-key-terms-definitions.pdf. Accessed March 20, 2023.
Jackson A. The difference between DEI and anti-racism at work, according to the diversity chief of a $37 billion company. CNBC. February 11, 2022. Available at: https://www.cnbc.com/2022/02/11/the-difference-between-dei-and-anti-racism-at-work-according-to-twilios-chief-of-diversity.html. Accessed March 20, 2023.
Jones CP. Systems of power, axes of inequity: Parallels, intersections, braiding the strands. Med Care. 2014;11(52):S71-S75.
National Association of County and City Health Officials. Health Equity and Social Justice. December 18, 2018. Available at: https://www.naccho.org/programs/public-health-infrastructure/health-equity. Accessed March 20, 2023.
National Cancer Institute. Division of Cancer Epidemiology & Genetics. Is “not racist” the same as “antiracist”? October 21, 2022. Available at: https://dceg.cancer.gov/about/diversity-and-inclusion/inclusivity-minute/2020/antiracism. Accessed March 20, 2023.
Tapia AT, Kirtzman F, Collins S. I Don’t Know What to Say! When Inclusive Language Leaves us at a Loss for Words. Korn Ferry 2022. Available at: https://www.kornferry.com/insights/featured-topics/diversity-equity-inclusion/when-inclusive-language-leaves-us-at-a-loss-for-words. Accessed March 20, 2023.
Tervalon M, Murray-García J. Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. J Care Health Care Poor Underserved. 9(2):117-125.
University of California San Francisco. Multicultural Resource Center. Racial Equity & Anti-Black Racism. UCSF Definition of racism. Available at: https://mrc.ucsf.edu/racial-equity-anti-black-racism. Accessed March 20, 2023.
University of Washington. School of Public Health. Equity, Diversity, and Inclusive, Glossary of Terms. Fall 2021. Available at: https://epi.washington.edu/sites/default/files/website_documents/DEI%20Glossary_Formatted_20190711.pdf. Accessed March 20, 2023.
US Office of Personnel Management. Diversity, equity, inclusion, and accessibility. Available at: www.opm.gov/policy-data-oversight/diversity-and-inclusion/. Accessed March 20, 2023.