The Lexicon’s Purpose
The American College of Surgeons has a long-standing commitment to the principles of Inclusive Excellence (IE). In alignment with that commitment, the ACS Lexicon on IE was designed to serve as a practical resource for ACS members, staff, and others who engage with any aspect of IE in surgical and healthcare settings. This Lexicon offers a common language and understanding of how ACS defines key terms that are most relevant to IE topics in the surgical sphere. The ACS IE Lexicon was also developed to promote critical reflection on language and word choice. As part of the ACS IE 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 IE, 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 IE 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 IE related issues as well, and today’s environment provides an opportunity to focus on race. As such, our recommendations are focused on antiracism.”
Development and Usage of the Lexicon
Development of the IE Lexicon required a comprehensive, collaborative approach. Prior to the launch of the ACS Office of IE 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 IE conducted a thorough literature review of IE terminology and usage in healthcare, surgical settings, association management, and other relevant disciplines. The References Appendix 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 IE-related terms. Only terms that are most germane to IE 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 Inclusive Excellence Resource and Implementation Toolkit.
I think developing a Lexicon that includes the definition of terms with some historical, social, or cultural context, where appropriate, helps serve the user by providing insights and nuances that go beyond the scope of a standard definition. I agree that such a framework should be concise to properly engage the user.
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-IE@facs.org with any comments or questions.
Acknowledgments
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 Inclusive Excellence 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.”
The Resource Library
The ACS Resource Library on Inclusive Excellence provides information and evidence designed to help members and staff of the American College of Surgeons optimize inclusivity in healthcare and surgical contexts. These resources will provide a better understanding of the data and evidence that support the work of inclusive excellence efforts in the College, academia, and everyday practice.