Click here to learn more about and authentically share land acknowledgment at the beginning of each presentation.¹

Northwestern University is an example of an institution that has incorporated the use of land acknowledgment and has commissioned work from an indigenous artist as part of its work on Native American and Indigenous Initiatives:

Why do we recognize the land?

To recognize the land is an expression of gratitude and appreciation to those whose territory you reside on and a way of honoring the Indigenous people who have been living and working on the land from time immemorial. It is important to understand the long-standing history that has brought you to reside on the land and to seek to understand your place within that history. Land acknowledgments do not exist in a past tense or historical context: colonialism is a current ongoing process, and we need to build our mindfulness of our present participation. It is also worth noting that acknowledging the land is Indigenous protocol. Shared from lspring.org.²

To prioritize cultivating an inclusive space, it is important to share your gender pronouns.

The University of California San Francisco (UCSF) has created a campaign entitled, Pronouns Matter, whereby "a key element of creating a safe space for people of all sexes and gender identities is the respectful use of gender pronouns." They share ways to be inclusive in using and respecting gender pronouns:

Incorporate gender pronouns in everyday use with these strategies:

• Edit your email signature to include your pronouns
• Verbal introductions and check-ins are great opportunities to solicit gender pronouns. As names and pronouns can change over time, it is preferable to regularly incorporate these questions into meetings and introductions. Asking about a person's pronouns may initially feel awkward or uncomfortable, but it is preferable to making hurtful assumptions and using the wrong pronoun. Here are some ways you can do this:

 "What pronouns do you use?"

  "How would you like me to refer to you?"

  "How would you like to be addressed?"

  "Can you remind me which pronouns you like for yourself?"

  "My name is Joshua, and my pronouns are he, him, and his. What about you?"

• Wear your pronouns sticker on your ID badge.
• Include pronouns and update your profile on your institution’s directory
• At the beginning of your presentation, share your name and gender pronouns when introducing yourself, and include it on the first slide of your presentation.

Provide representation of folks with diverse social identities and intersectionality of those identities including by age, disability, faith, gender, gender Identity, gender expression, race/ethnicity, skin tones in images.

This helps cultivate a space of belonging when folks feel seen and represented in images and in your learners, staff and leadership. A study conducted at the Yale School of Medicine and published in the Society for General Internal Medicine showed, “Art plays an important role in creating a welcoming space in higher education...paintings as a demonstration of their school’s values, which they identified as whiteness, elitism, maleness, and power. The study says that participants thought that portraits exacerbated feelings of being judged and unwelcome at the school, or that ‘this institution was never meant for me.’”³

Evenly represent all genders (non-binary, transgender, cis-gender folks) in curricula, learning cases, and presentations. Ensure that people with different sexuality/sexual orientation are included. Avoid using stereotypes in these depictions.

It is important to Include non-binary, gay, lesbian or transgender individuals in your institution’s curriculum, learning cases, presentations and images. Do not limit their inclusion in discussions focused on sexual health.

Provide equal representation of women in curricula, learning cases, and presentations. Do not create monolithic representations of women in images focused solely on reproductive health issues.

Amplify the representation of variety of genders in cases about pregnancy and birthing-related issues to be fully inclusive of birth narratives, such as those of folks who identify as women, transgender and gender non-conforming individuals.

Prioritize information in all didactics, presentations, and curricular materials to include content on racial, ethnic and gender disparities and inequities.

Climate change can feel daunting, but we know it's of utmost importance and does not impact everyone in an equitable fashion. This is a great resource that was presented at a family medicine conference in 2022 that can help us all tackle the problem no matter your role.

View and Download Here

The four following demographic collection best practices sections include resources and tools to support your data collection interests as they relate to demographics. Our goal is to support your efforts in ways that center equity each step of the way

• Do: Examine your purpose for collecting demographic data. How will the information be used? What decisions will be made based on the information? Who will benefit? Are there potential risks or harms? Be sure to inform respondents about how their information will be used.
• Do: Understand the opportunities and risks involving data disaggregation. Granularity should be balanced with confidentiality.
• Do: Reference and cite any community-generated sources that you utilize in your research. Be upfront with community groups about how you will use their data.
  
• Do: Create a plan for protecting data. What is your data collection system? Who are the data system administrators, and how will decisions be made about permitting/restricting access? Be sure to inform respondents about how their data will be protected. 
  
• Do: Create a plan for community engagement. If you are collecting demographics information about a community targeted by inequities, how will your efforts be shared?
  
• Do: Remember the human stories behind the numbers.

• Do: Allow a self-describe option so that respondents can provide their own identity description if they do not feel any of the options you provide describe them
• Do: Consider the tradeoffs between free response questions vs providing your own response options. Free response options will generally provide the most accurate data and allow individuals to describe themselves in a way that is most authentic to them but will take more time to analyze (e.g., 26 unique responses generated from a free text question vs 5 unique responses from a multiple-choice question).
• Do: Use alphabetical order instead of listing statistical majority first so that you are presenting the options in a way that does not indicate order of importance
• Do: Allow respondents to skip any demographics question or select “prefer not to answer” unless it is absolutely necessary to obtain (e.g., for randomization)
• Do: Take extra precautions with a small sample size and consider how asking specific demographic questions could make individuals feel they are at risk of being identified.
• Do: Think about whether you are trying to assess a type of person vs a lived experience. Often we ask about things like race/ethnicity and sex when we really mean to ask about things like racism and sexism. Asking about person-level characteristics and drawing conclusions from them can have the unintended consequence of making the story about the person rather than about the systems/institutions/environments that cause negative outcomes. Validated measures that assess prejudice and discrimination exist and you are encouraged to explore them.
• Do not: Use the term sexual preference when asking about one’s sexual orientation as who one is sexually attracted to is not a preference. You can instead use “sexual orientation,” “sexual identity,” or ask how one identifies and then provide a list of sexual orientations.
• Do not: Use othering language (e.g., listing “other” as an option) as this can reinforce an “us vs them” mentality or imply that someone identifying with a group/identity is seen as other

While the specific demographic questions you use will depend on several factors specific to your project and audience, included in the following guides are sample inclusive questions to reference and guidelines for developing demographic questions:

NCWIT Guide to Demographic Survey Questions: https://wpassets.ncwit.org/wp-content/uploads/2021/10/29170259/Surveys_DemographicsGuide_10292021.pdf

NAMI: Core Demographic Questions Explained: https://www.nami.org/getmedia/5adbaa46-26ff-4704-b9ac-f5c01ad3f8ed/Core-Demographic-Questions-Explainer-Field

UCLA Williams Institute: https://williamsinstitute.law.ucla.edu/publications/geniuss-trans-pop-based-survey/

Harvard ORARC Inclusive Demographic Data Collection: https://www.hsph.harvard.edu/regulatory-affairs-and-research-compliance/wp-content/uploads/sites/2352/2023/05/ORARC-Tip-Sheet-Inclusive-Demographic-Data-Collection.pdf

Articles

Flanagin A, Frey T, Christiansen SL, AMA Manual of Style Committee. Updated Guidance on the Reporting of Race and Ethnicity in Medical and Science Journals. JAMA. 2021;326(7):621–627. doi:10.1001/jama.2021.13304

Books

Noble, S. U. (2018). Algorithms of Oppression. NYU Press.

Tuhiwai Smith, L. (2021). Decolonizing Methodologies: Research and Indigenous Peoples. Bloomsbury Publishing.

Websites

Conducting Research Through an Anti-racism Lens https://libguides.umn.edu/antiracismlens

              We All Count (their community forum is very helpful and you can post your own questions) https://weallcount.com/

              Considerations for Conducting Evaluation Using a Culturally Responsive and Racial Equity Lens https://mphi.org/wp-content/uploads/2022/05/Considerations-for-Conducting-Evaluation-Using-a-Culturally-Responsive-and-Racial-Equity-Lens.pdf

Race is a social construct. Racism, not race, is a social determinant of health and plays a significant role that adversely impacts health outcomes in minoritized communities.

 

Refer to the image below shared from the report, Towards the Abolition of Biological Race in Medicine and Public Health: Transforming Clinical Education, Research, and Practice, with the graphic from Dr. Joia Crear-Perry.⁴

Graphic adapted by Dr. Joia Crear-Perry, originally from Tackling Health Inequities through Public Health Practice, by R. Hofrichter and R. Bhatia.⁵

There are disparities and inequities that exist across ALL specialty areas and should be included in the content whenever possible. There are several great resources and guides on how to do this well.

• Acknowledge and explain racial disparities in disease incidence and treatment administration.
• When discussing any racial disparity, emphasize race as a social construct and that these differences are most significantly explained by social, economic, and/or political inequities.
• Emphasize the important role of the physician as part of the social problem (unconscious bias, perpetrator, and perpetuator of systemic/institutional racism) and also part of the solution in their niche or area of work/expertise.
• Consider examples of health disparities and inequities in the community and if resources in the community exist, specifically mention them. Make sure to not represent minoritized communities from only a deficit model. Amplify and celebrate the strengths and assets of historically marginalized communities to prevent stereotyping and a monolithic narrative, as author Chimamanda Ngozi Adichie shares in her Ted Talk of the Danger of a Single Story⁶
• Resist the urge to use or recommend ‘calculators’ or metrics that include race as a biologic factor of disease/illness without discussing the social (biased, racist, oppressive) implications of it (examples include GFR, ASCVD risk, VBAC, etc.). The New England Journal of Medicine has a great paper outlining these calculators and concerns regarding equity.⁷
• Disparities exist for other areas outside of race/ethnicity, including gender, ethnicity, religious affiliation, immigration status, age, disability, and more. Take other aspects of identity into account when discussing disparities. Consider the importance of the intersectionality of identities, as coined by Dr. Kimberlé Crenshaw in her Ted Talk on the urgency of intersectionality.⁸
• Emphasize cultural humility while avoiding generalizations, biases, and stereotypes. Refer to this video documentary⁹ by San Francisco State professor Vivian Chávez (which also references the work of Dr. Melanie Tervalon and Dr. Jann Murray-Garcia, who created the term cultural humility¹⁰), and learn about the principles of cultural humility, which include:

**Lifelong learning and critical self-reflection

**Recognizing and changing power imbalances

**Developing institutional accountability

Remove words, images, and topics that are inflammatory, create harm, and may cause trauma or re-traumatization through triggering content.

Consider having materials reviewed by a committee to prevent this from occurring. When images or videos are shared that contain content that are inflammatory, create harm and/or cause trauma, it is important to preface the sharing of that material with a trigger warning. At the University of Michigan, they prioritize the use of trigger warnings and have a resource guide with these goals towards inclusive teaching¹¹:

**To explain what content and trigger warnings are.

**To encourage a recognition of the importance of the mental and emotional wellbeing of students.

**To clarify the value of the content and trigger warnings and how they contribute to inclusive pedagogy.

**To offer various ways to implement content and trigger warnings in your classroom.

Ensure proper use of terminology related to gender, race, ethnicity, and sexuality.

There are several great resources to help with cultivating shared language and vocabulary. Here is an example of one resource with inclusive terminology^12.

 

Even when using these resources, you may get things wrong. Be willing to acknowledge your imperfection while striving to be better.

Whether it is an individual with a disability or a nursing mother, it is important that we allow every individual to learn material and gather information.

Institutions are working on universal design to allow for inclusive learning spaces. The University of Arizona uses guidelines to help ensure accessibility to materials and presentations. This includes questions on how you are presenting material, what format is being used, and can materials be adapted for individuals with a disability? Creating inclusive spaces and learning environments ensures that all individuals are able to show up in that space and optimize learning of information. This helps all individuals when we are intentional about how spaces are set up to optimize an environment that is conducive for all to receive and learn the material. Vanderbilt University’s IRIS Center has incorporated a comprehensive guide on presentation accommodations.¹³

Be intentional on how you plan to facilitate and encourage participation of the diverse opinions and voices in the audience.

When providing action items or recommendations, consider how power, privilege, and aspects of identity may play a role.

For example - Recommending healthy food and walking more doesn’t take into account that people may not have access to healthy, affordable food options or safe, accessible areas in which to exercise or have the ability to walk/exercise.

1. Native Governance Center. A Guide to Indigenous Land Acknowledgment https://nativegov.org/a-guide-to-indigenous-land-acknowledgment/.

2. LSPRIG. Know The Land: Territories Campaign  [Available from: http://www.lspirg.org/knowtheland accessed March 2021.

3. Fitzsousa E, Anderson N, Reisman A. “This institution was never meant for me”: The Impact of Institutional Historical Portraiture on Medical Students. Journal of general internal medicine 2019;34(12):2738-39.

4. Chadha N, Lim B, Kane M, et al. Toward the Abolition of Biological Race in Medicine. UC Berkeley: Othering & Belonging Institute 2020;Retrieved from https://escholarship.org/uc/item/4gt3n0dd

5. Hofrichter R, Bhatia R. Tackling Health Inequities Through Public Health Practice: Theory To Action. 2nd ed. New York: Oxford University Press 2010.

6. Ngozi Adichie C. The Danger of a Single Story. TEDGlobal 2009, 2009:https://www.ted.com/talks/chimamanda_ngozi_adichie_the_danger_of_a_single_story.

7. Vyas DA, Eisenstein LG, Jones DS. Hidden in Plain Sight - Reconsidering the Use of Race Correction in Clinical Algorithms. N Engl J Med 2020;383(9):874-82. doi: 10.1056/NEJMms2004740 [published Online First: 2020/08/28]

8. Crenshaw K. The Urgency of Intersectionality. TEDWomen 2016, 2016:https://www.ted.com/talks/kimberle_crenshaw_the_urgency_of_intersectionality.

9. Chavez V. Cultural Humility: People, Principles and Practices., 2012:https://www.youtube.com/watch?v=SaSHLbS1V4w.

10. Tervalon M, Murray-García J. Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. J Health Care Poor Underserved 1998;9(2):117-25. doi: 10.1353/hpu.2010.0233 [published Online First: 1999/03/12]

11. University of Michigan. An Introduction to Content Warnings and Trigger Warnings. https://siteslsaumichedu/inclusive-teaching/an-introduction-to-content-warnings-and-trigger-warnings/ PDF available here: https://siteslsaumichedu/inclusive-teaching-sandbox/wp-content/uploads/sites/853/2021/02/An-Introduction-to-Content-Warnings-and-Trigger-Warnings-Draftpdf.

12. Diversity Best Practices. Research Report: Glossary of Terms for Diversity, Equity, & Inclusion. 

13. The IRIS Center. Examples of Presentation Accommodations https://iris.peabody.vanderbilt.edu/wp-content/uploads/modules/jj1/pdf/iris_pres_accomm_ex.pdf.