werful ways implicit bias can act is through language. Currently, many in surgery lack a robust understanding of how their language can perpetuate gender or other stereotypes. Often, when it comes to terminology reform, male and female skeptics alike shrug off a need for change, dismissing any linguistic modernization as mere political-correctness. This approach is neither helpful nor appropriate. Here we review the science detailing the ways language reinforces gender inequality and offer strategies to decrease linguistic bias. Why You Should Care: The Impact of Gender Bias in Language Linguistic relativity, or the idea that language directs thought, has been shown to operate in multiple contexts. 5 , 6 In a 2014 study, investigators demonstrated that objects’ grammatical gender strongly predicted whether Spanish/Russian (gendered language) speakers classified objects as feminine or masculine. 7 In other words, their language guided their decisions. In this case the result seems inconsequential—few would be deeply invested in whether a table is referred to in masculine or feminine terms; however, linguistic relativity becomes problematic when language reinforces inequality. There is growing evidence that societies with gendered language consistently display deeper gender inequality than societies with neutral language. 8 , 9 For instance, in the aforementioned study, Russian/Spanish-speaking participants displayed more sexism on the study’s social attitude scale than their English-speaking counterparts. Similarly, using the Global Gender Gap Index which “benchmarks national gender gaps on economic, political, education- and health-based criteria”, Prewitt-Freilino et. al demonstrated that countries where >70% of the population spoke a gendered language scored lower on both the overall index and on economic subscales. 10 In this context, it appears that language not only reflects and defines culture, but actually shapes cultural norms. Language appears to play a Medical Center Drive, Ann Arbor, MI 48109, (P) 734-936-5792, dtelem@med.umich.edu Keywords: Gender bias, gendered language, linguistics, gender-fair language, gender-neutral language, surgery PMC Copyright notice PMCID: PMC5774006  NIHMSID: NIHMS932623  PMID: 28902666 The publisher's version of this article is available at Ann Surg Introduction “The influence of language on thought is obligatory 5 , 6 In a 2014 study, investigators demonstrated that objects’ grammatical gender strongly predicted whether Spanish/Russian (gendered language) speakers classified objects as feminine or masculine. 7 In other words, their language guided their decisions. In this case the result seems inconsequential—few would be deeply invested in whether a table is referred to in masculine or feminine terms; however, linguistic relativity becomes problematic when language reinforces inequality. There is growing evidence that societies with gendered language consistently display deeper gender inequality than societies with neutral language. Language appears to play a particularly important role in molding individuals’ attitudes toward gender and occupation. Bem and Bem’s landmark study reported that women were significantly less likely to apply for jobs with masculine suffixes (- man versus – person ). 11 In a simulated hiring experiment, German-speaking business students rated standardized female applicants as less suitable for high-power positions when the job description used male rather than paired forms (e.g. Geschäftsführer versus Geschäftsführerin/Geschäftsführer ). 12 Moreover, research suggests that language-induced stereotyping can be difficult to overcome. 16 – 20 Formal recommendations frequently praise female physicians for “being part of a team”, highlight women’s teaching abilities, and refer to ‘her training’. In contrast, male physicians’ evaluations commend their “decisiveness”, often reference their research, and refer to ‘his career.’ Differences extend to verbal language as well. As reported by Files et al., women introduced by men in professional settings were significantly less likely to be referred to by their title than men introduced by men. 21 This linguistic bias, although often implicit and unintentional, reinforces gender norms and perpetuates stereotyping. Moreover, because many of these biases operate at the subconscious level, they are difficult to identify and address. Thus, mindful strategies to combat biases are needed. What can you do: Strategies to Avoid Gender Bias in Language Gender-fair language has been proposed to reduce both discrimination and gender stereotyping. This can be accomplished through a variety of approaches, a few of which are highlighted here: 1. Language Neutralization Here, gender-neutral forms replace masculine forms or are removed all together. For example, in lieu of gender-specific words such as “chairman” or “policeman”, the corresponding “chairperson” or “police officer” is used. In cases where the gender is unknown or indeterminate, or in languages where the traditional norm is to use a male pronoun to refer to all genders, a neutral pronoun should be used instead. 22 ‘They” is now widely accepted to have both singular and plural usages. The use of ‘(s)he’ or ‘him/her’ is better than exclusively defaulting to a male generic, although this terminology reinforces gender binaries and may still be problematic for transgender individuals. Completely new pronouns such as ‘ze’ also exist, but have not been widely adopted. 2013;27(3):200–211. [ Google Scholar ] 24. Stahlberg D, Sczesny S. Effekte des generischen Maskulinums und alternativer Sprachformen auf den gedanklichen Einbezug von Frauen. Psychologische Rundschau. 2001;52(3):131–140. [ Google Scholar ] 25. Gustafsson Sendén M, Bäck EA, Lindqvist A. Introducing a gender-neutral pronoun in a natural gender language: the influence of time on attitudes and behavior. Frontiers in Psychology. 2015;6:893. doi: 10.3389/fpsyg.2015.00893.