Developing an inclusive and sensitive approach to pronoun usage is an increasingly important consideration for the credentialing industry. The Merriam-Webster Dictionary has updated their definition of they as a pronoun used to refer to a singular person whose gender is intentionally undisclosed gender or whose gender identity is nonbinary.¹ As other prominent dictionaries and style manuals continue to update guidance on gender terminology and pronoun usage, best practices are likely to evolve regarding fairness and bias in exam development and diversity, equity and inclusion (DEI) efforts within credentialing organizations. Despite best intentions and efforts, some language can be construed as insensitive or biased, which can impact candidate experience and performance, as well as employee engagement and sense of belonging in organizations. Using terminology and language that is accurate and unbiased helps create a more positive experience for candidates, staff and stakeholders.

When evaluating current pronoun usage and whether it is respectful and inclusive, below are a few, specific areas where credentialing bodies can initially focus their efforts.

Exam Content

Credentialing assessments often have high-stakes outcomes that impact professional and employment opportunities; therefore, it is critical that examinations provide a valid and fair assessment of candidate proficiency. Sex and gender-specific pronouns may be relevant to include in certain item constructs, while irrelevant in others. Per the AMA Manual of Style, when it is not medically or otherwise relevant, the use of sex- and gender-neutral terminology is preferred to avoid stereotyping and bias.² Credentialing organizations may consider adapting item writing practices to include gender-neutral language, such as the use of they/them/their as a singular pronoun, or generically referring to a role or person within the item (e.g., a credentialing specialist, a patient) to prevent potential bias when developing exam content.

Item Writing Training

Training staff and subject matter experts (SMEs) to write and edit items with sensitivity to bias and stereotyping is imperative to ensure score reliability. A biased item can cause two candidates with similar knowledge and abilities to perform differently on an exam, potentially due to distracting or offensive language.³ It is best practice to provide item writers with clear guidance on how to avoid developing biased items. The guidance may include editorial style rules for gender- and sex-neutral language, when appropriate, and instructions to perform sensitivity reviews of items to ensure an inclusive and equity-based approach to race, gender, age, sexual orientation, disability and socioeconomic status. To avoid undue influence on candidates’ perceptions and performance, use gender-neutral terminology in exam content whenever possible. Unless sex is relevant to the construct, it is recommended to not include it as an attribute of the subject in the item.

Item Editing

Second to that of the subject matter expert, the role of the editor is perhaps the most critical in ensuring unbiased, accurate and neutral pronoun usage in exam content. In addition to reviewing items for adherence to psychometric best practices, editors complete a comprehensive editorial review for alignment with the credentialing organization’s preferred editorial sources. Discussions regarding gender terminology has become more salient, and consequently, style manuals continue to revise guidance to promote clarity and inclusivity. The Associated Press issued a “Transgender Coverage Topical Guide” with updated guidance on gender terminology and pronoun usage in July 2022. The Associated Press provided recommendations when using they as a singular pronoun, such as using plural verbs and rephrasing if more than one person is suggested. The guide also clarified gender- and sex-related terminology, such as sex assigned at birth as the preferred term to sex.⁴ Editors performing a sensitivity review of items may consider editing exam content according to the guidance published by their organization’s preferred editorial manual and the recommendation of SMEs.

The AMA Manual of Style describes gender as a “cultural indicator of a person’s personal and social identity” and recommends that sex, the biological attributes of males and females, should only be specified when it is relevant. Following this guidance, the American Nurses Credentialing Center (ANCC) Measurement Services’ internal style guide addresses the preference for consistent use of general terms, such as patients rather than woman, man or child. A person-first approach to language strives to emphasize the individual and not equate them with their condition, nationality or religion, or gender when it is not relevant to the exam item.

Policies and Procedures

Another way credentialing organizations can improve gender neutrality is to review and update existing documentation, such as its policies and procedures. Organizations should consider refining the language in their documentation to remove potentially inaccurate and unnecessary references to gender or gendered titles and roles. The AMA Manual of Style recommends avoiding the use of chairman, fireman and layman and using sex-neutral terms, such as chairperson, firefighter and layperson. To ensure gender and sex neutrality is maintained in new and revised documentation, train responsible staff on pronoun usage best practices when writing, editing and approving policies and procedures.

Staff and Stakeholders

Many organizations are currently examining and changing their policies and initiatives regarding pronoun usage, inclusion and sensitivity in the workplace. While some staff and stakeholders may use gender-specific personal pronouns that align with their sex assigned at birth, such as she/her/hers or he/him/his, or honorifics, such as Mr., Ms., Miss and Mrs., some may communicate a desire to be addressed by personal pronouns and honorifics that are different from their sex assigned at birth or are gender neutral. The diverse identities and backgrounds of staff and stakeholders (e.g., SMEs, credential holders, board members) require an inclusive and intentional position regarding the use of personal pronouns, including nonbinary pronouns, such as they/them/theirs, and gender-neutral honorifics (e.g., Mx). The Board of Certified Safety Professionals (BCSP) added the option for candidates/applicants/credential holders to select Mx as an honorific in their user profiles. BCSP is also discussing other options for credential holders to note their preferred pronouns if they desire to do so. In conjunction with the human resources department, credentialing organizations should start the conversation about creating an inclusive, respectful and safe environment for each employee and stakeholder.

As society advances to embrace inclusivity of diverse identities and promote equity, the considerations listed here will assist credentialing bodies to have the necessary conversations (or continue for those who have already begun the journey) to adopt inclusive language in all credentialing business areas.

References

1. Merriam-Webster. (n.d.). They. In Merriam-Webster.com dictionary. Retrieved December 4, 2022, from https://www.merriam-webster.com/dictionary/they
2. American Medical Association, & Editors, T. J. N. (2020). AMA Manual of Style: A Guide for Authors and Editors. Oxford University Press.
3. Haladyna, T. M. (2015). Developing and Validating Multiple-choice Test Items (3rd ed.). Routledge.
4. AP Stylebook Online Topical Guides. (n.d.). AP Stylebook. https://www.apstylebook.com/topical_most_recent