Bias in the Basics: A Multi-Loop Framework for Auditing Foundational Medical Texts through an Equity Lens

This paper critically examines the exclusionary dimensions faced by the marginalised transgender, diverse Sexual Orientation, Gender Identity, and Expression (SOGIESC), and disability community in foundational medical physiology textbooks. A literature review of both international and Indian textbooks was conducted to identify stereotypes, and other forms of discriminatory language. These linguistic choices are not neutral—they shape the attitudes of future healthcare professionals and contribute to the systemic inaccessibility of care for these communities. Our analysis revealed a pervasive presence of exclusionary terms and implicit biases which we feel perpetuate stigma, erase identities, and normalise marginalisation of these population. Recognising that merely correcting isolated terms is insufficient, we propose an Inclusive Language Textbook Audit Tool grounded in a multi-loop learning framework. This tool moves from surface-level corrections (single-loop learning) to questioning underlying assumptions (double-loop learning) and transforming the cultural and institutional contexts that sustain exclusion (triple-loop learning). Embedding this framework into textbook audits offers a systematic path from tokenistic edits to systemic inclusion. We call on textbook authors, publishers, and educators to adopt this tool to ensure linguistic equity in medical education. Revising foundational texts is not only a matter of accuracy; it is an ethical imperative to cultivate a generation of healthcare professionals committed to equity, dignity, and justice for all patients.