When Kathy Burleson, a senior lecturer of biology at Hamline University, was preparing to teach a course on the biology of women, she was surprised that she couldn’t find any images of the female muscular system to use for the class. “I got really curious about the discrepancies in how women’s and men’s bodies are portrayed across anatomy and physiology textbooks,” she said. To learn more, she embarked on a research project in 2016 with the goal of helping to close diversity gaps in STEM.“ Textbook images tell us a story about science and who belongs in science,” she said. “My hope is that, informed from interviews and data, we can give textbook publishers something to think about.”

The project has three phases:

• In the first phase, she asked her students to review seven anatomy and physiology textbooks, six of which have been around for many years (with regularly updated editions), and one published recently, analyzing the content across five dimensions: sex, race, body size, age, and disability status.
• In the second phase, they interviewed some of the books’ authors and illustrators to ask how they decided which images to use.
• In the third phase, they surveyed students in seven North American colleges and universities to explore which images they preferred to see when learning anatomy and physiology. They received 600 responses and are still analyzing the data.

The key finding so far is a lack of diverse images. “There were gaps in representation in all the [diversity] categories across textbooks,” she said. She found that female and male bodies appeared roughly equally in photos of everyday people. But when it came to depictions of the muscular and respiratory systems, the images were almost all men.

Based on what she learned, Burleson shared the following advice for textbook authors, illustrators, and publishers:

• Work on being as diverse and inclusive as you can be, realizing there’s not always a perfect solution and you only have so much control.
• Try to avoid unnecessarily gendered language (like saying a “woman’s ovary” when “ovary” is sufficient).
• Be mindful of how you’re representing different groups of people. “Do you only see images of people with larger body sizes in a disease condition?” she asks. Vary the context to show patients and professionals of all sizes, races, etc. “Make sure the images students see in class represent the world around them.”

Burleson noted that textbook publishers are making improvements, often hiring “diversity readers” to guide them. “More gender and racial diversity has been stressed since we started,” she said. But many textbooks still aren’t addressing age and body size, she said.

At the same time, Burleson acknowledges that it’s often tricky for publishers and authors to find language that can convey information clearly, accurately, and succinctly while also communicating complexities related to diversity and inclusion. That’s where instructors can play a role. “I can explain what a textbook can’t,” Burleson said.