Immune literacy directly impacts communities across lines of race, ethnicity, gender, socioeconomic status, and other social factors. Gaps in equitable teaching practices within this field are particularly concerning. Due to its biomedical and societal relevance, immunology instructors are uniquely positioned to disrupt harmful stereotypes by reimagining course materials through an IDE-A lens. Without deliberate attention to IDE-A principles, immunology education risks perpetuating rather than challenging biases that contribute to health disparities.

While often treated as objective, teaching materials - including textbooks - reflect the values and perspectives of their authors and the contexts in which they are produced. Research has shown that content omissions and representational choices can unintentionally reinforce structural inequities in education (Apple, 2004). For example, teaching materials that overlook the ways race intersects with health or that rely on stereotypical imagery in case studies may contribute to biased clinical reasoning and diagnoses (Metzl and Hansen, 2014) and can negatively affect students’ sense of belonging, particularly those from historically excluded groups (Acosta and Ackerman-Barger, 2017).

The Inclusive Excellence framework (AACU, 2015) provides a foundation for integrating inclusivity and equity into immunology education. The framework posits that institutional and academic excellence are inseparable from a commitment to inclusion, and that meaningful learning environments are those in which all students, not just the historically privileged, can thrive. This framework can inform the tools and approaches for curriculum and course design, which includes textbook selection. Even so, while tools and resources exist to evaluate course design through an IDE-A lens, rubrics to assess immunology textbooks are currently absent from the literature.

This gap in textbook evaluation tools reveals a critical need at the individual teaching level. By developing a rubric specifically for evaluating immunology textbooks through an IDE-A lens, our work fills this gap - expanding the tools available to educators and supporting stronger alignment between course content and broader institutional equity goals. To address this need for textbook evaluation using IDE-A principles, the IDE-A rubric assessment focused on four key areas, defined based on curated resources (Table 1) as:

The raters evaluated the textbooks based on the IDE-A rubric categories of:

To assess the level of agreement among raters, Krippendorff’s alpha (K-alpha) was calculated using the K-alpha calculator ⁶ (Marzi et al., 2024a). For textbook 1, K-alpha (Ordinal Scale) is 0.762, and for textbook 2, K-alpha (Ordinal Scale) is 0.733; both scores indicate moderate agreement between raters for the stated conclusions. For textbook 3, K-alpha (Ordinal Scale) is 0.880, exceeding the 0.8 threshold for a satisfactory level of agreement between raters.

The average scores on each rubric category for textbooks 1, 2, and 3 are depicted in Figure 2, where each dot indicates a rater. The variation in rater agreement is indicated by the vertical distance between the two dots. Example comments from the raters corresponding to low, medium, and high ratings on each rubric category are depicted in Table 2.

The raters agreed that all three textbooks are in the developing stage regarding their overall commitment to the IDE-A framework (Figure 2), suggesting the textbooks do not clearly mention IDE-A principles, do not define IDE-A-related terms, or do not consistently apply the IDE-A framework. Reviewers noted, “There is no mention of the intention to include diverse perspectives,” and “The author mentions in the Preface that the text is solely relaying immunology facts and not to be used to provide a historical context.” With respect to accessibility, both reviewers agreed that while the textbooks were not free, they can be purchased in different formats at lower cost than hardcover versions.

Raters agreed that textbook 2 was in the developing stage of textbook imagery representation, while mixed views were expressed for textbooks 1 and 3. Textbook 3 was rated between developing and absent stages, while textbook 1 was rated at the present or exemplary stage of inclusive representation. One reviewer noted that, “The author does show cartoon images to represent humans…with various colors used to represent different skin tones (grey, salmon, white, brown). The cartoon outlines are generally gender-neutral. Thus, the different skin tones represent diversity.” The other reviewer noted consistency with ethnic diversity of names used in end-of-chapter questions.

The raters were in strong agreement on the application of the rubric criteria for affordability and accessibility, scoring all three textbooks as a 1 in the category of cost burden. This suggests that the rating process captured the developing stage for this criterion. The raters were also in agreement that accessibility was exemplary for all three textbooks, with incorporation of many features to meet required UDL standards.

In rating the textbooks using the rubric, there were areas of high agreement, while some differences in interpretation of specific rating categories became apparent. The more quantifiable and easily definable concepts of affordability and accessibility showed complete agreement. Criteria requiring reflection on the philosophical framing of IDE-A values, including representation of diverse imagery and acknowledgement of the history of the field, showed variation in scores. While the rubric is a grounding tool for discussion, the raters will bring a lens shaped by their own lived experiences and biases. The two raters have different ethnicities and disciplinary backgrounds, and teach immunology in different contexts (undergraduate immunology, graduate-level immunology integrated with pathology and infectious diseases, or immunology in a human anatomy and physiology undergraduate course). These dissimilarities could have contributed to the variation in ratings for the subjective categories. Post-rating discussions resulted in the recognition that nuances in assessment can be understood to reflect IDE-A “in context,” i.e., the rating of a textbook’s suitability for a specific instructor in a specific classroom will be somewhat contextual and subjective, and therefore complete agreement is not necessary across all facets of the IDE-A rubric. In its application, we recommend using a similar approach, where educators can use the rubric to assess a textbook independently or to guide a discussion with other educators. The latter can be particularly beneficial in diversifying and broadening perspectives on IDE-A-related issues.

In this article, we present a shared perspective on a rubric that can be adopted to evaluate immunology textbooks through an IDE-A lens. The need for this rubric originated from the changes in classroom dynamics of the three immunology educators among the co-authors, who teach diverse student populations. To develop an informed perspective, they collaborated with social scientists and librarians who possess extensive experience with IDE-A values in various contexts. The rubric and accompanying discussion are an invitation to immunology instructors to engage in thoughtful reflection on how to best cater to all students through the choice of textbooks. Future work will entail assessing the validity and reliability of this rubric to ensure its accuracy and consistency.

While organizational- and departmental-level DEI assessment tools like PULSE and PAITE exist, they do not evaluate teaching materials. The IDE-A rubric fills this critical gap, equipping individual instructors with a practical tool to assess immunology textbooks - and textbooks in STEM fields more broadly - through an inclusive, diverse, equitable, and accessible lens. This focused approach complements higher-level strategies, strengthening the toolkit for advancing IDE-A principles across institutional levels. By bridging the gap between systemic goals and teaching choices, the IDE-A rubric empowers educators to make course content decisions that align with values of inclusive excellence in higher education.

Building on this, the IDE-A rubric guides instructors through a reflective assessment process before textbook adoption. It asks educators to assess representation and stereotype threat in human names, images, and case examples, even when the majority of illustrations in immunology textbooks may present cells, shapes, or line and arrow models. An example of thoughtful discussion that emerged in the process of rating the textbooks was about use of names versus initials in case studies and questions. While names may make the content relatable for students, they also risk perpetuating stereotypes. Beyond content assessment, the rubric also prompts educators to consider the impact of access and accessibility barriers, including cost. The rubric’s rating of overall commitment to the IDE-A framework acknowledges the impact of conscious engagement with these values by authors and publishers.

Textbooks have a long publication cycle, with many years elapsing between editions. We recognize that different markets, institutional policies, and evolving regulatory guidelines around ADA and IDE-A principles may need to be considered when applying this rubric. Therefore, the rubric itself is not overly prescriptive, allowing for more longevity and broader applicability as an initial framework. Given that textbook choice is only one facet of creating an inclusive learning experience, additional work is needed to incorporate other curricular elements into pedagogical practice to foster an inclusive learning environment, such as student-teacher dialog (Killpack and Melón, 2020), syllabus tone (Harnish and Bridges, 2011), course structure (Tanner, 2013) and other IDE-A informed content (Dewsbury, 2017).

The pedagogical value of the IDE-A rubric lies in its practical application: it helps instructors move from abstract commitment to inclusivity, diversity, equity, and accessibility toward tangible, informed decisions about their teaching tools. This approach of looking beyond the microscope represents a paradigm shift from focusing solely on scientific content to also examining how educational materials serve all learners. This tool supports inclusive curriculum design by offering a clear, reflective process for evaluating whether course textbooks align with the goals of the Inclusive Excellence framework (AACU, 2015). In doing so, the IDE-A rubric empowers educators to foster learning environments that affirm students’ identities and reflect their lived experiences, promote critical thinking about the intersection of science and society, and contribute to cultivating future scientists and health professionals who consciously challenge systemic inequities and advance health justice.