In the context of current U.S. racial justice movements, analysis of racism in medicine within medical education is a critical task for all institutions. To educate the next generation of physicians about racism in medicine and out of concern that the curriculum required critical assessment and change, a group of students and faculty at Boston University School of Medicine (BUSM) initiated a longitudinal curricular analysis through a vertical integration group, commissioned by the Medical Education Committee, from May 2019 to June 2020. The curriculum analysis and the major outcomes and guiding principles that emerged from it are described as a path forward, toward a more inclusive curriculum. The major elements of this analysis included a comprehensive internal curricular assessment and an external assessment of peer institutions that led to the development of key curricular recommendations and overarching equity and specific racially focused equity competencies. The curricular recommendations fall into the following domains: (1) challenging the persistence of biological/genetic notions of race, (2) embedding structural practices in medical education to dismantle racism in medicine, and (3) promoting institutional climate change. Initial steps to implement these recommendations are described. The authors believe that the historic and present reality of racism in America and in medicine has impacted medical education specifically, and more broadly, the practice of medicine, trainee experience, and patient outcomes. The key findings of the BUSM analysis are transferable to other medical education institutions, and the described review process can support peer institutions as they engage in the imperative work of institutional reflection and addressing the salient ideas and practices that uphold racism in medicine.

Cultural awareness training for health professionals is now commonplace across a variety of sectors. Its popularity has spawned several alternatives (i.e., cultural competence, cultural safety, cultural humility, cultural intelligence) and overlapping derivatives (diversity training, anti-racism training, micro-aggression training). The ever-increasing reach of cultural awareness initiatives in health settings has generally been well intentioned - to improve cross-cultural clinical encounters and patient outcomes with the broader expectation of reducing health disparities. Yet the capacity of cultural awareness training to accomplish or even impact such outcomes is seldom comprehensively scrutinized. In response, this paper applies a much needed critical lens to cultural awareness training and its derivatives by examining their underpinning philosophies, assumptions and most importantly, verification of their effectiveness. The paper finds cultural awareness approaches to be over-generalizing, simplistic and impractical. They may even induce unintended negative consequences. Decades of research point to their failure to realize meaningful outcomes in health care settings and beyond. Broader expectations of their capacity to reduce health disparities are almost certainly unachievable. Alternative suggestions for improving cross-cultural health care interactions and research are discussed within.

To be responsive to the needs of today's pluralistic society, physicians require an understanding of the essential link between culture, power and ethical practice. Using a case example, the authors argue that medical educators need to: (a) critically consider how the educative process joins medical knowledge and power; (b) develop pedagogy that can bring questions of power, culture and ethics to the forefront during the process of medical knowledge construction; and (c) create an opportunity for students to learn how to work collaboratively with diverse cultures and values.

Calls for more broad-based, integrated, useful knowledge now abound in the world of global environmental change science. They evidence many scientists' desire to help humanity confront the momentous biophysical implications of its own actions. But they also reveal a limited conception of social science and virtually ignore the humanities. They thereby endorse a stunted conception of 'human dimensions' at a time when the challenges posed by global environmental change are increasing in magnitude, scale and scope. Here, we make the case for a richer conception predicated on broader intellectual engagement and identify some preconditions for its practical fulfilment. Interdisciplinary dialogue, we suggest, should engender plural representations of Earth's present and future that are reflective of divergent human values and aspirations. In turn, this might insure publics and decision-makers against overly narrow conceptions of what is possible and desirable as they consider the profound questions raised by global environmental change.

A number of global change scientists have been enjoining their peers to alter their modus operandi. Calls have been issued for more ‘decision relevant’ forms of inquiry more squarely focused on ‘human dimensions’ as societies enter a ‘no analogue’ planetary situation. This paper analyses the way certain geoscientists who study global change imagine the ‘people disciplines’ to be of relevance to their own endeavours. It reveals a rather narrow understanding of the social sciences to be in play, alongside a largely nominal inclusion of the humanities. The paper suggests reasons for this combination of partiality and omission, and suggests why a much wider and more plural understanding of human dimensions is important. This understanding, it is shown, should rebound on the human dimensions of global change science itself. Some suggestions for new encounters between geoscientists, environmental social scientists and humanists are offered. Around 30 years after the first global change research programmes were created, it is unfortunate that the wider social sciences and humanities are not more visible to, and engaged with, global change scientists. Their relative marginality is a long-run problem. Yet visibility and engagement are vital to avoid ‘science imperialism’ by default in our knowledge of people–planet interactions in the Anthropocene. One hopes that in less than a decade hence, visibility and engagement increase significantly.

Understanding how climate change will affect global health is a defining challenge of this century. This is predicated, however, on our ability to combine climate and health data to investigate the ways in which variations in climate, weather, and health outcomes interact. There is growing evidence to support the value of place- and community-based monitoring and surveillance efforts, which can contribute to improving both the quality and equity of data collection needed to investigate and understand the impacts of climate change on health. The inclusion of multiple and diverse knowledge systems in climate-health surveillance presents many benefits, as well as challenges. We conducted a systematic review, synthesis, and confidence assessment of the published literature on integrated monitoring and surveillance systems for climate change and public health. We examined the inclusion of diverse knowledge systems in climate-health literature, focusing on: (1) analytical framing of integrated monitoring and surveillance system processes; (2) key contributions of Indigenous knowledge and local knowledge systems to integrated monitoring and surveillance systems processes; and (3) patterns of inclusion within these processes. In total, 24 studies met the inclusion criteria and were included for data extraction, appraisal, and analysis. Our findings indicate that the inclusion of diverse knowledge systems contributes to integrated climate-health monitoring and surveillance systems across multiple processes of detection, attribution, and action. These contributions include: the definition of meaningful problems; the collection of more responsive data; the reduction of selection and source biases; the processing and interpretation of more comprehensive datasets; the reduction of scale dependent biases; the development of multi-scale policy; long-term future planning; immediate decision making and prioritization of key issues; as well as creating effective knowledge-information-action pathways. The value of our findings and this review is to demonstrate how neither scientific, Indigenous, nor local knowledge systems alone will be able to contribute the breadth and depth of information necessary to detect, attribute, and inform action along pathways of climate-health impact. Rather, it is the divergence or discordance between the methodologies and evidences of different knowledge systems that can contribute uniquely to this understanding. We critically discuss the possibility of what we, mainly local communities and experts, stand to lose if these processes of inclusion are not equitable. We explore how to shift the existing patterns of inclusion into balance by ensuring the equity of contributions and justice of inclusion in these integrated monitoring and surveillance system processes.

Abstract In this paper, we develop and apply the concept of ‘insight discovery’ as a key competence for transdisciplinary research and learning. To address complex societal and environmental problems facing the world today, a particular expertise that can identify new connections between diverse knowledge fields is needed in order to integrate diverse perspectives from a wide range of stakeholders and develop novel solutions. The capacity for “insight discovery” means becoming aware of personal mental representations of the world and being able to shape and integrate perspectives different from one’s own. Based on experiences and empirical observations within the scope of an educational programme for Masters students, PhD candidates and post-doctoral researchers, we suggest that insights are the outcome of a learning process influenced by the collective and environment in which they are conceived, rather than instant moments of individual brilliance. The process which we describe, named the insight discovery process (IDP), is made up of five aspects. Within a group setting, a person begins with an “original mental model”, experiences an “insight trigger”, processes new information within the “liminal space”, “formulates an insight” and eventually forms an “adapted mental model”. There is a potential for incorporating such process as a fundamental competence for transdisciplinary curricula in undergraduate and graduate programmes by cultivating specific practices and safe learning environments, focused on the enquiry, exchange and integration of diverse perspectives.