Learning objectives for medical education…and how they can improve medical practice

Bolnick, D. I., Steinel, N., Reynolds, A. W., & Bolnick, D. A. (2017). Learning Objectives for Weaving Evolutionary Thinking into Medical Education. Medical Science Educator, 27(1), 137–145. https://doi.org/10.1007/s40670-017-0375-7  

This new article from the Bolnick group at UT Austin argues describes three learning objectives and three ways they can improve medical practice…IFF they are incorporated into the medical curriculum. 

“We suggest that there are three very general reasons why evolution is relevant to the daily practice of medicine: 1. Understanding the evolutionary origins of genetic diversity within and among human populations helps physicians make appropriate diagnoses and plan treatments. 2. Pathogens and tumors are evolving populations. We must account for their evolution during diagnosis, treatment, and control 3. Evolution provides analytical tools, such as phylogenetics and population genetics, that are used in diagnostics to identify pathogens, trace sources of infection, determine patient ancestry, and interpret genetic markers of disease risk.

We suggest that teaching these ideas in medical school will improve medical practice in three ways. First, understanding evolution can improve diagnosis. For example, familiarity with human evolutionary history and genetic diversity can help physicians avoid racial stereotyping that can lead to misdiagnosis of genetic disorders (case study in box 1). Second, understanding evolution can improve preventative or treatment plans. For example, physicians should have an accurate understanding of natural selection when treating pathogens or tumors that may evolve resistance to drugs (case study in box 2). Third, evolution provides an integrated conceptual framework that helps students learn medical concepts, particularly via comparative anatomy and physiology, and understanding the genetic, environmental, and pathogenic causes of disease.”   p. 138

Abstract Basic science is integral to medical education because it teaches future physicians the fundamental principles of biology they need to become lifelong learners and keep up with expanding medical knowledge. One of these fundamental principles is evolution, which has many practical applications in medicine. Consequently, there is increasing interest in integrating evolutionary biology into medical education. To realize this goal, educators should focus on practical aspects of how knowledge of evolution improves a physician’s ability to prevent, diagnose, and treat disease. This perspective should be woven throughout the curriculum, so evolution comes to be seen as a broadly relevant concept rather than a distinct and peripheral discipline. In particular, we suggest that three general learning objectives be integrated broadly into medical education. First, medical students should be able to apply knowledge of human evolutionary history to explain how genetic variation within and among human populations affects risk, diagnosis, and treatment of disease. Second, students should understand how evolution has led to variation within and between pathogen populations (and tumors), affecting diagnosis and treatment. Third, students should understand how analytical tools from evolutionary genetics are used to determine patient ancestry, disease risk, and pathogen origins. We provide multiple specific topics, case studies, and learning activities within each of these three objectives. The evolutionary medicine learning objectives listed here meet multiple competencies and objectives outlined in the Association of American Medical Colleges (AAMC)/ Howard Hughes Medical Institute (HHMI) 2009 report on the Scientific Foundations for Future Physicians.

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