Some medical schools are beginning to think about a formal curse in evolutionary medicine. But teaching time appears to be “precious” and curriculum committees need guidance as to when can they donate a few hours to our discipline. In general most traditional medical curricula focus on the preclinical sciences in the first years and clinical sciences in the latter years . Medical Schools in the British Commonwealth and much of Europe generally take students direct from high school who may have relatively little biological education and certainly no formal introduction to evolution. In the USA, medical education is generally a graduate education but even here the student may have had no formal exposure to basic evolutionary biology. In problem based teaching courses there is little room at all for formal teaching and this will be a greater challenge for the mentors themselves will generally have little comfort in the space.
Thus the challenge for introducing evolutionary medicine into the curriculum is two-fold – first, to provide a basic understanding of evolutionary principles and, second, to make these relevant to the language of the medical student and to the clinically focused perspective they have. In addition, many components of a traditional evolutionary biology course may well be inappropriate or of lesser importance (e.g. macroevolution, phylogenetics, mathematical approaches to selection etc). The issue of relevance arises, particularly if extensive use of non-human examples is used.
In teaching as in other aspects of life timing is everything. One issue that has been raised is whether we should formally teach evolutionary medicine in the earlier or later parts of the course. There are arguments for both and an ideal outcome would be for both early and late exposure but, given that currently there is no exposure, such a beneficial mutation seems a remote outcome! On the one hand, there is a strong argument that evolutionary medicine is as much a basic science as molecular biology and physiology and to teach about ultimate causes at the same time as one is teaching about proximate biology is best. On the other hand, the work of Williams and Nesse demonstrates how evolutionary thinking can be applied in clinical medicine and public health and the student may gain a better appreciation of the ecological framework of the individual once exposed to a clinical setting. Evolutionary medicine requires the health professional to think more broadly than in the traditional terms of the medical, family and social history.
Pragmatically we will grab what exposure we can get – no doubt the solution will vary but my own view is that it is best taught alongside pathology, which focuses on disease causation. In many medical schools, pathology teaching occurs at the start of the clinical years – it has the advantage that we can marry proximate and ultimate causation. The next challenge is what to teach – that will be the subject of a later posting.
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I have experience in teaching immunology to medical students as part of the basic science curriculum at Case Western Reserve University. Whenever possible, I have made an effort to link evolutionary principles and concepts to immunological concepts. In teaching about the clonal selection hypothesis, the connection is especially apparent, as the time-dependent changes in clonal composition of the lymphoid populations in a single immune system represent a legitimate example of Darwinian evolution on an ontogenetic timescale.
Other examples of medically-relevant, evolution-related points that arise in teaching immunology and related disciplines include the mutation of and selection focused on antibody variable region genes expressed in B lymphocytes, the shift and drift of influenza A viruses, the enormous genetic variation of HIV, the development of resistance for therapeutic agents used to treat pathogens (bacterial, viral, parasitic), and the extensive polymorphisms of the HLA class I and class II genes.
In addition, I have for some years taught a graduate course (Immunology, Evolution, and Logic) that is open to medical students although not always well-subscribed by that group. This course focuses on the the theme of immune recognition and aims to show how an evolutionary perspective is crucial to understanding the relationships between structure and function for antigen-specific receptors.
I expect that it would be challenging in our current medical school curriculum to reserve a block of time dedicated solely to evolutionary medicine. While I would potentially support such an evolution-dedicated slot, I think it can be useful in the meantime to integrate evolutionary principles and evidence with standard components of the existing curriculum.
Great work once again. I am a medical engineer student and I love visiting your site and learning about the latest news. Keep it up! 🙂
I’m a medical student from Croatia and, yes, evolutionary concepts are often glossed over in the curriculum. Still, if one keeps their eyes open, it’s obvious they keep cropping up.
For example, Stryer’s book of biochemistry makes a big point of similar protein domains occuring in different enzymes. Currently I’m studying for a Microbiology test – evolution is hard to ignore there. About a year ago, during the university science festival, an evolutionist held a lecture in one of our buildings and many students came to hear what he had to say. In my three years of medical education so far – preclinical sciences, because my school follows the general European model – I have taken two classes specifically designed to teach evolutionary principles: Comparative Anatomy and Evolutionary and Developmental Origins of Man. Granted, both were elective. All in all, I feel evolution is reasonably well-represented in my med school, though perhaps only for those of us who activelly seek to study it.
However, I see a big flaw in the way evolution is taught to elementary school and high school students. In Croatia, teaching evolution in school centers around the history of the idea, ways to prove it, and memorizing famous evolutionary links such as the latimeria. One gets the idea evolution is something that is relevant only for historic purposes or for people seeking an argument with the blindly religious. (Incidentally, although we are a largely Catholic country, a lot of people firmly believe the theory of evolution.) Most people I know, including myself, hated the evolutionary lectures in school because they were boring. Only later, when I started college, did I see the broader implications for evolutionary theory. I think evolution would generate a lot more respect and interest if it was presented in a better way, as a tool for making scientific progress… And then, maybe, it would be easier to place an accent on evolution in higher education, including medical schools.