The Evolution & Medicine Review

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.