Evolutionary Medicine and the Medical School Curriculum: Meeting Students Along Their Paths to Medical School

Abstract

Over the past several years, numerous reports that have been independently prepared by prestigious organizations in the U.S. have agreed that new approaches to improve teaching and learning of biology at both the pre-college and undergraduate levels are important and timely. Their recommendations, which are based on emerging research about human learning and cognition, are in agreement that evolution is an organizing principle and foundation of modern biology and should be presented as such. This paper provides an overview of the conclusions and recommendations from those reports and proposes that helping students learn evolution through the lens of human examples that are part of the emerging field of evolutionary medicine could help biology educators improve the teaching of evolution, and biology more generally, by asking students to address biological problems that are inherently interesting and motivating.

A revolution is underway in biology. The major focus of the biological sciences—understanding life—remains the same, but the science has experienced a major transformation. Many of the most exciting discoveries in the biological sciences during the second half of the 20th century occurred at the intersections of established disciplines. Emerging interdisciplinary fields such as genomics, proteomics, metagenomics, synthetic biology, biochemistry, bioinformatics, computational biology, and systems biology are leading to new discoveries, and some are changing the ways we think about and engage in biological research and explore established biological fields (such as evolutionary biology). These new integrated fields, spread across the diversity of life sciences, are opening up a vast array of practical applications, ranging from new medical approaches, to alternative sources of energy, to new theoretical bases in the behavioral and social sciences.

American Association for the Advancement of Science, 2011, p. 3

Nothing in biology makes sense except in the light of evolution.

Dobzhansky, 1973

In 2009, the National Academy of Sciences (NAS) organized and hosted an Arthur M. Sackler Colloquium in Washington, DC that focused on evolution, health, and medicine.¹ As part of that colloquium, Randolph Nesse presented a paper and ultimately coauthored a paper, “Making Evolutionary Biology a Basic Science for Medicine” (Nesse et al. 2010), that appeared as part of the set of papers from the colloquium in the Proceedings of the National Academy of Sciences. In that paper, Nesse et al. argued that:

Knowledge about evolution provides physicians with an integrative framework that links otherwise disparate bits of knowledge. It replaces the prevalent view of bodies as machines with a biological view of bodies shaped by evolutionary processes. Like other basic sciences, evolutionary biology needs to be taught both before and during medical school. Most introductory biology courses are insufficient to establish competency in evolutionary biology. Premedical students need evolution courses, possibly ones that emphasize medically relevant aspects. In medical school, evolutionary biology should be taught as one of the basic medical sciences. This will require a course that reviews basic principles and specific medical applications, followed by an integrated presentation of evolutionary aspects that apply to each disease and organ system. Evolutionary biology is not just another topic vying for inclusion in the curriculum; it is an essential foundation for a biological understanding of health and disease. (p. 1800).

I serve as the staff officer who oversees the efforts of the NAS to promote effective teaching and confront challenges to the teaching of evolution. Accordingly, the president of the Institute of Medicine asked me to organize an exploratory meeting around the theme of the opportunities and challenges of introducing concepts of evolution into the curriculum of the nation’s medical schools, based in part on Nesse et al.’s paper and the urging of several members of the Institute of Medicine who have been engaged in this issue.

Participants in the October 2010 meeting included a dean and a faculty member from two medical schools, faculty who are currently teaching undergraduate courses on evolutionary medicine at several research-intensive universities, an evolution researcher, and representatives from the Howard Hughes Medical Institute, National Institutes of Health, the Association of American Medical Colleges, National Evolutionary Synthesis Center, College Board, the Biological Sciences Curriculum Study, and disciplinary societies in the life sciences. Several participants are members of the Institute of Medicine and the National Academy of Sciences. They agreed that preparing future physicians to have an evolutionary perspective on both wellness and disease could be an important part of their training. Such preparation could enable more comprehensive consideration of biology in diagnosis and treatment and in understanding the etiology of diseases. However, concern was also raised by those who represented medical schools that the medical curriculum is already overcrowded and that other aspects of health essential to effective practice of medicine are also given minimal coverage in today’s curriculum. Why, they asked, should evolution receive greater attention than those other issues?

However, by the time the meeting ended, some of the skeptics had been swayed by the importance of integrating “evolutionary thinking” into the medical school curriculum. One important reason for that change was the ensuing discussion about emerging opportunities to introduce evolutionary concepts to students at multiple stages of their preparation prior to professional medical training, from high school through the undergraduate years. They also became less skeptical after learning that, over the past three years, a series of reports from the National Academy of Sciences and Institute of Medicine (2008), College Board (2011), the American Association for the Advancement of Science (2011), the Association of American Medical Colleges and the Howard Hughes Medical Institute (2009), and most recently the National Research Council (2011a) have all emphasized the central importance of evolution to modern biology. Taken together, these reports and the collection of articles that appear in this special issue of Evolution: Education and Outreach offer a series of pathways for students who will pursue an array of careers in the medical sciences (and those who won’t) to study evolution as both an organizing theme to biology education at various levels and as an opportunity to better understand the processes, nature, and limits of science.

This essay focuses on these new opportunities. It emphasizes how teaching and learning evolutionary concepts through the lens of evolutionary medicine can serve as a vehicle for engaging a broader spectrum of students in the sciences that precede medical education. It also argues that a greater emphasis on evolutionary medicine in biology courses from high school through professional training is consistent with findings from the scholarly literature on human learning and cognition, which has begun to elucidate effective practices to improve teaching and learning. That research has demonstrated that people learn subject matter more effectively and retain that information longer when (1) the relevance of what is being taught is made clear at the outset and reinforced throughout the learning experience, and (2) when learners are actively helped to make connections with what they are learning and other subject areas (e.g., summarized in National Research Council 2000).

Teaching evolutionary concepts by emphasizing evolutionary medicine addresses both of these principles. Students are inherently interested in their bodies, the processes and the diseases that affect their health and well-being. Thus, using the lens of evolutionary medicine can help students more easily understand the importance and relevance of evolution more generally. And the confluence of thinking about the importance of evolution as a subject from grade school to grad school affords faculty in pre-college, postsecondary, and professional institutions opportunities to help students build expertise in this subject area as well as connect it to all other areas of the life sciences.

Individually and collectively, knowledge of the content and recommendations in these documents can reinforce the efforts of individual faculty who would like to infuse evolutionary concepts into existing life sciences courses (both introductory and advanced) or develop new ones, especially for students who will not pursue majors in the life sciences or other science, technology, engineering, and mathematics (STEM) disciplines. They also can serve as the basis for much needed discussions among faculty colleagues about the role of evolution in general, and evolutionary medicine in particular, in the broader spectrum of pathways through biology majors and related programs and the collective responsibility of faculty to make such opportunities available (e.g., National Research Council 2003b; American Association for the Advancement of Science 2011).