With the increasing significance of evolutionary concepts in medicine (Nesse et al. 2006), it is important to know how the Muslim medical community in general, and Pakistan’s medical students in particular, are receptive to such an education. Although our sample was not representative of all the medical students in Pakistan, it still provides useful insight into this underresearched subject. The aim here was to provide a descriptive picture of appreciation of evolutionary medicine in a population of Pakistani medical students along with their awareness and acceptance about the theory of evolution, since these are hypothesized to affect the receptiveness of the student toward evolutionary medicine.
The results show that medical students have a low acceptance (mean MATE = 58.32) of evolutionary theory, which corresponds with the low acceptance of evolutionary theory in the general Pakistani population (Hameed 2008), Pakistani high school students (research led by the Evolution Education Research Center at McGill University), and Pakistani doctors practicing in the U.S. (Everhart and Hameed, in preparation). Since most of these studies don’t use MATE to grade acceptance, a direct comparison cannot be made. However, it is interesting to note that the mean score was higher than in a study carried out on high school biology students in the U.S. (Rutledge and Sadler 2007). Despite this low acceptance, the participants of our study acknowledged that the theory is recognized to be true in most scientific circles. The majority of participants did reject the idea that humans are the product of evolution; however, lesser disagreement was observed when asked if all animals came into existence at the same time. There was very low percentage (8.2%) of respondents who believed in young Earth creationism, an observation consistent with earlier studies (Hameed, Fall Conference on Darwin and Evolution in the Muslim World 2009).
It was not our aim to answer why acceptance follows the trend it does, i.e., why Pakistani students had a low acceptance. With our results, however, we do propose two factors which affect acceptance to evolutionary theory—yet the question is open to further investigation. The first factor that we propose for low acceptance is the clash of religious beliefs with evolutionary teachings. We deduce this from the finding that 68.1% of students agreed that evolutionary theory cannot be true since it disagrees with the teachings of the Quran. Thus, taking the religious sentiment of the population into account is important before introducing evolutionary medicine in the curriculum. A similar approach is taken in the current high school curriculum of Pakistan, where verses in support of the theory are included in chapters relating to evolution in the biology textbook. The efficacy of this approach nevertheless is debatable. A minority (11.5%) believed that there was no disagreement between evolutionary theory and Islamic teachings. Still, among the 88.5% who did see a contradiction, only 68.1% saw this as grounds enough to reject the theory. This provides evidence that our respondents, like the general Pakistani public are divided on the issue of religion and evolution, where they appear willing to trade off some religious views for scientific advancement and technology (Hameed, Mcgill Symposium 2009). We propose that this aspect be investigated further by grading the religiosity of the participants and taking into account their sectarian and denominational beliefs. The second reason for the low acceptance can be the lack of a thorough understanding (mean score = 5.20) of the theory among the students. Although students are for the most part familiar with some evolutionary concepts, such as meiosis being the source of variability, homology of structures, and a Lamarckian idea of evolution, they do not comprehend the exact process of evolution as they confuse it with change of simple animals into complex animals and change of monkeys into humans, as per popular misconception. As the usual source of the students’ knowledge regarding evolution is what they learnt in a high school biology course, their knowledge about evolution is quite limited. Though the current high school curriculum in Pakistan includes comprehensive coverage of evolutionary topics including the phylogenic relationships of various organisms, one can argue that in order to improve evolutionary knowledge, high school biology curriculum needs to be amended. Since the Pakistan Academy of Sciences, being a signatory to the “IAP statement on the teaching of evolution,” has already taken note of this point, further change to the curriculum would have only limited benefit. It can also be argued that since evolutionary biology does not receive appropriate emphasis by the biology teachers, (Rutledge and Mitchell 2002), their attitude toward evolutionary theory is affecting the students’ knowledge. Therefore, arranging workshops to train teachers and to assess their understanding and teaching methods may improve students’ knowledge of evolution.
Our results indicate that despite their low knowledge and acceptance of the theory, medical students do admit that prior knowledge of evolutionary biology would improve medical research and clinical practice (participants in our study agreed more for medical research than clinical practice). In a study carried out in the UK in 1997, 75% of the respondents from medical schools believed that evolutionary biology is relevant to training of doctors. This figure is similar to Pakistani medical students’ idea that evolutionary medicine would improve medical research (Nesse and Schiffman 2003). Still, medical students do not believe that the time is yet suitable for introducing evolutionary medicine as a subject in the medical curriculum. As the medical curriculum is perceived as being too extensive already, it is probably best to integrate the subject in the current curriculum rather than introducing it as a separate subject. Also, most students agreed that such concepts are already being taught in the current curriculum. This can be attributed to the use of foreign textbooks that include paragraphs about various aspects of evolutionary medicine. Along with the lengthy curriculum, students also pointed out that lack of resources would make it difficult to teach evolutionary medicine to medical students. These include both monetary and human resources. With the health budget of Pakistan being 2.6% of the GDP (WHO 2011), the perception is correct, as diversion of already meager resources to establish new labs and teachers’ training would rather be spent on other basic departments that need much improvement. The above factors may be compared to Nesse and Schiffman (2003), where deans of medical colleges in North America saw an extensive curriculum, lack of faculty, and monetary resources as the major factors that would affect teaching of evolutionary medicine. However, they did not identify religion as a significant hindrance to teaching evolutionary medicine.
The limitation of our sample size means that the study was not representative of all Pakistani medical students. Future studies with a larger sample including other medical colleges would provide a better understanding. Including other populations, such as postgraduate students and medical college faculty members’ views, will provide a more wide-ranging picture. Results for knowledge of evolutionary theory from this region should be the focus for future studies as the modified instrument used in this study was not evaluated for validity and reliability. Also regression and correlation analysis of various factors and religiosity would help map the picture completely.