A Clinical Perspective in Evolutionary Medicine: What We Wish We Had Learned in Medical School

Abstract

Medical students have much to gain by understanding how evolutionary principles affect human health and disease. Many theoretical and experimental studies have applied lessons from evolutionary biology to issues of critical importance to medical science. A firm grasp of evolution and natural selection is required to understand why the human body remains vulnerable to many diseases. Although we often integrate evolutionary concepts when we teach medical students and residents, the vast majority of medical students never receive any instruction on evolution. As a result, many trainees lack the tools to understand key advances and miss valuable opportunities for education and research. Here, we outline some of the evolutionary principles that we wished we had learned during our medical training.Keywords Medical education . Evolution . Natural selection . Phylogeny . Virulence . Host defenses . Tradeoffs . Ultimate causation Evolution and Medical EducationMedical students must learn an ever-increasing volume of information in medical school. Many worthy topics, including prevention, public health, clinical reasoning, ethics, health policy, communication skills, and professionalism, now compete with the traditional core biomedical sciences, such as biochemistry, genetics, and pathophysiology. It is no wonder then that any effort to introduce another science-evolutionary biology-into the medical curriculum is a difficult endeavor.In a 2003 survey of North American medical school deans, 48% said understanding the concepts of evolution is important for physicians. However, not a single medical school taught evolutionary biology as a basic science, no medical school required evolution as a prerequisite for admission, only 16% had Ph.D. faculty in evolutionary biology, and schools devoted a median of only four hours of curricular time on core topics in evolution (Nesse and Schiffman 2003). Complicating matters further, one of ten medical students in Glasgow rejected the notion of long-term evolution on religious grounds (Downie 2004). Thus, more than 15 years after the publication of the seminal text, Why We Get Sick: The New Science of Darwinian Medicine (Nesse and Williams 1994), many physicians remain unaware of evolution's most relevant principles.Evolutionary (Darwinian) medicine is the application of evolutionary principles, including natural selection, adaptation, phylogenetics, and evolutionary constraints, to understanding health and disease. In this paper, we argue that a working knowledge of evolution is well worth the time and effort by students of medicine. We review selected concepts in evolutionary medicine that we wish we had learned when we were in medical school. This missed educational opportunity would teach students to ask evolutionary "why" questions of diseases and develop skills to recognize evolutionary paradoxes and patterns in medicine. As we describe, evolutionary biology is an integrative science whose concepts can help students and professionals improve learning, teaching, practice, ...

Teleological reasoning, not acceptance of evolution, impacts students’ ability to learn natural selection

“…Recent articles have examined the various ways that this could be accomplished in high school (Beardsley et al 2011) and college (Meikle and Scott 2011). Evolutionary medicine has also been proposed as an essential component of the medical school curriculum (Alcock and Schwartz 2011;Jenkins and Antolin 2011;Labov 2011;Nesse et al 2010;Stearns et al 2010). …”

Factors influencing minority student decisions to consider a career in evolutionary biology

“…Higher rates of religiosity may drive African Americans to choose disciplines that do not require training in evolutionary biology, perhaps to minimize conflict with their religious beliefs. Despite recent calls for the inclusion of evolution into medical school curriculum (Stearns 2011;Alcock and Schwartz 2011;Meikle and Scott 2011;National Research Council and National Academy of Sciences 2012 Thinking Evolutionarily), evolutionary medicine is still viewed as an elective.…”

Evolution and Medicine in Undergraduate Education: A Prescription for All Biology Students

“…The website Evolution and Medicine Review (http://evmedreview) provides a resource for sharing news about events and relevant articles, as well as a list of syllabi and other resources useful for educators (Box 2). The December 2011 issue of Evolution: Education and Outreach includes by Stearns (2011b), Omenn (2011), and Alcock and Schwartz (2011) that provide specific suggestions for courses linking evolution to medicine and public health. Other articles in the same issue provide excellent examples of the synthesis of evolution and medicine in cancer (Casas‐Selves and DeGregori 2011), vaccine development (Hanley 2011), and scurvy (Buklijas et al 2011) and highlight a new module for teaching evolution and medicine (Beardsley et al 2011).…”