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Groups say med school training must evolve

Medical training must adapt to include coursework covering evolutionary biology, according to a group of leading researchers.

Momentum for such change seems to be building. This past summer, the Association of American Medical Colleges (AAMC) and the Howard Hughes Medical Institute (HHMI) jointly issued a report on the topic, entitled Scientific Foundations for Future Physicians. It suggested that a key medical school competency should be to show an understanding of how evolution by natural selection leads to the diversity of life on earth.

Now a paper from attendees of a US National Academy of Sciences meeting on the subject is adding to the call (Proc. Natl. Acad. Sci. USA, doi: 10.1073/pnas.0906224106; 2009). The paper, published last month, offers more detailed suggestions as to why and how the incorporation of evolution into medical education should occur.

“The case for ensuring that physicians and medical researchers are able to use evolutionary biology just as fully as other basic sciences is compelling,” says Randolph Nesse, of the University of Michigan, lead author of the paper. “The constraints that inhibit change are severe, however. Most medical schools do not have a single evolutionary biologist on the faculty.”

Nesse's paper cites examples of where evolutionary knowledge can benefit those working in medicine. An awareness of why humans have evolved the fever response, for example, could help doctors understand when it is safe to use drugs to block fever.

However, he says there are deeper reasons that medical students should learn more about evolutionary biology: “if many of our engineers believed in perpetual motion and thought that heavier objects fall faster, no one would say 'provide hard evidence that engineers who learn the laws of thermodynamics and gravity build better bridges',” he points out. “We insist that engineers learn physics as a basic science. Physicians need to learn evolutionary biology for the same reason.”

The joint AAMC-HHMI report from the summer emphasized a similar theme, although it did not go so far as to recommend specific curriculum changes.

“The AAMC does not collect specific data on medical school syllabi,” says Ann Bonham, chief science officer of the Association of American Medical Colleges. “We expect that schools may include content related to evolutionary biology without labeling it as such.”

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Cressey, D. Groups say med school training must evolve. Nat Med 15, 1338 (2009).

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