Many have never even been exposed to the necessity of

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Unformatted text preview: th through a course in evolutionary medicine. Many have never even been exposed to the necessity of nding evolutionary and proximate explanations. Implementation of recommendations commissioned by the American Association of Medical Colleges and the Howard Hughes Medical Institute (AAMC-HHMI) would help change the situation. Twenty-two PNAS | January 26, 2010 | vol. 107 | suppl. 1 | 1801 leading scientists, physicians, and medical educators met ve times from 2007 to 2009 to recommend scienti c foundations for future physicians (43). Instead of speci c courses, they recommend education that results in eight competencies that should be mastered by students entering medical education (E 1–8) and eight more for students in the course of medical education (M 1–8). E 1–7 correspond roughly to mathematics, scienti c methods, physics, chemistry, biochemistry, cell biology, physiology, and facultative adaptations to internal and external changes. E8 is about evolutionary biology. As far as we are aware, this is the rst recommendation from a major medical education body that physicians need to master evolutionary biology. The AAMCHHMI report frames the evolution competency broadly, “Demonstrate an understanding of how the organizing principle of evolution by natural selection explains the diversity of life on Earth.” This could include all of evolutionary biology. The speci c wording seems to emphasize phylogeny and phenomena at the level of the species and above, however, some especially important medical applications involve how selection shaped traits that allow individuals to adapt to their environments and the role of evolutionary factors other than selection. A more inclusive global competency could be phrased: “Demonstrate an understanding of how natural selection and other evolutionary processes account for the history of life and the relationships among species, how these processes have endowed organisms with traits that promote reproductive success, and why they leave some aspects of the human body vulnerable to disease.” The areas E 1–7 are established components of premedical education, so much previous thought has gone into how they can best be taught, augmented by those in the AAMC-HHMI report. Evolutionary biology, however, is just now being recognized as a basic science for medicine. Only a few papers address the issues. Two studies document the absence of evolutionary biology from the medical curriculum (44, 45), and several articles make general recommendations about teaching evolutionary biology in medicine (46–48). This article is an attempt by a diverse group of scientists to address the question systematically. Our suggestions are based on discussions by three overlapping groups of authors. Some of us spent 2007–2008 at the Berlin Institute for Advanced Study working together on evolutionary applications in medicine and optimal education strategies. Four others had extensive discussions in the course of organizing the Sackler Colloquium. Finally, four others presented papers at the colloquium on topics related to the role of evolution in medical education. Our opinions are, of course, diverse. This article summarizes major areas of agreement and it attempts to clarify some issues on which opinions differ. We recognize that evolution is of equal importance for other health professions, such as nursing, and that it is especially important for public health. However, because somewhat different issues arise for each eld, we decided to limit our recommendations here to the eld of medicine. General Conclusions and Recommendations We generally agree on ve global points: 1. Better education about evolutionary biology and its applications in medicine will have substantial bene ts for physicians, their patients, public health workers, researchers, and other health professionals. This conclusion is supported by other articles in this colloquium and by explanatory material below in association with speci c recommendations. 2. Much of this education needs to be provided or initiated before beginning formal medical studies. Like mathematics, chemistry, genetics, and the study of biological mechanisms (proximate biology), evolutionary biology is a basic science that should be taught before medical school. 1802 | www.pnas.org/cgi/doi/10.1073/pnas.0906224106 3. 4. 5. The evolution content in introductory biology courses is insuf cient; specialized undergraduate courses will be important. We hold varying opinions about whether to recommend general overview courses or courses specialized to the needs of future physicians. All agree that substantial evolution education is essential. Some aspects of evolutionary biology need to be taught as a part of the medical curriculum, despite the practical challenges. The medical curriculum is already overly full. However, medically relevant principles of evolutionary biology need to be taught during professional school, just as they are for other basic sciences such as anatomy, genetics, and physiology. Evolutionary biology is a unifying principle that provides a...
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