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Evolution and the curriculum

BMJ 2008; 336 doi: https://doi.org/10.1136/sbmj.0804148 (Published 01 April 2008) Cite this as: BMJ 2008;336:0804148
  1. Daniel Racey, third year medical student1,
  2. Stuart West, professor of evolutionary biology2
  1. 1Peninsula Medical School
  2. 2School of Biological Sciences, University of Edinburgh, Edinburgh EH9 3JT

Given the importance of evolution in explaining disease, Daniel Racey and Stuart West believe it merits more teaching time

Nothing in biology makes sense except in the light of evolution. Theodosius Dobzhansky, 19731

Charles Darwin began his academic career as a medical student. Fortunately, he found his studies at the University of Edinburgh tedious and unpleasant. He dropped out, took another degree, and embarked on the voyage of the Beagle. The rest is history.

Since then medical degrees have changed to prevent talented students such as Darwin leaving the profession. Curriculums have been explicitly designed to promote deep understanding of principles rather than rote learning of facts.2

This article assumes that evolution through natural selection has been the major mechanism in shaping the biology of humans and pathogens. This is not a controversial view within the scientific community. However, a substantial minority of medical undergraduates find the concept that humans evolved from apes difficult to accept, even though they may have no problem acknowledging the evidence for microevolution (changes below the level of the species). About 10% prefer literal creationist views for human genesis than the scientifically accepted theory of natural selection.3

Hardly any curriculum time

It seems that a profound understanding of human disease requires some understanding of how diseases evolve. However, medical schools give evolution only a cursory amount of time. In the most recent survey only 11% of UK medical schools included evolutionary biology in the core curriculum.3 Consequently, 89% of UK medical students will probably not be taught evolutionary principles during their degree. Similar figures have been reported in surveys of medical schools in the United States and Australia.45

Historically, the content of medical curriculums was decided when physiology and biochemistry were in their heyday and evolutionary biology was not fashionable. Recent surveys …

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