title: The status of evolutionary medicine education in North American medical schools.
abstract: BACKGROUND
  Medical and public health scientists are using evolution to devise new strategies to solve major health problems. But based on a 2003 survey, medical curricula may not adequately prepare physicians to evaluate and extend these advances. This study assessed the change in coverage of evolution in North American medical schools since 2003 and identified opportunities for enriching medical education.
  
  
  METHODS
  In 2013, curriculum deans for all North American medical schools were invited to rate curricular coverage and perceived importance of 12 core principles, the extent of anticipated controversy from adding evolution, and the usefulness of 13 teaching resources. Differences between schools were assessed by Pearson's chi-square test, Student's t-test, and Spearman's correlation. Open-ended questions sought insight into perceived barriers and benefits.
  
  
  RESULTS
  Despite repeated follow-up, 60 schools (39%) responded to the survey. There was no evidence of sample bias. The three evolutionary principles rated most important were antibiotic resistance, environmental mismatch, and somatic selection in cancer. While importance and coverage of principles were correlated (r = 0.76, P < 0.01), coverage (at least moderate) lagged behind importance (at least moderate) by an average of 21% (SD = 6%). Compared to 2003, a range of evolutionary principles were covered by 4 to 74% more schools. Nearly half (48%) of responders anticipated igniting controversy at their medical school if they added evolution to their curriculum. The teaching resources ranked most useful were model test questions and answers, case studies, and model curricula for existing courses/rotations. Limited resources (faculty expertise) were cited as the major barrier to adding more evolution, but benefits included a deeper understanding and improved patient care.
  
  
  CONCLUSIONS
  North American medical schools have increased the evolution content in their curricula over the past decade. However, coverage is not commensurate with importance. At a few medical schools, anticipated controversy impedes teaching more evolution. Efforts to improve evolution education in medical schools should be directed toward boosting faculty expertise and crafting resources that can be easily integrated into existing curricula.
authors.affiliation: University of Kansas Medical Center, 3901 W Rainbow Blvd, Kansas City, KS, 66160, USA. bhidaka@kumc.edu.
authors.forename: Brandon H
authors.initials: BH
authors.lastname: Hidaka
authors.affiliation: McGill University, 3700 McTavish Street, Room 244, Montréal, Québec, H3A 1Y2, Canada. anila.asghar@mcgill.ca.
authors.forename: Anila
authors.initials: A
authors.lastname: Asghar
authors.affiliation: Arizona State University, 411 North Central Avenue, Phoenix, AZ, 85004, USA. aktipis@asu.edu.
authors.forename: C Athena
authors.initials: CA
authors.lastname: Aktipis
authors.affiliation: Arizona State University, 411 North Central Avenue, Phoenix, AZ, 85004, USA. nesse@asu.edu.
authors.forename: Randolph M
authors.initials: RM
authors.lastname: Nesse
authors.affiliation: Penn State College of Medicine, 500 University Drive, Hershey, PA, 17033, USA. twolpaw@hmc.psu.edu.
authors.forename: Terry M
authors.initials: TM
authors.lastname: Wolpaw
authors.affiliation: New York University School of Medicine, 550 1st Ave, New York, NY, 10016, USA. Nicole.skursky@nyumc.org.
authors.forename: Nicole K
authors.initials: NK
authors.lastname: Skursky
authors.affiliation: New York University School of Medicine, 550 1st Ave, New York, NY, 10016, USA. katelyn.bennett@va.gov.
authors.forename: Katelyn J
authors.initials: KJ
authors.lastname: Bennett
authors.affiliation: New York University School of Medicine, 550 1st Ave, New York, NY, 10016, USA. matthew.beyrouty@va.gov.
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Beyrouty
authors.affiliation: New York University School of Medicine, 550 1st Ave, New York, NY, 10016, USA. mark.schwartz@nyumc.org.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Schwartz
mesh_terms: D016009:Chi-Square Distribution; D003479:Curriculum / Q000639:trends*; D004504:Education, Medical, Undergraduate / Q000379:methods*; D004521:Educational Measurement; D005180:Faculty, Medical / Q000458:organization & administration*; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008511:Medicine; D020380:Needs Assessment; D009656:North America; D012577:Schools, Medical / Q000639:trends*; D011795:Surveys and Questionnaires