Anatomical Core Syllabus in an Evolutionary Medical Curriculum

The Anatomical Core Syllabus in an Evolutionary Medical Curriculum Noel T. Boaz, Ph.D., M.D.

Integrative Centers for Science and Medicine

Desired Learning Outcomes in Medical School and Why Evolutionary Medicine is an Optimal Paradigm Learning Outcomes Desired from a Medical Curriculum: •

Broad Knowledge Base that has NOT been Memorized Without Understanding (MWU)

•

Critical Thinking Skills and Diagnostic Acumen

•

Confidence in their Observations and Self-Reliant

•

Humility before the Subject

•

Interprofessional Collaboration

•

Ability to Communicate and Culturally Attuned

•

Ability to Research - Know How to Find Answers

Evolutionary Medicine: •

Applies Evo-Devo Biological Systems-based Principles to Problems in Human Healthcare (versus “Body-as-Machine”)

•

Asks “Why” Questions and Rejects “Idiopathic” as a Diagnosis

•

Researches Pathologies as Naturalistic Phenomena Resulting from Evolutionary Challenges from Other Species, Environmental Change, Physiological Defenses, and Failures of Evolved Adaptations

•

Explains Structure, Function, and Dysfunction in the Mode of Scientific Narrative

Narrative of evolving human anatomy is foundational to Evolutionary Medicine Evolutionary Medicine - the application of principles of evolutionary and developmental biology to problems in human healthcare.

Pathology results from a failure in the morphophysiological adaptations evolved at, or primarily at, an evolutionary stage.

This “anthropogenic” historical perspective of structures makes anatomy understandable as a hierarchical simple-to-complex continuum of adaptations through time extending from cells to tissues to organs to systems.

Multi-disciplinary evo-devo integration is a more powerful paradigm than the “biopsycho-social” model • More effective differential diagnoses • More insightful theoretical perspectives • Better patient outcomes

Evolutionary narratives are empirically testable hypotheses Increasingly accurate geochronological and molecular clock control allow crossdisciplinary registration of evolutionary events Agreement of 7 narrative elements across 9 paradigmatic tools constitute the “Core Empirical Diagonal” and satisfies minimum requirement for working hypotheses

HOW TO LEARN: The anatomy that students dissect in the laboratory is understood to have been built ontogenetically upon homeotic-gene-driven development of differentiating body segments.

Homo sapiens

8

6

17

Amphibia

4.0 X 104 years – present

Aquatic

Homo Chordate

7

Carnegie Stages 8 -11

5

Fish

Carnegie Stage 16

16

Semi-Aquatic

2.5 X 106 – 4.0 X 104 years

Terrestrial, Diurnal Carnegie Stages 12 - 15

7.5 - 3.6 X 108 years

Prebiotic

0

9

Prokaryote

Animal

Carnegie Stage 1

1

4

3.0 – 2.0 X 108 years Carnegie Stage 17 - 20

14 10

Terrestrial, Nocturnal

Carnegie Stages 3 -5

Unicellular Eukaryote

15

Hominoidea

12

2.3 X 107 – 6.0 X 106 years

2 3 Morula

Blastocyst

6.5 X 108 – 6.5 X 107 years 4.8 – 2.3 X 107 years

Carnegie Stage 2

Mammalia

Anthropoidea

11

13

Arboreal, Nocturnal Point of Basic Science or Clinical Integration Images from Boaz, N.T. and A. J. Almquist Biological Anthropology, A Synthetic Approach to Human Evolution, Prentice-Hall, 1997, 2002 Levels of Human Evolution from Boaz, N.T. Evolving Health, John Wiley & Sons, 2003

Plesiadapiform

5.6 – 4.8 X 107 years

6.5 – 5.6 X 107 years

Prosimian

WHAT TO LEARN: Corpus of Knowledge I – IFAA Terminologicae Structures within Systems Structure

simple

complex

Terminologica Histologica Terminologica Anatomica

Terminologica Embryologica

early

Time

later

WHAT TO LEARN: Corpus of Knowledge II – Anatomical “Competencies” from the American Association of Anatomy (2019) Concepts with Clinical Relevance • Gross Anatomy • Embryology • Histology • Neuroanatomy

Ontophylogenetic Framework

WILL IT WORK? Starting an Evolutionary Medical Curriculum at Libyan International Medical University “Understanding the complexity of systems is facilitated by studying the development of systems from simple to complex. There are two naturally occurring unfoldings of systems from simple to complex that are instructive: 1) ontogeny or the embryological development of systems as individual organisms begin their life cycles, and 2) phylogeny or the historical development of systems in lineages (populations) of organisms through time. Our systemsbased design of a basic medical science curriculum utilizes the vector of simple-to-complex and incorporates both ontogenetic and phylogenetic biology. “ • • • • •

Systems-Based Curriculum Problem-Based Learning Community-Medicine-Focused Five Faculties: Medicine, Dentistry, Nursing, Pharmacy, and General Science Libya’s First Private University and Ranked as Libya’s #1 Medical School in 2011 “Spiral of Life” Exhibit at Libyan National Museum, Tripoli

Abstract The dilemma faced by anatomists embracing the Evolutionary Medicine paradigm as they design curricula is how to define the core information that should be learned within the allotted course time and still convey the desired breadth of understanding. Two authoritative compendia, both with avowed clinical relevance, are the IFAA Terminologica series (Anatomica, Embryologica, and Histologica) and the recommended core curricular objectives recently released by the Anatomical Competencies Project of the American Association of Anatomists (Embryology, Gross Anatomy, Histology, and Neuroanatomy). Broad overlap in these two resources serve as a foundation for an evolutionary anatomy approach. Learning anatomical organizing concepts that enable critical thinking about structures and associated clinical entities should be emphasized over rote memorization of anatomical terms. Horizontal integration and Inquiry-based Learning reduce redundancy among courses. A regional dissection plan based on ontophylogenetics is well-suited to a systems-based curriculum.