Evolution and Medicine: An Inquiry-Based High School Curriculum Supplement
© Springer Science+Business Media, LLC 2011
Published: 8 October 2011
Evolution and Medicine is a curriculum supplement designed by the National Institutes of Health (NIH) and the Biological Sciences Curriculum Study (BSCS) for high school students. The supplement is freely available from NIH’s Office of Science Education (OSE) as a part of the NIH curriculum supplement series. Development of the supplement was a collaborative effort that included input from a panel of experts in medicine, evolution, education, and educational technology. In total, the curriculum supplement includes five inquiry-based lessons that are integrated into the BSCS 5E instructional model (based on constructivist learning theory). The goal was to develop a 2-week curriculum to help students understand major concepts of evolution using the dynamic, modern, and relevant context of medicine. A diverse group of students and teachers across the US participated in a formative evaluation of a field test version of the curriculum. High school students made significant learning gains from pretest to posttest, with a relatively large effect size for student understanding of common ancestry and a relatively small effect size for student understanding of natural selection. There was no statistically significant difference in achievement gains between white students and all other racial/ethnic categories. Overall, the evaluation suggests that a curriculum that emphasizes the role of evolution in medicine, uses a constructivist instructional model, and is grounded in inquiry is relatively well-received by teachers and students and shows promise for increasing student learning in evolution.
KeywordsEvolution Natural selection Common ancestry Instructional model Inquiry High school Evolution and medicine
Understanding evolution is critical for true biological literacy (Dobzhansky 1973). However, evolution education research highlights the many difficulties in teaching and learning about evolution. One major barrier is the numerous misconceptions that students and the general public have about evolution, including both natural selection (Bishop and Anderson 1990) and interpreting evolutionary trees and common ancestry (Naegle 2009; Perry et al. 2008). Misconceptions about the nature of science also contribute to difficulties in understanding evolution (Sandoval and Reiser 2004). Many scientists and educators recognize that most curriculum materials for teaching about evolution do not help students address their prior conceptions. Moreover, few curricula portray evolution as a current and dynamic science, nor do they show why understanding evolution is relevant (Hillis 2007).
To help address this issue, the National Institutes of Health (NIH) and the Biological Sciences Curriculum Study (BSCS) partnered to develop a curriculum supplement that is freely available to high school teachers and their students. As part of its mission to discover and expand knowledge in biomedical sciences to enhance the Nation’s health and to motivate and train the next generation of scientists, NIH has developed 19 educational supplements to primary and secondary science curricula on topics ranging from infectious disease, sleep, hearing, drug addiction, and DNA. The concepts from each supplement align with relevant concepts in the National Science Education Standards (National Research Council 1996). The curriculum supplements are available through NIH’s Office of Science Education website (http://science.education.nih.gov). Lessons within the supplements reinforce the concept of “science” as a verb, the active process of investigating and understanding the natural world rather than a noun, a static body of knowledge to be memorized. Evolution is also an active process that underlies the extraordinary diversity and complexity of all living things, and it touches on every aspect of modern medical science. Evolution is fundamental to understanding how our genomes are organized, why new infectious diseases are continuously arising and how disease-causing organisms become resistant to drugs, and why certain disorders are common in some populations and not in others. Evolutionary thinking aids scientists in developing animal models of disease that enable drug testing and discovery. Evolutionary comparisons based on genetic data have become a powerful tool that scientists and physicians are now using to identify and understand genetic disorders and to identify genes that, because of their importance to life processes, have persisted for millions of years.
The major goal of the project was to develop a relatively short curriculum supplement that leveraged evidence-based approaches to teaching about evolution, using evolution in medicine as a context. Medicine is a useful vehicle to demonstrate the relevance of evolution because evolution profoundly impacts problems faced by doctors and health-related events in the news. This supplement illustrates that understanding evolutionary processes is fundamental to understanding and promoting human health and to developing better medical interventions. The supplement provides teachers with access to new resources to support the biology curriculum and provides students with opportunities to participate in inquiry-based learning and investigate evolution in action using real examples relevant to their lives.
Teaching science as inquiry with a strong emphasis on developing explanations and arguments based on evidence (Sandoval and Reiser 2004; Passmore and Stewart 2002; Asterhan and Schwarz 2007). Throughout the supplement, students are asked to develop explanations and evaluate alternate explanations in light of evidence they have gathered.
Promoting conceptual change by first asking students to record their initial ideas about major concepts, then providing students with experiences and investigations to help them recognize and confront any misconceptions. Throughout their experiences, students should frequently reflect on how their thinking has changed (Bransford et al. 2000; Vosniadou 2008) To help implement a constructivist approach, we used a rigorously tested instructional model (the BSCS 5E instructional model) that helps students understand content and use higher-level reasoning (Wilson et al. 2010).
In remaining sections, we describe the curriculum development process used by NIH and BSCS, briefly describe the five lessons that make up the curriculum supplement, and provide data from the formative evaluation of a field-test version of the supplement.
Curriculum Development Process
Student learning outcomes for the Evolution and Medicine supplement as determined by the advisory board
1. Students will understand the importance of evolutionary comparisons for studying biomedical problems.
• Students will understand the importance of biologists studying genomes of a large number of other organisms and other humans.
• Students will appreciate the value of using other organisms as model systems for studying health-related issues in humans.
• Students will recognize that the rates of evolutionary change in genetic sequences give clues about the role of purifying and diversifying selection on that region.
• Students will be able to describe how rates of evolution relate to medical applications (for example, how the mechanisms of evolution affect the development and use of vaccines).
2. Students will understand the role of evolution in diseases.
• Students will understand that evolution explains many aspects of why humans (as a species) are the way they are.
• Students will understand that health and disease are related to our evolutionary history.
• Students will understand that selection is acting at the level of the phenotype, and phenotype is a product of genes, environment, and their interactions.
• Students will understand that natural selection influences health only to the extent that it influences reproductive success.
• Students will understand that evolution often involves tradeoffs which can influence health.
3. Students will understand the role of evolution in infectious diseases, including evolution of antibiotic and antiviral resistance.
• Students will be able to describe how evolutionary processes can affect antibiotic/antiviral resistance.
• Students will understand the role of evolutionary theory in the development and use of vaccines and other treatments.
• Students will understand the role of evolutionary theory in identifying and understanding the origin and trajectory of pathogens.
To help students meet the learning goals for the curriculum, an external design team of high school teachers, subject matter experts, and representatives from NIH and BSCS met for several days of lesson development and writing. This team, with the input of the advisory board, provided initial designs for the activities, including identifying relevant data sets, studies, and approaches used in evolution and medicine. Additionally, the team developed exemplary ideas for using web-based educational technology. Using input from the advisory board and external design team, curriculum developers at BSCS, in partnership with multimedia experts and representatives from NIH, put structure and form to the activities and materials, culminating in a close-to-complete version that was field-tested with high school students across the country. The results of the field test are further described in the section entitled Formative Evaluation of Evolution and Medicine.
Results from the field test were analyzed to give the advisory board, curriculum developers, and multimedia experts evidence on which to base their decisions for modifying and improving the curriculum. After implementing suggested changes to the curriculum, the revised materials were sent to ten external scientific reviewers, as well as multiple reviewers within NIH. Suggestions from the reviewers were implemented into a final version of the curriculum. In total, the development and revision process lasted over two years.
Brief Description of the Lessons
Five lessons were developed to meet the student learning goals of the supplement. In total, the lessons require an average of 12 50-minute periods. The curriculum was designed to function as a coherent unit of instruction, and the lessons were carefully sequenced within the BSCS 5E Instructional model (Bybee et al. 2006). Individual lessons are not intended to stand alone. Three of the lessons have an associated web-based interactive component. The preferred mode of teaching is to use the web-based interactives, however, alternatives are provided that only use print-based materials for classrooms without access to the internet. The web-based interactives also have alternative interactives to provide accessibility to people with disabilities. A brief description of the lessons follows. We only describe the web-based option for lessons that have both a web-based and print-based option.
Lesson 1, Engage—Ideas about the Role of Evolution in Medicine
The five major principles of natural selection that are emphasized in the supplement, based on work by Bray Speth et al. (2009)
Major principles of natural selection
Variation: Individuals within a population vary in many traits, including physical and biochemical ones.
Inheritance: Some of the differences in traits among individuals can be passed from parents to offspring.
Origin of variation: Some of the variation in traits among individuals has a genetic basis. This variation originated, often many generations ago, as mutations—changes in the genetic information that are random with respect to the needs of the organism.
Fitness: Both the environment and the traits individuals possess affect survival and reproduction. Individuals with heritable traits that enable them to better survive and reproduce in a particular environment will leave more offspring.
Evolutionary change in populations: The frequency of traits and the alleles that affect those traits change in a population over time.
The second activity of Lesson 1, Models and Medicine, is designed to reveal students’ prior understanding of common ancestry and their ability to interpret evolutionary trees, or phylogenies. The activity centers on students investigating and interpreting data for the Pax6 gene and its resulting protein, which is involved in eye development during embryogenesis. Students examine amino acid sequences for the Pax6 protein from humans and three species that are model organisms in medical studies: mice, zebrafish, and fruit flies. Students also interpret the results of genetics experiments involving all four species and consider their interpretations in light of a phylogeny of the four species. After making an initial attempt, students are given a brief orientation in interpreting phylogenies; then they revise their original answers. At the conclusion of the activity, students document their initial ideas about the following question, “How does shared ancestry explain why scientists can use model organisms to learn about human health?” Students return to their answers to this critical question later in the supplement.
Lesson 2, Explore—Investigating Lactose Intolerance and Evolution
Lesson 3, Explain—Evolutionary Processes and Patterns Inform Medicine
“Explain” activities give the learners relevant experiences through which they can fully construct an explanation of a major concept and guide them to compare their explanation to explanations accepted by science. Given that the curriculum supplement provides students with opportunities to learn about two major concepts, natural selection and common ancestry, there are two activities that make up the “Explain” lesson. In the first activity, “Investigating a Mystery Disease,” students use information from medical tests and a virtual microscope to diagnose the cause of anemia in patients from Papua New Guinea. Through this analysis, students recognize that many of the patients suffer from alpha-thalassemia. Again, through guided inquiry, students recognize that the geographic distribution of alpha-thalassemia overlaps with areas in which malaria is a serious health issue. Students then use data from published studies (Williams et al. 2005; Fowkes et al. 2008) and the principles of natural selection to explain the relatively high frequency of the disease in certain populations. Students are formally introduced to the five features of natural selection for the first time in this lesson, and they are given the opportunity to revise their explanations based on natural selection from the “Engage” and “Explore” lessons.
Alpha-thalassemia was chosen as an example to build on the fact that many students learn about sickle cell anemia and malaria in typical introductory high school biology courses. The advisory and design teams felt that learning of a second disease that follows a pattern similar to sickle cell anemia’s could help students apply their understanding of the concepts of natural selection to a broader range of problems.
Lesson 4, Elaborate—Using Evolution to Understand Influenza
Lesson 5, Evaluate—Evaluating Evolutionary Explanations
“Evaluating” activities give students the opportunity to demonstrate to themselves and to their teacher what they have learned over the course of the curriculum supplement. In this lesson, students use what they learned about evolution and medicine to review an article that focuses on vitamin C and evolution, written for a school publication. The article, written by a fictional fellow student, contains statements based on common misconceptions for students’ understanding of natural selection and common ancestry. The students’ task is to try to find specific errors, explain the incorrect statements, and correct the information. In the final portion of the activity, students reflect on the multiple examples of natural selection they explored throughout the supplement. Students are asked to choose one of the examples and create a labeled illustration demonstrating the process of natural selection. In a class discussion, students are asked to draw connections among all the different examples of natural selection they explored in the supplement. This step is included to help students recognize that they explored general principles that apply to all examples of natural selection.
Formative Evaluation of Evolution and Medicine
The curriculum developed by NIH and BSCS was field-tested in classrooms across the country in the winter and spring of 2010. This formative evaluation of the curriculum was designed to gather data on the feasibility and usability of the materials from both teachers and students. We also sought to begin to explore data on the effectiveness of the lessons to help students achieve the specific learning outcomes outlined by the advisory board. The advisory board, NIH, and curriculum developers at BSCS used the findings to revise and improve the final version of the curriculum supplement.
BSCS attempted to include a diverse group of teachers, schools, and students in the field test. In making our selections, we sought a balance in geographic location, schools from urban, suburban, and rural areas, students representing a variety of ethnic, economic, and cultural backgrounds; a range of teacher backgrounds, from relatively new teachers to more experienced teachers; and a balance of genders among teachers. BSCS selected 12 primary field-test teachers who attended a two-day field-test orientation at BSCS headquarters. Fifteen additional teachers were invited to participate in the secondary field test. Secondary field-test teachers did not attend the field-test orientation. Instead, materials were sent directly to them, and they were asked to use them according to the guidelines in the “Teacher Background Materials” without any additional professional development.
Feasibility and usability were measured with evaluation of materials surveys that were administered online to teachers, with a paper and pencil version for students. For each of the five activities, teachers answered 11 to 13 Likert-style and open-ended items. Teachers also answered five overall questions about the supplement. Teachers were queried for their opinions about the impact of the lessons on student interest, effectiveness in meeting learning outcomes, conceptual and practical difficulties with the lessons, value of the graphics and web components, and changes they recommended. We also gathered feedback from students who participated in the field test. Students responded to 23 Likert-style questions about their interest in the supplement, how they thought the lessons affected their level of understanding, the usefulness of the graphics and web-based materials, and other general questions about the quality and effectiveness of the supplement. Students also provided open-ended items concerning changes they would like to see in the supplement.
Student knowledge tests were administered before and after students participated in the field test to enable us to gain preliminary insights into the effectiveness of the lessons in helping students achieve the specific learning outcomes. Pre/posttests consisted of ten multiple choice items, each followed with a confidence rating. Six multiple choice questions were derived from published instruments to meet the assessment needs of the high school student population. The use of similar questions facilitated comparisons of our results and those from other evolution education researchers working with undergraduate students (Bray Speth et al. 2009). Three items were adapted from the Conceptual Inventory of Natural Selection (CINS; Anderson et al. 2002), two from a “tree-thinking” concept inventory (Naegle 2009), and one from a study of middle school student learning in evolution (Beardsley 2004, based on items in Bishop and Anderson 1990). Four new questions were developed that measured students’ understanding of concepts specifically aligned with the role of evolution in medicine.
Summary of race/ethnicities for students completing the pretest and posttest (n = 792). Students were instructed to select all race/ethnicity categories that apply to them, explaining why the sum is greater than 100%
American Indian or Alaska Native
Hispanic or Latino/a
Native Hawaiian or other Pacific Islander
Results from the Field Test
Teacher evaluation of the materials
Difficulty for students
Implementation difficulty for teachers
The lesson was engaging for students
The interactive materials were invaluable because they enabled the students to look for patterns in the data more effectively and because they enabled the students to do the kind of data analysis (e.g. the blood testing) which they otherwise would not normally be able to do.
I think the selection of diseases that were used in relating and understanding evolution and medicine are very relevant and appropriate. The selection is very critical to the integration of evolutionary thinking in medicine so students can deeply understand the concepts of evolution and allow them to get involved in analyzing theories and ideas of evolution.
Using different experimental results to really see how scientists compile and use data (blood samples, enzyme studies, genotypic studies, evoprints) made students aware of the importance of evolution—both in humans and in pathogens.
Student evaluation of how the curriculum influenced their understanding
1. My understanding of the role of evolution in medicine increased.
2. My understanding of why humans are susceptible to disease increased.
3. My understanding of how natural selection informs medicine increased
4. My understanding of how analyses of genetic sequences inform medicine increased.
Summary of pretest and posttest results
Pretest mean number correct
Posttest mean number correct
Cohen’s d effect size (lower, upper 95% confidence intervals)
Complete test (10 items)
p < .001
0.7 (.58, .80)
Common ancestry only (5 items)
p < .001
0.8 (.70, .92)
Natural selection only (5 items)
p < .001
0.2 (.10, .31)
An analysis of differences between groups revealed no significant differences between male and female students on posttest score. However, students who do not receive free or reduced-price lunch scored significantly higher on both the pretest and posttest than students who do receive free or reduced-price lunch. We used orthogonal contrast coding to examine whether or not there were differences between students in posttest score based on race/ethnicity, after controlling for pretest score. The findings of that analysis indicate that there was no significant difference between white students and all other racial/ethnic groups (B = −0.051, p = 0.325).
Correlations of self-reported student interest in biology, student ability in science, and acceptance of evolution, versus normalized gains in achievement
Normalized gain scores
Pearson r correlation
Pearson r correlation
Pearson r correlation
Student interest in biology
Student ability in science
Acceptance of evolution
Teaching evolution is difficult. Teachers need curriculum materials that both portray evolution as modern and dynamic and that are based on the most promising instructional practices. Most of the studies on evolution education are conducted at the college level and focus on students in one classroom or geographic area (Beardsley et al. 2011). We believe that the Evolution and Medicine curriculum supplement helps fill this vital need for teaching about evolution at the high school level while emphasizing science as inquiry. A broad range of experts contributed to the development of this supplement, and preliminary evidence suggests that the curriculum is useable, feasible, and well-received by high school teachers and students.
Preliminary comparisons of our results to results from other researchers in evolution education suggest that high school students using the intervention achieved gains similar to or greater than gains achieved by students at the college level (Asterhan and Schwarz 2007; Abraham et al. 2009). This is significant because the students in the field test are younger and are presumably from a broader range of socioeconomic backgrounds than the students in the studies at the college level. For example, Bray Speth et al. (2009) used similar CINS items to three of the items that were modified for use in this study to measure student understanding of natural selection in an undergraduate introductory biology class for majors that focused on evolution. The students in their study spent a longer time learning about evolution compared to the high school students in our study. On average, teachers in our study required 12 class periods of approximately 50 minutes in length to complete the supplement (600 minutes). The undergraduate students learned about evolution through eight 80-minute class periods and four lab periods of three hours each (1,360 minutes, over twice as much time). On ten items, the college students’ class average improved from 5.1 to 6.8 (no effect size reported). In both studies, students struggled the most with questions focused on variation and inheritance. Understanding common ancestry and tree interpretation showed higher gains (effect size 0.8), similar to results obtained for college students by Perry et al. (2008).
One important result from the evaluation of the field-test materials is that students made significant gains in their understandings of common ancestry and natural selection. A second important result was the lack of significant differences between white students and all other racial/ethnic categories. These data add to a growing research base that supports the use of inquiry-based pedagogical approaches grounded in a constructivist instructional model like the BSCS 5E instructional model. These data, along with teacher reflection data, also begin to suggest that making evolution relevant to students’ lives, especially through the compelling lens of modern medical science, may lead to better student learning outcomes. A more rigorous study would be a logical next step to further investigate the impact of these curricular materials on student learning and student attitudes about science in general and evolution specifically.
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