Heralding the 200th anniversary of Darwin's birth, Randolph Nesse affirms, in the December 2008 issue of The Lancet, his vision that the basic science curricula of medical school include evolutionary biology. Nesse suggests that evolutionary biology would unite the basic science principles of the preclinical years and serve as an explanatory tool in the doctor–patient encounter.
This article visits this same question, but from a different vantage. Here, the author argues that the primacy of the basic sciences in medical education sanctions medical practice based on reasoning from scientific principles. Such an approach is outdated and dangerous in the era of top-down, evidence-based medicine (EBM). The author offers a new approach to the preclinical years: encounter-based medical education, which elevates the doctor–patient encounter as the prime subject of study in medical education. The author describes the historical roots of the shift to EBM and highlights the inadequacy of problem-based learning to resolve its challenges. The article details the advantages of an encounter-based approach to medical education.