Abstract

In a unique collaboration between Zoo New England and Harvard Medical School, MD and MD/PhD students in their senior year have the opportunity to complete a 1-mo clinical rotation where they are encouraged to think about the commonalities of medicine and physiology in health and disease across all species and the context within overall health of the ecosystem. Believed to be the only formal program of its kind, the elective is designed to foster transdisciplinary collaboration to deepen understanding, gain valuable insights, and to benefit healthcare for both humans and animals. The main point behind the experience is to help medical students appreciate the concept of One Health—the intersection of human health, animal health, and ecosystem health. The goal is to understand that humans exist in an ecosystem shared by many other beings and the health of all is interdependent on each other. The One Health concept is not one that is typically taught in medical schools today and exposing students to the broader picture of ecosystem health and the role of biodiversity in protecting human health has an immediate impact on their perception of health in a broader context. The intent is that as these students move through their careers, they see beyond the single organ system they are working on, or the single patient they are treating, and consider all of the patients within the context of the ecosystem they live in, and what they can do to promote the health of all.

Core to our mission at Zoo New England is the preservation of biodiversity and saving species from extinction. Showing medical students how biodiversity is actually beneficial to human health, is an exciting and rewarding experience.

Students accompany the veterinarians in their daily clinical practice and are actively engaged in all aspects of case management, diagnostic work-up, and treatment of zoological species. This foundation of comparative medicine provides the basis for broader discussions on One Health, while a syllabus that includes weekly reading assignments and review of current literature introduces concepts such as the protective role of biodiversity for human health, and how ecosystem disturbances and climate change can influence emerging infectious disease threats.

During the last week of the students’ rotation, they are challenged to develop a novel research proposal that benefits both animal and human health and incorporates ecosystem concerns wherever possible. While there is not currently the resource capacity to pursue every avenue of research that the students propose, some have resulted in exciting new partnerships and projects, including the development of genomic investigations of disease in zoological species being conducted between Zoo New England and the Broad Institute of MIT and Harvard. Not only does this work have the potential to improve sustainable management of healthy populations of species, but it also informs a greater understanding of the biological mechanisms of the same diseases in humans and has promoted transdisciplinary collaboration between zoo veterinarians, geneticists, and scientists working in human disease research.

The first student to participate in the clinical rotation did so as an independent study in 2015.¹ Word of mouth quickly spread through the medical school and more students followed, leading to faculty interest and the formation of a formal elective. Since the One Health Clinical Elective was formally added to the Harvard Medical School course catalog in early winter 2017, the response has been overwhelmingly positive. It has proven to be an enriching experience for students and Zoo New England staff alike, and has become so popular that there is a substantial waitlist for participation.

Significant national attention was received when a story featuring the program appeared in the July 3, 2018 edition of the New York Times Science Times dominating both the front and back covers of the section. Additional media and national television coverage followed.

This is a model that might easily be replicated throughout the country or internationally between other zoos and medical schools. We encourage other zoo veterinarians to consider reaching out to local medical schools and explore similar opportunities. It is extremely gratifying to see how receptive and engaged the students are, and how much they have to offer to the daily clinical practice with our veterinarians. They have elevated our medical knowledge in multiple cases.

Through the elective, we intend that students gain a deeper understanding of how interconnected humans, animals, and the ecosystem truly are, and in turn, think more broadly when confronted with medical challenges. In its most practical form, the zoo rotation is a great way for medical students to understand origins of disease and disease development in species beyond Homo sapiens. It’s also an opportunity to hone clinical acumen and judgment by working with patients who can’t articulate symptoms, and in a setting without the advanced diagnostic and therapeutic resources that typically characterize the Harvard teaching hospitals. However, the One Health initiative represents much more: it is perhaps one of the best ways for students to cerebrally and viscerally understand how life on earth is so interconnected, how the health and diversity of all life on Earth critically impacts human wellness, and how human behaviors affect the rest of the planet.

Acknowledgments

The authors thank the Animal Health staff at Zoo New England for their dedication to teaching students, especially Dr. Megan Watson, Dr. Brianne Phillips, and our team of veterinary technicians. We also thank Ms. Terry Galuszka, Harvard Medical School Registrar, for her assistance with setting up the elective and keeping track of the many students inquiring about registering.

Literature Cited

1.  Evrony G. A wild rotation. J Am Med Assoc. 2016;316(7):713–714.