By Brooke Wardrop

Harvard Medical Students Experience a Diverse Range of Patients in Unique Zoo Rotation

A Baird’s tapir calf due for a routine physical.

A ring-tailed lemur with juvenile diabetes.

A Kenyan sand boa with unexplained weight loss.

Overseeing the care of all of these patients is all in a day’s work for Zoo New England’s Animal Health department. Moreover, thanks to the One Health Clinical Elective, it’s all in a day’s work for students from Harvard Medical School.

In a unique collaboration between Zoo New England (Franklin Park Zoo in Boston, Mass., and Stone Zoo in Stoneham, Mass.) and Harvard Medical School, MD and MD/PhD students in their senior year have the opportunity to complete a one-month 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.

Under the leadership of Dr. Eric Baitchman, vice president of animal health and conservation at Zoo New England, the One Health Clinical Elective, believed to be the only formal program of its kind, is designed to foster transdisciplinary collaboration to deepen understanding, gain valuable insights, and to benefit healthcare for both humans and animals.

“Core to our mission at Zoo New England is the preservation of biodiversity and saving species from extinction. Showing these medical students how biodiversity is actually beneficial to human health, is very exciting,” said Dr. Baitchman.

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 weekly reading assignments introduce concepts such as the protective role of biodiversity for human health, or 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.  One example considers using new genomic sequencing technology to better characterize immunologic differences between amphibian species that are either sensitive or resistant to chytridiomycosis, a devastating disease that is causing global declines of wild amphibians.

This makes a strong connection to One Health in the fact that massive declines of amphibians in the tropics and the resultant loss of biodiversity in those ecosystems has important implications for human and ecosystem health.  While there is not the resource capacity to pursue every avenue of research that the students propose, some have resulted in new partnerships and projects, such as 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.

“The real point behind the experience is to help medical students appreciate the concept of One Health—which is the intersection of human health, animal health, and ecosystem health. We want them to understand that humans exist in an ecosystem shared by many other beings and the health of all is interdependent on each other,” said Dr. Baitchman. “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. We hope that when these students continue through their careers, that they see beyond the single organ system they are working on, or the single patient they are treating, to see all of their patients within the context of the ecosystem they live in, and what they can do to promote the health of all.”

In 2015, Dr. Gilad Evrony was the first student to partake in the clinical rotation at Zoo New England’s Franklin Park Zoo and Stone Zoo, and the experience made a lasting impression.

“What most surprised me was that working with the vets felt familiar from day one. I had always assumed that the practices were totally different, yet despite our different paths, we shared a language, a way of thinking about how bodies get sick, and the ideals of working to relieve suffering caused by disease. Meeting the vets was like meeting long lost family,” said Dr. Evrony, a Harvard graduate who recently completed a pediatrics residency at Mount Sinai Hospital in New York. “This is an opportunity for medical students to leverage insights from veterinary medicine, which harbors so many diverse lessons and surprises about how bodies work and get sick, to teach medical students to think more broadly and critically. Fostering this two-way communication has been the most important result of this rotation.”

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. The elective, which has proven to be an enriching experience for students and Zoo New England staff alike, has proven so popular that there is a waitlist for participation.

For Dr. Joseph Rosenthal, who completed his one-month rotation in April 2018, he found it most rewarding to work with the Zoo staff and partake in the daily free flow of ideas about approaches to care for such a diverse range of animal patients.

“It’s easy enough to be told that as a medical student you should be prepared to encounter a patient that doesn’t fit into your cookie cutter standard of a given disease, but to think about odd eye movements in a bongo or pathologic fractures in a duck? Those are true medical challenges that have stayed with me, and helped broaden my thought process just when I needed it most—right before the transition between being a medical student and being a doctor on the front lines of challenging patient care,” said Dr. Rosenthal, who graduated with honors in May 2018 from Harvard Medical School and is currently a resident in the Harvard Neurology Residency Program.

Through the One Health Clinical Elective, Dr. Baitchman hopes 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. It is a sentiment shared by Dr. Richard N. Mitchell, MD, who is a professor of pathology at Harvard Medical School and Brigham and Women’s Hospital in Boston.

“In its most practical form, the zoo rotation is a great way 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 amazing diagnostic and therapeutic resources that typically characterize the Harvard teaching hospitals,” said Dr. Mitchell. “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 the non-humans critically impacts human wellness, and how human behaviors affect the rest of the planet.”

Brooke Wardrop is the senior director of marketing and communications at Zoo New England.