A prospective before-and-after trial of an educational intervention about pharmaceutical marketing

Teaching medical students how to interact with the pharmaceutical industry: A scoping review

Objectives: The influence of the pharmaceutical industry is of significant concern in physician prescribing decisions; medical students may not be fully equipped with the knowledge or skills to manage interactions with industry prior to graduation. The aim of this study was to evaluate the characteristics of educational interventions undertaken to improve students' knowledge, attitudes, and skills in managing interactions with the pharmaceutical industry. Methods: A systematic search of Ovid Medline, EMBASE, CINAHL and ERIC databases identified 3210 primary studies with keywords related to "pharmaceutical industry" and "undergraduate medical education". Eleven articles were included for review. Results: Disparate methods of teaching medical students how to interact with the pharmaceutical industry were identified, making it difficult to compare the effectiveness of different educational interventions. All the included studies achieved the aims of the described intervention, at least in the short term, suggesting perhaps any education related to interactions with the pharmaceutical industry can aid students in managing these situations. Conclusions: The lack of an evidence-base means more research into the identification of educational interventions which engender durable changes in students' knowledge, attitudes, and skills to manage interactions with the pharmaceutical industry are required. Any intervention will likely be context-dependent, as a universal approach is hindered by the fact different countries have different laws governing pharmaceutical industry-physician interaction.

Active Learning to Promote Early and Effective Physician Interaction with Pharmaceutical Industry Marketing Practices

BACKGROUND

Interactions with pharmaceutical companies influence physicians' prescribing behavior. Less than half of US family medicine residency programs have educational curricula addressing their influence. However, medical students have extensive exposure to pharmaceutical industry marketing during their early years of training. We developed a successful and required active learning curriculum for medical students during their first-year of medical school.

METHODOLOGY

A philosopher bioethicist lectured to first-year medical students on the ethical issues surrounding the interactions with pharmaceutical representatives and outlined the three principles approach to clinical ethics as presented in the American Board of Internal Medicine Physician Charter (2002). The lecture also described the eight physician types offered by Fugh-Berman et al. Students watched two fictitious physician-pharmaceutical representative interactions. To promote active learning, students were provided a 3 × 3 Bingo card with each physician type. The bioethicist facilitated a discussion addressing the interactions.

RESULTS

Two hundred twenty-nine first-year medical students participated in this required intervention. Fifty-two percent of first-year medical students had already interacted with pharmaceutical representatives. The session changed students' opinions of pharmaceutical representatives and their ability to identify strategies to mitigate their influence. Students articulated ethical issues involved in the interaction, techniques used by pharmaceutical representatives, and techniques that could be used by medical students or physicians. Ninety-one percent of students believed they could independently find reliable information about a drug.

CONCLUSION

The session was effective to start the conversation regarding the ethical issues involved with the interaction between medical students/physicians and pharmaceutical representatives in the first year of medical school.

Challenges in Optimizing Medical Education for Rheumatologists

The field of rheumatology has expanded rapidly in recent years, and innovations in immunology, epigenetics, and bone metabolism continue at an astonishing pace. In this fast changing field, optimizing medical education for rheumatologists is vital for maintaining a competent workforce to meet the needs of patients with rheumatic diseases. Several key challenges lie ahead and efforts to optimize medical education for rheumatologists are discussed in this article.

Conflicts of Interest in Medicine. A Systematic Review of Published and Scientifically evaluated Curricula

Objective: Conflicts of interests resulting from interactions with pharmaceutical companies are pervasive in medicine and can result in an undue influence on physicians' decision-making. The objective of this systematic review is to analyze published and scientifically evaluated curricula for medical students and residents regarding such conflicts of interest. We begin by describing the covered topics and teaching methods; afterwards we analyze the quality of the curricula using the published data on their evaluations and comparing the content with content recommended for such curricula. Methods: We searched Pubmed, PsycInfo, EMBASE, OECD, WISO, SOWI and googlescholar up to and including the 5th of September 2016. Publications describing curricula for residents or medical students on the topic of conflicts of interest in medicine and evaluating them for their effects on the participants' learning were included. We analyzed the covered topics and the teaching methods used and compared them with recommendations by the American Medical Students' Association (AMSA) and Health Action International (HAI). Results: The literature search resulted in 20 publications that fulfilled our search criteria. In five trials, a control group was used, in no trial the participants were randomized to intervention or control group. 16/20 published curricula primarily covered marketing strategies by pharmaceutical companies, especially the interaction with pharmaceutical sales representatives (PSRs). Most curricula only covered a limited number of topics recommended by AMSA/HAI. The most frequent teaching method was a group discussion, which was used in 18/20 curricula; all curricula used at least one interactive teaching method. The evaluation of the curricula was heterogeneous in results as well as design. Some publications described a change of attitudes toward a stronger skepticism regarding interactions with pharmaceutical companies. Four publications described improved knowledge, one publication described a change in behavior toward a reduction of the acceptance of gifts. Conclusion: The trials conducted to this date regarding curricula on conflicts of interests are methodologically flawed and the described curricula lack important topics beyond marketing strategies of pharmaceutical companies. In addition, there are no data so far on the sustainability of the courses' effects on participants' behavior. It is therefore necessary to develop a model curriculum that covers a broader variety of topics and to evaluate it using a well thought-out methodology to create a foundation for the further improvement of teaching conflicts of interest in medicine.

Exploring Perceptions of Early-Career Psychiatrists About Their Relationships With the Pharmaceutical Industry

OBJECTIVES

The pharmaceutical industry has engaged physicians through medical education, patient care, and medical research. New conflict of interest policy has highlighted the challenges to these relationships. The objective of this study was to explore the perceptions that early career psychiatrists (e.g. those within 5 years of entering practice) have regarding their relationship with the pharmaceutical industry.

METHODS

Data were collected through semi-structured interviews and were analysed using a grounded theory methodology. Interviews were conducted and analyzed in an iterative way using a constant comparison approach in which data were collected and open coded for themes and subthemes. As new interviews were conducted, the themes were applied to data along with emergent themes and previous interviews recoded until additional interviews failed to provide new themes and thematic saturation was achieved. Through axial coding, a process of relating codes (categories and concepts) to each other, the theory was generated to explain the core variable mediating perceptions participants had about the relationship with industry.

RESULTS

The participants described increasing frequency of experiences with industry throughout training into practice. Their perceptions developed through training, physician culture, industry promotion, and their own practices. In managing the relationship with industry, participants would either avoid interactions or engage in behaviors aimed to reduce the risk of influence. Maintaining one's professional integrity was the underlying driver used to manage the relationship with industry.

CONCLUSIONS

Psychiatrists develop perceptions about industry through experience and observation leading them to develop their own strategies to manage these relationships while maintaining their professional integrity.

German medical students' exposure and attitudes toward pharmaceutical promotion: a cross-sectional survey

OBJECTIVE

Early contact of medical students with pharmaceutical promotion has been shown in many international studies. We assessed the frequency and places of contact of German medical students to pharmaceutical promotion and examined their attitudes toward pharmaceutical promotional activities.

METHODS

This cross-sectional survey was based on a self-developed questionnaire. It was distributed to all clinical students at the University of Goettingen Medical School in 2010. A 4-point rating scale was used to assess the attitudes toward different statements regarding pharmaceutical promotion.

RESULTS

The overall response rate was 55% (702/1287). The proportion of students with direct contact to pharmaceutical sales representatives increased from 21% in the first clinical year up to 77% in the final year. 60% were contacted during their elective clerkship. 80% had accepted promotional gifts. 86% stated their prescribing behavior to be unsusceptible to the influence of accepting promotional gifts. However, 35% of the unsusceptible students assumed doctors to be susceptible. Almost all (90%) reported that dealing with pharmaceutical promotion was never addressed during lectures and 65% did not feel well prepared for interactions with the pharmaceutical industry. 19% agreed to prohibit contacts between medical students and the pharmaceutical industry.

CONCLUSIONS

German medical students get in contact with pharmaceutical promotion early and frequently. There is limited awareness for associated conflicts of interests. Medical schools need to regulate contacts and incorporate the topic in their curriculum to prepare students for interactions with the pharmaceutical industry.

Assessment of cognitive biases and biostatistics knowledge of medical residents: a multicenter, cross-sectional questionnaire study

PURPOSE

The aim of this study is to determine the perceived familiarity of medical residents with statistical concepts, assess their ability to integrate these concepts in clinical scenarios, and investigate their susceptibility to the gambler's fallacy and the conjunction fallacy.

METHODS

A multi-institutional, cross-sectional survey of Greek medical residents was performed. Participants were asked to indicate their familiarity with basic statistical concepts and answer clinically oriented questions designed to assess their biostatistics knowledge and cognitive biases. Univariate, bivariate, and multivariate statistical models were used for the evaluation of data.

RESULTS

Out of 153 respondents (76.5% response rate), only two participants (1.3%) were able to answer all seven biostatistics knowledge questions correctly while 29 residents (19%) gave incorrect answers to all questions. The proportion of correct answers to each biostatistics knowledge question ranged from 15 to 51.6%. Residents with greater self-reported familiarity were more likely to perform better on the respective knowledge question (all p<0.01). Multivariate analysis of the effect of individual resident characteristics on questionnaire performance showed that previous education outside Greece, primarily during medical school, was associated with lower biostatistics knowledge scores (p<0.001). A little more than half of the respondents (54.2%) answered the gambler's fallacy quiz correctly. Residents with higher performance on the biostatistics knowledge questions were less prone to the gambler's fallacy (odds ratio 1.38, 95% confidence intervals 1.12-1.70, p=0.003). Only 48 residents (31.4%) did not violate the conjunction rule.

CONCLUSIONS

A large number of medical residents are unable to correctly interpret crucial statistical concepts that are commonly found in the medical literature. They are also especially prone to the gambler's fallacy bias, which may undermine clinical judgment and medical decision making. Formalized systematic teaching of biostatistics during residency will be required to de-bias residents and ensure that they are proficient in understanding and communicating statistical information.

Changing interactions between physician trainees and the pharmaceutical industry: a national survey

BACKGROUND

Increasingly, medical school policies limit pharmaceutical representatives' access to students and gifts from drugmakers, but little is known about how these policies affect student attitudes toward industry.

OBJECTIVE

To assess interactions between trainees and the pharmaceutical industry, and to determine whether learning environment characteristics influence students' practices and attitudes.

DESIGN, PARTICIPANTS

We conducted a cross-sectional survey with a nationally-representative sample of first- and fourth-year medical students and third-year residents, stratified by medical school, including ≥ 14 randomly selected trainees at each level per school.

MAIN MEASURES

We measured frequency of industry interactions and attitudes regarding how such interactions affect medical training and the profession. Chi-squared tests assessed bivariate linear trend, and hierarchical logistic regression models were fitted to assess associations between trainees' attitudes and their schools' National Institutes of Health (NIH) funding levels and American Medical Student Association (AMSA) PharmFree Scorecard grades reflecting industry-related conflict of interest policies.

KEY RESULTS

Among 1,610 student (49.3 % response rate) and 739 resident (43.1 %) respondents, industry-sponsored gifts were common, rising from 33.0 % (first-year students) to 56.8 % (fourth-year students) and 54 % (residents) (p < 0.001). These gifts included meals outside the hospital (reported by 5 % first-year students, 13.4 % fourth-year students, 27.5 % residents (p < 0.001)) and free drug samples (reported by 7.4 % first-year students, 14.1 % fourth-year students, 14.3 % residents (p < 0.001)). The perception that industry interactions lead to bias was prevalent, but the belief that physicians receive valuable education through these interactions increased (64.1 % to 67.5 % to 79.8 %, p < 0.001). Students in schools receiving more NIH funding reported industry gifts less often (OR = 0.51, 95 % CI: 0.38-0.68, p < 0.001), but the strength of institutional conflict of interest policies was not associated with this variable.

CONCLUSIONS

Despite recent policy changes, a substantial number of trainees continue to receive gifts from pharmaceutical representatives. We found no relation between these outcomes and a school's policies concerning interactions with industry.

Premedical students' exposure to the pharmaceutical industry's marketing practices

PURPOSE

Physicians' exposure to pharmaceutical industry marketing raises concerns about their ability to make unbiased, evidence-based prescription decisions. This exposure begins early in medical education. The authors examined the frequency and context of such exposures for students before matriculation to medical school.

METHOD

The authors distributed two separate but related questionnaires to all 389 students who matriculated at the University of Chicago Pritzker School of Medicine between 2007 and 2010. The survey inquired about interactions with the pharmaceutical industry before entering medical school. Descriptive statistics and Wilcoxon rank sum tests were used to analyze data.

RESULTS

Across four years, 282 (72.5%) students responded to the first survey; 219 (56.3%) responded to the follow-up survey. The majority of those (62.1%) had interacted with or were exposed to pharmaceutical marketing before medical school. The most common interactions were accepting a pen (50.2%) and attending a sponsored lunch (37.9%), which occurred most commonly while shadowing (33.6% and 42.2%, respectively). The next most common interactions were receiving a small gift (24.7%) and attending a sponsored dinner (20.6%), which occurred most commonly in "other" contexts, such as through family and while working in a medical setting (48.2% and 48.9%, respectively).

CONCLUSIONS

The majority of students had interacted with the pharmaceutical industry before medical school. The differences in context indicate that students enter medical school with a heterogeneous set of exposures to pharmaceutical marketing. Medical schools should consider interventions to enhance students' knowledge of the impact of pharmaceutical marketing on physicians' prescribing practices.

Structured pharmaceutical representative interactions and counterdetailing sessions as components of medical resident education

INTRODUCTION

Educational activities should be developed to teach residents how to constructively interact with pharmaceutical representatives and how to critically assess the provided information.

METHODS

An educational study was implemented during the 2010-2011 academic year in an internal medicine residency program. The study included an initial educational session on physician-industry relations and then 4 interactive sessions with the pharmaceutical representatives, each followed by a counterdetailing session provided by a clinical pharmacist. Study surveys were conducted to evaluate resident attitudes concerning pharmaceutical representative presented information before and after the counterdetailing sessions.

RESULTS

A total of 27 residents (n = 27) participated in the study. The study results revealed that residents learned new relevant product information from the representatives (P = .002) and strongly agreed that counterdetailing was beneficial (P = .009). Residents further agreed that they would recommend counterdetailing presentations to peers, suggested minimal changes to session formatting, and recommended its continued inclusion in their curriculum.

CONCLUSIONS

This study demonstrated benefits of a comprehensive program to teach residents how to constructively interact with the pharmaceutical representatives and critically assess the information provided by the representatives. Best practices for incorporating interaction and counterdetailing sessions into medical resident curriculum should be further studied.

Relationships between medicine and industry: approaches to the problem of conflicts of interest

Relationships between physicians and industry are prevalent in medical education, clinical practice, and research, as well as at the level of medical institutions. These relationships can be valuable for the advancement of medicine but have also received increased scrutiny in recent years because they create conflicts of interest that pose a risk of biasing the judgments of physicians. Responses to these conflicts of interest by medical institutions, journals, and governments have utilized four main tools: education, disclosure, management, and prohibition. Each of the four has its advantages and drawbacks. Medicine faces the challenge of tailoring the use of these tools to minimize the risk of bias while allowing useful medical-industry collaborations to proceed. Viewing the dilemmas created by physicians' relationships with industry as a version of the principal-agent problem, which is much discussed by economists, may help in developing creative approaches to these issues.

Physician attitudes toward industry: a view across the specialties

OBJECTIVES

To explore attitudes of physicians from all specialties toward gifts from and interactions with the pharmaceutical and medical device industries.

DESIGN

Anonymous, cross-sectional survey distributed and collected between June 1 and September 1, 2008.

SETTING

Hospitals in the Mount Sinai School of Medicine consortium in the New York, New York, metropolitan area.

PARTICIPANTS

Faculty and trainee physicians from all clinical departments.

MAIN OUTCOME MEASURES

Attitudes toward industry interactions and gifts and their appropriateness measured on 4-point Likert scales.

RESULTS

A total of 590 physicians and medical students completed the survey (response rate, 67.0%); 351 (59.5%) were male, 230 (39.0%) were attending physicians, and 131 (23.7%) of 553 (excluding medical students) were from surgical specialties. Attitudes toward industry and gifts were generally positive: 72.2% found sponsored lunches appropriate, whereas 25.4% considered large gifts appropriate. Surgeons, trainees, and those unfamiliar with institutional policies on industry interactions held more positive attitudes than others and were more likely to deem some gifts appropriate, including industry funding of residency programs and, among surgeons, receiving meals, travel expenses, and payments for attending lectures. Nonattending physicians held more positive attitudes toward receiving meals in clinical settings, textbooks, and samples.

CONCLUSIONS

Physicians continue to hold positive attitudes toward marketing-oriented activities of the pharmaceutical and device industries. Changes in medical culture and physician education focused on surgeons and trainees may align physician attitudes with current policy trends.

Teaching trainees to negotiate research collaborations with industry: a mentorship model

Research collaborations with the pharmaceutical industry can offer valuable opportunities for academic psychiatrists to gain access to important resources. Such relationships, however, often produce significant conflicts of interest, and recent attention has focused on the ways in which these conflicts can compromise research integrity. Psychiatric residents generally receive little education about industry-academia interactions. The authors report their experience collaborating on a research project with representatives of a pharmaceutical company, and they propose a model for teaching psychiatric trainees responsible and productive engagement with industry investigators.

Appropriateness of collaborations between industry and the medical profession: physicians' perceptions

BACKGROUND

Physicians' ratings of the appropriateness of collaboration and of receiving payment for collaboration with the pharmaceutical and medical device industries may differ.

METHODS

We administered an anonymous, cross-sectional survey to a convenience sample of faculty and postgraduate physicians from all departments within the 11 hospitals affiliated with the Mount Sinai School of Medicine in New York City and New Jersey. We examined 12 collaborations with the pharmaceutical and medical device industries using 4-point Likert scales, ranging from very appropriate to very inappropriate.

RESULTS

Surveys were distributed to physicians within 35 departments at 11 hospitals; 590 surveys were completed by physicians at 9 hospitals, yielding a 67% response rate. Physicians' assessment of appropriateness varied among the different collaborations, ranging from nearly all rating developing a drug or device (92%) and designing a drug/device trial (91%) as appropriate to fewer rating preparing a manuscript of a drug/device trial (60%) and recruiting patients for a drug/device trial (65%) as appropriate for physicians not involved in trial design. Physicians consistently rated receiving payment for collaboration as appropriate less often than they rated the collaboration itself as appropriate and ratings varied among the collaborations. For example, 81% rated receiving payment to develop a drug or device as appropriate, whereas 38% rated receiving payment to recruit patients for a drug/device trial when the physician was not involved in trial design as appropriate.

CONCLUSIONS

Physicians' broadly perceived most collaboration with the pharmaceutical and medical device industries, and of receiving payment for collaboration, as appropriate.

Prescribers and pharmaceutical representatives: why are we still meeting?

CONTEXT

Research suggests that pharmaceutical marketing influences prescribing and may cause cognitive dissonance for prescribers. This work has primarily been with physicians and physician-trainees. Questions remain regarding why prescribers continue to meet with pharmaceutical representatives (PRs).

OBJECTIVE

To describe the reasons that prescribers from various health professions continue to interact with PRs despite growing evidence of the influence of these interactions.

DESIGN, SETTING, AND PARTICIPANTS

Multi-disciplinary focus groups with 61 participants held in practice settings and at society meetings.

RESULTS

Most prescribers participating in our focus groups believe that overall PR interactions are beneficial to patient care and practice health. They either trust the information from PRs or feel that they are equipped to evaluate it independently. Despite acknowledgement of study findings to the contrary, prescribers state that they are able to effectively manage PR interactions such that their own prescribing is not adversely impacted. Prescribers describe few specific strategies or policies for these interactions, and report that policies are not consistently implemented with all members of a clinic or institution. Some prescribers perceive an inherent contradiction between academic centers and national societies receiving money from pharmaceutical companies, and then recommending restriction at the level of the individual prescriber. Prescribers with different training backgrounds present a few novel reasons for these meetings.

CONCLUSIONS

Despite evidence that PR detailing influences prescribing, providers from several health professions continue to believe that PR interactions improve patient care, and that they can adequately evaluate and filter information presented to them by PRs. Focus group comments suggest that cultural change is necessary to break the norms that exist in many settings. Applying policies consistently, considering non-physician members of the healthcare team, working with trainees, restructuring the current primary care model and offering convenient, individualized, non-biased educational options may aid success.

Debunking myths in physician-industry conflicts of interest

PURPOSE

To call attention to the myths that surround physician-industry conflicts of interest, to refute their validity, and to propose ways to address them so as to insure that physicians make medical practice decisions in the best interest of their patients.

DESIGN

Perspective.

METHODS

Review, analysis, and discussion of the implications of selected pertinent literature.

RESULTS

Physicians often have voluntary financial relationships with industry based on behaviors and motivations that include entitlement, recognition, belonging, and money. The pharmaceutical and device industry spends billions of dollars annually in marketing to physicians. The sophisticated marketing plan seeks access to physicians through gifting mechanisms to ingratiate them and to influence them to prescribe industry's drugs and to purchase its products. Despite widely accepted studies that demonstrate that industry's marketing activities influence physicians' medical practice behavior to the detriment of patients and the public, physicians persist in voicing myths to justify their partaking of industry's largesse. Many physicians believe that their voluntary financial conflicts of interest with industry can be managed by simply disclosing them and by "being honest." Yet there is no support from well-conducted studies to support the effectiveness of this approach.

CONCLUSIONS

Medical organizations and academic institutions are the ones to take the lead in recognizing that these voluntary financial conflicts of interest are unacceptable and should be stopped. Such conflicts mainly relate to the acceptance of gifts and money that are designed to influence behavior and are a form of financial coercion.

A systematic review of curricula on relationships between residents and the pharmaceutical industry

CONTEXT

Research has demonstrated the potential adverse impact of pharmaceutical company marketing techniques on doctor knowledge and prescribing practices. Lack of experience may make resident doctors particularly vulnerable to pharmaceutical industry influence. Curricula addressing resident-pharmaceutical industry relations have been reported, but there is no consensus regarding the best approach to take.

OBJECTIVE

This study aimed to review published curricula that address resident-pharmaceutical industry relations and to assess them for content, validity and outcomes measures.

METHODS

Curricula were identified via searches of electronic databases and bibliographies of collected articles. Inclusion criteria required articles to describe an educational curriculum, applied in graduate medical education, on relations between doctors and the pharmaceutical industry.

RESULTS

The search identified 9 curricula. Most addressed detailing of residents by pharmaceutical representatives. Two articles described curriculum development. Eight articles included an evaluation component; only 1 included a control group for comparison. Modest improvements were noted in resident confidence, knowledge of guidelines, belief in the potential influence of marketing on behaviour, and self-reported acceptance of gifts. Only 2 evaluations used a validated outcome instrument, and no studies included longterm follow-up.

CONCLUSIONS

A limited number of curricula have addressed resident-pharmaceutical industry interactions. Inconsistency in content, application and evaluation methodology prevents any meaningful synthesis of data. Resident attitudes and behaviours may be affected, but the outcome measures used lacked sufficient validity to assess improvements in knowledge and analytic skills. A clearer delineation of the curriculum development process and the use of standardised outcome measures would facilitate the reproduction of positive results at other institutions.

To what extent do educational interventions impact medical trainees' attitudes and behaviors regarding industry-trainee and industry-physician relationships?

BACKGROUND

Recently, academic medical centers have been asked to take the lead in voluntarily instituting more stringent regulations regarding pharmaceutical industry interactions not only with physicians but also with medical trainees.

OBJECTIVE

Our goal was to summarize the recent literature regarding the impact of educational interventions and regulatory policies on trainee perceptions of pharmaceutical industry interactions and/or pharmaceutical industry-related trainee behavior.

METHODS

We searched Medline and the bibliographies of review articles for relevant studies. Articles published before the Accreditation Council for Continuing Medical Education standards for commercial support of continuing medical education were issued in 1991 were excluded. Two reviewers selected empiric studies that (1) reported empiric data about educational interventions that were meant to shape trainee knowledge, attitudes, or practices concerning the pharmaceutical industry or (2) evaluated the impact of regulatory policies on trainee attitudes or behaviors.

RESULTS

From 247 identified articles, 12 met the inclusion criteria. In 2 of these studies, the impact of regulatory policies on trainee attitudes and/or behaviors was assessed. In the remaining 10 studies, the impact of various educational interventions developed by training programs or schools to shape trainee knowledge, attitudes, or practices concerning the pharmaceutical industry were evaluated.

CONCLUSIONS

Although modest in size, a body of empirical research exists that might inform medical educators. Beyond institutional policy that excludes the pharmaceutical industry, the evidence reviewed suggests that well-designed seminars, role playing, and focused curricula can affect trainee attitudes and behavior, although it is not entirely clear whether these changes are sustainable over the long-term.

Residents' perceptions over time of pharmaceutical industry interactions and gifts and the effect of an educational intervention

PURPOSE

To describe change in residents' attitudes toward gifts from and interactions with industry and to measure the effects of a formal educational workshop on changes in perceptions.

METHOD

At the University of Chicago, 118 internal medicine residents completed an observational survey and took part in a controlled intervention across three years (2001-2004) of residency. Four cohorts of residents completing the program in 2004-2007 participated. The intervention was an interactive educational workshop, including reviews of literature and guidelines, and three videos demonstrating routine resident interactions with pharmaceutical representatives. Residents graduating in 2005 were the intervention group and residents graduating in 2004 the comparison group. Analysis of variance and linear regression models were used to determine the relationship between variables.

RESULTS

Residents perceived "lunch sponsored at noon conference" and "pharmaceutical representative brief talk at noon conference" as increasingly appropriate over their training period (p < .02). Residents perceived "pens, notepads, pocket antibiotic guides" as increasingly appropriate and "tickets to sporting events," "round of golf," and "travel/registration for national conference" as increasingly inappropriate (p < .05). The intervention group was more likely to rate only one item, "lunch at noon conference," as less appropriate (p = .042).

CONCLUSIONS

Residents' perceptions toward industry gifts and interactions changed modestly during their training to reflect institutional policy. "Appropriate" gifts of minimal value were generally perceived as increasingly appropriate, whereas "inappropriate" gifts were perceived as increasingly inappropriate over time. An educational workshop alone may not significantly alter residents' perceptions toward industry without the implementation of broad and consistent institutional policy.

The relationship between paediatricians and commerce

The interaction between doctors and commerce, particularly the pharmaceutical industry, has recently been subject to increasing scrutiny. Doctors are now exposed to mounting influence from industry as it spends large amounts of money on marketing, is heavily involved with continuing medical education and sponsors a major proportion of research. Conflicts of interest may exist on both sides of the relationship: doctors can be manipulated and companies need to be profitable. Paediatricians are just as open to this influence as are other members of the medical profession. There is evidence that clinical practice is altered by interaction with industry, although doctors appear to deny the likelihood of being influenced. There are significant concerns over the increasing involvement of the pharmaceutical industry with research, although the regulation of the industry continues to be strengthened and the process of research is becoming more transparent. Disclosure of conflicts of interest involving authorship is now common practice and should extend to all facets of the relationship. However, collaboration continues to be necessary in order to develop new therapies, maximise research and particularly in paediatrics, to test medications in children. Paediatricians need to be aware of the sources of influence and understand current guidelines so that interactions with industry continue to be appropriate.