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

Educational program in onco-urology for young urologists: What are their needs?

PURPOSE

The emergence of new communication media such as digital contents are progressively replacing more traditional medias in the field of educational programs. Our purpose was to assess urologist in training aspirations regarding urological education.

METHODS

Members of a national urologist in training association were sent an anonymous online questionnaire regarding their medical formation in the field of urology. Responders interest for urological sub-specialty or education support (new tools and traditional support) were evaluated through a 5-point Likert scale.

RESULTS

Overall, 109 young urologists (26%) responded to the survey. Most of the respondents worked during their training in an academic hospital (n=89, 82%). The three favorite tools for training chosen by the responders were: videos, workshop or masterclass, and podcasts (responders very interested were respectively n=64 (58.7%), n=50 (45.9%), and n=49 (45%)). E-mail newsletters were reported as the less useful educational tool by participants (n=38, 34.9%). Participants were very interested in improving their surgical skills and their radiological knowledge. Responders who were the most attracted by PCa were much more looking to improve their systemic treatment and radiological knowledges.

CONCLUSIONS

Urologic-oncology was a priority regarding education for urologists in training. A majority of participants expressed a lack in their surgical education, revealing a reduced OR access and underlining utilization of new tools such as simulation. New digital contents such as social media or podcast achieved high interest for the participants, instead of more traditional media. There is a need that educational content evolve and uses new digital media.

LEVEL OF EVIDENCE

3.

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.

Ethics and Industry Interactions: Impact on Specialty Training, Clinical Practice, and Research

Physicians in training and their mentors must be cognizant of ethical concerns related to industry interactions. Mentors perceived to have conflicts of interest or to be engaging in misconduct can unconsciously and profoundly affect the learning and academic environment by implying certain values and expectations. Despite increased awareness of ethical concerns related to industry interactions in clinical practice and research, there remains a need for interventions to prevent ethical transgressions. Ethics education is essential and a move in the right direction, but it alone is likely inadequate in preventing unethical behavior. Education should be supplemented with ethical environments at institutions.

[The pharmaceutical industry and specialised medical training: Residents' perceptions in Madrid, Spain]

OBJECTIVE

To assess the frequency of exposure and attitudes to the pharmaceutical industry (PI) of residents in the Region of Madrid (RM), Spain, and to analyse the association with specialty, professional environment and training.

METHODS

Cross-sectional electronic survey in May and June 2015 of all medical residents in RM. We collected sociodemographic variables and those of interaction with the PI in four blocks: frequency of interactions, attitudes and perceptions, environment and regulatory framework, and skills; with the first two blocks we created a Synthetic PI Interaction Index (SPIII). Bivariate and multivariate analysis of logistic regression.

RESULTS

350 resident's responses (28% family and community medicine [FCM], 57% hospital, 15% others). Ninety-eight percent reported interacting with the PI. Twenty percent believed their prescribing was influenced by the PI and 48% believed it was influenced by other doctors. Sixty-five precent considered more training necessary. Ninety-six percent had received no information from their college of physicians, 80% did not know the regulations in their medical society and 50% were unaware of those of their institution. Hospital specialty residents showed more likelihood of SPIII ≥ percentile 75 than those of FCM (odds ratio [OR]: 3.96; 95% confidence interval [95%CI]: 1.88-8.35). Training in informal settings was associated with SPIII ≤ percentile 25 (OR: 2.83; 95%CI: 1.32-6.07).

CONCLUSIONS

The medical residents in RM had a high level of interaction with the PI and believed its influence low. Hospital specialty residents showed more interaction with the PI. Regulations were not well known by residents and they consideredmore training necessary.

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.

Medical Schools' Industry Interaction Policies Not Associated With Trainees' Self-Reported Behavior as Residents: Results of a National Survey

BACKGROUND

Medical students attending schools with policies limiting industry/student interactions report fewer relationships with pharmaceutical representatives.

OBJECTIVE

To investigate whether associations between students' medical school policies and their more limited industry interaction behaviors persist into residency.

METHODS

We randomly sampled 1800 third-year residents who graduated from 120 allopathic US-based medical schools, using the American Medical Association Physician Masterfile. We surveyed them in 2011 to determine self-reported behavior and preferences for brand-name prescriptions, and we calculated the strength of their medical schools' industry interaction policies using the 2008 American Medical Student Association and Institute on Medicine as a Profession databases. We used logistic regression to estimate the association between strength of school policies and residents' behaviors with adjustments for class size, postresidency career plan, and concern about medical school debt.

RESULTS

We achieved a 44% survey response rate (n = 739). Residents who graduated from schools with restrictive policies were no more or less likely to accept industry gifts or industry-sponsored meals, speak with marketing representative about drug products, attend industry-sponsored lectures, or prefer brand-name medications than residents who graduated from schools with less restrictive policies. Residents who correctly answered evidence-based prescription questions were about 30% less likely to have attended industry-sponsored lectures (OR = 0.72, 95% CI 0.56-0.98).

CONCLUSIONS

Any effect that medical school industry interaction policies had on insulating students from pharmaceutical marketing did not persist in the behavior of residents in our sample. This suggests that residency training environments are important in influencing behavior.

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.

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.

Student feedback about The Skeptic Doctor, a module on pharmaceutical promotion

Pharmaceutical promotion is an integral part of modern medical practice. Surveys show that medical students have a positive attitude towards promotion. Pharmaceutical promotion is not adequately taught in medical schools. A module based on the manual produced by Health Action International was conducted for second year medical students at KIST Medical College, Lalitpur, Nepal. Student feedback on various aspects of the module was obtained using a semi-structured questionnaire. Eighty-six of the 100 students (86%) provided feedback about the module. Forty-five (52.3%) were female and 39 (45.3%) were male. Participant feedback about the module was positive. Small group work and role plays were appreciated, and the ratings of the module and the manual were satisfactory. Respondents felt pharmaceutical promotion will play an important role in their future practice and that the module prepared them to respond appropriately to promotion and select and use medicines properly. The module further developed on issues covered during pharmacology practical and majority felt the module was of relevance to Nepal. Students appreciated the module though there were suggestions for improvement. The module should be considered during the years of clinical training (third and fourth years) and internship and in other medical schools.

New paradigms for physician-industry relations: overview and application for SVS members

Relationships between physicians and their industry partners have ranged from spectacular collaborations that produce extraordinary advances in patient care, such as endovascular aneurysm repair, to humiliating scandals such as extravagant trips and bogus "consulting" agreements resulting in legal actions. It is the latter which have led many to call for the end of all physician-industry relationships, and the former which mandate their preservation. While these two examples are representative of extremes at each end of the spectrum of this issue, in reality the majority of physician-industry relationships are far more complex, and the line between appropriate and inappropriate, and ethical and unethical, is hard to draw. The benefits of our relationships with industry are many: partnering to develop new therapies and technologies, educating and training physicians around new therapies and technologies, support of continuing medical education (CME), fellowship training, and patient education. The pitfall and danger of this relationship is that support from industry, be it a meal, a pen, an educational grant, or flattery, may unduly and inappropriately influence physician decision making around a specific company's product. While it is clear that free trips are not within the realm of proper interaction, what about unrestricted educational grants to institutions, or support of CME activities, professional society meetings, and new device training? As a result of the intense scrutiny of relationships between physicians and industry recently, multiple diverse entities (Association of American Medical Colleges, American Medical Association, Accreditation Council for Continuing Medical Education, professional medical associations, academic medical centers, industry, and government) have generated guidelines and policies with very different perspectives, reflective of their different missions. These policies range from vague and lenient, with only basic limitation of the physician-industry relationship, to extremely rigid and strict, with only minimal interaction and mission support permitted. Given the many changes in oversight and expectations for the relationship between physicians and industry, it is important for vascular surgeons to be aware of the background behind these modifications, the evidence that they are needed, and the positions of the diverse organizations and institutions that have already defined their policies on this issue.

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.

A survey of german physicians in private practice about contacts with pharmaceutical sales representatives

BACKGROUND

Physicians and pharmaceutical sales representatives (PSR) are in regular contact. The goal of the present study is systematically to assess the kind of contacts that take place and their quality with a survey of physicians in private practice. A further goal is to determine whether alternatives to current practices can be envisioned.

METHODS

100 physicians in each of three specialties (neurology/psychiatry, general medicine, and cardiology) were surveyed with a questionnaire containing 37 questions. 208 (69.3%) questionnaires were anonymously filled out and returned.

RESULTS

77% (n = 160) of all physicians were visited by PSR at least once a week, and 19% (n = 39) every day. Pharmaceutical samples, items of office stationery and free lunches were the most commonly received gifts. 49% (n = 102) stated that they only occasionally, rarely, or never receive adequate information from PSR, and 76% (n = 158) stated that PSR often or always wanted to influence their prescribing patterns. Only 6% (n = 13) considered themselves to be often or always influenced, while 21% (n = 44) believed this of their colleagues. The physicians generally did not believe that PSR visits and drug company-sponsored educational events delivered objective information, in contrast to medical texts and non-sponsored educational events. Nonetheless, 52% (n = 108) of the physicians would regret the cessation of PSR visits, because PSRs give practical prescribing information, offer support for continuing medical education, and provide pharmaceutical samples.

CONCLUSION

PSR visits and attempts to influence physicians' prescribing behavior are a part of everyday life in private medical practice, yet only a few physicians consider themselves to be susceptible to this kind of influence. A more critical attitude among physicians, and the creation of alternative educational events without drug company sponsoring, might lead to more independence and perhaps to more rational and less costly drug-prescribing practices.

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.

Pharmaceutical industry marketing: understanding its impact on women's health

The delivery of modern health care entails significant involvement from the pharmaceutical industry, including developing and manufacturing drugs. However, the industry also has tremendous influence on the practice of medicine through its considerable marketing efforts, both to patients through direct to consumer advertising, and to physicians through detailing, providing samples, continuing medical education, and other efforts. This article will review the role that pharmaceutical marketing plays in health care, and the substantial evidence surrounding its influence on patient and physician behaviors, with additional discussion of the medical device industry, all with particular attention to women's health. Understanding the effects of pharmaceutical marketing on women's health, through discussion of relevant examples-including oral contraceptive pills, drugs for premenstrual dysphoric disorder, Pap smear cytology techniques, and neonatal herpes prophylaxis-will help ensure that women receive unbiased, evidenced-based care. We will conclude with a discussion of guidelines that have been proposed by professional organizations, policy makers, and universities, to assist physicians in managing exposure to pharmaceutical marketing.

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.

Promoting an environment of professionalism: the University of Chicago "Roadmap"

In 2005, the University of Chicago Pritzker School of Medicine unveiled an institution-wide Roadmap to Professionalism designed to both increase awareness about issues of medical professionalism across the institution and gain a better understanding of how medical trainees' professional behaviors' change during their training as a result of the medical learning environment. The authors describe the institution's approach and progress to date. To gain buy-in from all levels of learners at the Pritzker School of Medicine, the initiative uses vertically integrated advisory groups to engage medical trainees in the assessment and development of experiential workshops and evaluation initiatives based on the principles outlined in the American Board of Internal Medicine / American College of Physicians / European Federation of Internal Medicine's Physician Charter for Medical Professionalism. Advisory groups provide targeted assessments and programming at each stage of the medical learner: preclinical students, clinical students, residents, and faculty. Surveys of medical students' perceptions of professionalism have provided an important baseline assessment of the learning environment, from which the professionalism steering committee plans to target future curricular interventions. Efforts to engage residents have focused on experiential workshops addressing interactions with the pharmaceutical industry and patient-care hand-offs, as well as the development of a tool for patients to evaluate their resident physicians. The establishment of a series of medical education grants aimed at supporting professionalism research has helped raise faculty awareness. This institution's approach and experience to date may provide valuable lessons for educators and leaders aiming to assess and improve their learning environments.

Third-year medical students' participation in and perceptions of unprofessional behaviors

BACKGROUND

Students' perceptions of and participation in unprofessional behaviors may change during clinical clerkships.

METHOD

Third-year students anonymously reported observation, participation, and perceptions of 27 unprofessional behaviors before and five months after clerkships.

RESULTS

Student observation (21 of 27) and participation (17 of 27) in unprofessional behaviors increased (P < .05). Students perceived unprofessional behaviors as increasingly appropriate (P < .05 for six behaviors). Participation in unprofessional behaviors was associated with diminished likelihood of perceiving a behavior as unprofessional (P < .05 for nine behaviors).

CONCLUSIONS

Student observation and participation in unprofessional behaviors increased during clerkships. Participation in unprofessional behaviors is associated with perceiving these behaviors as acceptable.

The Devil Is in the Details: The Pharmaceutical Industry’s Use of Gifts to Physicians as Marketing Strategy

Marketing costs exceed 30% of revenues for the pharmaceutical industry, with over 90% of the effort aimed at physicians. Although there are currently unprecedented numbers of regulatory activities focusing on relationships between the pharmaceutical industry and the medical profession, such legislation is often unrecognized or flouted. The potential influence, although minimized by both parties, must not be ignored. Physicians and drug companies will need to re-evaluate their responsibilities to their patients and their shareholders, and both groups should assume proactive and guidance roles in the transformation.

Physicians and drug representatives: exploring the dynamics of the relationship

BACKGROUND

Interactions between physicians and drug representatives are common, even though research shows that physicians understand the conflict of interest between marketing and patient care. Little is known about how physicians resolve this contradiction.

OBJECTIVE

To determine physicians' techniques for managing cognitive inconsistencies within their relationships with drug representatives.

DESIGN, SETTING, AND PARTICIPANTS

Six focus groups were conducted with 32 academic and community physicians in San Diego, Atlanta, and Chicago.

MEASUREMENTS

Qualitative analysis of focus group transcripts to determine physicians' attitudes towards conflict of interest and detailing, their beliefs about the quality of information conveyed and the impact on prescribing, and their resolution of the conflict between detailers' desire to sell product and patient care.

RESULTS

Physicians understood the concept of conflict of interest and applied it to relationships with detailers. However, they maintained favorable views of physician-detailer exchanges. Holding these mutually contradictory attitudes, physicians were in a position of cognitive dissonance. To resolve the dissonance, they used a variety of denials and rationalizations: They avoided thinking about the conflict of interest, they disagreed that industry relationships affected physician behavior, they denied responsibility for the problem, they enumerated techniques for remaining impartial, and they reasoned that meetings with detailers were educational and benefited patients.

CONCLUSIONS

Although physicians understood the concept of conflict of interest, relationships with detailers set up psychological dynamics that influenced their reasoning. Our findings suggest that voluntary guidelines, like those proposed by most major medical societies, are inadequate. It may be that only the prohibition of physician-detailer interactions will be effective.

Attitudes of preclinical and clinical medical students toward interactions with the pharmaceutical industry

PURPOSE

Medical school is a critical time for physicians in training to learn the professional norms of interacting with the pharmaceutical industry, yet little is known about how students' attitudes vary during the course of training. This study sought to determine students' opinions about pharmaceutical industry interactions with medical students and whether these opinions differ between preclinical and clinical students.

METHOD

The authors surveyed medical students at Harvard Medical School (HMS) from November 2003 through January 2004 using a six-question survey. The authors then analyzed how responses differed among the classes.

RESULTS

Out of 723 questionnaires, 418 were returned--an overall response rate of 58%. A total of 107 (26%) students believed that it is appropriate for medical students to accept gifts from pharmaceutical companies, and 76 (18%) agreed that the medical school curriculum should include events sponsored by the pharmaceutical industry. Many students--253 (61%)--reported that they do not feel adequately educated about pharmaceutical industry-medical professionals' interactions. Preclinical and clinical students had similar opinions for the majority of their responses. Finally, students who reported feeling better educated about pharmaceutical industry interactions tended to be less skeptical of the industry and more likely to view interactions with the industry as appropriate.

CONCLUSIONS

Students' opinions about interactions with the pharmaceutical industry were similar between preclinical and clinical students, suggesting that the current medical school experience may have limited impact on students' views about interactions with the pharmaceutical industry.