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Sierles FS, Kessler KH, Mintz M, Beck G, Starr S, Lynn DJ, Chao J, Cleary LM, Shore W, Stengel TL, Brodkey AC. Changes in medical students' exposure to and attitudes about drug company interactions from 2003 to 2012: a multi-institutional follow-up survey. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:1137-1146. [PMID: 25785675 DOI: 10.1097/acm.0000000000000686] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To ascertain whether changes occurred in medical student exposure to and attitudes about drug company interactions from 2003-2012, which factors influence exposure and attitudes, and whether exposure and attitudes influence future plans to interact with drug companies. METHOD In 2012, the authors surveyed 1,269 third-year students at eight U.S. medical schools. Items explored student exposure to, attitudes toward, and future plans regarding drug company interactions. The authors compared 2012 survey data with their 2003 survey data from third-year students at the same schools. RESULTS The 2012 response rate was 68.2% (866/1,269). Compared with 2003, in 2012, students were significantly less frequently exposed to interactions (1.6/month versus 4.1/month, P < .001), less likely to feel entitled to gifts (41.8% versus 80.3%, P < .001), and more apt to feel gifts could influence them (44.3% versus 31.2%, P < .001). In 2012, 545/839 students (65.0%) reported private outpatient offices were the main location of exposure to pharmaceutical representatives, despite spending only 18.4% of their clerkship-rotation time there. In 2012, 310/703 students (44.1%) were unaware their schools had rules restricting interactions, and 467/837 (55.8%) planned to interact with pharmaceutical representatives during residency. CONCLUSIONS Students in 2012 had less exposure to drug company interactions and were more likely to have skeptical attitudes than students in 2003. These changes are consistent with national organizations' recommendations to limit and teach about these interactions. Continued efforts to study and influence students' and physician role models' exposures to and attitudes about drug companies are warranted.
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Affiliation(s)
- Frederick S Sierles
- F.S. Sierles is professor emeritus, Department of Psychiatry and Behavioral Sciences, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois. K.H. Kessler is associate professor, Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois. M. Mintz is associate professor, Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC. G. Beck is director, Curriculum Research and Education Office, and assistant professor, Department of Pediatrics, University of Nebraska College of Medicine, Omaha, Nebraska. S. Starr is director, Science of Health Care Delivery Education, and assistant professor, Department of Pediatrics, Mayo Clinic College of Medicine, Rochester, Minnesota. D.J. Lynn is associate dean for student life and professor, Department of Neurology, Ohio State University School of Medicine, Columbus, Ohio. J. Chao is professor and clerkship director, Department of Family Medicine and Community Health, Case Western University School of Medicine, Cleveland, Ohio. L.M. Cleary is senior associate dean for education and professor, Department of Internal Medicine, State University of New York Upstate Medical University, Syracuse, New York. W. Shore is professor emeritus, Department of Family and Community Medicine, and Permanente Medical Group endowed teaching chair in primary care, University of California, San Francisco, School of Medicine, San Francisco, California. T.L. Stengel is an independent communications consultant to Kerry, Inc., Beloit, Wisconsin. A.C. Brodkey is associate clinical professor, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Chang HJ, Lee YM, Lee YH, Kwon HJ. Investigation of Unethical and Unprofessional Behavior in Korean Residency Training. TEACHING AND LEARNING IN MEDICINE 2015; 27:370-378. [PMID: 26507994 DOI: 10.1080/10401334.2015.1077128] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
UNLABELLED PHENOMENON: Medical ethics and professionalism are fundamental competencies for all physicians, and resident physicians have to develop these competencies during their training. Although Korea has a reputation for having the highest quality medical practice in East Asia, improvements in the technological aspects of care have outpaced the developments in institutional systems and education needed to fulfill social responsibility. Enhancing professionalism education during postgraduate training requires thorough exposition of this situation. APPROACH Twenty residents from 17 clinical departments at 1 Korean tertiary university-affiliated hospital were recruited, and in-depth interviews were conducted in person by an interviewer who was a fellow resident with participants. Interviewees recalled and described personal experiences or observations of misbehaviors that had occurred during their residency training. Researchers recorded and transcribed all interviews, and 4 researchers conducted a thematic analysis. FINDINGS Authors extracted 48 descriptors representing 8 categories of unethical and unprofessional behaviors from the transcripts: (a) substandard practice, (b) violation of work ethics, (c) misconduct related to conflict of interest, (d) dishonesty with patients, (e) violation of patient confidentiality, (f) lack of respect for patients, (g) lack of respect for colleagues, and (h) misconduct in research. Each of the interviewees mentioned between 3 and 18 descriptors. "Not fulfilling basic duties for patient care" was the most frequently mentioned misconduct, followed by "fabricating patient medical status or test results to meet preoperative criteria for anesthesia" and "verbal or physical abuse of junior doctors." INSIGHTS: Residents reported a diverse variety of unethical and unprofessional behaviors throughout their training and described the ethical distress they suffered in the real clinical situations. The results of this study support the notion that reinforcing ethics and professionalism education during postgraduate medical training in a practical and authentic way will help trainees manage the ethical conflicts or dilemmas they will inevitably encounter.
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Affiliation(s)
- Hyung-Joo Chang
- a Department of Medical Humanities , Korea University College of Medicine , Seoul , Korea
| | - Young-Mee Lee
- a Department of Medical Humanities , Korea University College of Medicine , Seoul , Korea
| | - Young-Hee Lee
- a Department of Medical Humanities , Korea University College of Medicine , Seoul , Korea
| | - Hyo-Jin Kwon
- a Department of Medical Humanities , Korea University College of Medicine , Seoul , Korea
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Jahnke K, Kremer MS, Schmidt CO, Kochen MM, Chenot JF. German medical students' exposure and attitudes toward pharmaceutical promotion: a cross-sectional survey. GMS ZEITSCHRIFT FUR MEDIZINISCHE AUSBILDUNG 2014; 31:Doc32. [PMID: 25228934 PMCID: PMC4152996 DOI: 10.3205/zma000924] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 04/21/2014] [Accepted: 06/05/2014] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Kristine Jahnke
- Universitätsmedizin Greifswald, Institut für Community Medicine, Abteilung Allgemeinmedizin, Greifswald, Deuschland
| | - Marcel Stephan Kremer
- Universitätsmedizin Greifswald, Institut für Community Medicine, Abteilung Allgemeinmedizin, Greifswald, Deuschland
| | - Carsten Oliver Schmidt
- Universitätsmedizin Greifswald, Institut für Community Medicine, Abteilung Study of Health in Pomerania - Klinisch-epidemiologische Forschung (SHIP-KEF), Greifswald, Deuschland
| | - Michael M. Kochen
- Universitätsmedizin Göttingen, Institut für Allgemeinmedizin, Göttingen, Deutschland
| | - Jean-François Chenot
- Universitätsmedizin Greifswald, Institut für Community Medicine, Abteilung Allgemeinmedizin, Greifswald, Deuschland
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Etain B, Guittet L, Weiss N, Gajdos V, Katsahian S. Attitudes of medical students towards conflict of interest: a national survey in France. PLoS One 2014; 9:e92858. [PMID: 24671179 PMCID: PMC3966819 DOI: 10.1371/journal.pone.0092858] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 02/26/2014] [Indexed: 11/19/2022] Open
Abstract
Following recent health scandals in France, the French parliament adopted law n°2011-2012 to regulate ties between physicians and the pharmaceutical industry. The law also requires pharmaceutical companies to publicize financial and other benefits given to medical students. In this context, we administered a survey to medical students in France, in an effort to identify priorities for future education regarding conflicts of interest (COI). This web-based survey encompassed knowledge about, training on, personal exposure to, and opinions on COI among preclinical and clinical students as well as residents. Two thousand one hundred and one (2,101) students participated. Although most students (64.6%) believed that they are able to define what a COI is, they failed to correctly identify several situations as COI (receiving a gift, being offered a meal, being invited to a conference). Most students reported feeling inadequately educated about COI (85.2%). Compared to other class levels, residents were more exposed to pharmaceutical sales representatives. This exposure is highly associated to receipt of gifts (OR 14.51, 95% CI 11.67-18.05). Medical students were aware of potential bias induced by COI with respect to drug prescriptions and research, but felt personally immune towards COI. In our survey, personal research performed by students was more likely to be associated with perception of potential bias on prescription for self (but not for others) than attending a lecture on COI. Promulgating laws that regulate ties between physicians/students and the pharmaceutical industry is a mandatory first step. However, complementary strategies should be implemented within medical schools, in particular, specific training about COI in early medical education.
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Affiliation(s)
- Bruno Etain
- AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France
- * E-mail:
| | - Lydia Guittet
- INSERM U1086 Cancers & Preventions, CHU de Caen, Caen, France
| | - Nicolas Weiss
- AP-HP, Neurological Intensive Care Unit, Neurology Department, Institut Hospitalo-Universitaire-A, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Vincent Gajdos
- APHP, Pediatric Department, Hôpital Antoine Béclère, Clamart, France
- Université Paris Sud, Kremlin Bicêtre, France
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Zaki NM. Pharmacists' and physicians' perception and exposure to drug promotion: A Saudi study. Saudi Pharm J 2014; 22:528-36. [PMID: 25561865 PMCID: PMC4281594 DOI: 10.1016/j.jsps.2014.02.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 02/15/2014] [Indexed: 11/20/2022] Open
Abstract
Introduction Drug promotion has to contribute to a more rational use of drugs. Concerns arise if promotion negatively influences prescribing/dispensing pattern. It is warranted to assess exposure and attitudes to, and acceptance of, drug promotion among pharmacists and physicians. Methodology Adopting a randomized, multiple site and cross-sectional survey study, questionnaires (n = 250) were completed by physicians and pharmacists to investigate the exposure, acceptance or skepticism of Saudi physicians/pharmacists to drug promotion as well as their perception of the appropriateness of gifts and to check if they had any teaching/training about dealing with medical representatives (MRs) and Pharma promotion. Results Significantly more pharmacists than physicians (32% vs. 23%; p < 0.05) reported being taught or educated about the ethics of drug promotion. The experience level was significantly associated with the teaching or training that the physicians and pharmacists received. Conference registration fees and drug samples were the most appropriate promotional gift for the physicians (67% and 66%, respectively; p < 0.01) whereas for pharmacists, the drug sample was considered the most suitable donation (79%). More pharmacists perceived drug companies as a useful way to gain knowledge about drugs than physicians (75% vs. 65%; p < 0.01). A higher proportion of both groups were accepting drug promotion than those skeptical about it. Conclusion The majority of physicians or pharmacists participating in this study have received gifts from pharmaceutical companies. The drug samples and printed educational materials are the most widely accepted gifts. Recent graduates and those with few years of experience had higher teaching/training than experienced physicians and pharmacists in pharmaceutical promotion ethics and tactics to deal with MRs. On the other hand, experienced healthcare team were more approached and targeted by pharmaceutical companies and MRs. It is highly recommended to implement courses/discussion groups on the ethical interaction between healthcare professionals and pharmaceutical companies in the curriculum of both pharmacy and medicine. Updating the physicians and pharmacists after graduation, as part of continued medical/pharmacy education, will eventually improve the healthcare professionals’ capability to act to the patients’ welfare.
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Affiliation(s)
- Noha M Zaki
- Department of Pharmaceutics and Pharmaceutical Technology, College of Pharmacy, Taif University, Taif, Saudi Arabia
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Lieb K, Koch C. Conflicts of interest in medical school: missing policies and high need for student information at most German universities. GMS ZEITSCHRIFT FUR MEDIZINISCHE AUSBILDUNG 2014; 31:Doc10. [PMID: 24575152 PMCID: PMC3935160 DOI: 10.3205/zma000902] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 12/05/2013] [Accepted: 01/14/2014] [Indexed: 12/02/2022]
Abstract
Objectives: Medical students interact with pharmaceutical representatives already during medical school. The goal of this study was to find out: Do policies exist at German medical faculties that govern the interactions between medical students and pharmaceutical representatives, do schools offer courses on the subject and do students attend these courses? And What are the attitudes of medical students concerning the role of pharmaceutical companies in medical teaching?
Methods: All 36 German medical faculty deans and 1,151 medical students at eight German universities were asked to complete a questionnaire of 4 and 7 questions, respectively, regarding the above mentioned topics. Results: 30 (83,3%) deans and 1,038 (90.3%) medical students filled in the questionnaire, respectively. According to the deans' answers, only one school had a policy concerning conflicts of interest and one had a policy governing the interactions between medical students and industry. 8 (26.7%) deans showed an interest in constructing a policy or educational an activity on this subject. 149 (14,4%) students had participated in an activity that focussed the subject of conflicts of interest and 779 (77,8%) wanted more education on the subject. 701 (73,4%) were opposed to an improvement of medical studies through financial support by pharmaceutical companies, whereas 216 (21,9%) were of the opinion that students should not meet with pharmaceutical representatives. Conclusions: Unlike in other countries, like the US, most German medical faculties do not have policies that govern the interactions between medical students and pharmaceutical companies. Since most students want to be taught more about these interactions, the implementation of respective policies and lectures would be desirable.
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Affiliation(s)
- Klaus Lieb
- University Medical Center Mainz, Department of Psychiatry and Psychotherapy, Mainz, Germany
| | - Cora Koch
- Westfälische Wilhelms-University of Münster, Münster, Germany
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Reid L, Herder M. The speakers' bureau system: a form of peer selling. OPEN MEDICINE : A PEER-REVIEWED, INDEPENDENT, OPEN-ACCESS JOURNAL 2013; 7:e31-9. [PMID: 24348883 DOI: pmid/24348883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 01/28/2013] [Accepted: 01/28/2013] [Indexed: 01/28/2023]
Abstract
In the speakers' bureau system, physicians are recruited and trained by pharmaceutical, biotechnology, and medical device companies to deliver information about products to other physicians, in exchange for a fee. Using publicly available disclosures, we assessed the thesis that speakers' bureau involvement is not a feature of academic medicine in Canada, by estimating the prevalence of participation in speakers' bureaus among Canadian faculty in one medical specialty, cardiology. We analyzed the relevant features of an actual contract made public by the physician addressee and applied the Canadian Medical Association (CMA) guidelines on physician-industry relations to participation in a speakers' bureau. We argue that speakers' bureau participation constitutes a form of peer selling that should be understood to contravene the prohibition on product endorsement in the CMA Code of Ethics. Academic medical institutions, in conjunction with regulatory colleges, should continue and strengthen their policies to address participation in speakers' bureaus.
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Geraci SA, Thigpen SC. The fundamental need for relative value metrics in educational innovation. Am J Med 2011; 124:1086-9. [PMID: 22017786 DOI: 10.1016/j.amjmed.2011.07.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 05/21/2011] [Accepted: 07/18/2011] [Indexed: 11/24/2022]
Affiliation(s)
- Stephen A Geraci
- Department of Internal Medicine, University of Mississippi School of Medicine, Jackson, MS, USA.
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