Medical residents need training to interact with pharmaceutical representatives

04/15/04

WINSTON-SALEM, N.C. Medical residents need to learn that there's "no free lunch" when it comes to their interactions with drug company representatives, say researchers from Wake Forest University Baptist Medical Center in the current issue of Academic Medicine.

The researchers found a compelling need for medical residency training programs to include information about drug company marketing techniques and how physician interactions with sales representatives can affect what medications they prescribe.

"Pharmaceutical companies spend billions of dollars on marketing with the goal of changing doctors' behaviors and there's good data that shows it works," said Raquel Watkins, M.D., lead researcher and assistant professor of internal medicine. "To be informed decision-makers, physicians need to be aware of this potential conflict of interest."

Watkins and colleagues conducted surveys about the need for resident training on these issues and developed a six-hour curriculum for internal medicine residents at Wake Forest Baptist.

Through a review of published manuscripts in this field, the researchers found that only 25 percent of internal medicine residency programs in the United States have formal instruction on how to interact with drug company sales representatives. The researchers conducted a survey of 200 internal medicine faculty members and residents that found low levels of knowledge about drug company marketing techniques and professional guidelines on interacting with sales representatives.

For example, the number of residents who were familiar with statements from professional organizations and research on physician-pharmaceutical industry interactions ranged from only 1 percent to 9 percent. The 88 residents surveyed had trained at 46 different medical schools, suggesting that medical schools should consider incorporating a similar curriculum, said Watkins.

Previous research has shown that physician prescribing patterns are influenced by interactions with drug company representatives. In a study reported in the Journal of General Internal Medicine in 2000, for example, 90 percent of physicians said they would dispense a drug sample for treating hypertension that differed from their preferred drug choice.

Watkins and colleagues developed a six-hour curriculum designed to teach internal medicine residents about the ethics of their interactions with drug company representatives and about the potential for their prescribing patterns to be influenced.

The training included videotaped interviews with patients about how they are affected by drug costs and their thoughts on gifts from drug companies to doctors. Residents also learned about drug company marketing strategies and how to critically interpret promotional materials. They also reviewed statements from professional organizations about the interactions between physicians and drug company representatives.

Before the pilot unit was implemented, residents took a test to measure their knowledge about how patients perceive relationships between physicians and drug company representatives, the ethical issues surrounding the relationships, and the level of marketing by the pharmaceutical industry. The residents had a mean score of 33 percent. On the same test after the pilot unit, the mean score was 86 percent.

"Our research shows a compelling need for innovative approaches to provide residents the skills, knowledge and attitudes to interact appropriately with pharmaceutical representatives," said Watkins.

Watkins' co-researcher was James Kimberly Jr., M.D., an assistant professor of internal medicine at Wake Forest Baptist.

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