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Original Investigation |

Association of Marketing Interactions With Medical Trainees’ Knowledge About Evidence-Based Prescribing:  Results From a National Survey

Kirsten E. Austad, MD1,2; Jerry Avorn, MD1; Jessica M. Franklin, PhD1; Eric G. Campbell, PhD3,4; Aaron S. Kesselheim, MD, JD, MPH1,2
[+] Author Affiliations
1Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital–Harvard Medical School, Boston, Massachusetts
2Edmond J. Safra Center for Ethics at Harvard University, Cambridge, Massachusetts
3Mongan Institute for Health Policy–Massachusetts General Hospital, Boston, Massachusetts
4Harvard Medical School, Boston, Massachusetts
JAMA Intern Med. 2014;174(8):1283-1290. doi:10.1001/jamainternmed.2014.2202.
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Importance  In recent years, numerous US medical schools and academic medical centers have enacted policies preventing pharmaceutical sales representatives from interacting directly with students. Little is known about how pharmaceutical sales representatives affect trainees’ knowledge about pharmaceutical prescribing.

Objective  To determine whether there is an association between medical trainees’ interactions with pharmaceutical promotion and their preferences in medication use.

Design, Setting, and Participants  We surveyed a nationally representative sample of first- and fourth-year medical students and third-year residents by randomly selecting at least 14 trainees at each level per school.

Exposures  All trainees were asked how often they used different educational resources to learn about prescription drugs. Among fourth-year students and residents, we posed a series of multiple choice knowledge questions asking about the appropriate initial therapy for clinical scenarios involving patients with diabetes, hyperlipidemia, hypertension, and difficulty sleeping.

Main Outcomes and Measures  Evidence-based answers followed widely used clinical guidelines, while marketed-drug answers favored brand-name drugs over generic alternatives. We used survey answers to build an industry relations index assessing each trainee’s level of acceptance of pharmaceutical promotion; we used proportional odds logistic regression models to estimate the association between the index and responses to the knowledge questions.

Results  The 1601 student (49.0% response rate) and 735 resident (42.9% response rate) respondents reported common use of unfiltered sources of drug information such as Google (74.2%-88.9%) and Wikipedia (45.2%-84.5%). We found that 48% to 90% of fourth-year students and residents accurately identified evidence-based prescribing choices. A 10-point higher industry relations index was associated with 15% lower odds of selecting an evidence-based prescribing choice (odds ratio [OR], 0.85; 95% CI, 0.79-0.92) (P < .001). There was also a significant association between the industry relations index and greater odds of choosing to prescribe brand-name drugs (OR, 1.08; 95% CI, 1.00-1.16) (P = .04).

Conclusions and Relevance  Among physician trainees, our survey showed an association between positive attitudes toward industry-physician interactions and less knowledge about evidence-based prescribing and greater inclination to recommend brand-name drugs. Policies intended to insulate trainees from pharmaceutical marketing may promote better educational outcomes.

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Figure.
Association Between Industry Relations and Responses to Clinical Scenarios Among Medical Trainees

Odds ratios (ORs) comparing the odds of an evidence-based answer (A) or marketed-drug answer (B) between trainees with a 10-point difference in their industry relations index.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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