AAMC Executive Council Sets Guidelines On Industry Marketing To Residents

ORR effort helps craft statement aimed at better awareness

"We hope that the AAMC statement will serve as a catalyst for institutions as well as specialty societies, causing them to think about specific issues and problem areas as they deal with residents and their interactions with industry." - Devdutta Sangvai, ORR immediate past chair

Acknowledging the potential influence of the medical industry's marketing on doctors' prescribing and professional behavior, the AAMC Executive Council approved five guiding principles in February to assist residents in their interactions with representatives from pharmaceutical and medical equipment manufacturers.

The "Resident Physician and Medical Industry Interactions: Guiding Principles" statement is the culmination of an effort by the Organization of Resident Representatives (ORR), and is designed to help residents build skills to better interpret promotional product information and to develop an awareness of marketing techniques.

"We at the ORR are really excited about the AAMC's decision to pursue this policy," said Devdutta Sangvai, M.D., ORR immediate past-chair and a resident in the family medicine department at the Duke University Medical Center. "We realize that residency issues have been increasingly at the forefront of AAMC focus areas, more so in the last five years than ever before. It's gratifying to see the association taking a proactive role to contribute to the right type of interaction between residents and industry."

Process began two years ago

Since the ORR undertook a discussion in the spring of 2001 on the appropriate role of medical industry representatives in the educational setting, a growing body of research has suggested that residents have not been properly educated about the possible influence of both direct and indirect marketing on them.

Considering that residents often learn about recent innovations and new products through informal presentations by medical industry product representatives - a practice known as "detailing" - the ORR saw the need to create guidelines that would bring about a structured educational interaction between residents and industry.

The guidelines should consist of evidence-based disclosure of product information, the organization leaders decided, and should include disclosure by attending physicians making product presentations of any fiduciary relationship they might have with the company manufacturing the product.

"One of the things the ORR noticed is that if a resident - or any practitioner, for that matter - has had a recent detailing presentation done for them, it's not uncommon to see an increase in the prescribing of the medicine that was detailed," said Dr. Sangvai.

With such concerns in mind, the AAMC approved the following principles to guide resident interactions with the medical industry:

• Residents should be made aware of the limitations of the current methods of medical industry promotions and the potential conflicts of interest that can result from the gifting process.
• Residents should look to their specialty societies, sponsoring institutions, and educators for guidelines on industry interactions.
• Each institution should develop explicit guidelines on the amount and type of direct interaction industry representatives may have with residents, and make those guidelines clear to residents, as well as industry representatives.
• Recognizing that residents will encounter medical industry personnel and literature throughout their careers, teaching about the interplay between physicians and industry should be part of the formal GME curriculum, to include information on potential conflicts of interest and the influence of marketing.
• Residents and GME directors should work with medical industry representatives to formulate evidence-based product presentations with structured faculty participation, and minimize or eliminate gifts and promotional items that can lead to conflicts of interest or the appearance of impropriety.

Some guidelines in place

A number of specialty organizations have already put out their own guidelines, Dr. Sangvai said. "These guidelines primarily have to do with macro issues, as they relate to the gifting process and to what is considered appropriate behavior. Several large societies have looked to the American Medical Association policies that define what is acceptable gifting and what is an unacceptable relationship between industry and physicians."

Some institutional programs also have their own guidelines, he added. "A few have requested that no gifting be conducted in their institution, and that any money that would have gone to gifting be donated to an unrestricted educational fund to purchase textbooks, for example."

This initiative will help ensure that the educational mission of GME doesn't get compromised, Dr. Sangvai said. "We hope that the latest AAMC statement will serve as a catalyst for institutions as well as specialty societies, causing them to think about specific issues and problem areas as they deal with residents and their interactions with industry."

- Suria Santana

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