Journal of General Internal Medicine

, Volume 28, Issue 8, pp 1064–1071 | Cite as

Changing Interactions Between Physician Trainees and the Pharmaceutical Industry: A National Survey

  • Kirsten E. Austad
  • Jerry Avorn
  • Jessica M. Franklin
  • Mary K. Kowal
  • Eric G. Campbell
  • Aaron S. KesselheimEmail author
Original Research



Increasingly, medical school policies limit pharmaceutical representatives’ access to students and gifts from drugmakers, but little is known about how these policies affect student attitudes toward industry.


To assess interactions between trainees and the pharmaceutical industry, and to determine whether learning environment characteristics influence students’ practices and attitudes.


We conducted a cross-sectional survey with a nationally-representative sample of first- and fourth-year medical students and third-year residents, stratified by medical school, including ≥ 14 randomly selected trainees at each level per school.


We measured frequency of industry interactions and attitudes regarding how such interactions affect medical training and the profession. Chi-squared tests assessed bivariate linear trend, and hierarchical logistic regression models were fitted to assess associations between trainees’ attitudes and their schools’ National Institutes of Health (NIH) funding levels and American Medical Student Association (AMSA) PharmFree Scorecard grades reflecting industry-related conflict of interest policies.


Among 1,610 student (49.3 % response rate) and 739 resident (43.1 %) respondents, industry-sponsored gifts were common, rising from 33.0 % (first-year students) to 56.8 % (fourth-year students) and 54 % (residents) (p < 0.001). These gifts included meals outside the hospital (reported by 5 % first-year students, 13.4 % fourth-year students, 27.5 % residents (p < 0.001)) and free drug samples (reported by 7.4 % first-year students, 14.1 % fourth-year students, 14.3 % residents (p < 0.001)). The perception that industry interactions lead to bias was prevalent, but the belief that physicians receive valuable education through these interactions increased (64.1 % to 67.5 % to 79.8 %, p < 0.001). Students in schools receiving more NIH funding reported industry gifts less often (OR = 0.51, 95 % CI: 0.38–0.68, p < 0.001), but the strength of institutional conflict of interest policies was not associated with this variable.


Despite recent policy changes, a substantial number of trainees continue to receive gifts from pharmaceutical representatives. We found no relation between these outcomes and a school’s policies concerning interactions with industry.


pharmaceutical industry undergraduate medical education drug promotion conflict of interest 



The authors would like to thank Prof. Lawrence Lessig of Harvard Law School for his helpful comments on the study, and to acknowledge useful input from members of the Research Ethics Program of the Harvard Clinical and Translational Science Center. Study funded by a grant from the Edmond J. Safra Center for Ethics at Harvard University. Dr. Kesselheim is supported by a career development award from the Agency for Healthcare Research & Quality (K08HS18465-01), and a Robert Wood Johnson Foundation Investigator Award in Health Policy Research. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Conflict of Interest

The authors declare that they do not have a conflict of interest. Ms. Austad reports being a member of the American Medical Student Association (AMSA) and has received funding to support travel and lodging to attend AMSA conferences.

Supplementary material

11606_2013_2361_MOESM1_ESM.pdf (105 kb)
ESM 1 (PDF 105 kb)


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Copyright information

© Society of General Internal Medicine 2013

Authors and Affiliations

  • Kirsten E. Austad
    • 1
    • 2
  • Jerry Avorn
    • 1
  • Jessica M. Franklin
    • 1
  • Mary K. Kowal
    • 1
  • Eric G. Campbell
    • 3
  • Aaron S. Kesselheim
    • 1
    • 2
    Email author
  1. 1.Division of Pharmacoepidemiology and Pharmacoeconomics, Department of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonUSA
  2. 2.Edmond J. Safra Center for EthicsHarvard UniversityCambridgeUSA
  3. 3.Mongan Institute for Health PolicyMassachusetts General Hospital and Harvard Medical SchoolBostonUSA

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