Interactions with the pharmaceutical industry: experiences and attitudes of psychiatry residents, interns and clerks.

OBJECTIVE To examine the type and number of interactions of psychiatry residents, interns and clerks with sales representatives of pharmaceutical companies and the attitudes of physicians-in-training toward these interactions. DESIGN Survey conducted with the use of a self-report questionnaire. SETTING Seven teaching hospitals affiliated with the Department of Psychiatry, University of Toronto. PARTICIPANTS All 105 residents, interns and clerks training in psychiatry at the seven teaching hospitals between October 1993 and February 1994 were eligible; 74 completed questionnaires, for a response rate of 70%. One respondent was excluded from the analysis. OUTCOME MEASURES Number of personal meetings and "drug lunches" attended, number of drug samples and promotional items received and estimated value of gifts received by each physician-in-training during a 1-year period as well as attitudes of residents, interns and clerks about interactions with pharmaceutical representatives. RESULTS Median number of personal meetings reported was 1 (range 0 to 35), of drug lunches attended was 10 (range 0 to 70), of promotional items received was 2 (range 0 to 75) and of drug samples received was 1 (range 0 to 20). Trainees' median estimate of the value of gifts received was $20 (range $0 to $800 Fewer than one third felt that pharmaceutical representatives were a source of accurate information about drugs; however, 71% (52/73) disagreed with the statement that representatives should be banned from making presentations. Although only 15% (11/73) felt they had sufficient training about meeting with pharmaceutical representatives, 34% (25/73) felt that discussions with representatives would have no impact on their prescribing practices, and 56% (41/73) felt that receiving gifts would have no impact on prescribing. Fewer than half said they would maintain the same degree of contact with representatives if they did not receive promotional gifts. The more money and promotional items a physician-in-training had received, the more likely he or she was to believe that discussions with representatives did not affect prescribing (p < 0.05). Clerks, interns and junior (first-year and second-year) residents attended two to three times more drug lunches than senior (third-year and fourth-year) residents, and significantly more junior than senior residents felt that pharmaceutical representatives have a valuable teaching role. Junior residents were three times more likely than senior residents to have received drug samples. CONCLUSIONS Interactions between pharmaceutical representatives and psychiatry residents, interns and clerks are common. The physicians-in-training perceive little educational value in these contacts and many, especially clerks, interns and junior residents, disavow the potential of these interactions to influence prescribing. Therefore, supervisors of postgraduate medical training programs may wish to provide instruction concerning potential conflicts of interest inherent in these types of interactions.