Issues affecting trainees and students


An important part of any educational program is the establishment of a lifelong commitment to learning, to the cultivation of habits of critical reflection and to ongoing relationships with respected colleagues and mentors. Institutions should pay attention to the achievement of such goals, especially in relation to the inherent values of learning and practice. This will involve particular attention to the core question of pecuniary and non-pecuniary interests.

Exposure of healthcare trainees and students to industry marketing and promotion influences the development of their attitudes and practices. Many of the issues raised in relation to qualified practitioners, for example those concerning industry-sponsored travel to conferences or meetings, drug samples, meals, and receipt of gifts, apply equally to trainees and students and other members of the health professions. There are, however, some additional issues that arise specifically in the educational setting.

There is evidence that pharmaceutical promotion to medical students and postgraduate trainees is widespread, is accepted by trainees, and changes behaviour. Students may be particularly vulnerable to approaches by industry representatives because they are unfamiliar with the issues involved, lack the critical faculties necessary for evaluating them and, having limited financial resources, find small gifts and other perquisites attractive.

It should be one of the objectives in the education of health professionals (at the undergraduate, postgraduate and professional levels) to promote awareness of the issues regarding relationships with industry, including the importance of constructive engagements and the risks associated with pecuniary and non-pecuniary dualities of interest.

Key points
  • The issues arising in relation to individual practitioners and researchers apply equally to students, trainees and teachers.

  • Healthcare education curricula should include learning about the ethical issues arising in relation to the role of industry in the health professions.

Development of an ethical culture that fosters critical attitudes towards relationships with industry

The environment in which education and training takes place has an important impact upon teaching and learning. Educational institutions, professional organisations, hospitals and individual practitioners should therefore seek to set good examples through their own practices. This may require avoidance of pharmaceutical sponsorship of grand rounds, clinical meetings and other events.

Hospitals sometimes encourage the use of certain pharmaceutical products or devices or restrict the use of others after negotiating with manufacturers or distributors in relation to cost. These actions may be interpreted, especially by trainees and students, to mean that the products supported have greater efficacy or safety than alternatives available in the community.

Practitioners, medical educators and institutions involved in training should ensure that such arrangements are not misinterpreted by trainees and students. Students should be encouraged to reflect critically on the role of industry marketing on clinical policy and practice, especially the distribution of promotional material and industry-controlled presentations as well as their own possible unconscious bias.

Key points
  • Training programs should include discussions about the role of industry, dualities and conflicts of interest, and the evaluation and interpretation of industry material.

  • The role of institutional policies and the practices of individual clinicians, teachers and mentors in shaping the behaviour of trainees and students should be recognised in the development of curricula.

  • Undergraduate and postgraduate medical education should include education about the extent of interactions between industry and health professionals, the impact of these relationships, the ethical issues that arise as a consequence, and strategies for managing risks and realising benefits associated with them.

Interests and responsibilities of educational institutions and societies

Institutions involved in education in the healthcare setting – including universities, professional societies and hospitals – have responsibilities both to their trainees and students and to the wider community to address the issues concerning relationships between practitioners and industry. These issues include both the content of teaching programs and the relationships the institutions themselves establish with various industrial organisations.

Content of teaching programs

A key objective of teaching programs should be to develop the abilities of trainees and students to think critically about both scientific and ethical issues, including those concerned with the nature of evidence and its relationship to clinical and research practice, the social roles and responsibilities of the professions, and the potential influences of industry on both practice and policy development.

Teaching programs should also contain explicit discussion about the concepts of interests, dualities and conflicts of interests, the implications of relationships between the health professions and industry, and strategies to ensure that the purposes and processes of the professions are protected from inappropriate influences. It is important that the nature and potential significance of both pecuniary and non-pecuniary interests are covered and the conditions needed to ensure open, unobstructed dialogue in the clinical and research settings.

Relations between educational institutions and industry

As emphasised previously, healthcare education should be undertaken exclusively by organisations and institutions that are free from commercial obligations and agendas and should be distinguished from training or promotional activities associated with industry.

Educational institutions should establish clear and transparent policies regarding their relationships with industry. They should ensure that any activities in which they are involved, with educational content, are free from influence from commercial interests. This will generally require policies that separate the development of educational or scientific programs from the possibility of influence from pharmaceutical companies or other industry representatives in the manner specified elsewhere in these Guidelines. It may also require public disclosure of transfers of value between the institutions and industry.

Key points
  • The relationships that educational institutions have with industry should be publicly declared and should be open for critique by practitioners, teachers, trainees and students.

  • Those involved in health professional education should declare the interests they have as a consequence of their relationships with industry. This information should be accessible to the professional education community, trainees, students and to the public.

  • Teaching materials developed by industry should not be used in health professional education.

  • Hospitals, universities, academic medical institutions and medical centres should discontinue the practice of pharmaceutical company-funded lectures and meals.

Interactions with pharmaceutical representatives

Marketing strategies of pharmaceutical companies often target undergraduate students and postgraduate trainees, who as a result may be less sceptical of the claims made by industry. In spite of this, trainees and students often do not believe that their own prescribing habits will be influenced by pharmaceutical industry interactions.

Trainees and students should be encouraged to be cautious regarding their interactions with industry and should consider carefully how they wish to conduct such interactions throughout their working lives.

Key points
  • Educational institutions, including universities, colleges and hospitals, should be encouraged to prohibit formal contact between trainees and students and pharmaceutical representatives.

  • Interactions with pharmaceutical sales representatives should be avoided at clinical teaching sites.

  • The general principles that apply to health practitioners should also apply to trainees and students.

Gifts, travel and attendance at meetings

Trainees and students should in general not receive gifts of any kind from industry. This includes medical equipment, food and entertainment, drug samples, travel support and support for student organisations and publications.

Hospitals, universities, academic medical institutions and medical centres should not accept pharmaceutical company-funded lectures and meals.

Exceptions include formal grant, award or exchange programs administered through a third party, as these are provided according to clearly stated guidelines and subject to auspice by professional or educational bodies. In cases of uncertainty, an ethics committee may be consulted.

Key point

Gifts from industry should not be offered to students and postgraduate trainees and they should not accept them. Exceptions may include formal grants, awards or exchange programs administered through a third party, with no sponsor involvement in decisions concerning which trainees and students are awarded the grant.

Supervision, mentoring and continuing professional development programs

As discussed here and in Issues affecting health practitioners, continuing educational programs are potentially subject to influence from industry providers in a manner that may distort their content and compromise their educational value.

It is desirable that such programs remain under the supervision of independent, disinterested educators committed primarily to discharging their pedagogical responsibilities. The conditions discussed previously in relation to such programs should be rigorously observed.

Need for specific policies regarding trainees and students

It is recommended that policies be devised by institutions involved in health professional education about ethical issues relevant to trainees and students, postgraduate trainees and their teachers.

Hospitals, universities, academic medical institutions and medical centres may need to give consideration to sponsorship of meetings and grand rounds, and individual practitioners involved in training may need to review their personal approaches to the use of promotional materials. It is important that teachers and mentors provide good examples to trainees and students in their own personal attitudes and behaviours.

Key points
  • Institutions involved in health professional education should develop policies covering sponsorship of meetings and grand rounds and the use of promotional materials.

  • Teachers and mentors should consider the examples they set to trainees and students in their personal attitudes and behaviours.

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