Zipkin Daniella A, Steinman Michael A
Department of Internal Medicine, California Pacific Medical Center, San Francisco, CA, USA.
J Gen Intern Med. 2005 Aug;20(8):777-86. doi: 10.1111/j.1525-1497.2005.0134.x.
Medical school and residency are formative years in establishing patterns of prescribing. We aimed to review the literature regarding the extent of pharmaceutical industry contact with trainees, attitudes about these interactions, and effects on trainee prescribing behavior, with an emphasis on points of potential intervention and policy formation.
We searched MEDLINE from 1966 until May 2004 for English language articles. All original articles were included if the abstract reported content relevant to medical training and the pharmaceutical industry. Editorials, guidelines, and policy recommendations were excluded.
Contact with pharmaceutical representatives was common among residents. The majority of trainees felt that the interactions were appropriate. A minority felt that their own prescribing could be influenced by contact or gifts, but were more likely to believe that others' prescribing could be influenced. Resident prescribing was associated with pharmaceutical representative visits and the availability of samples. A variety of policy and educational interventions appear to influence resident attitudes toward interactions with industry, although data on the long-term effects of these interventions are limited. Overall, residents reported insufficient training in this area.
The pharmaceutical industry has a significant presence during residency training, has gained the overall acceptance of trainees, and appears to influence prescribing behavior. Training programs can benefit from policies and curricula that teach residents about industry influence and ways in which to critically evaluate information that they are given. Recommendations for local and national approaches are discussed.
医学院校学习阶段和住院医师培训阶段是确立处方模式的关键时期。我们旨在回顾有关制药行业与学员接触程度、对这些互动的态度以及对学员处方行为影响的文献，重点关注潜在干预点和政策形成。
我们检索了1966年至2004年5月期间MEDLINE数据库中的英文文章。如果摘要报道了与医学培训和制药行业相关的内容，则纳入所有原始文章。排除社论、指南和政策建议。
住院医师与制药代表接触很常见。大多数受训者认为这种互动是合适的。少数人认为自己的处方可能会受到接触或礼品的影响，但更有可能认为他人的处方会受到影响。住院医师的处方行为与制药代表的拜访以及样品的提供有关。尽管这些干预措施长期效果的数据有限，但各种政策和教育干预措施似乎会影响住院医师对与行业互动的态度。总体而言，住院医师报告称在这方面的培训不足。
制药行业在住院医师培训期间存在感显著，已获得学员的总体认可，且似乎会影响处方行为。培训项目可受益于相关政策和课程，这些政策和课程能教导住院医师了解行业影响以及批判性评估所获信息的方法。文中讨论了针对地方和国家层面方法的建议。
