The long-term effect of policies restricting contact between residents
and pharmaceutical company representatives (PCRs) during internal medicine
training is unknown. The McMaster University Department of Medicine in Hamilton,
Ontario, implemented a policy restricting PCR contact with trainees in 1992,
whereas the Department of Medicine at the University of Toronto, Toronto,
Ontario, has no such policy.
To determine if the presence of a restrictive policy and the frequency
of contact with PCRs during internal medicine training predict attitudes and
behavior several years after completion of training.
Design, Setting, and Participants
Retrospective analysis of the attitudes and behavior of 3 cohorts of
physicians: University of Toronto trainees, prepolicy McMaster trainees, and
postpolicy McMaster trainees. Surveys were mailed to 242 former University
of Toronto and 57 former McMaster trainees who completed their internal medicine
training between 1990 and 1996, with response rates of 163 (67%) and 42 (74%),
Main Outcome Measures
Physician attitude, assessed by a question about the perceived helpfulness
of PCR information, and behavior, assessed by whether physicians met with
PCRs in the office and the frequency of contacts with PCRs (current contact
score, consisting of conversations with PCRs, PCR-sponsored events attended,
gifts, honoraria, and consulting fees received).
In both the unadjusted and multiple regression analyses, postpolicy
McMaster trainees were less likely to find information from PCRs beneficial
in guiding their practice compared with Toronto and prepolicy McMaster trainees,
with unadjusted odds ratios (ORs) of 0.44 (95% confidence interval [CI], 0.20-0.94)
and 0.39 (95% CI, 0.13-1.22), respectively. All 3 groups were equally likely
to report that they met with PCRs in their office in the past year (88%).
Postpolicy McMaster trainees had a lower current contact score compared with
Toronto (9.3 vs 10.9; P = .04) and prepolicy McMaster
trainees (9.3 vs 10.8; P = .18). In multiple regression
models, greater frequency of contact with PCRs during training was a predictor
of increased perceived benefit of PCR information (OR, 1.29; 95% CI, 1.13-1.47)
and was positively correlated with the current contact score (partial r = 0.49; P<.001). Number of
PCR-sponsored rounds attended during training was not a consistent predictor
of attitudes or behavior.
Policies restricting PCR access to internal medicine trainees and the
amount of contact during residency appear to affect future attitudes and behavior