(2005; 61 pages)
The initial faxed survey reached 1014 medical and pharmacy faculties in 110 countries. We received 710 contact names in 91 countries from the initial faxed query and e-mail listserve postings. Of these, 564 were individuals involved in education on drug promotion. We sent a detailed questionnaire to all of them. Two hundred and sixty two (46%) responded, of whom 34 (13%) were excluded (duplicates or not teaching about drug promotion). Results are based on 228 respondents from 64 countries, 91 from pharmacy schools and 137 from medical schools. Responses were classified by WHO region. There were 92 respondents from Europe, 56 from the Americas, 31 from the Western Pacific, 20 each from Africa and South-East Asia, and 9 from the Eastern Mediterranean.
Nearly three-quarters of respondents, 165 (72%), reported that education about drug promotion is part of the required curriculum at their institution, and over half reported more than one type of course on promotion. However, nearly one-third of medical and one-fifth of pharmacy respondents reported only 1-2 hours of education on promotion within the required curriculum. Total reported educational time, in all types of courses, was significantly greater at pharmacy than medical schools: 50 (55%) reported more than 10 hours of education on promotion in total, as compared with 39 (28%) of medical faculty respondents.
Over half the respondents were educating students on one or more of the following issues: advertisements, sales representatives, sponsored conferences and seminars, promotional ‘research’, gifts and industry funded journals. More pharmacy than medical respondents covered promotion on the Internet (59% vs. 29%) and patient requests for advertised medicines (50% vs. 33%).
Three-quarters of respondents, 170 (75%) covered the regulation and/or ethics of drug promotion, with the highest proportion of these reporting that they discussed national government regulation of promotion, followed by professional codes, and the ethics of interactions with the industry.
The most commonly reported educational technique was lectures, 192 (84% overall), followed by small group discussions in tutorials and workshops (65%). Those who allocated one-half day or less to education on drug promotion were highly likely to list lectures as the only type of educational technique used. Most of those spending 10 hours or more used small group discussions as well as lectures, and more than half also carried out critical analyses of sample advertisements.
The involvement of sales representatives in education can help students to better understand the types of promotional techniques used and to respond appropriately. Only 15% of respondents involved sales representatives, more often pharmacists than physicians: 20% vs. 12%.
The survey included questions on what educators were aiming to achieve: the most common aims were to teach critical appraisal of promotion, increase students’ use of independent information sources, and to improve prescribing or dispensing after graduation. As one medical educator from the Americas stated, “I am trying to open their eyes so they can see for themselves and will be more sceptical in the future.”
Inclusion of questions on drug promotion in student examinations provides a signal that the topic is considered important. Overall, half of respondents said that questions on promotion were included in exams, but this was much more frequent among pharmacy than medical faculty respondents: 68% vs. 37%. Only a small minority of educators systematically evaluated the effectiveness of education: 19% overall. This was most often a written or oral course appraisal soliciting students’ opinions about a session (15% of respondents). Effects on behaviour and longer-term outcomes were rarely being evaluated.
What was respondents’ judgment of the degree of success of education on drug promotion in meeting its intended goals? There was no difference in the likelihood that pharmacy or medical faculty respondents judged the programme to be successful. However, those devoting at least 4 hours to education were more likely to judge their work to be at least somewhat successful than those devoting a half day or less: 70% vs. 41%. The most frequently cited barrier was lack of integration into the curriculum, followed by inadequate time allocation, lack of continuation during clinical training, and lack of interest from other university faculty. Those who spent 4 hours or less on the issue were more likely than others to judge inadequate time allocation as a barrier to success.
Respondents were asked what types of course materials they had developed. The most common type listed was PowerPoint presentations (55%). Course materials were rarely available on the Internet, and usually only in sites with limited access.