The most frequent barriers to success mentioned across the sample were lack of integration into the curriculum, inadequate time allocation and lack of continuity during practical or clinical training. There were some differences in responses between pharmacy and medical faculty respondents, as shown on Table 11, with medical respondents more likely to report lack of continuity, perceived irrelevance, students’ desire for gifts, students’ overconfidence, pharmaceutical industry financing, or previous student exposure to promotion as barriers.
Table 11a shows little relationship between barriers to success and allotted time for instruction. Those educating for less than half a day were more likely to mention inadequate time allocation as a barrier to success, as compared to the rest of the study sample. Interestingly, there was no difference in the proportion citing inadequate time allocation among those educating for 4-9 hours and those educating for 10 hours or more.
Table 11b provides a breakdown of reported barriers to success by region and Table 11c provides respondents’ comments.
Table 11: Main barriers to success
| |
Pharmacy
n=91 |
Medical
n=137 |
Combined
n=228 |
Lack of integration into the curriculum |
36 (40%) |
63 (46%) |
99 (43%) |
Inadequate time allocation |
36 (40%) |
58 (42%) |
94 (41%) |
Lack of continuation during clinical training* |
25 (28%) |
65 (47%) |
90 (40%) |
Lack of interest from other university faculty |
26 (29%) |
51 (37%) |
77 (34%) |
Students’ desire to receive gifts from drug companies* |
9 (10%) |
41 (30%) |
50 (22%) |
Perceived irrelevance to students’ work after graduation* |
12 (13%) |
35 (26%) |
47 (21%) |
Pharmaceutical industry financing of student activities at their institution* |
6 (7%) |
32 (23%) |
38 (17%) |
Students’ overconfidence in their abilities* |
7 (8%) |
30 (22%) |
37 (16%) |
Previous student exposure to promotion* |
8 (9%) |
26 (19%) |
34 (15%) |
Other |
12 (13%) |
18 (13%) |
30 (13%) |
*pharmacy and medical differed, p<.05 chi-square analysis
Table 11a: Barriers to success versus total educational time
| |
Half day or less
n=69 |
4 - 9 hours
n=66 |
10 hours or more
n=89 |
Lack of integration into the curriculum |
36 (52%) |
29 (44%) |
32 (36%) |
Inadequate time allocation |
36 (52%)* |
23 (35%) |
34 (38%) |
Lack of continuation during clinical training |
32 (46%) |
24 (36%) |
33 (37%) |
Lack of interest from other university faculty |
30 (44%) |
23 (35%) |
22 (25%) |
Perceived irrelevance to students’ work after graduation |
16 (23%) |
12 (18%) |
19 (21%) |
Students’ desire to receive gifts from drug companies |
16 (23%) |
16 (27%) |
17 (19%) |
Students’ overconfidence in their abilities |
13 (19%) |
10 (15%) |
13 (15%) |
Pharmaceutical industry financing of student activities at their institution |
13 (19%) |
10 (15%) |
14 (16%) |
Previous student exposure to promotion |
7 (10%) |
10 (15%) |
16 (18%) |
Other |
10 (15%) |
8 (12%) |
11 (12%) |
*p<.05 vs. more than half a day (4-9 hours and 10 or more hours combined)
Table 11b: Reported barriers to success by region
| |
Europe
n=92 |
Americas
n=56 |
W. Pacific
n=31 |
Africa
n=20 |
S.E. Asia
n=20 |
E Medit.
n=9 |
Lack of integration into the curriculum |
33 (36%) |
25 (45%) |
15 (48%) |
8 (40%) |
10(50%) |
8 (89%) |
Inadequate time allocation |
30 (33%) |
24 (43%) |
17 (55%) |
10(50%) |
10(50%) |
3 (33%) |
Lack of continuation during clinical training |
40 (44%) |
20 (36%) |
11 (36%) |
6 (30%) |
10(50%) |
3 (33%) |
Lack of interest from other university faculty |
32 (35%) |
22 (39%) |
9 (29%) |
3 (15%) |
7 (35%) |
4 (44%) |
Perceived irrelevance to students’ work after graduation |
20 (22%) |
7 (13%) |
6 (19%) |
5 (25%) |
6 (30%) |
3 (33%) |
Students’ desire to receive gifts from drug companies |
16 (17%) |
16 (29%) |
8 (26%) |
3 (15%) |
7 (35%) |
0 |
Students’ overconfidence in their abilities |
18 (20%) |
12 (21%) |
4 (13%) |
1 (5%) |
2 (10%) |
0 |
Pharmaceutical industry financing of student activities at their institution |
13 (14%) |
11 (20%) |
7 (23%) |
4 (20%) |
2 (10%) |
1 (11%) |
Previous student exposure to promotion |
12 (13%) |
9 (16%) |
3 (10%) |
7 (35%) |
3 (15%) |
0 |
Other |
13 (14%) |
3 (5%) |
6 (19%) |
4 (20%) |
2 (10%) |
2 (22%) |
Table 11c: Comments on barriers to success
Africa |
Pharmacy |
Lack of placed value on importance of this subject
I do not perceive any barriers in my situation. From this survey I now have a few ideas that I can start implementing from this year and keep track of the progress we make |
Medical |
Threats from big pharma, big pharma funding other hospital charities, thus making it difficult to “restrict” their activities
Drug shortages leave practitioners with little choice from one given by promoters |
Americas |
Pharmacy |
We are a new school of pharmacy and just implementing a curriculum |
Medical |
The medical school especially post-graduate, actively undermines objective education by promoting opportunities for drug companies to subsidize morning Grand Rounds (coffee and donuts), noon rounds (“sponsored” lunches with drug rep in attendance) etc.
Lack of positive role modelling by other residents and attendants |
South-East Asia |
Medical |
We have not seriously thought about it
Lack of outcome measurement |
Europe |
Pharmacy |
The lack of pharmaceutical sales representatives involvement in teaching about promotion
Real world pressure after leaving the university
No barriers
Los alumnos piensan que todo esto es importante, pero les preocupa no trabajar o perder el trabajo. Por ello, es frecuente que alumnos con premisas claras en estos temas acaben inmersos en el sistema de promoción de la industria farmacéutica
Lack of student interest |
Medical |
The Administration has now started courses that are given by epidemiologists
Resignation of participants, society gives priority to company interests over public interests
Only one clinical pharmacologist at medical school!!!
Lack of interest with opinion leaders for practicing physicians
For the biopharmaceutical programme mentioned above, a barrier might be that most students imagine themselves as later employees of Pharma and therefore positively inclined towards industry. This doesn’t seem to be a major problem though.
Drug companies financing the activities of student and giving gifts after they graduate
Deficit of goodwill from authorities
Attitude of opinion leaders in the faculty |
Western Pacific |
Pharmacy |
Lack of critical appraisal skills, many students do not perceive what is a conflict of interest
Drug company contract research money |
Medical |
Students and residents see the effect of drug promotion by pharmaceutical companies on the prescribing practices and lifestyles of consultants, most especially the so-called “opinion leaders” in various specialty societies
Lack of guidebook or references for teaching
Inappropriate attitudes to drug promotion demonstrated by academics! |
Eastern Mediterranean |
Pharmacy |
There is no recognized effort at all levels to deal with this
There are other priorities to be studied by the stakeholders more important than the issue of promotion, e.g. quality assurance... |
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