The updated AMSA scorecard of conflict-of-interest policies: a survey of U.S. medical schools.

Daniel J Carlat,Reshma Ramachandran,Joseph S Ross,Teddy Fagrelius,Sallyann Bergh

doi:10.1186/s12909-016-0725-y

Abstract

BackgroundBest practices for conflict-of-interest (COI) policies in medical schools have evolved rapidly over the past decade, in part motivated by the American Medical Student Association (AMSA) scorecard that has publicly graded schools since 2007. This report describes the methodological update and impact of revisions to the scorecard in 2014.MethodsThe original AMSA scorecard (used annually from 2008 to 2013) was revised by a work group to improve its methodology and to increase the stringency of its criteria for scoring COI policies. All U.S. medical schools (both allopathic and osteopathic; n = 160) were invited to submit their COI policies to AMSA for scoring with the new scorecard; web site searches were used to acquire policy information for schools that did not submit. The authors developed a codebook and analyzed 14 distinct categories of COI policies, pertaining to activities such as industry-funded gifts, meals, educational events, site access for sales reps, and conflict-of-interest disclosure requirements. The analysis yielded four possible grades for each school: A, B, C, or I (incomplete). The authors compared 2014 grades with 2013 grades, and compared the distribution of grades of schools by type (allopathic vs. osteopathic) and geographical region.ResultsA total of 27 (16.9 %) medical schools scored A grades, indicating that their COI policies were strong, 81 (50.6 %) scored B, 25 (15.6 %) scored C and 26 (16.3 %) policies scored I. As compared to 2013, in 2014 fewer schools qualified for A grades (17.0 % vs. 26.0 %; p = 0.05). The grade distributions of allopathic and osteopathic schools were significantly different (p < 0.0001), with osteopathic schools more likely than allopathic schools to have incomplete policies. There were no significant grade differences by geographical region.ConclusionsThe revised 2014 AMSA scorecard, with its more stringent criteria for evaluating COI policies, assigned fewer As and more Bs and Cs than in years past. This was the first study to identify schools with COI policies stronger than those recommended in 2008 by the Association of American Medical Colleges. Developing more stringent COI policies should be helpful in reducing the influence of pharmaceutical and device industry marketing on both trainees and faculty in American medical schools.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0725-y) contains supplementary material, which is available to authorized users.

Highlights

Best practices for conflict-of-interest (COI) policies in medical schools have evolved rapidly over the past decade, in part motivated by the American Medical Student Association (AMSA) scorecard that has publicly graded schools since 2007
Influential were the recommendations published by the Association of American Medical Colleges (AAMC) which recommended the elimination, or strict regulation, of a variety of industry-funded activities, such as the provision of gifts and meals, continuing medical education (CME), speakers bureaus and the presence of sales representatives on campus [3]
Schools were invited to submit policies directly to AMSA, which were analyzed on a four-point scale from 0 to 3

Summary

Introduction

Best practices for conflict-of-interest (COI) policies in medical schools have evolved rapidly over the past decade, in part motivated by the American Medical Student Association (AMSA) scorecard that has publicly graded schools since 2007. Studies have shown that industry influence—whether in the form of gifts, commercially supported education, or visits with pharmaceutical representatives—can lead to more expensive and less evidence-based prescribing practices [2]. In response to these concerns, several national organizations recommended that medical schools create explicit guidelines for regulating the relationships between physicians and industry. In 2007, the American Medical Student Association (AMSA) began assessing medical schools’ conflict-ofinterest (COI) policies by reporting whether or not schools had developed such policies. In 2008, AMSA collaborated with the Pew Prescription Project to create a more elaborate scorecard which analyzed 11 COI policy domains, such as industry-funded gifts and meals, educational programs, and scholarships. Schools which did not respond to requests for policies received an automatic F, while those reporting that their policies were under revision scored a provisional I for in process

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