Turkish Final Year Medical Students’ Exposure to and Attitudes Concerning Drug Company Interactions: A Perspective from a Minimally Regulated Environment for Medical Students

Interactions between drug companies and medical students may affect evidence-based medical practice and patient safety. The aim of this study was to assess drug company–medical student interactions in a medical faculty where limited specific national or institutional regulations apply between drug companies and medical students. The objectives of the study were to determine the exposure and attitudes of final year medical students in terms of drug company–medical student and physician interactions, to identify factors affecting those attitudes and to provide data for policymakers working on the regulation of interactions between drug companies and medical students. This anonymous questionnaire-based study of 154 medical final year medical students at the Karadeniz Technical University Medical Faculty, Trabzon, Turkey, in April and May 2015 attracted a response rate of 92.2% (n/N, 154/164). Exposure to interaction with a pharmaceutical representative was reported by 90.3% (139/154) of students, and 68.8% (106/154) reported experiencing such interaction alongside a resident. In addition, 83.7% (128/153) of students reported an interaction during internship. Furthermore, 69.9% (107/153) of students agreed that interactions influence physicians’ prescription preferences, while 33.1% (51/154) thought that a medical student should never accept a gift from a drug company and 24.7% (38/154) agreed with the proposition that “drug companies should not hold activities in medical faculties”. Students with rational prescription training expressed greater agreement with the statement “I am skeptical concerning the information provided by drug companies during interactions” than those who had not received such training, and this finding was supported by logistic regression [O.R.(C.I), p -3.7(1.2–11.5), p = 0.022]. Acceptance of advertisement brochures was found to significantly reduce the level of agreement with the proposition that “A physician should not accept any gift from a drug company.” (0.3[0.1–0.9], p = 0.030). In summary, exposure to drug companies was widespread among our final year medical students who, like students in both Western and non-Western societies, hold permissive attitudes concerning accepting gifts, and drug advertising brochures may relax those permissive attitudes still further. Rational prescription training was useful in generating rational attitudes. Policies concerning drug company–medical student relationships should be developed in Turkey as well as internationally.

制药企业与医学生之间的互动，可能会影响循证医学实践（evidence-based medical practice）与患者安全。本研究旨在评估某医学院校内的制药企业-医学生互动情况，该国针对制药企业与医学生之间的特定国家或院校级监管规范较为有限。本研究的目标为：明确土耳其特拉布宗市黑海技术大学医学院2015年4-5月的应届医学生，在制药企业互动与医师互动相关方面的暴露情况及态度，识别影响这些态度的因素，并为致力于制定制药企业与医学生互动监管政策的决策者提供数据支撑。本研究为基于匿名问卷的调查，共纳入该校164名应届医学生，最终回收有效问卷154份，有效回收率为92.2%（n/N=154/164）。90.3%（139/154）的学生报告曾接触过医药代表（pharmaceutical representative）；68.8%（106/154）的学生表示曾与住院医师一同参与此类互动。此外，83.7%（128/153）的学生称在实习阶段曾有过此类互动。69.9%（107/153）的学生认同"制药企业与医学生的互动会影响医师的处方偏好"这一观点；33.1%（51/154）的学生认为医学生绝不应接受制药企业的馈赠；24.7%（38/154）的学生赞成"制药企业不应在医学院校内开展活动"这一提议。接受过合理处方培训的学生，相较于未接受该培训的学生，更倾向于认同"我对互动过程中制药企业提供的信息持怀疑态度"这一表述，该结果经logistic回归（logistic regression）分析验证具有统计学意义[比值比(置信区间)：3.7(1.2~11.5)，p=0.022]。而接受过医药广告宣传手册的学生，对"医师不应接受制药企业的任何馈赠"这一提议的认同程度显著降低[0.3(0.1~0.9)，p=0.030]。综上，本研究中的应届医学生群体普遍存在接触制药企业的情况，与西方及非西方社会的医学生类似，该群体对接受馈赠持较为包容的态度，而医药广告宣传手册可能会进一步强化这种包容倾向。合理处方培训有助于培养理性的职业态度。土耳其及全球范围内均应制定针对制药企业与医学生关系的监管政策。