Establishing the need and identifying goals for a curriculum in medical business ethics: a survey of students and residents at two medical centers in Missouri

BMC Research Notes

James M DuBois¹  Kamal Gursahani⁴  Erin Bakanas²  Elena M Kraus³ 

[1] Division of General Medical Sciences, Washington University School of Medicine, 660 South Euclid Ave, Box 8005, Saint Louis MO 63110, USA;Department of Internal Medicine Division of General Internal Medicine, 12 South FDT, Saint Louis University School of Medicine, 1402 South Grand Blvd, Saint Louis MO 63104, USA;Bander Center for Medical Business Ethics, Saint Louis University, Salus Center 3545 Lafayette Ave, Saint Louis MO 63104-1314, USA;Department of Surgery, Division of Emergency Medicine, Saint Louis University School of Medicine, 3635 Vista Avenue at Grand Blvd, Saint Louis MO 63110, USA

关键词: Healthcare industry;    Business in medicine;    Graduate medical education;    Medical education;    Medical ethics;    Clinical ethics;    Professional ethics;    Medical business ethics;   

Others  :  1127299
DOI  :  10.1186/1756-0500-7-708

 received in 2013-09-16, accepted in 2014-08-06,  发布年份 2014

【 摘 要 】

Background

In recent years, issues in medical business ethics (MBE), such as conflicts of interest (COI), Medicare fraud and abuse, and the structure and functioning of reimbursement systems, have received significant attention from the media and professional associations in the United States. As a result of highly publicized instances of financial interests altering physician decision-making, major professional organizations and government bodies have produced reports and guidelines to encourage self-regulation and impose rules to limit physician relationships with for-profit entities. Nevertheless, no published curricula exist in the area of MBE. This study aimed to establish a baseline level of knowledge and the educational goals medical students and residents prioritize in the area of MBE.

Methods

732 medical students and 380 residents at two academic medical centers in the state of Missouri, USA, completed a brief survey indicating their awareness of major MBE guidance documents, knowledge of key MBE research, beliefs about the goals of an education in MBE, and the areas of MBE they were most interested in learning more about.

Results

Medical students and residents had little awareness of recent and major reports on MBE topics, and had minimal knowledge of basic MBE facts. Residents scored statistically better than medical students in both of these areas. Medical students and residents were in close agreement regarding the goals of an MBE curriculum. Both groups showed significant interest in learning more about MBE topics with an emphasis on background topics such as “the business aspects of medicine” and “health care delivery systems”.

Conclusions

The content of major reports by professional associations and expert bodies has not trickled down to medical students and residents, yet both groups are interested in learning more about MBE topics. Our survey suggests potentially beneficial ways to frame and embed MBE topics into the larger framework of medical education.

【 授权许可】

   
2014 Kraus et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Dana J, Loewenstein G: A social science perspective on gifts to physicians from industry. JAMA 2003, 290(2):252-255.
• [2]Campbell EG, Gruen RL, Mountford J, Miller LG, Cleary PD, Blumenthal D: A national survey of physician-industry relationships. N Engl J Med 2007, 356(17):1742-1750.
• [3]Bekelman JE, Li Y, Gross CP: Scope and impact of financial conflicts of interest in biomedical research. JAMA 2003, 289(4):454-465.
• [4]Wazana A: Physicians and the pharmaceutical industry: is a gift ever just a gift? JAMA 2000, 283(3):373-380.
• [5]Anderson E, Kraus E: Re-examining empirical data through the lens of personal narratives on living with conflicts of interest in medicine. Narrative Inquiry in Bioethics 2011, 1:2.
• [6]DuBois JM: Introduction: conflicting interest in medicine: stories by physicians on how financing affects their work. Narrative Inquiry in Bioethics 2011, 1(2):65-66.
• [7]Levy CJ: Doctor admits he did needless surgery on the mentally ill. In The New York Times. New York: The New York Times Company; 2003.
• [8]Armstrong D: Harvard Researchers Fail to Report Drug Payments. In Wall Street Journal. New York: The New York Times Company; 2008.
• [9]ᅟ: Family Doctor Charged with $400,000 Insurance Fraud. In The Associated Press State & Local Wire. Chicago: Associated Press; 2000.
• [10]Doctor sentenced for bilking insurance: Doctor Sentenced for Bilking Insurance. In The Associated Press, State & Local Wire. Chicago: Associated Press; 2002.
• [11]Institute of Medicine: Conflict of Interest in Medical Research, Education, and Practice. Washington, DC; 2009.
• [12]Association of American Medical Colleges: In the Interest of Patients: Recommendations for Physician Financial Relationships and Clinical Decision Making. Washington, DC; 2010.
• [13]Association of American Medical Colleges: Report of the AAMC Task Force on Industry Funding of Medical Education to the AAMC Executive Council. Washington, DC; 2008.
• [14]Korn D, Carlat D: Conflicts of interest in medical education: recommendations from the Pew Task Force on Medical Conflicts of Interest. JAMA 2013, 210(22):2397-2398.
• [15]Office of Inspector General, U.S. Department of Health and Human Services: A Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud and Abuse. Washington, DC; 2010.
• [16]Code of Federal Regulations: 42 Parts 402 and 403. Washington, DC; 2013. [Federal Register, vol. 78]
• [17]Zinner DE, DesRoches CM, Bristol SJ, Clarridge B, Campbell EG: Tightening conflict of interest policies: the impact of 2005 ethics rules at the NIH. Acad Med 2010, 85(11):1685-1691.
• [18]Austad KE, Avorn J, Kesselheim AS: Medical students' exposure to and attitudes about the pharmaceutical industry: a systematic review. PLoS Med 2011, 8(5):e1001037.
• [19]Swing SR: The ACGME outcome project: retrospective and prospective. Med Teach 2007, 29:648-654.
• [20]Roberts LW, Green Hammond KA, Geppert CMA, Warner TD: The positive role of professionalism and ethics training in medical education: a comparison of medical student and resident perspectives. Acad Psychiatry 2004, 28(3):170-182.
• [21]Taitsman JK: Educating physicians to prevent fraud, waste, and abuse. N Engl J Med 2011, 364(2):102-103.
• [22]Association of American Medical Colleges: Medical School Graduation Questionnaire: 2013 All Schools Summary Report. Washington, D.C; 2013.
• [23]Eckles R, Meslin E, Gaffney M: Medical ethics education: Where are we? Where should we be going? Rev Acad Med 2005, 80(12):1143-1152.
• [24]AMSA PharmFree Best Practice Policies. [http://www.pharmfree.org/campaign/best-practice-policies webcite]
• [25]Code on Interactions with Healthcare Professionals. Washington, DC: Pharmaceutical Research and Manufacturers of America; 2008:1-36.
• [26]Chimonas S, Kassirer JP: No more free drug samples? PLoS Med 2009, 6:5.
• [27]Baumgartner MR: Physician self-referral and joint venture prohibitions: necessary shield against abusive practices or overregulation? J Corp Law 1994, 19(2):313-352.
• [28]Chimonas S, Brennan TA, Rothman DJ: Physicians and drug representatives: exploring the dynamics of the relationship. J Gen Intern Med 2007, 22(2):184-190.
• [29]Steinman MA, Shlipak MG, McPhee SJ: Of principles and pens: attitudes and practices of medicine housestaff toward pharmaceutical industry promotions. Am J Med 2001, 110(7):551-557.
• [30]Soyk C, Pfefferkorn B, McBride P, Rieselbach R: Medical student exposure to and attitudes about pharmaceutical companies. Wis Med J 2010, 109(3):142.
• [31]DuBois JM, Kraus EM, Gursahani K, Mikulec A, Bakanas E: Curricular priorities for business ethics in medical practice and research: Recommendations from a Delphi consensus panel. BMC Med Educaccepted
• [32]Roberts LW, Warner TD, Hammond KAG, Geppert CMA, Heinrich T: Becoming a good doctor: perceived need for ethics training focused on practical and professional development topics. Acad Psychiatry 2005, 29(3):301-309.