Conflict of interest policies at Belgian medical faculties: Cross-sectional study indicates little oversight

Abstract

Background Medical students encounter pharmaceutical promotion from the very start of their training. Medical schools have an important role to play in educating medical students regarding the interactions between healthcare professionals (HCPs) and industry and in protecting them from commercial influence and conflict of interest (COI). In 2019, medical student associations in Belgium and abroad called for more preparation in dealing with COI and for a more independent medical training. As little information is available on the situation in our country, we undertook an assessment of conflict of interest policies at Belgium’s medical schools. We relied on a methodology already used in studies from USA, Canada, Australia, France and Germany and adapted it to the Belgian context. Methods We identified 10 medical schools in Belgium. We searched the website of each medical school in November 2019 with standardized keywords for COI policies and learning activities on COI in the curriculum. The deans of medicine were invited to participate by sending us information that we could have overlooked during our web-based searches. We also consulted personal contacts within faculties among students and teachers. Based on a list of 15 criteria adapted from North American and French studies, we calculated a total for each faculty of medicine with a maximum score of 30 points. Results By December 2019, we had gathered a set of written documents for four faculties of medicine (40%) containing policies with varying degrees of precision and relevance to our survey. We found elements of the curriculum addressing the COI issue for one faculty (10%). In all cases, these policies consisted of “moderate” initiatives with little or no “restrictive” elements. Only one faculty showed interest in our study by providing us with relevant information (10%). Half of the faculty notified us of their refusal to participate in the study (50%) and the other faculties either did not respond or did not provide us with any information (40%). The maximum score obtained was 3 out of 30 points with six faculties scoring 0 (60%). Conclusion There is little transparency regarding interactions between medical students and pharmaceutical companies at Belgian medical faculties, which may create COI issues. Initiatives to protect students from pharmaceutical promotion and to train them to manage their future interaction with pharmaceutical companies have a limited scope and are isolated. This is inconsistent with international recommendations from Health Action International, World Health Organization or the American Medical Students’ Association. The Belgian government has legislated in favor of more transparency in the relation between HCPs and pharmaceutical industry. Indeed, it made the disclosure of benefits granted by the industry compulsory and limited their value. Our results show that there is still some way to go to ensure an independent medical training for future Belgian physicians.

Content and strength of conflict of interest policies at Scandinavian medical schools: a cross sectional study

“…This was instrumental in raising awareness on COI among academic institutions; for example, the media attention generated by the AMSA scorecard influenced the development of COI policies in several US medical schools [ 8 ] and the institutional scores have improved year after year likely due to these rankings. Moreover, the AMSA scorecard has since been adapted and used in similar studies conducted in Australia, Belgium, Canada, France, and Germany [ 9 – 13 ].…”

“…However, the majority of the studies were conducted in North America and little is known about COI policies at European medical schools apart from the three studies from Central Europe [ 9 , 11 , 13 ]. We therefore decided to investigate the content and strength of COI policies at Scandinavian medical schools.…”

Awareness and perception of pharmacy researchers about conflict of interest: A study from the MENA region

“…One way to improve COI management and reporting is to include the concepts of COI as an integral part of medical students’ undergraduate curriculum and education ( Andresen et al ., 2017 ; Bechoux et al ., 2021 ; Deis et al ., 2020 ), thus, avoiding COI cases among pharmacists who are likely to become future researchers and experts working with the drug industry. A previous study from Jordan showed that the majority of graduating-year pharmacy students were unaware of COI, which was related to the limited coverage of COI concepts in their pharmacy curriculum ( Ababneh et al ., 2020 ).…”

Conflict of interest policies at Australian medical schools

“…18 The US experience also attracted international attention, with subsequent studies on medical school COI policies conducted in Canada, Germany, France and Belgium. [20][21][22][23] A recent systematic review found extensive variation in COI policies at medical schools in high-income countries, with no published research in low-and middle-income countries. 24 The systematic review concluded that there was weaker oversight of COI in medical education in Europe than in North America.…”

“…Following this public attention, many academic institutions across the United States strengthened their COI policies 18 . The US experience also attracted international attention, with subsequent studies on medical school COI policies conducted in Canada, Germany, France and Belgium 20–23 . A recent systematic review found extensive variation in COI policies at medical schools in high‐income countries, with no published research in low‐ and middle‐income countries 24 .…”