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Commercial Influence and Learner-Perceived Bias in Continuing Medical Education

Steinman, Michael A. MD; Boscardin, Christy K. PhD; Aguayo, Leslie CCMEP; Baron, Robert B. MD, MS

doi: 10.1097/ACM.0b013e3181c51d3f
Academia-Industry Relationship

Purpose To directly examine the relationship between commercial support of continuing medical education (CME) and perceived bias in the content of these activities.

Method Cross-sectional study of 213 accredited live educational programs organized by a university provider of CME from 2005 to 2007. A standard question from course evaluations was used to determine the degree to which attendees believed commercial bias was present. Binomial regression models were used to determine the association between course features that may introduce commercial bias and the extent of perceived bias at those CME activities.

Results Mean response rate for attendee evaluations was 56% (SD 15%). Commercial support covered 20%-49% of costs for 45 (21%) educational activities, and ≥50% of costs for 46 activities (22%). Few course participants perceived commercial bias, with a median of 97% (interquartile range 95%-99%) of respondents stating that the activity they attended was free of commercial bias. There was no association between extent of commercial support and the degree of perceived bias in CME activities. Similarly, perceived bias did not vary for 11 of 12 event characteristics evaluated as potential sources of commercial bias, or by score on a risk index designed to prospectively assess risk of commercial bias.

Conclusions Rates of perceived bias were low for the vast majority of CME activities in the sample and did not differ by the degree of industry support or other event characteristics. Further study is needed to determine whether commercial influence persisted in more subtle forms that were difficult for participants to detect.

Dr. Steinman is staff physician, San Francisco VA Medical Center, and assistant professor of medicine, Division of Geriatrics, University of California, San Francisco, California.

Dr. Boscardin is assistant adjunct professor, Division of General Internal Medicine and Office of Medical Education, University of California, San Francisco, California.

Ms. Aguayo is administrative director, Office of Medical Education, University of California, San Francisco, California.

Dr. Baron is professor of medicine and associate dean for graduate and continuing medical education, University of California, San Francisco, California.

Correspondence should be addressed to Dr. Steinman, San Francisco VA Medical Center, Box 181-G, 4150 Clement St., San Francisco, CA 94121; telephone: (415) 221-4810, x3677; fax: (415) 750-6641; e-mail:

Editor's Note: A commentary on this article appears on page 9.

© 2010 Association of American Medical Colleges