title: Big Pharma on the Farm: Students Are Exposed to Pharmaceutical Marketing More Often in Rural Clinics.
abstract: OBJECTIVE
  Pharmaceutical marketing techniques are effective in changing the behavior of health care providers in ways that deviate from evidence-based practices. To mitigate the influence of pharmaceutical marketing on learners, academic medical centers (AMCs) have adopted policies to limit student/industry interaction. Many clinical experiences occur outside of the AMC. The purpose of this study was to compare medical students' exposure to pharmaceutical marketing in off-campus rural and urban underserved clinical sites.
  
  
  METHODS
  The University of Washington School of Medicine Rural and Underserved Opportunities Program (RUOP) places rising second-year medical students in underserved clinical sites in five northwestern states. We surveyed RUOP students to evaluate their exposure to pharmaceutical marketing.
  
  
  RESULTS
  Of 120 students, 86 (72%) completed surveys. Sixty-five (76%) did their RUOP rotation in rural areas. Students in rural locations were more likely to report exposure to pharmaceutical marketing. Distribution of free drug samples was reportedly three times higher in rural than urban sites (54% versus 15%). Doctors meeting with sales representatives were reported as four times higher in rural clinics (40% versus 10%).
  
  
  CONCLUSIONS
  Students at rural sites reported exposure to pharmaceutical marketing more than those in urban settings. Rural medical educators should provide faculty development for community clinicians on the influences of pharmaceutical marketing on learners. Medical schools must review local clinic and institution-wide policies to limit pharmaceutical marketing exposure to learners in the rural learning environment.
authors.affiliation: Department of Family Medicine, University of Washington.
authors.forename: David V
authors.initials: DV
authors.lastname: Evans
authors.forename: Toby
authors.initials: T
authors.lastname: Keys
authors.forename: Laurel
authors.initials: L
authors.lastname: Desnick
authors.forename: C Holly
authors.initials: CH
authors.lastname: A Andrilla
authors.forename: Danielle
authors.initials: D
authors.lastname: Bienz
authors.forename: Roger
authors.initials: R
authors.lastname: Rosenblatt
mesh_terms: D001291:Attitude of Health Personnel; D002982:Clinical Clerkship; D016265:Conflict of Interest; D004345:Drug Industry / Q000379:methods*; D004501:Education, Medical; D004504:Education, Medical, Undergraduate; D037921:Gift Giving / Q000941:ethics; D006801:Humans; D007400:Interprofessional Relations; D040541:Marketing / Q000706:statistics & numerical data*; D011050:Policy Making; D019035:Rural Health Services / Q000706:statistics & numerical data*; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires; D014861:Washington