Executive Summary

Updated February 25, 2025
This document reflects school assessments as of the above date. For the most current assessments, please reference the main Scorecard page.

Why we need a Scorecard:

The American Medical Student Association (AMSA) introduced the first PharmFree Scorecard in 2007, with the 2016 Scorecard marking its eighth iteration. Since its launch, the AMSA Scorecard team has remained dedicated to objectively evaluating conflict-of-interest policies and curricula at the 173 allopathic and osteopathic medical colleges across the United States and Puerto Rico.

The Scorecard is a dynamic tool that assigns letter grades to assess schools’ performance in fourteen potential areas of conflict of interest. It provides a broad overview of the evolving landscape of conflict-of-interest policies in U.S. medical education, along with detailed evaluations of individual policies that regulate industry interactions among students, faculty, and the pharmaceutical and medical device industries.

While collaborations between academic physicians and industry contribute to advancements in medical research and treatment, they can also introduce biases into medical education, favoring specific products. Research has shown that industry influence—whether through gifts, commercially supported education, or meetings with pharmaceutical representatives—can lead to more costly and less evidence-based prescribing practices. Medical schools and academic medical centers have been at the forefront of establishing new standards for conflict-of-interest policies, following strong guidelines set by the Association of American Medical Colleges (AAMC) in 2008 and the Institute of Medicine in 2009. In 2012, The Pew Charitable Trusts furthered these efforts by assembling an expert task force from academic medical centers to develop updated recommendations for best practices in managing conflicts of interest.

AMSA revised its Scorecard to align with many of these recommendations, strengthening the criteria by which policies are assessed. With the upcoming release of a federal database detailing all financial relationships between physicians and industry, increased scrutiny of these interactions is more important than ever.

The latest Scorecard introduces three new categories that were not included in previous editions:

Extension of conflict-of-interest policies to community affiliates
Ghostwriting and honorary authorship
Enforcement and sanctions of policies

Additionally, site access for pharmaceutical sales representatives and medical device representatives is now evaluated as two separate domains.

Some institutions may see a decline in their grades this year due to the Scorecard’s heightened expectations for a conflict-free medical education environment. Even schools with strong policies may find it challenging to meet these aspirational standards. Through its Scorecard, AMSA aims to inspire institutions to adopt higher standards in conflict-of-interest regulation, reinforcing the commitment to unbiased medical education.

You can also download archives of the 2008, 2009, and 2010, and 2014 policy assessments.

Summary of Results:

As of September 1, 2016, 90 medical schools completed our submission form, confirming that their policies remained current or providing new policies for AMSA’s evaluation. This represented a 52% response rate, an increase from 48% in the 2014 Scorecard update. To maintain our role as a comprehensive database of U.S. medical schools, we also assessed non-reporting schools by searching publicly available documents online (see Methodology for details).

Of the 173 U.S. medical schools, 42 received an “A” (24%), 76 received a “B” (44%), 28 received a “C” (16%), and 28 were marked as Incomplete (16%). Schools’ conflict-of-interest policies generally fell into three major categories:

Excellent or model policies (A): At least half of the 14 conflict-of-interest domains met best-practice criteria (a domain score of 3 out of 3).
Good or solid policies (B): All 14 domains met the criteria for good practices (a domain score of 2).
Poor or deficient policies (C): More than one domain was rated as a poor practice (1).

Additionally, 28 schools (16%) received an “I” for Incomplete. These schools either did not submit policies, had incomplete policies based on our web search, or provided policies that did not cover all required domains. These institutions are encouraged to submit updated policy information to AMSA for a possible re-evaluation.

Trends and Analysis:

This year, the percentage of schools earning a top grade of A increased from 17% to 24%. In 2014, 67% of schools received either an A or B rating. This year, that percentage remains nearly the same at 68%, even with the inclusion of 12 additional schools in the Scorecard. Due to the more rigorous criteria applied in this year’s evaluation, fewer schools achieved an A or B compared to the previous year: In 2013, 72% of schools earned one of the top two grades, whereas in 2014, this proportion dropped slightly to 67%. This overall decline was entirely driven by a decrease in the number of A grades, from 40 in 2013 to 27 in 2014. However, the number of schools with solid B policies increased from 74 in 2013 to 81 this year.

As with the 2014 Scorecard, no school received a perfect score of 100. However, several institutions stood out for submitting exceptionally strong policies: Florida International University Herbert Wertheim College of Medicine, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Indiana University School of Medicine, and the University of Chicago Division of the Biological Sciences Pritzker School of Medicine. Each of these four schools received a total score of 96, meaning all but two of their policy domains met AMSA’s highest criteria.

B Policies on the Verge of Excellence

Many schools with solid B policies are close to achieving A status with relatively minor improvements. For instance, 13 schools that received a B narrowly missed an A rating because only six of their conflict-of-interest (COI) domains, rather than the required seven (half), earned perfect scores.

For these schools, making one of the following policy adjustments could elevate them from a B to an A:

Requiring faculty to disclose conflicts of interest directly to students and trainees
Mandating that faculty cover their own meal expenses during industry-supported continuing medical education activities
Discouraging faculty and trainee participation in industry marketing programs

Trends by Domain:

This year, all domains retained the same criteria from the 2014 Scorecard, allowing for year-to-year comparisons.

Two domains remained essentially unchanged from previous years, making direct comparisons possible: industry-funded promotional speaking and site access for pharmaceutical sales representatives.

Gifts: A perfect score requires a total ban on industry-funded gifts of any kind or value, including textbooks, even if funded indirectly through a department. Perfect scores in 2016: 94, up from 79 in 2014.
Meals: A perfect score mandates that no industry-funded meals of any kind or value are allowed, including indirectly funded meals provided during CME courses. Perfect scores in 2016: 42, up from 24 in 2013.
Industry-funded promotional speaking: A perfect score requires that faculty be prohibited from engaging in industry-sponsored promotional speaking. This domain has seen steady improvement since 2008. In 2016, 84 schools effectively banned faculty from participating in industry promotional speaker bureaus, up from 79 in 2014, 44 in 2013, 31 in 2011-12, 19 in 2010, 10 in 2009, and 4 in 2008.
Industry funding of CME: A perfect score requires no industry funding for accredited CME, except under strictly defined conditions, such as through a central, undesignated, blinded pool of funds. Perfect scores in 2016: 26, up from 5 in 2014.
Attendance at Industry-Sponsored Promotional Programs: A perfect score requires faculty, students, and trainees to be prohibited or strongly discouraged from attending promotional programs. Perfect scores in 2016: 32, up from 25 in 2014.
Scholarships: A perfect score requires schools to refuse industry funding for student conference attendance. Before 2014, industry funding was acceptable as long as the funder had no role in selecting recipients, leading to 123 schools receiving top ratings. In 2014, only three institutions had policies preventing industry funding. This year, more schools have strengthened their policies. Perfect scores in 2016: 16, up from 3 in 2014.
Ghostwriting and honorary authorship: A perfect score requires a strict prohibition of ghostwriting and honorary authorship. This domain was introduced in 2014, and many schools were found to have strong policies. Perfect scores in 2016: 113, up from 105 in 2014.
Consulting and Advising Relationships: A perfect score requires schools to prohibit or strongly discourage faculty from consulting or advising purely for commercial or marketing purposes. Perfect scores in 2016: 40, up from 25 in 2014.
Pharmaceutical sales representative access: Twenty schools now either ban site access for pharmaceutical sales representatives or have policies that effectively prevent them from engaging in marketing activities. This continues a positive trend from 9 in 2014, 4 in 2013, 2 in 2011-12 and 2010, and 1 in 2009 and 2008.
Medical device representatives: A perfect score permits representatives in patient care areas only for legitimate, non-marketing purposes, such as providing necessary technical assistance or training on already purchased equipment. Perfect scores in 2016: 105, up from 91 in 2014.
Disclosure: A perfect score requires both internal disclosure to the institution and external disclosure to trainees and audiences. Perfect scores in 2016: 65, up from 51 in 2014.
COI Curriculum: A perfect score requires a medical school curriculum that comprehensively covers the curricular content and objectives outlined in AMSA’s standards for a “model curriculum.” Perfect scores in 2016: 44, up from 34 in 2014.
Extension of COI policies to adjunct faculty and affiliated institutions: A perfect score requires policies to apply to all institutional employees, including full-time, part-time, volunteer faculty, students, and trainees, regardless of their worksite—even if that site does not follow the same policy. Perfect scores in 2016: 72, up from 50 in 2014.
Enforcement and sanctions: A perfect score requires general oversight to ensure compliance with policies, along with enforcement measures and sanctions for noncompliance. Perfect scores in 2016: 131, up from 126.

The following is a streamlined list of all 2014 domains and the number of schools receiving perfect scores in each:

Gifts – 94
Meals – 42
Industry-funded promotional speaking relationships (not ACCME-accredited) – 84
Industry-support of ACCME-accredited CME – 26
Attendance of industry-sponsored promotional events – 32
Industry-supported scholarships and awards – 16
Ghostwriting and honorary authorship – 113
Consulting and advising relationships – 40
Access of pharmaceutical sales representatives – 20
Access of medical device representatives – 105
Conflict of interest disclosure – 65
COI curriculum – 44
Extension of COI policies to community affiliates – 72
Enforcement and Sanctions of Policies – 131