Updated October 24, 2016; Additional updates will be published at the conclusion of the 2018 analysis
This document reflects school assessments as of the above date. For the most current assessments, please reference the main Scorecard page.
The American Medical Student Association (AMSA) launched the first PharmFree Scorecard in 2007 with the 2018 Scorecard being its ninth iteration. Since its inception, the AMSA Scorecard team has been committed to objectively evaluating conflict-of-interest policies and curricula at the 187 allopathic and osteopathic medical colleges in the United States and Puerto Rico.
The Scorecard is an evolving tool that uses letter grades to assess schools’ performance in fourteen potential areas of conflict of interest. It offers a comprehensive look at the changing landscape of conflict-of-interest policies across U.S. medical education, as well as in-depth assessments of individual policies that govern industry interaction between students, faculty, and the pharmaceutical and medical device industries.
While the relationships between academic physicians and industry benefit medical research and treatment, they can bias medical education in favor of specific products. Studies have shown that industry influence—whether in the form of gifts, commercially supported education, or simply visits with pharmaceutical representatives—can lead to more expensive and less evidence-based prescribing practices. Medical schools and academic medical centers have been leaders in setting new standards for policies on potential conflicts of interest, as supported by 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 continued this tradition by convening an expert task force of leaders from academic medical centers to create a new set of recommendations for best practices in conflict of interest policies at academic medical centers.
AMSA revised its Scorecard to reflect many of the recommendations of this task force. These changes represent an intentional strengthening of the standards of excellence with which policies are evaluated and scored. With the impending release of a federal database disclosing all financial relationships between physicians and industry, greater scrutiny of the appropriateness of these certain industry activities is particularly critical.
The new Scorecard adds three categories not present in prior years, including:
Moreover, Site access to pharmaceutical sales representatives and medical device representatives are now scored as two separate domains.
Some institutions will notice a decline in their grades this year, because the new scorecard envisions an ideal, conflict-free medical education environment—one that will not be easy for all medical schools, even those with good policies, to achieve. Through its Scorecard, AMSA seeks to encourage schools to adopt aspirational standards in conflict of interest regulation.
As of September 1, 2016, 90 medical schools completed our submission form indicating their policies were still current or submitting new policies to AMSA for Scoring. This was a 52% response rate, increased from 48% the 2014 Scorecard update. In order to continue our tradition of serving as a comprehensive database of U.S. medical schools, we nevertheless scored non-reporting schools by searching for publically available documents online (see Methodology for more details.)
Of the 173 US medical schools, 42 receive “A”s (24%), 76 “B”s (44%), 28 “C”s (16%), and 28 Incompletes (16%) In general, schools’ conflict of interest policies fall into three major categories of policy quality:
In addition, 28 schools (16%) received “I” for Incomplete. These were schools that either did not submit policies, and for which our web search yielded incomplete policies or schools that submitted policies that do not cover all domains. These institutions are encouraged to share updated policy information with AMSA for a possible re-grade.
This year, the percentage of schools receiving a top grade of A increased from 17% to 24%. In 2014, 67% of schools received either an A or B rating. This year, the percentage remains virtually unchanged at 68% even with the inclusion of 12 additional schools into the Scorecard. Consistent with the more stringent criteria of this year’s Scorecard, fewer schools received grades of A or B this year than last: In 2013, 72% of schools received the top two grades, whereas in 2014 this proportion dropped slightly to 67%. This overall decrease was entirely due to a drop off in the number of A grades (40 in 2013, and 27 in 2014). In fact, the number of schools with solid B policies increased from 74 in 2013 to 81 this year.
Similar to the 2014 Scorecard, no school received a perfect 100. Nonetheless, several institutions deserve particular attention for the submission of extremely 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 University of Chicago Division of the Biological Sciences The Pritzker School of Medicine. This year, these 4 schools each received a total score of 96 indicating that all but 2 domains were found to be consistent with AMSA’s top criteria.
“B” policies on the verge of excellence
Many of the solid B schools’ policies would reach “A” status with relatively minor improvements. For example, 13 “B” schools with particularly strong policies narrowly missed model status because only 6, rather than 7 (half), of their COI domains had perfect scores.
Depending on the school, one of the following relatively minor policy adjustments would propel them from a B to an A score:
This year, all domains retained the same criteria from 2014 Scorecard and therefore allow year to year comparisons.
Two domains were essentially unchanged from prior years and therefore allow year to year comparisons: industry-funded promotional speaking and site access for pharmaceutical sales representatives.
The following is a streamlined list of all 2014 domains and the number of schools receiving perfect scores in each: