Integrating Pharmaceutical-Supported Research Evidence in Residency Training

To the Editor: As residency program directors, we read with interest the recent article by David B. Merrill, M.D., et al. (1), published in the April 2010 issue of the Journal (1). This article highlighted a number of very important issues in resident education. As pointed out, pharmaceutical-industry-supported research has been playing an increasingly important role in academia, but most residency programs provide little or no training about the controversies and intricacies involved in these relationships (2). Although this area encompasses a number of core competence issues, such issues are not covered in most residency curricula (3). It is encouraging that the psychiatric field as a whole is moving away from this once cozy and awkward relationship with the big pharmaceutical companies, but it is important to introduce ways to educate future residents about the financial, ethical, and clinical implications of collaboration with the pharmaceutical industry on a consistent basis.

We recommend that involvement with pharmaceutical-supported research be an integral part of any resident training program. This can certainly be achieved through the participation of residents with an ongoing pharmaceutical-sponsored research project. However, in practice, these opportunities are limited outside of research-oriented training programs. These relationships can also be addressed in the didactics program for residents, preferably by a senior researcher who is knowledgeable about these relationships.

At the Delaware Psychiatry Residency Program, we have introduced lectures based on the empirical data of physician interactions with industry. Residents develop a better understanding about their biases and prescribing practices but also develop an appreciation of the ethical framework in which to evaluate physician contact and dealings with industry. In addition to the didactics highlighting these topics, residents have also visited a local pharmaceutical manufacturing facility with three senior faculty members. This opportunity not only provided them with the unique experience of learning about what is involved in medication development but also encouraged discussion about physicians' attitudes toward the drug industry.

Although most physicians participate only occasionally in company-sponsored trials, most see detailers and attend company-sponsored CME courses. Appropriate and ethical interaction with the pharmaceutical industry should be an integral part of psychiatry training.