Date of Award

9-16-2010

Document Type

Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Elizabeth Claus

Second Advisor

Mark Schlesinger

Abstract

An ever increasing number of biomedical researchers and physicians are engaged in financial relationships with the pharmaceutical industry. One of the policies that has been most widely used to manage author conflicts of interest (COI) in academic literature has been the COI disclosure statement. It is assumed that such disclosures allow the reader to consider the authors potential for bias while evaluating a source. This study explored how medical students and residents use conflict-of-interest statements during internet-based searches for prescribing information, in the context of their overall information search behaviors. Methods: The sample consisted of 20 medical students and 5 internal medicine residents at an academic medical center. The subjects were given written clinical scenarios in which they were instructed to make a prescribing decision regarding a novel drug by searching the internet for relevant information (each case lasted 10-15 minutes.) Different levels of promptsthat encouraged subjects to consider author conflicts of interest during their information searchwere given to the subject groups: no prompting (Open), an author disclosure-containing article (Guided), and explicit instructions (COI Instruction.) The subjects were instructed to think aloud during all cases, and both computer screen activity and verbal comments were recorded with Morae software. Frequency of exposure to COI-containing sources and viewing of disclosure statements was analyzed, and thematic analysis was performed on the verbal transcripts. Results: None (0%) of the subjects spontaneously searched for or read author COI information, and subjects largely relied on abstract-level sources, of which the majority (77% overall) had corresponding author COIs disclosed in the full-text articles (22% of the abstracts had inaccessible author COI information.) When explicitly prompted to find and read COI disclosures, most medical students still failed to access full-text articles and locate the statements (disclosures were accessed in 27% of cases), while the majority of residents (in 60% of cases) successfully found the disclosures. The think aloud transcripts suggest that when subjects actually read the author disclosure statements, they express an impulse to discount or scrutinize the information more closely. Conclusions: Reading author COI disclosures is likely not part of the routine information search behavior of medical students and residents. If author disclosure statements will continue to be the mainstay of COI management, educational interventions should be implemented to train medical students and residents to more regularly read author COI disclosures and incorporate this information into their source evaluation. Journals should consider placing disclosure statements in a more prominent, accessible location in the article.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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