From leadership research to district action: Changes in U.S. medical school conflict of interest policies from 2014 to 2023

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Evidence and transfer

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Abstract Background Concerns about the influence of the pharmaceutical industry on medical education, ranging from education of students to professional development, have led professional societies to recommend regulation of interactions between industry and medical schools. The objective of this study was to evaluate conflict of interest (COI) policies at medical schools in 2023 compared to 2014. Methods This study used a cross-sectional design to evaluate the COI policies at the top 30 medical schools identified by US News and World Report rankings. The authors collected policies by survey and review of public websites, and assessed their quality across 15 domains informed by guidelines published by leading national organizations and previous PharmFree Scorecards. Each domain was graded on a 3-level scale derived from professional organization guidelines, which when totaled corresponded to the following letter grades: an “A” (score 38–45), “B” (32–37), “C” (25–31), and “I/F” (< 25). This study assessed industry payments to school leadership using the 2023 Open Payments database. Results Eleven of thirty medical schools submitted COI policies, and the remainder were analyzed based on publicly available information. No school received an “A,” 22 (73.3%) schools received a “B”, 6 (20.0%) schools received a “C”, and 2 (6.7%) schools received an “I/F”. Most schools had model policies around COI enforcement (29/30, 96.7%), gift acceptance (25/30, 83.3%), and ghostwriting (24/30, 80.0%). No schools had model policies in limiting direct faculty payments. When comparing 2014 and 2023 Scorecards over the shared 14 domains, 14 (46.7%) schools had a decrease in score, 11 (36.7%) schools had an increase, and 5 (16.7%) schools had no change. Faculty at every school accepted industry payments, including 20 (16.7%) deans and 52 (19.3%) of clerkship directors. Conclusions Medical school COI policies remain less stringent than consensus recommendations; thus, renewed attention to policies and implementation is needed to ensure bias-free medical education.

Study methods

This study used a cross-sectional analysis of COI policies of 30 medical institutions, chosen as the top ranked by the 2022 iteration of US News and World Report “Best Medical Schools: Research” list.[18] The report’s rankings are based on assessments by medical school deans and residency program directors, student scores, and federal research grants received.[20] We utilized the US News and World Report rankings to ensure consistency in the methodology between the prior and current iterations of the scorecard. Evaluation of COI policies included 14 domains from the 2014 AMSA Scorecard and one new domain: direct industry payments to faculty documented on Open Payments.[19] We then compared school policies in 2023 to those from 2014, overall and by individual domain. Similar to prior iterations of the AMSA Scorecard, this study did not require formal ethics approval due to the lack of human subjects, material, or data.[21]

Limitations

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A 90-day district inquiry

Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
Days 16–30 · Design. Select one recurring district decision. Publish the decision owner, evidence requirements, consultation process and appeal route; test the process on a bounded low-risk decision. Agree participation, privacy protections, baseline and stopping rules before starting.
Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
Days 61–90 · Decide. Track decision time, unresolved objections, documented reasons, appeals and access differences. Review whether the process changes who can participate and who carries the burden. Make a dated decision to stop, revise or extend the inquiry.

Board decision brief

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Attribution and reuse

Shamik Bhat; Devika A Shenoy; Magda Wojtara; Alissa Kainrath; Oak Sonfist; Jantzen Faulkner; Brianna Wang; Linnea Wilson; Timothy S Anderson. Changes in U.S. medical school conflict of interest policies from 2014 to 2023. PLOS One (2026-03-06). https://doi.org/10.1371/journal.pone.0344046

Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.