Medical Education and Communication Companies: How Ideal a Fit for Pharmacists?

A few years ago, I left a career in academia to accept a position with a medical education and communication company (MECC). I had never worked for an MECC before, but I had spoken with friends and colleagues who had taken similar jobs and seemed happy with their choices. I worked for the company as a medical writer for about a year, when I departed to join AJHP's editorial staff.

Given this experience, I was particularly interested in the commentaries in this issue written by pharmacists employed by MECCs.[1,2,3,4] The authors appear content with their jobs and believe that MECCs offer pharmacists a rewarding environment.[1] MECCs certainly extend a variety of job opportunities to pharmacists and others with advanced professional degrees. In fact, some of the brightest people I know work in such companies. However, there are challenges and occasional compromises associated with working in such settings.

Most MECCs are for-profit companies whose primary revenue source is the pharmaceutical industry. MECCs are very forthcoming about their business goals. During its sales pitch to potential clients, one MECC says it "never loses sight of the strategic value of its programs to enhance its client's corporate image and to strengthen brands."[5] Another company promotes itself as "putting the science of medicine to work for you. Preparing and building the market through professional education."

According to Relman and Angell,[6] medical education "requires an unbiased analysis of all the available evidence, led by experts who have no vested interest in the drugs that they are discussing." Yet an employee of an MECC works for clients with a decidedly vested interest in the prescription drug market. I was often reminded of this as a medical writer when I was asked to cast clients' products in a favorable light. This was easy to achieve for novel products with distinct advantages over other agents, but it became a struggle when the assignment involved a "me-too" drug with no apparent additional benefits beyond the competition.

Then there are the controversies surrounding ghost authorship, which is a service provided by most MECCs. Medical writers ghostwrite scientific articles, yet their act of writing is completely detached from their claim to authorship. When preparing a drug review, the medical writer conducts the literature search, retrieves and reviews the essential articles, organizes the relevant information, and drafts the entire manuscript. The authors listed in the byline are merely prominent clinicians who are paid an honorarium for the insertion of their names. In most cases they do little more than take a last-minute look at the completed manuscript. The real author's contributions are rarely acknowledged. As an editor, I have had the occasional experience of contacting the person listed as the corresponding author, only to be referred to the anonymous medical writer who actually wrote the paper.

Some pharmacists may feel that such misappropriation of authorship undermines the integrity of the biomedical literature. Why hide the medical writer's contributions, especially if he or she is commissioned by a company with a commercial interest in the paper? After all, aren't the editors and readers of biomedical journals entitled to honesty in medical writing?

More than 100 MECCs operate in the United States today.[1] Most of them offer pharmacists interesting opportunities and competitive salaries and benefits. However, working for an MECC may not be an ideal fit for every pharmacist. Some will become disillusioned once they learn about the challenges and compromises involved.

Erie School District to buy former medical building for new home for administration

Erie School District says new administration building will be better for public

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The Erie School District is ready to buy a building to replace its 113-year old administration building at West 21st and Sassafras streets.

The offices will not move far. The district has reached a deal to buy a former medical offices building at West 19th and Sassafras streets, two blocks north of the current administration building.

The purchase price for the 20-year-old building is $2.8 million.

The Erie School Board authorized Erie schools Superintendent Brian Polito to pursue the deal, and the board is expected to approve the purchase at its monthly meeting on Wednesday night at East Middle School. The proposed deal is on the agenda, posted on Friday.

The purchase, if approved, will break the district's trend of selling buildings to raise money and to get surplus property off its books. But Polito said the deal makes financial sense for the district.

The district's architects estimate that renovating the current administration building would cost $13 million, according to district records. Polito said he and his staff looked into buying the former medical building as they were looking for alternatives to the costly repairs to the current building.

"This is an opportunity for us to save the district millions of dollars and move into a better building," Polito said.

Among other things, the current building needs a new roof, a new heating and ventilation system and repairs to a retaining wall on the north side of the building. The new HVAC system would cost $2.5 million and the new roof and repairs to the retaining wall $1 million each, for a total of $4.5 million for those three areas alone, according to district records.

The district is still exploring how much it will need to spend to make adjustments to the medical offices building, district officials said. But the cost of buying the medical offices building and altering it will be much less than renovating the current administration building, Polito said. The savings could be as much as $3.5 million to $5 million, according to the district.

"This move is going to save us millions of dollars rather than doing a renovation" of the current building, Polito said.

He said the district wants to move the offices to the new location sometime within the first three months of 2024.

The Erie School District is buying the building from an entity called ARHC SMERIPA01 LLC, based in New York City. It is subsidiary of a company called Healthcare Trust Inc., according to records with the federal Securities and Exchange Commission.

ARHC SMERIPA01 bought the building for $6.1 million in 2015, according to Erie County exam records. Until several years ago, the building housed medical offices affiliated with Allegheny Health Network, which includes Saint Vincent Hospital in Erie.

The medical offices building is 28,500 square feet, according to exam records. The Erie School district lists the square footage of its current building at 42,000.

The current building was never designed to be an office building, however. It opened in 1910 as the Erie School District's Washington School. It closed in 1976 and was sold to different owners before the school district repurchased it in 1999 for $1.2 million, plus another $200,000 for computers and furniture already in the building.

The district bought the building from Saint Vincent Health Center in 1999. Saint Vincent bought the building in 1982 and operated its school of nursing there.

The district needed the building for a new administration building. In 1999, it sold what had been its administration building, a former bowling alley at 1511 Peach St., to a group of social service agencies led by Perseus House. That sale price was $550,000, according to exam records.

The school district undertook a number of structural changes at the current administration building, but the layout is still limited by the building's original use as a school. Polito said the new building, which features a large amount of glass, is more open and better for visitors.

"It is a good option for us," Polito said.

"The best part is that the public will able to access child accounting, special education departments much easier because of the way that building is laid out," said Neal Brokman, the assistant superintendent who handles building issues for the Erie School District. "There is ample parking. It overall will be a better opportunity for us as a district as well as the public."

The Erie School District had planned to renovate the current administration building as part of Polito's plan, launched in 2018, to make all the district's schools and other buildings "warm, safe and dry." The district had already planned to set aside money in its budget for improvements to the current building, but at the estimated cost of $13 million, Polito said.

The 10,000-student district had neglected its buildings for years as it struggled to stay financially solvent.

The situation changed in 2017, when the state General Assembly approved an additional state allocation of $14 million per year for the district going forward. That funding boost as well as other increases in state funding has allowed the district to end its financial crisis and start investing in its educational programs and buildings.

Under Polito's plan, the district has renovated a number of schools, including Erie High School, where the work is ongoing. The district is also building a new school to replace the aging Edison Elementary School on East Lake Road.

And though the building plans always called for the renovation of the current administration building, it has been focusing on the schools.

"Part of the reason it is falling apart is that we intentionally put money into our schools first," Polito said.

The Erie School District plans to put its current administration building on the market soon after the district completes the purchase of the new building, Polito said. The current property includes parking lots, including a large unpaved overflow lot east of the building, toward Peach Street.

The building will be the last the district expects to have on the market for years to come.

The district in 2017 launched a plan to sell six unused properties. The last of those six properties on the market was the former Irving School, the sale of which the School Board is also scheduled to approve at Wednesday night's meeting. The district closed Irving School in 2012 due to declining enrollment.

The administration building will become the district's final unused property once the Irving sale goes through.

In its most recent sale, the School Board in February approved a deal to sell the former Burton School to the Urban Erie Community Development Corp. for $110,000.

Selling Burton School: Erie School Board OKs deal for neighborhood nonprofit to buy, revamp former Burton School

The district closed Burton, across from Rodger Young Park on Buffalo Road, at the same time as it closed Irving, also due to declining enrollment. Burton opened in 1894, making it one of the school district's oldest buildings.

Irving opened in 1897. It covers 60,000 square feet and sits on approximately 2.3 acres at 2310 Plum St., just east of Washington Park. The school district also owns 1.77 acres, including a softball field, next to the school.

The School Board on Wednesday night will vote on two deals, according to the agenda. One is for the sale of the Irving property to Secured Storage LLC, an Erie self-storage business, for $150,000. Secured Storage in May got a zoning variance to operate in the neighborhood, which is zoned R-2, for medium density residential.

The other is deal is for the sale of the softball field to Erie Homes for Children & Adults, for $109,000. EHCA builds and manages group homes.

Selling Irving School: Zoning variance OK'd for self-storage business to operate at Erie's former Irving School

The school district had been asking as much as $449,000 for the Irving property. Several other offers fell through, and Polito said selling the property now is best for the district given the general lack of interest in the property from prospective buyers. He also said the district has discussed with EHCA the neighbors' desire to preserve green space near Irving School.

"They are very well aware of the neighbors' concerns," Polito said.

Contact Ed Palattella at epalattella@timesnews.com. Follow him on Twitter @ETNpalattella.

This article originally appeared on Erie Times-News: Erie School District to buy former medical building for new home for administration

NMC releases final Graduate Medical Education Regulations 2023, check out details

New Delhi: Introducing changes in the undergraduate medical education system, the Graduate Medical Education Regulations, 2023 have finally been published in the official Gazette by the National Medical Commission (NMC).

Publishing the Regulations, the Undergraduate Medical Education Board (UGMEB) of NMC mentioned, "In exercise of overall powers conferred by the National Medical Commission Act, 2019 vis-à-vis medical education in general and specifically by sub-section (1) of section 24; and sub-section (h), (i), (j), (k), (o), (p), (p), (q), (r), (s) of sub-section (2) of section 57 of the said Act, the National Medical Commission makes the following Regulations...These Regulations may be called the “Graduate Medical Education Regulations, 2023” or “GMER-23” in its abbreviated form."

"These Regulations shall come into force from the date of their publication in the official Gazette," mentioned the official Gazette notification dated June 2, 2023.

Introducing the draft in the public domain on February 27, 2023, NMC earlier invited comments from the public and stakeholders in this regard and asked them to share the comments within 30 days.

Also Read: Following NMC Draft Proposal, Govt Considering Common Counselling for admission to MBBS, PG medical courses: Report

These new regulations have addressed the skills expected of a scholar graduating UG Medical Education, the duties of medical universities to partner with NMC, maintenance of proper records by the universities and institutes, development of strategies for optimal utilization of evolving technology etc.

Apart from this, NMC in the draft also discussed about the admission, counselling and migration process involving the UG medical admission including the conduct of NEET UG, the eligibility criteria, break of tie-in marks of NEET UG, common counselling, and student migration.

Besides, the minimum standards of requirements for medical education, competency based dynamic curriculum at undergraduate level, training period and maximum duration of UG medical students, choice-based credit courses, mandatory internship, faculty development programme, student welfare- all these issues were also included in the draft regulations.

These drafts have now been published in the official Gazette along with some relevant changes. Some of these major changes include a doubling of the amount of penalty for medical colleges in case of backdoor entries. In the draft, NMC had specified that medical colleges violating the norms for MBBS admission shall have to pay a huge fine ranging from Rs 50 lakh to Rs 1 crore per seat.

However, in the final version of the Regulations that have been published in the Gazette it has been mentioned that medical colleges violating the norms for admitting MBBS students will be fined Rs one crore to Rs two crore for the first two instances of non-compliance.

Another major change has been introduced in the case of student migration as well. While the draft allowed migration from a government medical college to a government institute and from a non-government (private) medical college to a non-government institute, the final rules specify that students will not be allowed to migrate from one college to another.

The final provisions of the Regulations, as published in the official Gazette, are as follows:

It has been mentioned in the Regulations that the Graduating Medical Scholar shall be able to-

1) Apply the gained knowledge and skill to ensure health for all to the maximum extent possible.

2) Achieve competence in the holistic practice of medicine encompassing promotive, preventive, curative and rehabilitative aspects of common diseases.

3) Develop a scientific temper, acquire education experience for proficiency in the profession and promote healthy living.

4) Appreciate the socio-psychological, cultural, economic, and environmental factors affecting health and develop a humane attitude towards the patients in discharging one‟s professional responsibilities.

5) Possess the attitude for continued self-learning to seek further expertise and to pursue research in any chosen area of medicine, research, and documental skills.

6) Acquire basic management skills in human resources, materials and resource management related to health care delivery, general hospital management, principal inventory skills and counselling.

7) Able to work as a leading partner in healthcare teams and acquire proficiency in communication skills.

8) Develop personal characteristics and attitudes required for professional life such as personal integrity, sense of responsibility and dependability and ability to relate to or show concern for other individuals.

9) Become an exemplary citizen by observing the highest standards of professional ethics and working towards fulfilling social and professional obligations to respond to national aspirations.

10) Evolution of medical education is aimed at making it more learner-centric (rather than pedagogic), patient-centric, gender-sensitive, outcome -oriented and environment appropriate. The result is an outcome-driven curriculum which conforms to global trends. Emphasis is made on the alignment and integration of subjects both horizontally and vertically while respecting the strengths and necessity of subject-based instruction and exam. This has necessitated a deviation from using “broad competencies” to end-of-phase subject (sub) competencies.

11) The importance of ethical values, responsiveness to the needs of the patient and acquisition of communication skills is underscored by providing dedicated curriculum time in the form of a longitudinal program based on Attitude, Ethics and Communication (AETCOM) competencies. Emphasis has been placed on collaborative and inter-disciplinary team work, professionalism, altruism and respect in professional relationships with due sensitivity to differences in thought, social and economic position and gender.

"WHEREAS the Institutions imparting graduate medical education shall continually work to synchronize the institutional goals with the national goals to produce the kind of trained manpower with higher knowledge, appropriate skills and impeccable ethical standards required," it further mentioned.

Duties of Medical Institutes & Universities:

According to the Regulations, the medical institutes/ Deemed to be Universities will partner with NMC to-

a. Implement an appropriate curriculum to provide high-quality and affordable undergraduate medical education to the student to make him a complete Bachelor of Medicine and Surgery, and a competent Physician of the first contact.

b. To provide training in clinical and practical skills along with theoretical knowledge, an emphasis upon attitude, ethics, and communication skills to ensure imparting competency-based medical education.

c. Encourage students towards self-directed learning, which will impart an adequate basic knowledge of human health, including the knowledge from indigenous systems of healthcare in India; Yoga and healthy living aspects are introduced during their training to develop harmony, and peace, relieve stress and alleviate depression amongst students.

d. Encourage students to take up skill training in the subjects and areas of their choice, which shall stimulate their logical and scientific thinking, and problem-solving at the community level and individual levels.

e. Encourage the students to achieve and maintain the highest ethical standards in training and profession.

f. Provide periodic and transparent exam of medical education being imparted by Medical Institutions across the nation to meet with highest global standards.

g. Inspire confidence in the students to handle emergencies and calamities at all levels.

"Without prejudice to the above, the concerned medical institutions/ Deemed to be Universities shall ensure that proper records of the work shall be maintained so that they form the basis of objective, efficient and transparent internal exam of students;

Provided further that, these maintained and well-classified documents shall be made available for consultation at all times, particularly for the purposes of exam of the Medical College either by the concerned University or NMC," further mentioned the Regulations.

"The concerned University shall encourage the Medical Colleges to offer optimal number and variety of choice-based credit courses which shall traction the medical education in producing the outcomes of a medical graduate, as identified by these Regulations," it added.

Admission, Counselling & Migration:

Conduct of NEET-UG:

GMER-23 Regulations mention that either the National Medical Commission may conduct the NEET-UG or may designate any such agency or authority by whatever name called, to cause the NEET-UG to be conducted, provided NMC may designate multiple agencies or authorities, to conduct NEET-UG if such deployment suits the overall purpose.

"The UGMEB shall determine the language, manner and modalities etc., of conducting the NEET-UG by way of Notification;

Provided that, the UGMEB shall notify with reasonable lead time when it decides to change its policies with regard to the conduct of NEET-UG so that aspiring students are not put to detriment," the regulations specified.

Eligibility criteria:

According to the Regulations, no student shall be eligible to pursue graduate medical education either in India or elsewhere (if they want to return and practice in India), except by scoring the minimum eligible score at the NEET- UG exam.

"Provided the UGMEB shall by notification announce the list of eligible students from time to time," it added.

Break of tie-in marks at NEET-UG:

The regulations mention that "In case of tie-in marks of the students appearing for NEET-UG, the respective marks obtained in Physics followed by Chemistry and further followed by Biology in the NEET- UG shall be considered; Provided if the tie were to continue, then draw of lots by using the computer, with no human intervention, the eligible candidates shall be selected."

Eligibility criteria for taking NEET-UG:

It has been mentioned in the Regulations that no aspirant shall be allowed to appear in the NEET-UG-

a. unless he has completed the age of 17 years as on or before 31stJanuary of the year that the candidate shall be appearing for NEET- UG examination; and

b. Has passed 10 +2 (or equivalent) with subjects of Physics, Chemistry Biology/ Biotechnology and English.

Common Counselling:

"Without prejudice to anything stated in the present Regulations or other NMC Regulations, there shall be common counselling for admission to graduate courses in medicine for all Medical Institutions in India based on the merit list of the NEET-UG," mentioned the Regulations.

"Counselling shall entirely be based on the seat matrix provided by National Medical Commission; Provided the common counseling may have multiple rounds as may be necessary," it added.

Conduct of Common Counselling:

According to the Regulations, the UGMEB shall publish guidelines for the conduct of common counselling, and the designated authority under section 17 below shall conduct the common counselling in conformity with such published guidelines.

"The Government of India will decide and notify the agency and method of counseling of all undergraduate seats," it mentioned.

Penalties for Admission any other way than Counselling:

Strictly barring any student from taking admission in any other way than counselling, the GMER-2023 mentioned, "No medical institute shall admit any candidate to the Graduate Medical Education course in contravention of these regulations; Provided the Medical Institution granting admission to any student in contravention of these Regulations, shall be liable to be fined Rupees one crore or fee for the entire course duration, whichever is higher, per seat for the first time and for the second time of non-compliance, Rupees two crore or double the amount of fees for the entire course duration whichever is higher per seat, and for any subsequent non-compliance or continued contravention the Medical Institution shall be barred from granting admissions to any student from the next academic year..."

"Provided further that such Student admitted in contravention of this mandate shall be discharged from the Medical College and double the number of seats shall be reduced for one or more years," it further added.

Submission of the final list:

The regulations mentioned, "The respective designated authorities (who have conducted the common counselling) shall submit the final list of students in the prescribed proforma to the UGMEB within one (01) week of the completion of the common counselling, which in turn shall publish that list in the NMC website.

Provided each institution shall also submit the final list of students admitted, in the prescribed proforma as detailed in the MSR, to the UGMEB within one week of the last date of the joining course, declared by the UGMEB;"

"Provided only those Medical Institutions that were permitted to admit the students prior to the date of Notification of common counselling are allowed to admit students, and the Medical Institutions getting requisite permission later to the date of Notification of common counselling shall participate in the next academic year‟s common counselling to admit students," it added.

Explanation: requisite permission shall also apply mutatis mutandis for the increase of seat strength in medical institutions already established.

Student migration:

Putting a stop to student migration, the new regulations clarified, "No student designated to a Medical Institution, notwithstanding anything stated in these regulations, shall seek migration to any other Medical Institution."

Minimum Standards of Requirements (MSR) for Medical Education:

"Medical Institutions shall follow the guidelines for minimum standards of requirements (MSR) for undergraduate medical education prescribed by the UGMEB of NMC from time to time," mentioned the Regulations.

Competency-Based Dynamic Curriculum at Undergraduate Level:

Curriculum:

According to the Regulations, "...the UGMEB shall publish the model curriculum and the outcome objectives of the same from time to time on the NMC website, which shall form the base for the development of a detailed medical curriculum by the concerned Universities, along with the appropriate methodology to impart meaningful education."

"The details of the requirements shall conform to the prescribed standards. These standards are subject to modification from time to time with the changing healthcare scenario," it added.

Training Period and Maximum Duration:

Every student admitted in accordance with these Regulations, shall undergo training as per the guidelines published by the UGMEB of NMC and displayed on the NMC website from time to time;

Provided under no circumstances the student shall be allowed more than four (04) attempts for first year (First Professional MBBS) and no student shall be allowed to continue undergraduate medical course after nine (09) years from the date of admission into the course, mentioned the Regulations.

Choice-based credit courses:

The Regulations specified that there shall be a variety of choice-based credit courses of limited duration offered by the Medical Institutions in addition to the NMC curriculum and the curriculum prescribed by their respective University to their graduating students without hampering the medical graduate curriculum;

Provided the meaningful imparting of these choice-based credit courses shall be given due weightage, while accreditation and rating of the Medical Institutions by the Medical Assessment and Rating Board of NMC.

Internship:

"The student admitted into a Graduate Medical Education Programme shall not be deemed to have completed his graduation until he completes his rotating medical internship as per Compulsory Rotating Medical Internship Regulations, 2021," the regulations mentioned.

Faculty Development Program:

"The new curriculum training requires the teaching faculty to understand and apply the concepts of group dynamics in teaching students, team building exercises, and small group teachings, encourage the students towards self-directed learning and enhance their skills to become team leaders at the primary health care level. These training skills shall be imparted through various programmes as described in the guidelines to be notified from time to time," the regulations added.

Student Welfare:

The student welfare is central to good learning atmosphere. The issues related to ragging disrupt student's well- being. Hence, students are expected to abide by Prevention and Prohibition of Ragging in Medical Colleges and Institutions Regulations, 2021;

Provided that there shall be an elected student association and representation of students in decision making by the Medical College/ Institution affecting student welfare, mentioned the new regulations.

To view the notice, click on the link below –

https://medicaldialogues.in/pdf_upload/graduate-medical-211503.pdf

Also Read: New NMC Regulations spell out Harsher Penalties for Backdoor MBBS admissions in medical colleges