This post was authored by Akhil Narang, MD, a fellow-in-training at the University of Chicago.

As a trainee in internal medicine it was rare for me to have any contact with the pharmaceutical industry. There were no representatives at breakfast passing out information sheets on medications. There were no industry-sponsored lunches or dinner lectures.

However, after starting my cardiology fellowship it has become apparent that a relationship with industry is more complex. After speaking to colleagues around the country, I’ve learned that it’s common (and arguably important) to have industry representatives present (at times) in the cath or electrophysiology labs. Whether it’s using a new atherectomy system for a complex percutaneous coronary intervention case or a novel ablation catheter, these representatives provide needed technical support for clinicians. In addition, they provide education to the fellows and the support staff.

As a fellow-in-training (FIT), there can be numerous points of contact with industry. Companies host multi-day courses (often for free) for trainees on a variety of topics including mechanical support for heart failure, basic electrophysiology, and interventional cardiology. Sponsored by industry, our attendings frequently lecture at local restaurants on the latest in lipidology, advances in heart failure, novel anticoagulants, and many other topics. Having attended several of these programs, fellows from every cardiology program in Chicago are typically in attendance.

As a medical student, I was cautioned against supporting events financially backed by industry. This mentality was widely accepted throughout residency as well. Now as a fellow I’m conflicted on how to navigate this matter. On one hand, many of the lectures and courses have an important role in furthering my education (and are seemingly free of bias). For example, I’ve attended programs by Chicago-area faculty on basic electrophysiology concepts and management of dyslipidemia that outwardly appeared to have no bias. These were outstanding fellow-level lectures that had no mention of the sponsoring company beyond the welcome remarks. On the other hand, exposure to industry in any capacity likely has an impact on future practice and prescribing habits.

There is little doubt that the billions of dollars invested by industry into research have led to key advances in the science and practice of cardiology. The plethora of educational programs offered to FITs and practicing cardiologists – both in the community and in academic centers – can be highly informational. As a fellow, it’s important to strike the right balance between benefiting from these educational experiences while being protected from unwanted marketing. At many institutions, including my own, companies can leave fliers in our conference room on industry-sponsored events but they cannot speak about their product at our conferences or e-mail us directly.

The involvement and exposure of fellows with industry is not straightforward any my feelings are ever evolving. Having benefited greatly from previous educational programs, I no longer subscribe to the mentality that trainees and clinicians should have absolutely no contact with industry. At the same time, if I do attend industry-events, I do my best to seek out events that don’t focus on a specific drug but rather a topic (i.e. hypertension). Furthermore, I’m more inclined to attend events if the speaker is known to me and I can confirm their talk is free from overt bias.

As trainees we are faced with negotiating this complex topic frequently. There are multiple ways to handle this issue and from my conversations with co-fellows and faculty, everyone feels differently. Few would disagree that fellowship should be a protected learning space that is free from bombardment by industry. At the same time, however, in the right setting, industry may meaningfully impact our education. The trick is to find the right balance.

View the ACC’s principles for relationships with industry here. Statements or opinions expressed on the Blog reflect the views of the contributor, and do not reflect the official views of the ACC, unless otherwise noted.

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