Ours is the first systematic study assessing the effects of complimentary food on attendance at MGR. We found that, compared with attendance during the pre-complimentary food period, MGR attendance during the complimentary food period was significantly greater. These results suggest that providing free food may enhance attendance at MGR. The survey administered at the conclusion of the study period adds to these findings. A majority of respondents indicated that they were more likely to attend MGR because of the complimentary food and that their attendance increased because of it (although, compared with residents and fellow respondents, fewer faculty respondents reported that their attendance at MGR increased as a result of the complimentary food).
A number of factors (eg, program content and barriers to attendance) affect physician attendance at CME activities . Survey data indicate that several barriers affect physicians' decisions to attend MGR, such as conflicting meetings, little presenter-attendee interaction, and inconvenient location . Likewise, survey data indicate that some institutions provide complimentary food in an attempt to improve attendance at MGR . Given that MGR occurs at noon at our institution, complimentary food not only removes a barrier (ie, by eliminating the need to choose between seeking food and attending MGR) but also adds an incentive for attending MGR (complimentary food). Some have described incentives as "the cornerstone of modern life" , and commonly acknowledged incentives for attending MGR, such as gaining new knowledge and CME credit, may not be sufficient for maintaining attendance. Although some view incentives negatively, incentives can be effective [5, 6, 8, 14]. Therefore, as one examines strategies to increase attendance at MGR, one should consider not only removal of barriers but also the effect of incentives.
Although providing complimentary food may be associated with increased attendance at MGR, it also increases the cost of conducting MGR, which, for many departments, is the most expensive conference to conduct . The cost of providing complimentary food at MGR at our institution is approximately $60,000 per year. To defray these costs, many departments, including ours, have garnered industry (eg, pharmaceutical) financial support [1–3, 15, 16].
Industry support of MGR raises the ethical concern of industry influence over MGR organizers, content, speakers, and attendees [1–3, 17, 18]. This concern can be addressed by using the following guidelines: 1) industry support should be unrestricted; 2) MGR speakers should disclose to attendees any conflicts of interest; 3) industry representatives should not determine MGR content; and 4) presentations at MGR should be unbiased, especially when the industry sponsor's products are discussed [3, 19, 20]. These guidelines are rigorously followed at our institution. Notably, our MGR attendees did not perceive inappropriate industry influence over the conference. However, measuring the influence of industry support by self-report may be biased. A recent study concluded that physicians' attitudes regarding industry support of CME activities may be biased (ie, those attending industry-supported activities are less likely to report bias than those attending non-industry-supported activities) .
Our study has several limitations. Although we used a prospective, before-and-after design, our study was neither randomized nor blinded. However, such a design would have been impractical. We could not control for or compare the quality of presentations during the 2 study periods, and, therefore, we do not know whether this factor contributed to an increased attendance at the MGR sessions. However, we compared attendance data matched for time of year to minimize bias (eg, related to holidays). Furthermore, advertisement of MGR did not change during the 2 study periods. We did not change the time of day or the day of the week that MGR was held during the study period. In addition, although our survey data suggest that faculty, fellows, and residents may behave differently in response to complimentary food as an incentive for attending MGR, we were unable to break down the attendance data according to attendee training status. Furthermore, we were unable to break down the attendance data by physician versus nonphysician attendees. Finally, although providing complimentary food at MGR at our institution was associated with increased attendance, our results may not be generalizable to other institutions. Likewise, care should be taken when applying our results to other educational activities. Future research should address these limitations.