Qualitative exploration of the medical learner's journey into correctional health care at an academic medical center and its implications for medical education

Training on Corrections and Health Within U.S. Academic Health Professions Education: A Scoping Review

Despite the scale, inequity, and consequences of mass incarceration, health care provider knowledge and awareness on correctional health remain limited. Understanding the educational experiences of health professions learners and the studies used to evaluate them can provide useful information about current gaps to guide future curricular improvement. To address this need, we conducted a scoping review of peer-reviewed studies examining United States-based academic health professions educational programs on correctional health. Studies were coded based on study characteristics, learner outcomes, and degree to which they contained elements described in relevant position statements by two professional medical associations. Overall, 27 articles (1975-2021) were included. Learner outcomes were primarily documented at the "reactions" (93%) and "learning" (52%) levels of the Kirkpatrick model (1979), relative to "behaviors" (11%) and "long-term outcomes" (0%). Comparison of curricula to select position statements revealed multiple content gaps in the realms of prevalent conditions requiring expertise (e.g., violence and self-harm); ethical and medical-legal considerations (e.g., privatization of correctional health care); and correctional health care systems, structures, and administration. Taken together, findings highlight gaps in, and opportunities for, correctional health educational programs. Addressing health care workforce training needs is a necessary yet insufficient step to achieving health equity for populations affected by incarceration.

Unlocking Silent Suffering: Addressing the Otorhinolaryngologic Needs of Incarcerated Persons Through Carceral Health Education

Mass incarceration in the United States presents major healthcare challenges, and otorhinolaryngology-related needs within carceral settings are underrecognized. Public health crises, as exemplified by the COVID-19 pandemic which led to over 3,000 deaths among incarcerated individuals, can intensify disparities. Both acute otorhinolaryngology conditions, such as craniomaxillofacial trauma, impending airway compromise, and life-threatening infection, as well as more chronic conditions such as cancer, sinusitis, or ear infections can lead to impaired quality of life, disability, or preventable mortality. Incarcerated individuals experience substantial healthcare disparities, which are driven by intrinsic individual and carceral facility factors such as resource scarcity, structural barriers, limited self-advocacy, and social determinants of health, as well as extrinsic factors related to societal misconceptions, inadequate education of healthcare providers on carceral healthcare, and underdeveloped care systems. To address these issues, a comprehensive approach is needed, incorporating experiential learning, bias reduction, and trust building. Early clinical exposure, enhanced public health education, and community outreach efforts are conducive to cultivating structural competence and relevant skills. Carceral health initiatives can thus raise awareness and enhance the healthcare of incarcerated individuals. Healthcare professionals can expand their roles to advocate for equitable care, prioritize rehabilitation over punishment, and support individuals upon reentry into society. Healthcare professionals in otorhinolaryngology, play a pivotal role in addressing the needs of incarcerated individuals, with nurses, physicians, and allied health stakeholders working together. Education, advocacy, and compassionate care provide the basis for a more equitable and humane carceral healthcare system that upholds the dignity and well-being of all individuals.

Medical educators' perspectives on the barriers and enablers of teaching public health in the undergraduate medical schools: a systematic review

Background

Having relevant public health content in the undergraduate medical curriculum is critical to preparing medical doctors for emerging health issues and increased public health roles. Medical educators are central to this effort.

Objective

This systematic review synthesises the most relevant and up-to-date evidence on medical educators’ perspectives regarding the barriers and enablers on incorporating public health teaching in the undergraduate medical curricula.

Methods

Seven databases were searched for articles published between 1 January 2010 and 31 December 2021. Articles were included if they were available in full-text English or Indonesian language, peer-reviewed, and focused on medical educators’ perspectives on teaching public health in the undergraduate medical curricula. Findings were integrated to answer the review question using thematic analysis.

Results

Twenty-nine articles were included in the final review. Three major themes emerged: (i) space in the medical curricula, (ii) confidence/capabilities of medical educators, and (iii) institutional support. Overcrowded curricula, lack of consensus about the scope and level of public health to incorporate into teaching, ensuring the quality and the relevance of content with what is required in real practice, as well as inadequate institutional support are major challenges in teaching public health to medical students.

Conclusions

Integrating public health into other subjects is largely seen as a solution. This requires strong institutional support in the form of financial, logistic, and technical support; structured training for medical educators on how to incorporate the content into their subjects; and a recognition of the important role that public health educators play.

Stakeholder-engaged research is necessary across the criminal-legal spectrum

People with lived experience of incarceration have higher rates of morbidity and mortality compared to people without history of incarceration. Research conducted unethically in prisons and jails led to increased scrutiny of research to ensure the needs of those studied are protected. One consequence of increased restrictions on research with criminal-legal involved populations is reluctance to engage in research evaluations of healthcare for people who are incarcerated and people who have lived experience of incarceration. Ethical research can be done in partnership with people with lived experience of incarceration and other key stakeholders and should be encouraged. In this article, we describe how stakeholder engagement can be accomplished in this setting, and further, how such engagement leads to impactful research that can be disseminated and implemented across disciplines and communities. The goal is to build trust across the spectrum of people who work, live in, or are impacted by the criminal-legal system, with the purpose of moving toward health equity.

Medical Students' Knowledge and Attitudes Regarding Justice-Involved Health

Despite the demonstrated need for sustainable and effective carceral health care, justice-involved medical education curricula are limited, and it's unclear if informal clinical education is sufficient. Investigators aimed to quantify medical student involvement with carceral populations and explore how students' knowledge of and attitudes towards justice-involved patients changed over the course of their training. A survey was designed by the investigators and sent to all current medical students at a single United States medical school. Stata 14.0 was used to compare results between the years of medical school. Differences between groups were tested using linear regression. Most 4th year students reported working in a carceral health setting. An increase in overall knowledge of justice-involved patients was observed as carceral medicine education (p_trend = 0.02), hours worked in a jail (p_trend < 0.01), and substance abuse training (p_trend < 0.01) increased. Overall attitude score increased with the students' reported number of hours working in a jail (p_trend < 0.01) and the amount of substance abuse training (p_trend < 0.01). Finally, we found a trend of increasing knowledge and attitude scores as the year of standing increased (p_trend < 0.01). Our data suggest that most USC medical students work in a carceral setting during medical school. Didactic and experiential learning opportunities correlated with improved knowledge of and attitude toward justice-involved patients, with increases in both metrics increasing as the year in medical school increased. However, senior medical students still scored poorly. These findings underscore the need for a formal curriculum to train our healthcare workforce in health equity for carceral populations.