Fulfilling the Mission of Academic Medicine: Training Residents in the Health Needs of Prisoners

Abstract

The single mission of academic medicine is the pursuit of health for all. This mandate serves as a reminder to focus care on vulnerable and underserved populations. The 12 million Americans who cycle through correctional facilities each year are arguably among the most vulnerable populations in this country; predominantly black, with a high burden of disease and many barriers to care after release. Medical training programs should provide exposure to the health needs of prisoners. Residents could establish care with inmates prior to release and arrange follow-up in the community. This addition to training would not only provide care to this underserved group, but also would train residents in the myriad problems prisoners face, and foster social responsibility.

Public Health and the Epidemic of Incarceration

“…All trainees, regardless of the branch of medicine or public health they intend to enter, may garner a greater sense of social responsibility and compassion for those they treat by direct contact with the most marginalized populations and the unique responsibilities this contact entails on the part of the researcher (88). The use of prisons and jails as training sites further allows trainees to be introduced to both the opportunities to reach large numbers of disadvantaged clients and the challenges, in the case of jails, of working with high-turnover populations.…”

The Impact of Incarceration on Obesity: Are Prisoners with Chronic Diseases Becoming Overweight and Obese during Their Confinement?

“…These studies and the state of correctional health around the globe are the reasons why public health professionals, researchers, and educators should have an interest in corrections and offenders. The health risks for individuals who are overweight or obese are clear, in that, these individuals are at much greater risk of developing conditions, such as hypertension, type 2 diabetes, coronary heart disease (CHD), and stroke, as well as mental health problems, such as depression, compared to their normal weight peers [ 6 , 7 ].…”

Ethics Students Go to the Jail

“…Results published in 2001 from a national survey that looked at correctional health care education in medical residencies [1], two articles that appeared more recently and discuss the merits and importance of partnerships between academic medical centers and correctional institutions [2,3], and our own literature and internet searches suggest that there is not widespread placement of health care trainees in correctional facilities. Nevertheless, we found descriptions of programs that provide trainees in various clinical professions-including medicine, nursing, and occupational therapy-the opportunity to learn and practice in a correctional setting [3][4][5][6][7][8][9][10].…”

“…For instance, they must learn to negotiate the conflicting demands inherent in caring for incarcerated persons while also respecting the need of the institution to maintain order and security through measures such as regimented medication management and restrictions on privacy [4,5,11]. Much of what trainees gain from working in correctional health care, however, is transferable to noncorrectional settings, including the learning that comes from managing a wide range of chronic conditions [2][3][4][5][6][7][8][9], providing care to a diverse and generally underserved population [2,4,[6][7][8], and negotiating relationships in which mistrust is a potential factor [4-6, 9, 12]. In this paper, we consider whether there are analogous benefits for clinical ethics students who rotate in a correctional facility.…”