Medical Education about the Care of Addicted Incarcerated Persons: A National Survey of Residency Programs

Abstract

In June 1998, there were 1.8 million inmates in correctional facilities for adults; 1.2 million in state and federal prisons and 600,000 in municipal/county jails (668 persons per 100,000 U.S. population). Rates of TB, AIDS, mental illness, and substance abuse are 2-13 times higher in persons living in jails and prisons. This study was designed to assess the level of training offered to residents in seven medical specialties in the care of addicted incarcerated persons. The study design involved two stages. The first entailed a mailed survey to 1,831 residency directors in family medicine, internal medicine, osteopathic medicine, pediatrics, obstetrics and gynecology, psychiatry, and emergency medicine. The second stage was a telephone interview, about substance use disorders, of faculty listed by the residency directors as teaching residents. The mailed survey was completed by 1,205 residency directors (66%). The 769 faculty from those identified programs, who participated in the telephone interview, reported that only 14% of their residency programs offered lectures or conferences on the care of incarcerated persons, yet 44% of the programs had residents caring for incarcerated persons with substance abuse problems, in a clinical setting. Only 22% offered clinical experiences for residents in a correctional facility.We recognize that our survey of correctional health and substance abuse training is limited, but as such, a greater number of respondents to our survey do not teach residents addiction medicine topics pertaining to prevention, evaluation, intervention, and management of the addicted criminal offender/patient in a correctional setting or give adequate clinical exposure to this special population. The data suggests a need to develop and implement educational programs on medical care for this high-risk and expanding population.

Effectiveness and Organization of Addiction Medicine Training Across the Globe

“…Of the 29 articles included in this review, nine studies reported on surveys on the need for addiction medicine training (table 1) [23,24,27,47,48,49,50,51,52]. These studies did not relate directly to the specific objectives of our study.…”

“…However, in almost half of other postgraduate medical training curricula, no time is allocated to topics related to addiction medicine [47]. All studies found that faculties consider addiction medicine training highly relevant, but at the same time report a lack of availability of adequate training programs [23,24,27,47,48,49,50,51,52]. …”

Medicine and Mass Incarceration: Education and Advocacy in the New York City Jail System

“…While select academic health centers have partnered with correctional systems, providing educational experiences in correctional health to nursing, social work, pharmacy and physician trainees, most academic health centers do not maintain such a relationship [14]. One survey found that only 14 percent of residency programs offered lectures or conferences on the care of incarcerated persons, and only 22 percent offered clinical experiences in a correctional facility [15]. Most experiences are offered as electives and not as required rotations [16].…”

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].…”