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

Abstract

Correctional systems in several U.S. states have entered into partnerships with academic medical centers (AMCs) to provide healthcare for persons who are incarcerated. One AMC specializing in the care of incarcerated patients is the University of Texas Medical Branch at Galveston (UTMB), which hosts the only dedicated prison hospital in the U.S. and supplies 80% of the medical care for the entire Texas Department of Criminal Justice (TDCJ). Nearly all medical students and residents at UTMB take part in the care of the incarcerated. This research, through qualitative exploration using focus group discussions, sets out to characterize the correctional care learning environment medical trainees enter. Participants outlined an institutional culture of low prioritization and neglect that dominated the learning environment in the prison hospital, resulting in treatment of the incarcerated as second-class patients. Medical learners pointed to delays in care, both within the prison hospital and within the TDCJ system, where diagnostic, laboratory, and medical procedures were delivered to incarcerated patients at a lower priority compared to free-world patients. Medical learners elaborated further on ethical issues that included the moral judgment of those who are incarcerated, bias in clinical decision making, and concerns for patient autonomy. Medical learners were left to grapple with complex challenges like the problem of dual loyalties without opportunities to critically reflect upon what they experienced. This study finds that, without specific vulnerable populations training for both trainees and correctional care faculty to address these institutional dynamics, AMCs risk replicating a system of exploitation and neglect of incarcerated patients and thereby exacerbating health inequities.

‘You have to be almost dead before they ever really work on you in prison’: A qualitative study of formerly incarcerated women’s health care experiences during incarceration in Louisiana, U.S.

“…trauma‐informed care, addressing gender‐specific medical complaints, and conducting routine gynaecological exams and procedures for providers in women's facilities). Academic medical centres are increasingly incorporating special training related to caring for incarcerated populations into their curricula (Hashmi et al., 2021). The next generation of healthcare professionals may desire careers in carceral facilities, particularly if their training is informed by research and interaction with people who have been incarcerated.…”

“…Academic medical centres are increasingly incorporating special training related to caring for incarcerated populations into their curricula (Hashmi et al, 2021). Force, 2020), but ongoing structures to ensure health for incarcerated people must be codified.…”

Equitable Care for Pregnant Incarcerated Women: Infant Contact After Birth—A Human Right

“…Individual bias and institutional norms perpetuate stereotypes of incarcerated persons and propagate the idea of the “unworthiness” and “dangerousness” of an incarcerated mother 20–22 . Wardens, Departments of Corrections and hospital staff may internalize the belief that incarcerated women are more likely to harm their children.…”

“…Individual bias and institutional norms perpetuate stereotypes of incarcerated persons and propagate the idea of the "unworthiness" and "dangerousness" of an incarcerated mother. [20][21][22] Wardens, Departments of Corrections and hospital staff may internalize the belief that incarcerated women are more likely to harm their children. However, there are no documented cases of women who are incarcerated at the time of birth intentionally harming their newborns during the fi rst days of life.…”

Medical Students’ Knowledge and Attitudes Regarding Justice-Involved Health

“…Of these, several primarily trained residents, and most gave no mention of formal instruction in ethics, vulnerable populations, or structural causes of illness [10]. At one large Texas institution where nearly all medical students contribute to the care of incarcerated patients, authors discussed the difficulties that medical learners face when they are exposed to the harsh realities of care delivery behind bars without a curricular framework in which to scaffold their experiences [11].…”