Teaching resident physicians to work with the previously incarcerated patient

Abstract

Over 2 million adults in the United States are incarcerated and over 650,000 return to the community each year. This disparate population is known to have an elevated burden of chronic disease and lower socioeconomic status. Medical residency training about care for incarcerated or previously incarcerated patients is significantly lacking in the United States. Curriculum can be developed and implemented in residency programs to help physicians learn how to work with this population, be sensitive to their unique needs, and achieve positive health outcomes. This article describes a method for "educating the educators" based on a workshop presented at a peer-reviewed national conference during the fall of 2016. Attendees participated in exercises addressing assumptions, expectations, bias, and worldview and increased their ability for self-reflection when interacting with patients who are or have experienced incarceration. In this session, strategies were identified that engaged the patient with the goal to aid in patient retention and compliance. Future steps include development of a formal curriculum for training in this area, incorporation into existing community medicine rotations or electives, and establishment of structured transition clinics where residents can be exposed to this population on a more regular basis and improve their overall health outcomes.

Family Medicine Resident Education About Health Disparities Associated With Incarceration: A CERA Research Study

“…6 Individuals with diverse identities continue to be disproportionately represented, which additionally introduces both conscious and unconscious bias, further impacting the care provided upon reentry. 7,8 Residency training sites are often safety-net clinics that provide care to vulnerable population groups. Physicians and physicians in training must be educated about and mindful of these factors when providing medical care.…”

“…These patients can require a higher level of medical care coordination and understanding from their physician. 8 In 2001, 1,200 residency directors at primary care programs were surveyed about whether they offered training experiences or education about working with incarcerated or previously incarcerated patients. While only 14% reported offering instruction regarding this topic and 22% reported offering clinical experiences, a discordant 44% reported that their practices cared for these patients.…”