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

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dc.contributor.authorHashmi, Ahmar H.en
dc.contributor.authorBennett, Alina M.en
dc.contributor.authorTajuddin, Nadeem N.en
dc.contributor.authorHester, Rebeccaen
dc.contributor.authorGlenn, Jason E.en
dc.contributor.departmentScience, Technology, and Societyen
dc.date.accessioned2020-12-07T14:12:49Zen
dc.date.available2020-12-07T14:12:49Zen
dc.date.issued2020-10-19en
dc.description.abstractCorrectional 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.en
dc.format.mimetypeapplication/pdfen
dc.identifier.doihttps://doi.org/10.1007/s10459-020-09997-4en
dc.identifier.eissn1573-1677en
dc.identifier.issn1382-4996en
dc.identifier.pmid33074443en
dc.identifier.urihttp://hdl.handle.net/10919/101025en
dc.language.isoenen
dc.rightsCreative Commons Attribution 4.0 Internationalen
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.subjectAcademic medical centersen
dc.subjectAttitudeen
dc.subjectCurriculumen
dc.subjectGraduate medical educationen
dc.subjectPrisonersen
dc.subjectStandard of careen
dc.subjectUndergraduate medical educationen
dc.titleQualitative exploration of the medical learner's journey into correctional health care at an academic medical center and its implications for medical educationen
dc.title.serialAdvances in Health Sciences Educationen
dc.typeArticle - Refereeden
dc.type.dcmitypeTexten
dc.type.dcmitypeStillImageen

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