Medical Students' Knowledge and Attitudes Regarding Justice-Involved Health.

Margaret English,Melissa Lee Wilson,Fatimata Sanogo,Todd Schneberk,Rebecca Trotzky-Sirr,Jeffrey Riddell

doi:10.3390/healthcare9101302

Abstract

Despite the demonstrated need for sustainable and effective carceral health care, justice-involved medical education curricula are limited, and it’s unclear if informal clinical education is sufficient. Investigators aimed to quantify medical student involvement with carceral populations and explore how students’ knowledge of and attitudes towards justice-involved patients changed over the course of their training. A survey was designed by the investigators and sent to all current medical students at a single United States medical school. Stata 14.0 was used to compare results between the years of medical school. Differences between groups were tested using linear regression. Most 4th year students reported working in a carceral health setting. An increase in overall knowledge of justice-involved patients was observed as carceral medicine education (ptrend = 0.02), hours worked in a jail (ptrend < 0.01), and substance abuse training (ptrend < 0.01) increased. Overall attitude score increased with the students’ reported number of hours working in a jail (ptrend < 0.01) and the amount of substance abuse training (ptrend < 0.01). Finally, we found a trend of increasing knowledge and attitude scores as the year of standing increased (ptrend < 0.01). Our data suggest that most USC medical students work in a carceral setting during medical school. Didactic and experiential learning opportunities correlated with improved knowledge of and attitude toward justice-involved patients, with increases in both metrics increasing as the year in medical school increased. However, senior medical students still scored poorly. These findings underscore the need for a formal curriculum to train our healthcare workforce in health equity for carceral populations.

Highlights

Justice-involved individuals have unique health concerns that are not being addressed by the currentUnited States (US) healthcare system and physician workforce [1]
After a detailed literature review and interviews with correctional health providers at two institutions (LAC + University of Southern California (USC) and the Twin Towers Correctional Facility), we developed a brief questionnaire modeled after the existing Substance Abuse Attitudes Survey (SAAS) [12] to expand its relevance to carceral populations
752 email invitations were sent to all current medical students to participate in the survey

Summary

Introduction

Justice-involved individuals (defined as people who are recently or currently incarcerated or on parole) have unique health concerns that are not being addressed by the currentUS healthcare system and physician workforce [1]. Despite the need for sustainable and effective carceral health care, recruiting well-trained doctors to work in correctional settings is difficult: there is not a sufficient supply of properly trained healthcare professionals to serve this uniquely vulnerable population. These difficulties may stem from widespread concerns about provider safety in caring for carceral populations as well as lack of prestige of correctional health jobs [3]. In this mutually beneficial partnership, jails and prisons allow students to see the value of providing meaningful care to the disadvantaged while educating developing clinicians on unique pathologies and the critical importance of primary and chronic disease management

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