Background: The United States incarcerates more people than any other country (1) and there are gross inequities in who is incarcerated. Native Americans are more than twice as likely to be incarcerated as White Americans (2); Black Americans are incarcerated at a rates five times higher (3). People with lower incomes face higher incarceration rates, and over 500,000 people are currently incarcerated only because they are unable to pay fees or fines (4,5). Providing health care to people who are incarcerated is a matter of health equity. A 2019 survey of 49 US medical schools found that 23% had a stand-alone curriculum in correctional health with a mean time of 31-60 minutes, while another 54% integrated the topic into other curricula with a mean time of 60-120 minutes (6). The Johns Hopkins School of Medicine offers a 3.5 hour elective to first and second year medical students (7). To our knowledge, there is no in-depth interdisciplinary course on this topic available at a medical school in the US.
Purpose: In 2018, “Medicine 809: The Intersection of Incarceration and Health Care” was created as a graduate-level course to educate medical, nursing, pharmacy, and physician assistant students in this important area of health equity. In addition to providing an introduction to issues of incarceration and health, the course also aims to encourage providers to consider working in correctional health upon graduation and/or make them comfortable working with people who are or have been incarcerated in their own clinical environments. Finally, Medicine 809 promotes the concept of incarceration as a social determinant of health. The course has been offered each academic year for four cycles. After each cycle, evaluations are completed by participating students to assess how well the course achieved its goals.
Description: Medicine 809 is a hybrid of live panels and online modules. Prior to the COVID pandemic, the course also included a correctional facility tour. Panel presentations include adults impacted by incarceration, correctional health providers, advocates, and reentry staff. Virtual modules address topics such as mental health, HIV/AIDS, and trends in correctional health care. Each student is paired with a mentor; the mentors are physicians, nurses, and administrators, among others. Mentors work at local, state, and federal correctional facilities, as well as at non-correctional locations. The course culminates in a quality improvement project addressing a gap or challenge identified by the student in collaboration with their mentor. In the four cycles of the course, 35 students completed at least a portion of the evaluation; of these, 21 were medical students, 12 pharmacy, 1 nursing, and 1 physician assistant. On a scale from 1 (strongly disagree) to 7 (strongly agree), the average rating was 6.4 or above for all evaluation questions (Table 1). Every respondent either agreed or strongly agreed that they would like to learn more about health care in correctional settings, and a majority agreed or strongly agreed that they would consider working in a correctional setting (Figure 1).
Conclusions: Medicine 809 has been an effective tool for piquing students’ interest in providing care for people who are incarcerated. Future plans include cross-listing the course in other fields, including physical therapy, and adding training on advocacy efforts. Other health professional schools should consider creating a similar course as a means of expanding their education on health equity.
