Training on Corrections and Health Within U.S. Academic Health Professions Education: A Scoping Review

Despite the scale, inequity, and consequences of mass incarceration, health care provider knowledge and awareness on correctional health remain limited. Understanding the educational experiences of health professions learners and the studies used to evaluate them can provide useful information about current gaps to guide future curricular improvement. To address this need, we conducted a scoping review of peer-reviewed studies examining United States-based academic health professions educational programs on correctional health. Studies were coded based on study characteristics, learner outcomes, and degree to which they contained elements described in relevant position statements by two professional medical associations. Overall, 27 articles (1975-2021) were included. Learner outcomes were primarily documented at the "reactions" (93%) and "learning" (52%) levels of the Kirkpatrick model (1979), relative to "behaviors" (11%) and "long-term outcomes" (0%). Comparison of curricula to select position statements revealed multiple content gaps in the realms of prevalent conditions requiring expertise (e.g., violence and self-harm); ethical and medical-legal considerations (e.g., privatization of correctional health care); and correctional health care systems, structures, and administration. Taken together, findings highlight gaps in, and opportunities for, correctional health educational programs. Addressing health care workforce training needs is a necessary yet insufficient step to achieving health equity for populations affected by incarceration.

Dental education and prison health: A scoping review

INTRODUCTION

There is a huge oral disease burden among imprisoned people. Comprehensive guidelines are available on prison dentistry. Prison dental education is important to increase the quality and quantity of the dental workforce in prisons. It improves student perceptions about imprisoned people and gives students a sense of social responsibility and accountability.

OBJECTIVES

The aim of the scoping review was to determine what is known in the literature about teaching pre-doctoral dental students about prison health.

METHODS

A literature search was conducted on seven databases accessed through the Public Health England knowledge and library services. These databases were AMED, Embase, Emcare, Medline, Social Care Institute for Excellence, Web of Science, and Social Care Online. Appraisal of quality was done for included studies.

RESULTS

Eleven papers were included in the review, all of which are based in the USA. Two articles looked at dental students as one group engaged in prison health education while five considered imprisoned people as one of the vulnerable populations focused on dental education. Only four articles solely looked at prison dental education. Program design with a collaborative approach between prisons and teaching institutions, and the positive impact of prison health education on dental students emerged as important.

CONCLUSION

The evidence suggests prison dental education to be important in reducing the high burden of oral diseases among the incarcerated by influencing the present and future prison dental workforce. It also improves students' understanding of social determinants of health. Further studies are needed to determine the most effective teaching methods and models.

Which factors are associated with the number of dental providers employed in correctional settings?

OBJECTIVES

Individuals experiencing incarceration are at increased risk of poor oral health. The purpose of this study was to identify state-level factors that influence the number of oral healthcare providers employed in US correctional settings.

METHODS

This ecological study utilized the National Survey of Prison Health Care (NSPHC) to identify the total number of dentists employed in US correctional facilities. Descriptive statistics were calculated and a linear regression was used to identify predictors of the total number of dentists employed in correctional settings by state.

RESULTS

The mean number of dentists and dental hygienists/assistants per 10,000 individuals experiencing incarceration was 9.33 ± 4.54 and 11.53 ± 7.02, respectively. The only significant contributor to dental employment was healthcare spending per individual experiencing incarceration (Coefficient = 0.96; p = 0.004).

CONCLUSIONS

These findings illustrate the need to develop novel methods of encouraging oral healthcare providers to join the correctional healthcare workforce.

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

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.

How are the social determinants of health being taught in dental education?

INTRODUCTION

The social determinants of health that influence how wellness and illness are experienced within society must be a core component of dental curricula where aspiring dental professionals are taught about the aetiology and social history of dental diseases. Through this scoping review, we examine the current approaches that have been employed to incorporate the social determinants of health within dental curricula.

METHODS

Using a scoping review methodology, we searched the databases Scopus, PubMed, and Embase using keywords relevant to the social determinants of health and dental education.

RESULTS

Following screening and sorting, 36 articles were included within this review. The majority of the articles described research that evaluated outcomes of educational interventions with relevance to the social determinants of health. The remainder of the included studies discussed attitudes and readiness relative to the social determinants of health and how this core competency could be taught effectively.

CONCLUSION

The included literature revealed that the social determinants of health frequently are not the focus of educational activities in dental curricula, with students frequently having little active guidance on how they might make sense of their educational experiences in this domain. The socioeconomic, cultural, political, geographic, and structural barriers that contribute to patients being impacted by the social determinants of health should be explicitly addressed and discussed with students as a foundation element of the dental curriculum.