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Qualitative exploration of the medical learner’s journey into correctional health care at an academic medical center and its implications for medical education
Advances in Health Sciences Education ( IF 4 ) Pub Date : 2020-10-19 , DOI: 10.1007/s10459-020-09997-4
Ahmar H. Hashmi , Alina M. Bennett , Nadeem N. Tajuddin , Rebecca J. Hester , Jason E. Glenn

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.

中文翻译:

医学学习者在学术医疗中心进入矫正医疗保健的定性探索及其对医学教育的影响

美国几个州的惩教系统已与学术医疗中心 (AMC) 建立合作伙伴关系,为被监禁的人提供医疗保健。加尔维斯顿的德克萨斯大学医学分院 (UTMB) 是一家专门护理被监禁患者的 AMC,它是美国唯一一家专门的监狱医院,为整个德州刑事司法部 (TDCJ) 提供 80% 的医疗服务。 )。几乎所有 UTMB 的医学生和居民都参与了对被监禁者的照顾。本研究通过使用焦点小组讨论的定性探索,着手描述医学实习生进入的矫正护理学习环境。参与者概述了在监狱医院的学习环境中占主导地位的低优先级和忽视的制度文化,导致被监禁的人被当作二等病人对待。医学学习者指出,监狱医院和 TDCJ 系统内的护理延迟,与自由世界患者相比,在这些系统中,诊断、实验室和医疗程序以较低的优先级提供给被监禁的患者。医学学习者进一步阐述了伦理问题,包括被监禁者的道德判断、临床决策的偏见以及对患者自主权的担忧。医学学习者不得不应对复杂的挑战,例如双重忠诚问题,而没有机会批判性地反思他们的经历。本研究发现,如果没有针对受训人员和惩教人员进行特定的弱势群体培训来解决这些机构动态,
更新日期:2020-10-19
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