A Survey of Family Medicine Residency Programs in Washington: Evaluating the Current State of Correctional Health Training and Future Recommendations

Abstract

Background: There are more than 2.2 million people in the US under correctional control, exceeding corresponding population growth and crime rates. (Nowotny, 2021). Correctional control is a term used to refer to individuals who are under some form of correctional supervision, including those who are incarcerated in jails or prisons, as well as those who are on probation or parole. These individuals are subject to various forms of monitoring and restrictions, which can have a significant impact on health and well-being (Massoglia & Remster, 2019a). People experiencing incarceration are often highly historically marginalized. African American and Latino, as well as low income individuals and communities are disproportionately affected (Whitehorn, 2021). Incarceration exacerbates disparities in health care access, quality of care, and overall quality of life (Minkler, 2020). The delivery of healthcare within the criminal-legal system is often unpredictable, leading to episodic, poorly coordinated acute, chronic, and preventative care. Unfortunately, undergraduate and graduate medical education training programs often do not recognize the importance of learning to care for currently or formerly incarcerated people. Due to the unique healthcare needs of these underserved populations, it is important for physicians to have training in correctional health care. Methods: A cross-sectional survey was developed and sent to the program directors for all 21 Family Medicine residency programs in Washington State. In addition to demographic questions such as program structure and number of residents in the program, key survey topics included questions about dedicated training in correctional health, barriers in establishing correctional health curriculum, and interest in implementing or expanding these curricula. Descriptive statistics were summarized in each area in regard to demographics, content, attitudes, and open ended responses. Results: A response rate of 80% was achieved, with n=17 responses. The majority of respondents were from either a community-based and university-affiliated program. The majority of programs do not currently care for incarcerated people receiving medical care outside of the jail/prison/juvenile detention setting (n=10, 59%). Of those who do currently care for incarcerated people, the majority of the time was in an inpatient rotation or outpatient setting. Also from those who currently care for incarcerated people, all included some didactic learning component (n=6, 100%). Common barriers to expanding correctional medicine in curriculum were time constraints and difficulty scheduling, faculty bandwidth, paperwork, and lack of partnership with correctional facilities. Conclusion: This study highlights the need to address correctional health in family medicine residency training programs, as the majority do not currently provide dedicated correctional medicine training. The findings emphasize the need for increased educational awareness and cross-sector partnerships to better prepare future family medicine physicians for the unique health challenges faced by incarcerated individuals. Furthermore, by recognizing that incarcerated individuals are integral to community health, improvements can be made for individuals transitioning out of incarceration and reducing health disparities among this disadvantaged population. Overcoming these barriers will ensure comprehensive medical training, ultimately fostering health equity.