The State of Medical Education on Criminal Justice Health: A Systematic Review.

Abstract

Background: The justice-involved population faces significant health disparities yet is often overlooked in medical education, resulting in medical providers having limited preparation to serve this community. The objective of this study is to understand the scope and context of medical education in correctional healthcare.

Methods: Literature was systematically reviewed for curriculum on correctional healthcare aimed at undergraduate or graduate medical learners in U.S. educational institutions. The search strategy was developed with the guidance of a medical research librarian and included five literature databases, which were analyzed by two data analysts. The risk of bias was assessed using the appropriate Critical Appraisal Skills Programme checklists.

Results: Our search identified 49 studies highlighting 95 unique curricula. Curricula were evenly split between the undergraduate (n = 44) and graduate (n = 50) level. The two most represented specialties were psychiatry (n = 43) and general medicine (n = 30). Educational modalities included clinical rotation (n = 48), didactics (n = 14), or a combination (n = 28). Curricula increased knowledge in correctional and specialty-specific medicine and improved attitudes towards justice-involved patients; however, there was no significant effect on plans to work with the justice-involved population. Common themes of curricula included treating justice-involved patients with respect (n = 23), structure and function of the legal system (n = 20), and career recruitment (n = 16).

Discussion: There is limited education on the care of the justice-involved population and most learners are unlikely to experience education on this population during their training despite the extensive and unique health and psycho-social needs of this population. Quality of education remains variable and challenging to assess due to limited outcome data and the low quality of literature; however, our thorough search strategy and standardized approach allow for a complete and accurate representation of the literature.

Systematic review registration number: Registration number CRD42023427470.