Medical Student Reflections on a Prison Psychiatric Experience: A Qualitative Analysis.

Abstract

Objective: Large numbers of people with psychiatric illness receive treatment in jails and prisons, yet the experience of medical learners in carceral settings is underexplored. This study analyzed medical student reflections following a carceral psychiatry rotation to understand students' pre-rotation beliefs and whether these ideas were changed by the clinical experience. The authors sought to understand whether the clinical experience motivated students or deterred them from pursuing work in carceral medicine.

Methods: Two independent coders reviewed deidentified student reflections (n = 19) from July 2022 to October 2025 and developed a codebook of themes using an inductive approach. Reflections were qualitatively coded in ATLAS.ti software using the agreed-upon codebook. Codes were revised as further themes emerged and discrepancies were resolved by consensus.

Results: Five main categories were identified in student reflections: (1) preconceived notions; (2) perceptions of the prison environment; (3) perceptions of the people in prisons; (4) perceptions of the prison system; and (5) insights gained. Most students found that their clinical experience did not align with their preconceived beliefs, specifically concerning safety or the perceived aggressiveness of incarcerated people. Many recognized the shortcomings of the carceral system while simultaneously acknowledging the rewarding elements of their experience, including how many clinical interactions humanized incarcerated individuals.

Conclusions: Students' preconceived notions were challenged most during direct student-patient interactions, suggesting that clinical rotations involving direct patient care may hold unique value as compared to lecture-based curricula about carceral health care. Ultimately, the elective led many students to consider working with incarcerated people in the future.