A scoping review of medical education and care of patients with criminal-legal system involvement

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BACKGROUND: Caring for over 5 million people in the United States with criminal-legal system involvement (CLSI) poses unique ethical and medical considerations for physicians. Despite the rise of academic medical center partnerships with correctional facilities, no framework to teach learners to navigate the care of patients with CLSI exists. The current literature lacks a clear picture of the motivations, formats, and quality of educational interventions for medical learners providing care to patients with CLSI. This scoping review examines educational interventions and commentaries on caring for patients with CLSI in medical trainees. METHODS: Using the Arksey and O’Malley framework methodology, the authors searched PubMed, Embase, MedEdPORTAL, and Web of Science to identify English-language peer-reviewed studies. Articles were included if they (1) included medical trainees, (2) involved patients with CLSI and (3) had an educational component. Data extracted included the study type, motivations, and relevant stakeholders. For educational intervention studies, the authors also extracted the learner characteristics, format and content, assessment tools, and study quality. RESULTS: Equity and public health were the most common motivations for CLSI educational interventions. Most published educational interventions were academic health center-correctional facility partnerships featuring clinical rotations among medical schools and residency programs. The most common residency specialties were psychiatry, family medicine, and internal medicine. However, most published CLSI educational interventions relied on exposure to patients with CLSI and lacked explicit curricula or rigorous learner assessments. CONCLUSION: Our findings demonstrate a perceived need for training regarding the care of patients with CLSI. However, current published educational interventions rely on clinical exposure to patients with CLSI and lack an explicit curriculum and rigorous learner assessments. Development of core competencies utilizing the frameworks of structural competency and prison abolition theory may help inform future educational interventions regarding the care of patients with CLSI.

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