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Prison Health Opportunities for Medical Students and Residents

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Prison Health Opportunities for Medical Students and Residents Heather Filek Amanda Degenhardt Alvin Keng Ruth Elwood Martin John Koehn. FMF 2013 * * * * * * * New ... – PowerPoint PPT presentation

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Title: Prison Health Opportunities for Medical Students and Residents


1
Prison Health Opportunities for Medical Students
and Residents
Heather Filek Amanda Degenhardt Alvin Keng Ruth
Elwood Martin John Koehn .
FMF 2013
2
Health Advocacy
  • Physicians are the natural attorneys of the
    poor, and social problems fall to a large extent
    within their jurisdiction.
  • - RUDOLF VIRCHOW

3
Health Advocate Role
Definition As Health Advocates, physicians
responsibly use their expertise and influence to
advance the health and well-being of individual
patients, communities, and populations.
Frank et al, CanMEDs, 2005.
4
Incarceration in Canada
  • Approx 54,498 individuals in custody
  • Higher prevalence of mental illness and substance
    use disorders
  • First Nations over represented

Stats Canada 2010/11.
5
Go directly to jail
6
Objectives
  1. Review CanMEDS competencies that prison health
    educational opportunities can foster.
  2. Understand the opportunities available for
    medical students and residents.
  3. Network with others who are interested in prison
    health education.

7
History of the Prison Health Project
Amanda Degenhardt University of British
Columbia MSI 4 .
FMF 2013
8
Hx of Prison Health Program
  • 2nd year of medicineCSLO
  • Started 5 years ago
  • Initiative to present inmates with information on
    health and infectious diseases
  • Unique and marginalized population.
  • Groups of two to deliver 1 hr presentation
  • Audience 12-15 inmates
  • Locations Fraser Regional Corrections
    Centre(FRCC), North Fraser Pre-trial Centre
    (NFPC), and Alouette Correctional Centre for
    Women (ACCW)

9
Locations
Green Federal Red Forensic Psychiatric
Hospital Yellow Provincial Blue Youth Custody
10
Hx of Prison Health Program
  • The prison population has unique health needs
  • Mental illness
  • Poverty
  • Addictions
  • Infectious diseases
  • Restricted access limited knowledge of the
    health and human rights concerns of prisoners
  • Developing student deliverables
  • Over the years project development progressed
  • BC Corrections relationship
  • Module Content
  • Memorandum of Understanding (MOU) to formalize
    students relationship with BC Corrections
  • Expansion into the Juvenile institutions

11
Modules Developed
  • Navigating the Health Care System
  • Mental Health
  • Basic Hygiene
  • Womens Health
  • Infectious Disease
  • Health Your Child
  • Sexual Health

12
Challenges with Presentations
  • More examples pertinent with the prison
    population
  • Mental health had basic science kept it more
    big picture
  • Careful that photos arent triggers or too
    extreme as this illicit disruptions
  • Remove medical jargon

13
Pilot Project
  • Adapt and deliver youth targeted health modules
    (basic hygiene, sexual health, navigating the
    health care system) to juvenile inmates at the
    Burnaby Youth Custody Services Centre
  • More relaxed atmosphere
  • More time spent on QA
  • Health Jeopardy

14
Following pilot
  • Well received and felt this could be an
    independent CSLO
  • Safe Relationships (Harassment, Abuse, Neglect
    and Positive Role Models)
  • Sexual Identity
  • Mental Health (Body Image, Self-Esteem and
    Bullying)
  • Mental Health (Depression, Anxiety, Bipolar,
    Psychosis, Suicide)
  • Addictions (Drugs, Alcohol and Smoking)
  • Nutrition and Exercise
  • Dental Health
  • Sleep and Growth
  • Body Modification (Tattoos, Piercings)
  • Risky Behaviour, Accidental Injury and Prevention

15
Personal Experience
  • Youth a lot of food for thought
  • How do we stop them from entering into the
    juvenile system? Once in, how do we stop the
    cycle?
  • What is my role as a member of the community and
    as a health care professional
  • CanMeds
  • Communicator
  • Listen effectively to elucidate concerns and
    address them
  • Nonverbasl cues
  • Safe environment to talk confidentiality and
    rapport
  • Advocate
  • Community resources
  • Medical Expert
  • Explain and provide information to both child and
    parents to better understand the issue they have
    come in with

16
Personal Experience
  • Incarcerated individuals are marginalized
    population that is unheard
  • Not allowed dental floss (potential weapon)
  • No access to dental care
  • Lack of awareness of health care rights
  • Fear or discomfort sharing personal information
  • When its appropriate to see a doctor
  • What a good patient-physician relationship looks
    like
  • Acted as a health advocate health promotion and
    disease prevention

17
Future Effect on my Medical School Experience
  • 3rd year of clerkship was in an integrated
    community clerkship
  • Weekly family practice office managed transition
    houses therefore some patients were previously
    incarcerated
  • Allowed me to be open and accepting of the
    patients
  • Cohesive relationship to address their needs
    which include acute and longstanding issues

18
Prison Health Project 2012/13
Alvin Keng University of British Columbia MSI 3 .
FMF 2013
19
Prison Health Project in 2012-13
  • Inherited the project from medical students of
    prior year
  • UBC Medicine Year 2 Doctors, Patients and
    Society (DPAS) course - Community Service
    Learning Option (CSLO)
  • Team of 7 students in 2012-13

20
Locations
  • Essential Skills to Success
  • Fraser Regional Corrections Centre
  • North Fraser Pre-Trial Centre
  • Alouette Correctional Center for Women
  • Surrey Pre-Trial Services Centre
  • Burnaby Youth Custody Services Centre

21
Existing Modules
  • Navigating the Health Care System
  • Mental Health
  • Basic Hygiene
  • Womens Health
  • Infectious Disease
  • Health Your Child
  • Sexual Health (at Burnaby Youth Custody Services
    Centre)

22
Navigating the Health Care System
  • Explained the health care system in BC with a
    focus on a community POV
  • Sample topics how to find a family doctor, MSP,
    Pharmacare, how to get the most from a doctors
    appointment

23
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24
Mental Health
  • Discussed common mental disorders and how to stay
    healthy mentally
  • Sample topics depression, bipolar disorder,
    anxiety disorders, substance abuse, recognizing
    suicide risk, staying mentally health in prison
    and in the community

25
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26
Womens Health
  • Discussed different areas of womens health
    pertinent to incarcerated females
  • Sample topics STIs, breast cancer, the well
    woman exam, contraception

27
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28
Infectious Diseases
  • Reviewed common infectious diseases, modes of
    transmission, prevention treatment
  • Not presented in 2012-13
  • Sample topics HBV, HCV, HIV, Scabies, Lice, TB

29
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30
Health Your Child
  • Discussed healthy pregnancies, young child
    development, and healthy lifestyles
  • Sample topics when to see a doctor during
    pregnancy, nutrition and healthy living tips,
    dangers of cigarettes, alcohol, drugs in
    pregnancy, child nutrition

31
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32
Sexual Health
  • Developed for youth to discuss common STIs, and
    prevention, prevention, prevention!
  • Sample topics Gonorrhea, chlamydia, HPV,
    herpes, HIV, contraception, prevention

33
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34
New Modules for 2012-13
  • Self Care
  • Substance Abuse
  • Mens Health

35
Self Care
  • Discussed self-care and its relationship to
    health
  • Rationale Rehashed basic hygiene module to
    include nutrition and sleep hygiene
  • Sample topics nutrition, preventable
    communicable diseases, exercise, sleep hygiene,
    stress relief

36
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37
Substance Abuse
  • Reviewed common substances of abuse and their
    impact on health
  • Rationale Identified as a gap by our community
    partner
  • Sample topics Sleeping medications, anabolic
    steroids, acetaminophen, cocaine, etc.

38
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39
Mens Health
  • Discussed major health issues affecting men,
  • Rationale Identified as a major gap and area of
    interest
  • Sample topics The Big 5, testicular disease,
    prostate disease, the importance of screening,
    sexual dysfunction
  • Mens Health Initiative of BC

40
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41
Lessons for the Future
  • Inmates have unique needs and restrictions
  • Connection to the outside community
  • Engaging inmates in their health
  • Measurable impact
  • Prison is a unique community with nuances
    difficult to understand for an outsider

42
Students experience of prison health education
during medical school
Heather Filek University of British Columbia MSI
4 Filek H et al. Med Teach. 2013 Nov35(11)
938-43 .
FMF 2013
43
Purpose
  • Social responsibility is a core component of
    medical education1 how are students learning to
    be socially responsible?
  • CanMEDS competencies
  • Health Advocate, Communicator, Collaborator
  • Purpose of the study to explore the impact of
    pre-clinical prison health education on medical
    students

1Faulkner, L., McCurdy, R. (2000) Teaching
medical students social responsibility the right
thing to do. Academic Medicine, 75(4) 346 - 350
44
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45
Methods
  • Students and residents who participated in the
    DPAS420 CSLO Prison Project as 2nd year medical
    students. Recruitment via invitation email
    convenience sampling
  • 10 in-depth interviews
  • Each interview audio-recorded and transcribed
    verbatim
  • Analysis via interpretive description, a method
    to capture themes and patterns within subjective
    perceptions2
  • UBC Behavioural Research Ethics Board certificate
    of approval was obtained

2Thorne, S. (2000). Data analysis in qualitative
research. Evidence Based Nursing, 3, 68-70
46
Findings
  • Four main themes were identified as the major
    impacts of being exposed to the prison population
    during medical school training

47
Theme 1
  • Exposure to incarcerated populations increases
    students insight into issues that diverse
    marginalized sub-populations encounter
  • the value of having prison health as part of
    medical school would be that it exposes you to
    more or less every marginalized population you
    could imagine. Its the immigrants, its women,
    its homelessness, its aboriginal, its drug
    addicted

48
Theme 2
  • Positive interactions with the incarcerated
    individuals enhances relationship building
  • Received warm welcome from incarcerated
    individuals
  • Positive relationships between inmates and future
    HCP
  • We got really good feedback from the inmates
    themselvesthat positive interaction was
    something wed hoped to foster.

49
Theme 3
  • Collaboration reinforces teamwork skills
  • BC Corrections
  • Prison wardens guards
  • Health Care in correctional facilities
  • UBC faculty
  • Its just like the hospital where things
    function a lot more smoothly when everyone from
    the team gets along. And respects one another.

50
Theme 4
  • Community placements garner important learning
    opportunities within the medical school
    curriculum
  • Its experiences I can tie back to when I come
    into contact with patients who have been through
    the prison system.
  • Its not something you can learn in a
    textbook.its only through interacting with the
    people that you can break down the stereotypes
    that you have and feel more comfortable
    interacting with that population.

51
Conclusion of study
  • Findings CanMEDS competencies (Health Advocate,
    Communicator, Collaborator)
  • Our findings demonstrated that pre-clinical
    exposure to incarcerated individuals and prison
    health education provided a unique setting for
    medical students to develop an increased sense of
    social responsibility and accountability.

52
  • So I think I developed a sense of compassion for
    a group of people that I didnt previously
    understand as well. Hopefully that makes me a
    better physician for that.

53
Opportunities abound!
  • New Prison Health Advocacy Elective
  • Regional shadowing opportunities
  • Health promotion projects
  • Research
  • .

 
FMF 2013
54
Prison Health Advocacy Elective
  • 4-week elective rotation through UBC
  • Emphasis on the health advocate role
  • Embedded cultural competency certification
  • Multi-site options

55
Shadowing
  • Representative prison physicians on SIFP
    committee from every region of Canada
  • Kingston, ONT
  • St. Johns, NFLD
  • St. Albert, SASK
  • Vancouver, BC

56
Health Promotion
  • Established projects in BC
  • Support for distributed initiatives through the
    Collaborating Centre for Prison Health and
    Education

57
Research and Policy
  • Working groups established to contribute to
    position papers on issues
  • Segregation
  • Access to effective addiction treatment

58
A National Conversation
  • Physicians working in prisons have a unique skill
    set
  • Learners have potential to contribute a great
    deal
  • Well positioned to advocate for change

59
Thanks!
  • Questions
  • Comment
  • Share contacts
  • Ben prison.elective_at_familymed.ubc.ca
  •  
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