Prison Health
Opportunities for
Medical Students
and Residents
Heather Filek
Amanda Degenhardt
Alvin Keng
Ruth Elwood Martin
John Koehn
FMF 2013
Health Advocacy
“Physicians are the natural attorneys of the
poor, and social problems fall to a large
extent within their jurisdiction.”
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
Frank et al, CanMEDs, 2005.
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.
Go directly to jail…
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.
History of the
Prison Health
Amanda Degenhardt
University of British Columbia
FMF 2013
Hx of Prison Health Program
• 2nd year of medicine—CSLO
• 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)
Green = Federal
Yellow = Provincial
Red = Forensic Psychiatric Hospital
Blue = Youth Custody
Hx of Prison Health Program
• The prison population has unique health needs:
Mental illness
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
Modules Developed
Navigating the Health Care System
Mental Health
Basic Hygiene
Women’s Health
Infectious Disease
Health & Your Child
Sexual Health
Challenges with Presentations
• More examples pertinent with the prison
• Mental health had basic science – kept it
more “big” picture
• Careful that photos aren’t “triggers” or too
extreme as this illicit disruptions
• Remove medical jargon
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 Q&A
• Health Jeopardy
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
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
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 it’s appropriate to see a doctor
– What a good patient-physician relationship looks
• Acted as a health advocate – health
promotion and disease prevention
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
• Cohesive relationship to address their needs
which include acute and longstanding issues
Prison Health
Project 2012/13
Alvin Keng
University of British Columbia
FMF 2013
Prison Health Project in 201213
• 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
• 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
Existing Modules
Navigating the Health Care System
Mental Health
Basic Hygiene
Women’s Health
Infectious Disease
Health & Your Child
Sexual Health (at Burnaby Youth Custody
Services Centre)
Navigating the Health Care
• 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 doctor’s appointment
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
Women’s Health
• Discussed different areas of women’s
health pertinent to incarcerated females
• Sample topics: STIs, breast cancer, the
well woman exam, contraception
Infectious Diseases
• Reviewed common infectious diseases,
modes of transmission, prevention &
• Not presented in 2012-13
• Sample topics: HBV, HCV, HIV, Scabies,
Lice, TB
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
Sexual Health
• Developed for youth to discuss common
STIs, and prevention, prevention,
• Sample topics: Gonorrhea, chlamydia,
HPV, herpes, HIV, contraception,
New Modules for 2012-13
• Self Care
• Substance Abuse
• Men’s Health
Self Care
• Discussed self-care and its relationship to
• Rationale: Rehashed basic hygiene
module to include nutrition and sleep
• Sample topics: nutrition, preventable
communicable diseases, exercise, sleep
hygiene, stress relief
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.
Men’s Health
• Discussed major health issues affecting
• 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
• Men’s Health Initiative of BC
Lessons for the Future
• Inmates have unique needs and
• Connection to the outside community
• Engaging inmates in their health
• Measurable impact
• Prison is a unique community with
nuances difficult to understand for an
experience of
prison health
education during
medical school
Heather Filek
University of British Columbia
Filek H et al. Med Teach. 2013 Nov;35(11): 938-43 FMF 2013
• 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
L., McCurdy, R. (2000) Teaching medical students social responsibility:
the right thing to do. Academic Medicine, 75(4): 346 - 350
• 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
S. (2000). Data analysis in qualitative research. Evidence Based Nursing, 3,
Four main themes were identified as the
major impacts of being exposed to the
prison population during medical school
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. It’s the immigrants, it’s
women, it’s homelessness, it’s aboriginal, it’s
drug addicted…”
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
themselves…that positive interaction was
something we’d hoped to foster.”
Theme #3
Collaboration reinforces teamwork skills
BC Corrections
Prison wardens & guards
Health Care in correctional facilities
UBC faculty
“It’s just like the hospital where things function
a lot more smoothly when everyone from the
team gets along. And respects one another.”
Theme #4
Community placements garner important learning
opportunities within the medical school curriculum
“It’s experiences I can tie back to when I come into
contact with patients who have been through the
prison system.”
“It’s not something you can learn in a textbook….it’s
only through interacting with the people that you
can break down the stereotypes that you have and
feel more comfortable interacting with that
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.
“So I think I developed a sense of
compassion for a group of people that I
didn’t previously understand as well.
Hopefully that makes me a better
physician for that.”
Opportunities abound!
New Prison Health Advocacy Elective
Regional shadowing opportunities
Health promotion projects
FMF 2013
Prison Health Advocacy
• 4-week elective rotation through UBC
• Emphasis on the health advocate role
• Embedded cultural competency
• Multi-site options
• Representative prison physicians on SIFP
committee from every region of Canada
– Kingston, ONT
– St. John’s, NFLD
– St. Albert, SASK
– Vancouver, BC
Health Promotion
• Established projects
in BC
• Support for distributed
initiatives through the
Collaborating Centre
for Prison Health and
Research and Policy
• Working groups established to contribute
to position papers on issues:
Access to effective addiction treatment
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
•Share contacts
•Ben: [email protected]

Prison Health Opportunities for Medical Students and Residents