Abstract
Over the course of 10 weeks, 12 first-year medical students from our institution designed and implemented an educational service initiative at a federal detention center. The project sought to enhance incarcerated individuals’ academic preparedness for the General Educational Development (GED) exam while integrating health-related learning to promote well-being. Medical students provided weekly 4-hr sessions that covered anatomy, nutrition, mathematics, English, and Spanish, along with short lessons on sexually transmitted diseases, arthritis, and skin cancer. Educational strategies included bilingual instruction, visual aids, and post-class quizzes. Among the 1,053 incarcerated individuals housed in a federal detention center, students were able to impact a total of 814 individuals (77% of the population). Using Kern’s six-step model for curriculum design, the initiative addressed both general and targeted educational needs, ensuring structured planning, implementation, and evaluation. This collaborative effort enriched the students’ communication and teaching skills, strengthening their empathy toward incarcerated and marginalized populations. Despite logistical and security challenges, the project illustrated how medical education can extend beyond clinical spaces to foster community rehabilitation and health promotion. The partnership between our medical institution and federal detention center highlights the transformative potential of service-based learning to improve educational equity, promote social reintegration, and cultivate medical students’ sense of professional responsibility. This initiative demonstrates how structured service-learning can inform public health education and policy by integrating medical training with detention center rehabilitation.
Keywords
Assessment of Needs
Educational inequities within carceral facilities perpetuate social marginalization and limit post-release opportunities. In this federal detention center population, there is an urgent need for rehabilitation programs emphasizing education and health literacy. Many incarcerated individuals have limited formal education and low GED completion rates. Simultaneously, medical students often lack exposure to carceral environments, missing opportunities to learn about systemic determinants of health and community-based rehabilitation.
Program Overview
From January 2024 to March 2024, 12 first-year medical students collaborated with staff at a federal detention center to deliver a structured 10-week bilingual curriculum. This collaboration was born from the university’s Longitudinal Primary Care Preceptorship (LPCP) course that focuses on providing students with experiences in health promotion during community intervention. The institution forged a liaison with the Metropolitan Detention Center (MDC) in Guaynabo and created a space for this initiative to take place for the first time. Based on the Kern Model, the curriculum was built around the population’s needs identified by the facility staff and in accordance with the institution’s educational goals and objectives (Sweet & Palazzi, 2015). This curriculum included academic subjects such as anatomy, nutrition, mathematics, English, and Spanish that were supplemented by health-based modules on sexually transmitted diseases, arthritis, and skin cancer. Students prepared handouts, visual materials, and after-class quizzes to reinforce learning. Teaching was held for 4 hr weekly in small-group settings, which fostered interactive discussions and peer-to-peer engagement. The 2024 cohort was the first to participate in this initiative, and the positive feedback from both the institution and the students alike drove this to become a permanent fixture in the courses’ curriculum. Because all data were de-identified, this study was considered exempt from institutional review board (IRB) oversight.
Challenges and Successes
The program was designed to enhance incarcerated individuals’ educational performance, particularly for GED readiness, while promoting health awareness and self-efficacy (Ramaswamy et al., 2015). Preliminary assessments indicated improved quiz scores, active participation, and positive feedback from incarcerated individuals and facility educators. In addition, medical students reported greater appreciation of health disparities and improved skills in public communication and pedagogy. Challenges included navigating security clearance processes, adapting lesson plans to differing literacy levels, and balancing medical coursework with service commitments. Despite these barriers, the project succeeded in building a sustainable partnership between the medical school and the carceral facility. The collaborative environment fostered trust, consistency, and shared responsibility among students, faculty, and carceral staff. The educational sessions hosted each week were publicly announced, and attendance was voluntary for all individuals of the carceral unit where it was offered. Throughout our time at the institution, 814 unique individuals attended the sessions provided, which accounts for 77% of MDC Guaynabo’s total population of 1,053 men and women of ages ranging from 18 to 77 years.
Lessons Learned
Teaching in a carceral environment requires flexibility, cultural humility, and an understanding of trauma-informed pedagogy. Early planning and faculty mentorship were essential to maintain structure and continuity. The use of Kern’s curriculum model provided a clear framework for iterative improvement (Sweet & Palazzi, 2015; Table 1). Importantly, both medical students and incarcerated individuals benefited; the former by developing empathy and teaching confidence, and the latter by acquiring tangible educational skills and improving their health literacy (Uemura et al., 2021).
Application of Kern’s Six-Step Model in a Federal Institution’s Educational Program
Implications for Practice
Integrating community-based education within carceral settings can be a powerful tool for both medical and social rehabilitation. Health promotion programs led by medical students can bridge institutional gaps, enhance humanistic competencies, and support reintegration through education (Gaes, 2008). Other medical schools may replicate this initiative by establishing partnerships with local carceral facilities, using structured frameworks such as the Kern model to ensure accountability, reflection, and measurable outcomes (Sweet & Palazzi, 2015; Table 1). Educational topics were identified in collaboration with the facility’s education department and aligned with GED curricular priorities.
