PC1025: Changing Medical Education: Addressing Firearm Violence Prevention and Education in Pediatric and Emergency Medicine Residency Programs

Background: Firearms are a national leading cause of death amongst pediatric patients. While physician counseling prevents firearm morbidity and mortality, counseling rates remain low. Few medical schools or residency programs provide firearm injury prevention (FIP) training, safety counseling, and anticipatory guidance. Given the national increase in firearm-related deaths and the absence of standardized firearm violence prevention and education (FVPE), we provided a FVPE lecture to Emergency Medicine (EM) and Pediatric residents and assessed its impact on confidence, comfortability, and perceived barriers to FIP counseling.

Methods: This prospective cohort study included EM residents at an urban medical center. The intervention was a 30-minute pre-recorded video lecture about FVPE and anticipatory guidance created by experts in FIP. Residents completed pre-lecture, post-lecture, 3-month, and 6-month follow-up surveys. Survey data was collected in REDCap using an 11-point Likert scale and included demographics, firearm experience, and FVPE counseling comfort, confidence, and barriers. Data was then combined into low (0-3), moderate (4-6), and high (7-10) categories and descriptive statistics were calculated in Microsoft Excel. Participants who completed both pre- and post-lecture surveys were included in the analysis.

Results: Of the 30 eligible participants, 12 completed the pre- and post- surveys. All were EM residents (ages 25-34), 50% were first-year residents, and 67% were male. 83% and 17% reported previous use and ownership of a firearm, respectively. 92% treated a patient with a firearm injury. Residents were most concerned about firearm-related suicide (58%), homicide (25%), and accidental injury (17%) in their patient populations. 25% had no prior FVPE during medical training. 58% and 25% only sometimes and never asked about FIP, respectively. 92% reported a post-lecture increase in comfort and confidence in FIP counseling, with an average increase of 2-3 points out of 10. (Table 1). The proportion of residents reporting high comfort and confidence increased from 8-17% (pre-lecture) to 42% (post-lecture). “Limited time” was the most selected barrier to counseling (92%), with the impact shifting from mostly “moderate” to “low” post-lecture (Figure 1). Before the lecture, 25% designated “not knowing what to do if I recognize that a patient is at risk of injury and has a firearm” as having a high impact on preventing counseling. This fell to 0% after the lecture, however, 17% still felt this would be a “moderate” barrier.

Conclusion: While most residents had firearm experience, FIP counseling remained low. A brief FVPE lecture improved a group of EM residents’ comfort and confidence, and helped reduce barriers to FIP counseling. Next steps are to include a group of pediatric residents, thereby tripling and diversifying our study population. Given these positive results, we suggest incorporating FVPE into medical education.