Resident Physician Children's Hospital Los Angeles Redlands, California, United States
Background: Firearms are the leading cause of injury-related death in children and adolescents in the United States. Pediatric residents, at many institutions, do not receive any standardized formal education regarding screening for firearm access and harm reduction best practices. Implementation of a firearm safety curriculum can improve pediatric comfort and competence with screening and patient counseling. Objective: In this study, we implemented a medical provider firearm safety curriculum at a large, quaternary care children’s hospital to improve comfort and competence in counseling patients and families regarding firearm access and safe storage. Design/Methods: We identified common barriers to firearm screening and harm reduction counseling. These included lack of comfort with using appropriate firearm terminology, implicit biases precluding universal screening, and lack of knowledge with evidence-based harm reduction practices. We designed a one hour long firearm safety didactic informed by these barriers. This information was presented to the pediatric residents at Children’s Hospital Los Angeles. Attendees were surveyed before the didactic to assess baseline firearm safety knowledge and screening comfort, and after to detect any changes in provider knowledge and comfort level with the material. Results: Over 60% of pediatric resident physicians identified lack of knowledge as the primary barrier to addressing the topic of firearms at well child visits. In our first cohort (n=30), 22% of pediatric residents surveyed answered that they felt comfortable or very comfortable with counseling families about firearms and safe storage. Eleven residents responded after the didactic with nearly 82% answering that they felt comfortable or very comfortable with counseling (Figure 1A). In our second cohort (n=27), only 11% of pediatric residents surveyed rated their knowledge of firearm storage options as good or excellent prior to the didactic session (Figure 1B), compared 50% to after the didactic (n=4) with final results still pending. The pre and post didactic results of our initial cohort demonstrate a nearly 60% increase in provider comfort with discussing firearms.
Conclusion(s): Our survey results of didactic attendees demonstrate an increase in comfort and knowledge with counseling on firearms and safe storage with the implementation of a formal curriculum. In the future, we aim to expand our study population to other primary care and acute-care providers to target more opportunities for primary injury prevention secondary to firearms.
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