Education Columns

Brooke Schwartz, BSc, Florida International University Herbert Wertheim College of Medicine, Miami, FL; Praveen D. Wickremasinghe, BA, Florida International University Herbert Wertheim College of Medicine, Miami, FL; Cesar Larancuent, BSc, Florida International University Herbert Wertheim College of Medicine, Miami, FL; Gregory W. Schneider, MD, Roseman University College of Medicine, Las Vegas, NV; Rachel Clarke, PhD, CHES, Florida International University Herbert Wertheim College of Medicine, Miami, FL; Prasad B. Bhoite, MPH, MBA, Florida International University Herbert Wertheim College of Medicine, Miami, FL

Introduction

Firearm-related injuries remain a leading cause of preventable death in the United States (US) annually¹. Unsafe firearm practices lead to accidental and intentional injuries, including suicide^2,3. Public health practitioners and medical educators recognize firearm violence as a crisis, yet most medical school curricula in the US lack any education on gun safety⁴.  On surveys, most medical students feel uncomfortable with or are likely to avoid the topic altogether in future practice⁵.  Our medical student and faculty team developed and implemented a pilot gun safety curriculum.

Methods

We created an evidence-based Firearm Violence Prevention (FVP) Curriculum Guide, published it on the American Medical Student Association website, and piloted it at our institution⁶. Schools can deliver the curriculum as a single- or multiple-session intervention and assess educational effectiveness. The focus is on discussing FVP with patients and on gun violence as a public health concern, not as a political topic.  After a single-session training at Florida International University Herbert Wertheim College of Medicine, 2nd-year students took pre- and post-session self-assessment questionnaires. Pre- and post-session average values for the categorical survey responses were compared using a Mann-Whitney U test.

Results

Changes in pre-session to post-session survey scores show attitudes about gun violence as a public health issue did not change significantly.  Pre- and post-session scores for comfort in querying patients about gun ownership and counseling about gun safety did change significantly (p<0.01). Medical students’ perceived role in gun safety as well as comfort in educating fellow peers also differed significantly from pretest to posttest (p<0.01).

Conclusion

In our pilot, student attitudes regarding gun violence did not change, consistent with the emphasis on patient education and “firearm safety” rather than “gun control.” One study limitation was the inability to use participant identifiers, so we could not track individual attitude changes before and after the session. In subsequent sessions, we hope to use additional post-session questions that assess impacts on anticipated future actions by our learners.  The project team encourages schools nationwide to use and evaluate the FVP Curriculum Guide. Our pilot suggests that students find the curriculum effective, and other institutions can build on this experience.

References:

1. Stark DE, Shah NH. Funding and Publication of Research on Gun Violence and Other Leading Causes of Death. 2017;317(1):84–85. doi:10.1001/jama.2016.16215
2. Solnick SJ, Hemenway D. Unintentional firearm deaths in the United States 2005–2015. Injury Epidemiology. 2019;6(1):42. doi:10.1186/s40621-019-0220-0.
3. Gun Violence in America: An Analysis of 2018 CDC Data, EFSGV, Feb. 2020, https://www.wboy.com/wp-content/uploads/sites/43/2020/05/Gun-Violence-in-America_An-Analysis-of-2018-CDC-Data_February2020.pdf.
4. Yanes AF. Gun Violence and Firearm Safety in Medical School Curricula: Missed Opportunities to Improve Patient Health. JAMA Intern Med. 2017;177(1):11–12. doi:10.1001/jamainternmed.2016.6734
5. Pallin R, Teasdale S, Agnoli A, Spitzer S, Asif-Sattar R, Wintemute GJ, Barnhorst A. Talking about firearm injury prevention with patients: a survey of medical residents. BMC Med Educ. 2022 Jan 3;22(1):14. doi: 10.1186/s12909-021-03024-9. Erratum in: BMC Med Educ. 2022 Feb 24;22(1):126. PMID: 34980095; PMCID: PMC8725249.
6. Schwartz B, Wickremasinghe P, Larancuent C, O'Meara M, Ezzi A, Denton A. Integrating Firearm Safety Into Medical School Curricula . American Medical Student Association. https://www.amsa.org/wp-content/uploads/2022/02/MSGS-FVP-Curriculum.pdf. Published 2021. Accessed December 9, 2022.