Pediatric resident firearm-related anticipatory guidance: Why are we still not talking about guns?

Abstract

This study characterizes the current firearm-related anticipatory guidance practices of pediatricians-in-training and the factors affecting those practices. In this study of Pediatric residents in the Mid-Atlantic region, surveys were distributed to 189 trainees at three hospitals. Eighty-one responses were collected between June 2017 and March 2018. The survey gathered information about the residents' values related to firearms, firearm-specific counseling practices, barriers to providing counseling, and educational needs related to firearms. The residents surveyed overwhelmingly agreed (96%) that physicians have a responsibility to counsel patients on the risks posed by firearms. However, most (63%) never provide firearm-related counseling or do so in only 1-5% of well-child visits. Their unfamiliarity with safe storage devices contributes to a lack of comfort providing counseling. For pediatricians to provide potentially lifesaving counseling on firearm safety, they must be well-versed in the subject and feel comfortable and confident in doing so. Educational interventions addressing physician self-efficacy are necessary to accomplish this. There is an urgent need to develop a comprehensive firearm safety education program for physicians and trainees to improve firearm counseling.

Association of Firearm Access, Use, and Victimization During Adolescence With Firearm Perpetration During Adulthood in a 16-Year Longitudinal Study of Youth Involved in the Juvenile Justice System

“… 98 , 99 Pediatricians can counsel parents that ammunition should be removed and locked up separately, 100 and that firearms must be stored using cable locks, lockboxes, gun safes, or trigger locks. 101 , 102 Weighed against the risk of injury and death, the cost is negligible: $25 for a pistol-sized lock box and $130 for a full-size gun safe. 103 Pediatricians can encourage indigent parents to participate in safe storage programs, such as Project ChildSafe, 104 which provides free gun-safety kits.…”

Evaluating the Use of a Pamphlet as an Educational Tool to Improve Safe Firearm Storage in the Home

“…8 However, physicians are unlikely to provide this counseling, even though they feel they have a “responsibility to counsel families about firearms.” 9 Only about 20% of pediatricians report asking more than 5% of their patients about gun ownership, 9 and among pediatric residents the results are similar with 63% never providing firearm-related counseling or doing so in only 1% to 5% of well-child visits. 10 In the same survey of pediatric trainees, which included those at our institution, commonly cited barriers to the provision of firearm safety counseling included lack of sufficient time to provide counseling and lack of familiarity with safe storage devices. 10…”

“…10 In the same survey of pediatric trainees, which included those at our institution, commonly cited barriers to the provision of firearm safety counseling included lack of sufficient time to provide counseling and lack of familiarity with safe storage devices. 10…”

“…9 Only about 20% of pediatricians report asking more than 5% of their patients about gun ownership, 9 and among pediatric residents the results are similar with 63% never providing firearm-related counseling or doing so in only 1% to 5% of well-child visits. 10 In the same survey of pediatric trainees, which included those at our institution, commonly cited barriers to the provision of firearm safety counseling included lack of sufficient time to provide counseling and lack of familiarity with safe storage devices. 10 To assist with the barrier of insufficient time to provide counseling, we created and distributed a trifold pamphlet to patients and families to educate them on firearm injury risks and firearm storage to encourage the adoption of safe firearm storage practices in the home.…”

“…10 In the same survey of pediatric trainees, which included those at our institution, commonly cited barriers to the provision of firearm safety counseling included lack of sufficient time to provide counseling and lack of familiarity with safe storage devices. 10 To assist with the barrier of insufficient time to provide counseling, we created and distributed a trifold pamphlet to patients and families to educate them on firearm injury risks and firearm storage to encourage the adoption of safe firearm storage practices in the home. This study presents the results of the evaluation of the pamphlet as an educational tool in a busy clinic setting.…”