Additional data collected included household exposure to firearms in childhood, firearm ownership, and belief that physicians should ask about and provide safe storage counseling (1 = Strongly Disagree 5 = Strongly Agree).Ĭhart reviews were conducted by research assistants (RAs), abstracting data from 25 consecutive WCEs per resident preceding/following curriculum completion. Data on completion time, curriculum quality (1 = Very Poor 5 = Excellent), and likelihood of utilization of training in future practice (1 = Strongly Disagree 5 = Strongly Agree) were collected. Participants completed a post-test immediately following the modules. Counseling barriers were assessed response options were adopted from prior qualitative literature. These were assessed on immediate post-test and 6-month follow-up surveys.Īt baseline and 6-month post-training, participants self-reported frequency of providing firearm safety counseling on a 5-point Likert scale (1 = Never 5 = Always). 12, 13 A 5-item Likert response scale (1 = Not at all 5 = Extremely) was used for each item and mean scores were used in analyses. Primary outcome measures included self-efficacy to provide firearms safety behavioral counseling, confidence providing technical education about storage techniques, and knowledge about access to written resources.
A handout provided residents a relevant takeaway. Additional module content included epidemiology, medical record documentation recommendations and clinical scenarios demonstrating motivational interviewing techniques giving residents an opportunity to observe and emulate counseling techniques. Video format facilitated a demonstration of firearms and their safe storage-an option not allowable in person on hospital campus due to safety restrictions and difficult to replicate at an off-site location for each resident. Web-based design allowed integration into residents’ required Pediatric Community Health (PCH) rotation and asynchronous review, on residents’ own time, in an online education platform (Canvas).
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11 Educators created web-based video modules ( Figure, using free recording studios and Camtasia software. Literature review and opinion from injury prevention experts guided development of educational goals/objectives using adult learning principles based on the conceptual framework of Bandura’s Social Cognitive Theory. 10 A 2014 baseline needs assessment survey of University of Michigan pediatric residents found <20% always asked about firearms.
Here, we describe a web-based asynchronous curriculum that includes firearm injury epidemiology, safe storage, and injury prevention counseling to improve residents’ ability to provide firearm safety anticipatory guidance during WCEs.Ĭurriculum development utilized an adapted-Kerns approach. Many suburban residency programs have less exposure to pediatric firearm violence/injury, and residents may benefit from more comprehensive training. 8 One previously published curriculum has been developed/tested 9 however, this was implemented in an urban residency program where baseline knowledge was high.
7 Many programs do not provide this training. There is a need to develop comprehensive firearm injury prevention education for residents. 6 Pediatricians with higher perceived self-efficacy in discussing such techniques are more likely to discuss these topics with families. 5 Screening/counseling barriers include time constraints, concerns about effectiveness of screening/counseling, and inadequate training in counseling methods and technical aspects of firearm injury prevention (i.e., storage/locking mechanisms). While brief physician-counseling interventions can increase safe storage practices, 4 a minority of pediatricians regularly counsel on safe firearm storage/temporary removal during high-risk periods at well-child visits (WCEs) (23% and 16%, respectively). 2 The American Academy of Pediatrics encourages physician counseling on firearm safe storage as an effective injury prevention measure. 1 One in three US households contains at least one firearm and among these households with children, ~20% store firearms unsafely, increasing risk for firearm injury.
Firearms are the second leading cause of death among children and adolescents.
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