To the Editor:
In 2019, there were nearly 40,000 deaths from firearms in the United States. 1 Despite growing evidence that physician screening and counseling can identify and impact firearm safety behaviors, few physicians regularly counsel patients about these topics, and even fewer report having received formal training on how to do so. 2 To our knowledge, medical students are rarely—if ever—exposed to these topics in the undergraduate medical education environment.
To help ensure the next generation of physicians is prepared to curb the firearm injury epidemic, the Warren Alpert Medical School of Brown University is in the process of incorporating a new, 4-year longitudinal curriculum. The curriculum addresses firearm injury epidemiology, risk assessment, firearm safety and injury prevention counseling for patients, and the stabilization and treatment of firearm injuries.
In years 1 and 2, the curriculum is embedded within the health system sciences and doctoring courses. Students are introduced to the epidemiology of firearm injuries, taught to integrate firearm screening questions into social histories, provided training on safe storage of firearms and on risk assessment, and trained to counsel at-risk patients on firearm safety in a culturally competent manner. These skills are then applied in small groups with practice cases.
In years 3 and 4, students will apply these skills to their clinical rotations. The firearm curriculum will be enmeshed within several clerkships across multiple departments, building upon the skills learned in preclinical years. The years 3 and 4 curriculum emphasizes stabilization, treatment, and impact of firearm injuries. For example, in the pediatrics clerkship, students will relate the importance of firearm counseling on safe storage of firearms to child development and safety. In the surgery clerkship, students will learn about the stabilization and treatment of firearm injuries. In psychiatry, the curriculum will focus on the importance of lethal-means counseling in preventing suicide, as well as the long-term mental health implications for survivors, families, and communities.
This curriculum promises to fill a significant gap in our school’s undergraduate medical education and could serve as a framework for other medical schools nationally. Learning and practicing these crucial skills during medical school will help normalize firearm safety counseling as an important part of practice. Future work will evaluate outcomes. Ultimately, such training represents a small but important step toward reducing deaths and injuries from firearms.
1. Centers for Disease Control and Prevention.. Underlying cause of death, 1999-2019. CDC WONDER. http://wonder.cdc.gov/ucd-icd10.html
. Published 2020. Accessed September 1, 2021.
2. Puttagunta R, Coverdale TR, Coverdale J. What is taught on firearm safety in undergraduate, graduate, and continuing medical education? A review of educational programs. Acad Psychiatry. 2016;40:821–824.