Firearm Safety Counseling for Gun Violence Prevention

Overseen By German Chavez, B.A.

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of California, Los Angeles

Disqualifiers: Non-DGSOM Class of 2027

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 2

176 Participants Needed

Trial Summary

What is the purpose of this trial?

The preclinical curriculum related to firearm violence and safety counseling at the UCLA David Geffen School of Medicine (DGSOM) has been expanded for the Class of 2027, informed by the results and conclusions of an initial study of firearm safety counseling by medical students (ClinicalTrials.gov ID: NCT05242627), which was conducted by the present study team. The 1-hour firearm safety counseling training session used in that study will be taught again to first-year medical students in the Class of 2027, but training will be augmented with additional instruction; the Class will receive additional comprehensive instruction on suicide risk assessment and will participate in small group breakout sessions, to facilitate the opportunity for students to discuss issues related to firearm violence as a public health issue and to practice firearm safety counseling with standardized patient actors (SPs). Assessment of access to firearms and firearm safety counseling will be added as a standard component of the Social History that students are taught to obtain from patients during clinical examinations. The goal of the expanded training is to increase the prevalence of medical student counseling when they are conducting a history and physical examination in a simulated patient encounter with an SP 6 months after the initial training session, when compared to results from the initial study. The scenario provided to the SP will be identical to that used in the initial study and is a situation in which firearm safety counseling is warranted. Students will participate in a survey to ascertain their knowledge of firearm violence and their attitudes about physician counseling about firearm safety, prior to formal instruction. Informed consent will be obtained from students to use their responses in educational research. Following the didactic and small group sessions, students will be asked to complete a post-training survey that is similar to the original survey, as a means of assessing knowledge gained and any change in attitudes about physician counseling. The simulated patient encounter will occur approximately 6 months later, after which students will complete another survey to determine retention of knowledge and their experience during the simulated patient encounter. Students will not be told before the encounter that they will be evaluated regarding firearm safety counseling. The SP will identify which students did and did not raise the issue of firearm safety. Videos recorded of each students' sessions (routinely obtained for grading purposes) will be viewed by investigators for those students who provide informed consent, to determine the quality of counseling, if it was conducted. Results from this follow-up study will be compared to the results of the initial study as a historical control, to determine whether augmentation of firearm safety counseling training above a 1-hour didactic session increases firearm safety counseling by medical students in a clinical setting and whether it improves retention of knowledge about firearm violence.

Will I have to stop taking my current medications?

The trial does not specify whether participants need to stop taking their current medications.

What data supports the effectiveness of the treatment Expanded Clinical Firearm Safety Counseling Training?

The 5 A's of Firearm Safety Counseling framework showed that after specific training, clinicians felt more comfortable and provided better quality counseling on firearm injury prevention in a simulated setting, suggesting it could be an effective tool for real-world clinical use. ^{1 2 3 4 5}

Is Firearm Safety Counseling safe for participants in clinical trials?

The available research on Firearm Safety Counseling, including the 5 A's framework, focuses on improving clinicians' comfort and skills in discussing firearm safety with patients. There is no indication of safety concerns for participants in these educational and counseling interventions. ^{1 3 4 6 7}

How is the Expanded Clinical Firearm Safety Counseling Training different from other treatments for gun violence prevention?

This treatment is unique because it focuses on training healthcare providers, particularly in family practice and pediatrics, to effectively counsel patients on firearm safety, which is not commonly included in medical education. It uses resources like video training and curriculum guides to improve providers' confidence and knowledge in discussing safe firearm practices with patients. ^{3 4 8 9 10}

Eligibility Criteria

This trial is for members of the UCLA David Geffen School of Medicine (DGSOM) Class of 2027. It aims to assess and enhance their skills in firearm safety counseling.

Inclusion Criteria

Member of the DGSOM Class of 2027

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Training

Students receive a 1-hour firearm safety counseling training session, augmented with additional instruction on suicide risk assessment and small group breakout sessions.

1 day

1 session (in-person)

Simulated Patient Encounter

Approximately 6 months after the initial training, students participate in a simulated patient encounter to assess retention of knowledge and application of firearm safety counseling.

1 day

1 session (in-person)

Follow-up

Participants are monitored for retention of knowledge and effectiveness of training through surveys conducted prior to training, immediately after training, and 6 months after training.

6 months

Treatment Details

Interventions

• Expanded Clinical Firearm Safety Counseling Training

Trial Overview The study tests an expanded clinical firearm safety counseling training program, which includes additional instruction on suicide risk assessment and practice sessions with standardized patients.

Participant Groups

Group I: DGSOM Class of 2027 Experimental Treatment 1 Intervention

Who Is Running the Clinical Trial?

University of California, Los Angeles

Lead Sponsor

Trials

1,594

Recruited

10,430,000+

University of California, Davis

Collaborator

Trials

958

Recruited

4,816,000+

Findings from Research

The 5 A's of Firearm Safety Counseling significantly improved the comfort level and quality of counseling provided by clinical trainees on firearm injury prevention, with only 4% feeling uncomfortable after training compared to over 60% before.

The study involved 29 participants in a simulation-based randomized controlled trial, showing that specific training on the 5 A's led to a notable enhancement in the counseling quality compared to didactic education alone, indicating its potential as an effective tool for clinicians.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The 5 A's of firearm safety counseling: Validating a clinical counseling methodology for firearms in a simulation-based randomized controlled trial. Hoops, K., McCourt, A., Crifasi, CK.[2023]

The study found that gun ownership among families of pediatric patients decreased slightly from 9.4% to 7.0% after an educational intervention, but this change was not statistically significant.

While the intervention did not significantly improve overall gun storage practices, it did lead to a reduction in the number of families keeping guns loaded, from 1.6% to 0.5.%, indicating a potential positive impact on safety.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pediatric practice based evaluation of the Steps to Prevent Firearm Injury program. Oatis, PJ., Fenn Buderer, NM., Cummings, P., et al.[2019]

A survey of 218 medical residents and fellows revealed significant barriers to discussing firearm safety with patients, including uncertainty about how to respond to patients' firearm access answers (72.1%) and lack of time (66.2%).

Over 90% of respondents expressed a desire for more training on firearm injury prevention, indicating that improved education could enhance clinicians' ability to assess risk and counsel patients effectively.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Talking about firearm injury prevention with patients: a survey of medical residents. Pallin, R., Teasdale, S., Agnoli, A., et al.[2022]

After participating in the Safer training program, pediatric clinicians reported a significant increase in their confidence (self-efficacy) in counseling about firearm safe storage, with scores improving from a median of 50 to 80 (P < .001).

The frequency of counseling on firearm safety also increased significantly, with clinicians reporting a median frequency of 50 sessions post-training compared to 10 sessions at baseline (P < .001), indicating the training's effectiveness in promoting safer firearm storage practices.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

One Step Closer to Safer: Counseling Outcomes from American Academy of Pediatrics Firearm Safe Storage Education Training. Gastineau, KAB., Bell, R., Hanes, A., et al.[2023]

20% of parents surveyed reported having a firearm in their home, highlighting a significant exposure to guns among children attending urban pediatric clinics.

A large majority (82%) of parents expressed interest in receiving information on safe gun storage, indicating a strong receptivity to firearm injury prevention counseling from healthcare providers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Parents' attitudes toward firearm injury prevention counseling in urban pediatric clinics. Haught, K., Grossman, D., Connell, F.[2010]

In a 2015 survey of 3932 participants, 61% of firearm owners reported receiving formal firearm training, which is similar to estimates from 1994, indicating no significant change in training rates over two decades.

The most common training topics included safe handling, safe storage, and accident prevention, but only 15% of firearm owners received training on suicide prevention, highlighting a gap in critical safety education.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Formal firearm training among adults in the USA: results of a national survey. Rowhani-Rahbar, A., Lyons, VH., Simonetti, JA., et al.[2019]

A significant gap exists between physicians' knowledge of firearm safety counseling (65% aware) and their actual practice of discussing it with patients (only 25% often engage in such conversations).

Participation in continuing medical education (CME) on gun safety is linked to increased likelihood of physicians providing firearm safety counseling, suggesting that enhancing CME opportunities could improve physician engagement in this critical area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Continuing Medical Education and Firearm Violence Counseling. Damari, ND., Ahluwalia, KS., Viera, AJ., et al.[2019]

A six-lecture series on firearm safety significantly increased psychiatric residents' interest and confidence in firearm safety guidance, as shown by a pre- and post-lecture survey involving 27 participants.

The educational intervention effectively improved residents' understanding of risk assessment, safety guidance, and relevant legislation related to firearms, highlighting the need for such training in psychiatric education.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using Longitudinal Curriculum to Improve Psychiatry Residents' Attitudes Regarding Firearm Anticipatory Guidance. Stillman, I., Ehrman, S., Amalfitano, A., et al.[2023]

A self-paced online curriculum was developed to address pediatric residents' lack of confidence in providing firearm safety guidance, which included video demonstrations and safe storage options.

The curriculum significantly improved residents' self-efficacy, confidence, and knowledge regarding firearm injury prevention counseling, indicating its effectiveness as a training tool.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pilot of an Asynchronous Web-Based Video Curriculum to Improve Firearm Safety Counseling by Pediatric Residents. Naughton, MA., Rajput, S., Hashikawa, AN., et al.[2021]

Only 16% of family practice residency programs in the U.S. provide formal training in firearm safety counseling, indicating a significant gap in education on this important public health issue.

Many residency directors perceive barriers to implementing firearm safety counseling, including a lack of trained personnel and educational resources, and less than 14% believe such counseling would effectively reduce firearm-related injuries or deaths.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Training in firearm safety counseling in family practice residency programs. Price, JH., Bedell, AW., Everett, SA., et al.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

The 5 A's of firearm safety counseling: Validating a clinical counseling methodology for firearms in a simulation-based randomized controlled trial. [2023]

2. England pubmed.ncbi.nlm.nih.gov

Pediatric practice based evaluation of the Steps to Prevent Firearm Injury program. [2019]

3. England pubmed.ncbi.nlm.nih.gov

Talking about firearm injury prevention with patients: a survey of medical residents. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

One Step Closer to Safer: Counseling Outcomes from American Academy of Pediatrics Firearm Safe Storage Education Training. [2023]

5. United States pubmed.ncbi.nlm.nih.gov

Parents' attitudes toward firearm injury prevention counseling in urban pediatric clinics. [2010]

6. England pubmed.ncbi.nlm.nih.gov

Formal firearm training among adults in the USA: results of a national survey. [2019]

7. United States pubmed.ncbi.nlm.nih.gov

Continuing Medical Education and Firearm Violence Counseling. [2019]

8. United States pubmed.ncbi.nlm.nih.gov

Using Longitudinal Curriculum to Improve Psychiatry Residents' Attitudes Regarding Firearm Anticipatory Guidance. [2023]

9. United States pubmed.ncbi.nlm.nih.gov

Pilot of an Asynchronous Web-Based Video Curriculum to Improve Firearm Safety Counseling by Pediatric Residents. [2021]

10. Netherlands pubmed.ncbi.nlm.nih.gov

Training in firearm safety counseling in family practice residency programs. [2022]