A next step in gun violence prevention: required training for physicians

On July 25th, 2022, the Bipartisan Safer Communities Act was finally signed into law after an arduous journey through Congress. This bill was put into motion following the mass shootings that took place in Uvalde, Texas and Buffalo, New York nearly one month prior. Although this bill was unprecedented in terms of bipartisan gun violence legislation, many specific programs and implementations need to be further explored in order to actually reduce gun violence.

However, the bipartisan gun safety bill does an adequate job of addressing gun-related interpersonal violence by blocking perpetrators of abuse on a dating partner from obtaining a firearm, closing what has been known to be a “boyfriend loophole” (“S. 2938 – Bipartisan Safer Communities Act” 2022). Similarly, through massive funding for Extreme Risk Protection Order (ERPO) laws, also known as “red-flag laws”, states can work to better address removing guns from those in mental and emotional crises who may use guns irrationally (“The Bipartisan Safer Communities Act: What’s Next?” 2022).

High rates of gun-related suicide, interpersonal violence, and unintentional injury persist. Among the 45,022 firearm-related deaths in 2020, 54% were suicides and nearly 1% were accidental/preventable (“Gun Deaths in America” 2020). In addition, 4,357 of these deaths were children aged 1-19, with 35% being suicides and 15% being accidents, and the rest attributable to assault (McGough et al. 2022).

As part of the Bipartisan Safer Communities Act, Congress allocated $250 million in community violence intervention (CVI) programming, designating gun violence as a public health issue (Horwitz and Cantrell 2022). According to Johns Hopkins University, CVI programs are designed to approach gun violence from a public health perspective, focusing on those at-risk of either being victims of gun violence and committing gun violence. One specific programming includes hospital-based violence intervention programs (HVIPs). HVIPs often involve a combination of medical staff and community partners, but physicians can also play a direct role in preventing gun violence, and reach those who may not seem high risk, as accidental deaths are especially common among youth when there is a gun present at home (Philadelphia Department of Public Health 2022).

Physicians have extensive training in treating gunshot wounds and injuries, but they also have almost just as important of a role in gun violence prevention. Physicians have the unique opportunity to have intimate, yet universal conversations with patients (Sathya and Kapoor 2021). They often ask routine questions about seat belts, diet, drugs/alcohol, so firearm possession can easily be included too.

With funding from the Bipartisan Safer Communities Act, states should move forward to require physicians to receive gun violence prevention training. As outlined by the BulletPoint project, gun violence prevention training provides physicians with information on how to have conversations with patients who have access to firearms, especially those at risk for interpersonal violence, suicide, and accidental injury (Howard 2022). Literature suggests that clinical intervention by physicians can improve safer storage of guns and address gun safety as a whole among high-risk populations (Rozko et al. 2016). However, many physicians do not have this training. A 2021 study among Emergency Medicine Practitioners found that only 46.1% of the sample felt that they had adequate knowledge to educate patients on gun violence prevention (Farcy et al. 2021). Furthermore, while a majority of physicians agree that gun violence is a public health issue, only 13-18% of reporting medical schools have required courses on gun violence prevention (Barron, Hargarten, and Webb 2021).

While the Bipartisan Safer Communities Act has designated funds toward community violence intervention, a next step towards gun violence prevention should approach gun violence as a public health issue head on, providing states with the funds to implement standard physician training programs to current physicians as well as those pursuing continuing medical education. Physicians have the unique opportunity to have conversations with patients and families about gun violence and gun safety, but this ability is rooted in whether they receive training on how to approach these topics. Authors at Johns Hopkins University and University of California Davis, for example, have developed multi-tiered programs teaching physicians about how to converse with patients about gun storage, safety, and preventing gun-related injury (Hoops 2022). In order to build safer communities, move towards preventing gun violence, and address underrepresented high risk populations, community members should be able to learn and converse with a person of authority on health-related issues: their physician.

References

Barron, Avery, et al. “Gun Violence Education in Medical School: A Call to Action.” Teaching and Learning in Medicine, vol. 34, no. 3, Apr. 2021, pp. 295–300, doi:10.1080/10401334.2021.1906254.

“Child and Teen Firearm Mortality in the U.S. and Peer Countries.” KFF, 8 July 2022, https://www.kff.org/global-health-policy/issue-brief/child-and-teen-firearm-mortality-in-the-u-s-and-peer-countries/.

Farcy, David A., et al. “Emergency Physician Survey on Firearm Injury Prevention: Where Can We Improve?” Western Journal of Emergency Medicine, vol. 22, no. 2, Mar. 2021, doi:10.5811/westjem.2020.11.49283.

“Gun Deaths in America, 2020.” Injury Facts, 7 Mar. 2018, https://injuryfacts.nsc.org/home-and-community/safety-topics/guns/.

Hoops, Katherine, et al. “Consensus-Driven Priorities for Firearm Injury Education... : Academic Medicine.” LWW, Jan. 2022, https://journals.lww.com/academicmedicine/Fulltext/2022/01000/Consensus_Driven_Priorities_for_Firearm_Injury.29.aspx.

Horwitz, Joshua, and Spencer Cantrell. “Seizing A Critical Opportunity To Reduce Gun Violence: The Bipartisan Safer Communities Act.” Health Affairs, 7 Oct. 2022, https://www.healthaffairs.org/content/forefront/seizing-critical-opportunity-reduce-gun-violence-bipartisan-safer-communities-act.

Howard, Lisa. Free Course to Help Health Care Providers Reduce Gun Violence. 8 Jan. 2022, https://health.ucdavis.edu/news/headlines/free-course-to-help-health-care-providers-reduce-gun-violence-/2022/08.

Roszko, et al. “Clinician Attitudes, Screening Practices, and Interventions to Reduce Firearm-Related Injury.” Epidemiologic Reviews, vol. 38, no. 1, Feb. 2016, pp. 87–110, doi:10.1093/epirev/mxv005.

“Strategies to Reduce Community Gun Violence.” Johns Hopkins Bloomberg School of Public Health, https://publichealth.jhu.edu/departments/health-policy-and-management/research-and-practice/center-for-gun-violence-solutions/solutions/strategies-to-reduce-community-gun-violence.

“The Bipartisan Gun Safety Reform Bill: What’s Next?” Sandy Hook Promise, 13 June 2022, https://www.sandyhookpromise.org/blog/news/the-bipartisan-gun-safety-reform-bill-whats-next/.

Cover Photo by Chip Vincent on Unsplash