267 - Counseling with Confidence: Educating Pediatric Residents on Safe Firearm Storage

Publication Number: 2257.267

Priya P. Shah, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Jungwon Min, University of Pennsylvania, Philadelphia, PA, United States; Kimberly J.. Sterner-Stein, Childrens Hospital of Philadelphia, philadelphia, PA, United States; Dorothy R. Novick, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Joel Fein, Perelman School of Medicine, Media, PA, United States

Background: Unsecured firearms dramatically increase the risk of youth firearm injury and death, and counseling from a health care provider - especially when coupled with free gun lock distribution - can significantly improve secure storage rates. However, medical trainees report lack of knowledge and confidence in counseling about safe firearm storage, and clinicians are often concerned that this counseling could negatively impact their relationship with families.

Objective: To address these barriers, we designed and evaluated a safe firearm storage curriculum for pediatric residents.

Design/Methods: We conducted an in-person Firearm Safety in Clinical Care curriculum for 112 pediatric trainees at our freestanding children's hospital from January 2024 to April 2025. This interactive 1.5-hour session, delivered by a pediatric attending and senior resident on eight separate occasions, included background data, technical information, motivational interviewing techniques, and role-play opportunities. Survey questions administered immediately before and after the session assessed attitudes, skills, confidence, and perceived barriers using a five-point Likert Scale (Strongly Disagree, Disagree, Neutral, Agree, Strongly Agree). We compared anonymously matched pre-and post-session responses using McNemar's test.

Results: Of 112 total participants, 78 completed both pre- and post-surveys (51 PL-1, 14 PL-2, 13 PL-3). Prior to training, 99% of participants agreed or strongly agreed that firearm-related injury and death is a significant issue for children, firearm safety is important to them, and that pediatricians should engage in firearm safety education. There was a statistically significant improvement in knowledge of how to screen for firearms (p=0.001) and confidence in counseling on safe firearm storage (p < 0.001), and decrease in concern that potential conflict around this issue could impact therapeutic relationships with families (p=0.016). A small percentage of residents (10%) still had concerns that discussing safe storage could imply support for gun ownership.

Conclusion(s): Pediatric residents recognize the substantial impact of firearm injuries on the patients they serve. A brief, in-person targeted curriculum can meaningfully enhance their knowledge and confidence in providing safe storage counseling in clinical settings, and can help alleviate concerns that this type of counseling could damage their therapeutic relationships with families.

Table 1: Matched Survey Responses Before and After Firearm Safety Curriculum for Pediatric Residents (n=78)
Standard descriptive statistics for anonymously matched pre-session and post-session survey responses with n (%) reported for Agree/Strongly Agree responses. Comparisons completed using McNemar's test. Bold denotes significant p-value <0.05.