Two Medical Students’ Perspectives: Utilizing Research as a Means of Advocating for Firearm Safety

Christopher Zaro, BA and Symren Dhaliwal, BS

Despite the dismay that comes with every national atrocity and the frustration and pain with every local tragedy, the general community has long seen firearm violence as an issue discrete from the world of healthcare (1). As the medical community shudders at the recent statistics ranking firearm violence as the leading cause of death in children, there is little consensus on what physicians can do to solve the firearm violence epidemic (2). Beyond the National Rifle Association (NRA) and gun lobbyists’ incendiary treatment of the firearm conversation, there are many reasons why clinicians and institutions are loath to address and appropriately combat the problem. The temporary gag law in Florida which prohibited clinicians from asking patients about firearms, while since struck down decisively in the United States Court of Appeals, still reverberates through clinical practice (3). Even with children with histories of trauma—often stemming from witnessing firearm violence—where I saw the long-lasting and complex effects these events have on young minds. After these experiences, I wanted to understand the topic from a more clinical and research-based perspective. I was lucky enough to meet Dr. Michael Hirsh during my first year at UMass Chan Medical School and join a research project analyzing a national database of pediatric firearm injuries. We evaluated who was getting injured, what types of injuries were most common, and how sick these kids were compared to other kids in the hospital. Dr. Hirsh and I have continued working together on a project focused on medical students’ comfort around firearm counseling and injury prevention. We conducted a survey to evaluate whether medical students felt comfortable having discussions with patients and parents regarding firearms in the home and safe storage techniques, whether they remembered having a provider address the topic, and whether they wanted this topic incorporated into their curriculum. We hope to use this information to create a longitudinal lesson plan where students are taught the basics of firearm violence in America, made aware of safe storage techniques, and are given opportunities to practice counseling on standardized patients as well as in clinical settings. We are hopeful that this project will lead to increased awareness and sustained comfort around firearm counseling. though most clinicians see firearm violence as a public health issue, the pervasive stigma, discomfort, and lack of experience surrounding this topic remain (4). However, as medical students, in researching firearm violence, we are attempting to bring this epidemic a sense of legitimacy and urgency in and beyond the healthcare community.

Symren

On December 12, 2012, I was sitting in my high school cafeteria when we heard news of a mass shooting at an elementary school just miles away in Sandy Hook, Connecticut. While I watched the landscape of my neighboring town change as the school was demolished and multiple playgrounds built in the children’s honor, I felt myself becoming hypervigilant to stories of firearm violence in the news. Before medical school I worked with children with histories of trauma—often stemming from witnessing firearm violence—where I saw the long-lasting and complex effects these events have on young minds. After these experiences, I wanted to understand the topic from a more clinical and research-based perspective. I was lucky enough to meet Dr. Michael Hirsh during my first year at UMass Chan Medical School and join a research project analyzing a national database of pediatric firearm injuries. We evaluated who was getting injured, what types of injuries were most common, and how sick these kids were compared to other kids in the hospital. Dr. Hirsh and I have continued working together on a project focused on medical students’ comfort around firearm counseling and injury prevention. We conducted a survey to evaluate whether medical students felt comfortable having discussions with patients and parents regarding firearms in the home and safe storage techniques, whether they remembered having a provider address the topic, and whether they wanted this topic incorporated into their curriculum. We hope to use this information to create a longitudinal lesson plan where students are taught the basics of firearm violence in America, made aware of safe storage techniques, and are given opportunities to practice counseling on standardized patients as well as in clinical settings. We are hopeful that this project will lead to increased awareness and sustained comfort around firearm counseling.

Chris

The first physician I shadowed was a pediatrician in rural, southwestern Vermont. During every physical, she asked a few direct questions: “Is there a gun in the home? Where is it stored? Is the ammunition stored separately?” In the six years since, I have not heard a clinician ask those questions again during a visit. Confused as to what force kept snatching this question from the lips of physicians, I found myself enamored by the field of preventative medicine and the role clinicians can play in averting calamitous everyday injuries and acts of violence that ravage the health of our communities. The project I am crafting with Dr. Hirsh at UMass Chan Medical School first surveys pediatricians about their practices with regards to firearm safety relative to other areas of injury prevention such as automobile and sports safety. From there, we plan on working directly with a group of pediatricians to create a standardized system of dispensing gun locks to any patient who wants one. Lastly, to address the threat posed by gun violence, we aim to work with gun ranges and local police departments throughout Massachusetts to create a Firearm Storage Map: a resource available online and in emergency departments that patients can use to find a temporary place to store a gun outside of the home for 48 to72 hours. Beyond preventing morbidity and mortality, our hope is that by probing these caregivers, gun ranges and police departments about their approach to firearms and pushing forward this research, medical students can have a hand in helping UMass Chan establish innovative and effective strategies for addressing the firearm epidemic.

There are organizations at UMass Chan Medical School and in our local community that offer opportunities for everyone to learn more about and take action against gun violence. The Worcester Gun Buy Back program allows students to run events where community members can relinquish their firearms to local police departments. Our local chapter of Scrubs Addressing the Firearms Epidemic--a national alliance of medical schools focusing on combating the firearm epidemic with research, advocacy, and education--has enriched us with a pool of various strategies, contacts, and inspiration to transform the perspective of the healthcare community. The Massachusetts Medical Society Committee on Violence Intervention and Prevention works on broader issues of violence in the community and allows community members to get involved in local policy efforts.

The issue of gun violence in America is extremely complex and requires change from multiple angles. As medical students at UMass Chan we are in a privileged position to engage in research with experts in the field and complement this work with community activism and policy advocacy.

Christopher Zaro, BA, is an MD Candidate in the Class of 2025 at UMass Chan Medical School.

Symren Dhaliwal, BS, is an MD candidate in the Class of 2023 at the UMass Chan Medical School.

References

1. Knoepke CE, Allen A, Ranney ML, Wintemute GJ, Matlock DD, Betz ME. Loaded Questions: Internet Commenters’ Opinions on Physician-Patient Firearm Safety Conversations. West J Emerg Med. 2017 Aug;18(5):903-912. doi: 10.5811/ westjem.2017.6.34849. Epub 2017 Jul 11. PMID: 28874943; PMCID: PMC5576627.

2. Goldstick JE, Cunningham RM, Carter PM. Current Causes of Death in Children and Adolescents in the United States. N Engl J Med. 2022 May 19;386(20):1955-1956. doi: 10.1056/ NEJMc2201761. Epub 2022 Apr 20. PMID: 35443104.

3. Parmet WE, Smith JA, Miller M. Physicians, Firearms, and Free Speech - Overturning Florida’s Firearm-Safety Gag Rule. N Engl J Med. 2017 May 18;376(20):1901-1903. doi: 10.1056/ NEJMp1702516. Epub 2017 Apr 12. PMID: 28402707.

4. Thai JN, Saghir HA, Pokhrel P, Post RE. Perceptions and Experiences of Family Physicians Regarding Firearm Safety Counseling. Fam Med. 2021;53(3):181-188. https://doi. org/10.22454/FamMed.2021.813476.