How Pediatricians Can Promote Gun Safety

Eight years ago, Cassandra Crifasi took her kids to the pediatrician and was asked the standard home safety questions: How did her family store medication and cleaning products? Did they have the right car seats? 

Then: Are there guns in the home?

“I said yes, fully prepared to talk about how we stored them,” says Crifasi, PhD ’14, MPH, an assistant professor in Health Policy and Management and deputy director of the Johns Hopkins Center for Gun Violence Prevention and Policy. 

But the visibly uncomfortable pediatrician rushed to another topic.

Crifasi later relayed the experience to Katherine Hoops, MD, MPH ’10, a colleague at the Center and a pediatric intensivist physician at Johns Hopkins Hospital. Hoops told her such awkward encounters were all too common.

Hoops, also a gun owner, has always felt comfortable talking with patients about firearms, trigger locks, and safes. But most of her colleagues avoided the politicized subject altogether.

Despite firearms being a leading cause of death for children and adults in the U.S., gun safety is rarely a part of physicians’ education.

“I saw patients dying of gun injuries, and clinicians who didn’t feel equipped to talk about it,” says Hoops. “Despite firearms being a leading cause of death for children and adults in the U.S., gun safety is rarely a part of physicians’ education.”

In 2017 and 2018, she and Crifasi surveyed a group of pediatric residents. While the residents overwhelmingly said they should counsel patients on gun risks, most never did.

So, the duo developed a training module at the Hopkins Medicine Simulation Center, in which medical residents advised at-risk “patients” (who were actually medical actors)  with gun access. Initially, most residents gave little guidance beyond suggesting removal of firearms from the home.

The residents were then split into two groups. Both groups took a course on firearm injury epidemiology, but one group got added training in gun storage basics and counseling techniques. Back in the simulation, those doctors were able to discuss detailed gun safety strategies with patients. The other group saw no change. 

“Simply telling providers about the burden of gun violence doesn’t change the quality of their counseling at all,” says Crifasi. “It’s really that next step, focusing on language and tools, where we see significant improvement.” 

Hoops and Crifasi plan to continue the training this fall and hope to adapt it to a clinical setting soon. The team has also launched online curricula with these tools.

“When a patient has a pool, we don’t just say ‘get rid of it.’ We advise them about its dangers, to put a fence around it and supervise their kids,” says Crifasi. “We need a similar approach with guns. It should not be so taboo.”