Educating Physicians About Firearm Safety and Injury Prevention

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On this episode of the Academic Medicine Podcast, guests Katherine Hoops, MD, MPH, Andra Blomkalns, MD, MBA, and Allison Augustus-Wallace, PhD, MS, MNS, join host Toni Gallo to talk about firearm safety and injury prevention education. They discuss the role of physicians in engaging patients and communities in firearm injury risk reduction, the current state of firearm injury prevention education, and where the academic medicine community needs to go from here.

This episode is now available through Apple Podcasts, Spotify, and anywhere else podcasts are available.

A transcript is below.

Read the articles discussed in this episode: 

Read the complete collection of articles on firearm injury prevention published in Academic Medicine.

Transcript

Toni Gallo:

Before we begin, a quick note. This episode discusses suicide. If you or a loved one is in distress, the National Suicide Prevention Lifeline provides free and confidential support online at 988lifeline.org or over the phone at 988.

Hi, everyone. I’m Toni Gallo. I’m a staff editor with Academic Medicine and host of today’s episode. In 2019, there were almost 40,000 firearm deaths in the United States, a number that rose to more than 45,000 in 2020. A large portion of firearm deaths each year are suicides. There are also unintentional injury deaths, which are a particular risk among younger children; homicides, including peer violence and intimate partner violence; and the mass shootings that draw national and international attention. In addition, firearm injuries are among the leading causes of death for almost all age groups in the United States, including for children and teenagers. Many medical organizations have identified firearm injury and death as a public health crisis. Yet fewer than 30% of medical schools reported including any firearm-related content in their curriculum in 2020. And recently we’ve seen calls from medical students, residents, and others for more training in firearm safety and injury prevention.

Toni Gallo:

Earlier this summer, Academic Medicine put together a collection of articles published in the journal on firearm injury prevention, including some descriptions of firearm safety and injury prevention education and discussions about the role of health professionals in responding to this public health crisis. I’ll put the link to that collection in the notes for this episode. Today, I’m joined by the authors of two of the articles in that collection, Dr. Katherine Hoops and Dr. Andra Blomkalns and by a member of the journal’s editorial board, Dr. Allison Augustus-Wallace. And we’ll be talking about the role of physicians in engaging patients and communities in firearm injury risk reduction, the current state of firearm injury prevention education in the health professions, about the content and impact of the national consensus guidelines that Katherine and her coauthors put forth, and where the academic medicine community needs to go from here. So with that, let’s get started and do introductions. Allison, would you like to go first?

Allison Augustus-Wallace:

Sure. Thank you, Toni. So my name is Allison Augustus-Wallace, as she stated. I’m from Baton Rouge, Louisiana. I am an associate professor at the LSU Health Sciences Center in New Orleans, Louisiana, where I serve in the Office of Diversity and Community Engagement in the School of Medicine. I wear a number of hats in the space of diversity affairs. I’m a trained biochemist, and primarily my responsibilities are in those kind of combined areas of biomedical education as well as medical education. Thank you.

Toni Gallo:

Thanks very much. Katherine?

Katherine Hoops:

Sure. Thanks, Toni. My name is Katherine Hoops. I am an assistant professor of pediatric critical care medicine at Johns Hopkins where I’m also core faculty in the Center for Gun Violence Solutions in the Johns Hopkins Bloomberg School of Public Health. So in my clinical life, I’m a pediatric intensivist. I work in the pediatric ICU at my institution and, in my research time, I do a range of work focused on clinician engagement in and education on firearm injury prevention.

Toni Gallo:

Thank you. Andra?

Andra Blomkalns:

Hello. Thank you. And thank you, Toni, for having me on this podcast. My name is Andra Blomkalns, I’m professor and chair of emergency medicine at Stanford University School of Medicine. I practice emergency medicine clinically, and then also have an interest in racist medical practice, cultural competencies, and implicit bias associated with firearm injury. I consider myself a responsible gun owner and have been for most of my adult life and particularly interested in this topic and how we can further educate our health care professionals in this important public policy initiative.

Toni Gallo:

I want to thank you all for joining the podcast today. And I thought we could get started with a discussion about language and the importance of the terminology that we use. In both Andra and Katherine’s papers, you use the term firearm injury instead of gun violence which I think we maybe see in the media more often or other terminology. And I wonder if you could talk just a little bit about why you have chosen to use that terminology and the importance of specific words in this area.

Andra Blomkalns:

Well, language really, really matters. And we see this a lot in medicine and I’ll give a couple other examples, like we’ve changed from using the term sexually transmitted disease to sexually transmitted infection because it’s more palatable, less repugnant, I guess, to talk about someone having an infection because all of us get infections of a variety of types. Or “motor vehicle accident.” Many times these are not accidents. These are intoxicated, irresponsible drivers, these are “collisions.” So this is very similar. To say firearm injury is something people would want to discuss, prevent, talk about, engage in, whereas firearm violence, people generally, to me at least, want to withdraw from the discussion or want to turn away from things like the term “violence.” I don’t know. How about you guys? That’s kind of the way I see it.

Katherine Hoops:

I totally agree. I also think firearm injury is simply more inclusive, right? It’s encompassing unintentional injury, interpersonal violence, and suicide. I think when many people hear gun violence, they think of interpersonal violence, homicide, mass shootings, but not of self-directed violence or suicide, and certainly not of unintentional injuries. And to kind of follow on something you just said, Andra, when we say “accident” that implies that it’s not preventable, right? So that’s why I especially when we’re talking about unintentional gun injuries do not talk about accidents, right? I don’t talk about accidental gun injuries, but rather unintentional because again words matter.

Allison Augustus-Wallace:

I agree with the evolution of the language with respect to the use of this term. I agree that it’s more inclusive. I think it includes all of those ways for which these types of injuries can occur. And so again, I agree with both of you in the respect of the evolution inclusively of using the term as it is, “firearm injury.” In addition to that, I do agree. I think that individuals are more likely to discuss it and move into a space of seeking greater understanding. Because again, it aligns itself in such a way that now you’re merging public health with medicine. So you’re bringing different aspects in different communities and individuals that may have knowledge or are seeking additional knowledge. They’re coming into a space where they have more accessibility to information and they bring information with them. So I think it’s a combination where you’re expanding the conversation and actually an opportunity for greater discussion and possibly even more effective policy development.

Andra Blomkalns:

I will add just briefly that what I think is most important is that people are talking about it, and I almost don’t care what they call it as long as we actually start talking about it and engage in the discussion, particularly as it pertains to medical education. But yeah, I think we’re all in agreement as to the appropriate terminology.

Allison Augustus-Wallace:

Absolutely.

Toni Gallo:

Let’s talk a little bit about what this looks like in medical education right now. I wonder if you could all talk about if there are… What does firearm safety and injury prevention education look like at the medical school level, the graduate medical education level, for practicing physicians? What’s out there right now and maybe what are some gaps or are there specific audiences or groups that are being missed that aren’t receiving this education?

Katherine Hoops:

So I think unfortunately in its current state, there are gaps everywhere at the UME, GME, CME levels, right? So at the UME level, the Association of American Medical Colleges follows all these curricular changes and about 25% of medical schools included some kind of firearm-related content in 2020. And that’s a pretty marked improvement from five years prior. And in some of our surveys, work that I and other colleagues have done, we know that only about 20% of residents endorse having received some kind of firearm-related education. But fortunately, there is a lot of great work ongoing to fill those gaps, right?

Katherine Hoops:

So I’ll be eager to see the AAMC’s curriculum reviews over the next few years as more schools have more resources including the work that some of us have done in this area to enhance curriculum development so that their learners are getting more education on firearm and violence prevention. But I can’t say enough that addressing an incredibly complex and multifactorial problem like gun violence requires an all-hands-on-deck approach and we need to be educating all clinicians, all health professionals, public health professionals on firearm injury and violence prevention. So our curriculum for example, was designed to be implemented or drawn from, to build nursing curricula, social work curricula, as well as medical education curricula.

Andra Blomkalns:

I’m in agreement with Dr. Hoops. I think there’s a great paucity of education regarding firearm injury, gun violence, and the topic in general. And to some degree, it’s been stigmatized and it’s going to just take a gradual acceptance that this is part of the national conversation. This is part of health care. This is part of medicine and just like many things it’s not going away no matter how much we want to wish it to do so. And it’s just, I mean, a matter of time and it’s our responsibility to include this within the educational portfolio and a public health necessity to do so. So right now it’s just not in there enough. I’m hopeful and all my colleagues are hopeful that it will increase over time. And it’s going to take brave folks like the folks who are on this call to move things forward and continue doing the research and publishing the items that we need to encourage people to include these items in their curricula.

Allison Augustus-Wallace:

I think as my two colleagues have just stated, it’s ongoing. This is really a comfort level for even individuals that must be addressed to speak in this space. If you look at some of the literature, it has not been well developed or is being developed in the sense that even medical education is kind of catching up in coming into this space about the conversation. It did not feel necessarily comfortable, or it did not necessarily know how to speak about this particular. Individuals come to this space they have some general knowledge, but how does that translate into communication with students as well as patients? And so at this stage, it’s in the early stages, but I think it’s moving in a positive direction where again, the dialogue has begun. We’re coming on board with common terminology and a comfort level where we all are as citizens have a responsibility to move into this space, as well as that we’re wearing the hats in this area of academic medicine.

Allison Augustus-Wallace:

It’s part of our responsibility whether we are in the classroom, speaking with patients, it’s part of our responsibility and therefore we have the responsibility to educate ourselves so that we can bring this information into this space and initiate this type of dialogue. So it’s ongoing, it’s developing. And I think it’s going to actually push us beyond our limits in a sense. In some spaces I know for even myself, this is something that I’m abreast of, but having the opportunity to really move into this space and have this dialogue, I find it refreshing. I find I’m moving in a space of even myself for evolution. So I’m enjoying this part even being here this morning to start this conversation, myself as an individual. So I am being transparent in this space. So I think as we move along, we’re all going to grow and learn and speak better, be able to actually articulate our concerns as well as our knowledge in this space and expand the knowledge base.

Toni Gallo:

And I want to encourage anybody who’s listening, who is doing work in this area, please submit it to Academic Medicine, it’s a topic we’re interested in. As all of you have said, there’s just not a lot of scholarship out there right now. So if you are implementing a program or thinking about these topics, please write it up and submit it to us. This is definitely something we want to make sure that the scholarship develops around. So we have the best information.

You all have mentioned the idea of becoming comfortable, talking about firearm injury prevention and firearm safety. And I wonder if you’ve had conversations with colleagues at your institutions around how additional education could be implemented or where the barriers are. And I wonder if you could just maybe talk about what those conversations are like. Is there interest in adding additional programs, or adding curricula, or is this something that there needs to be more awareness about first before you can kind of take that next step?

Andra Blomkalns:

Well, I’ll say the biggest competition that I see is just time. I mean, the medical professionals are being asked to learn more and more and more yet medical education being funded less and less and less, and people wanting to graduate sooner and sooner and sooner, and the training program’s getting shorter. So it doesn’t make any sense if we’re now asking trainees and future physicians and future care providers to learn twice as much as we did perhaps in the 1950s and 60s to attend training programs that are half as long. So the math is, I’m not a mathematician, it doesn’t add up. I don’t think it’s difficult to see how that doesn’t add up. So in this case, if we add education about one topic, we have to eliminate something. And making that decision about eliminating something is very, very difficult. And I don’t know what to choose. So it’s a matter of almost creating matter in this situation. So I think we’re at a real crux of trying to understand that we can’t keep cramming more into a smaller space.

Katherine Hoops:

I totally agree. It’s definitely a challenge, it’s hard even for us people who are really dedicated to this to fit it into even our home institution’s curricula, right? Because it’s not that sepsis isn’t important. And so we can eliminate education on one disease process to talk about another. But of course, I’m always encouraged to see that there is interest. There is a dedication to including this in curricula, at different institutions, and in all of our programs, right? Because if we’re going to improve everyone’s confidence engaging in these conversations, we’ve got to first achieve a baseline level of competence. And so we’ve really got to increase the amount of education that all of our clinicians are getting on firearm injury. But again, it’s sometimes a challenge to figure out how best to do that, but definitely encouraged to see many, many of my colleagues really dedicated to enhancing their learners’ education on firearm injury.

Allison Augustus-Wallace:

I agree. And I think in addition to what we find ourselves in this space trying to cram in, in respect to information, we can’t afford to remove anything to insert. And so I think as we look at this, it’s a matter of an introduction and a beginning of a dialogue and then incorporated overall into our lifelong learning, expressing that this is an ongoing, as is all the other information lifelong. And so we beginning opening the door, beginning these conversations. And so while the trainings, unfortunately, or rather as we evolve, as I won’t say, unfortunately, but as we evolve and we realize what is needed, I think it’s a matter of realizing what’s up front, what’s in the middle, what’s in kind of in the rearview, but everything’s coming along together.

Allison Augustus-Wallace:

I think that’s what’s most important. So regardless of the length of the training, depending on the institution, that’s what that institution believes that’s best for their learners. So we move forward with accepting that. But overall, collectively, I think it’s a lifelong learning process that we all need to incorporate ourselves into. And so we need to lead by example and we’re in such a way that if our learners see us doing it and then the use of that, so to speak hidden curriculum, they see us doing it, then they will do it. And so then we all are better forward collectively.

Andra Blomkalns:

I love that because that is where we find the extra time is becoming the lifelong learners and so forth. And I keep hearing my own colleagues and colleagues in other specialties saying, “Well, I really don’t want to do CME. And CME is expensive. And I went to school for seven gazillion years and I don’t want to go to school anymore.” It’s like, get over ourselves. We have to continue learning and it’s a lot less intensive than medical school or professional school was. So it’s our obligation to continue learning what these new things are and what we need to be responsible for. So I’m going to make myself very unpopular and say CME should be more rigorous and there should be more of it because we can’t cram it all into the initial education period.

Allison Augustus-Wallace:

You just can’t. And I agree with you. We should all take on that responsibility. I mean, that’s what we signed up for. We knew that whether we, for myself as a PhD biomedical education, biochemistry, I’ve made a point of, as I insert myself into academic medicine, that’s my responsibility. So I learn when available when having the opportunity I go forward with early CMEs myself. And so I think that’s important in this space that we have that responsibility and we engage ourselves and immerse ourselves consistently for growth. That’s how we stay fresh.

Toni Gallo:

I want to turn to the national consensus guidelines that Katherine and her coauthors developed because this is really looking at what does education look like, what’s the content of education. So maybe Katherine, you can give us kind of an overview of what the guidelines are, how they’re meant to be used, and maybe if you’ve heard from anybody about how they’ve been put into practice since you published them.

Katherine Hoops:

Yeah, sure. So I’ll answer the last part first and just a resounding yes that I know that many of my colleagues, those who have participated in the project, but also new friends and colleagues who’ve reached out from other centers, have gone on to use those priorities to generate curricula, integrate into existing curricula at their institutions. Others, myself included, have used them to generate eLearning modules and podcasts. And I hope dozens more have done so on their own. But we’ve certainly gotten a lot of wonderful feedback that they’ve been useful to many of our colleagues in a lot of different settings across the country.

Katherine Hoops:

And that was the goal, right? So the project itself created a set of crosscutting basic and advanced learning objectives that were applicable to all types of firearm injury and all medical disciplines and specialties, right? So these are objectives that could be used by any educator to create educational content that fit their learners’ needs and setting. And our hope was that with an improved foundation for curriculum development and program building, we could make the challenging work that we’ve been talking about, of our medical educators, a little lighter. And in so doing promote better education on, and engagement in, firearm injury prevention in the next generation of clinicians, but also among all of us in continuing education spaces too.

Andra Blomkalns:

Katherine, what I really liked about it was it sort of broke it down into digestible pieces because for an educator to just say, Oh my gosh, I need to do this for my group, or my constituency, or so forth just seems so monstrous. And I can look at those, okay, maybe we can tackle that this year or this quarter, this semester, or this period or something, or this block, in a way that it really changed the frame of my mind in terms of how to break it down into a way that seemed manageable. Because initially it just seems like such a huge task, and I really appreciated the thoughtfulness of you and your coauthors and being able to distill it in a way that I think all of us in all specialties and disciplines can understand.

Katherine Hoops:

Thank you. Because it is, it’s a huge topic. It’s not something that you can accomplish in a one-hour didactic by any stretch of the imagination, right? But you can break out a few of those objectives and turn them into a 30-minute talk here and there. So thank you. I’m glad that folks have found it useful.

Toni Gallo:

I want to talk a little bit now about the different roles that physicians and health professionals can play with patients in their communities around firearm safety and injury prevention. Katherine and Andra, in your papers you talk a little bit about kind of the interpersonal bedside role of health professionals counseling their patients, thinking about risk reduction, really as part of the patient-physician relationship, what can individuals do in that space? So I wonder if you can talk a little bit about what that looks like and what health professionals can do and then maybe around how would you educate, how would you get health professionals to be more comfortable in that space, more comfortable counseling patients, and…

Andra Blomkalns:

So I think encounters with medical professionals still over time and even now for people are still a big deal. I mean it’s uh… In emergency medicine, certainly, no one starts their day hoping to go to an emergency department, but even going to any health care professional, it is a big part of anybody’s day. And I think physicians have a wonderful opportunity to add to preventive health and engage patients in some of these discussions in different ways. And in some ways, I think we’re obligated to do so. And we can’t do everything for everyone, but I do think it’s an opportunity to talk about whatever that preventive health measure might be. In this case, it could be features of firearm injury or gun safety, particularly, and much the same way we’ve talked about smoking or other things similarly in the past.

Andra Blomkalns:

So I think that discussion is going to vary between specialty, vary between type of physician, obviously in the age and the appropriate maturity of the patient. But right now, I’m not aware that that’s a common thing to bring into medical practice. I’ll say I just started doing that in the last year or so. It just wasn’t part of the sort of common thing that I would bring up or talk about. And I’m not sure why, well, I guess I know why, it’s like no one else was doing it either, but we’ve started talking about domestic violence. We’ve started talking about preventive things in other health care and smoking and obesity. And we can say to people, “You’re overweight and you need to consider that.” So there are other tough topics to talk about and we can embrace this one as well.

Katherine Hoops:

I totally agree. Right. We play a really important role in our patients’ lives, right? And to anybody, don’t underestimate how influential you are in your patients’ lives, right? And when we can approach a conversation with our patients, with respect and seeking understanding of their perspectives, we can better engage in a thoughtful dialogue about that patient or that family’s risks and how best to mitigate their individual risks of injuries. I say a lot that counseling on firearm injury prevention should be universal, but the content has to be customized. Injury prevention counseling isn’t one size fits all and everybody’s needs and abilities are different. But to echo Andra, right, this is no different than counseling on car seats, bike helmets, fall prevention, or any other preventive health measure. Your patients trust you to be a credible source of information. So again, going back to what you were saying before, it’s your responsibility to educate yourself on firearm safety so that then you can impart that knowledge and engage in a discussion with your patients.

Allison Augustus-Wallace:

Toni, may I ask a question of the two authors on this because I’m just curious in this particular space? So how do you propose incorporation of cultural competency in this space as you move into these types of discussion? I’m just wondering in that perspective, the integration between because we always have to be mindful about ensuring that we are culturally, and I say competent, it’s really cultural aware and having an awareness and difference in values and so on and so forth. So I’m just wondering how do you integrate that potentially in types of conversations that you’re proposing?

Andra Blomkalns:

I think that’s incredibly important and it’s the necessity of having the patient feel safe, respected, and that the care provider is somewhat knowledgeable about their culture, their situation, and otherwise it falls completely flat or even can have a significant negative effect. So, yeah, this is a tough needle to thread because there’s a lot, and even more so for other medical conditions we’re learning that cultural competencies are so incredibly important and that it’s not just one size fits all when it comes to medicine.

Andra Blomkalns:

So this is not only for firearm injury or gun safety or otherwise, this is across the breadth of different medical conditions so that the cultural competencies alone have to be incorporated across medical education and across medical practice. And not only for this. Although this, there’s tremendous stigma and tremendous bias associated with gun ownership and gun violence and gun, sorry, I even said gun violence because I was talking about stigma, right? Just hit me in there. So it just, there is. And some people don’t want to talk about it and so … or find it repugnant to talk about. So I believe it’s across medical education and not necessarily just in this realm.

Allison Augustus-Wallace:

Agreed. Absolutely. Thank you.

Toni Gallo:

In thinking about building that relationship between physicians and patients in both of your papers, you really talked about a trauma-informed approach to both counseling and caring for patients and their families who have been affected by firearm injury. And I wonder if you could talk a little bit about, I think that kind of builds on what we’ve been talking about, approaching these conversations from a trauma-informed care perspective and what that would look like, kind of the importance of doing that.

Katherine Hoops:

All right. Sure. So I think that we all have a responsibility to practice trauma-informed care, to implement trauma-informed approaches, and to build trauma-informed systems. And just for those, I’m a pediatrician, right? So a trauma-informed approach is part of our vernacular. It’s part of our training, but for those who may not have heard this terminology, right? A trauma-informed framework is one that acknowledges the ubiquity of trauma and it assesses for, recognizes, and response to the effects of traumatic stress, including but not limited to violence. But we know that implementation of a trauma-informed approach is known to promote resilience and recovery and interrupt pathways to violence. So I think we probably all agree, right? That this is an important perspective to use when you were approaching patients in all disciplines in all settings and also needs to be a core part of education too for more providers.

Andra Blomkalns:

And particularly with this topic, that’s not part of my natural vernacular and I’ll have to confess, I just sort of look it up and read about it because it’s not something that was just part of something that was as I would necessarily talk about, but this, the words themselves, “gun,” “shooting,” all those things evoke such powerful emotions and thoughts and feelings that you can’t help but have to incorporate those parts in the discussion or education of any of these things. So I would say I’d liken this topic to the topics of rape or abortion or other things that people find difficult talking about, that the trauma-informed care approach is going to be really, really, really important.

Allison Augustus-Wallace:

It is important that we are continuing to have this type of dialogue because I think that’s the reason where we are or where we’ve created this uncomfortableness. I think the fact that we kind of fulfilled a self-fulfilling prophecy in the sense, where we’re uncomfortable because we’re not speaking about it. And so I think the more that we move into this space and we are having these types of dialogues and articulating and having uncomfortable conversations. We learn from uncomfortable conversations and moving from that space and teaching our learners how to have what may be perceived as uncomfortable conversations, where we can all learn from this information, how to better articulate concepts in these spaces. I think that’s where we are on this journey so to speak. And I’ll say that these are not the only … we’re talking about, firearm injury today, but these are not the only conversations that we need to have.

Allison Augustus-Wallace:

We are in a space where if we don’t have these types of conversations, there are so many freedoms and so on and so forth that we are looking at backtracking, okay. That if we don’t have these conversations and we don’t be more proactive in this space. We have to be more proactive and transformational as opposed to react because otherwise, we wake up one day and the conversations that we should have had that would’ve allowed us to move forward. The conversations were maybe too late. And so now we’re trying to regain ground as opposed to move forward. So I think it’s important that we are awakening ourselves for this type of dialogue and serving as examples for our learners in this space as well. It’s important, it’s important. They learn from us and so we must lead by example.

Andra Blomkalns:

Absolutely. I mean, these are issues of public health, and I don’t think anyone can argue that we don’t want our public to be healthy and that’s at least one thing we can have as common ground. And when it comes to things that compromise the public from being healthy, then it is incumbent upon medicine and particularly academic medicine to take part in these conversations and help educate all of us and the public about the ramifications of some of these decisions. So we can at least agree on public health. At least we have a starting ground, but I do agree that particularly academic medicine needs to engage in a more enthusiastic and robust fashion.

Toni Gallo:

Let’s talk about that a little bit. You also mentioned in your papers, the component of the role of physicians in their larger communities. So outside of just relationships with patients, what does that look like? What does it look like for academic medicine to be part of these conversations, to affect important public health topics both within communities and also in the national conversation? How would you encourage colleagues and other health professionals to really take part in those conversations?

Andra Blomkalns:

Well, I think everybody has a different way of doing these things. Part of this is podcasts just like these. Other parts are education of their own local community or national community. And whether that’s in blogs or tweets or other social media methods. It can take on a number of different forms. I do think education of the community is important and that we can’t assume that everyone starts from the same level of knowledge for any of these conditions, and particularly with firearm injury in the areas that Dr. Hoops’ paper very nicely outlines, those are all very different.

Andra Blomkalns:

And so many of us, I think so many people go immediately to mass shooting because that gets a lot of media attention and all that, but there’s the deaths, the number of deaths are actually much more in any of the other categories. So that alone would be important education to discuss. And maybe we can employ the help of media and other avenues to help educate the public about actually what gun injury, firearm prevention and so forth, firearm injury prevention, really means, and it’s not just people at the mall or in schools that we’re talking about.

Allison Augustus-Wallace:

And I agree with that and to just follow up in respect to that particular publication, I appreciate the fact that there was the inclusion of suicide prevention, especially with the 988 number coming online. I think it was very timely and that’s often a part of this discussion that is left out. It’s not addressed as directly or intentionally as maybe it should be. And so, including that as part of the conversation I thought was very important moving and as well as all of the other ideas that you presented as well in your publication, and I think that it was an alignment of ensuring that as much, that we can include in the conversation, it is included in the conversation. And again, while we see so much of one type on the news, we can’t forget the rest. And so moving us in such a way that it’s a collective understanding of what all of this encompasses. I think that was very important and nicely addressed in your publication.

Katherine Hoops:

Thanks, y’all. And just to echo, right? Mass shootings account for about 2% to 3% of gun deaths every year contrasted to suicide at 60%, right? So I think just disseminating accurate information that we as clinicians that can educate our families at the dinner table, our colleagues, our trainees, our learners in a classroom setting, all of that dissemination of accurate information is important. And for some of us, we’re going to choose to find and use our voices in other ways to advocate for policies that we know will benefit our patients and their families, right? So I just encourage people, not only to be familiar with the data but then also know the laws in your state, know the resources in your community that can help your patients, right? Because you know the needs of your patients. And if those resources aren’t there, I challenge everyone to then use your voices, use that accurate information to then advocate for the things that your patients need.

Toni Gallo:

So we’re about coming to the end of our time here. I want to give you each a chance if you have any final thoughts that you want to share with listeners, anything about where you think the field should go in terms of education or practice, this is your chance. So we’ll give everybody one last opportunity. Andra, would you like to start?

Andra Blomkalns:

I suppose so, thank you so much for calling on me. I’ll start by 2 major points. One is that there’s nothing in medical education that we can afford to kick out. So it has to be added to the collective information that already has to be crammed into medical education brains at all levels. So in that, that just extends the time of learning for all of us. And so lifelong learning, adding things to the continuing medical education curriculum, making medicine and health policy a part of your career and not just something that ends when you graduate and get the diploma is I just think a natural responsibility that we have to consider as a natural part of being a doctor or a health professional.

Andra Blomkalns:

And then 2 … I think it’s incumbent upon medicine, academic medicine, care providers to speak up, educate their public, educate their government officials, and so forth in health policy, public health policy matters, particularly when it comes to some of these decisions that can really truly affect public health and how our society lives. And it’s sometimes we view ourselves not particularly in the advocacy realm, but this is certainly a time period, and this is certainly a topic, firearm injury, where we can make a difference in starting the conversation, having the conversation, educating the public, and making this a focus whereby we can educate the public by a respected body of humans and influence the outcome.

Katherine Hoops:

Exactly. I think we know that it takes more than good medicine to achieve good health. And we, as clinicians often have a front-row seat to bear witness to failed policies. So again, I would challenge folks to use their voices to advocate for the things that we know are based in evidence to work. And where do we go from here, onward and upward, right? We’ve got to have a “yes, and” approach to this education. And for us, for our project, creating that curriculum was the culmination of an incredible amount of work by our whole team but it was only the beginning and the implementation of that curriculum makes all the prior work look easy. And so we want to be here to be a resource for everyone as they’re building programs in their own institutions too.

Allison Augustus-Wallace:

First, I want to thank both of you for contributing to this space. I think it’s a space that had not clearly been addressed as intentionally as before. And so that you’ve segued into this particular space. I know as an individual in academic medicine, I appreciate it. I think it’s opening a door beginning to articulate these important concepts and giving us, providing a roadmap for how we move forward in this space. So at least we’re starting, we have a starting space. I think it’s important that as you mentioned, both of you have mentioned, we need to really help our colleagues, learners, family, friends, whomever we’re encountering. This is public health. And so we really need to move into the space that we are more comfortable in articulating what public health is and therefore being involved. We need to be involved in understanding the policies in our states.

Allison Augustus-Wallace:

We need to understand and have conversations with those individuals who are creating policy and not just supporting individuals because they might have a town hall meeting that you have an opportunity to take a photo or have a photo. It’s deeper than that. It’s understanding do you know what policy is? Do you know how to create policy? Do you understand how policy affects real-life people on the ground? And so having those conversations with individuals and making sure that everyone as best as possible understands their civics and their civic responsibility in that sense, I think that is what allows for us to have a deeper understanding and appreciation for public health.

Allison Augustus-Wallace:

And so, as we’re deriving curricula or we’re deriving policies, we can do so in a more effective, intentional way where we’re all more educated in this space. And that doesn’t mean if you’re not well-rounded in all of the terminology, that’s okay. But coming into this space and having access to data and to knowledge, and being able to interpret that in such a way that everyone can understand it as best as we can, I think that’s what’s important. Being more intentional and inclusive in the dialogue, in the conversation so that we have better outcomes. I think that’s the goal.

Toni Gallo:

I want to thank you all for joining the podcast today. And I want to encourage all of our listeners to visit academicmedicine.org to find the articles that we discussed today, as well as the complete collection on firearm injury prevention education. If you or your colleagues have work in this area, consider submitting it to us for peer review and publication.

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