On June 25, 2024, the U.S. Surgeon General released an advisory addressing the public health crisis of firearm violence in the U.S. The advisory highlighted statistics and called for health systems to facilitate education on safe and secure firearm storage.

Key findings from the advisory and related research included:

1. Firearm violence was the leading cause of death for U.S. children and adolescents.
2. Between 2012 and 2022, firearm suicide increased by 20% across the U.S. population.
3. From 1999 to 2020, an estimated 434,000 youth experienced the death of a parent due to firearms.

A Viewpoint published in JAMA Internal Medicine by student-physician Okum emphasized the need for such education, citing personal experiences in Baltimore, Maryland. Okum described seeing "Don't Shoot, Children at Play" scrawled on a sidewalk near a school playground, illustrating the impact of firearm violence on communities.

The commentary by Chana A. Sacks, MD, MPH, from the Division of General Internal Medicine and Mongan Institute at Massachusetts General Hospital, Boston, discussed the integration of firearm violence prevention education into medical school curricula. Dr. Sacks argued that this integration would not require adding entirely new competencies, but rather incorporating these topics into existing frameworks of risk assessment, safety counseling, and trauma-informed care.

Three clinical scenarios where firearm access and safety discussions were relevant to patient care were presented:

1. An 80-year-old man with potential cognitive impairment
2. A 30-year-old veteran seeking care for mental health concerns
3. A 5-year-old child at a routine pediatric appointment

In each case, assessing home safety, including firearm access, was described as an integral part of patient-centered clinical care.

The commentary highlighted existing efforts to address this educational gap:

1. Massachusetts General Hospital: Interns practiced counseling skills with standardized patients.
2. Cincinnati Children's Hospital Medical Center: Physicians adapted training to a virtual reality environment.
3. University of Texas Health Science System at Houston: A workshop incorporating role-play scenarios was developed.

These programs aimed to equip medical students with knowledge of firearm violence epidemiology, secure storage strategies, and risk stratification and counseling techniques. Dr. Sacks suggested that effective education in this area should allow students to practice skills and develop appropriate language and counseling styles.

Resources mentioned in the commentary included:

1. The BulletPoints Project, which provided information on counseling techniques.
2. A study by Pinholt et al. on assessing gun ownership risks in older adults.
3. Research by Rickert et al. on implementing gun violence prevention training for first-year residents.

The commentary noted that the Surgeon General's advisory specifically called for "health systems to facilitate education on safe and secure firearm storage." It emphasized that identifying and addressing modifiable risk factors was a regular part of a physician's practice, and teaching those risk factors and related counseling skills was a regular part of medical education.

Dr. Sacks pointed out that knowledge about the disproportionately high rate of firearm suicide among U.S. veterans was essential to care for this population. The commentary also noted that routine preventive counseling was a cornerstone of pediatric care.