K.L. Mueller is assistant professor, Department of Emergency Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri; ORCID: https://orcid.org/0000-0001-9799-0861 .
A.L. Blomkalns is professor and chair, Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California.
Acad Med. 2022 Oct 1;97(10):1433-1437. doi: 10.1097/ACM.0000000000004707. Epub 2022 Apr 19.
The medical community recognizes that firearm injury is a public health problem. Yet we lack both the tools for and the implementation of evidence-based firearm injury screening and counseling techniques. One reason for these deficits is the lack of clinical training related to engaging patients in firearm injury risk reduction. In this issue, Rickert et al describe a pre-post evaluation of a 2-part firearm injury prevention training curriculum for first-year medical residents at a single academic medical center. Their manuscript serves an important, but still preliminary, step forward for the field of postgraduate medical education on firearm injury and its prevention. Important elements of this project and paper consist of the inclusion of multiple medical disciplines and the use of standardized patients to evaluate participants' learning. This project also points to the need for further growth. We must commit to consistently and conscientiously framing injuries from guns not as "gun violence" but rather as "firearm injuries" to ensure that they are considered squarely in both the public health space and the clinical space. An ideal curriculum would also highlight the importance of trauma-informed care, cultural competency, and antiracist medical practice while countering implicit biases (e.g., toward gun owners, victims of firearm violence, perpetrators of violence). It should address barriers, as well as facilitators, to change. And most importantly, future educational work must evaluate the effect of these trainings on actual clinical practice-and, even better, the efficacy of education in changing behavior and patient-level outcomes.
医学界认识到,枪支伤害是一个公共卫生问题。然而,我们既缺乏基于证据的枪支伤害筛查和咨询技术的工具,也缺乏实施这些技术的手段。造成这些不足的原因之一是缺乏与患者参与枪支伤害风险降低相关的临床培训。在本期杂志中,Rickert 等人描述了对单一学术医疗中心的一年级住院医师进行两部分枪支伤害预防培训课程的前后评估。他们的论文为研究生医学教育领域的枪支伤害及其预防迈出了重要但仍初步的一步。该项目和论文的重要内容包括纳入多个医学学科和使用标准化患者来评估参与者的学习情况。该项目还指出需要进一步发展。我们必须承诺始终如一地、有意识地将枪支造成的伤害描述为“枪支伤害”,而不是“枪支暴力”,以确保它们在公共卫生领域和临床领域都得到明确考虑。一个理想的课程还将强调创伤知情护理、文化能力和反种族主义医学实践的重要性,同时应对隐性偏见(例如,对枪支拥有者、枪支暴力受害者、暴力行为实施者的偏见)。它应该解决变革的障碍和促进因素。最重要的是,未来的教育工作必须评估这些培训对实际临床实践的影响,甚至更好的是,评估教育在改变行为和患者层面结果方面的效果。