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Student-led class prepares future physicians for the realities of gun violence

Students participating in the
Students participating in the "Physicians and Gun Violence: What you need to Know" blue book course discuss different scenarios where they may need to talk to patients about guns as part of the course. (Photo by Meredith Raine)

Physicians are integral in treating injuries suffered from a gunshot wound, but what is their role in the broader conversation of prevention and awareness?

A blue book course created by students at McGovern Medical School at UTHealth seeks to answer that question.

Gun violence claims more than 30,000 lives annually, according to the Centers for Disease Control and Prevention and the National Center for Health Statistics. For each person killed, two others are wounded, and there is an increased likelihood of fatalities in domestic violence situations and suicide if there is a gun in the home, according to gun violence statistics compiled by Sandy McKay, MD, FAAP, assistant professor in pediatrics and advocacy education coordinator at McGovern Medical School.

The Bureau of Alcohol, Tobacco, Firearms, and Explosives estimates there are more than 270 million firearms in the United States, according to statistics compiled by McKay and used in the course. The Pew Research Center estimates 35.7 percent of Texas adults own a firearm.

Second-year McGovern Medical School students Michael Bagg and Marina Ibraheim created blue book course “Physicians and Gun Violence: What You Need to Know” in 2017. It includes a series of lectures, and students can receive course credit as an elective for attending three sessions.

The sessions evaluate what physically happens when a bullet hits the body, common treatment for the wounds, how to assess whether there is a risk of violence to a patient, characteristics seen in those who commit gun violence, and how to talk to patients about guns and safe storage.

The discussions are intentionally fact-based and apolitical.

“The courses are meant for respectful discussion,” Bagg said. “The goal was to create an environment that allowed participants to learn new information that might respectfully challenge their views.”

The conversation factor is important for Bagg and Ibraheim; the idea for the course sprouted from a lack of discussion following the Las Vegas shooting in October 2017. The shooting left at least 58 people dead after a gunman shot at a concert from a nearby hotel room. Following the deadliest mass shooting in modern American history, the medical students said there wasn’t much – if any – conversation about it in their circles.

“This started with the Las Vegas shooting, but the ball kept rolling,” Bagg said. “Personally, I had a hard time not doing anything. I was soul-searching on what solutions I could bring to the table other than an impassioned Facebook post. This is how I contributed to a solution. I didn’t want to wait on the sidelines to finish medical school and residency to make a difference.”

The program is one of the first student- or faculty-led gun violence courses in the nation. The students thanked medical school leadership for supporting their efforts.

Health care providers are in a unique position to advocate for their patients. Bagg said he believes the biggest opportunities for doctors to make an impact is with safe storage, with a potential for pediatricians to talk to new parents about gun safety.

Approximately 4.8 million children under 18 live in a household with a loaded and unlocked firearm, according to McKay’s presentation. Within that group, 73 percent of children age 9 and younger reported knowing the location of household firearms, and 89 percent of accidental shooting deaths among children happen in the home.

Ibraheim said she believes physicians have an opportunity to help patients through these conversations, but must take care in how they are presented.

“It’s important to respect what patients want to do with their lives,” she said. “It can be helpful to try to say something if what the patient is doing is unhelpful or unhealthy, but you don’t want to judge a person who has a different perspective on the issue. I don’t think that judging a person would be fruitful when establishing and maintaining a strong patient-doctor alliance.”

Bagg said the key to successful conversations is to have the patient’s well-being at the forefront.

“You’re here for your patients, not a political ideology,” he said. “You can do so much more if you’re genuine, you’re intentional, and stay true to your professionalism.”

The program is held once a year, in the fall. In its second year, interest has remained high. There were 48 students who earned course credit in the inaugural class. Another 70 completed the course in 2019, including some students from Baylor College of Medicine.

That’s partly because gun violence and doctors’ roles in the conversation have stayed in the news cycle.

In 2017, a federal appeals court overturned a 2011 Florida law called the “Privacy of Firearm Owners Act,” which imposed fines of up to $10,000 and the potential for a physician to lose a medical license for talking to patients about guns. The court overturned the law, citing that it restricted the free speech of doctors.

In response, the National Rifle Association tweeted a response that physicians needed to “stay in their lane” when it comes to gun violence. Physicians responded with the viral hashtags #thisismylane and #thisisourlane, posting tragic stories about how doctors deal with the realities of gun violence, and photos of bloodstained scrubs and operating rooms after trying to care for gunshot victims. Bagg wrote an op-ed in the Houston Chronicle on the topic.

“This topic will stay relevant as long as it’s still a problem, and it appears to still be a problem,” Ibraheim said. “I think the program will be able to sustain itself so long as it continues to foster an open, apolitical, and nonjudgmental environment for discussion.”

Ibraheim and Bagg are mentoring two first-year medical students to take over the blue book course. The hope is that the student-led initiative will be passed down from class to class.

“We want to ensure the students we selected were of the same mindset – that the aim of the course is to create a place for discussion, not a place to pontificate and politicize an already polarizing issue,” Ibraheim said.

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