An Automated Virtual Reality Intervention to Enhance Firearm Safety Counseling in Pediatrics

The investigators will recruit pediatric clinicians to participate in an automated screen-based virtual reality intervention. Clinicians will be recruited from clinical locations that offer a variety of setting types (urban, suburban, and rural).

• An Automated Virtual Reality Intervention to Support Firearm Safety Counseling in Clinicians (Behavioral): The automated virtual reality intervention allows clinicians to deliberately practice firearm safety counseling skills through verbal interactions with virtual characters with receipt of immediate feedback.

Primary outcomes

• Acceptability of Intervention Measure [From completion of the virtual reality intervention to 2 months]: Four items, Scale score is average across individual items, Minimum score: 1, Maximum score: 5. higher scores indicate better acceptability
• Appropriateness of the Intervention Measure [From completion of the virtual reality intervention to 2 months]: Four items, Scale score is average across individual items, Minimum score: 1, Maximum score: 5. higher scores indicate better appropriateness
• Feasibility of the Intervention Measure [From completion of the virtual reality intervention to 2 months]: Four items, Scale score is average across individual items, Minimum score: 1, Maximum score: 5. higher scores indicate better feasibility

Secondary outcomes

• De Novo Survey Item for Assessing Social Cognitive Theory Construct Behavioral Capability [From completion of the virtual reality intervention to 2 months]: One item, Scale score of individual items, Minimum score: 1, Maximum score: 5. higher score indicates more behavioral capability
• De Novo Survey Items for Assessing Social Cognitive Theory Construct Self-Efficacy [From completion of the virtual reality intervention to 2 months]: Eight items, Scale score for individual items, Minimum score: 0, Maximum score: 4. Higher scores indicate more self-efficacy.
• De Novo Survey Items for Assessing Social Cognitive Theory Construct Expectations [From completion of the virtual reality intervention to 2 months]: Three items, Scale score of individual items, Minimum score: 1, Maximum score: 5. Higher scores indicate more expectations.
• De Novo Survey Items for Assessing Social Cognitive Theory Construct Expectancies [From completion of the virtual reality intervention to 2 months]: Six items, Scale score of individual items, Minimum score: 1, Maximum score: 5. higher scores indicate higher expectancies for prioritizing firearm safety discussions across different ages for well-child visits.

Other outcomes

• De Novo Standardized Patient Encounter Assessment Tool - Assessing Fidelity to the Virtual Reality Intervention Components [From completion of the virtual reality intervention to 6 months]: Participant's will engage in a standardized patient encounter to assess fidelity to behavioral skills reviewed during the virtual reality intervention, 20 items, maximum score: 20, minimum score: 0, scaled scores for firearm counseling skills and motivational interviewing skills, scaled scores determined by adding together individual items, 17 items related to firearm safety counseling, 3 items related to motivational interviewing

Sex: All, ages: 18 Years to any

Inclusion Criteria:

\- Pediatric Clinicians must meet one of the following inclusion criteria at each study site: Physicians (attending, fellow or resident), Licensed Nurse Practitioner, Physician's Assistant

Exclusion Criteria:

* Unable to read and write in English

• March M, Zackoff M, Fleck J, Meisman A, Humphrey K, MacDougall MC, Ehrlich S, Griggs C, Sacks C, Masiakos P, Klein M, Real F. A Randomized Trial of Virtual Reality Training to Improve Firearm Safety Counseling Skills. Acad Pediatr. 2025 Jan-Feb;25(1):102560. doi: 10.1016/j.acap.2024.08.005. Epub 2024 Aug 10. PMID 39128562
• Real FJ, Griggs C, March M, Masiakos PT, Meisman A, Felopulos G, Sacks CA, Zackoff MW. Feasibility and Acceptability of a Virtual Reality Curriculum to Support Firearm Safety Counseling Skills Among Pediatric Residents. J Grad Med Educ. 2024 Dec;16(6):740-746. doi: 10.4300/JGME-D-24-00022.1. Epub 2024 Dec 13. PMID 39677314
• March ML, Meisman AR, Zackoff MW, Klein MD, Real FJ. Caregivers' and Community Members' Perspectives on Firearm Safety Screening and Counseling During Pediatric Primary Care Visits. J Pediatr Clin Pract. 2024 Mar 14;12:200099. doi: 10.1016/j.jpedcp.2024.200099. eCollection 2024 Jun. PMID 39949418

NIH grants: K18HD117377