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Urban firearm violence (UFV) has independently been associated with redlining and firearm laws. This study aims to examine how state firearm laws moderate urban firearm violence in census tracts historically exposed to redlining. We conducted a retrospective ecological study of UFV in census tracts exposed to historic redlining. We analyzed state firearm laws using the Giffords gun law scorecard. The primary outcome was the incidence of firearm violence per 100,000, calculated using the Gun Violence Archive database. Among 16,236 census tracts in 38 states, the incidence of firearm violence increased with the proportion of area redlined across all levels of state firearm laws with 2.7-, 3.9-, and 3.2-times higher incidence in tracts with the greatest proportion redlined relative to the lowest in strong, moderate, and weak law states. Strong firearm laws aren't enough to overcome longstanding socioeconomic disparities that drive firearm violence in historically redlined communities. •Redlined communities experience disproportionately high rates of firearm violence.•Strong firearm laws reduce the overall incidence of urban firearm violence in the US.•The detrimental effects of redlining persist in states with strong firearm laws.

Background Simulation-based training (SBT) enhances medical education but is often limited in low-resource settings. This study aimed to describe the development, use, and cost implication of three low-cost models of soft tissue lesions for SBT of medical students in Rwanda as part of their general surgery clerkship. We also aimed to evaluate perceptions and knowledge gained from the course. Methods Surgical educators and healthcare providers from Rwanda and the United States partnered to design and implement SBT for soft tissue procedures. We prioritized three common procedures based on operative log reviews and a Delphi process: abscess drainage with/without ultrasound guidance; excision of a subcutaneous nodule; and wound debridement. Materials for the SBT models were locally sourced. Data was collected as a prospective cohort study assessing the participants pre- and post-course knowledge using the Kirkpatrick level one and two questions. Students’ self-reported confidence and course feedback was also collected. Results Cost was <$1.20 per model and each took ≤ 5 min of active time to construct. Sixty-two students participated over 3 iterations of the soft tissue SBT. Few students had previously observed nodule excision (8.3%), abscess drainage (10.0%), or wound debridement (27.1%). On a five-point Likert scale, student perception of confidence in performing soft tissue procedures improved by + 1.7 ( p  < 0.001) for nodule excision, + 1.4 ( p  < 0.001) for abscess drainage, and + 1.7 ( p  < 0.001) for wound debridement. Confidence scores were greater than or equal to 3.9 out of 5 for all procedures post-session. Conclusions SBT for management of soft-tissue lesions using low-cost, locally-sourced models was well-received, and increased students’ perceived confidence in three common procedures. These models may be adaptable to other procedural settings and learning levels.

Surgical simulation and video-based learning are limited in lower-resource settings. We sought to develop and assess a series of surgical tutorials using a low-cost simulator. We created 8 surgical skills and procedures videos using low-cost equipment. We assessed video quality using the DISCERN scale and the Global Quality Scale (GQS). Videos ranged from surgical techniques to complex procedures. We uploaded these to Youtube and included them in the curriculum of a medical school in Rwanda. Excluding the cost of the kit (25 USD), production costs ranged from 2 to 5 USD. All videos scored a mean DISCERN of 2.44 ​± ​1.05 and GQS of 3.06 ​± ​0.90. Generally, these lacked points on providing additional sources of information and addressing areas of uncertainty. This study addresses the demand for accessible surgical education resources. Using low-cost, standardized materials ensures consistency, democratization of training, and feasibility. •Developed surgical video tutorials using low-cost and locally sourced materials.•Produced the videos in collaboration with institutions from the USA and Rwanda.•Evaluated online engagement of each video based on reach and retention.•Analyzed the initiative, highlighting both successes and areas for improvement.•Offered actionable recommendations and best practices to improve and increase impact.