OBJECTIVE: To evaluate the efficacy of Resident Education And Counseling on Household (REACH) Firearm Safety, a novel virtual reality (VR) intervention. METHODS: We conducted a single-center, randomized controlled trial among pediatric residents in a Midwestern academic primary care center comparing REACH Firearm Safety with didactic training (intervention) to didactic training alone (control). In the intervention arm, participants practiced firearm safety counseling with virtual characters and received immediate feedback. All residents completed audio-recorded standardized patient (SP) encounters before and after the training as well as a retrospective pre-post survey. Two reviewers, blinded to the allocation arm, used a standardized assessment tool to generate performance scores. Outcomes of interest included the difference between groups in SP performance scores and self-reported confidence. RESULTS: From March to July 2023, 62% of eligible pediatric residents (n = 47/76) completed the allocated study tasks (intervention 19, control 28). In both groups, SP performance scores and self-reported confidence improved. Compared to the control group, the intervention group demonstrated improvement in sharing information on secure storage devices (P = 0.009) and increased confidence in providing information on secure storage (P = 0.002). CONCLUSIONS: Compared with didactic training alone, a VR intervention using deliberate practice improved residents' skills and confidence related to firearm safety counseling.