Evidence-Based Practice in Clinical Athletic Training Education

Evidence-Based Practice (EBP) concepts are becoming more prevalent in the educational curricula of nursing, medicine, physical therapy, and athletic training. The infusion of EBP in the clinical education experience of students has been slow especially in athletic training. The aim of Project I was to investigate approved clinical instructors (ACIs) experience and implementation of EBP with students through emergent design qualitative interviews. Project II was designed to develop and establish the reliability of the Evidence-Based Concepts Assessment (EBCA) to assess athletic trainers\u27 perceived importance, attitudes & beliefs, knowledge, confidence, accessibility, and barriers of EBP. Project III investigated the importance, knowledge, and confidence of athletic trainers in EBP concepts using the EBCA. The sixteen approved clinical instructors (ACIs) interviewed identified strategies of discovery, promotion of critical thinking, and sharing of information in how they implemented EBP with students. ACIs also expressed the need to model the EBP behavior for students to appreciate and implement in their clinical practice. Barriers of limited resources, personnel, academic program constraints, and personal knowledge were reported. Strategies to integrate didactic and clinical collaboration of EBP were identified. Project II demonstrated that each of the sub-scales of the EBCA were reliable. In addition, factors within each sub-scale were established to allow for further analysis of the data. The EBCA was utilized to assess the perceived importance, attitudes & beliefs, knowledge, confidence, accessibility, and barriers to EBP in individuals with a variety of athletic training roles. Athletic training clinicians, undergraduate athletic training education program directors, approved clinical instructors, post-professional educators, and post-professional students were contacted to participate in completing the EBCA. Overall participants demonstrated a high level (3.49/4.0 ± .41) of perceived importance for EBP. Despite the high level of importance, participants\u27 overall total knowledge scores were low (64.2% ± 1.29) and they reported that they were only mildly to moderately confident in their knowledge (2.71/4.0 ± .55). Athletic training clinicians demonstrated significantly lower knowledge and confidence scores than all other participants. Individuals with a terminal degree demonstrated significantly higher knowledge scores and confidence in knowledge than all other participants

Perceptions of Approved Clinical Instructors: Barriers in the Implementation of Evidence-Based Practice

Context: As evidence-based practice (EBP) becomes prevalent in athletic training education, the barriers that Approved Clinical Instructors (ACIs) experience in implementing it with students need to be understood. Objective: To investigate barriers ACIs face when implementing EBP concepts in clinical practice and in teaching EBP to professional athletic training students and to investigate the educational emphases to improve the barriers. Design: Qualitative study. Setting: Telephone interviews. Patients or Other Participants: Sixteen ACIs (11 men, 5 women; experience as an athletic trainer = 10 ± 4.7 years, experience as an ACI = 6.81 ± 3.9 years) were interviewed. Data Collection and Analysis: We interviewed each participant by telephone. Interview data were analyzed and coded for common themes and subthemes regarding barriers and educational emphases. Themes were triangulated through multiple-analyst triangulation and interpretive verification. Results: Barriers to EBP incorporation and educational emphasis placed on EBP were the main themes reported. Resources, personnel, and student characteristics were subthemes identified as barriers. Resource barriers included time, equipment, access to current literature, and knowledge. Coworkers, clinicians, and coaches who were unwilling to accept evidence regarding advancements in treatment were identified as personnel barriers. Programmatic improvement and communication improvement were subthemes of the educational emphasis placed on EBP theme. The ACIs reported the need for better integration between the clinical setting and the classroom and expressed the need for EBP to be integrated throughout the athletic training education program. Conclusions: Integration of the classroom and clinical experience is important in advancing ACIs\u27 use of EBP with their students. Collaborative efforts within the clinical and academic program could help address the barriers ACIs face when implementing EBP. This collaboration could positively affect the ability of ACIs to implement EBP within their clinical practices

Approved Clinical Instructors\u27 Perspectives on Implementation Strategies in Evidence-Based Practices for Athletic Training Students

Context: Understanding implementation strategies of Approved Clinibal Instructors (ACIs) who use evidence-based practice (EBP) in clinical instruction will help promote the use of EBP in clinical practice. Objective: To examine the perspectives and experiences of ACIs using EBP concepts in undergraduate athletic training education programs to determine the importance of using these concepts in clinical practice, clinical EBP implementation strategies for students, and challenges of implementing EBP into clinical practice while mentoring and teaching their students. Design: Qualitative study. Setting: Telephone interviews. Patients or Other Participants: Sixteen ACIs (11 men, 5 women; experience as a certified athletic trainer = 10 ± 4.7 years, experience as an ACI = 6.8 ± 3.9 years) were interviewed. Data Collection and Analysis: We interviewed each participant by telephone. Interview transcripts were analyzed and coded for common themes and subthemes regarding implementation strategies. Established themes were triangulated through peer review and member checking to verify the data. Results: The ACIs identified EBP implementation as important for validation of the profession, changing paradigm shift, improving patient care, and improving student educational experiences. They promoted 3 methods of implementing EBP concepts with their students: self-discovery, promoting critical thinking, and sharing information. They assisted students with the steps of EBP and often faced challenges in implementation of the first 3 steps of EBP: defining a clinical question, literature searching, and literature appraisal. Finally, ACIs indicated that modeling the behavior of making clinical decisions based on evidence was the best way to encourage students to continue using EBP. Conclusions: Athletic training education program directors should encourage and recommend specific techniques for EBP implementation in the clinical setting. The ACIs believed that role modeling is a strategy that can be used to promote the use of EBP with students. Training of ACIs should include methods by which to address the steps of the EBP process while still promoting critical thinking

An Evidence-Based Practice Educational Intervention for Athletic Trainers: A Randomized Controlled Trial

Context: As evidence-based practice (EBP) becomes a necessity in athletic training, Web-based modules have been developed and made available to the National Athletic Trainers\u27 Association membership as a mechanism to educate athletic trainers (ATs) on concepts of EBP. Objective: To assess the effect of an educational intervention on enhancing knowledge of EBP among ATs. Design: Randomized controlled trial. Setting: Web-based modules and knowledge assessment. Patients or Other Participants: A total of 164 of 473 ATs (34.7% response rate), including professional athletic training students, graduate students, clinical preceptors, educators, and clinicians, were randomized into a control group (40 men, 42 women) or experimental group (33 men, 49 women). Intervention(s): Ten Web-based modules were developed that covered concepts involved in the EBP process. Both groups completed the Evidence-Based Practice Knowledge Assessment before and after the intervention phase. During the intervention phase, the experimental group had access to the Web-based modules for 4 weeks, whereas the control group had no direct responsibilities for the investigation. The knowledge assessment consisted of 60 multiple choice questions pertaining to concepts presented in the 10 modules. Test-retest reliability was determined to be good (intraclass correlation coefficient [2,1] = 0.726, 95% confidence interval = 0.605, 0.814). Main Outcome Measure(s): Independent variables consisted of group (control, experimental) and time (preassessment, postassessment). Knowledge scores were tabulated by awarding 1 point for each correct answer (maximum = 60). Between-group and within-group differences were calculated using a 2 × 2 repeated-measures analysis of variance (P ≤ .05), post hoc t tests, and Hedges g effect size with 95% confidence intervals. Results: We found a group × time interaction (F1,162 = 26.29, P \u3c .001). No differences were identified between the control (30.12 ± 5.73) and experimental (30.65 ± 5.93) groups during the preassessment (t162 = 0.58, P = .84). The experimental group (36.35 ± 8.58) obtained higher scores on the postassessment than the control group (30.99 ± 6.33; t162 = 4.55, P = .01). No differences were identified among time instances within the control group (t81 = 1.77, P = .08); however, the experimental group obtained higher scores on the postassessment than the preassessment (t81 = 7.07, P \u3c .001). Conclusions: An educational intervention consisting of 10 Web-based modules was an effective mechanism to increase knowledge of foundational EBP concepts among ATs. However, it is not known whether ATs are integrating EBP into daily clinical practice. Researchers should determine whether increased knowledge of EBP affects the daily clinical decision making of ATs

Postprofessional Athletic Training Students\u27 Perceptions Concerning the Health Care Competencies

Context: Over a decade ago, the Institute of Medicine indicated that all health care professionals should be educated in several health care competency areas (quality improvement, health care informatics, interprofessional education and collaborative practice, evidence-based practice, and patient-centered care). Despite this initiative, athletic training has only recently incorporated these competencies throughout education. Objective: To assess postprofessional athletic training students\u27 perceived abilities and importance regarding 6 core competencies. Design: Cross-sectional. Setting: Self-reported paper survey. Patients or Other Participants: A total of 221 from a convenience sample of 258 postprofessional athletic training students (85.7%) completed the survey (82 males, 138 females; age = 23.29 ± 2.05 years). Main Outcome Measure(s): The survey consisted of several concept statements for each competency, and perceptions were collected via Likert-scale items (range 1-4). Composite perceived ability and importance Likert-scale scores were achieved by tabulating all values and then averaging the scores back to the Likert scale. Higher scores indicated that participants perceived themselves to have greater ability and that the concepts were more important for implementation in clinical practice. Results: Overall, postprofessional athletic training students perceived they were able to implement the concepts of the competencies into their daily practice and perceived all of the competencies to be moderately to extremely important for implementation. However, while participants globally perceived they were able to implement the competencies, they disagreed or strongly disagreed they were able to implement some concepts, particularly within health care informatics and patient-centered care, as a part of their clinical practice. Conclusions: Postprofessional athletic training students recognize the importance of the core competencies and perceive they are able to implement these competencies throughout clinical practice. However, as postprofessional athletic training students continue to advance their skills as clinicians, the benefits of health care informatics and incorporating real-time electronic patient data to support their clinical decisions should be emphasized

Student Knowledge, Attitudes, and Use of Evidence-Based Concepts Following an Educational Intervention

Context: While evidence-based practice (EBP) concepts are being taught in health profession education programs, models of instruction and effectiveness of these models are not evident in athletic training. Objective: To evaluate the effectiveness of the Evidence-Based Teaching Model (EBTM) in increasing student knowledge, attitudes, and use of evidence-based concepts. Design: Within subjects design with pre- and post-test evaluations of students\u27 knowledge, attitudes, and intended use using the researcher-developed Evidence-Based Concepts: Knowledge, Attitudes and Use (EBCKAU) survey. Setting: CAATE-accredited undergraduate programs. Participants: Eighty-two students from a stratified purposeful sample of 9 institutions were enrolled in the study, 78 students (95%) completed the knowledge portion of the survey, while 68 students (83%) fully completed the knowledge, attitudes, and use portions of the survey. Data Collection and Analysis: The EBCKAU survey was used to assess student factors relating to EBP through multiple choice, Likert scale, and open-ended questions. Results: Students significantly increased their knowledge, confidence in knowledge, familiarity with, and confidence in use of EBP skills following the EBTM. Prior to the EBTM, students earned a mean knowledge score of 50%. This improved to 66% post-EBTM. Students\u27 interest and perceived importance scores did not increase. Barriers to student use of EBP included time, available resources, ACI open-mindedness, and experience. Conclusions: The EBTM was effective in improving student factors related to knowledge and use of EBP concepts. To our knowledge, this is the first published teaching model that assessed student outcomes related to EBP in athletic training education

Educator Perceptions of the Evidence-Based Teaching Model in Undergraduate Athletic Training Education

Context: While research recommends that health professions expand the instruction and use of evidence-based practice (EBP) due to the individualized approach to patient health care, few examples of the incorporation of EBP into academic courses exist in athletic training. Objective: To evaluate educators\u27 perceptions of the Evidence-Based Teaching Model (EBTM) as a strategy to introduce EBP concepts to athletic training (AT) students. Design: Qualitative program evaluation including semi-structured interviews. Setting: Institutions that sponsor CAATE-accredited professional undergraduate programs. Participants: Stratified purposeful sampling of 9 experienced educators (2 males, 7 females average years teaching 8 plus or minus 5 years) teaching therapeutic modalities or rehabilitation were trained in the EBTM and interviewed regarding their experience. Measures: Educators\u27 experiences regarding implementation of the EBTM. Coded categories were triangulated via member checks and peer review to establish trustworthiness of the findings. Results: Educators valued the EBTM as a method to implement evidence-based concepts within a short time frame in their course, and perceived it as a user-friendly and effective teaching tool. Assignments requiring direct interaction between students and clinical instructors were considered most favorable. Training materials provided educators with a new perspective of how to implement EBP at the professional level. Conclusions: Implementation of the EBTM helped educators attain their goals of expanding evidence-based concepts within professional undergraduate curricula and increasing student and clinical instructor interaction. Overall, the EBTM provided a mechanism to begin incorporation of EBP concepts in athletic training curricula

Mass spectrometry-based ligand binding assays on adenosine A(1) and A(2A) receptors

Conventional methods to measure ligand-receptor binding parameters typically require radiolabeled ligands as probes. Despite the robustness of radioligand binding assays, they carry inherent disadvantages in terms of safety precautions, expensive synthesis, special lab requirements, and waste disposal. Mass spectrometry (MS) is a method that can selectively detect ligands without the need of a label. The sensitivity of MS equipment increases progressively, and currently, it is possible to detect low ligand quantities that are usually found in ligand binding assays. We developed a label-free MS ligand binding (MS binding) assay on the adenosine A(1) and A(2A) receptors (A(1)AR and A(2A)AR), which are well-characterized members of the class A G protein-coupled receptor (GPCR) family. Radioligand binding assays for both receptors are well established, and ample data is available to compare and evaluate the performance of an MS binding assay. 1,3-Dipropyl-8-cyclopentyl-xanthine (DPCPX) and 4-(2-((7-amino-2-(furan-2-yl)-[1,2,4]triazolo[1,5-a]-[1,3,5]triazin-5-yl)amino)ethyl)phenol (ZM-241,385) are high-affinity ligands selective for the A(1)AR and A(2A)AR, respectively. To proof the feasibility of MS binding on the A(1)AR and A(2A)AR, we first developed an MS detection method for unlabeled DPCPX and ZM-241,385. To serve as internal standards, both compounds were also deuterium-labeled. Subsequently, we investigated whether the two unlabeled compounds could substitute for their radiolabeled counterparts as marker ligands in binding experiments, including saturation, displacement, dissociation, and competition association assays. Furthermore, we investigated the accuracy of these assays if the use of internal standards was excluded. The results demonstrate the feasibility of the MS binding assay, even in the absence of a deuterium-labeled internal standard, and provide great promise for the further development of label-free assays based on MS for other GPCRs. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s11302-015-9477-0) contains supplementary material, which is available to authorized users