High School Influences on the Selection of Athletic Training as a Career

Context: Research suggests internships, mentorship, and specialized school programs positively influence career selection; however, little data exists specific to athletic training. Objective: We identified high school (HS) experiences influencing career choice in college athletic training students (ATS). Design: Our survey included 35 Likert-type close-ended questions, which were reviewed by a panel of faculty and peers to establish content and construct validity. Setting: Participants completed an online questionnaire at their convenience. Participants: 217 college ATS (153 female, 64 male) from a random selection of accredited programs on the east coast. We excluded minors, freshmen, and undecided majors from the study. Informed consent was implied by proceeding to the questionnaire. Data Collection and Analysis: We used descriptive statistics to analyze the data collected via a secure website. Results: Mentors were most influential in the decision of career path (62.4%;n=131/210) with 85.2% (n=138/162) reporting mentors were readily available to answer questions regarding career options and 53.1% (n=86/162) counseled them regarding HS electives. Of participants involved in an internship (41.0%;n=86/210), most developed such opportunities independently (66.3%;n=57/86). Respondents who attended traditional HS suggested providing diverse electives (71.9%;n=133/185), additional internship (53.5%;n=99/185), and mentorship (33.0%;n=61/185) opportunities to effectively educate students regarding career options. Conclusions: College ATS that gained internship experience during HS report the opportunity positively influenced their career selection. Mentors support HS students by offering insight and expertise in guiding students’ career choices. Participants suggested HS afford diverse electives with internship and mentorship opportunities to positively influence interested students towards pursuing a career in athletic training

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Continuing Professional Education in Athletic Training: Is Knowledge Acquired and Retained?

Objective: The purpose of this study was to assess certified athletic trainers\u27 knowledge acquisition, knowledge retention, and satisfaction, following a continuing professional education (CPE) program offered in either a traditional, lecture-oriented format or an interactive format addressing adult learning strategy preferences. Design: We used a pre-test, post-test experimental design with comparison groups utilizing stratified randomization. Setting: The CPE program was held in the University wellness center classrooms. Subjects: Forty-six certified athletic trainers participated. Measurements: After determination of learning strategy preferences, a 30 item multiple-choice exam was administered prior to, immediately after, and one-month following the CPE program to determine level of knowledge acquisition and retention. Participant self-reported level of satisfaction was assessed with a questionnaire immediately following the CPE program. Results: A significant main effect for treatment (F2,70 = 6.02, p \u3c 0.004) was observed indicating that subjects in the lecture format CPE program acquired and retained more knowledge than subjects in the interactive format regardless of learning strategy preference. There was no significant loss in knowledge observed one-month following the CPE program regardless of learning strategy preference or treatment (lecture or interactive CPE format). No significant differences in level of satisfaction by treatment (lecture or interactive CPE format) or by learning strategy preference (navigators, problem-solvers, or navigators) were noted; however, 13 (28.3%) reported an excellent level of satisfaction (mean satisfaction score of 4.0) and 31 (67.4%) reported an above average level of satisfaction (mean satisfaction scores of 3.0 to 3.88). Conclusions: Our data indicate that lecture format CPE programs may be optimal for knowledge acquisition and retention, independent of learning strategy preference. Knowledge retention did not decrease regardless of learning strategy preference or CPE format and actually demonstrated a further increase using the lecture format. Although our data suggest that participant satisfaction is independent of learning strategy preference and CPE format, the homogeneity of responses made it difficult to detect any relationship with regard to learning style preference and satisfaction

Leadership Styles, Behaviors, and Outcomes of Athletic Training Education Program Directors

Context: With the increase in athletic training education programs, the demand for a highly qualified faculty member to serve as program director (PD) and fill the multiple roles and responsibilities of the position has increased. A successful PD must possess leadership skills crucial for the evolving academic environment. Research suggests that educational leaders must provide both transactional and transformational leadership if athletic trainers are to secure a legitimate place as healthcare providers. Objective: To describe the leadership styles and behaviors of athletic training education PDs and to describe the associations between leadership style, behavior, outcome, and experience. Design: We will utilize a survey design to identify the leadership styles, behaviors, outcomes, and experiences of athletic training education PDs. Setting: On-line questionnaire. Participants: The population of this study will be limited to the academic PDs of the 360 accredited entry-level athletic training education programs in the United States. Intervention The investigation will utilize the Multifactor Leadership Questionnaire (MLQ). The MLQ is a validated tool composed of 45 items that identify and measure key leadership and effectiveness behaviors shown to be strongly linked with both individual and organizational success. In addition to the leader, it is recommended that all persons working above, below, and directly at the same organizational level as the leader rate the leader. Raters evaluate how frequently, or to what degree, they have observed the leader engage in 32 specific behaviors. Main Outcome Measure(s): Statistical analysis will be utilized to describe the associations between leadership styles

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research