Evidence-Based Practice in Undergraduate Athletic Training Education

As Evidence-Based Practice (EBP) has progressed within medicine, nursing, and physical therapy, athletic training has been subsequently slow to infuse EBP and its associated concepts at the professional level. The aim of Project I was to determine athletic training instructors experience and use of evidence-based concepts (EBC) during instruction through emergent design qualitative interviews. Project II was designed to establish the Evidence-Based Teaching Model (EBTM) as a tool for athletic training educators\u27 to use to introduce EBP concepts to professional students. Project I featured 11 educators from Commission on Accreditation of Athletic Training Education (CAATE) programs. Instructors identified primary approaches to EBC implementation within their programs: curricular emphasis, teaching strategies, and student activities that followed Bloom\u27s revised taxonomy. Categories of need for EBP instruction including respect for the athletic training profession, use of EBP as part of the decision-making toolbox, and for third-party reimbursement were found in Project 1B. Barriers included time, role strain, knowledge, and the gap between clinical and educational practices. Strategies for surmounting barriers included identifying a starting point for inclusion and approaching implementation from a faculty perspective. Project II included nine educators and their respective students for program evaluation of the EBTM and analysis of the effects of the EBTM on student knowledge, attitudes, and use of EBCs. The EBTM was designed to instruct the five core steps of EBCs. Overall, instructors valued the EBTM to implement EBCs and perceived it as a user-friendly teaching tool. Assignments requiring direct interaction between students and approved clinical instructors were considered most favorable. Eighty-two students underwent a within subjects\u27 pre/post-test evaluation through the Evidence-Based Concepts: Knowledge, Attitudes, and Use (EBCKAU) survey; 78 students (95%) completed the knowledge portion of the evaluations, while 68 (83%) fully completed the knowledge, attitudes, and use portions of the survey. Students significantly increased their knowledge, confidence in knowledge, familiarity, and confidence in use of EBP skills. Prior to the EBTM, students mean knowledge was 50% correct overall, with post-EBTM mean scores increasing to 66%. Students\u27 interest and importance scores did not increase. Student barriers included time, available resources, ACI open-mindedness, and experience

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

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

Athletic Training Student Core Competency Implementation During Patient Encounters

Context: Health care research evidence suggests that early patient encounters (PEs), as well as the purposeful implementation of professional core competencies (CCs), for athletic training students (ATSs) may be beneficial to their ability to provide care. However, no investigators have related facets of the clinical education experience with CC implementation as a form of summative assessment of the clinical experience. Objective: To determine the relationship between the frequency and length of PEs, as well as the student\u27s role and clinical site during PEs, and the students\u27 perceived CC implementation during these encounters. Design: Cross-sectional study. Setting: Professional athletic training program, National Collegiate Athletic Association Division I institution. Patients or Other Participants: We purposefully recruited 1 athletic training program that used E*Value software; 40 participants (31 females, 9 males) enrolled in the professional phase (12 first year, 14 second year, 14 third year) participated. Intervention(s): Participants viewed a 20-minute recorded CC educational module followed by educational handouts, which were also posted online for reference throughout the semester. The E*Value software was used to track PEs, including the type of encounter (ie, actual patient, practice encounter, didactic practice scenario), the type of site where the encounter occurred (university, high school), and the participant\u27s role (observed, assisted, performed), as well as responses to an added block of questions indicating which, if any, of the CCs were implemented during the PE. Main Outcome Measure(s): Variables per patient were PE length (minutes), participant role, site at which the encounter occurred, and whether any of the 6 CCs were implemented (yes/no). Variables per participant were average encounter length (minutes), encounter frequency, modal role, clinical site assignment, and the number of times each CC was implemented. Separate 1-way analyses of variance were used to examine the relationships between role or clinical site and implementation of total number of CCs. Multiple linear regressions were used to determine how the average length and frequency of PEs were related to the average and total number of implemented CCs. Binary logistic regression models indicated how the length of each encounter, role of the participant, and type of clinical site related to the implementation of each CC. Results:  The roles of participants during PEs were related to their ability to implement the total number of CCs (F = 103.48, P \u3c .001). Those who observed were likely to implement fewer total CCs than those who assisted (M diff = −0.29, P \u3c .001); those who assisted were likely to implement more total CCs than those who performed (M diff = 0.32, P \u3c .001). Frequency of encounters was the only significant variable in the model examining all independent variables with CC implementation (b4,32= 3.34, t = 9.46, P \u3c .001). Conclusions:  The role of the student, namely assisting during PEs, and the volume of PEs should be considered priorities for students to promote greater CC implementation

Use of Evidence-Based Practice Among Athletic Training Educators, Clinicians, and Students, Part 1: Perceived Importance, Knowledge, and Confidence

Context: Although evidence-based practice (EBP) has become more prevalent, athletic trainers\u27 perceptions of importance and knowledge of these concepts and their confidence in EBP are largely unknown. Objective: To assess perceived importance and knowledge of and confidence in EBP concepts in athletic trainers in various roles and with different degree levels. Design: Cross-sectional study. Setting: Online survey instrument. Patients or Other Participants: The survey was sent to 6702 athletic training educators, clinicians, and postprofessional students. A total of 1209 completed the survey, for a response rate of 18.04%. Main Outcome Measure(s): Demographic information and perceived importance and knowledge of and confidence in the steps of EBP were obtained. One-way analysis of variance, a Kruskal-Wallis test, and an independent-samples t test were used to determine differences in scores among the demographic variables. Results: Athletic trainers demonstrated low knowledge scores (64.2% ± 1.29%) and mild to moderate confidence (2.71 ± 0.55 out of 4.0). They valued EBP as moderately to extremely important (3.49 ± 0.41 out of 4.0). Perceived importance scores differed among roles (clinicians unaffiliated with an education program scored lower than postprofessional educators, P = .001) and highest educational degree attained (athletic trainers with terminal degrees scored higher than those with bachelor\u27s or master\u27s degrees, P \u3c .001). Postprofessional athletic training students demonstrated the highest total EBP knowledge scores (4.65 ± 0.91), whereas clinicians demonstrated the lowest scores (3.62 ± 1.35). Individuals with terminal degrees had higher (P \u3c .001) total knowledge scores (4.31 ± 1.24) than those with bachelor\u27s (3.78 ± 1.2) or master\u27s degrees (3.76 ± 1.35). Postprofessional educators demonstrated greater confidence in knowledge scores (3.36 ± 0.40 out of 4.0) than did those in all other athletic training roles (P \u3c .001). Conclusions: Overall knowledge of the basic EBP steps remained low across the various athletic trainers\u27 roles. The higher level of importance indicated that athletic trainers valued EBP, but this value was not reflected in the knowledge of EBP concepts. Individuals with a terminal degree possessed higher knowledge scores than those with other educational preparations; however, EBP knowledge needs to increase across all demographics of the profession

Effect of Procedure Type on Core Competency Implementation by Athletic Training Students

Context Core competencies (CCs) are now a required component of educational content in all types of Commission on Accreditation of Athletic Training Education-accredited athletic training programs. There is limited evidence demonstrating which procedures included during patient encounters (PEs) occurring in clinical education allow for implementation of CCs. Objective To determine the relationship between procedures performed by athletic training students during PEs on CC implementation. Design Panel design. Setting Undergraduate, professional athletic training program, National Collegiate Athletic Association Division I institution. Patients or Other Participants We purposefully recruited 1 athletic training program that used E*Value (Medhub) software; 40 participants (31 female, 9 male) enrolled in the professional phase (12 first year, 14 second year, 14 third year) participated. Interventions Participants viewed a 20 minute recorded CC education module followed by educational handouts, which were available online for reference throughout the semester. E*Value was used to track procedures (prevention, evaluation, manual therapy, rehabilitation, treatment, diagnostic, surgical, or other) performed during PEs and an added block of questions indicating which, if any, of the CCs were implemented during the PE. Main Outcome Measure(s) Independent variables included procedures performed during PEs and whether any of the 6 CCs were implemented (yes/no). Binary logistic regression models determined how the type of procedure performed related to the implementation of each CC. Results Regression models were significant for 5 of the 6 CCs: patient-centered care (PCC; ${\rm{\chi }}_7^2$ = 62.949, P \u3c .001), interprofessional education and collaborative practice (IPECP; ${\rm{\chi }}_6^2$ = 41.172, P \u3c .001), health care informatics (⁠${\rm{\chi }}_7^2$ = 186.487, P \u3c .001), evidence-based practice (EBP) (⁠${\rm{\chi }}_8^2$ = 54.712, P \u3c .001), and quality improvement (⁠${\rm{\chi }}_7^2$ = 67.967, P \u3c .001). Participants including evaluation procedures during PE were 3.6 and 1.3 times more likely to implement PCC and IPECP, respectively. Participants including a diagnostic procedure were 4.2 and 2.9 times more likely to implement EBP and IPECP, respectively, and 0.2 times less likely to implement health care informatics. Participants incorporating a manual therapy procedure were 2.6, 1.7, and 2.1 times more likely to implement PCC, EBP, and quality improvement, respectively

Athletic Training Student Core Competency Implementation During Patient Encounters

CONTEXT: Health care research evidence suggests that early patient encounters (PEs), as well as the purposeful implementation of professional core competencies (CCs), for athletic training students (ATSs) may be beneficial to their ability to provide care. However, no investigators have related facets of the clinical education experience with CC implementation as a form of summative assessment of the clinical experience. OBJECTIVE: To determine the relationship between the frequency and length of PEs, as well as the student\u27s role and clinical site during PEs, and the students\u27 perceived CC implementation during these encounters. DESIGN: Cross-sectional study. SETTING: Professional athletic training program, National Collegiate Athletic Association Division I institution. PATIENTS OR OTHER PARTICIPANTS: We purposefully recruited 1 athletic training program that used E*Value software; 40 participants (31 females, 9 males) enrolled in the professional phase (12 first year, 14 second year, 14 third year) participated. INTERVENTION(S): Participants viewed a 20-minute recorded CC educational module followed by educational handouts, which were also posted online for reference throughout the semester. The E*Value software was used to track PEs, including the type of encounter (ie, actual patient, practice encounter, didactic practice scenario), the type of site where the encounter occurred (university, high school), and the participant\u27s role (observed, assisted, performed), as well as responses to an added block of questions indicating which, if any, of the CCs were implemented during the PE. MAIN OUTCOME MEASURE(S): Variables per patient were PE length (minutes), participant role, site at which the encounter occurred, and whether any of the 6 CCs were implemented ( yes/ no). Variables per participant were average encounter length (minutes), encounter frequency, modal role, clinical site assignment, and the number of times each CC was implemented. Separate 1-way analyses of variance were used to examine the relationships between role or clinical site and implementation of total number of CCs. Multiple linear regressions were used to determine how the average length and frequency of PEs were related to the average and total number of implemented CCs. Binary logistic regression models indicated how the length of each encounter, role of the participant, and type of clinical site related to the implementation of each CC. RESULTS: The roles of participants during PEs were related to their ability to implement the total number of CCs ( F = 103.48, P \u3c .001). Those who observed were likely to implement fewer total CCs than those who assisted (M diff = -0.29, P \u3c .001); those who assisted were likely to implement more total CCs than those who performed (M diff = 0.32, P \u3c .001). Frequency of encounters was the only significant variable in the model examining all independent variables with CC implementation ( b4,32 = 3.34, t = 9.46, P \u3c .001). CONCLUSIONS: The role of the student, namely assisting during PEs, and the volume of PEs should be considered priorities for students to promote greater CC implementation