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

Barriers to Scholarship Integration in Professional Athletic Training Programs and Resources Needed to Overcome Barriers: A Report from the Association for Athletic Training Education Research Network

Context: Athletic training program administrators have identified that it is important to incorporate a scholarship component into professional education curricula. Objective: Explore the barriers to implementing student scholarship in professional programs and identify resources necessary to overcome the barriers. Design: Consensual qualitative research. Setting: Individual teleconference interview. Patients or Other Participants: A total of 17 program directors of professional programs was interviewed. Data Collection and Analysis: Programs reported an average of 3 ± 1 core faculty supporting 37 ± 21 students, with 3 ± 2 faculty involved in scholarship activities of their students. Data saturation guided the number of participants.Interviews occurred using a semistructured interview guide. All interviews were recorded and transcribed verbatim. Data were analyzed by a 3 person research team and coded into themes and categories based on a consensus process. Credibility was established by using multiple researchers, an external auditor, and member checks. Results: Two major themes emerged from the data: (1) current challenges and shortcomings and (2) resources and strategies needed to achieve scholarship. Participants noted a lack of research or scholarship culture at their current institution and a lack of faculty time and expertise to implement and guide research throughout the curriculum as current challenges. Participants further identified that a lack of clear expectations for how much scholarship was necessary and lack of buy-in from faculty, students, and preceptors made it difficult to implement scholarly projects in the curriculum. Necessary resources to overcome barriers included institutional support in the form of faculty release, support, training, or all of the aforementioned. Participants identified that collaborative research opportunities as well as publicly available examples of completed student scholarly activity would further guide them in overcoming the curricular challenge of implementing scholarship. Conclusions: Internal institutional support, external peer collaboration, and public examples of success are necessary to overcome barriers to scholarship integration in professional athletic training curricula

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

Adolescent Athletes’ Perspectives on the Social Implications of Sport-Related Concussion

Purpose: Sport-related concussion can affect many domains of a patient’s health status. Social functioning is an important consideration, especially for adolescent athletes. Our purpose was to explore adolescent athletes’ social perspectives regarding sport and concussion. Methods: Using a qualitative study design we interviewed 12 interscholastic athletes who had sustained a sport-related concussion. The interviews focused on injury details, and explored the physical, psychosocial, emotional, and spiritual components of sport and health. Themes and categories were identified using the consensual qualitative research process by a three-person research team. A comprehensive codebook that captured the main themes and categories resulted. Results: Following concussion, participants discussed two primary themes: perceptions regarding the social aspects of sport and social perspectives regarding their concussion. Specific categories related to the social aspects of sport included: friendships and family and decision to participate based on peers. Specific categories regarding the social perspectives of the concussion included uncertainty of the diagnosis, perceptions of others regarding their injury, being ashamed of the concussion, parent and peer roles, and communication and expectation about their concussion. Conclusions: Participation in sport and removal from sport following a concussion have significant social implications for adolescent athletes. Specifically, the perceptions of peers, parents/guardians, and others regarding the injury can influence reporting of symptoms and recovery following concussion. Limited communication regarding recovery and expectations post-concussion may cause undue social pressures to return to activity prematurely. Providing a supportive environment in which patients can recover from concussion while engaging with peers and teammates is important. Anticipatory guidance, with education regarding the possible signs and symptoms, risk factors pre- and post-injury, and recovery expectations following a concussion are important to include in post-injury management and should be known to all stakeholders

Supporting Students after a Concussion: School Administrators’ Perspectives

Students with a concussion may experience challenges when returning to school and completing schoolwork. Therefore, students may require temporary academic support throughout the recovery process. The purpose of this study was to examine school administrators’ perceptions of the return to school process and provision of academic adjustments (AA) after concussion. Online surveys were analyzed using a series of descriptive, chi-square, and Mann Whitney tests. School administrators strongly agreed a concussion can affect school performance and were supportive of providing AA for symptomatic students. More school administrators with access to an athletic trainer and who completed concussion training had an established team to monitor concussions and reported students had received AA after concussion. To better prepare school professionals and enhance the support for students after a concussion, school administrators can develop a school-based concussion team, organize in-service training on concussion, and identify pertinent school and district-based resources to facilitate this care

Content Validation of the Athletic Training Milestones: A Report from the Association for Athletic Training Education Research Network

The Athletic Training Milestones were developed as a comprehensive framework to assess athletic trainers\u27 knowledge, skill, and behavior acquisition across the continuum of athletic training practice. However, without established content validity, it is unclear whether the Athletic Training Milestones can be used effectively as a clinical evaluation and research tool to evaluate competence and performance across multiple users and sites. We conducted a highly conservative content validity index (CVI) with data from 12 content experts. Our findings revealed an extremely high overall scale CVI of 0.99, and CVI scores of the 28 individual subcompetency items assessed ranged from 0.83 to 1.00. For the athletic training profession to truly embrace competency-based evaluation and performance assessments, we need a highly valid and comprehensive instrument, such as the Athletic Training Milestones

Athletic Trainer\u27s Perceptions of and Experiences With Professional Development Approaches for Enhancing Clinical Documentation

Context Little is known about how athletic trainers (ATs) learn clinical documentation, but previous studies have identified that ATs have a need for more educational resources specific to documentation. Objective To obtain ATs\u27 perspectives on learning clinical documentation. Design Qualitative study. Setting Web-based audio interviews. Patients or Other Participants Twenty-nine ATs who completed 2 different continuing education (CE) clinical documentation modules. Participants averaged 36.2 ± 9.0 years of age and included 16 women and 13 men representing 21 US states and 8 clinical practice settings. Data Collection and Analysis Participants were recruited from a group of ATs who completed 1 of 2 web-based CE clinical documentation modules. Within 3 weeks of completing the educational modules, participants were interviewed regarding their perceptions of how they learn clinical documentation, including their experiences completing the modules. Using the Consensual Qualitative Research approach, 3 researchers and 1 internal auditor inductively analyzed the data during 5 rounds of consensus coding. Trustworthiness measures included multianalyst triangulation, data source triangulation, and peer review. Results Two themes emerged from the data, including (1) mechanisms of learning documentation and (2) benefits of the educational modules. Athletic trainers primarily learn documentation through professional education and workforce training, but training appears to be inconsistent. Participants perceived that both educational modules were effective at increasing their knowledge and confidence related to learning documentation. The CE modules incited a growth mindset and intention to change behavior. Conclusions Athletic trainers are satisfied with web-based CE learning experiences specific to clinical documentation and may benefit from more CE offered in these formats. Educators are encouraged to integrate clinical documentation principles throughout the curriculum during both didactic and clinical education. Workforce training is also valuable for improving knowledge and skills related to clinical documentation, and employers should onboard and support ATs as they start new positions

Core Competency-Related Professional Behaviors During Patient Encounters: A Report From the Association for Athletic Training Education Research Network

Context: To enhance the quality of patient care, it is important that athletic trainers integrate the components of the core competencies (CCs; evidence-based practice [EBP], patient-centered care [PCC], health information technology [HIT], interprofessional education and collaborative practice [IPECP], quality improvement [QI], professionalism) as a part of routine clinical practice. In what ways, if any, athletic training students (ATSs) are currently integrating CCs into patient encounters (PEs) during clinical experiences is unclear. Objective: To describe which professional behaviors associated with the CCs were implemented by ATSs during PEs that occurred during clinical experiences. Design: Multisite panel design. Setting: A total of 12 professional athletic training programs (5 bachelor\u27s, 7 master\u27s level). Patients or Other Participants: A total of 363 ATSs from the athletic training programs that used E*Value software to document PEs during clinical experiences participated. Main Outcome Measure(s): During each PE, ATSs were asked to report whether professional behaviors reflecting 5 of the CCs occurred (the professionalism CC was excluded). Summary statistics, including means ± SDs, counts, and percentages were tabulated for the professional behaviors of each CC. Results: Data from 30 630 PEs were collected during the study period. Professional behaviors related to EBP were the most frequently incorporated during PEs (74.3%, n = 22 773), followed by QI (72.3%, n = 22 147), PCC (56.6%, n = 17 326), HIT (35.4%, n = 10 857), and IPECP (18.4%, n = 5627). Conclusions: It is unsurprising that EBP and PCC behaviors were 2 of the most frequently incorporated CCs during PEs due to the emphasis on these competencies during the past several years. However, it is surprising that ATSs did not incorporate behaviors related to either HIT (in 65% of PEs) or IPECP (in 82% of PEs). These findings suggest that directed efforts are needed to ensure that ATSs are provided opportunities to incorporate professional behaviors related to the CCs during clinical experiences

Characteristics of Patient Encounters for Athletic Training Students During Clinical Education: A Report from the AATE Research Network

Context: To enhance the quality of patient care, athletic training students (ATSs) should experience a wide variety of clinical practice settings, interact with diverse patient populations, and engage with patients that have a wide variety of conditions. It is unclear in what ways, if any, ATSs have diverse opportunities during clinical experiences. Objective: To describe the characteristics of patient encounters (PEs) ATSs engage in during clinical experiences. Design: Multi-site, panel design. Setting: 12 professional athletic training programs (ATPs; 5 Bachelor, 7 Master\u27s). Patients or Other Participants: 363 ATSs from the ATPs that used E*Value software to document PEs during clinical experiences participated in this study. Main Outcome Measures: During each PE, ATSs were asked to log the clinical site at which the PE occurred (college/university, secondary school, clinic, other), the procedures performed during the patient encounter (e.g., knee evaluation, lower leg flexibility/ROM, cryotherapy), and the diagnoses, with ICD-10 code, of the patient (e.g., S83.512A Knee Sprain, ACL). Results: 30,630 PEs were entered by 363 ATSs across unique 278 clinical settings. More than 80% of PEs occurred at college/university and secondary school settings. More than half of diagnoses recorded were designated as lower body region. Examination and evaluation procedures and application of therapeutic modality procedures contributed approximately 27% of procedures each. Conclusions: It is surprising that ATSs are not gaining experience in all clinical practice settings in which athletic trainers commonly practice, and our data suggest that students may be consigned to working with more frequently occurring injuries which may not prepare them for the realities of autonomous clinical practice. These findings suggest that directed efforts are needed to ensure ATSs are provided opportunities to engage with h diverse patient populations with a variety of conditions in an array of clinical site types during clinical experiences