Athletic Training Students' Perspectives and Performance When Learning Online

Context:The Examination of Professional Degree Level document presented to the National Athletic Trainers' Association Board of Directors states that research in athletic training education has not investigated differences in the critical-thinking skills of professional athletic training students.Objective:Investigate the differences in critical thinking and other demographic variables across first-year athletic training students enrolled in professional bachelor's- and master's-degree programs.Design:Quantitative study.Setting:District 10 athletic training programs.Patients or Other Participants:Students (N = 40) enrolled within their first 6 months of a professional athletic training program were asked to complete the California Critical Thinking Skills Test (CCTST). Twelve first-year master's-degree students (8 female, 4 male) and 28 bachelor's-degree students (18 female, 10 male) completed the CCTST (age = 20.73 ± 3.09 years).Main Outcome Measure(s):Athletic training students in District 10 were asked to complete the CCTST during the first 6 months of their respective programs. Independent t tests were used to evaluate the difference in critical-thinking scores between professional master's- and bachelor's-degree athletic training students. A 1-way analysis of variance was conducted to determine differences in critical-thinking skills with regard to gender, age, and parental educational level.Results:There were no statistically significant differences in critical-thinking skills between bachelor's- and master's-degree athletic training students enrolled in a professional athletic training program (P = .991). Additionally, there were no statistically significant differences in critical-thinking skills with regard to gender (P = .156), age (P = .410), or parental education level (P = .156).Conclusions:The results suggest master's students do not have greater critical-thinking skills than professional bachelor's students before engaging in athletic training education. Therefore, as the professional degree of athletic training transitions to the graduate level, athletic training educators may need to investigate and use pedagogical practices that will graduate critically thinking athletic trainers.

Context The increased prevalence of mental health conditions and athletic training education’s heightened focus on behavioral and mental health necessitate an examination of teaching techniques for this material. This study explores the impact of virtual pedagogical strategies on athletic training students’ knowledge and confidence with mental health recognition and referral to help educators determine best practices for content delivery. Objective This study examined the effect of Mental Health First Aid (MHFA) training on students’ knowledge and confidence in mental health recognition and referral. The impact of group allocation (standardized patient [SP] encounters, case-based learning [CBL], and control) on these outcomes was also assessed. Design Randomized controllled trial portion from a sequential, explanatory mixed-methods design. Setting Online learning environment. Patients or Other Participants Convenience sample of 70 students (25 men, 44 women, 1 nonbinary; aged 23.38 ± 2.27 years) from Commission on Accreditation of Athletic Training Education-accredited graduate-level professional athletic training programs. Intervention(s) All participants completed MHFA training followed by either no intervention, an SP encounter, or CBL activity. Main Outcome Measure(s) Mental health recognition and referral skills as measured by an electronic knowledge assessment and self-reported confidence scale whose content validity were established by an expert panel. Results A mixed-model analysis of variance showed significant improvement from pretest to posttest for both knowledge and confidence [knowledge: F(1,67) = 70.31, P < .001; confidence: F(1,67) = 206.41, P < .001]. This relationship was similar among all 3 groups. No significant difference in knowledge or confidence was found between the control, SP, and CBL groups. Conclusions With the increased need to care for patients’ behavioral and mental health, professional athletic training programs and continuing education should consider incorporating MHFA training to improve content knowledge and confidence in skills. While no numerical difference between the groups was shown by this study, supplementation with simulation through CBL or SP encounters provides an opportunity for application specific to athletic training practice, which may help reinforce concepts and enhance clinical readiness.

ContextThe United States transgender patient population often suffers from insufficient health care and faces barriers to obtaining health care. Understanding the current classroom education provided in professional athletic training programs related to patient-centered and transgender patient care is necessary to foster improvements to the education of future health care providers.ObjectiveTo explore the education, comfort, and experience of professional athletic training students and program directors (PDs) on patient-centered care (PCC) and transgender patient care.DesignCross-sectional survey.SettingOnline survey.Patients or Other ParticipantsA total of 74 PDs of Commission on Accreditation of Athletic Training Education-accredited professional athletic training programs (age = 46 ± 9 years) and 452 athletic training students (age = 23 ± 3 years) responded to the survey.Data Collection and AnalysisTwo surveys were created from literature and were reviewed by a committee of content experts. Participants were sent links to their respective survey in March 2020. Surveys contained questions on demographic information, PCC, and transgender patient care. Data were analyzed descriptively with follow-up χ2 analyses comparing athletic training students' comfort and competence between those who learned and did not learn about transgender patient care.ResultsMost PDs reportedly felt comfortable (98.6%, n = 73) and competent (94.6%, n = 70) teaching PCC. Half (50% n = 37/74) of PDs include transgender health care in their program's curriculum but lacked competence (37.8%, n = 28) in teaching. All students felt comfortable (100%, n = 452) and competent (98.7%, n = 446) practicing PCC, but only 12.4% (n = 54) reported practicing it during clinical education. Less than half (43.1%, n = 195/452) of students learned about transgender patient care, yet most (78.3%, n = 354) felt comfortable but lacked competence (41.8% n = 189).ConclusionsFew students reportedly practice PCC during clinical education. Both groups perceived deficiencies in competence related to transgender patient care. We suggest PDs teach transgender health care in their curriculum and seek professional development to create meaningful educational experiences.

Purpose: The demands of athletic training students are substantial between academic and clinical responsibilities creating problems with commitment and retention. Grit and growth mindset have been associated with academic achievement and success; however, little research has assessed the presence of grit and growth mindset within athletic training students. Therefor the purpose of this study was to investigate the differences in grit and growth mindset between athletic training students and non-athletic training students majoring in general health sciences and to assess the relationship between grit and growth mindset in both athletic training students and non-athletic training students. Methods: A cross-sectional study was conducted utilizing a web-based survey to assess demographics, grit and growth mindset in undergraduate students. Univariate analyses and correlations were conducted to determine group comparisons and relationships between variables. Results: A total of 96 undergraduate students participated. Of the respondents 56% were athletic training students, 75% were female, and 83% were Caucasian. There was a significant difference in grit (U=800.50, p=.014) between groups with athletic training students (M=3.70, SD=.408) reporting lower levels of grit than non-athletic training students (M=3.93, SD=.413). Intelligence and talent growth mindset yielded no significant differences. A weak, positive correlation was found between grit and intelligence growth mindset (r=.341, p=.001) as well as between grit and talent growth mindset (r=.342, p=.001). Conclusion: The current study indicated differences in grit between athletic training and non-athletic training students, but not in growth mindset. Further research is needed to identify how these factors influence success and retention within athletic training programs.

Approved Clinical Instructors (ACIs; now known as preceptors) are expected to provide feedback to athletic training students (ATSs) during clinical education experiences. Researchers in other fields have found that clinical instructors and students often have different perceptions of actual and ideal feedback and that several factors may influence the feedback exchanges between instructors and students. However, understanding of these issues in athletic training education is minimal. To investigate the current characteristics and perceptions of and the influences on feedback exchanges between ATSs and ACIs. Qualitative study. One entry-level master's degree program accredited by the Commission on Accreditation of Athletic Training Education. Four ACIs and 4 second-year ATSs. Individual, semistructured interviews were conducted with participants and integrated with field notes and observations for analysis. We used the constant comparative approach to inductively analyze data and develop codes and categories. Member checking, triangulation, and peer debriefing were used to promote trustworthiness of the study. Participants described that feedback plays an important role in clinical education and has several purposes related to improving performance. The ACIs and ATSs also discussed several preferred characteristics of feedback. Participants identified 4 main influences on their feedback exchanges, including the ACI, the ATS, personalities, and the learning environment. The ACIs and ATSs had similar perceptions of ideal feedback in addition to the actual feedback that was provided during their clinical education experiences. Most of the preferences for feedback were aligned with recommendations in the literature, suggesting that existing research findings are applicable to athletic training clinical education. Several factors influenced the feedback exchanges between ACIs and ATSs, which clinical education coordinators should consider when selecting clinical sites and training ACIs.

ContextSport is an increasingly diverse context. This reality has prompted clinicians and educators to emphasize cultural competence education in athletic training. However, few efforts go beyond traditional, didactic methods and teach cultural competence in practically meaningful ways. One evidence-based approach that has potential to promote cultural competence in athletic training education is intergroup dialogue.ObjectiveTo describe intergroup dialogue in concept and research, demonstrate why this pedagogy can support cultural competence in athletic training education, and detail what such an approach looks like in practice.BackgroundIntergroup dialogue has origins in critical pedagogical philosophies and emerged as a part of broader social and political movements in the United States. Over the last 30 years, scholars have systematically employed and studied the approach in higher education.DescriptionIntergroup dialogue is an interdisciplinary approach that teaches people how to communicate across differences. Guided by trained facilitator(s), this method can help participants develop an understanding of diversity and practical skills to constructively navigate social-cultural differences in order to improve relationships and effect positive social change.Clinical Advantage(s)Intergroup dialogue can address the critical need for engaging pedagogy that helps athletic training students and practitioners develop cultural competencies. This method can equip those in athletic training with a critical awareness of social-cultural differences and practical skills to provide culturally sensitive care and promote equity.Conclusion(s)Athletic training educators can consider intergroup dialogue as a promising pedagogical approach to promote cultural competence in athletic training

Context: Standardized patients are more prominently used to both teach and evaluate students' clinical skills and abilities. Objective: To investigate whether athletic training students perceived an encounter with a standardized patient (SP) as realistic and worthwhile and to determine their perceived comfort in future lower extremity evaluations with standardized and actual patients. Design and setting: Cross-sectional. Athletic Training Research and Education Laboratory, on-campus athletic training room, and Clinical Proficiency Evaluation Room. Subjects: Twenty-nine undergraduate athletic training students (17 female, 12 male) at a Midwestern CAATE-accredited institution who had completed a lower extremity orthopedic evaluation course in the past 12 months. Measurements: A Standardized Patient Encounter Feedback Form consisting of 5 Likert scale items (1 = strongly disagree; 5 = strongly agree) regarding the participants' perceptions of SP encounters with foot/ankle and knee orthopedic cases (eg, worthwhile, realistic, confidence with future SPs and actual patients). Data was analyzed using descriptive statistics. Written comments regarding the strengths and weaknesses of the encounters were analyzed inductively. Results: The participants indicated (90%–100% of the time) that: they agreed or strongly agreed that the encounters were worthwhile and realistic; the cases presented were appropriate; they were provided with adequate performance feedback by the SPs; and that their lower extremity evaluation skills were helped by the experiences. The participants indicated (86%–93% of the time) that they agreed or strongly agreed that the encounters made them feel more comfortable about future evaluations with standardized and actual patients. Conclusions: It appears that SPs provide realistic and worthwhile experiences for athletic training students. Thus, cases could be developed to evaluate athletic training clinical proficiencies in the future.

Context Clinical education is an integral part of athletic training programs. This is where students should develop their professional identities and become socialized into the profession. Understanding the student and preceptor perspectives of the impact that clinical experiences have on students can provide valuable insight into this aspect of athletic training education. Objective To evaluate the impact of clinical education on the professional development of athletic training students from the student and preceptor perspective. Design Qualitative study. Setting Commission on Accreditation of Athletic Training Education–accredited undergraduate programs. Patients or Other Participants A total of 15 participants (7 athletic training students and 8 preceptors) from four schools enrolled in our study. Data Collection and Analysis One researcher conducted semistructured interviews over the phone or in person. Data analysis used a general inductive approach to reveal the dominant themes that related to our purpose. We achieved data credibility through multiple analyst triangulation, peer review, and member checks. Results Athletic training students and preceptors agree that clinical education is integral to the professional development process. Realistic and positive experiences and diversity in experiences were identified as factors affecting professional growth during clinical education experiences. Conclusions Athletic training students and preceptors have similar views on the importance of clinical placements on professional development. Clinical experiences provide students with the opportunity to learn more about the profession, affirm their career choice, practice knowledge and skills, and learn about themselves personally and professionally. The student and the fit/match of the placement directly impact the students' clinical experiences.

Context Researchers have reported that interacting with standardized patients (SPs) is a worthwhile and realistic experience for athletic training (AT) students. These encounters enhance students' interviewing skills, confidence as a clinician, clinical skill development, and interpersonal communication. Objective To determine how SP encounters impacted students' confidence in performing clinical evaluations. Design Pretest-posttest survey design. Setting Athletic training simulation lab. Patients or Other Participants Thirty-five students from the junior (n = 20) and senior (n = 15) AT cohorts from a public liberal arts institution in the Southeast. Intervention(s) Athletic training students completed 2 SP encounters per semester throughout an academic year in the AT program, totaling 4 SP encounters. Main Outcome Measure(s) Each student completed a 17-item Likert scale (1 = strongly disagree, 5 = strongly agree) that rated confidence levels immediately before and after each SP encounter. The confidence rating assessed students' confidence regarding how the SP encounter affected their confidence in completing patient evaluations (eg, identifying history questions, interpreting results of special tests). We computed descriptive statistics for all items Wilcoxon signed rank tests determined differences in pre-encounter and should be postencounter confidence ratings. Results Overall, students from both cohorts reported that the SP encounter improved confidence in completing clinical evaluations. Specifically, students reported a significant increase from pre-encounter to postencounter confidence ratings after nutrition-based (Z = −2.991, P = .004), knee (Z = −3.261, P = 0.001), concussion (Z = −3.294, P = .001), psychosocial intervention (Z = −3.062, P = .002), and general medical (Z = −3.524, P > .001) SP encounters. Conclusions The authenticity and fidelity of the SP encounter provided the AT students a real-time clinical evaluation in a nonthreatening environment. Students reported that their confidence improved after each encounter. By providing these experiences, AT students can become comfortable interacting with patients in clinical evaluations.

Context Professional identity development in professional master's (PM) athletic training students occurs over time and is influenced by numerous socializing factors. Although socialization processes of athletic training students have been examined, professional identity development related to the Weidman et al graduate and professional student socialization framework [Weidman JC, Twale DJ, Stein EL, et al. Socialization of Graduate and Professional Students in Higher Education: A Perilous Passage? ASHE-ERIC higher education report. Vol 28, No. 3. Jossey-Bass Higher and Adult Education Series; 2001] has never been examined in athletic training. This model values the multiple networks, individuals, and experiences that influence graduate students throughout their program. Objective To assess the lived experiences of 1 cohort of students enrolled in a PM athletic training program and determine what curricular and clinical education factors influence the development of professional identity. Design Qualitative study. Setting Focus group interview. Patients or Other Participants Ten of 12 (83%) students (5 females and 5 males) from a single PM athletic training cohort program participated. Data Collection and Analysis We conducted a focus group interview, which we transcribed verbatim, with participants during the last week of their last semester in the PM athletic training program. Data analysis was deductive and then inductive throughout the coding process, and we reached data saturation at the individual participant and cohort levels. We ensured trustworthiness through multiple analyst triangulation, peer expert review, and multiple data sources. Results Three factors influenced the development of the PM athletic training student's professional identity: (1) their clinical education experiences, (2) the cohort experience, and (3) their school/life balance. Within the clinical education experience, the immersive experience, clinical setting, and patients and preceptors were also influential. Conclusions This study used the Weidman et al socialization model. The experiences of PM athletic training students and their professional identity development are inclusive of the relationship with others throughout the educational experience, as well as their self-reflective practices within the field. It is important for stakeholders to understand the many factors that influence professional identity development.

Context International topics in athletic training are gaining recognition. Particularly interesting are opportunities for athletic training students to gain international experiences and develop cultural competence through study abroad. However, little is known about current international experience opportunities for these students. Objective To identify international experience opportunities for athletic training students, investigate student and faculty participation, and describe characteristics of institutions and programs offering such experiences. Design Survey. Setting Online. Patients or Other Participants All directors of Commission on Accreditation of Athletic Training Education–accredited professional athletic training programs were recruited. The response rate was 41.9% (163/389). Data Collection and Analysis An e-mail soliciting participation was sent in January 2019. The online survey had 4 sections: (1) questions about athletic training–related international experiences, (2) questions about discipline-related international experiences, (3) questions about athletic training faculty or student participation, and (4) demographic questions about the program or institution. Data were analyzed descriptively. The characteristics of programs offering athletic training–related international experiences were compared with programs offering discipline-related international experiences using χ2 tests for degree level, institution type, and athletic division. Results Twenty-nine programs (17.8%) offered athletic training–related international experiences and 68 programs (41.7%) offered discipline-related experiences. Private universities were more likely to offer an athletic training–related experience, and public universities more likely to offer a discipline-related experience (χ2 = 4.197, df = 1, P = .04). There were no other differences between institution types, program degree levels, or athletic divisions (all P > .05). Some programs reported no recent athletic training student (44%) or athletic training faculty (58%) participation in any international experience. Conclusions A minority of programs currently offer either athletic training–related or discipline-related international experiences. Characteristics of available programs vary widely. To keep pace with professional globalization, future work should identify ways to develop international experiences.

Background: Burnout is linked to various adverse outcomes (i.e., thoughts of dropout, depression, unprofessional behaviors) in healthcare students (i.e., nursing students, medical students). However, potential adverse outcomes associated with burnout in athletic training students, a subset of healthcare students, have yet to be identified. Objective: To adapt a previously tested theoretical model to explore relationships between student workload, burnout, and potential adverse outcomes in a sample of graduate athletic training students. Methods: An online survey assessing the variables of interest and study information was sent to program directors of graduate-level athletic training programs at their publicly accessible email addresses with a request to forward the opportunity to their students. This was a nationwide sample of graduate athletic training students with 320 graduate athletic training students completing the survey. Descriptive statistics and structural equation modeling was used in our analysis. Results: Structural equation modeling confirmed that our hypothesized model successfully described relationships between academic workload, burnout, and adverse outcomes in athletic training students. Specifically, academic workload predicted burnout, and burnout in turn predicted various adverse outcomes (i.e., thoughts of dropout, depression, unprofessional behaviors) in athletic training students. Educators should be aware of the potential adverse outcomes identified in this sample of athletic training students that have also been reported in other healthcare students. Conclusions: Methods to combat symptoms of burnout to enhance student well-being and avoid potential adverse outcomes should be identified. Future research should use the adapted theoretical model discussed in this article within other healthcare students' samples to understand further the complex network of relationships between academic workload, burnout, and adverse outcomes in the educational environment.

Context Graduates of athletic training programs (ATPs) have identified factors contributing to their persistence through professional education. However, program directors have yet to elaborate on programmatic attributes that might contribute to athletic training student retention in their respective ATPs. Objective To determine program directors' perceptions of ATP strengths and areas for improvement regarding athletic training student retention. Design Qualitative study. Setting Bachelor's ATPs. Patients or Other Participants Sixteen ATP directors with 6.0 ± 4.0 years of experience in their current positions. Main Outcome Measure(s) The participants completed audio recorded telephone interviews. We analyzed the data using principles of grounded theory and maintained trustworthiness using multiple-analyst triangulation, peer review, and member checks. Results We found 2 themes to describe the strengths of bachelor's ATPs. Our participants thought that they provided a student-centered approach and diverse clinical education experiences leading to a supportive and exciting environment to foster athletic training student learning. We categorized the student centered approach theme into 3 subthemes: program size, student engagement and program atmosphere, and academic and clinical cohesion. Conclusions Program directors should strive to provide athletic training students with individual attention to help them feel welcomed, valued, and important. A small program size or adequate personnel can foster interpersonal relations which can provide athletic training students with mentoring opportunities. Improving ATP cohesion can provide learning opportunities which assist students in making connections and promote the importance of the academic and clinical education components of the ATP. Engaging athletic training students early through a variety of clinical education experiences can assist professional socialization and foster excitement for the profession.

Appropriate methods for evaluating clinical proficiencies are essential in ensuring entry-level competence. To investigate the common methods athletic training education programs use to evaluate student performance of clinical proficiencies. Cross-sectional design. Public and private institutions nationwide. All program directors of athletic training education programs accredited by the Commission on Accreditation of Allied Health Education Programs as of January 2006 (n = 337); 201 (59.6%) program directors responded. The institutional survey consisted of 11 items regarding institutional and program demographics. The 14-item Methods of Clinical Proficiency Evaluation in Athletic Training survey consisted of respondents' demographic characteristics and Likert-scale items regarding clinical proficiency evaluation methods and barriers, educational content areas, and clinical experience settings. We used analyses of variance and independent t tests to assess differences among athletic training education program characteristics and the barriers, methods, content areas, and settings regarding clinical proficiency evaluation. Of the 3 methods investigated, simulations (n = 191, 95.0%) were the most prevalent method of clinical proficiency evaluation. An independent-samples t test revealed that more opportunities existed for real-time evaluations in the college or high school athletic training room (t(189) = 2.866, P = .037) than in other settings. Orthopaedic clinical examination and diagnosis (4.37 +/- 0.826) and therapeutic modalities (4.36 +/- 0.738) content areas were scored the highest in sufficient opportunities for real-time clinical proficiency evaluations. An inadequate volume of injuries or conditions (3.99 +/- 1.033) and injury/condition occurrence not coinciding with the clinical proficiency assessment timetable (4.06 +/- 0.995) were barriers to real-time evaluation. One-way analyses of variance revealed no difference between athletic training education program characteristics and the opportunities for and barriers to real-time evaluations among the various clinical experience settings. No one primary barrier hindered real-time clinical proficiency evaluation. To determine athletic training students' clinical proficiency for entry-level employment, athletic training education programs must incorporate standardized patients or take a disciplined approach to using simulation for instruction and evaluation.

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. To determine the relationship between the frequency and length of PEs, as well as the student's role and clinical site during PEs, and the students' perceived CC implementation during these encounters. Cross-sectional study. Professional athletic training program, National Collegiate Athletic Association Division I institution. 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. 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's 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. 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. The roles of participants during PEs were related to their ability to implement the total number of CCs ( F = 103.48, P < .001). Those who observed were likely to implement fewer total CCs than those who assisted (M diff = -0.29, P < .001); those who assisted were likely to implement more total CCs than those who performed (M diff = 0.32, P < .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 < .001). 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.