Standardized Patients Provide Realistic and Worthwhile Experiences for Athletic Training Students

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.

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.

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.

IntroductionThe ability to utilize the electronic health record (EHR) without compromising the doctor-patient relationship (DPR) is an essential skill of all physicians and trainees, yet little time is spent on educating or assessing learners on needed techniques. To address this gap, we developed a conventional OSCE station coupled with a simulated patient chart within the Epic program in order to assess our students' skills utilizing the EHR during a patient encounter.MethodsOf third-year medical students, 119 were given full access to the patient's simulated chart 24 hours in advance of their OSCE to review clinical data. During an in-person OSCE with a standardized patient (SP), students performed a focused history and physical, using the EHR to verify allergies and medications. Students completed an electronic patient note graded by faculty. SPs evaluated the students on communication and interpersonal skills with specific rubric elements. Faculty graded the students' notes to evaluate their expression of clinical reasoning in the assessment and plan.ResultsTraining SPs and faculty to assess students on EHR skills was feasible. After implementation of a comprehensive curriculum focused on EHR and DPR, there was a significant difference on EHR-related communication skills (M = 76.4, SD = 17.6) versus (M = 37, SD = 28.9) before curriculum enhancement t (117.9) = −12.4, p <.001.DiscussionThe EHR OSCE station provided a standardized method of assessing students' EHR skills during a patient encounter. Challenges still exist in the technological requirements to develop and deliver cases in today's EHR platform.

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.

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.

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.

Context Emergency and immediate care skills are often difficult to practice in real time during clinical education. One immediate care skill requiring advanced training that may not be implemented during clinical education is wound closure via suturing. Simple laceration management with sutures can be advantageous skill for athletic training students to learn and practice; however, deliberate practice with feedback in a realistic manner is necessitated. Objective To describe the use of hybrid simulation to practice suturing in professional and postprofessional athletic training programs. Background The practice of immediate and emergency skills is predominately classroom based and removes the patient experience. Simulation-based learning has provided athletic training educators an opportunity for skill practice with patient simulators and standardized patients to fill the gap. Description The hybrid simulation incorporates the use of a standardized live patient actor with an attached part-task–training simulated arm for suturing in a safe and realistic manner. Clinical Advantage(s) Incorporating a hybrid simulation encounter for practice of suturing skills requires multitasking and delivery of patient-centered care and promotes proper skill execution while receiving questions and direct feedback from the standardized patient. Conclusion(s) Suturing should be taught and assessed in a tiered format using part-task trainers such as pig skin and artificial skin pads. After skill development, a hybrid simulation as a summative assessment allows for the educator to evaluate the learners' interpersonal communication and technical skills in a safe manner.

본 연구는 표준화 환자를 활용한 호흡기계 환자 시뮬레이션 기반 교육을 보건계열 학생에게 적용한 후 학업만족도와 자기효능감, 임상수행능력에 미치는 효과를 기존의 시뮬레이션 교육과 비교 검증하기 위해 시도되었다. 비동등성 대조군 전후설계를 적용한 유사 실험연구로서 J시에 소재한 D대학 보건계열 3학년 학생 50명이 참여하였다. 실험군 25명에게는 표준화 환자를 활용한 호흡기계 환자 시뮬레이션 교육과 평가를 진행하였고 대조군 25명에게는 전통적인 시뮬레이션 교육과 평가를 실시하였다. 2013년 11월부터 180분간 주 1회씩 총 2회의 교육과 1회의 평가로 실시되었으며 수집된 자료는 SPSS/Win 18.0을 이용하여 실수와 백분율, t-test로 분석하였다. 본 연구 결과 표준화 환자를 활용한 호흡기계 환자 시뮬레이션 교육을 시행한 실험군에서 학업만족도와 자기효능감, 임상수행능력이 통계적으로 유의하게 높았다. 이상의 연구결과를 종합한 결과, 표준화 환자를 활용한 호흡기계 환자 시뮬레이션 기반 교육은 보건계열 대학생의 학업만족도와 자기효능감, 임상수행능력 향상에 기존의 시뮬레이션 교육보다 효과적임을 확인할 수 있었다. 따라서 다양한 분야에서 표준화 환자를 활용한 시나리오를 개발하고 시뮬레이션 교육과정에 적용하여 보건계열 학생들의 전문직 역량 강화를 위해 활용할 것을 제안한다. 【This study was conducted to examine the effects of a simulation-based learning scenario using standardized respiratory patients regarding emergency care on learning satisfaction, and self efficacy, clinical skill competency of health related department students. A quasi-experimental non-equivalent control group pre-post test design was used. A total of 50 students, 25 students for the experimental group and 25 students for the control group, The experimental group received the 2 educations sessions and 1 evaluation session with 180 minutes for each session. It was implemented in November, 2013. Data were analysed using frequency, ratio and t-test by the SPSS/Win 18.0. The experimental group who had the simulation-based learning scenario using standardized respiratory patients showed significantly higher learning satisfaction and self efficacy, clinical skill competency compared with the control group who had a traditional simulation education. Through this study, simulation-based learning scenario using standardized patients was verified to be an effective teaching method to be grow up on professional competency of health related department students. Also the simulation-based learning scenario using standardized patients should be developed in the various fields.】

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.

Pharmacist Licensure: Time to Step It Up?

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

Keck School of Medicine of the University of Southern California.

Context Technology continues to change throughout the world, and higher education is not absent from the adjustment. Athletic training educators should adapt to online learning opportunities that enhance the curriculum for their students. Objective To explore athletic training students' thoughts and knowledge when learning through a distance education platform. Design Cross-sectional, mixed-methods survey. Setting Six professional postbaccalaureate athletic training programs. Patients or Other Participants A total of 55 second-year athletic training students. Intervention(s) One-week asynchronous eLearning module focused on the background and use of telemedicine in health care. Main Outcome Measure(s) Participants completed the technology acceptance model tool before and after the module to gather their perspectives about online learning. During the eLearning module, knowledge acquisition was assessed with quizzes. Finally, a transactional distance theory tool including 2 open-ended response items was delivered at the end of the eLearning module. Results We identified that participants had a low acceptance for technology at the onset of the study that improved after the eLearning intervention for the constructs of self-efficacy (P = .010) and perceived ease of use (P ≤ .001) of eLearning technologies. The transactional distance tool highlighted that the facilitator and readings were helpful, which was also indicative of the scores on the module quizzes. We also identified benefits to eLearning from the student perspective, which included previous experiences, learning on their own time, and feelings that the module was productive to their growth as students. Some participants stated that the eLearning module presented too much work and was missing interaction, whereas others were neutral relative to the comparison between traditional and online learning. Conclusions Overall, the results of this study identified that technology acceptance and transactional distance are important components of online learning. Athletic training educators should educate learners regarding the differences in online education requirements.

To assess the quality of ratings of interviewing skills and oral English proficiency provided on a clinical skills OSCE by physician examiners, standardized patients (SPs), and communication skills experts. In 1998, 73 candidates to the Ontario International Medical Graduate (OIMG) Program completed a 29-station OSCE-type clinical skills selection examination. Physician examiners, SPs, and communication skills experts assessed components of oral English proficiency and interview performance. Based on these results, the frequency and generalizability of English-language flags, physician examiners' indications that spoken English skills were bad enough to significantly impede communication with patients; the reliability of the OIMG's Interview and Oral Performance Scales and generalizability of overall interview and oral performance ratings; and comparisons of repeated assessments by experts were calculated. Principal-components analysis was applied to the panels' ratings to determine a more economical expression of the language proficiency and interview communication skills results. The mean number of English-language flags per candidate was 2.1, the median was 1.0, and Cronbach's alpha of the ratings was 0.63. Means, SDs, and alphas of the physician examiners' and SPs' ratings of the interview performance scale were 9.15/10, 0.43, 0.36, and 9.30/10, 0. 56, 0.50, respectively. Corresponding values for overall interview performance ratings were 3.08/4, 0.30, 0.33, and 3.34/4, 0.32, 0.47. Means, SDs, and alphas of the physician examiners' and SPs' ratings of the oral performance scale were 8.54/10, 0.74, 0.78, and 8.74/10, 1.00, 0.76. Corresponding values for overall ratings of oral performance were 3.85/5, 0.51, 0.68, and 4.08/5, 0.60, 0.68. For the two experts' ratings of two contiguous five-minute interview stations, internal consistencies were 0.88 and 0.78. For the two experts' ratings of standardized ten-minute interviews, internal consistencies were 0.81 and 0.92. Correlations between the mean values of the experts' ratings of the ten- and five-minute stations were 0.45 and 0.51. Three factors emerged from the PCA, language proficiency, physician examiners' ratings of interview proficiency, and SPs' ratings of interview proficiency. Consistency between the physician examiners' and SPs' ratings of English proficiency was observed; less agreement was observed in their ratings of interviewing skills, and little agreement was observed between the experts' ratings. Communication skills results may be validly expressed by three measures: one overall global rating of language proficiency provided by physician examiners or SPs, and overall global ratings of interview proficiency provided separately by physician examiners and SPs.