Athletic Training Student Reflections Regarding a Computer-Based Online Non-Orthopedic Patient Simulation Experience

Athletic Training Educators' ConferenceApril 29–May 1, 2021

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:Athletic training students' ability to transition into professional practice is a critical component for the future of the profession. However, research on professional master's students' transition to practice and readiness to provide autonomous care is lacking.Objective:To determine professional master's athletic training students' perceptions regarding how they were prepared to transition to practice as clinicians.Design:Qualitative study.Setting:Professional master's athletic training programs.Patients or Other Participants:Sixteen students, 8 program directors, and 5 faculty members from professional master's athletic training programs.Main Outcome Measure(s):An online questionnaire was distributed via Qualtrics and analyzed using an inductive technique. Participants responded to a series of open-ended questions related to the structure and curricular offerings of their respective programs. We secured trustworthiness through multiple analyst triangulation and peer review.Results:We found that both students and faculty identified clinical education as the major facilitator in the socialization process used to prepare students for the transition into clinical practice. Three further subthemes emerged: (1) Both stakeholder groups felt that students gained experience through diverse and immersive clinical education experiences; (2) Preceptors provided mentorship; and (3) Students developed confidence to enter clinical practice as a result of these supported experiences.Conclusions:Professional master's programs provide clinical education experiences designed to help athletic training students gain the skills and confidence necessary to become autonomous practitioners. The diversity and mentorship contained within these experiences facilitates confidence and preparedness.

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.

Context Burnout is a common concern in the field of athletic training that may affect athletic training students. They may experience burnout because of stressors related to their clinical education responsibilities and course load. Various buffers have been suggested to reduce burnout in other health care settings; however, there is a limited body of research examining the effect of locus of control and optimism as buffers against burnout in athletic training populations. Objective To investigate whether a perceived internal locus of control and/or optimism can provide a buffer against burnout in athletic training students. Design and Setting A cross-sectional observational research design via Qualtrics survey. Patients or Other Participants A total of 48 professional master's athletic training students enrolled in Commission on Accrediting Athletic Training Education–accredited programs. Data Collection and Analysis Participants were sent a survey link that included demographic questions, the Copenhagen Burnout Inventory, Life Orientation Test–Revised, and the Rotter Internal/External Locus of Control Scale. Three multiple regression analyses were conducted to examine the relationships of personal burnout, work-related burnout, and client-related burnout with optimism and locus of control. A Pearson correlation was conducted on the significant findings to determine the strength of relationship among variables. Main Outcome Measure(s) Copenhagen Burnout Inventory, Life Orientation Test–Revised, Rotter Internal/External Locus of Control Scale. Results Significant relationships were identified between optimism and personal burnout (t = −3.30, P = .002) and between optimism and work-related burnout. (t = −2.48, P = .02). No significant relationships were identified between locus of control and any of the burnout-related variables (P > .05). Conclusion Optimism could be an effective buffer against student burnout in professional master's athletic training programs. Athletic training programs should implement various strategies to promote student optimism including proper social support strategies, time management, and stress management to help reduce the onset of burnout in students.

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 Professional master's (PM) athletic training programs (ATPs) are becoming more popular as the profession debates what the entry-level degree should be for athletic training. More information is needed related to the potential benefits of PM ATPs. Objective Describe the Commission on Accreditation of Athletic Training Education (CAATE) accredited PM ATPs including athletic training student retention rates and career placement rates as well as strengths and areas for improvement. Design Mixed-method study. Setting Professional master's ATPs. Patients or Other Participants We surveyed directors of all accredited PM ATPs and obtained responses from 15 out of the 25 directors (60.0%). Main Outcome Measure(s) We sent a link to an electronic survey to all directors. The survey asked background questions about the ATP, the institution, and the director. Using data saturation as a guide, we also performed follow-up telephone interviews with 8 directors to expand upon the data gathered in the survey, specifically related to aspects of their PM ATPs. We analyzed the data using grounded theory and maintained trustworthiness through multiple analyst triangulation, member checks, and a peer review. Results Our findings indicate an 88.7% retention rate and an 88.5% career placement rate for PM athletic training students. The directors responded very positively about their ATPs, particularly didactic education. The participants also felt they provide a positive environment which fosters student learning, excellent clinical education opportunities, and unique experiences beyond those typically offered at the undergraduate level. Many directors also noted they wanted to make personnel modifications to strengthen their ATPs. Conclusions We were able to provide descriptive information on PM ATPs. The participants described the didactic and clinical education experiences, social experiences, and overall ATP atmosphere as overwhelmingly positive. The small class sizes and involvement from faculty, staff, and preceptors helped create an environment, which fosters athletic training student learning.

Celebrating the Culture of Interprofessional Collaboration in Athletic Training

Context: Recent literature has focused on reasons for athletic training student persistence and departure. However, accredited professional bachelor's athletic training program (ATP) directors' opinions regarding student retention have yet to be studied, to our knowledge. Objective: To determine reasons for athletic training student persistence and departure from professional bachelor's ATPs across the United States from the program directors' (PDs') perspective. Design: Two-part qualitative study. Setting: Commission on Accreditation of Athletic Training Education professional bachelor's ATPs. Patients or Other Participants: For Part 1 of this study, we asked PDs of all 343 ATPs to complete an online survey, gathering responses from 177 (51.6%). Using data saturation as a guide, Part 2 included performing follow-up telephone interviews to gain further understanding, clarity, and triangulation with 16 randomly selected PDs. Main Outcome Measure(s): During Part 1, participants chronicled responses to open-ended questions as part of the online survey. For the second part of the study, the telephone interviews followed a semistructured format and were recorded to facilitate transcription. We analyzed data using grounded theory and secured trustworthiness by using multiple-analyst triangulation, member checks, and a peer review. Results: Program directors reported athletic training students persist due to their career goals, the personal relationships they create, and because they enjoy and are dedicated to athletic training. The respondents stated that athletic training students leave ATPs because of the academic rigor, the program not meeting expectations, a loss of interest, career considerations, and financial reasons. Conclusions: Program directors should educate prospective athletic training students about athletic training by providing a realistic explanation of the roles and responsibilities of the profession. Selecting clinical education sites with preceptors who enjoy their career choice and good working conditions may help solidify athletic training student commitment to the ATP and the athletic training profession.

Context: Sexual harassment is a growing concern in higher education. Athletic training students should feel safe in their programs, whether in the didactic or clinical setting. Though the Commission on Accreditation of Athletic Training Education creates standards to keep the students safe, there are none regarding sexual harassment training for athletic training students. Objective: To determine the rate of sexual harassment training in athletic training students, with a secondary purpose of determining, if indeed sexual harassment training occurs, whether it is associated with the college or university or is offered through an outside entity. Design: Survey. Setting: Online. Patients or Other Participants: Eight hundred eighty-five athletic training students (613 females, 272 males). Main Outcome Measure(s): Data were analyzed through SurveyMonkey, and the statistical software R. Frequency counts and percentages were determined. A Fisher exact test was run to determine if there was a relationship between the athletic training student's current knowledge and whether the athletic training student had received harassment training. Results: The study found that more than 50% of male and female athletic training students had not recieved sexual harassment training, whereas 75% of all respondents stated that they knew what resources were available to report issues of sexual harrassment. The odds of a person not knowing what resources were available to report harassment and not having training were 6 times the odds of those who had training and did not know what resources were available. Conclusions: Our study emphasizes the need for sexual harassment training in athletic training programs. Athletic training students need to know what sexual harassment is and who to report it to. Additionally, they should not feel threatened by reporting any instances of harassment.

Purpose: Rectal thermometry has been the best practice for recognizing exertional heat stroke (EHS) since 2015, but many certified athletic trainers fail to utilize this technique. Recent studies identified a barrier to implementation is a lack of self-confidence due to not having hands-on practice opportunities. To improve the adoption of rectal thermometry, the Commission on Accreditation of Athletic Training Education (CAATE) began requiring athletic training programs to train students in rectal thermometry in 2020. Providing authentic practice opportunities for low-incidence conditions such as EHS poses a challenge to some athletic training programs. Therefore, the purpose of this study was two-fold: 1) to identify the effect of high-fidelity simulation vs. mid-fidelity simulation on athletic training students’ self-confidence when performing rectal thermometry; 2) to determine if there were any differences in self-confidence between genders. Method: This study used an explanatory, mixed methods, two-group repeated measures research design. Participants were thirty-nine first-year professional Master of Athletic Training students. These students completed a simulated EHS encounter with either a high-fidelity simulation manikin (HFSM) (n=19) or a standardized patient (SP) (n=20). The outcome measures were The Athletic Trainer’s Self-Confidence Scale (ATSCS) and qualitative semi-structured open-ended interviews. Eight participants from each group (n=16) participated in qualitative interviews. Results: A repeated measures ANOVA with one within-subjects factor and two between-subjects factors revealed a statistically significant improvement from participants’ pre-intervention ATSCS score to the post-intervention ATSCS score regardless of group assignment. There were no statistically significant differences between groups or genders. We identified three major themes of athletic training students’ self-confidence that align with three sources of self-efficacy in Bandura’s Social Cognitive Theory: 1) past performance accomplishments, 2) verbal persuasion, and 3) imaginal future experiences performing rectal thermometry. Conclusions and Recommendations: A simulated EHS encounter with a standardized patient or a high-fidelity manikin is equally effective for improving first-year athletic training students’ self-confidence with performing rectal thermometry. Future research is needed to determine the effect of these encounters on a larger population and the long-term adoption of rectal thermometry in clinical practice.

Context Sexual harassment is a concern in health care professions and on college campuses nationwide. Athletic trainers are health care professionals who work in close conjunction with athletes, coaches, officials, and other stakeholders, predisposing them to potential sexual harassment occurrences. Objective To examine the experiences of sexual harassment of professional master's ATSs during their clinical education experiences. Design Mixed-method study. Setting Online questionnaire. Patients or Other Participants Eighty-seven athletic training students (68 women, 19 males; age = 23.40 ± 1.85 years; 44 first-year students, 43 second-year students) currently enrolled in Commission on Accreditation of Athletic Training Education (CAATE)–accredited professional master's athletic training programs. Data Collection and Analysis We sent an online questionnaire to CAATE-accredited professional master's athletic training program directors, along with a recruitment email encouraging program directors to send the questionnaire to students currently enrolled in the programs they lead. We validated the questionnaire using expert and peer review. We used a general inductive approach to analyze the results and used multi-analyst triangulation and peer review to ensure credibility. Results Our study revealed that 28.70% of participants reported they felt as though they were subjected to sexual harassment behaviors during clinical education. Themes reported through recipients' accounts of sexual harassment defined a timeline that started when sexual harassment most commonly manifested through inappropriate comments, followed by ATSs having to adjust after incidents instead of the perpetrators, and finally ended with insufficient resolution in which victims felt the situations should have been handled differently. Conclusions Sexual harassment affects some professional master's ATSs in clinical education settings. Athletic training program administrators should educate students on clearly defined policies and procedures that will lead to resolution when sexual harassment occurs during athletic training clinical education.

Context Student motivation has been linked to persistence until graduation for athletic training students. There is little research, however on ways athletic training programs (ATPs) foster student motivation. Objective To expand upon the existing literature regarding retention of students in ATPs, specifically examining the concept of student motivation to complete degree requirements from the perspective of the program director (PD). Design Qualitative study. Setting One-on-one telephone interviews. Patients or Other Participants Eight PDs from professional master's and 16 PDs from undergraduate ATPs. Data Collection and Analysis We asked PDs to participate in a tape-recorded semistructured telephone interview. We analyzed data using a general inductive approach and secured credibility by utilizing member checks, multiple analyst triangulation, and peer review. Results Motivation for degree completion, as evaluated by the PD, is fostered by internal motivation, program pride and continued tradition of program success, and accomplishment of the personal goal to become an athletic trainer. Conversely, 1 major theme, disinterest or dissatisfaction with a career in athletic training, evolved as a reason to not remain motivated to complete the degree requirements for athletic training. Conclusions Program directors reported that internal drive and the achievement of personal goals influence the persistence of students in their ATPs. Students are also motivated by the successes of previous students in the program and feel a responsibility to uphold the legacy.

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 who have a wide variety of conditions. It is unclear in what ways, if any, ATSs have diverse opportunities during clinical experiences. To describe the characteristics of patient encounters (PEs) ATSs engaged in during clinical experiences. Multisite panel design. Twelve professional athletic training programs (5 bachelor's, 7 master's). A total of 363 ATSs from the athletic training programs that used E*Value software to document PEs during clinical experiences. During each PE, ATSs were asked to log the clinical site at which the PE occurred (college or university, secondary school, clinic, or other), the procedures performed during the PE (eg, knee evaluation, lower leg flexibility or range of motion, cryotherapy), and the patient's diagnosis, with the International Classification of Diseases, Tenth Revision code (eg, S83.512A knee sprain, anterior cruciate ligament). A total of 30 630 PEs were entered by 338 ATSs across 278 unique clinical settings. More than 80% of PEs occurred in college or university and secondary school settings. More than half of the diagnoses were categorized as affecting the lower body region. Examination and evaluation procedures and application of therapeutic modality procedures each contributed approximately 27% of procedures. It was surprising that ATSs were not gaining experience in all clinical practice settings in which athletic trainers commonly practice. Our data suggest that students may be consigned to working with patients who have more frequently occurring injuries, which may not prepare them for the realities of autonomous clinical practice. These findings indicate that directed efforts are needed to ensure that ATSs are provided opportunities to engage with diverse patient populations who have a variety of conditions in an array of clinical site types during their clinical experiences.

Context Curricular design that addresses athletic training student competencies in patient centered care and cultural humility remains a challenge. Research suggests athletic training educators feel unprepared to teach cultural competency concepts yet are required to teach them due to accreditation standards. One evidence-based approach that has potential to promote cultural humility in athletic training students is graphic medicine (GM). Objective To assess how GM influences cultural awareness in athletic training students and to evaluate the utility of GM within the curriculum. Design Cross-sectional study. Setting Professional and postprofessional athletic training education program classrooms. Patients or Other Participants Eighty-seven athletic training students, the majority professional level (81.7%), who identified as White (77.0%), and female and woman (73.6%), with a mean age of 22.03 ± 2.60, participated in this study. Intervention(s) The intervention included 1 GM activity lasting 1 to 1.5 hours. Main Outcome Measure(s) Participants completed a preintervention and postintervention modified Cultural Awareness Scale, which is divided into 2 subscales: General Attitudes and Clinical Experiences. Descriptive statistics, paired t tests, analysis of variance, and analysis of covariance were performed to analyze the data. Results A single GM activity was insufficient to significantly enhance athletic training students’ cultural awareness. Although some improvements were noted, ongoing education is essential. Participants found the GM activity engaging and relevant to medical practice, indicating the value of embedding such practices into the curriculum for fostering inclusive patient care. Conclusions Graphic medicine offers a popular and meaningful method for impacting cultural awareness in athletic training students. Cultural humility is developed over time; therefore, activities fostering growth should be incorporated throughout athletic training programs.