Improving Athletic Trainers' Knowledge of Clinical Documentation through Novel Educational Interventions: A Randomized Controlled Trial.

Abstract

Athletic trainers (ATs) have reported the need for more educational resources about clinical documentation. To investigate the effectiveness of passive and active educational interventions to improve practicing ATs' clinical documentation knowledge. Randomized control trial, sequential explanatory mixed methods study. Online module(s), knowledge assessment and interviews. We emailed 18,981 practicing ATs across employment settings, of which 524 ATs were enrolled into a group [personalized learning pathway (PLP=178), passive reading list (PAS=176), control (CON=170)] then took the knowledge assessment. There were 364 ATs who did not complete the intervention and/or post-knowledge assessment; therefore, complete responses from 160 ATs (PLP=39, PAS=44, CON=77; age=36.6±11.2y, years certified=13.9±10.7y) were analyzed. Knowledge assessment (34 items) and interview guides (12-13 items) were developed, validated, and piloted with ATs prior to study commencement. We summed correct responses (1 point each, 34 points maximum) and calculated percentages and pre- and post-knowledge mean change scores. Differences among groups (PLP, PAS, CON) and time (pre- intervention, post-intervention) were calculated using a 3X2 repeated-measures ANOVA (P≤.05) with post hoc Tukey HSD. Semi-structured interviews were conducted (PLP=15, PAS=14), recorded, transcribed, and analyzed following the consensual qualitative research tradition. No differences in the pre-knowledge assessment were observed between-groups. We observed a group x time interaction (F2,157 = 15.30, P<.001; partial eta-squared=0.16). The PLP exhibited greater mean change (M=3.0±2.7) than PAS (M=1.7±3.0, P=.049) and CON (M=0.4±2.2, P<.001). Descriptively, ATs scored lowest on legal (61.3%±2.1%), value of the AT (63.7%±4.3%), and health information technology (65.3%±3.7%) items. Whereas ATs described being confident in their documentation knowledge, they also identified key content (eg, legal considerations, strategies) they deemed valuable. The educational interventions improved ATs' knowledge of clinical documentation and provided valuable resources for their clinical practice; however, targeted continuing education is needed to address knowledge gaps.