Approved Clinical Instructors Research Articles

Letter to the Editor: “High-Fidelity Meets Athletic Training Education: An Innovative Collaborative Teaching Project”

Letter to the Editor: “High-Fidelity Meets Athletic Training Education: An Innovative Collaborative Teaching Project”

Feedback in Clinical Education, Part II: Approved Clinical Instructor and Student Perceptions of and Influences on Feedback

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.

Perceptions of approved clinical instructors: barriers in the implementation of evidence-based practice.

As evidence-based practice (EBP) becomes prevalent in athletic training education, the barriers that Approved Clinical Instructors (ACIs) experience in implementing it with students need to be understood. To investigate barriers ACIs face when implementing EBP concepts in clinical practice and in teaching EBP to professional athletic training students and to investigate the educational emphases to improve the barriers. Qualitative study. Telephone interviews. Sixteen ACIs (11 men, 5 women; experience as an athletic trainer = 10 ± 4.7 years, experience as an ACI = 6.81 ± 3.9 years) were interviewed. We interviewed each participant by telephone. Interview data were analyzed and coded for common themes and subthemes regarding barriers and educational emphases. Themes were triangulated through multiple-analyst triangulation and interpretive verification. Barriers to EBP incorporation and educational emphasis placed on EBP were the main themes reported. Resources, personnel, and student characteristics were subthemes identified as barriers. Resource barriers included time, equipment, access to current literature, and knowledge. Coworkers, clinicians, and coaches who were unwilling to accept evidence regarding advancements in treatment were identified as personnel barriers. Programmatic improvement and communication improvement were subthemes of the educational emphasis placed on EBP theme. The ACIs reported the need for better integration between the clinical setting and the classroom and expressed the need for EBP to be integrated throughout the athletic training education program. Integration of the classroom and clinical experience is important in advancing ACIs' use of EBP with their students. Collaborative efforts within the clinical and academic program could help address the barriers ACIs face when implementing EBP. This collaboration could positively affect the ability of ACIs to implement EBP within their clinical practices.

Relationship Between Approved Clinical Instructors' Assessment of Athletic Training Student Clinical Performance and Their Clinical Grade

Context: Approved Clinical Instructors (ACIs) are integral to athletic training students' professional development. ACIs evaluate student clinical performance using assessment tools provided by educational programs. How ACI ratings of a student's clinical performance relate to their clinical grade remains unclear. Objective: To examine relationships between ACI evaluations of student clinical performance using an athletic training-specific inventory (Athletic Training Clinical Performance Inventory; ATCPI) and the student's clinical grade (CG) over a clinical experience. Design: Correlational. Setting: Large metropolitan university. Participants: 48 ACIs (M=20; F=28; Certified for 7.5+3.2yrs; ACIs for 3.2+1.5yrs) evaluating 62 undergraduate students (M=20; F=42). Interventions: ACIs completed the ATCPI twice (mid-semester, and end-of semester) during their student's clinical experience. The ATCPI is a 21-item instrument: Items 1–20 assess the student's clinical performance based on specific constructs (Specific) and item 21 is a rating of the student's overall clinical performance (Overall). ACIs also assigned students a clinical grade (CG). Pearson product-moment correlations examined relationships between Specific, Overall, and CG, with separate paired t-tests examining differences (p<.05). Main Outcome Measures: The ATCPI used a 4-point Likert-type scale anchored by 1 (Rarely) and 4 (Consistently), and CG (A=4, B=3, C=2 D =1, 0=F). Results: Two-hundred and sixty-six ATCPI instruments were completed over 4 academic years. The ATCPI demonstrated acceptable reliability (Cronbach's alpha=.88). All three measures were positively correlated (Specific and Overall, r(264)=.65, P <.001; Specific and CG r(264)=.63, P <.001; Overall and CG r(264)=.55, P<.001). No differences existed between Specific (3.5±0.4) and CG (3.5±0.7; t=.60, P =.55). However, Overall (3.6±0.7) was significantly higher than both Specific (t=−3.45, P<.000) and CG (t=2.05, P =.04). Conclusions: ACIs reliably assessed students' specific clinical performance and provided a relatively accurate grade. However, since the overall scores were higher than specific item scores, ACIs overestimated students' overall clinical performance. Additional research is necessary to examine the ATCPI as an assessment tool across multiple institutions and to determine how other variables affect ACI assessments of student performance.

Approved clinical instructors' perspectives on implementation strategies in evidence-based practice for athletic training students.

Understanding implementation strategies of Approved Clinical Instructors (ACIs) who use evidence-based practice (EBP) in clinical instruction will help promote the use of EBP in clinical practice. To examine the perspectives and experiences of ACIs using EBP concepts in undergraduate athletic training education programs to determine the importance of using these concepts in clinical practice, clinical EBP implementation strategies for students, and challenges of implementing EBP into clinical practice while mentoring and teaching their students. Qualitative study. Telephone interviews. Sixteen ACIs (11 men, 5 women; experience as a certified athletic trainer = 10 ± 4.7 years, experience as an ACI = 6.8 ± 3.9 years) were interviewed. We interviewed each participant by telephone. Interview transcripts were analyzed and coded for common themes and subthemes regarding implementation strategies. Established themes were triangulated through peer review and member checking to verify the data. The ACIs identified EBP implementation as important for validation of the profession, changing paradigm shift, improving patient care, and improving student educational experiences. They promoted 3 methods of implementing EBP concepts with their students: self-discovery, promoting critical thinking, and sharing information. They assisted students with the steps of EBP and often faced challenges in implementation of the first 3 steps of EBP: defining a clinical question, literature searching, and literature appraisal. Finally, ACIs indicated that modeling the behavior of making clinical decisions based on evidence was the best way to encourage students to continue using EBP. Athletic training education program directors should encourage and recommend specific techniques for EBP implementation in the clinical setting. The ACIs believed that role modeling is a strategy that can be used to promote the use of EBP with students. Training of ACIs should include methods by which to address the steps of the EBP process while still promoting critical thinking.

Provision of Feedback to Students, Part 2: Use of Clinical Encounter Cards

Feedback is an important aspect of athletic training clinical education. Feedback provides information to athletic training students about their clinical skill performances to correct and gUide future behavior. 1 Without feedback. a student often lacks accurate understanding of his or her clinical competence. 1 Effective feedback should provide specifIc, immediate information, and should actively engage the student. 1 Clinical Encounter Cards (CECs) can help an ACI (Approved Clinical Instructor) provide effective feedback to students, The purpose of Part 2 of this report is to describe CECs and to provide examples of their use in athletic training clinical education.

Provision of Feedback to Students, Part 1: Overview of Strategies

The relationship between an Approved Clinical Instructor (ACI) and athletic training students creates a unique instructional interaction, A low instructor-to-student ratio allows an ACI to regularly provide feedback to students about the status of their clinical skills. This feedback of student performance, whether it is confirming. correcting. or providing suggestions for change, can be given in many ways, such as written notes, verbal comments, or nonverbal communication (e.g., a nod of the head). 1,2 An additional way to provide feedback is with the use of Clinical Encounter Cards (CECs), CECs are small (i.e., the size of an index card), user-friendly feedback cards that provide a way for instructors to give valuable and efficient information to students about their clinical performances. 3 Part 1 of this two-part report addresses effective feedback, types of feedback. and how feedback is used in clinical education. Part 2 will provide examples of CECs and discuss ways in which they can be used in athletic training clinical education.

Career Decisions of Senior Athletic Training Students and Recent Graduates of Accredited Athletic Training Education Programs

Context: Athletic training students and graduates are faced with many factors that direct them into or away from the athletic training profession as a final career choice. Objective: The purpose of the study was to determine the career decisions made by athletic training students following graduation from an accredited professional athletic training edcuation program (ATEP) and what work-related and ATEP program factors influenced their career decisions. Design: A 42-question self-reporting web-based survey was used. Setting: CAATE/CAAHEP-accredited ATEP programs. Participants: Seventeen hundred and ninety-two seniors and recent graduates of CAATE/CAAHEP-accredited programs from May 2005 through June 2007. Outcome Measures: Descriptive statistics were utilized to obtain frequency counts of the participants' responses. Results: The majority of the participants (82.4%) chose to pursue a career as an athletic trainer (AT), while the remainder (17.6%), indicated they did not seek employment as an AT. The college/university setting was the most frequently selected by those employed (45.6%) and those seeking employment (35.6%) as an AT. All 8 ATEP factors (clinical experience hours, clinical experience variety, roles/functions of a clinical instructor [CI] or approved clinical instructor [ACI], preparation to enter the field, level of confidence, CI or ACI attitude toward work setting, CI or ACI demonstration of professionalism, and encouragement from faculty, CI or ACI) were found to be influential in the participants' decisions to pursue a career as an AT. Salary, number of work hours per week, found another profession more interesting, and uncertain or changing work schedule were the most influential factors reported for choosing to not pursue a career as an AT. Conclusions: The decision to pursue a career as an AT is influenced by ATEP faculty, ACIs, and CIs.

Perceived Preparedness of Graduate Assistant Approved Clinical Instructors for Supervision of Athletic Training Students in Professional Programs

Context: Approved clinical instructors (ACIs) are crucial for the development of athletic training students. Graduate students often serve as ACIs and usually do not have extensive clinical experience, and therefore may not feel adequately prepared to supervise students. Objectives: 1) To determine the perceived preparedness of graduate assistant ACIs in the supervision of athletic training students in professional programs; 2) To determine perceptions of ACI training. Design: Prospective, exploratory. Setting: Programs that have been accredited by the Commission on Accreditation of Athletic Training Education (CAATE) for five years or more. Participants: Thirty-three out of 140 graduate assistant ACIs (23.5% response rate) at 27 athletic training programs. Instrumentation: A 47-item Graduate Assistant ACI Perceived Preparedness online questionnaire. Data Analysis: Frequencies and percentages were used to describe the responses for questionnaire items; an ANOVA was used to examine self-assessment ratings among participant groups. Results: Participants felt prepared in learning styles (79%), ACI responsibilities (100%), evaluation and feedback of student performance (79%). They felt most prepared to evaluate and provide feedback in students' clinical skills and least prepared in evaluating and providing feedback for professional behaviors. The greatest challenges faced by participants included time constraints (69.7%), controlling the learning environment (57.6%), and understanding institutional policies and procedures related to clinical education (39.4%). When asked to self-assess their first-year performance supervising students on a scale of 0 (worst performance) to 10 (best performance), the mean [SD] score reported was 6.97 [1.2]. There were no differences in first-year self-assessment performance ratings between participants who thought ACI training was adequate and/or beneficial and those who did not (P=0.05). Conclusion: Most of the participants felt prepared to be an ACI as a graduate assistant and believed the ACI training to be adequate and beneficial. There were no differences in self-reported first-year performance ratings between participants who believed their training to be adequate and beneficial and those who did not.

Perceptions of Participants Involved in Peer Assisted Learning in a Professional Athletic Training Education Program

Objective: The objective of this study was to examine the perceptions, values, and experiences of individuals involved in peer assisted learning (PAL) in the clinical setting of an athletic training education program. Design and Setting: A qualitative research approach borrowing from grounded theory was used. Subjects: 15 participants, consisting of 9 athletic training students (ATS) and 6 Approved Clinical Instructors (ACIs), participated in this study. Measurements: Semi-structured interviews were recorded and transcribed verbatim for analysis. The interview data was analyzed inductively, borrowing from the grounded theory approach, utilizing both open and axial coding. Furthermore, a peer review, member checks by the participants, and the use of multiple data sources were used to establish trustworthiness. Results: Six main themes emerged from the analysis: 1) Defining PAL; 2) Role recognition; 3) Preference for active informal learning; 4) Value of PAL; 5) Peer Limitations; and 6) Recommendations related to PAL. Conclusions: Overall, this study provides an in-depth understanding of athletic training students' and ACIs' perceptions of PAL, and supports the conclusion that athletic training students in this program prefer to experience active and informal educational exchanges that occur naturally in the clinical setting rather than more formal learning experiences. These results suggest that PAL is beneficial and worthwhile.

Athletic Training Approved Clinical Instructors' Reports of Real-Time Opportunities for Evaluating Clinical Proficiencies

Appropriate methods for evaluating clinical proficiencies are essential to ensuring entry-level competence in athletic training. To identify the methods Approved Clinical Instructors (ACIs) use to evaluate student performance of clinical proficiencies. Cross-sectional design. Public and private institutions in National Athletic Trainers' Association (NATA) District 4. Approved Clinical Instructors from accredited athletic training education programs in the Great Lakes Athletic Trainers' Association, which is NATA District 4 (N = 135). Participants completed a previously validated survey instrument, Methods of Clinical Proficiency Evaluation in Athletic Training, that consisted of 15 items, including demographic characteristics of the respondents and Likert-scale items (1 = strongly disagree to 5 = strongly agree) regarding methods of clinical proficiency evaluation, barriers, educational content areas, and clinical experience settings. We used analyses of variance and 2-tailed, independent-samples t tests to assess differences among ACI demographic characteristics and the methods, barriers, educational content areas, settings, and opportunities for feedback regarding clinical proficiency evaluation. Qualitative analysis of respondents' comments was completed. The ACIs (n = 106 of 133 respondents, 79.7%) most often used simulations to evaluate clinical proficiencies. Only 59 (55.1%) of the 107 ACIs responding to a follow-up question reported that they feel students engage in a sufficient number of real-time evaluations to prepare them for entry-level practice. An independent-samples t test revealed that no particular clinical experience setting provided more opportunities than another for real-time evaluations (t(119) range, -0.909 to 1.796, P > or = .05). The occurrence of injuries not coinciding with the clinical proficiency evaluation timetable (4.00 + or - 0.832) was a barrier to real-time evaluations. Respondents' comments indicated much interest in opportunities and barriers regarding real-time clinical proficiency evaluations. Most clinical proficiencies are evaluated via simulations. The ACIs should maximize real-time situations to evaluate students' clinical proficiencies whenever feasible. Athletic training education program administrators should develop alternative methods of clinical proficiency evaluations.

Using a Wiki for Approved Clinical Instructor Training

Using a Wiki for Approved Clinical Instructor Training

Situational Supervision for Athletic Training Clinical Education

Introduction: The medical education model provides the basis for athletic training students to learn theoretical and practical skills. Clinical rotations are completed where they apply what they have learned under the direct supervision of a clinical instructor (CI) or approved clinical instructor (ACI). Approved clinical instructors are taught how to evaluate athletic training students' clinical skills and proficiencies, yet are left to decide for themselves how students should be supervised. No formal supervision training is required for potential CIs/ACIs. Situational Supervision is one potential model that can be used by athletic training educators to provide guidance to CIs/ACIs regarding student supervision. This model provides a method for students to be supervised according to their knowledge base, experience and self-confidence. Objective: To present the Situational Supervision Model that can be used to develop athletic training students' clinical skills. Background: Based on Blanchard and Hersey's Situational Leadership, Situational Supervision provides CIs/ACIs with one supervision model that can be used in athletic training clinical education. Description: As students become more comfortable with clinical skills and mature in motivation and competence, CIs/ACIs need to adapt supervision styles to match the students' progressing development. Clinical Advantages: Using situational supervision, clinical instruction becomes a cooperative interaction between CIs/ACIs and athletic training students that is dependent on the students' needs and abilities, which may result in higher satisfaction and production for both the students and the CIs/ACIs.

Using a Web-Based Database to Record and Monitor Athletic Training Students' Clinical Experiences

Objective: The purpose of this article is to introduce a documentation recording system employing the Microsoft Structured Query Language (MS-SQL) database used by the Athletic Training Education Program (ATEP) for recording and monitoring of athletic training student (ATS) clinical experiences and hours. Background: Monitoring ATSs clinical experiences and hours can be a monumental task for an athletic training education program director (PD). This article seeks to explain and demonstrate how a web-based database is incorporated into an athletic training education program to manage the ATSs clinical experiences. To date, a thorough review of the literature did not reveal any published documentation of a web-based database being used for monitoring ATSs clinical experiences. In our ATEP, prior documentation of the ATSs clinical experiences consisted of a paper-based system which involved the ATS writing down their clinical hours and having their assigned approved clinical instructor (ACI) or clinical instructors (CI) verify them. After reviewing other software application programs (i.e., Microsoft Excel and Microsoft Access), it was determined that these programs did not provide the flexibility needed for a program-wide database. Therefore, time management and evaluation accessibility constraints played a pivotal role in the decision to move to a web-based database.

Role Strain in Collegiate Athletic Training Approved Clinical Instructors

Certified athletic trainers who serve as Approved Clinical Instructors (ACIs) in the collegiate setting are balancing various roles (eg, patient care and related administrative tasks, clinical education). Whether this balancing act is associated with role strain in athletic trainers has not been examined. To examine the degree of, and contributing factors (eg, socialization experiences, professional and employment demographics, job congruency) to, role strain in collegiate ACIs. Cross-sectional survey design. Geographically stratified random sample of ACIs affiliated with accredited athletic training education programs at National Collegiate Athletic Association (NCAA) Division I, II, and III institutions. 118 collegiate ACIs (47 head athletic trainers, 45 assistant athletic trainers, 26 graduate assistant athletic trainers). The Athletic Training ACI Role Strain Inventory, which measures total degree of role strain, 7 subscales of role strain, socialization experiences, professional and employment characteristics, and congruency in job responsibilities. A total of 49% (n = 58) of the participants experienced a moderate to high degree of role strain. Role Overload was the highest contributing subscale to total role strain. No differences were noted between total role strain and role occupant groups, NCAA division, or sex. Graduate assistant athletic trainers experienced a greater degree of role incompetence than head athletic trainers did (P = .001). Division II ACIs reported a greater degree of inter-role conflict than those in Division I (P = .02). Female ACIs reported a greater degree of role incompetence than male ACIs (P = .01). Those ACIs who stated that the ACI training provided by their institution did not adequately prepare them for the role as an ACI experienced greater role strain (P < .001). The ACIs in the collegiate setting are experiencing role strain in balancing their roles as health care providers, clinical educators, and administrators. Methods to reduce role strain need to be considered.

Questioning Skills Demonstrated by Approved Clinical Instructors During Clinical Field Experiences

The current trend in athletic training clinical education places greater emphasis on the quality of interactions occurring between Approved Clinical Instructors (ACIs) and athletic training students (ATSs). Among other attributes, the ability of ACIs to facilitate and direct quality clinical learning experiences may be influenced by the skill with which the ACI is able to use selected teaching strategies. To gain insight into ACIs' use of questioning as a specific teaching strategy during the clinical education experiences of undergraduate ATSs. Qualitative case study design involving initial and stimulated-recall interviews, prolonged field observations, and audio recording of ACI-ATS interactions. The primary athletic training facility at one athletic training education program accredited by the Commission on Accreditation of Athletic Training Education. The 8 ACI participants included 3 full-time athletic training education program faculty members and 5 graduate-level assistants. The 24 ATS participants included 1 senior, 17 juniors, and 6 sophomores. Transcribed data collected from 8 initial interviews, 23 field observations, 23 audio-recorded ACI-ATS interactions and 54 stimulated-recall interviews were analyzed through microscopic, open, and axial coding, as well as coding for process. The cognition level of questions posed by ACIs was analyzed according to Sellappah and colleagues' Question Classification Framework. The ACI participants posed 712 questions during the 23 observation periods. Of the total questions, 70.37% were classified as low-level cognitive questions and 17.00% as high-level cognitive questions. The remaining 12.64% were classified as other. Although all ACIs used questioning during clinical instruction, 2 distinct questioning patterns were identified: strategic questioning and nonstrategic questioning. The way ACIs sequenced questions (their questioning pattern) appeared to be more important than the number of specific cognitive-level questions posed. Nonstrategic questioning appears to support knowledge and comprehension, whereas strategic questioning appears to support critical thinking.

Learning Professionalism in Athletic Training Education

Objective: Student learning of professionalism in athletic training education programs (ATEPs) can be varied and even elusive. The purpose of this article is to define professionalism and discuss its development in athletic training students. Background: Medical professions have studied extensively how students learn professionalism. However, with some studies reporting up to 90 different associated characteristics, no set definition of professionalism has been adopted. Students may learn professional behaviors in the classroom and the clinic. Research in medical education reports that a majority of this learning occurs in the clinical environment. Description: There are numerous ways to promote the learning of professionalism in athletic training students. After engaging each student personally in this pursuit, techniques such as communicating the mission and code of ethics of the National Athletic Trainers ' Association (NATA), clearly stating expectations the ATEP holds of students ' professional behavior, providing a variety of learning opportunities in different clinical settings, carefully selecting approved clinical instructors (ACIs), and using self-assessment and reflection are a few of the techniques recommended. The importance of the role of ACIs in the development of professional behaviors in athletic training students is stressed. Advantages: Without purposefully including the learning of professionalism in ATEP curriculums (the classroom and clinical experiences), students are at risk of not being prepared to represent and promote athletic training at the highest levels within the allied health professions.

Being an Effective Athletic Training Clinical Instructor

The responsibility to provide high-quality clinical instruction in athletic training professional preparation programs is increasing dramatically. Certainly, clinical education is a critical component of all allied medical-education programs; and athletic training is no exception. To succeed in the role of clinical instructor (CI) requires considerable attention to teaching that might not have been included in the CI's professional education. It is not uncommon to find that allied medical CIs do not have formal preparation in education and have been selected because of their professional skills rather than their teaching abilities (Jarski, Kulig, & Olson, 1990). Although expertise as a clinician is important, it does not guarantee expertise as a CL In addition, to succeed as a CI requires balancing clinical teaching and patient care. This is undoubtedly a complex task. In this article we identify the characteristics, qualities, and skills presented in the allied-medical-professions literature that are pertinent to developing effective CIs (see the sidebar). The information presented will be useful for athletic training approved clinical instructors (ACIs) and CIs, in general. The abbreviation CI will be used to represent both ACIs and CIs in this article.