Athletic Training Clinical Education Research Articles

Preceptor Training: Evaluation of an On-line Educational Module to Improve Preceptor Feedback

Purpose: Effective feedback delivery is critical to behavior modification and skill improvement in novice learners and athletic training programs often use annual training to teach preceptors to develop feedback skills. The purpose of this research project was to evaluate the effectiveness of an on-line asynchronous educational module for improving feedback delivery. Method: We used a single cohort, repeated measures design (pre, post, post-post) and an eAuthoring tool (Softchalk©) and online assessments (Qualtrics® Provo, UT) to evaluate the educational module. Preceptors (n=351) from 17 post-baccalaureate programs began the study; 48 completed all 3 assessments. We delivered a content validated lesson and assessments using various learning theories including video demonstrations with paired reflections. The desired outcome was to enhance the knowledge of effective feedback characteristics to be used in practice. The pre-test assessed self-reported feedback behaviors on a Likert Scale and knowledge (score=25). The immediate post-test reassessed feedback knowledge. At least 8 weeks following completion of the module, participants were asked to reassess feedback delivery behaviors. Throughout the process, participants provided a definition of “effective feedback” scored on 7 key criteria for effective feedback delivery. Descriptive statistics and paired t-tests were used to analyze the data and significance was set at Pa-priori. Results: Significant improvements (P-3.298 P=.001, Cohen’s d=.889). There were no other significant differences between pre-test and follow-up behaviors (P>.05), as participants generally agreed they performed effective feedback behaviors (mode=4) at both time points. Conclusions: Behaviors regarding effective feedback were not changed over the long-term, which may have been a result of the method of performance feedback. Preceptor training is both a requirement and a need in effective athletic training clinical education. Future research should aim to identify mechanisms to improve preceptor feedback and confirm preceptor perceptions through student evaluations.

The Experiences of Professional Master's Athletic Training Students with Sexual Harassment During Clinical Education

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.

Understanding Athletic Trainers' Knowledge, Intervention, and Barriers Toward Arthrogenic Muscle Inhibition.

Arthrogenic muscle inhibition (AMI) is a common neurophysiological response to joint injury. While athletic trainers (ATs) are constantly treating patients with AMI, it is unclear how clinicians are using the available evidence to treat the condition. To investigate ATs' general knowledge, clinical practice, and barriers for treating AMI. A cross-sectional web-based survey was utilized. The survey was distributed to a random sample of 3000 ATs from the National Athletic Trainers' Association and through social media. 143 board certified ATs (age: 34.6 [10.3]y; experience: 11.7 [9.8]y) from various clinical settings and educational backgrounds were included in the analysis. One hundred one respondents were able to correctly identify the definition of AMI. The majority of these respondents correctly reported that joint effusion (n = 95, 94.1%) and abnormal activity from joint receptors (n = 91, 90.1%) resulted in AMI. Of the 101 respondents, only 58 (57.4%) reported using disinhibitory interventions to treat AMI. The most frequently used evidence supported interventions were transcutaneous electrical nerve stimulation (n = 38, 65.5%), neuromuscular electrical stimulation (n = 33, 56.9%), and focal joint cooling (n = 25, 43.1%). The interventions used correctly most often based on current evidence were neuromuscular electrical stimulation (n = 29/33, 87.9%) and transcutaneous electrical nerve stimulation (n = 26/38, 68.4%). Overall, difficulty quantifying AMI (n = 62, 61.24%) and lack of education (n = 71, 76.2%) were most frequently perceived as barriers. Respondents that did not use disinhibitory interventions perceived lack of experience treating AMI, understanding the terminology, and access to therapeutic modalities more often than the respondents that reported using disinhibitory interventions. Further education about concepts and treatment about AMI is warranted for ATs. Continued understanding of ATs' clinical practice in regard to AMI may help identify gaps in athletic training clinical education.

Critical Assessment and Reflection on Experience Form: A Novel Approach to Clinical Assessment

Context There is a clear need for quality improvement in health care. The 2020 Commission on Accreditation of Athletic Training Education Standards for Professional Athletic Training Programs require students to apply concepts of quality improvement to provide athletic training care and deliver excellent patient outcomes. As such, programs may be looking for strategies to view students' clinical experiences through a lens of quality improvement. Objective To introduce the Critical Assessment and Reflection on Experience (CARE) form, which is a novel clinical education tool that assesses student clinical skills using critical reflection and quality improvement concepts. Background Historically, students have demonstrated achievement by comparing their skill performance with a competency checklist. Typically, the skills assessed, and the level of achievement expected progress to allow learning over time. However, current athletic training clinical education literature has shifted to promote experiential learning, critical thinking, and active reflection to develop competence. Description Students complete the CARE form after patient encounters or other clinical experiences. The form requires students to practice documentation and communication skills, but also to critically reflect on performance by applying quality improvement, patient safety, and evidence-based practice concepts. Clinical Advantage(s) The form holds advantages for multiple stakeholders, including students, preceptors, and program administrators. The CARE form encourages students to engage in authentic patient interactions rather than relying on contrived learning experiences. By encouraging live patient encounters, this tool results in less burden on preceptors to create additional opportunities for students. Program administrators can use the tool to incorporate quality improvement standards meaningfully into the curriculum. Additionally, the CARE form creates opportunity to document program assessment. Conclusion(s) Professional programs should consider implementing the CARE form as a clinical experience assessment tool to develop students' quality improvement and critical thinking skills when providing athletic training services.

Self-Confidence and Perceptions of Athletic Training Students Following Simulated Experiences: A Mixed-Methods Pilot Study

Purpose: Athletic training clinical education provides students with a variety of real-life patient encounters under the supervision of a credentialed athletic trainer. However, clinical education experiences may not allow for all students to practice more invasive or less common skills such as rectal thermometry. The purpose of this study was two-fold: 1) determine the effect of a series of low to high-fidelity simulated rectal thermometry experiences on athletic training students’ self-confidence scores; and 2) through a phenomenological qualitative approach, explore athletic training students’ perceptions following the simulated rectal thermometry experiences. Method: This study used a quasi-experimental, mixed methods, one-group repeated measures design. Participants were nine first year professional Master of Athletic Training students who completed four simulated experiences on the skill of rectal thermometry. The outcome measures were The Athletic Trainer’s Self-Confidence Scale (ATSCS) and qualitative semi-structured open-ended interviews. Results: Friedman’s ANOVA revealed a statistically significant improvement from the participant’s baseline ATSCS scores to the last post-test scores. We identified three major themes following qualitative interviews: 1) Perception changes before and after participation; 2) Benefits of a series of four simulations; 3) Explanations for the improvements in confidence and competence. Conclusions: A series of simulated learning activities using high-fidelity and standardized patient interactions can help improve athletic training students’ self-confidence. Though future research is needed, athletic training education programs should consider implementing simulated experiences to equip athletic training students to transition to practice.

Perceived Challenges of Clinical Immersion in Professional Master's Programs: A Report from the Athletic Training Clinical Education Network

Context A clinical immersive experience is a new requirement within the clinical education standards as outlined by the Commission on Accreditation of Athletic Training Education. Objective Determine athletic training program administrators' perceptions of challenges facing athletic training programs as they implement immersive clinical experiences during clinical education. Design Sequential mixed methods. Setting Commission on Accreditation of Athletic Training Education athletic training programs. Patients or Other Participants Twenty-four administrators (7 male, 17 female) from 24 institutions with undergraduate and professional master's programs (1 undergraduate, 12 professional master's, and 4 offering both undergraduate and master's programs) responded to the survey, which was Phase 1 of the study. Seventeen of those who previously completed the Phase 1 survey volunteered to participate in Phase 2 of one-on-one, semistructured phone interviews (4 clinical education coordinators, 12 program directors, 1 department chair). Data Collection Phase 1: 24 participants completed an online survey. Phase 2: 17 of the 24 respondents participated in a one-on-one, semistructured phone interview. Quantitative data collected in Phase 1 were analyzed by calculating means and frequencies, and in Phase 2, a general inductive approach was used to evaluate qualitative raw data from the interviews. Researcher triangulation and peer review were completed for credibility. Results The 3 subthemes that emerged specific to administrators' perceived challenges regarding immersive clinical experiences for students were (1) isolation, (2) financial burden, and (3) time engaged in learning. The 3 main subthemes that emerged specific to the administrators' perceived challenges regarding immersive clinical experience for programs were (1) lack of a definition of the experience, (2) scheduling, and (3) preceptor involvement. Conclusions Program administrators continue to seek clarity on when and how immersive clinical experiences should be implemented. These challenges, if not addressed, could influence buy-in from the faculty and preceptors, and affect the success of the student.

A Report from the Athletic Training Clinical Education Network on Scholarship Requirements in Professional Athletic Training Programs

Context Scholarship is a required element of the 2020 curricular content standards in professional athletic training education. Objective To explore the perceptions and experiences of implementing student scholarship within a professional program. Design Consensual qualitative research. Setting Individual phone interview. Patients or Other Participants Seventeen program directors of professional programs (professional bachelor's program = 12, 70.6%; professional master's program = 3, 17.6%; both = 2, 11.8%). Programs reported an average of 3 ± 1 core faculty (range, 1–5 faculty) supporting 37 ± 21 students (range, 3–96 students), with 3 ± 2 faculty (range, 1–8 faculty) involved in scholarship activities of their students. Data saturation guided the number of participants. Data Collection and Analysis Interviews occurred via phone using a semistructured interview guide. All interviews were audio-recorded and transcribed verbatim. Data were analyzed by a 3-person research team and coded into themes and categories based on a consensus process. Credibility was established by utilizing multiple researchers, an external auditor, and member checks. Results Two major themes emerged from the data: perceptions and mechanisms of scholarship. Student engagement in scholarship was perceived as valuable, but it was challenging to develop buy-in from students and preceptors. Participants felt that the term research carried a stigma, making it difficult to cultivate the value of scholarly clinical practice. When institutional culture embraced scholarship, participants indicated it was easier to integrate scholarly activities into the program. Participants reported students engaged in a variety of scholarly activities, including traditional research and evidence-based practice. Some scholarship experiences were singular, occurring once in the curriculum, while others were purposeful, sequenced, and integrated throughout the curriculum. Future scholarship endeavors included traditional theses and experimental research as well as practice-based, point-of-care research that might better integrate clinical practice and scholarship. Conclusions Participants perceived scholarship as important to professional preparation and required intentional action to integrate throughout the curriculum.

Lived Clinical Education Experiences of Professional Master’s Athletic Training Program Graduates

Purpose: Clinical education has been identified as a key aspect in the professional preparation of athletic trainers. The literature, however, has focused on clinical education at the undergraduate level rather than the graduate level, which is the future population of all CAATE-accredited athletic training programs. This study sought to describe the experiences of those who have completed athletic training clinical education at the master’s level, specifically focusing on the type of learning experiences they were granted and what influence the preceptor and the setting played in the overall experience. Method: This was a phenomenology study. Twelve graduates of CAATE-accredited professional master’s athletic training programs served as participants. All participants graduated after Spring 2014 and completed clinical education as a degree requirement. Three methods of data collection were utilized, including semi-structured interviews, prompted journaling and asynchronous online focus group discussion boards. Data was analyzed using a phenomenological reduction approach. Credibility of the data was confirmed with member checking, peer review and data triangulation. Results: Clinical education was determined to be a significant contributor to professional preparation of professional master’s athletic training students. Hands on-experiences, active preceptors and variety in clinical setting and opportunity were all cited as contributors to the success of clinical education. Participants described their experience as a significant commitment but valuable. Conclusions: Our findings suggest that clinical education should continue to be a requirement at the graduate level and that the clinical education curriculum should be designed to encourage hands-on learning and variety.

Advancement of Athletic Training Clinical Education Through Preceptor-Led Instructional Strategies

ContextAthletic training programs blend didactic experiences with clinical practice opportunities with varied patient populations. Traditionally, clinical education relies heavily on the preceptor to supervise, instruct, and mentor the professional athletic training student (P-ATS) during clinical education.ObjectiveTo describe a preceptor-led educational technique focused on creating meaningful clinical experiences that guide the P-ATS to self-reflect and improve clinical decision-making.BackgroundPreceptors are expected to create an effective learning environment at their clinical site that prepares the P-ATS for independent clinical practice, yet some authentic patient encounters and administrative tasks may not be possible because of the nature of the clinical site. By implementing novel clinical education techniques that mimic clinical practice, the P-ATS can engage in meaningful clinical experiences in a safe environment, which aids in professional readiness for independent clinical practice that address learner goals and deficiencies in areas with minimal opportunities for real-time encounters.DescriptionThe preceptor designed educational techniques to cultivate meaningful clinical experiences that included incognito standardized patient encounters, structured debriefing, and reflective journaling.Clinical AdvantagesA 3-fold benefit exists. First, the P-ATS engages in meaningful clinical experiences to enhance professional readiness for replication of independent clinical practice. Second, the P-ATS develops soft skills, such as metacognitive reflection and quality improvement strategies, after completing the debrief sessions and reflective journaling. Lastly, the preceptor shares contemporary expertise through designing and implementing instructional strategies that mentor the P-ATS through difficult conversations and unique patient presentations.ConclusionsImplementation of novel instructional strategies within clinical education demonstrates the ability for the P-ATS to engage in real-time clinical experiences in a safe environment and under the guidance of the preceptor.

Factors Affecting Student Persistence into Athletic Training Programs

Purpose: The purpose of this study was to examine the factors that contribute to student persistence and gauge prospective athletic training students' perceptions of experiences that contributed to their persistence. Method: The Athletic Training Student Persistence-Revised Survey was developed to gather data about program attributes, social, academic, clinical integration, and program commitment. Institutional demographics, program demographics, and program attributes were collected during interviews. Surveys were administered online through SurveyMonkey. Survey data were returned anonymously by designated contact persons (Athletic Training Program Directors or Clinical Education Coordinators) for all freshmen prospective athletic training students enrolled in the athletic training introductory course/s. Descriptive statistics and non-parametric differences and correlations were calculated. The inductive process was used in coding open-ended data. Results: The Mann Whitney U test and Spearman Rho analysis demonstrated significant results. Program attributes along with clinical integration had the weakest correlations (r = -0.36 and r = -0.32, respectively), while academic integration and program commitment had the strongest (r = -0.58 and r = -0.76, respectively). No predictive variables were found. Qualitatively, persisters and non-persisters managed the pre-application period differently. Additionally, the rapport between athletes and athletic trainers serving as preceptors, the relationships between prospective athletic training students and extant athletic training students, and the mentorship displayed by athletic training students were all contributors to persistence. Conclusions: Communication between the athletic training program director and prospective athletic training students is vital, but the core of the study revealed that what transpires during clinical observation hours, within the introductory course/s, between athletic trainers and athletes, and between athletic training students/preceptors and prospective athletic training students are of even greater importance. The findings demonstrated that decisions to persist are the result of all parties and components associated with the athletic training program, not just one.

Athletic Training Student Active Learning Time With and Without the Use of Bug-in-Ear Technology

Context: Clinical education experiences that actively engage students in patient care are important to the development of competent clinicians. It is important to assess athletic training students' time spent clinically and explore new technology that may facilitate more active learning during clinical education. Objective: To assess athletic training students' active learning time with and without the use of bug-in-ear technology. Design: Cross-sectional. Setting: High school, rehabilitation clinic, and college/university clinical sites affiliated with 3 Commission on Accreditation of Athletic Training Education–accredited undergraduate athletic training programs. Patients or Other Participants: Thirteen athletic training students (11 females, 2 males; 22.0 ± 1.8 years old, 1.8 ± 0.9 years enrolled in the current athletic training program) and 8 preceptors (5 females, 3 males; 35.4 ± 10.4 years old, 3.5 ± 2.9 years of experience as a preceptor) volunteered for this study. Intervention(s): The principal investigator observed preceptor-student interactions on 2 control days and 2 days using bug-in-ear technology. Participants and the principal investigator assessed students' active learning time at each observation period using the Athletic Training Clinical Education Time Framework. Main Outcome Measure(s): Minutes spent on instructional, clinical, managerial, engaged waiting, and down time as recorded on the Athletic Training Clinical Education Time Framework. Parametric (analysis of variance) and nonparametric (Wilcoxon signed-rank and Kruskal-Wallis) tests compared the perceived amount of time spent in each category between technologies and roles. Results: Bug-in-ear technology resulted in less time on managerial tasks (8.2% ± 5.1% versus 14.6% ± 9.8%; P < .01) and instruction (10.7% versus 12.7%, P < .01). The researcher observed significantly more unengaged waiting time than both the students and preceptors (both P < .01) perceived. Conclusions: Bug-in-ear technology may decrease managerial time and spoken instruction during clinical experiences. Preceptors and students significantly underestimate the amount of unengaged time spent during clinical education, which is of concern. Athletic training programs may also benefit from assessing and improving students' time spent actively learning during clinical education.

The Role and Load of the Athletic Training Clinical Education Coordinator

Context: The position of clinical education coordinator has been identified as a required one in athletic training education. However, the literature has yet to address the job responsibilities of clinical education coordinators and the commensurate work load/release time needed to accomplish these responsibilities in athletic training education. Objective: To determine the current practices of clinical education coordinators in athletic training program, their current load compensation, whether or not they feel their load compensation is appropriate, and what their ideal load compensation should be. Design: Mixed methods. Setting: Commission on Accreditation of Athletic Training Education–accredited education programs. Patients or Other Participants: A total of 120 clinical education coordinators. Main Outcome Measure(s): A survey was administered including both quantitative and qualitative questions. Quantitative data were analyzed statistically and qualitative data were analyzed using an inductive approach, revealing themes. Results: Statistically significant differences were found when comparing tenure with clinical track in the areas of scholarship and athletic training room coverage. Common job responsibilities for the clinical education coordinator were identified. The study also identified the current and perceived ideal load/release credit for clinical education coordinators based on their program size. Conclusions: Clinical education coordinators are incredibly valuable to all athletic training education programs. This study attempted to solidify their value through identifying job responsibilities and load credit criteria to ensure quality clinical education experiences for students.

Reciprocal Learning Among Preceptors and Athletic Training Students During Clinical Education, Part II: Facilitators and Barriers

Context:Reciprocal learning appears to be occurring in athletic training clinical education. Students and preceptors can learn from one another, particularly if both parties are open to learning from each other.Objective:Examine facilitators and barriers to reciprocal learning in the athletic training clinical education setting.Design:Exploratory qualitative study.Setting:Athletic training programs.Patients or Other Participants:Our recruitment, which was based upon data redundancy, included 10 preceptors and 10 athletic training students. The preceptors had an average of 5 ± 3.5 years of experience supervising students. The athletic training student sample consisted of 8 seniors and 2 juniors.Main Outcome Measures:Participants responded to a series of questions by journaling their thoughts and opinions. Data were collected and stored on QuestionPro, a secure website. Data were analyzed by a general inductive approach. Credibility was established by (1) researcher triangulation, (2) peer review, and (3) member checks.Results:The relationship between the preceptor and the student along with reception to reciprocal learning emerged as facilitators, while a lack of confidence on the students’ behalf and time constraints can limit chances for reciprocal learning.Conclusions:Reciprocal learning has been identified as being mutually beneficial to the student and preceptor. Our findings highlight that for this type of learning to be successful, there has to be a communal interest in learning and that the use of current clinical cases and students’ current coursework provide benchmarks for discussion and learning.

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.

Feedback in Clinical Education, Part I: Characteristics of Feedback Provided by Approved Clinical Instructors

Providing students with feedback is an important component of athletic training clinical education; however, little information is known about the feedback that Approved Clinical Instructors (ACIs; now known as preceptors) currently provide to athletic training students (ATSs). To characterize the feedback provided by ACIs to ATSs during clinical education experiences. Qualitative study. One National Collegiate Athletic Association Division I athletic training facility and 1 outpatient rehabilitation clinic that were clinical sites for 1 entry-level master's degree program accredited by the Commission on Accreditation of Athletic Training Education. A total of 4 ACIs with various experience levels and 4 second-year ATSs. Extensive field observations were audio recorded, transcribed, and integrated with field notes for analysis. The constant comparative approach of open, axial, and selective coding was used to inductively analyze data and develop codes and categories. Member checking, triangulation, and peer debriefing were used to promote trustworthiness of the study. The ACIs gave 88 feedback statements in 45 hours and 10 minutes of observation. Characteristics of feedback categories included purpose, timing, specificity, content, form, and privacy. Feedback that ACIs provided included several components that made each feedback exchange unique. The ACIs in our study provided feedback that is supported by the literature, suggesting that ACIs are using current recommendations for providing feedback. Feedback needs to be investigated across multiple athletic training education programs to gain more understanding of certain areas of feedback, including frequency, privacy, and form.

Clinical Preceptors' Perspectives on Clinical Education in Post-Professional Athletic Training Education Programs

Context: Clinical education is the interaction between a clinical preceptor and student within the clinical setting to help the student progress as a clinician. Post-professional athletic training clinical education is especially important to improve these students' clinical knowledge and skills. However, little research has been conducted to assess the pedagogical principles for clinical education at this level or what factors are necessary to enhance the clinical skills and decision-making abilities of post-professional students. Therefore, exploring the perspectives of clinical preceptors involved in post-professional education will help educators understand what strategies are necessary to improve post-professional athletic training education programs (PPATEPs). Objective: To qualitatively investigate clinical preceptors' perspectives and experiences regarding clinical education within PPATEPs. Design: Consensual qualitative research (CQR) with an emergent design. Setting: Telephone interviews were conducted with all participants. Patients or Other Participants: Eleven collegiate post-professional clinical preceptors (7 males, 4 females; average age = 38±7.3 years; average years as an athletic trainer = 15±6.6 years) who were affiliated with a PPATEP were interviewed, representing 11 out of 16 PPATEPs. Data Collection and Analysis: Interview transcripts were coded for themes and categories. Triangulation included a consensus process by the research team and member checking to verify the data. Results: Data analysis yielded four themes relating to clinical education in PPATEPs: importance of clinical education, clinical preceptor responsibilities, clinical preceptor qualities, and barriers to clinical education. Participants indicated that clinical education was important for students to develop clinical skills and give them opportunities to make patient care decisions, and that several fundamental responsibilities and qualities contribute to being an effective clinical preceptor at the post-professional level. Conclusions: Post-professional clinical preceptors recognized that an appropriate balance between autonomy and guided practice in clinical experiences fostered an effective learning environment which allowed post-professional students to improve their clinical and decision-making skills beyond their entry-level skill set. Preceptors should also demonstrate attributes of a clinician, educator, and communicator to be an effective mentor.

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.

Clinical Instructors' and Athletic Training Students' Perceptions of Teachable Moments in an Athletic Training Clinical Education Setting

For some time, educators have advised clinical instructors (CIs) to capture the elusive teachable moment in clinical education. However, a universal definition of a teachable moment does not exist. Without a clear understanding of this concept, CIs and athletic training students (ATSs) may have difficulty facilitating the teachable moment. To recognize and define a teachable moment as it relates to the athletic training clinical education setting and to identify potential barriers to creating the teachable moment. Mixed-methods design employing grounded theory and quantitative analysis. Collegiate sports medicine clinic affiliated with a Commission on Accreditation of Allied Health Education Programs-accredited athletic training education program. 11 CIs (6 men, 5 women) and 11 ATSs (3 men, 8 women). Participants completed a teachable moment questionnaire to define and identify teachable moments. Follow-up semistructured interviews were conducted after data collection. A qualitative analysis was conducted on responses using open, axial, and selective coding. Member checking was conducted to establish trustworthiness. Qualitative data were quantified to descriptively report the findings. Engaged clinical experiences were the overarching theme. Three major themes that defined a teachable moment emerged: (1) professional discourse about skills, techniques, research, and special cases; (2) authentic experience or actual hands-on experience; and (3) skill development or time for skill instruction, practice, role playing, and simulations. Participants reported 158 teachable moments (CIs = 75, ATSs = 83). Lack of time and other duties were examples of barriers hindering the teachable moment. The teachable moment occurs when a CI and an ATS actively participate and interact with each other to enhance learning and foster intellectual curiosity in the clinical education environment. An underlying barrier to the teachable moment is perceived to be the CI's day-to-day responsibilities.

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.