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

CONTEXT: Athletic trainers (ATs) have reported the need for more educational resources about clinical documentation. OBJECTIVE: To investigate the effectiveness of passive and active educational interventions to improve practicing ATs' clinical documentation knowledge. DESIGN: Randomized control trial, sequential explanatory mixed methods study. SETTING: Online module(s), knowledge assessment and interviews. PATIENTS OR OTHER PARTICIPANTS: 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. MAIN OUTCOME MEASURE(S): 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. RESULTS: 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. CONCLUSIONS: 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.

Athletic Trainers' Perceptions of and Experiences with Professional Development Approaches for Enhancing Clinical Documentation.

CONTEXT: Little is known about how athletic trainers (ATs) learn clinical documentation, but previous studies have identified that ATs desire a need for more educational resources specific to documentation. OBJECTIVE: To obtain ATs' perspectives on learning clinical documentation. DESIGN: Qualitative study. SETTING: Web-based audio interviews. PATIENTS OR OTHER PARTICIPANTS: 29 ATs who completed two different continuing education (CE) clinical documentation modules. Participants averaged 36.2±9.0 years of age and included 16 women and 13 men representing 21 U.S. states and 8 clinical practice settings. DATA COLLECTION AND ANALYSIS: Participants were recruited from a group of ATs who completed one of two web-based CE clinical documentation modules. Within 3 weeks of completing the educational modules, participants were interviewed regarding their perceptions of how they learn clinical documentation, including their experiences completing the modules. Using the Consensual Qualitative Research approach, 3 researchers and 1 internal auditor inductively analyzed the data during 5 rounds of consensus coding. Trustworthiness measures included multi-analyst triangulation, data source triangulation, and peer review. RESULTS: Two themes emerged from the data, including 1) mechanisms of learning documentation and 2) benefits of the educational modules. ATs primarily learn documentation through professional education and workforce training, but training appears to be inconsistent. Participants perceived both educational modules were effective at increasing their knowledge and confidence related to learning documentation. The CE modules incited a growth mindset and intention to change behavior. CONCLUSIONS: ATs are satisfied with web-based CE learning experiences specific to clinical documentation and may benefit from more CE offered in these formats. Educators are encouraged to integrate clinical documentation principles throughout the curriculum, during both didactic and clinical education. Workforce training is also valuable for improving knowledge and skills related to clinical documentation, and employers should onboard and support ATs as they start new positions.

Documentation Practices of Athletic Trainers Employed in the Clinic, Physician Practice, and Emerging Clinical Settings.

CONTEXT: The documentation practices of athletic trainers (ATs) employed in the secondary school setting, including their strategies for, barriers to, and perceptions of documentation, have been characterized in previous research. The documentation practices of ATs employed in other settings have yet to be studied in depth. OBJECTIVE: To examine the documentation practices of ATs employed in the clinic, physician practice, and emerging clinical settings. DESIGN: Qualitative study. SETTING: Web-based interviews. PATIENTS OR OTHER PARTICIPANTS: A total of 22 ATs: 11 employed in the clinic or physician practice setting and 11 employed in an emerging clinical setting. DATA COLLECTION AND ANALYSIS: The ATs employed in the settings of interest were recruited with purposeful, convenience, and snowball sampling. Participants were interviewed using a Web-based platform so that we could learn about their behaviors and perceptions of documentation. Data were analyzed using the consensual qualitative research approach, followed by a thematic analysis. Trustworthiness was addressed using data source triangulation, multiple-analyst triangulation, and an established interview guide and codebook. RESULTS: Participants described following clear guidelines for documentation established by regulatory agencies, employers, and electronic medical record templates. They were motivated to document for patient safety and to demonstrate value. Participants typically documented in real time and continuously, which was facilitated by employer requirements. The ATs described experiencing a learning curve for documentation due to the unique requirements of their settings, but learning was facilitated by employer guidance and mentorship. CONCLUSIONS: Employer guidelines, training, and ongoing support facilitated effective and thorough documentation in these clinical settings. Athletic trainers and employers in a variety of settings should consider establishing clear guidelines to promote thorough and effective documentation.

Patient Care Documentation in the Secondary School Setting: Unique Challenges and Needs.

CONTEXT: Athletic trainers (ATs) recognize patient care documentation as an important part of clinical practice. However, ATs using 1 electronic medical record (EMR) platform reported low accountability and lack of time as barriers to documentation. Whether ATs using paper, other EMRs, or a combined paper-electronic system exhibit similar behaviors or experience similar challenges is unclear. OBJECTIVE: To explore ATs' documentation behaviors and perceived challenges while using various systems to document patient care in the secondary school setting. DESIGN: Qualitative study. SETTING: Individual telephone interviews. PATIENTS OR OTHER PARTICIPANTS: Twenty ATs (12 women, 8 men; age = 38 ± 14 years; clinical experience = 15 ± 13 years; from National Athletic Trainers' Association Districts 2, 3, 6, 7, 8, 9, and 10) were recruited via purposeful and snowball-sampling techniques. DATA COLLECTION AND ANALYSIS: Two investigators conducted semistructured interviews, which were audio recorded and transcribed verbatim. Following the consensual qualitative research tradition, 3 researchers independently coded transcripts in 4 rounds using a codebook to confirm codes, themes, and data saturation. Multiple researchers, member checking, and peer reviewing were the methods used to triangulate data and enhance trustworthiness. RESULTS: The secondary school setting was central to 3 themes. The ATs identified challenges to documentation, including lack of time due to high patient volume and multiple providers or locations where care was provided. Oftentimes, these challenges affected their documentation behaviors, including the process of and criteria for whether to document or not, content documented, and location and timing of documentation. To enhance patient care documentation, ATs described the need for more professional development, including resources or specific guidelines and viewing how documentation has been used to improve clinical practice. CONCLUSIONS: Challenges particular to the secondary school setting affected ATs' documentation behaviors, regardless of the system used to document care. Targeted professional development is needed to promote best practices in patient care documentation.

Aspects of Technology That Influence Athletic Trainers' Current Patient Care Documentation Strategies in the Secondary School.

CONTEXT: Previous research on athletic trainers' (ATs) documentation practices in the secondary school setting has focused on users of 1 electronic medical record (EMR) platform. These studies have identified that ATs use multiple platforms for documentation, including paper, even when an EMR is available. OBJECTIVE: To examine the documentation practices of ATs who use various forms of patient care documentation, including paper, EMRs, or both. DESIGN: Qualitative study. SETTING: Individual telephone interviews. PATIENTS OR OTHER PARTICIPANTS: Twenty ATs participated in this study: 12 women and 8 men who averaged 38 ± 14 years of age, 15 ± 13 years of clinical experience, and 11 ± 11 years of employment at their current secondary school. DATA COLLECTION AND ANALYSIS: Semistructured telephone interviews were conducted to gain insight into ATs' documentation practices. Three researchers and 2 auditors inductively coded the transcripts using a consensual qualitative research process that consisted of 4 rounds of consensus coding and determination of data saturation. Trustworthiness was addressed with member checking, multiple-analyst triangulation, and peer review. RESULTS: The ATs' documentation practices were largely influenced by technology, organized in 3 themes. Participants' current documentation strategies included the use of both paper and EMRs, as they found different benefits to using each platform. Oftentimes documentation practices were shaped by technological challenges, including unreliable networks, software design problems, and the lack of a streamlined approach. Lastly, participants identified future strategies for improving documentation, including the need for better EMR options and streamlining their individual documentation behaviors. CONCLUSIONS: Many ATs wanted to incorporate EMRs in their clinical practice but faced challenges when attempting to do so. In turn, clinicians often duplicated documentation or used 2 platforms. Athletic trainers should communicate with administrators to select an EMR that fits their documentation needs and seek resources, such as network access and educational opportunities, to learn how to use EMRs.

Athletic Trainers' Practice Patterns Regarding Medical Documentation.

CONTEXT: Medical documentation is a required component of patient care in all health care professions. OBJECTIVE: To evaluate athletic trainers' perceived behaviors toward, barriers to, and confidence in their medical documentation. DESIGN: Cross-sectional study. SETTING: Web-based survey. PATIENTS OR OTHER PARTICIPANTS: We purchased a list of randomly selected e-mails from the National Athletic Trainers' Association. Of the 9578 participants, 1150 accessed our questionnaire (12.0% access rate), 1053 completed at least 1 portion, and 904 completed the questionnaire in its entirety (85.8% completion rate). Of the participants, 60.1% (n = 569/947) were female, 66.6% (n = 632/949) held a master's degree, 39.3% (n = 414/1053) worked in a collegiate or university setting, and 36.1% (n = 381/1053) worked in a secondary school setting. MAIN OUTCOME MEASURE(S): We used a 31-item questionnaire with demographics (12 items), medical documentation behaviors (16 items), barriers (2 items), and perceptions (1 multipart item) sections. The questionnaire explored athletic trainers' behaviors as well as confidence in, comfort with, and concerns about their documentation practices (Cronbach α = 0.887). We used descriptive statistics to identify characteristics of central tendency (mean, standard deviation, mode, frequency). RESULTS: Participants always (45.7%, n = 478/1046) or very frequently (39.0%, n = 408/1046) used a double documentation system consisting of electronic and paper records (50.4%, n = 523/1038). They most often documented to provide legal protection (86.8%, n = 914/1053), because it is a legal obligation (79.1%, n = 833/1053), or to track patient progress (83.9%, n = 883/1053). The most frequently cited barriers to medical documentation were time (76.5%, n = 806/1053), managing too many patients (51.9%, n = 547/1053), technological concerns (17.2%, n = 181/1053), and software limitations (17.2%, n = 181/1053). Respondents believed they were competent, comfortable, and confident in their documentation practices. CONCLUSIONS: We were able to evaluate the generalizability of previous research while adding to the understanding of the behaviors toward, barriers to, and perceptions about medical documentation. We confirmed that time and patient load affected the ability to perform high-quality medical documentation.

Actual and Perceived Feedback Delivery During Athletic Training Clinical Education With and Without the Use of Bug-in-Ear Technology.

BACKGROUND: Effective feedback delivered to students during clinical education experiences is important to their development as healthcare providers. However, preceptors describe challenges with providing effective feedback. Researchers in teacher education have successfully used bug-in-ear technology, or two-way radios, to improve feedback in clinical fieldwork environments. OBJECTIVE: To examine actual and perceived feedback delivery by athletic training preceptors with and without the use of bug-in-ear technology. PROCEDURES: This qualitative study included 13 athletic training students and 8 preceptor volunteers from three athletic training programs. Four days of observations were conducted for each preceptor-student group, 2 days without and 2 days with bug-in-ear technology. Participants were then interviewed about their experiences. Use of peer-review, triangulation, and member checking improved trustworthiness of the study. RESULTS: Preceptors provided corrective and confirming feedback along with instruction. Most feedback provided by preceptors is focused on their clinical skill performance. Lastly, participants perceived a change in feedback with bug-in-ear technology, but no changes were observed. CONCLUSIONS: Preceptors should be encouraged to continue delivering feedback that confirms and corrects behavior, prompts instruction, and helps with skill performance. Although bug-in-ear technology did not increase feedback delivery, participants perceived a positive change with the technology and no negative impacts were observed.

Junior Athletic Training Faculty Members' Perceptions of Doctoral Education on Their Role Transition.

AIMS: Faculty members in healthcare professions have an important role in developing future clinicians, and preparation for their responsibilities is important. The purpose of this study was to examine junior athletic training faculty members' perceptions of doctoral preparation using a qualitative, phenomenological design. METHODS: We included 20 athletic training faculty members (14 women, 6 men) who were 32±3 yrs of age and averaged 2±2 yrs as full-time faculty members in accredited athletic training programs. We audio-recorded and transcribed verbatim semi-structured telephone interviews designed to gain participants' perspectives on their doctoral education and transition to their faculty role. Two investigators analyzed data using a phenomenological approach, and saturation was obtained. Trustworthiness was established with the use of member checking, multiple analyst triangulation, and peer review. RESULTS: Perceptions of doctoral preparation emerged into three themes: 1) doctoral preparation emphasizes research preparation, 2) teaching experience is important, and 3) faculty desire more preparation for faculty life and administrative responsibilities. Generally, participants felt highly prepared to do research, somewhat prepared to teach, and inadequately prepared for faculty life and administrative duties. CONCLUSIONS: Doctoral program advisors and administrators should consider diversifying doctoral education to more holistically prepare faculty members.

Future Strategies to Enhance Patient Care Documentation Among Athletic Trainers: A Report From the Athletic Training Practice-Based Research Network.

CONTEXT: High-quality patient care documentation is an essential component of any health care professional's daily practice. Whereas athletic trainers (ATs) recognize the importance of patient care documentation, several barriers may prevent them from producing high-quality patient care documentation. OBJECTIVE: To explore beneficial strategies and techniques that ATs perceived would enhance the quality of patient care documentation in the secondary school setting. DESIGN: Qualitative study. SETTING: Individual telephone interviews. PATIENTS OR OTHER PARTICIPANTS: Ten ATs who were members of the Athletic Training Practice-Based Research Network and employed in the secondary school setting were interviewed (4 men, 6 women with 7.1 ± 7.8 years of athletic training experience). DATA COLLECTION AND ANALYSIS: An individual telephone interview was conducted with each participant. Once transcribed, data were analyzed into common themes and categories per the consensual qualitative research tradition. Trustworthiness of the data was achieved through triangulation strategies: (1) the inclusion of multiple researchers to ensure accuracy and representativeness of the data and (2) participant member checking. RESULTS: Participants identified several documentation strategies they perceived would be helpful to improve the quality of patient care documentation, including mode and consistency of documentation and the need for a standardized process as well as the need for system standardization. In addition, participants discussed the need for more education on patient care documentation. Specifically, they identified ways of learning and strategies for future education to enhance patient care documentation across the profession. CONCLUSIONS: As athletic training continues to evolve, it is crucial that ATs are well educated on how to produce high-quality patient care documentation as a part of routine practice. Continuing professional development opportunities are needed to promote lifelong learning in the area of patient care documentation.

Paired Athletic Training Preceptors' and Students' Perceptions of Effective Preceptor Characteristics.

BACKGROUND: Preceptors are important contributors to the professional development of students in allied healthcare programs. Considering their role in supervising and teaching students during clinical education, it is important that preceptors understand and embody effective characteristics and behaviors. Most existing research on preceptor effectiveness in nursing, medicine, and dietetics professions has examined preceptor and student perceptions of effective behaviors independently. OBJECTIVE: The purpose of our study was to investigate effective preceptor behaviors from perspectives of paired preceptors and students affiliated with athletic training programs. PROCEDURES: This qualitative study included interviews of eight paired groups of preceptors (n=8) and athletic training students (n=13) within collegiate, rehabilitation clinic, and high school settings. Data were analyzed using a general inductive approach using open, axial, and selective coding. RESULTS: Our participants concurred that effective preceptors: 1) communicate expectations early and often, 2) demonstrate approachability and openness towards students, 3) provide hands-on patient care responsibilities, and 4) take the time to actively instruct students. CONCLUSIONS: Preceptors are encouraged to exhibit these effective instructional and interpersonal behaviors. Based on these themes, allied health program administrators should provide preceptor trainings that encourage these behaviors to enhance student learning and professional preparation.

Athletic Trainers' Reasons for and Mechanics of Documenting Patient Care: A Report From the Athletic Training Practice-Based Research Network.

CONTEXT: Documenting patient care is an important responsibility of athletic trainers (ATs). However, little is known about ATs' reasons for documenting patient care and the mechanics of completing documentation tasks. OBJECTIVE: To understand ATs' perceptions about reasons for and the mechanics of patient care documentation. DESIGN: Qualitative study. SETTING: Individual telephone interviews with Athletic Training Practice-Based Research Network members. PATIENTS OR OTHER PARTICIPANTS: Ten ATs employed in the secondary school setting (age = 32.6 ± 11.4 years, athletic training experience = 7.1 ± 7.8 years) were recruited using a criterion-based sampling technique. Participants were Athletic Training Practice-Based Research Network members who used the Clinical Outcomes Research Education for Athletic Trainers electronic medical record system and practiced in 6 states. DATA COLLECTION AND ANALYSIS: We used the consensual qualitative research tradition. One investigator conducted individual telephone interviews with each participant. Data collection was considered complete after the research team determined that data saturation was reached. Interviews were transcribed verbatim and independently analyzed by 4 research team members following the process of open, axial, and selective coding. After independently categorizing interview responses into categories and themes, the members of the research team developed a consensus codebook, reanalyzed all interviews, and came to a final agreement on the findings. Trustworthiness was established through multiple-analyst triangulation and member checking. RESULTS: Participants identified 3 reasons for documenting patient care: communication, monitoring patient care, and legal implications. Four subcategories emerged from the mechanics-of-documentation theme: location, time of day, length of time, and criteria for documenting. The ATs described different criteria for documenting patient care, ranging from documenting every injury in the same manner to documenting time-loss and follow-up injuries differently. CONCLUSIONS: Whereas ATs recognized individual mechanisms that enabled them to document patient care, they may need more guidance on the appropriate criteria for documenting various patient care encounters and strategies to help them document more effectively.

Athletic Trainers' Perceptions of and Barriers to Patient Care Documentation: A Report From the Athletic Training Practice-Based Research Network.

CONTEXT: For the practice characteristics of the services athletic trainers (ATs) provide to be identified, all ATs must complete high-quality patient care documentation. However, little is known about ATs' perceptions of patient care documentation or the potential barriers they may encounter while trying to ensure high-quality documentation. OBJECTIVE: To explore ATs' perceptions of and barriers to patient care documentation via the Clinical Outcomes Research Education for Athletic Trainers (CORE-AT) electronic medical record system in the secondary school setting. DESIGN: Qualitative study. SETTING: Individual telephone interviews. PATIENTS OR OTHER PARTICIPANTS: We interviewed 10 ATs (4 men, 6 women; age = 32.6 ± 11.4 years, athletic training experience = 7.1 ± 7.8 years) who were members of the Athletic Training Practice-Based Research Network (AT-PBRN) and employed in the secondary school setting. DATA COLLECTION AND ANALYSIS: We conducted an individual interview with each participant. After transcription of the interviews, the data were analyzed into common themes and categories following the consensual qualitative research tradition. Data triangulation occurred through member checking and multiple researchers to ensure accuracy during data analysis. RESULTS: Participants revealed several perceptions of patient care documentation, consisting of quality, expectations and accountability, priority, incentive, and culture of the secondary school setting. In addition, we identified barriers to quality patient care documentation: lack of time, lack of accountability for documenting patient care, inadequate facility resources, and lack of personnel. Participants discussed the volume of patients as a unique challenge in the secondary school setting. CONCLUSIONS: Whereas ATs perceived patient care documentation as important, several practical barriers may inhibit their ability to complete high-quality documentation of the services they provide. Effective strategies to improve the quality of patient care documentation among ATs are needed to ensure that their value, particularly in the secondary school setting, is accurately characterized.

Promising and Established Investigators' Experiences Participating in the National Athletic Trainers' Association Foundation Research Mentor Program.

CONTEXT: Mentorship is a helpful resource for individuals who transition from doctoral student to tenure-track faculty member. The National Athletic Trainers' Association (NATA) Research & Education Foundation offers a Research Mentor Program to provide mentorship to promising investigators, particularly as they work to establish independent lines of research. OBJECTIVE: To gain the perspectives of promising and established investigators on their participation in the NATA Foundation Research Mentor Program. DESIGN: Qualitative, phenomenological research. SETTING: Higher education institutions. PATIENTS OR OTHER PARTICIPANTS: Seven promising investigators (5 women, 2 men) and 7 established investigators (2 women, 5 men), all of whom had completed the NATA Foundation Research Mentor Program. Data Collection and Analysis We developed and piloted intervi: ew guides designed to gain participants' perspectives on their experiences participating in the NATA Foundation Research Mentor Program. Semistructured telephone interviews were completed with each individual and transcribed verbatim. Data were analyzed using a phenomenological approach, and saturation was obtained. Trustworthiness was established with the use of member checking, multiple-analyst triangulation, and data-source triangulation. RESULTS: Three themes emerged from the interviews: (1) motivation, (2) collaboration, and (3) resources. Participants were motivated to become involved because they saw the value of mentorship, and mentees desired guidance in their research. Participants believed that collaboration on a project contributed to a positive relationship, and they also desired additional program and professional resources to support novice faculty. CONCLUSIONS: Promising and established investigators should be encouraged to engage in mentoring relationships to facilitate mentees' research agendas and professional development. The NATA Foundation and athletic training profession may consider providing additional resources for novice faculty, such as training on effective mentoring; grant writing and other research-related tasks; and support for broader faculty responsibilities, such as teaching, service, and work-life balance.