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.

Influences of Athletic Trainers' Return-to-Activity Assessments for Patients With an Ankle Sprain.

CONTEXT: Athletic trainers (ATs) inconsistently apply rehabilitation-oriented assessments (ROASTs) when deciding return-to-activity readiness for patients with an ankle sprain. Facilitators and barriers that are most influential to ATs' assessment selection remain unknown. OBJECTIVE: To examine facilitators of and barriers to ATs' selection of outcome assessments when determining return-to-activity readiness for patients with an ankle sprain. DESIGN: Cross-sectional study. SETTING: Online survey. PATIENTS OR OTHER PARTICIPANTS: We sent an online survey to 10 000 clinically practicing ATs. The survey was accessed by 676 individuals, of whom 574 submitted responses (85% completion rate), and 541 respondents met the inclusion criteria. MAIN OUTCOME MEASURE(S): The survey was designed to explore facilitators and barriers influencing ATs' selection of pain; ankle-joint swelling, range of motion, arthrokinematics, and strength; balance; gait; functional capacity; physical activity level; and patient-reported outcome assessments when making return-to-activity decisions for patients after an ankle sprain. The survey asked for reasons that participants chose to use or not use each measure (eg, previous education, personal comfort, most appropriate, available or feasible, perceived value, and other). The survey contained 12 demographic items that characterized the sample of respondents and were examined as potential influences on the facilitators and barriers. Chi-square analysis was used to identify relationships among participant demographics and facilitators of or barriers to assessment selection. RESULTS: Selection of each ROAST and non-ROAST was most commonly facilitated by previous education, availability or feasibility, or perceived value. Avoidance of each ROAST was most often caused by the lack of previous education, availability or feasibility, or perceived value. The presence of facilitators and barriers was affected by various demographic variables. CONCLUSIONS: A variety of facilitators and barriers affected ATs' implementation of expert-recommended assessments when determining return-to-activity readiness in patients with an ankle sprain. Some subpopulations of ATs experienced more favorable or prohibitive conditions for assessment use.

Athletic Trainers' Perceptions of Salary Negotiation Decision-Making During the Hiring Process.

CONTEXT: Appropriate salaries for athletic trainers (ATs) have been a contentious topic for decades. While professional advocacy efforts to increase ATs' salaries have gained traction, little is known about ATs' experiences with negotiation during the hiring process. OBJECTIVE: To explore the reasons, influences, and factors influencing ATs' negotiation decisions. DESIGN: Qualitative study. SETTING: Individual video interviews. PATIENTS OR OTHER PARTICIPANTS: 28 ATs who participated in a previous study and indicated a willingness to participate in the qualitative follow-up were interviewed (17 women, 10 men, 1 non-binary individual; age = 37.8±8.9 years; athletic training experience = 15.1±8.3 years). Of the 28 participants, 18 did negotiate, while 10 did not. DATA COLLECTION AND ANALYSIS: An individual videoconference interview was conducted with each participant. After transcription, data were analyzed into themes and categories following the consensual qualitative research tradition. To ensure trustworthiness of the findings, we confirmed accuracy through member checks, triangulated the data using multi-analyst research teams, and confirmed representativeness by including an external auditor. RESULTS: Four parallel themes emerged during data analysis; factors for determining salary negotiation, reasons for negotiating/not negotiating, negotiation influencers/deterrents, and experiences with negotiation/impact of not negotiating. CONCLUSIONS: Negotiators used a variety of data sources to support their requests, and their decisions were motivated by their known value, the area's cost of living, and their current financial or employment situations. Negotiators relied on previous experiences to guide negotiations and provided successes and regrets from their negotiation experience. Nonnegotiators also used a variety of data types but were deterred by fear: of not knowing how to negotiate, losing the offer, or off 26 ending those involved. Non-negotiators highlighted lack of confidence they had in their ability to negotiate and provided the financial consequences and personal regrets from not negotiating. More training, education, and publicly available data are needed to assist ATs in future negotiation attempts.

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.

Muslim Collegiate Student-Athletes' Experience with Fasting During Ramadan While Participating in Sport.

CONTEXT: As colleges and universities continue to focus on creating diverse, equitable, and inclusive environments, it is important to gain more knowledge on the experiences that Muslim student-athletes have while fasting during the month of Ramadan. While previous researchers have investigated the physical effects of fasting on the body, little is known about the challenges or support Muslim student athletes experience while fasting and participating in sport during Ramadan. OBJECTIVE: To explore the experiences of Muslim collegiate student-athletes regarding fasting during Ramadan while participating in sports. DESIGN: Consensual qualitative research. SETTING: Individual video interviews. PARTICIPANTS: 12 Muslim collegiate student-athletes (4 women, 8 men; age = 19.9±1.4 years) from 7 universities across 7 states were interview. DATA COLLECTION AND ANALYSIS: semi-structured interview guide consisting of questions pertaining to the Muslim student-athletes' beliefs, challenges, experiences, and feelings were used to gather perceptions of fasting during Ramadan while participating in sport. Data were analyzed by a multi-analyst research team and coded into common themes and categories via a multi-phase consensus process. RESULTS: Four major themes emerged from the interview process, including the significance of fasting and Ramadan (familial influence, religious belief, introspection and spiritual growth), intrinsic challenges (physical mental and emotional, time constraints), extrinsic challenges (lack of available resources, knowledge and curiosity of others, lack of understanding by others) and various support (sport-specific support, community support, desired support) that impacted participants' experiences with fasting during Ramadan while participating in sport. CONCLUSIONS: The athletic community should seek to better support Muslim student-athletes and respect the importance of fasting during Ramadan. Parties interested in the success of these athletes in sport should improve their understanding regarding Ramadan and the desired support of Muslim student-athletes during fasting.

Influence of Gender in Preceptor-Student Dyads on Student Performance in Clinical Education: A Report from the AATE Research Network.

CONTEXT: Health professions education programs incorporate clinical education to prepare students for autonomous clinical practice. Although preceptor-student gender dyads impact student evaluations, specific influences of gender dyad pairings on student autonomy and behavior implementation have not been identified. OBJECTIVE: To examine the influence of preceptor-student gender dyads on athletic training student opportunities to engage in clinical practice during clinical experiences and to determine whether constitution of preceptor-student gender dyads influenced student ability to enact professional behaviors during patient encounters (PEs). METHODS: Multisite panel design involving 12 professional athletic training programs (ATPs, 5 undergraduate, 7 graduate). Participants included 338 athletic training students enrolled in ATPs that used E*Value to document PEs during clinical experiences. Student gender, student role in the PE (observe, assist, or perform), preceptor gender, and student implementation of behaviors associated with core competencies during the PE were measured outcomes. RESULTS: The 30,446 PEs were categorized into 4 preceptor-student dyad categories. Female students with male preceptors were less likely to perform PEs than they were to observe them (OR 0.76; 95%CI 0.69, 0.83; p<0.001). Female students with female preceptors reported fewer opportunities for behaviors associated with interprofessional education and collaborative practice (IPECP) (X2(3)=16.6, p=0.001). CONCLUSIONS: Female athletic training students under male preceptorship had fewer opportunities to perform during PEs, and female students under female preceptorship had limited opportunities to participate in IPECP. Health professions education program administrators should encourage students to advocate for opportunities in autonomous practice and implementation of professional behaviors.

Implementation of Patient-Centered Care by Athletic Training Students during Clinical Experiences: A Report from the Association of Athletic Training Education Research Network.

Patient-centered care (PCC) is a core competency that should be required by all healthcare education programs, but little is known about its implementation in athletic training clinical experiences. Therefore, we examined characteristics of patient encounters documented by athletic training students implementing PCC behaviors. A multisite panel design was used to recruit 363 students from twelve professional athletic training programs (five undergraduate, seven graduate). Over 1.5 years, clinical experience patient encounter data were logged in E*Value Case Logs, including student role during the encounter, length of encounter, and clinical site. Generalized estimating equations models characterized the likelihood students included PCC behaviors in 30,522 encounters. Discussing patient goals was associated with student role (χ2(2) = 40.6, p < 0.001) and length of encounter (χ2(4) = 67.6, p < 0.001). Using patient-reported outcome measures was associated with student role (χ2(2) = 21.6, p < 0.001), length of encounter (χ2(4) = 34.5, p < 0.001), and clinical site (χ2(3) = 17.3, p = 0.001). Implementing clinician-rated outcome measures was affected by length of encounter (χ2(4) = 27.9, p < 0.001) and clinical site (χ2(3) = 8.6, p = 0.04). PCC behaviors were largely associated with student role and length of encounters; clinical site had less impact. Athletic training educators should emphasize progressive autonomous supervision with preceptors and encourage students to facilitate slightly longer patient visits, when possible, to incorporate more PCC behaviors.

Athletic Trainers' Perceptions of and Experience with Social Determinants of Health.

The role that social determinants of health (SDHs) play in athletic healthcare is gaining attention, yet little is known about athletic trainers' (ATs) perceptions of and encounters with the impact of SDHs. The purpose of this study was to evaluate ATs' perceptions of various SDHs and their experience treating patients whose health and well-being were influenced by SDHs. This was a cross-sectional, web-based survey completed by 1694 ATs (completion rate = 92.6%; 61.1% female; age = 36.6 ± 10.8 years). The survey consisted of several multipart questions focusing on specific SDHs. Descriptive statistics were used to report frequencies and percentages. Results indicated widespread agreement that SDHs matter to patient health and are of concern in athletic healthcare. The SDHs that ATs most commonly reported encountering included lifestyle choices (n = 1306/1406; 93.0%), social support (n = 1185/1427; 83.0%), income (n = 1167/1502; 77.7%), and access to quality and timely healthcare (n = 1093/1420, 77.0%). The SDHs that ATs least commonly reported having experience with was governmental policy (n = 684/1411; 48%). The perceived importance of SDHs among ATs and their commonly reported experiences managing patient cases in which SDHs negatively influence patients' health and healthcare suggest that efforts to assess these factors are needed so that strategies to address their influence on athletic healthcare can be identified.

Athletic Trainers' Familiarity, Comfort, Knowledge, and Recognition of Social Determinants of Health.

CONTEXT: Social determinants of health (SDH)-education, transportation, housing, employment, health systems and services, economic status, and physical and social environments-influence patient outcomes; therefore, athletic trainers (ATs) need to be able to understand and address these factors. However, little is known about how ATs perceive SDH or how knowledgeable they are about social factors that contribute to patient health and well-being. OBJECTIVE: To evaluate ATs' familiarity and comfort with SDH and their perceived knowledge and recognition of SDH. DESIGN: Cross-sectional. SETTING: Online survey. PATIENTS OR OTHER PARTICIPANTS: Our survey was distributed to 17 000 ATs; 1829 accessed it (access rate=10.8%), and 1694 completed it (completion rate=92.6%, AT experience=15.2±10.6 years, age=36.6±10.8 years). MAIN OUTCOME MEASURES: The survey included multipart questions that evaluated ATs' perceptions of their familiarity, comfort, and knowledge about SDH. Data were summarized using descriptive statistics. RESULTS: Few respondents (4.1%, 70/1691) reported they were extremely familiar with SDH. Most reported being moderately familiar (45.0%, 761/1691), minimally familiar (34.7%, 587/1691), or not familiar at all (16.1%, 273/1691). For questions about comfort, few reported being extremely comfortable (3.5%, 59/1691) with SDH, and most reported being moderately comfortable (35.4%, 598/1691), minimally comfortable (41.1%, 695/1691), or not comfortable at all (18.6%, 314/1691). For questions about knowledge, few reported being extremely knowledgeable (2.7%, 46/1686) about SDH, and the majority reported being moderately (38.9%, 622/1686), minimally (41.8%, 704/1686) or not knowledgeable at all (18.6%, 314/1686). Over half of ATs accurately categorized 8 of the 9 SDH listed in the survey, and 22% endorsed more correct than incorrect items. CONCLUSIONS: A majority of ATs perceived their familiarity, comfort, and knowledge about SDH to be moderate-to-low, which may reflect the relatively recent emphasis on SDH in athletic healthcare. Because SDH can have a major impact on patient health and well-being, strategies should be developed for educating ATs about SDH. Developing strategies to increase comfort with the SDH in patient care is critical to ensure that those factors that can be addressed at the patient level are identified and managed.

Masculinity, optimism bias, and perceived pressure from stakeholders influence on student-athlete concussion reporting intentions and behavior.

Objective: Determine how a) masculinity, b) optimism bias, and c) perceived pressure from stakeholders predict concussion reporting intentions and behavior. Participants: Collegiate student-athletes (n = 369). Methods: Student-athletes completed surveys of Conformity to Masculine Norms Inventory-46 (nine sections), optimism bias (optimist, neutral, pessimist), perceived pressure from stakeholders (six stakeholder sections), reporting intentions (symptom and concussion), and behavior (symptom and concussion). Four separate stepwise multivariate regression analyses were conducted. Results: A one-point increase in playboy, heterosexual self-preservation, being neutral or optimist compared to a pessimist symptom reporting intention decreased. A one-point increase in sport primacy, perceived pressure from athletic administration, being neutral or optimist compared to pessimist concussion reporting intentions increased 0.05, and decreased 0.23, 0.35, and 0.32, respectively. A one-point increase in violence and playboy increased the odds of being a "non-reporter" by 30% and 40%. Conclusions: Pessimistic views regarding concussion risks may result in greater concussion reporting intentions, however these findings did not influence behavior.

University educators' perceptions of academic adjustments following a concussion for student-athletes and non-student-athletes.

Objective: To identify (1) university educators' perceptions of academic adjustments (AA), and (2) if teaching experience correlated with AA perceptions following concussion. Participants: Two hundred twenty educators. Methods: University educators were invited to complete a survey containing four subsections; this manuscript focuses on AA following concussion. Objective 1 was descriptive; we conducted spearman's rho correlations between years of teaching experience and AA perceptions to address objective 2. Results: Educators were moderately familiar with AA but were not confident in their knowledge about AA following concussion. Participants who provided AA following concussion most often allowed excused absences and extra time for exams/assignments. There were no significant relationships between teaching experience and perceptions of AA. Conclusions: University educators largely feel unprepared to provide or recommend AA following concussion but had favorable AA perceptions following concussion. Standardized policies or referral sites within the university system may be warranted to improve post-concussion AA.

Negotiation Practices of Athletic Trainers Employed in the Clinical Setting.

CONTEXT: Athletic trainers (ATs) are comparatively underpaid relative to peer healthcare professionals. While many factors contribute to salary and benefits of a given employment position, negotiation is a factor of the final salary and benefits package that is achieved. It is unclear to what extent ATs negotiate salary or other terms of employment during the hiring process. OBJECTIVE: To explore the negotiation practices of ATs during the hiring process. DESIGN: Cross-sectional. SETTING: Web-based survey. PATIENTS OR OTHER PARTICIPANTS: 587 ATs employed in the clinical setting that previously held at least one full-time employment position. MAIN OUTCOME MEASURES: Independent variables included several demographic factors as well as current salary range. Dependent variables were participants' responses to various survey items focused on experiences with salary and terms of employment negotiation. Summary statistics were used to characterize all variables and multiple chi-square analyses (p<.05) were performed to determine significant influences of independent variables on negotiation practices. RESULTS: More than half of ATs did not attempt to negotiate their salary (57.6%), and almost three-quarters of ATs did not negotiate terms of employment (70.5%) during the hiring process. The most successfully negotiated terms were moving expenses (72.3%) and continuing education funding/reimbursement (62.7%). The influence of demographic factors on negotiation and negotiation success varied with significant findings for: number of previous full-time employment positions, gender, marital status, salary range, and number of dependents. CONCLUSIONS: It is alarming that more than half of ATs do not negotiate salary or terms of employment during the hiring process. While widespread training on negotiation practices is warranted, our findings suggest it would be most beneficial for early-career and women ATs. ATs must become comfortable with negotiating salary and terms of employment in order to effect change on the average salary and employment status of those in the profession.

Assessments Used by Athletic Trainers to Decide Return-to-Activity Readiness in Patients.

CONTEXT: Patients with ankle sprains are often cared for by athletic trainers (ATs). Expert consensus was previously established for Rehabilitation-Oriented Assessments (ROASTs) that should be included in ankle sprain evaluations. However, it is unknown what methods ATs use to determine return-to-activity readiness following an ankle sprain. OBJECTIVE: Our purpose was to identify ATs' methods for determining patients' return-to-activity readiness following an ankle sprain and demographic determinants of ATs' methods. SETTING: Online survey Study Design: Cross-sectional study Level of Evidence: CEBM Level 1 Participants: We recruited 10,000 clinically practicing ATs. A total of 676 accessed the survey, 574 submitted responses (85% completion rate), and 541 respondents met inclusion criteria. MAIN OUTCOME MEASURES: We distributed an online survey to participants to ask them about their assessment of pain, swelling, range of motion, arthrokinematics, strength, balance, gait, functional capacity, physical activity level, and patient-reported outcomes in deciding return-to-activity. Descriptive statistics characterized participant demographics and frequencies of assessment measures used by ATs. Chi-square analyses identified relationships between demographics and assessment selection. RESULTS: Pain, swelling, range of motion, strength, balance, gait, and functional capacity were assessed by 76-97% of ATs. Arthrokinematics, physical activity level, and patient-reported outcomes were assessed by 25-36% of participants. When selecting specific assessment methods, ATs often did not use recommended ROASTs. ATs with higher degrees, more advance educational programs, employment in non-traditional settings, more clinical experience, and familiarity with expert consensus recommendations were more likely to use ROASTs. CONCLUSIONS: Before approving return-to-activity for patients with ankle sprains, some recommended outcomes and assessment methods are not evaluated by ATs. Practice in non-traditional settings, more advanced degrees, more clinical experience, and familiarity with expert-consensus guidelines appear to facilitate use of ROASTs.

Characteristics of Patient Encounters for Athletic Training Students During Clinical Education: A Report From the Association for Athletic Training Education Research Network.

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

Core Competency-Related Professional Behaviors During Patient Encounters: A Report From the Association for Athletic Training Education Research Network.

CONTEXT: To enhance the quality of patient care, it is important that athletic trainers integrate the components of the core competencies (CCs; evidence-based practice [EBP], patient-centered care [PCC], health information technology [HIT], interprofessional education and collaborative practice [IPECP], quality improvement [QI], professionalism) as a part of routine clinical practice. In what ways, if any, athletic training students (ATSs) are currently integrating CCs into patient encounters (PEs) during clinical experiences is unclear. OBJECTIVE: To describe which professional behaviors associated with the CCs were implemented by ATSs during PEs that occurred during clinical experiences. DESIGN: Multisite panel design. SETTING: A total of 12 professional athletic training programs (5 bachelor's, 7 master's level). PATIENTS OR OTHER PARTICIPANTS: A total of 363 ATSs from the athletic training programs that used E*Value software to document PEs during clinical experiences participated. MAIN OUTCOME MEASURE(S): During each PE, ATSs were asked to report whether professional behaviors reflecting 5 of the CCs occurred (the professionalism CC was excluded). Summary statistics, including means ± SDs, counts, and percentages were tabulated for the professional behaviors of each CC. RESULTS: Data from 30 630 PEs were collected during the study period. Professional behaviors related to EBP were the most frequently incorporated during PEs (74.3%, n = 22 773), followed by QI (72.3%, n = 22 147), PCC (56.6%, n = 17 326), HIT (35.4%, n = 10 857), and IPECP (18.4%, n = 5627). CONCLUSIONS: It is unsurprising that EBP and PCC behaviors were 2 of the most frequently incorporated CCs during PEs due to the emphasis on these competencies during the past several years. However, it is surprising that ATSs did not incorporate behaviors related to either HIT (in 65% of PEs) or IPECP (in 82% of PEs). These findings suggest that directed efforts are needed to ensure that ATSs are provided opportunities to incorporate professional behaviors related to the CCs during clinical experiences.

Social Determinants of Health: Considerations for Athletic Health Care.

Health disparities are prevalent concerns in the United States and a frequent topic of conversation in the public health realm. Causes of health disparities include social inequities and social determinants of health. Although social determinants of health have been suggested to contribute more to individual and population health than the health care provided, this concept in athletic health care has received little attention. Therefore, the purpose of our article was to describe social determinants of health, present examples of social determinants, and discuss actionable steps for the athletic training profession to become more culturally proficient. By increasing the awareness of and acknowledging social determinants of health, athletic trainers will be positioned to improve patient outcomes more readily and contribute to ongoing conversations at the policy level of health care.

The Critical Need for Advanced Training in Electronic Records Use: Implications for Clinical Practice, Education, and the Advancement of Athletic Training.

CONTEXT: The effective use of electronic records (ie, electronic health records or electronic medical records) is essential to professional initiatives and the overall advancement of the athletic training profession. However, evidence suggests that comprehensive patient care documentation and widespread use of electronic records are still limited in athletic training. The lack of formal training and education for clinicians and students is often cited as a primary barrier to electronic record use. Other health care disciplines have used academic electronic health record (AEHR) systems to address these barriers with promising results. OBJECTIVES: To identify common challenges associated with the effective use of electronic records in clinical practice, discuss how an AEHR system can address these challenges and encourage more effective use of electronic records, and describe strategies for deploying AEHRs in the athletic training profession. DESCRIPTION: The AEHR is an electronic records system specifically designed for educational use to support simulation learning among all types of learners (eg, practicing clinicians, students). Mimicking the form and function of an electronic health record, the AEHR offers various educational tasks, including patient care documentation projects, critical reviews of standardized patient cases, and assessments of patient care data for quality improvement efforts. CLINICAL AND RESEARCH ADVANTAGES: Recent evidence suggests that the use of an AEHR can improve knowledge and enhance skills. Specifically, AEHR use has been associated with enhanced attitudes toward electronic health record technology, increased informatics competencies, and improved documentation skills. Also, the use of an AEHR has been associated with improved critical thinking and decision-making skills. This tool appears to be valuable for health professions education, and athletic training stands to benefit from its use to better train and upskill clinicians and students alike for clinical practice. Although the implementation of an AEHR will require much time and large-scale coordinated efforts, it will be a worthy investment to address current challenges and advance the athletic training profession.

A Qualitative Analysis of Concussion-Reporting Behavior in Collegiate Student-Athletes With a History of Sport-Related Concussion.

CONTEXT: Many survey-based methods have been used to explore concussion-reporting behavior. However, because the decision to report or conceal a concussion is likely multifactorial, this may narrow the findings, as the surveys were largely designed by the researchers. OBJECTIVE: To explore student-athletes' perspectives regarding factors that may influence the reporting of sport-related concussion. DESIGN: Qualitative study. SETTING: National Collegiate Athletic Association Division I athletics. PATIENTS OR OTHER PARTICIPANTS: We conducted 17 semistructured interviews with student-athletes who had sustained 1 or more concussions while attending a large university (men = 4, women = 13, age = 20.9 ± 1.3 years). DATA COLLECTION AND ANALYSIS: After data saturation and member checks, a 5-cycle analytic process was completed: topical review, literature review, data collection and summarizing using a codebook developed by a 3-person research team, linking of findings to current research, and final interpretations. RESULTS: We discovered 3 themes. Participants discussed concussion perceptions by describing their understanding of a concussion, their own injury experiences, and their perceptions of symptom severity and duration. Regarding reporting behavior, participants described an order of individuals with whom they would speak, symptoms present in order to report (eg, feeling different from normal), immediate reactions, and influential factors for mitigating short- and long-term consequences. Lastly, participants discussed the value of support systems, such as how coaches can both positively and negatively influence reporting and athletic trainer involvement. CONCLUSIONS: Participants often drew from their own concussion experiences in naming common concussion signs and symptoms. Additionally, they indicated that both short- and long-term health consequences influenced and deterred their seeking care and that their support systems, including coaches and athletic trainers, played a role in their concussion experience. Research is needed to determine if using student-athletes' own words to describe a concussion and incorporating student-athletes' support systems, especially coaches and athletic trainers, is effective in increasing concussion reporting.

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.