Athletic training students' engagement in interprofessional education in the classroom and during clinical education.

Interprofessional education is an area of emphasis within healthcare. Little is known regarding what other healthcare professions athletic training students engage with during interprofessional education. Therefore, our purpose was to identify the healthcare students that athletic training students engage with in the classroom/laboratory and during clinical education. We used a cross-sectional survey design with open-ended questions to survey 90 athletic training program directors. Data were analyzed using descriptive statistics and an analysis of variance to determine differences between demographic characteristics and engagement with other healthcare students in the classroom/laboratory and during clinical education. The alpha level was set at .05. Overall, athletic training students regularly engaged with students from other healthcare professions in the classroom/laboratory and during clinical education, with physical therapy and nursing being most common. Unfortunately, more than 30% of respondents indicated no engagement with other healthcare professions during clinical education or in the classroom. It was concluded that athletic training faculty need to capitalize on opportunities to expose athletic training students to other healthcare students, as well as utilizing teaching and evaluation strategies that foster interprofessional education and practice. Similarly, students need to capitalized on opportunities to engage in interprofessional practice.

Antiplasmodial dihetarylthioethers target the coenzyme A synthesis pathway in Plasmodium falciparum erythrocytic stages.

BACKGROUND: Malaria is a widespread infectious disease that threatens a large proportion of the population in tropical and subtropical areas. Given the emerging resistance against the current standard anti-malaria chemotherapeutics, the development of alternative drugs is urgently needed. New anti-malarials representing chemotypes unrelated to currently used drugs have an increased potential for displaying novel mechanisms of action and thus exhibit low risk of cross-resistance against established drugs. RESULTS: Phenotypic screening of a small library (32 kinase-inhibitor analogs) against Plasmodium falciparum NF54-luc asexual erythrocytic stage parasites identified a diarylthioether structurally unrelated to registered drugs. Hit expansion led to a series in which the most potent congener displayed nanomolar antiparasitic activity (IC50 = 39 nM, 3D7 strain). Structure-activity relationship analysis revealed a thieno[2,3-d]pyrimidine on one side of the thioether linkage as a prerequisite for antiplasmodial activity. Within the series, the oxazole derivative KuWei173 showed high potency (IC50 = 75 nM; 3D7 strain), good solubility in aqueous solvents (1.33 mM), and >100-fold selectivity toward human cell lines. Rescue experiments identified inhibition of the plasmodial coenzyme A synthesis as a possible mode of action for this compound class. CONCLUSIONS: The class of antiplasmodial bishetarylthioethers reported here has been shown to interfere with plasmodial coenzyme A synthesis, a mechanism of action not yet exploited for registered anti-malarial drugs. The oxazole congener KuWei173 displays double-digit nanomolar antiplasmodial activity, selectivity against human cell lines, high drug likeness, and thus represents a promising chemical starting point for further drug development.

Hydration and Fluid Replacement Knowledge, Attitudes, Barriers, and Behaviors of NCAA Division 1 American Football Players.

Judge, LW, Kumley, RF, Bellar, DM, Pike, KL, Pierson, EE, Weidner, T, Pearson, D, and Friesen, CA. Hydration and fluid replacement knowledge, attitudes, barriers, and behaviors of NCAA Division 1 American football players. J Strength Cond Res 30(11): 2972-2978, 2016-Hydration is an important part of athletic performance, and understanding athletes' hydration knowledge, attitudes, barriers, and behaviors is critical for sport practitioners. The aim of this study was to assess National Collegiate Athletic Association (NCAA) Division 1 (D1) American football players, with regard to hydration and fluid intake before, during, and after exercise, and to apply this assessment to their overall hydration practice. The sample consisted of 100 student-athletes from 2 different NCAA D1 universities, who participated in voluntary summer football conditioning. Participants completed a survey to identify the fluid and hydration knowledge, attitudes and behaviors, demographic data, primary football position, previous nutrition education, and barriers to adequate fluid consumption. The average Hydration Knowledge Score (HKS) for the participants in the present study was 11.8 ± 1.9 (69.4% correct), with scores ranging from 42 to 100% correct. Four key misunderstandings regarding hydration, specifically related to intervals of hydration habits among the study subjects, were revealed. Only 24% of the players reported drinking enough fluids before, during, immediately after, and 2 hours after practice. Generalized linear model analysis predicted the outcome variable HKS (χ = 28.001, p = 0.045), with nutrition education (Wald χ = 8.250, p = 0.041) and position on the football team (χ = 9.361, p = 0.025) being significant predictors. "Backs" (e.g., quarterbacks, running backs, and defensive backs) demonstrated significantly higher hydration knowledge than "Linemen" (p = 0.014). Findings indicated that if changes are not made to increase hydration awareness levels among football teams, serious health consequences, including potential fatalities, could occur on the field, especially among heavier linemen.

Novel 2-Phenoxyanilide Congeners Derived from a Hit Structure of the TCAMS: Synthesis and Evaluation of Their in Vitro Activity against Plasmodium falciparum.

The Tres Cantos Antimalarial Compound Set (TCAMS) is a publicly available compound library which contains 13533 hit structures with confirmed activity against Plasmodium falciparum, the infective agent responsible for malaria tropica. The TCAMS provides a variety of starting points for the investigation of new antiplasmodial drug leads. One of the promising compounds is TCMDC-137332, which seemed to be a good starting point due to its antiplasmodial potency and its predicted physicochemical properties. Several new analogues based on a 2-phenoxyanilide scaffold were synthesized by standard amide coupling reactions and were fully characterized regarding their identity and purity by spectroscopic and chromatographic methods. Furthermore, the results of the biological evaluation of all congeners against Plasmodium falciparum NF54 strains are presented. The findings of our in vitro screening could not confirm the presumed nanomolar antiplasmodial activity of TCMDC-137332 and its derivatives.

Novel dengue virus NS2B/NS3 protease inhibitors.

Dengue fever is a severe, widespread, and neglected disease with more than 2 million diagnosed infections per year. The dengue virus NS2B/NS3 protease (PR) represents a prime target for rational drug design. At the moment, there are no clinical PR inhibitors (PIs) available. We have identified diaryl (thio)ethers as candidates for a novel class of PIs. Here, we report the selective and noncompetitive inhibition of the serotype 2 and 3 dengue virus PR in vitro and in cells by benzothiazole derivatives exhibiting 50% inhibitory concentrations (IC50s) in the low-micromolar range. Inhibition of replication of DENV serotypes 1 to 3 was specific, since all substances influenced neither hepatitis C virus (HCV) nor HIV-1 replication. Molecular docking suggests binding at a specific allosteric binding site. In addition to the in vitro assays, a cell-based PR assay was developed to test these substances in a replication-independent way. The new compounds inhibited the DENV PR with IC50s in the low-micromolar or submicromolar range in cells. Furthermore, these novel PIs inhibit viral replication at submicromolar concentrations.

Perceived frequency of peer-assisted learning in the laboratory and collegiate clinical settings.

CONTEXT: Peer-assisted learning (PAL) has been recommended as an educational strategy to improve students' skill acquisition and supplement the role of the clinical instructor (CI). How frequently students actually engage in PAL in different settings is unknown. OBJECTIVE: To determine the perceived frequency of planned and unplanned PAL (peer modeling, peer feedback and assessment, peer mentoring) in different settings. DESIGN: Cross-sectional study. SETTING: Laboratory and collegiate clinical settings. PATIENTS OR OTHER PARTICIPANTS: A total of 933 students, 84 administrators, and 208 CIs representing 52 (15%) accredited athletic training education programs. INTERVENTION(S): Three versions (student, CI, administrator) of the Athletic Training Peer Assisted Learning Survey (AT-PALS) were administered. Cronbach α values ranged from .80 to .90. MAIN OUTCOME MEASURE(S): Administrators' and CIs' perceived frequency of 3 PAL categories under 2 conditions (planned, unplanned) and in 2 settings (instructional laboratory, collegiate clinical). Self-reported frequency of students' engagement in 3 categories of PAL in 2 settings. RESULTS: Administrators and CIs perceived that unplanned PAL (0.39 ± 0.22) occurred more frequently than planned PAL (0.29 ± 0.19) regardless of category or setting (F(1,282) = 83.48, P < .001). They perceived that PAL occurred more frequently in the collegiate clinical (0.46 ± 0.22) than laboratory (0.21 ± 0.24) setting regardless of condition or category (F(1,282) = 217.17, P < .001). Students reported engaging in PAL more frequently in the collegiate clinical (3.31 ± 0.56) than laboratory (3.26 ± 0.62) setting regardless of category (F(1,860) = 13.40, P < .001). We found a main effect for category (F(2,859) = 1318.02, P < .001), with students reporting they engaged in peer modeling (4.01 ± 0.60) more frequently than peer mentoring (2.99 ± 0.88) (P < .001) and peer assessment and feedback (2.86 ± 0.64) (P < .001). CONCLUSIONS: Participants perceived that students engage in unplanned PAL in the collegiate clinical setting with a stronger inclination toward engagement in peer modeling. Educators should develop planned PAL activities to capitalize on the inherent desire of the students to collaborate with their peers.

Preferences for and barriers to formal and informal athletic training continuing education activities.

CONTEXT: Our previous research determined the frequency of participation and perceived effect of formal and informal continuing education (CE) activities. However, actual preferences for and barriers to CE must be characterized. OBJECTIVE: To determine the types of formal and informal CE activities preferred by athletic trainers (ATs) and barriers to their participation in these activities. DESIGN: Cross-sectional study. SETTING: Athletic training practice settings. PATIENTS OR OTHER PARTICIPANTS: Of a geographically stratified random sample of 1000 ATs, 427 ATs (42.7%) completed the survey. MAIN OUTCOME MEASURE(S): As part of a larger study, the Survey of Formal and Informal Athletic Training Continuing Education Activities (FIATCEA) was developed and administered electronically. The FIATCEA consists of demographic characteristics and Likert scale items (1 = strongly disagree, 5 = strongly agree) about preferred CE activities and barriers to these activities. Internal consistency of survey items, as determined by Cronbach α, was 0.638 for preferred CE activities and 0.860 for barriers to these activities. Descriptive statistics were computed for all items. Differences between respondent demographic characteristics and preferred CE activities and barriers to these activities were determined via analysis of variance and dependent t tests. The α level was set at .05. RESULTS: Hands-on clinical workshops and professional networking were the preferred formal and informal CE activities, respectively. The most frequently reported barriers to formal CE were the cost of attending and travel distance, whereas the most frequently reported barriers to informal CE were personal and job-specific factors. Differences were noted between both the cost of CE and travel distance to CE and all other barriers to CE participation (F(1,411) = 233.54, P < .001). CONCLUSIONS: Overall, ATs preferred formal CE activities. The same barriers (eg, cost, travel distance) to formal CE appeared to be universal to all ATs. Informal CE was highly valued by ATs because it could be individualized.

Formal and informal continuing education activities and athletic training professional practice.

CONTEXT: Continuing education (CE) is intended to promote professional growth and, ultimately, to enhance professional practice. OBJECTIVE: To determine certified athletic trainers' participation in formal (ie, approved for CE credit) and informal (ie, not approved for CE credit) CE activities and the perceived effect these activities have on professional practice with regard to improving knowledge, clinical skills and abilities, attitudes toward patient care, and patient care itself. DESIGN: Cross-sectional study. SETTING: Athletic training practice settings. PATIENTS OR OTHER PARTICIPANTS: Of a geographic, stratified random sample of 1000 athletic trainers, 427 (42.7%) completed the survey. MAIN OUTCOME MEASURE(S): The Survey of Formal and Informal Athletic Training Continuing Education Activities was developed and administered electronically. The survey consisted of demographic characteristics and Likert-scale items regarding CE participation and perceived effect of CE on professional practice. Internal consistency of survey items was determined using the Cronbach alpha (alpha = 0.945). Descriptive statistics were computed for all items. An analysis of variance and dependent t tests were calculated to determine differences among respondents' demographic characteristics and their participation in, and perceived effect of, CE activities. The alpha level was set at .05. RESULTS: Respondents completed more informal CE activities than formal CE activities. Participation in informal CE activities included reading athletic training journals (75.4%), whereas formal CE activities included attending a Board of Certification-approved workshop, seminar, or professional conference not conducted by the National Athletic Trainers' Association or affiliates or committees (75.6%). Informal CE activities were perceived to improve clinical skills or abilities and attitudes toward patient care. Formal CE activities were perceived to enhance knowledge. CONCLUSIONS: More respondents completed informal CE activities than formal CE activities. Both formal and informal CE activities were perceived to enhance athletic training professional practice. Informal CE activities should be explored and considered for CE credit.

Athletic training approved clinical instructors' reports of real-time opportunities for evaluating clinical proficiencies.

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

Evaluation of athletic training students' clinical proficiencies.

CONTEXT: Appropriate methods for evaluating clinical proficiencies are essential in ensuring entry-level competence. OBJECTIVE: To investigate the common methods athletic training education programs use to evaluate student performance of clinical proficiencies. DESIGN: Cross-sectional design. SETTING: Public and private institutions nationwide. PATIENTS OR OTHER PARTICIPANTS: All program directors of athletic training education programs accredited by the Commission on Accreditation of Allied Health Education Programs as of January 2006 (n = 337); 201 (59.6%) program directors responded. DATA COLLECTION AND ANALYSIS: The institutional survey consisted of 11 items regarding institutional and program demographics. The 14-item Methods of Clinical Proficiency Evaluation in Athletic Training survey consisted of respondents' demographic characteristics and Likert-scale items regarding clinical proficiency evaluation methods and barriers, educational content areas, and clinical experience settings. We used analyses of variance and independent t tests to assess differences among athletic training education program characteristics and the barriers, methods, content areas, and settings regarding clinical proficiency evaluation. RESULTS: Of the 3 methods investigated, simulations (n = 191, 95.0%) were the most prevalent method of clinical proficiency evaluation. An independent-samples t test revealed that more opportunities existed for real-time evaluations in the college or high school athletic training room (t(189) = 2.866, P = .037) than in other settings. Orthopaedic clinical examination and diagnosis (4.37 +/- 0.826) and therapeutic modalities (4.36 +/- 0.738) content areas were scored the highest in sufficient opportunities for real-time clinical proficiency evaluations. An inadequate volume of injuries or conditions (3.99 +/- 1.033) and injury/condition occurrence not coinciding with the clinical proficiency assessment timetable (4.06 +/- 0.995) were barriers to real-time evaluation. One-way analyses of variance revealed no difference between athletic training education program characteristics and the opportunities for and barriers to real-time evaluations among the various clinical experience settings. CONCLUSIONS: No one primary barrier hindered real-time clinical proficiency evaluation. To determine athletic training students' clinical proficiency for entry-level employment, athletic training education programs must incorporate standardized patients or take a disciplined approach to using simulation for instruction and evaluation.

Role strain in collegiate athletic training approved clinical instructors.

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

Peer-assisted learning and orthopaedic evaluation psychomotor skills.

CONTEXT: Athletic training educators often anecdotally suggest that athletic training students enhance their learning by teaching their peers. However, peer-assisted learning (PAL) has not been examined within athletic training education to provide evidence for PAL's current use or for its use as a pedagogic tool. OBJECTIVE: To assess the effectiveness of intentional, formal PAL on the performance of psychomotor skills and to identify students' perceptions of PAL. DESIGN: Randomized, pretest-posttest experimental design. SETTING: Athletic Training Research and Education Laboratory. PATIENTS OR OTHER PARTICIPANTS: Fifty-one undergraduate students (27 athletic training majors, 24 nonmajors). INTERVENTION(S): Review sessions led by either an Approved Clinical Instructor or peer tutor. MAIN OUTCOME MEASURE(S): We assessed pretest and posttest performance scores (number of correct skills) and the amount of time to complete the psychomotor skills in 3 categories of orthopaedic evaluation of the hand and wrist for subjects assigned to either a peer tutor or an Approved Clinical Instructor review group. Using the Athletic Training Peer-Assisted Learning Assessment Survey, we evaluated the perceptions of students assigned to the peer-tutor group regarding the benefits of, and preferences for, PAL. RESULTS: Differences in the pretest-posttest skill scores were noted in both groups (P < .05). No differences in the posttest skills scores or the times to perform the skills were seen between the groups. The Athletic Training Peer-Assisted Learning Assessment Survey revealed that most (n = 19, 70.4%) of the subjects felt less anxious when practicing psychomotor skills with peer tutors than with the laboratory instructor, and many students (n = 12, 44.4%) felt more self-confident when practicing psychomotor skills with a peer tutor. CONCLUSIONS: Peer-assisted learning appears to be a valid method for improving athletic training psychomotor skills. Peers can be resources for practicing clinical skills and report benefiting from the collaboration. Peer-assisted learning should be deliberately integrated into athletic training education programs to enhance student learning and collaboration.

Peer-assisted learning in the athletic training clinical setting.

CONTEXT: Athletic training educators often anecdotally suggest that athletic training students enhance their learning by teaching their peers. However, peer-assisted learning (PAL) has not been examined within athletic training education in order to provide evidence for its current use or as a pedagogic tool. OBJECTIVE: To describe the prevalence of PAL in athletic training clinical education and to identify students' perceptions of PAL. DESIGN: Descriptive. SETTING: "The Athletic Training Student Seminar" at the National Athletic Trainers' Association 2002 Annual Meeting and Clinical Symposia. PATIENTS OR OTHER PARTICIPANTS: A convenience sample of 138 entry-level male and female athletic training students. MAIN OUTCOME MEASURE(S): Students' perceptions regarding the prevalence and benefits of and preferences for PAL were measured using the Athletic Training Peer-Assisted Learning Assessment Survey. The Survey is a self-report tool with 4 items regarding the prevalence of PAL and 7 items regarding perceived benefits and preferences. RESULTS: A total of 66% of participants practiced a moderate to large amount of their clinical skills with other athletic training students. Sixty percent of students reported feeling less anxious when performing clinical skills on patients in front of other athletic training students than in front of their clinical instructors. Chi-square analysis revealed that 91% of students enrolled in Commission on Accreditation of Allied Health Education Programs-accredited athletic training education programs learned a minimal to small amount of clinical skills from their peers compared with 65% of students in Joint Review Committee on Educational Programs in Athletic Training-candidacy schools (chi2(3) = 14.57, P < .01). Multiple analysis of variance revealed significant interactions between sex and academic level on several items regarding benefits and preferences. CONCLUSIONS: According to athletic training students, PAL is occurring in the athletic training clinical setting. Entry-level students are utilizing their peers as resources for practicing clinical skills and report benefiting from the collaboration. Educators should consider deliberately integrating PAL into athletic training education programs to enhance student learning and collaboration.

Athletic training students in the college/ university setting and the scope of clinical education.

CONTEXT: Athletic training education programs must provide the proper type and amount of clinical supervision in order for athletic training students to obtain appropriate clinical education and to meet Board of Certification examination requirements. OBJECTIVE: To assess athletic training students' perceptions of the type and amount of clinical supervision received during clinical education. DESIGN: Cross-sectional design. SETTING: 124 CAAHEP-accredited NCAA institutions. PATIENTS OR OTHER PARTICIPANTS: We obtained a national stratified random sample (by National Athletic Trainers' Association district) of undergraduate athletic training students from 61 Commission on Accreditation of Allied Health Education Programs-accredited athletic training education programs. A total of 851 athletic training students participated in the study. MAIN OUTCOME MEASURE(S): Differences among athletic training students with first-aider/provider qualifications, student supervision during moderate-risk and increased-risk sports, program/institutional characteristics, type and amount of clinical supervision, and students' academic level and mean percentage of time spent in different types of clinical supervision. RESULTS: A total of 276 (32.4%) of the students reported that they supplied medical care and athletic training-related coverage beyond that of a first aider/provider. Athletic training students stating that they traveled with teams without supervision numbered 342 (40.2%). A significant difference was noted between the amount of supervision reported by sophomore and senior students ( P < .01). CONCLUSIONS: Athletic training students do not seem to be receiving appropriate clinical supervision and are often acting outside the scope of clinical education.

Importance and applicability of approved clinical instructor standards and criteria to certified athletic trainers in different clinical education settings.

CONTEXT: For optimal clinical education of athletic training students, Clinical Instructor Educators and program directors need to proactively select, train, and evaluate their Approved Clinical Instructors (ACIs). OBJECTIVE: To assess the relative importance and applicability of ACI standards to certified athletic trainers employed in different athletic training clinical education settings. DESIGN: Respondents rated and ranked the importance and applicability of the 7 standards presented by Weidner and Henning. Crucial standards to warrant dropping an ACI from the clinical education program were also listed. SETTING: Mailed questionnaire. PATIENTS OR OTHER PARTICIPANTS: A total of 55 program directors invited their ACIs, representing different types of clinical settings, to complete the questionnaire. Of the 399 ACIs who responded, 30 (8%) worked in clinics, 50 (13%) in high schools, and 319 (79%) in colleges or universities. MAIN OUTCOME MEASURE(S): We compared the mean scores of the importance and applicability ratings and rankings by employment setting. Chi-square analyses were calculated to measure associations between employment settings and whether a standard was crucial. Respondents' comments were also assessed. RESULTS: No significant differences were noted among employment settings for overall importance and applicability ratings. A difference was seen for only interpersonal relationships, with clinic and high school respondents giving this standard higher importance and applicability ratings than college/university respondents. No associations were shown between the settings and whether a standard was marked as crucial. The importance of a standard and barriers to implementing a standard (particularly ACI role strain) were the most common themes. CONCLUSIONS: The Weidner and Henning standards are considered to be important and applicable across a variety of athletic training clinical education settings. Legal and ethical behavior was considered the most crucial standard. The ACIs seemed to be encountering role strain in their dual roles as clinicians and clinical instructors, a problem warranting further investigation.

Development of Standards and Criteria for the Selection, Training, and Evaluation of Athletic Training Approved Clinical Instructors.

OBJECTIVE: To develop standards and associated criteria for the selection, training, and evaluation of athletic training approved clinical instructors (ACIs). DESIGN AND SETTING: A previously developed set of 7 physical therapy clinical instructor standards/criteria and 2 additional standards/criteria developed through a review of the literature were systematically adapted, judged, and revised through a Delphi technique. SUBJECTS: Athletic training education experts currently employed as program directors for entry-level Commission on Accreditation of Allied Health Education Programs-accredited athletic training educational programs and who had the following: a doctoral degree, at least 5 years of supervising athletic training students, and familiarity/experience with clinical instruction in various athletic training clinical education settings. MEASUREMENTS: We used panelists' critiques and ratings to make sequential revisions in a series of 3 Delphi rounds. Standards were rated as to whether they were clear, necessary, and appropriate. We rated criteria for the associated standard as to whether they were useful, helpful, clear, specific, and consistent. RESULTS: We developed a final set of 7 standards and 50 associated criteria to measure these standards. The accepted standards include the following: legal and ethical behavior, communication skills, interpersonal relationships, instructional skills, supervisory and administrative skills, evaluation of performance, and clinical skills and knowledge. CONCLUSIONS: The 7 standards and associated criteria developed in this research project could be used not only for selecting, training, and evaluating an ACI but also for developing an understanding of the requirements of clinical education in general. Further research should include validating these standards/criteria among athletic training ACIs representing different types of clinical settings.

Female collegiate windmill pitchers: influences to injury incidence.

Few studies have examined fast-pitch softball pitchers and associated injuries. The aim of this study was to investigate injuries occurring to collegiate softball pitchers and associated influential factors. A web-based survey of 181 Division I (n = 45), II (n = 30), and III (n = 54) collegiate softball pitchers was conducted. The survey involved self-reported data from the previous year that addressed (a) demographic information, (b) pitching and game data, (c) training program information, and (d) injury reporting. Demographic information, pitching and game data, and training program information were not statistically significant (p < 0.05) in relation to injury. Descriptive statistics were used to report totals and percentages of pitchers surveyed. Among 131 reported injuries, 36 were acute, 92 chronic/overuse, and 3 unspecified. Of the total injuries, 80 were directly from pitching, with 33 shoulder-related and 16 related to the lower back. Among injured pitchers, 109 took nonsteroidal anti-inflammatory drugs, 140 used modalities, 11 received surgeries, and 95 saw additional specialists. Pitchers are at a risk for injury, with 72.8% of surveyed pitchers being injured during the 2001-02 year.

Historical Perspective of Athletic Training Clinical Education.

OBJECTIVE: To present a historical perspective of the development and evolution of clinical education in the medical and allied health professions, with a special interest in athletic training; to gain a better understanding and appreciation of the depth and breadth of the structured and formal clinical education needed in athletic training, for both the present and the future. DATA SOURCES: Information was drawn from the Educational Resources Information Center (1966-2001), MEDLINE (1966-2001), SPORT Discus (1830-2002), and CINAHL (1982-2002) searches of historical literature relating to the development of medical, allied health, and athletic training clinical education. Key words searched were clinical education, clinical instruction, medical education, allied health education, history of medical education, athletic training education, and history of clerkships. We also used reference materials cited in historical textbooks on medical education. DATA SYNTHESIS: Clinical education in American medical schools evolved from a primarily didactic process to the clinical-clerkship model. In contrast, athletic training professional preparation was initially more steeped in clinical experiences and less in didactic instruction. CONCLUSIONS/RECOMMENDATIONS: Reviewing medical education over the past century and allied health clinical education over the past 30 years provides interesting insights about the past, present, and future of athletic training professional preparation. Athletic training clinical education is undergoing reform and development, which will subsequently enhance the profession. Athletic training has entered an exciting era in its history.

Clinical Supervision of Athletic Training Students at Colleges and Universities Needs Improvement.

OBJECTIVES: To assess the type and amount of clinical supervision athletic training students received during clinical education. DESIGN AND SETTING: An online survey was conducted with a questionnaire developed specifically for this study. SUBJECTS: Head athletic trainers from National Collegiate Athletic Association Division I (28), Division II (34), and Division III institutions (30). Thirty-four represented Commission on the Accreditation of Allied Health Education Programs-accredited athletic training education programs, 20 represented athletic training programs in Joint Review Commission on Athletic Training candidacy, and 35 offered the internship route. MEASUREMENTS: Descriptive statistics were computed. Three sets of chi-square analyses were completed to assess associations among athletic training students with first-responder qualifications, program and institution characteristics, certified athletic trainer medical coverage of moderate- and increased-risk sports, and clinical supervision. A trend analysis of students' class standing and time spent in different types of clinical supervision was also completed. The alpha level was set at <.05. RESULTS: Most of the athletic training students (83.7%), particularly in accredited programs, had first-responder qualifications. More than half of the head athletic trainers (59.8%) indicated that athletic training students were authorized to provide medical care coverage without supervision. A minimal amount of medical care coverage of moderate- and increased-risk sports was unsupervised. No significant difference between the size of the education or athletic program and type and amount of clinical supervision was noted. Freshman athletic training students spent more time in direct clinical supervision and less time in unsupervised experience, but the opposite was true for senior students. CONCLUSIONS: Athletic training students are being utilized beyond appropriate clinical supervision and the scope of clinical education. Future research should employ methods using nonparticipant observation of clinical instructors' supervision of students as well as students' own perceptions of their clinical supervision.

Clinical-Education-Setting Standards Are Helpful in the Professional Preparation of Employed, Entry-Level Certified Athletic Trainers.

OBJECTIVE: To determine the helpfulness of clinical-education-setting standards in the professional preparation of entry-level certified athletic trainers. DESIGN AND SETTING: We developed a 22-item questionnaire based on the 12 standards presented by Weidner and Laurent. Subjects used a Likert scale (0 = no help, 5 = very helpful) to indicate their perceptions of the helpfulness of each standard in preparing them for their roles and responsibilities as certified athletic trainers. SUBJECTS: We surveyed employed, entry-level certified athletic trainers who recently completed Commission on Accreditation of Allied Health Education Programs-accredited athletic training education programs. MEASUREMENTS: Percentage means were computed for the helpfulness ratings of each standard. A percentage mean was computed for the overall contribution of clinical education to professional development. Chi-square analyses were used to assess the differences in helpfulness ratings among respondents. RESULTS: The overall mean score across all standards was 4.17. No significant differences in the helpfulness ratings of any of the respondents were noted regardless of sex, ethnicity, number of clinical-education hours, total semesters of clinical education, settings in which students gained clinical experience, or current employment (P