Preparticipation Cardiovascular Screening: An Infrastructure Assessment in Collegiate Athletics.

OBJECTIVE: To assess the available infrastructure for secondary testing after preparticipation cardiovascular screening of collegiate athletes. DESIGN: Cross-sectional study. SETTING: National Collegiate Athletic Association (NCAA) athletic programs PARTICIPANTS:: Team physicians. INTERVENTIONS: Online survey distributed by the NCAA and American Medical Society for Sports Medicine. MAIN OUTCOME MEASURES: Availability of secondary cardiovascular diagnostic testing and services. RESULTS: Team physicians from 235 schools completed the assessment, representing 21% of all NCAA schools. Ninety (38.3%) NCAA team physicians reported screening athletes using electrocardiogram (ECG). Division I schools were more likely than Division II and III schools to perform both screening ECG (RR, 2.38, P < 0.0001) and echocardiogram (RR, 2.83, P = 0.01). More than 97% of schools had access to resting echocardiogram, stress ECG/echocardiogram, and Holter monitoring within 25 miles with no significant variability between divisions, regions, or size of undergraduate student body. Cardiac magnetic resonance imaging and electrophysiology studies were available within 25 miles of more than 80% of schools, and genetics testing was available within 25 miles for 64.8%. CONCLUSIONS: Secondary testing for cardiovascular abnormalities seems to be readily available for NCAA athletes, regardless of division, region, or school size.

Key factors affecting the integration of interprofessional education into human resources for health reform: a Lao People's Democratic Republic case study.

Lao People's Democratic Republic (Lao PDR) with a population of 6.8 million is a low middle-income country in Southeast Asia. Despite economic development, Lao PDR is still characterized by a weak health system. The Ministry of Health has launched health reforms to provide better health services and University of Health Sciences (UHS) plays an essential role in Human Resources for Health (HRH) reform. Especially, the importance of its role in training health professionals from entry-level to continuing education has been increased. In 2016, the UHS embedded an Interprofessional Education (IPE) concept into a pre-qualifying course, in collaboration with the World Health Organization and the Gunma University Centre for Research and Training on IPE. As a pilot study, some students from faculties of Medicine, Pharmacy, Dentistry, Nursing, and Medical Technology participated in a community-based IPE program. Results suggested that students participating in the IPE program showed more positive attitudes toward collaborative practice than students who did not participate in the IPE program. Based on the results, the UHS is planning to develop an IPE program for health workers. In this article, we describe the strategic international collaboration and discuss the keys to successful IPE planning and implementation in line with HRH reform.

Community-oriented medical education: bringing perspectives to curriculum planners in Damascus University.

The varying health needs in Syria because of the trend of increasing communicable and noncommunicable diseases necessitate new curricula for all health professions schools in which community health needs, socio-cultural aspects of health and disease can be emphasized. There is a need to produce more primary level healthcare professionals who are trained to apply the principles, policies and strategies of the World Health Organization and achieve better health for all. A new perspective in the Faculty of Dentistry in Damascus University has been suggested and is presented here. Graduates generally are not well prepared to provide primary level healthcare in the community. Community-oriented medical education (COME) can produce health-oriented professionals who are equipped with broad skills and able to work for health promotion, disease prevention, and cure. Health orientation is one of the most radical features of COME, wherein the curriculum is appropriate to learners' future practice in the community. Community orientation enables students to become more people focused so that they can work towards people's self-empowerment, change people's attitudes and behaviors, and improve their self-awareness and esteem. This viewpoint addresses the importance of redesigning the dental curriculum and the need to implement COME in Damascus University. It is proposed as an example of changes needed in all health professions schools in Syria. The call to redesign the curricula to serve the health needs of the Syrian population will be difficult to achieve but is vital. Improving our understanding of the concept of COME and having all sectors of government and society commit to it will make the transition possible and will make the COME a reality.

[The Luxembourg Society for Sports Medicine (SLM) after 60 years]. / La société Luxembourgeoise de Medecine du Sport (SLMS) a 60 ans.

This review will mainly focus the last 10 years of the society's history because several important changes occurred during this relatively short period. The most important was the creation of the first clinical sports medicine department in Luxembourg in 2004. This modern new infrastructure was made possible by the recruitment of 2 highly competent sports physicians, the excellent collaboration of the governing board of the Centre Hospitalier de Luxembourg (CHL) and the support of the sports minister. In 2008 the new department received the label "Medical Olympic Centre of Luxembourg". One year later a Research Lab of Sports Medicine (CRP-Santé) completed the new concept. Thus within 4 years the structure of Luxembourgish sports medicine was completely rearranged and includes today orthopaedic surgery and traumatology, functional rehabilitation, sports cardiology, exercise physiology, physiotherapy and specific sports medicine research. An important new challenge of the SLMS will be to integrate the external sports physicians into this new infrastructure. Another ongoing mission of the SLMS will be the education and training of new young sports medicine specialists. Here the new department could play an outstanding role and the SLMS is in close negotiations with the University of Luxembourg, in charge of academic education in Luxembourg. A recruitment of new young sports physicians is necessary to perpetuate the routine sports medicine exams in the 15 regional centres in Luxembourg, where such an exam is mandatory in order to get an official sports licence. Since 2010 an ECG exam has been added for all new licence candidates, according to the recent recommendations of the scientific societies. New young sports physicians will also be needed to assure the medical attendance of the different national teams of Luxembourg. Until 1985 these activities were confined only to the Olympic teams every 4 years, but since the implementation of the Games of the Small European Countries in 1985, where rather big teams represent Luxembourg every two years, this mission has become more important. The history of the SLMS reflects the development both of sports and sports medicine during the last 60 years. At the beginning of the 21.century sports medicine is well settled in the Grand-duchy of Luxembourg.

[Investigation indicators of physical activity in different categories of students].

The article presents the results of the study of dynamics of changes in the basic indicators of physical activity in different age groups of students studying in secondary schools, colleges and universities of the country. The studies revealed that there were three periods when naturally there is a temporary decrease in physical activity of students and changes in its structure. The reasons for this are the child's adaptation to the conditions of education in elementary school, intensive preparation of the alder pupils for entry to higher education and the lack of an effective system of independent physical training graduate students in most universities. Due to fact that there are objective reasons for these periods is explained by the need to develop special training programs for the respective categories of students.

Challenges Faced by Collegiate Athletic Trainers, Part I: Organizational Conflict and Clinical Decision Making.

CONTEXT: Organizational conflict, particularly between coaches and medical professionals, has been reported in collegiate athletics. Different values create room for conflict between coaches and athletic trainers (ATs); however, ATs' experiences when making medical decisions are not fully understood. OBJECTIVE: To investigate the presence of organizational conflict regarding medical decision making and determine if differences exist across athletic affiliations. DESIGN: Cross-sectional study. SETTING: Collegiate athletics (National Collegiate Athletic Association [NCAA], National Association of Intercollegiate Athletics [NAIA], National Junior College Athletic Association [NJCAA]). PATIENTS OR OTHER PARTICIPANTS: A total of 434 ATs responded (age = 27.7 ± 3.2 years, years certified = 5.2 ± 2.7), representing the NCAA Division I (DI; n = 199), Division II (DII; n = 67), Division III (DIII; n = 108); NAIA (n = 37); and NJCAA (n = 23) settings. MAIN OUTCOME MEASURE(S): The survey instrument contained quantitative measures and open-ended questions, with affiliation as our primary independent variable. Responses to Likert-scale questions (1 = strongly agree, 5 = strongly disagree) regarding organizational pressures within athletics served as the dependent variables. Kruskal-Wallis analysis-of-variance and Mann-Whitney U post hoc tests assessed differences in organizational conflict across affiliations. Open-ended questions were analyzed inductively. RESULTS: We obtained a 14.47% (434 of 3000) response rate. National Collegiate Athletic Association DI ATs disagreed less than NCAA DII and DIII and NJCAA ATs that they would worry about job security if turnover in the head coaching position occurred (P < .05). Regarding the influence of coaches on job performance, differences were found between NCAA DI and DIII and between DI and NJCAA ATs (P < .01). Visibility of the injury and situational factors influenced the level of perceived pressure. CONCLUSIONS: Athletic trainers perceived pressure from coaches regarding medical decision making. Division I ATs placed greater emphasis on the role that coaches played in their job performance and job security. Athletic departments should consider transitioning to patient-centered models of care to better align values and reduce the external pressures placed on ATs.

Challenges Faced by Collegiate Athletic Trainers, Part II: Treating Concussed Student-Athletes.

CONTEXT: Conflict between athletic trainers (ATs) and other stakeholders can occur because of competing interests over medical decisions regarding concussion. However, we are unaware of any studies specifically exploring these situations across various collegiate athletic affiliations. OBJECTIVE: To investigate the challenges faced by ATs when treating concussed student-athletes. DESIGN: Qualitative study. SETTING: Online questionnaire. PATIENTS OR OTHER PARTICIPANTS: A total of 434 ATs (267 women, 166 men, 1 missing data; age = 27.73 ± 3.24 years, experience = 5.17 ± 2.67 years) completed the questionnaire (response rate = 14.47%). Our participants represented multiple employment settings within intercollegiate athletics. DATA COLLECTION AND ANALYSIS: We sent an online questionnaire to 3000 ATs working in the collegiate and university setting across the United States. A survey expert verified face, content, and construct validity of the questionnaire in 2 rounds of review, and 3 ATs completed a content-validity tool before we finalized the survey. We analyzed the qualitative data using a general inductive approach and ensured trustworthiness through multiple-analyst triangulation and peer review. RESULTS: When we examined the responses from our participants regarding their work with student-athletes who had sustained concussions, we found 2 major themes, each with subthemes. First, educational efforts appeared to be only modestly effective because of a lack of honesty, noncompliant actions, and coach interference. Second, return to learn was challenging because of a lack of communication among stakeholders, athletes being anxious about needing accommodations, and difficulty convincing faculty to provide reasonable accommodations. CONCLUSIONS: Based on our findings, we recommend continued efforts to improve the culture surrounding concussion in collegiate athletes. Athletic trainers should include key stakeholders such as coaches, student-athletes, parents, faculty, and other educational administrators in their educational efforts to improve the policies and culture surrounding concussion treatment.

Collegiate Athletic Trainers' Experiences With External Pressures Faced During Decision Making.

CONTEXT: Conflict is prevalent between sports medicine professionals and coaching staffs regarding return-to-play decisions for athletes after injury in the National Collegiate Athletic Association (NCAA) Division I setting. The firsthand experiences of athletic trainers (ATs) regarding such conflict have not been fully investigated. OBJECTIVE: To better understand the outside pressures ATs face when making medical decisions regarding patient care and return to play after injury in the NCAA Division I Football Bowl Subdivision (FBS) setting. DESIGN: Qualitative study. SETTING: Semistructured one-on-one telephone interviews. PATIENTS OR OTHER PARTICIPANTS: Nine ATs (4 men, 5 women; age = 31 ± 8 years [range = 24-48 years]; years certified = 9 ± 8). DATA COLLECTION AND ANALYSIS: Interviews were audio recorded and later transcribed. Thematic analysis was completed phenomenologically. Researcher triangulation, peer review, and member checks were used to establish trustworthiness. RESULTS: Two major themes emerged from the qualitative analysis: (1) pressure is an expected component of the Division I FBS AT role, and (2) strategies can be implemented to mitigate the negative effects of pressure. Three subthemes supported the second major theme: (1) ensuring ongoing and frequent communication with stakeholders about an injured athlete's status and anticipated timeline for return to play, (2) providing a rationale to coaches or administrations to foster an understanding of why specific medical decisions are being made, and (3) establishing positive relationships with coaches, athletes, and administrations. CONCLUSIONS: External pressure regarding medical decisions was an anticipated occurrence for our sample. Such pressure was described as a natural part of the position, not negative but rather a product of the culture and environment of the Division I FBS setting. Athletic trainers who frequently face pressure from coaches and administration should use the aforementioned strategies to improve the workplace dynamic and foster an environment that focuses on patient-centered care.

Use of a flipped classroom in ophthalmology courses for nursing, dental and medical students: A quasi-experimental study using a mixed-methods approach.

BACKGROUND: Traditional teaching is associated with dilemmas, such as low motivation to learn and passive learning. In contrast, use of a flipped classroom with the proper learning design has the potential to promote accelerated learning, bolster transmission of competencies (i.e., critical thinking, communication and problem-solving skills) and improve teamwork capacity, all of which are of great significance in professional healthcare practice, including nursing, dentistry and medicine. OBJECTIVE: The aim of the study was to examine the effects of using a flipped classroom in ophthalmology courses for undergraduate nursing students, dental students and higher vocational medical students. DESIGN: A quasi-experimental design was used with an intervention (n = 100) and a comparison group (n = 100), pre-/post-testing measures and a mixed-methods approach. SETTING: A university in China. PARTICIPANTS: A total of 200 students were included. METHODS: Students' self-rated learning ability was measured before and after the courses, and skill exams were performed after the courses. In addition, interviews were conducted with the clinical medical students concerning their experiences of the flipped classroom. RESULTS: Students' self-rated learning ability improved significantly more in the intervention than in the comparison group, for the total scale and the three factors 'learning goals', 'self-efficacy and social learning' and 'problem-solving'. Skill exam scores were statistically significantly better in the intervention than in the comparison group. On the whole, the clinical medicine students felt the flipped classroom had a positive impact and improved their learning ability as well as knowledge in ophthalmology. CONCLUSIONS: Use of a flipped classroom for nursing, dental and clinical medical students in ophthalmology courses shows promising results in the form of students' skill exam scores and self-rated learning ability.

[Commemorating the foundation of the dental clinics. I. The foundation of the stomatology clinic (in Budapest, Hungary)]. / Az egyetemi fogászati klinikák alapításának évfordulóira I. A stomatológiai klinika megalapítása.

The roots of the Hungarian dental education date from the mid-19th century. After several unsuccessful attempts, the University Dental Institution was founded in 1890 under the leadership of József Akovy in provisional premises. To improve the bad infrastructural circumstances, a new building was erected in February 1909 to accommodate the new Clinic of Stomatology.

A Collaborative Approach to Assess Legacy Pollution in Communities Near a Lead-Acid Battery Smelter: The "Truth Fairy" Project.

Advocates for civil rights, environmental justice, and movements promoting social justice require data and may lack trust in public authorities, turning instead to academic scientists to help address their questions. Assessing historical exposure to toxic chemicals, especially in situations of a specific industrial source of pollution affecting a community, is critical for informing appropriate public health and policy responses. We describe a community-driven approach to integrate retrospective environmental hazard exposure assessment with community organizing to address concerns about the extent of exposure to toxic metals in a predominantly working-class, Latinx community living near a now-closed lead-acid battery smelter facility. Named the "Truth Fairy Project" by leaders of the community organization East Yard Communities for Environmental Justice, this community-university partnership aimed to assess prenatal and early-life exposures to toxic metals through biomarkers of exposure in baby/deciduous teeth. This partnership integrated community mobilization with empirical research, informing residents about toxic metal exposures and improving the community's capacity to respond to a public health crisis.

Peer Tutoring for Anatomy Workshops in Cambodia.

Historical loss of staff and teaching resources in Cambodia has resulted in significant challenges to anatomy education. Small group anatomy teaching opportunities are limited. A visit to Cambodia by a teaching team from the University of Melbourne in 2010 demonstrated it was possible to implement well-resourced anatomy workshops for this purpose. However, continuation of the workshop program was inhibited by the limited number of local teaching staff. In 2015, another team from the University of Melbourne returned to Cambodia to implement anatomy workshops that incorporated peer tutoring. The objective was to improve teacher-to-student ratios and to demonstrate that interactive anatomy workshops could be delivered successfully despite low staff numbers. The anatomy workshops were attended by 404 students of Medicine, Dentistry, Nursing, and Midwifery at the University of Puthisastra. Medical students were invited to act as peer tutors for nursing students. A five-point Likert scale questionnaire was used to determine student satisfaction with both the workshops and peer tutoring. The overwhelming majority were positive about the workshops and keen for them to continue. Almost all medical students who acted as peer tutors agreed or strongly agreed that this role increased their anatomical knowledge (98%) and confidence (94%). Most nursing students agreed or strongly agreed with statements that they would like peer tutoring to continue (94%) and that they would like to be peer tutors themselves (88%). This report demonstrates that peer tutoring could be an effective tool in educational settings where poor staff-to-student ratios limit delivery of interactive workshops.

Improving Diversity of Dental Students Through the Boston University Master's of Oral Health Sciences Postbaccalaureate Program.

Boston University Goldman School of Dental Medicine (GSDM), in collaboration with Boston University School of Medicine, introduced the Oral Health Sciences (OHS) pipeline program in 2005 to enhance the academic preparedness of students from underrepresented minority (URM) groups for dental school admission. The aim of this study was to evaluate the OHS program's success in preparing URM students for dental school, as measured by acceptance to dental school and performance in the first and second years. Data on 2005-15 program enrollees were collected from admissions records, the registrar, and the Office of Institutional Research on students' race/ethnicity, undergraduate and OHS grade point average (GPA), and Dental Admission Test (DAT) scores. Acceptance to dental school and performance at GSDM for non-URM OHS graduates, URM OHS graduates, and non-OHS dental students were compared. A total of 55 URM students completed the OHS program during this period, with 49 successfully matriculating to a dental school in the U.S. and 33 attending GSDM. Average OHS GPA was higher for those URM students accepted to dental school than for those who did not gain admission (3.36±0.30 vs. 2.94±0.19). Evaluation of the academic performance of URM OHS students in the first year (p=0.13) and second year (p=0.88) at GSDM showed that these students performed as well as the non-OHS and non-URM OHS students. These results demonstrate that the OHS master's program serves as a successful credential-enhancing program for dental school applicants, while also serving as a pipeline to increase the number of qualified applicants from URM groups.

Bullying experiences of dental interns working at four dental institutions of a developing country: A cross-sectional study.

BACKGROUND: Bullying is an aggressive and violent behavior marked by repetitive harassment of a weaker victim, which may also occur in the workplace including healthcare settings. Although extensively studied in the west, bullying of workers in the healthcare setting is largely underexplored in the South Asian context. OBJECTIVE: The aim of our study was to explore the phenomena of workplace bullying among dental interns in selected dental institutes of Karachi, Pakistan. METHODS: A cross-sectional study was conducted among dental interns working at four dental institutions in Karachi, Pakistan. The Negative acts questionnaire (NAQ-R), a standardized, validated tool was administered to identify bullying experiences among dental interns over the past six months; in addition, demographic information of participants as well as details about their exposure to bullying was collected. A multivariable binary logistic regression was used to identify the correlates of bullying in this population. The study was performed and reported according to the STROBE guidelines. Data was analyzed using STATA 12.0 and SPSS 19.0. RESULTS: A total of 125 participants were included in our analysis. Bullying prevalence among dental interns based on the operational definition by Mikkelsen stood at 36.8%, while self-labelled bullying was observed in 55 %. Males and participants from private institutions were more likely to self-label themselves as victims. 67% of respondents reported having witnessed bullying. Clinical faculty was identified as the most common perpetrator (23%) followed by colleagues 20% and the dental support staff 17%. Report of bullying among victims was low (14.5%) the most common reason being that "complaining is of no use" (28.8%) and "being afraid of the consequences" (22%). CONCLUSIONS: The results of the study indicate a high prevalence of bullying in the participating dental institutions. Our results indicate a clear need to implement antiviolence regulations, anti-bullying educational programs and advocate further research on interventions to minimize bullying, enhance learning and professional engagement of interns in dental institutions.

Health anxiety and cyberchondria among Ege University health science students.

It is common among health science students to incorrectly believe that they have contracted certain diseases they have recently studied. This can also be seen in the form of health anxiety and investigating health-related information via the internet. Health anxiety, cyberchondria and affecting factors are determined among health science students. The study was conducted at the faculties of Medicine, Pharmacy, Dentistry and Nursing in 2016-2017 with the participation of 874 students. The data were gathered using a questionnaire as well as health anxiety and cyberchondria severity scales. In the presence of a health problem, 14.2% of students seek health information via the internet. 83.7% use mobile phone to access the internet, » of students conduct health scanning once a week or more. To 65.4%, internet information is correct at medium and above level. No statistically significant difference was found with respect to students' gender, high school, places they lived before, parents' education and scales' scores. The cyberchondria scores of students with health problems are higher in the whole scale and in "distress and mistrust of medical professional" subscales. As the frequency of scanning on the internet increases, the scores of cyberchondria also increase significantly. Medical students had significantly higher scores in "distress, excessiveness and reassurance" subscales. Male students' "mistrust of medical professional and compulsion" subscales scores were also higher. It was determined that the presence of the health problem was effective on the cyberchondria. Identification of somatoform problems like health anxiety and cyberchondria may help to regulate the education program.

Philosophical reflections on the mission of the European College of Sport Science: Challenges and opportunities.

The European College of Sport Science (ECSS) was established in part to promote the integrated study of sports and related phenomena from multi- and interdisciplinary perspectives. There are significant and enduring philosophical, epistemological and professional challenges and opportunities that arise from this integrationist perspective. In this article, we reflect upon the challenges that have arisen in the development of sport sciences in the attempt to realize the ECSS mission. We identify three paradigmatic approaches to sports science: (1) the mechanistic; (2) the hermeneutic and (3) the critical. We critically evaluate these paradigms and their potential within the broad framework of integrationist ambitions for sports science as a scientific field.

A National Study on the Effects of Concussion in Collegiate Athletes and US Military Service Academy Members: The NCAA-DoD Concussion Assessment, Research and Education (CARE) Consortium Structure and Methods.

BACKGROUND: The natural history of mild traumatic brain injury (TBI) or concussion remains poorly defined and no objective biomarker of physiological recovery exists for clinical use. The National Collegiate Athletic Association (NCAA) and the US Department of Defense (DoD) established the Concussion Assessment, Research and Education (CARE) Consortium to study the natural history of clinical and neurobiological recovery after concussion in the service of improved injury prevention, safety and medical care for student-athletes and military personnel. OBJECTIVES: The objectives of this paper were to (i) describe the background and driving rationale for the CARE Consortium; (ii) outline the infrastructure of the Consortium policies, procedures, and governance; (iii) describe the longitudinal 6-month clinical and neurobiological study methodology; and (iv) characterize special considerations in the design and implementation of a multicenter trial. METHODS: Beginning Fall 2014, CARE Consortium institutions have recruited and enrolled 23,533 student-athletes and military service academy students (approximately 90% of eligible student-athletes and cadets; 64.6% male, 35.4% female). A total of 1174 concussions have been diagnosed in participating subjects, with both concussion and baseline cases deposited in the Federal Interagency Traumatic Brain Injury Research (FITBIR) database. CONCLUSIONS: Challenges have included coordinating regulatory issues across civilian and military institutions, operationalizing study procedures, neuroimaging protocol harmonization across sites and platforms, construction and maintenance of a relational database, and data quality and integrity monitoring. The NCAA-DoD CARE Consortium represents a comprehensive investigation of concussion in student-athletes and military service academy students. The richly characterized study sample and multidimensional approach provide an opportunity to advance the field of concussion science, not only among student athletes but in all populations at risk for mild TBI.

Organizational Infrastructure in the Collegiate Athletic Training Setting, Part II: Benefits of and Barriers in the Athletics Model.

CONTEXT: The athletics model, in which athletic training clinical programs are part of the athletics department, is the predominant model in the collegiate athletic training setting. Little is known about athletic trainers' (ATs') perceptions of this model, particularly as it relates to organizational hierarchy. OBJECTIVE: To explore the perceived benefits of and barriers in the athletics model. DESIGN: Qualitative study. SETTING: National Collegiate Athletic Association Divisions I and III. PATIENTS OR OTHER PARTICIPANTS: Eight full-time ATs (5 men, 3 women; age = 41 ± 13 years, time employed at the current institution = 14 ± 14 years, experience as a certified AT = 18 ± 13 years) working in the collegiate setting using the athletics model. DATA COLLECTION AND ANALYSIS: We conducted semistructured interviews via telephone or in person and used a general inductive approach to analyze the qualitative data. Multiple-analyst triangulation and peer review established trustworthiness. RESULTS: Two benefits and 3 barriers emerged from the data. Role identity emerged as a benefit that occurred with role clarity, validation, and acceptance of the collegiate AT personality. Role congruence emerged as a benefit of the athletics model that occurred with 2 lower-order themes: relationship building and physician alignment and support. Role strain, staffing concerns, and work-life conflict emerged as barriers in the athletics model. Role strain occurred with 2 primary lower-order themes: role incongruity and role conflict. CONCLUSIONS: The athletics model is the most common infrastructure for employing ATs in collegiate athletics. Participants expressed positive experiences via character identity, support, trust relationships, and longevity. However, common barriers remain. To reduce role strain, misaligning values, and work-life conflict, ATs working in the athletics model are encouraged to evaluate their relationships with coaches and their supervisor and consider team physician alignment. Moreover, measures to increase quality athletic training staff from a care rather than a coverage standpoint should be considered.

Organizational Infrastructure in the Collegiate Athletic Training Setting, Part III: Benefits of and Barriers in the Medical and Academic Models.

CONTEXT: Academic and medical models are emerging as alternatives to the athletics model, which is the more predominant model in the collegiate athletic training setting. Little is known about athletic trainers' (ATs') perceptions of these models. OBJECTIVE: To investigate the perceived benefits of and barriers in the medical and academic models. DESIGN: Qualitative study. SETTING: National Collegiate Athletic Association Divisions I, II, and III. PATIENTS OR OTHER PARTICIPANTS: A total of 16 full-time ATs (10 men, 6 women; age = 32 ± 6 years, experience = 10 ± 6 years) working in the medical (n = 8) or academic (n = 8) models. DATA COLLECTION AND ANALYSIS: We conducted semistructured telephone interviews and evaluated the qualitative data using a general inductive approach. Multiple-analyst triangulation and peer review were completed to satisfy data credibility. RESULTS: In the medical model, role congruency and work-life balance emerged as benefits, whereas role conflict, specifically intersender conflict with coaches, was a barrier. In the academic model, role congruency emerged as a benefit, and barriers were role strain and work-life conflict. Subscales of role strain included role conflict and role ambiguity for new employees. Role conflict stemmed from intersender conflict with coaches and athletics administrative personnel and interrole conflict with fulfilling multiple overlapping roles (academic, clinical, administrative). CONCLUSIONS: The infrastructure in which ATs provide medical care needs to be evaluated. We found that the medical model can support better alignment for both patient care and the wellbeing of ATs. Whereas the academic model has perceived benefits, role incongruence exists, mostly because of the role complexity associated with balancing teaching, patient-care, and administrative duties.