Context The athletic training profession recently added curricular content standards for emergency care that included drug overdose (DO) management. There is a gap in the literature regarding pedagogy best practices for this skill. Objective To examine the knowledge and skills of athletic training students specific to drug overdose management before and after an educational intervention and a 3-month follow-up. Design Concurrent multimethod crossover (3 periods, 3 interventions) study. Setting Simulation center. Patient or Other Participants Twenty-seven athletic training students (age = 23 ± 1 years) enrolled in a professional athletic training program. Intervention(s) Participants were randomly assigned to 3 groups and engaged in an evidence-based lecture followed by simulation-based training with a debrief. All participants practiced their skills with a part-task trainer, high-fidelity manikin, and in a standardized patient (SP) encounter in varying order based on group allocation. Main Outcome Measure(s) Knowledge assessment (pre, post, final exam), skill assessment (SP encounter, final exam) and written reflection. Data were analyzed using descriptive statistics with nonparametric comparisons of knowledge and skills. Results We identified that athletic training students were able to build and maintain confidence in DO management. Knowledge assessment scores improved from baseline (pre = 21.93 ± 5.39), following the intervention (post = 26.22 ± 5.71) and the final exam (final = 26.70 ± 3.98). We identified a significant difference ( P ≤ .001) in the SP encounter performance by groups, with the group that participated in the part-task trainer followed by the SP encounter having the highest scores. Participants expressed that the SP encounter was the preferred simulation method among learners, despite the stress it induced, as it provided the most realistic scenario. Conclusions The multimodal intervention, regardless of group, enhanced athletic training students’ confidence, knowledge, and skills for DO management. The skill assessment findings suggest that simulation sequencing has a potential benefit.

Context Primary care (PC) and population health have gained attention in athletic training due to gaps in access to PC services within the US health care system. In the literature, it has been suggested that athletic trainers (ATs) in interscholastic athletics provide PC services and are well positioned to contribute to larger goals of PC. However, evaluation of whether care in this setting aligns with the 4Cs of PC—first contact, coordinated, continuous, and comprehensive—is needed. Objective To validate a comprehensive list of health conditions and corresponding presentations an AT may need to recognize during first contact encounters. Design Delphi study. Setting Virtual focus group and asynchronous online rounds. Patients or Other Participants Eight panelists PC-specialized ATs (n = 5), PC sports medicine physicians (n = 2), and PC physicians (n = 1). Main Outcome Measure(s) Round 1 focus group: qualitative feedback on an initial condition list derived from publicly available data and position statements. Rounds 2 through 4: dichotomous voting (80% threshold) on condition inclusion and harm assessments (scale: no, minimal, moderate, or extreme harm). Experts also provided free-text feedback to guide structure and content. In rounds 4 and 5, panelists validated patient presentations, generated using artificial intelligence, for each accepted item. Presentations were validated if 80% of panelists agreed a competent AT should include the condition in their differential. Results Round 1 revealed conditions should be grouped to the level competent ATs are expected to recognize rather than by specific diagnosis. For example, ATs are expected to differentiate between types of heat illness at the point of care but not between arrhythmias. The final list included 86 items, each with harm assessments and validated patient presentations. Conclusions Content validity established for a list of conditions and presentations ATs may need to recognize during first contact encounters. Relevant implications for education, clinical practice, and defining the AT’s role in PC.

Athletic training students must move through a professional socialization process in order to become athletic trainers. Although formal socialization has been found to cultivate aspirations to pursue a career in athletic training, little is known about the impact of informal professional socialization on athletic training students’ professional commitment. Explore athletic training students’ informal professional socialization and their professional commitment to athletic training. Qualitative study. Online interview. Nine second-year professional master’s athletic training students (age = 23.8 ± 1.5 years; men = 1, women = 7, nonbinary participants = 1). Semistructured interviews were conducted, audio recorded, and transcribed. A 3-person analysis team used a multiphase process to create a consensual codebook represented by domains and categories from the responses. Trustworthiness and credibility of the consensus codebook were established through member checking, multianalyst triangulation, and auditing. Three domains emerged from analysis: (1) identity anchoring ; (2) influencers of professional identity ; and (3) identity vision . Before entering the program, the participants anchored their professional identity through interactions with health care professionals, sports, altruism, and personal interests. The clinical environment, interactions with mentors and peers, and professional development experiences influenced their professional identity and commitment when in the program. As a result, some participants identified a breadth of opportunities across various clinical settings and wanted to stay engaged in the profession, whereas some planned to migrate from the clinical practice and leave the profession. Professional commitment in second-year professional master’s athletic training students was reflected in their professional identity formation, a process influenced by both formal and informal professional socialization. Athletic training programs should be cognizant of this impact and formulate strategies based on educational pedagogies and identity formation theories to create a strong professional identity and develop professional commitment.

Context Telehealth is the delivery of health care services at a distance using information and communication technologies to diagnose, treat, and prevent injuries and diseases. Despite its increasing integration into clinical practice and its benefits, telehealth education has yet to catch up in many medical training programs. Objective To explore the lived experiences of physicians and athletic trainers engaged in clinical education who have used telehealth with patients for sports medicine–related care and explore how they believe providers could embed medical and athletic training students for clinical education opportunities when using telehealth. Design Qualitative. Setting Individual interview. Patients or Other Participants We recruited using social media and the National Athletic Trainers’ Association research survey database. In total, 15 health care providers (age = 37 ± 9 years; credentialed experience = 13 ± 7 years) completed the interview. Main Outcome Measure(s) Data were analyzed using the consensual qualitative research method with 3 primary coders, and trustworthiness was established through member checking, multianalyst triangulation, and an external reviewer. Results The analysis revealed 3 domains: justification, observations, and considerations. Participants described how they engaged learners in telemedicine encounters, primarily for observation only, and their approach to telehealth, which was more commonly used for patients who did not require hands-on time. Typically, participants noted their initiation to using telehealth was reactionary and justified their use of telehealth based on the access to patients, such as distance for the patient to the health care provider, time off, and their ability to get to the appointment. Health care operation concerns, patient comfort, and their own self-efficacy were considerations that affected their use of telehealth. Training opportunities were limited both for serving as preceptors and for performing telehealth examinations. Conclusions Preceptors and clinical teachers should be educated on creating meaningful hands-on experiences beyond observation because their efficacy as providers and teachers can deter a learner from these learning opportunities.

IntroductionTransgender and gender diverse people are substantially underrepresented in exercise science research. This limits the inclusivity and generalizability of evidence guiding exercise, physical activity, and physical rehabilitation practices. While prior health research has examined barriers and facilitators to transgender and gender diverse participation, little is known about how transgender and gender diverse individuals perceive exercise science research specifically. The purpose of this qualitative study was to explore factors that may influence transgender and gender diverse individuals' willingness to participate in exercise science research.MethodsUsing a Consensual Qualitative Research approach, we conducted semi-structured interviews with 17 transgender and gender diverse adults recruited via LGBTQIA2S+ university and community organizations in the United States. Data were analyzed via Consensual Qualitative Research methods to identify domains, categories, and subcategories reflecting shared topics and patterns in responses across participants.ResultsThree primary domains emerged: research participation, researcher decisions and behaviors, and safety. Participants described their willingness to participate as influenced by study design features, information clarity, and perceived benefits. Trust in researchers and institutions, inclusive recruitment procedures, and communication were also key facilitators of participation. Barriers included invasive study procedures, exclusionary eligibility criteria, ambiguous recruitment materials, and concerns about gender misclassification or misuse of data. Across domains, perceptions of political, physical, and psychosocial safety served as a central concern through which participants evaluated research opportunities. Participants emphasized that respectful communication, inclusive research practices, privacy protections, and culturally competent researchers were essential for safe and affirming research environments.DiscussionOur findings highlight the importance of intentional inclusivity in exercise science research design and recruitment. Implementing transparent communication, community-engaged recruitment, inclusive practices, and trauma-informed procedures may improve participation and representation of transgender and gender diverse individuals in exercise science research. Enhancing inclusion may address ethical responsibilities and strengthen the scientific validity and applicability of exercise science evidence.

Athletic trainers (ATs) play a critical role in delivering care to diverse patient populations but face significant challenges related to cultural competence and communication with nonnative English-speaking patients (NNES-Ps). To assess ATs’ cultural competence and their communication behaviors with NNES-Ps. Cross-sectional. Online survey. A total of 172 credentialed ATs participated, with most identifying as White (84.9%) and non-Hispanic (92.4%). Participants completed the Cultural Competence Assessment (CCA), the AT-NNES tool, and responded to case vignettes addressing communication challenges with NNES-Ps. Results revealed that ATs self-reported high cultural competence (84% on the CCA) but scored significantly lower (61.6%) on actual cultural competence behaviors, demonstrating a disparity between awareness and practice. Similarly, while ATs recognized the importance of culturally agile care (4.67/5), they rated their employers’ translation policies poorly (2.85/5) and noted limited access to interpreters (2.66/5). The vignettes further highlighted inconsistent communication strategies, with many ATs relying on gestures or bilingual teammates instead of professional interpreters, often due to resource limitations or lack of confidence. In the study, we also showed that ATs working in diverse environments reported higher comfort levels but emphasized the need for routine cultural competence training and systematic improvements in language resources. Despite their challenges, ATs demonstrated a willingness to improve communication strategies, as seen in their preference for using interpreters and providing materials in the patient’s preferred language in complex scenarios. The findings highlight the necessity of bridging the gap between cultural awareness and practical application by integrating training programs, ensuring consistent access to interpreters, and promoting policies prioritizing equitable care for linguistically and culturally diverse populations. These efforts are essential to enhancing outcomes for historically marginalized communities and fostering inclusive care in athletic training practice.

Research findings must be representative by creating a sample of individuals, ensuring the results can be generalized and applicable to a larger population, which has historically been guided by a power analysis. However, the varied research design methods require a unique approach to sampling and a formula for recruitment and size. Therefore, the purpose of this study was to analyze historical data from published manuscripts in the Journal of Athletic Training (JAT) relative to study design and sample sizes. A secondary purpose was to further explore metrics for survey-based research. This descriptive analysis explored 1267 publications in each issue of the JAT from January 2012 (Volume 47) to December 2022 (Volume 57). We extracted publications from the JAT website. Every article was entered into a spreadsheet (year of publication, publication title) and data specific to the study design and sample size were used for analysis. For studies that were coded as survey-based research, access, response, and completion rates were completed, and topic area and use of a power analysis were extracted. Data were analyzed using measures of central tendency (mean, median, range). Of the 1267 published studies, the most frequent design was cross-sectional (394, 31.1

Purpose: Athletic trainer (AT) turnover intention remains a challenge to the profession. Generational conflicts have emerged in employment culture across professions and may impact AT retention. This study aims to examine the impact of generational differences on measures that have been linked to the vitality of the profession. Methods: An online (Qualtrics, Provo, UT) cross-sectional survey was sent to 5,937 ATs through the NATA (5.8% response rate). Most participants identified as Millennial (227, 69.4%), European American (280, 85.6%) women (208, 63.6%) working in the secondary setting (136, 41.6%). The survey consisted of demographic questions, the Turnover Intention Scale-6 (TIS-6), Professional Identity and Values Scale-Athletic Training (PIVS-AT), and Professional Commitment Scale. We used a one-way ANOVA to compare professional identity (PI) between generations. Kruskal-Wallis analyses were used to compare turnover intention (TI) and professional commitment (PC) concerning generations. We used a multiple regression analysis to identify factors influencing professional commitment (p<.001). Results: Participants demonstrated expected levels of TI, PI, and PC. We identified significant differences between generations on PI (p<.001), PC (p<.001), and TI (p<.001). Specifically, Millennials and Baby Boomers (BOOM) (p<.001) and Generation Z (GenZ) and BOOM (p<.001) showed significant differences in PI. Turnover intention was significantly different between Millennials and BOOM (p<.001), and GenZ and Millennials (p=.03). Professional commitment was significantly different between Millennials and BOOM (p<.001), GenZ and BOOM (p=.03), and GenZ and GenX (p=.001). Collectively, generation, TI, and PI were significant and moderately predictive of PC (R-2=0.417, b=3.73, p<.001); however, TI was the most powerful, inversely predictive factor of PC (r=-0.148, p<.001) while PI weakly correlated with PC (r=0.042, p<.001). Conclusions: Significant differences in professional identity, professional commitment, and turnover intention exist among athletic trainers of different generations. Generational differences should continue to be studied in athletic training to avoid generational conflict as this could potentially increase retention and the vitality of the profession.

Context: Authors of extensive research have exposed health care disparities regarding socioeconomic status (SES) and race and ethnicity demographics. Previous researchers have shown significant differences in access to athletic training services (athletic trainer [AT] access) in the secondary school setting based on SES, but with limited samples. Objective: To investigate differences in AT access based on race and ethnicity and SES on a national scale. Design: Cross-sectional study. Setting: Database study using secondary analysis. Data were collected from the National Center for Education Statistics, Athletic Training Location and Services database, and US Census Bureau. Patients or Other Participants: A total of 10 983 public schools. Main Outcome Measure(s): Descriptive data were summarized by measures of central tendency. A 1-way analysis of variance determined differences between school characteristics (median household income, percentage of students eligible for free and reduced lunch, percentage of White students, and percentage of non-White students) based on AT access: full-time (FT-AT), part-time (PT-AT), and no AT (no-AT). A Bonferroni pairwise comparison was used for variables with significant main effects. Results: Across all schools included in the study, 43.8% had no-AT (n = 4812), 23.5% had PT-AT access (n = 2581), and 32.7% had FT-AT access (n = 3590). Significant effects were found between AT access and median household income (P < .001), the percentage of students eligible for free and reduced lunch (P < .001), the percentage of White students (P < .001), and the percentage of non-White students (P < .001). Schools with FT-AT access had a higher SES than PT-AT and no-AT schools. Significant differences existed between AT access groups and the race and ethnicity of schools. Schools with FT-AT access had a significantly lower percentage of non-White students (31.3%) than schools with no-AT (46.0%; P < .001). No significant differences between FT-AT and PT-AT access based on race and ethnicity demographics presented (P >= .13). Conclusions: Schools with higher SES had greater AT access, whereas schools with a higher percentage of nonWhite students were more likely to have no AT access, demonstrating the disparities in health care extends to athletic health care as well. To increase AT access, future initiatives should address the inequities where larger minority populations and counties of lower SES exist.

Purpose: Blood pressure (BP) assessment is a key component of pre-participation examinations and can aid athletic trainers (ATs) in diagnosing hypertension. However, the current pedagogical technique, which involves practicing BP assessment on healthy individuals, may not adequately prepare healthcare providers to recognize Korotkoff sounds at abnormal pressures during clinical practice. Therefore, the purpose of this study was to examine AT's ability to and confidence in assessing and interpreting BP using a high-fidelity simulator. Methods: We recruited ATs through conferences, in-services, and postprofessional athletic training programs. In total, 100 ATs from various job settings (age=31 +/- 11 years; men=37, women=63, clinical experience=8 +/- 10 years; self-identified hearing concerns=31; previous simulation experience=36) completed the cross-sectional study focused on descriptive quality assurance. First, participants verbally reported the professional guidelines they used in clinical practice to interpret findings. Second, ATs completed a practice trial BP assessment to familiarize themselves with the provided stethoscope, cuff, and high-fidelity manikin. Then, ATs completed 3 randomized BP assessment trials out of 11 pre-set BP cases. Participants reported the systolic and diastolic reading, interpretation (hypotension, hypertension, normal), and their confidence (0%=no confidence,100%=complete confidence) in assessing the BP and the interpretation for that case. Assessment correctness scores were calculated by case, with each correct systolic or diastolic value within a +/- 5 mmHg range counting as 1 and each incorrect value as 0. Results: Most participants (n=48) used the American Heart Association BP interpretation guidelines. Participants had a low overall assessment correctness score (42.67 +/- 20.88%) with only 50% of the systolic values (n=150; mean difference=-5.85 +/- 13.32) and 68.7% of the diastolic values (n=206; mean difference=-0.34 +/- 9.60) reported within +/- 5 mmHg. Participants were most accurate with Case 5 (normal) and least accurate with Case 2 (hypertensive). The participants correctly interpreted the BP by their reported guidelines in 56.3% of the trials (n=169). Despite the substandard performance, participants expressed high confidence in BP assessment (80 +/- 16%) and interpretation (87 +/- 16%). Conclusions: We identified a confidence-to-practice gap using simulation-based assessment with ATs having low achievement in assessing and interpreting BP despite their high confidence levels.

Patient-centered care (PCC) has been widely studied in health care. Often, PCC is considered a mindset; however, there are specific behaviors to address in PCC, such as medical interviewing, exploring a patient’s health literacy, and providing patient education. Much of the data specific to PCC relate to patient satisfaction rather than exploring provider behaviors. To assess the extent to which athletic trainers (ATs) create a patient-centered environment using a standardized case vignette and behavior checklist. Qualitative procedures with quantitative analysis. Individual, audio-only interview. Twenty-seven ATs (age = 34 ± 10 years; women = 15, men = 12; clinical experience = 10 ± 9 years) from the physician practice (n = 10), college (n = 9), or secondary school (n = 8) setting. Participants completed a 1-on-1 interview guided by a case vignette. In their verbal response, the participants were asked to share how they would approach care for the patient specific to their job setting, focusing on practical, real-world responses. Two researchers who reviewed each transcript independently scored the responses using the Assessment of Patient-Centered Care Checklist. The trustworthiness of the coding was ensured by using a multianalyst review of the data and an external audit. ATs reported several positive behaviors yet lacked an overall PCC approach, with an average score of 26.6% on the tool. No significant differences were identified for ATs based on job setting, years of experience, or highest degree earned. Our case vignette design allowed participants to share their approach to PCC through a common orthopedic patient scenario. The data gathered suggested that ATs are aware of the skills and strategies that PCC can use in clinical practice, yet they have the opportunity for improvement. Our data suggest that the lack of behaviors was not job, experience, or education specific, demonstrating the need for profession-wide training and feedback on PCC.

Purpose: Health literacy plays a vital role in patients' health and dictates their ability to locate, process, and understand basic health information to make informed decisions. Athletic trainers in the secondary school (SSATs) setting work with patients with varying health literacy levels. The purpose of this study was to explore SSATs' knowledge of health literacy and integration of best practice behaviors for patient education. Methods: A cross-sectional design, web-based survey including demographic, patient education practice behaviors, and health literacy knowledge assessment questions. Practice behavior questions identified techniques, strategies, and educational materials used during patient education. Health literacy knowledge assessment questions assessed health literacy knowledge of SSATs about patient education materials, reading levels, consequences and financial burden of low health literacy, and ways to enhance communication with patients with low health literacy. A Content Validity Index (CVI) assessed the demographic questions and practice behaviors questions (S-CVI/Ave = 0.94). A modified Delphi approach, including 3 athletic trainers with related expertise, was used to build consensus across 3 rounds of review on the knowledge assessment questions. Of the 13 original knowledge assessment questions proposed, only 10 had consensus for inclusion in the final instrument. Descriptive statistics were calculated using the measures of central tendency for demographics, practice behaviors, and the health literacy knowledge assessment. Results: Verbal communication, demonstration, and pictures were the most used patient education strategies. Just over half of the participants assessed the grade level of their own written patient education materials. Participants mostly learned about health literacy through continuing education or clinical/lived experience. The overall score for health literacy knowledge assessment was 1.5 +/- 1.1 out of 10 with a high score 4/10, indicating low knowledge on the assessment and impact of health literacy on patient care. The items correctly answered included understanding the average reading level of the U.S. population and best practices for reading level of patient education materials. Conclusion: SSATs scored particularly low on a consensus-validated health literacy knowledge assessment and reported few best practice patient education behaviors raising concerns for how well- prepared athletic trainers are for assessing health literacy and educating patients.

CONTEXT:The demographic landscape of the United States is changing daily, and the demand for representation in today's workforce is both a moral and practical imperative for creating workplaces diverse in thought, expression, and people. OBJECTIVE:The purpose of this study was to investigate workplace culture and the direct and indirect influence of supervisors on inclusion of minoritized communities, including those who have experienced marginalization for race, ethnicity, religion, national origin, age, marital status, ability, sexual orientation, sex, gender, gender identity and expression, socioeconomic status, spirituality, political affiliation, literacy, or the intersectionality of multiple identities. DESIGN:Consensual qualitative research study. SETTING:Semistructured interview. PATIENTS OR OTHER PARTICIPANTS:Eighteen participants were recruited through direct contact via their public domain email addresses that are located on college/university websites. DATA COLLECTION AND ANALYSIS:Demographic data were collected through a web-based recruitment survey, which was also used to schedule a semistructured interview. We used the multiphased consensual qualitative research tradition to identify domains and categories representative of the data. RESULTS:Three domains emerged. The environment domain spoke to the culture each supervisor created through relationship building and intention; intention was further characterized as active or passive behaviors whereby almost all participants described both. Only one-third of participants referenced diversity, equity, inclusion, and accessibility policies and procedures within their organization. The resources domain represented the existence and awareness of organizational diversity, equity, inclusion, and accessibility resources, or lack thereof. The perceptions domain characterized the beliefs of the supervisors relative to diversity, equity, inclusion, and accessibility. CONCLUSION:Structural efforts must include the creation and implementation of policies and procedures for employee inclusion, not just patient inclusion. The awareness and use of organizational resources is an important component to support supervisor efforts and should be leveraged from within the unit.

OBJECTIVE:Approximately 27,000 college marching band (MB) artists in the United States could benefit from access to healthcare services and patient-centered care (PCC). The purpose of this study was to explore healthcare providers (HCPs) who MB artists have access to and the artists' perceptions of PCC. METHODS:We used a cross-sectional, web-based survey to explore which providers MB artists had access to. In total, 751 MB artists (age 20±8 yrs) completed the survey. Respondents who reported no access or were unsure were prompted to complete an open-ended response describing what they would do if an injury or illness occurred. Participants who had access to an athletic trainer (AT) completed the Global Perceptions of Athletic Trainer Patient-Centered Care Tool (GPATPCC; a=0.90; 15 items [1 reverse-scored]; 4-point Likert scale [1=strongly disagree, 4=strongly agree, 0=unsure]; score=average). Participants with access to other HCPs completed the Consultation and Relational Empathy tool (CARE; a=0.97; 10 items; 5-point Likert scale [1=poor, 5=excellent]; score=sum). Scores for the tools were standardized (z-score), and a Mann-Whitney U test determined PCC differences between those with access to ATs and those with access to other HCPs. RESULTS:Overall, 42.5% of MB artists had access to a HCP. The MB artists with access to ATs expressed satisfaction (mean 3.05±0.67) on the GPATPCC tool. Participants who completed the CARE tool expressed they were satisfied (mean 39.59±8.78). However, 57.5% of MB artists reported having no access or being unsure, who commonly relied upon communicated with MB leadership (33.8%) when injured. No significant differences were identified between ATs and other HCP ratings of PCC (U=4615, z=-0.36 p=0.719). CONCLUSION:Over half of MB artists reported a lack of access or a lack of familiarity with what HCPs are available. Those with access to HCPs were satisfied with the care they received. Continued efforts should be focused on improving MB artists' access to HCPs.

Moral distress is prevalent in healthcare, and prolonged moral distress is directly linked to feelings of burnout and intent to leave the profession. Moral distress has been examined in other healthcare professions, including physician practice and nursing, but not in athletic training. Due to their likelihood to be isolated and have high patient loads, secondary school athletic trainers (SSATs) may experience moral distress. This study aimed to examine the experiences and perceptions of moral distress in SSATs. SSATs were recruited via email through the Athletic Training Locations and Services (ATLAS) database. A total of 603 SSATs completed the survey and were included for analysis. Participants completed the Measure of Moral Distress in Athletic Trainers (MMD-AT), a validated tool measuring moral distress on perception and frequency subscales. Descriptive statistics and ANOVAs were used to identify differences between demographic groups (age, gender identity, years of experience, employment setting, athletic training healthcare model). SSATs reported low levels of moral distress on the MMD-AT (M=26.9 +/- 20.3 out of 189); SSATs scored highest on organizational issues and lowest on patient care issues. Women (M=29.6) scored significantly higher on the MMD-AT than men (M=23.3, p<.001). Younger SSATs or those with less than 16 years of experience also scored significantly higher than older or more experienced SSATs (p<.001). SSATs experience moral distress, with younger and less experienced SSATs experiencing more moral distress than their counterparts. SSATs should focus on developing positive coping skills to mitigate the effects of longterm moral distress, and organizations should focus on initiatives related to reducing external factors of moral distress.

CONTEXT:A patient-centered care (PCC) environment allows athletic trainers (ATs) to develop trusting relationships with patients, enabling them to make the most informed care decisions. To provide PCC, the AT should assess health literacy and deliver quality patient education. OBJECTIVE:To explore the lived experiences of ATs from different job settings to identify how they deliver PCC specific to health literacy and patient education. DESIGN:Qualitative. SETTING:Virtual interviews. PATIENTS OR OTHER PARTICIPANTS:Twenty-seven ATs (age = 34 ± 10 years; women = 15, men = 12) from the physician practice (n = 10), college (n = 9), and secondary school (n = 8) settings. MAIN OUTCOME MEASURE(S):We interviewed the participants using a semistructured interview protocol. Three researchers coded the transcripts after the consensual qualitative research process for each job setting. Trustworthiness was achieved through multianalyst triangulation, member checking, and internal auditing. RESULTS:Four domains emerged from all interviews: (1) work environment, (2) essential traits and skills, (3) health literacy assessment strategies, and (4) patient education materials and delivery. In the work environment, ATs described the patient load, interprofessional relationships, and patient characteristics across settings. Essential traits and skills varied widely between settings, and ATs needed different strategies based on differing patient needs. For health literacy assessment strategies, ATs did not formally assess health literacy and relied on perceptions and assumptions. Effective digital information and health informatics strategies were described for patient education materials and delivery. CONCLUSIONS:ATs from physician practice, college, and secondary school settings describe using various strategies to create a patient-centered environment. Participants shared their behaviors in assessing health literacy and delivering patient education from various job settings.

Purpose: The therapeutic alliance refers to the relationship between patient and provider, consisting of bonds, goals, and tasks. A positive therapeutic alliance enhances care and leads to improved outcomes. The purpose of this study is to explore the lived experiences of college student-athletes relating to the development of the therapeutic alliance with athletic trainers. Methods: Consensual Qualitative Research (CQR) with semi-structured interviews. We used a semi-structured interview to explore the therapeutic alliance and lived experiences of participants. Participants included twelve college student-athletes who were currently under the care of an athletic trainer. Participants completed a semi-structured interview. We used a CQR approach to analyze qualitative data. For CQR, the data analysis team completed a multiphase coding process building a consensus codebook that was representative of the data. We then applied the codebook across all transcripts. Credibility and trustworthiness in the analysis were ensured through member-checking, multi-analyst review, internal and external auditing. Results: We identified three domains that aided in the development of the therapeutic alliance: empowerment, transparency, and intentionality. Participants described shared decision-making, flexibility, and education as factors that empowered them in their care. Being transparent through reciprocal communication and provider-centric communication provided participants trust in their athletic trainer. Finally, intentional actions such as communication, physical presence, goal setting, and instruction helped foster motivation and adherence for participants. Conclusions: College student-athletes in this study felt a strong bond with the athletic trainer, which played an important role in facilitating willingness to engage in their care. Participants felt the therapeutic alliance came from the athletic trainer being intentional and transparent, working to empower them. Athletic trainers should take intentional steps to foster a strong therapeutic alliance with patients to promote adherence and patient outcomes.

Emotional intelligence and professional identity have been associated with increased quality of work, increased productivity, and personal and organizational success. The purpose of this study was to explore the relationship between emotional intelligence and professional identity in athletic trainers. We used a cross-sectional survey (demographics [six items], Wong and Law Emotional Intelligence Scale [16 items], and Professional Identity and Values Scale [20 items]) of 345 certified athletic trainers (age = 38 +/- 12 years; female = 218, 63.2%; secondary school setting = 143, 42.3%; years of experience = 14 +/- 12 years). There was a moderate, positive correlation between composite scores from Wong and Law Emotional Intelligence Scale and Professional Identity and Values Scale (.541, p < .001). A regression demonstrated that age was the only predictor of emotional intelligence (r = .110, p = .003).

Context Although guidance is available, no nationally recognized standard exists for medical documentation in athletic training, leaving individual organizations responsible for setting expectations and enforcing policies. Previous research has examined clinician documentation behaviors; however, the supervisor’s role in creating policy and procedures, communicating expectations, and ensuring accountability has not been investigated. Objective To investigate supervisor practices regarding support, hindrance, and enforcement of medical documentation standards at an individual organization level. Design Mixed-methods study. Setting Online surveys and follow-up interviews. Patients or Other Participants We criterion sampled supervising athletic trainers (n = 1107) in National Collegiate Athletic Association member schools. The survey collected responses from 64 participants (age = 43 ± 11 years; years of experience as a supervisor = 12 ± 10; access rate = 9.6%; completion rate = 66.7%), and 12 (age = 35 ± 6 years; years of experience as a supervisor = 8 ± 5) participated in a follow-up interview. Data Collection and Analysis We used measures of central tendency to summarize survey data and the consensual qualitative research approach with a 3-person data analysis team and multiphase process to create a consensus codebook. We established trustworthiness using multiple-analyst triangulation, member checking, and internal and external auditing. Results Fewer than half of supervisors reported having formal written organization-level documentation policies (n = 45/93, 48%) and procedures (n = 32/93, 34%) and an expected timeline for completing documentation (n = 24/84, 29%). Participants described a framework relative to orienting new and existing employees, communicating policies and procedures, strategies for holding employees accountable, and identifying purpose. Limitations included lack of time, prioritization of other roles and responsibilities, and assumptions of prior training and record quality. Conclusion Despite a lack of clear policies, procedures, expectations, prioritization, and accountability strategies, supervisors still felt confident in their employees’ abilities to create complete and accurate records. This highlights a gap between supervisor and employee perceptions, as practicing athletic trainers have reported uncertainty regarding documentation practices in previous studies. Although supervisors perceive high confidence in their employees, clear organization standards, employer prioritization, and mechanisms for accountability surrounding documentation will result in improved patient care delivery, system outcomes, and legal compliance.

Context In previous research, athletic trainers (ATs) have identified the formal coursework and clinical experiences of their professional program as contributing to preparedness for autonomous practice. However, new graduates have reported a perceived lack of skills necessary for practicing autonomously. Objective The purpose of this study was to evaluate how programs provide progressively autonomous clinical education experiences and the role of these experiences in preparing future ATs. Design Qualitative study. Setting Virtual interviews. Patients or Other Participants A sample of 17 program administrators (program directors = 12, coordinators of clinical education = 5) representing 16 master of science in athletic training programs participated in this study. Main Outcome Measure(s) Each program completed a virtual interview guided by a semistructured interview protocol. A 3-person data analysis team identified emerging domains and categories through a multiphase approach. Member checking, multiple researcher triangulation, and auditing were used to establish trustworthiness. Results Four domains emerged from participant responses: (1) curricular design, (2) preparatory experience and outcomes, (3) preceptor role, and (4) assessments. We found that intentionality in curricular design to promote progressive autonomy was beneficial in facilitating transition to practice through improved knowledge, skills, and confidence. Due to the importance of clinical education in AT preparation, preceptors played a critical role in creating opportunities for learning in the clinical environment. However, the degree to which experiences were autonomous and the effectiveness of the student in those encounters were rarely measured. Limitations outlined by participants included accreditation and program length. Conclusions The development of knowledge, skills, and confidence through intentionally selected clinical experiences and guided by preceptor feedback are critical to establishing an autonomous practitioner. However, the program’s evaluations were predominantly traditional practice assessments and informal feedback, instead of an assessment of readiness for practice.