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Background Flossing includes wrapping a specialized latex band around a muscle group providing compression, partially occluding blood flow, followed by performing exercises. This is hypothesized to improve flexibility by dissipating myofascial adhesions; however, research is lacking. Objective To determine the effect of the application of a floss band to the thigh on hamstring flexibility and lower extremity power. Design Crossover Study Setting Exercise Physiology Laboratory. Participants Twenty-one recreationally active individuals (8 male, 13 female; age = 22.62±2.99 years; height = 171.52±9.08 cm; mass = 73.57±11.37 kg). Methods Three counterbalanced interventions were studied during body weight squats, lunges, and hamstring curls (without resistance): floss, sham, and control. The floss treatment included wrapping the Rogue Wide Voodoo Floss Band™ from the proximal knee to the gluteal fold at a pressure of 140 to 200 mmHg. The sham treatment included wrapping the same band in the same location with less pressure (10 to 40 mmHg) while the control treatment did not include floss band application. Hip flexion range of motion, via the straight leg raise, and power (single-leg vertical jump) were compared from pre-test to post-test using a 3x2 repeated measures ANOVA. Results There was a significant interaction between time and session for hamstring flexibility (F(2,40)=17.54, p2=0.47). Post hoc tests showed significant differences between pre- (86.14±8.06 degrees) and post-test (90.81±7.69 degrees) for the floss session (p95=3.35-5.98) and between pre- (87.67±7.51 degrees) and post-test (89.86±7.88 degrees) for the sham session (p=0.001, Mean Difference=2.19, CI95=0.98-3.40). There were no significant interactions for jump power (F(2,40)=1.82, P=0.18, η2=0.08, 1-β=0.36). Conclusions Flossing treatment increased hamstring flexibility more than the sham session without affecting lower body power. Flossing could be beneficial when treatment or performance preparation goals are increased flexibility without decreased power. Future studies should continue to examine the clinical effectiveness of flossing on an injured population.

Context The transition to practice of newly credentialed athletic trainers (ATs) has become an area of focus in the athletic training literature. However, no theoretical model has been developed to describe the phenomenon and drive investigation. Objective To better understand the lived experience of the transition to practice and develop a theoretical model of transition to practice for ATs. Design Qualitative study. Setting Telephone interviews. Patients or Other Participants Fourteen professional master's athletic training students (7 men, 7 women, age = 25.6 ± 3.7 years, from 9 higher education institutions) in the first year of clinical practice as newly credentialed ATs. Data Collection and Analysis Participants completed semistructured phone interviews at 3 timepoints over 12 to 15 months. The first interview was conducted just before graduation, the second 4 to 6 months later, and the third at 10 to 12 months. The interviews were transcribed and analyzed using a grounded theory approach. Results We developed a theoretical model to explain the causal conditions that triggered transition, how the causal conditions were experienced, the coping strategies used to persist through the first year of practice, and the consequences of those strategies. Conclusions The model provides a framework for new athletic training clinicians, educators, and employers to better understand the transition process in order to help new clinicians respond by accepting or adapting to their environment or their behaviors.

Context For an acute cardiac event, on-field equipment removal is suggested, although how lacrosse equipment removal may alter the time to first chest compression and time to first automated external defibrillator (AED) shock remains unknown. Objective To determine the time to first chest compression and first AED shock in 2 chest-exposure procedures with 2 pad types. Design Crossover study. Setting Simulation laboratory. Patients or Other Participants A total of 36 athletic trainers (21 women, 15 men; age = 30.58 ± 7.81 years). Main Outcome Measure(s) Participants worked in pairs to provide 2 rescuer cardiopulmonary resuscitation (CPR) interventions on a simulation manikin outfitted with lacrosse pads and helmet. Participants completed 8 trials per pair (2 chest-exposure procedures × 2 pad types × 2 participant roles). The dependent variables were the time to first compression (seconds) and time to first AED shock (seconds). The independent variables were chest-exposure procedure with 2 levels (procedure 1: removal of the helmet while initiating CPR over the pads, followed by pad retraction and AED application; procedure 2: removal of the helmet and pads, followed by CPR and AED application) and pad type (Warrior Burn Hitman shoulder pads; Warrior Nemesis chest protector). Results We found a significant interaction between chest-exposure procedure and pad type for the time to first compression (F1,35 = 4.66, P = .04, ω2p = 0.10), with faster times during procedure 1 for both the Nemesis pads (16.1 ± 3.4 seconds) and Hitman pads (16.1 ± 4.5 seconds) than during procedure 2 (Nemesis pads: 49.6 ± 12.9 seconds, P < .0001; Hitman pads: 53.8 ± 14.5 seconds, P < .0001). Conclusions Completing the initial cycle of chest compressions over either shoulder pads or a chest protector hastens the time to first chest compression without diminishing CPR quality, which may improve patient outcomes. The time to the first AED shock was not different between equipment procedures or pad types.

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.

Significant evidence has emerged that a high volume of sprinting during training is associated with an increased risk of non-contact injuries in professional soccer players. Training load has been reported as a modifiable risk factor for successive injury in soccer. Sprint workload measures and non-contact injuries were recorded weekly in twenty-one professional soccer players over a one season period. Odds ratio (OR) and relative risk (RR) were calculated based on the weeks of high and low load of total distance (TD), high-speed distance (HSD), sprint distance (SPD). and repeated sprints (RS). The Poisson distribution estimated the interval time between the last injury and the new injury. The weeks with high-load levels increased the risk of non-contact injury associated with TD (OR: 4.1, RR: 2.4), HSD (OR: 4.6, RR: 2.6), SPD (OR: 6.9, RR: 3.7), and RS (OR: 4.3, RR: 2.7). The time between injuries was significantly longer in weeks of low-load in TD (rate ratio time (RRT) 1.5 vs. 4.2), HSD (RRT: 1.6 vs. 4.6), and SPD (RRT: 1.7 vs. 7.7) compared to weeks of high-load. The findings highlight an increased risk of non-contact injuries during high weekly sprint workloads. Possibly, TD, HSD, and SPD measured via a wearable inertial measurement unit could be modeled to track training and to reduce non-contact injuries. Finally, the interval time between the last injury and the new injury at the high-load is shorter than the low-load.

In 2015, new practice recommendations to remove equipment prior to transport when cervical spine injury is suspected were released. The purpose of this study was to determine current emergency management practices and perceptions of the new practice recommendation. We received completed mixed-method surveys from 143 athletic trainers practicing in the Mid-Atlantic region (response rate = 10.11%). The majority of respondents stated that the number of personnel required, along with the training and time to practice equipment removal, were barriers to implementation. Requiring assistance from emergency medical services (EMS) was common, but many failed to practice with local EMS. Emergency management procedures should be appropriate given the resources (personnel and training) available. Collaboration between athletic trainers and EMS is needed.

The diagnosis and management of concussion is hindered by its diverse clinical presentation and assessment tools reliant on subjectively experienced symptoms. The biomechanical threshold of concussion is also not well understood, and asymptomatic concussion or "subconcussive impacts" of variable magnitudes are common in contact sports. Concerns have risen because athletes returning to activity too soon have an increased risk of prolonged recovery or long-term adverse health consequences. To date, little is understood on a molecular level regarding concussion and subconcussive impacts. Recent research suggests that neuroinflammatory mechanisms may serve an important role subsequent to concussion and possibly to subconcussive impacts. These studies suggest that autoantibodies may be a valuable tool for detection of acute concussion and monitoring for changes caused by cumulative exposure to subconcussive impacts. Hence, we aimed to profile the immunoglobulin (Ig)A autoantibody repertoire in saliva by screening a unique sport-related head trauma biobank. Saliva samples (

Background: Injuries in professional soccer are a significant concern for teams, and they are, mostly, caused by high training load. This cohort study described the relationship between workload parameters with the occurrence of non-contact injuries, during weeks with high and low workload in professional soccer players throughout the season.Methods: Twenty-one professional soccer players aged 28.3±3.9 yrs. who competed in the Iranian Persian Gulf Pro League participated in this 48-week study. The external load was monitored using global positioning system (GPS, GPSPORTS Systems Pty Ltd) and the type of injury was documented by the team's medical staff daily. Odds ratio (OR) and relative risk (RR) were calculated for non-contact injuries for high- and low-load weeks according to acute (AW), chronic (CW), acute to chronic workload ratio (ACWR), and AW variation (Δ-Acute) values. By using Poisson distribution, the interval between previous and new injuries were estimated.Results: Overall, 12 non-contact injuries occurred during high load and 9 during low load weeks. Based on the variables ACWR and Δ-AW, there was a significantly increased risk of sustaining non-contact injuries (p < 0.05) during high-load weeks for ACWR (OR: 4.67), and Δ-AW (OR: 4.07). Finally, the expected time between injuries was significantly shorter in high load weeks for ACWR [1.25 vs 3.33, rate ratio time (RRT)] and Δ-AW [1.33 vs 3.45, RRT] respectively, compared to low load weeks.Conclusion: The risk of sustaining injuries was significantly larger during high workload weeks for ACWR, and Δ-AW compared with low workload weeks. The high numbers for OR in high load weeks indicate that there is a significant relationship between workload and occurrence of non-contact injuries. The predicted time to new injuries is shorter in high load weeks compared to low load weeks. Therefore, the frequency of injuries is higher during high load weeks for ACWR and Δ-AW. ACWR and Δ-AW appear to be good indicators for estimating the injury risk, and the time interval between injuries.

Background Sports-related concussions are prevalent in the United States. Various diagnostic tools are utilized in order to monitor deviations from baseline in memory, reaction time, symptoms, and balance. Evidence indicates that dehydration may also alter the results of diagnostic tests. Purpose The purpose was to determine the effect of exercise-induced dehydration on performance related to concussion examination tools. Study Design Repeated measures design. Methods Seventeen recreationally competitive, non-concussed participants (age: 23.1±3.1 years, height:168.93±10.71 cm, mass: 66.16 ± 6.91 kg) performed three thermoneutral, counterbalanced sessions (rested control, euhydrated, dehydrated). Participants were either restricted (0.0 L/hr) or provided fluids (1.0 L/hr) while treadmill running for 60 min at an intensity equal to 65-70% age-predicted maximum heart rate (APMHR). The Sport Concussion Assessment Tool 3 (SCAT3) was utilized to assess symptoms, memory, balance, and coordination. Results Statistically significant differences were seen among sessions for symptom severity and symptom total. The rested control session had significantly lower values when compared to the dehydrated session. Additionally, the symptom total in the rested control was significantly lower than the euhydrated condition as well. No statistically significant differences were seen for the BESS or memory scores. Conclusions Mild exercise-induced dehydration results in increased self-reported symptoms associated with concussions. Clinicians tasked with monitoring and accurately diagnosing head trauma should take factors such as hydration status into account when assessing patients for concussion with the SCAT3. Clinicians should proceed with caution and not assume concussion as primary cause for symptom change. Level of evidence Level 3

Context: Teaching, scholarship, and service are required of all faculty in order to earn tenure. Faculty members hired directly from doctoral programs may not be adequately prepared to face the responsibilities of a full-time position in the professoriate. Objective: To explore what mechanisms as part of doctoral education influenced the perceptions of junior faculty development while transitioning postgraduation. Design: Qualitative phenomenological study. Setting: Fourteen higher education institutions. Patients or Other Participants: Sixteen junior faculty (7 male, 9 female, age = 32 ± 3.5 years) representing 7 National Athletic Trainers' Association districts participated. At the time of the interview, participants were within their first 3 years of a full-time faculty position. All participants earned doctorates from residential programs and had an assistantship position. Main Outcome Measure(s): All participants completed a semistructured telephone interview. The interview guide was focused on the experiences of junior faculty within their first 3 years in a tenure-track position. Questions were grounded within the literature and purpose of the study. We analyzed the interviews through a psychosocial developmental lens using a general inductive approach. Results: Two themes of doctoral preparation emerged that influenced the perceptions of junior faculty transitioning into a faculty role: breadth and depth of the doctoral assistantship and doctoral coursework related to academia. Doctoral assistantships with breadth and depth helped participants develop competence, while doctoral coursework related to academia provided content expertise. Conclusions: Doctoral education is the platform for transition into academia. Our findings suggest that doctoral program assistantships that provided both breadth and depth of experience facilitated transition. Coursework related to academia influenced perceptions of transition into the faculty role by exposing participants to pedagogy and higher education infrastructure.

Context:The responsibilities of new faculty members can be stressful because of the expectations of research, teaching, service, and for some, administration. The strain from transition and role complexity can impact faculty members' perceptions of the experience and therefore professional development.Objective:To understand how individual characteristics and behaviors influenced development of new faculty during their transition from doctoral students to faculty members.Design:Qualitative phenomenology study.Setting:Higher education institutions with Commission on Accreditation of Athletic Training Education-accredited athletic training programs.Patients or Other Participants:Sixteen junior faculty (7 males, 9 females, age = 32 ± 3.5 years) representing 7 National Athletic Trainers' Association districts and 14 different higher education institutions participated.Main Outcome Measure(s):A semistructured telephone interview protocol was used to examine the experiences of junior faculty within their first 3 years of a faculty role. Interviews were coded inductively using a psychosocial developmental interpretive lens. Credibility was established with saturation of the findings and researcher triangulation.Results:The data revealed 3 individual behavioral characteristics positively influenced the development of junior faculty through transition: (1) adaptive perfectionism, (2) competence gained through experience, and (3) the use of a mentor network. Our participants adapted personal expectations in light of outcomes that differed from personal standards; gained competence by seeking experience before, during, and after their doctoral studies; and used a mentor network to ease transition.Conclusions:Our findings suggest that individuals who are able to reflect on their performance and self-adjust personal standards and/or behaviors have a positive perception related to their ability to be successful during transition. Competence gained through experience apart from doctoral assistantships appears to facilitate the transition into higher education. Also, the creation and maintenance of a mentor network that provides a variety of support from multiple sources appears to improve transition by providing comradery, security, and help.

Quantifying head impacts is a vital component to understanding and preventing head trauma in sport. Our objective was to establish the frequency and magnitude of head impact mechanisms in men’s lacrosse athletes. Eleven male lacrosse athletes wore xPatch sensors during activity. Video footage of practices and games was analyzed to verify impacts and code them with impact mechanisms. The authors calculated incidence rates (IRs) per 1000 exposures with corresponding 95% confidence intervals (CIs) and used multivariate analysis of variances to compare the linear (g) and rotational (rad/s2) accelerations between mechanisms. A total of 167 head impacts were successfully verified and coded with a mechanism using video footage during 542 total exposures. The highest IR was head to body (IR = 118.08; 95% CI, 89.15–147.01), and the lowest was head to ball (IR = 3.69; 95% CI, 0–8.80) (incidence rate ratio = 32.00; 95% CI, 67.83–130.73). Analysis indicated that impact mechanism failed to significantly alter the combined dependent variables (multivariate F10,306 = 1.79, P = .06, η2 = .06, 1−β = 0.83). While head to head, body to head, and stick to head mechanisms are penalty-inducing offenses in men’s lacrosse, head to ground, head to ball, and combination impacts have similar head accelerations. If penalties and rules are created to protect players from traumatic head injury, the authors recommend stricter enforcement.

Background A reliable measure of dynamic postural control is needed for inclusion in the sports-related concussion assessment battery. Currently, there is not a clinical gold standard. The Limits of Stability (LOS) test has potential to be a useful tool to collect objective data on important dynamic postural stability variables. Psychometric properties of the LOS test with healthy young adults are yet to be established. Hypothesis/purpose The purpose of this study was to examine the intra-session and test-retest reliability for the LOS on the NeuroCom® VSR Sport when performed by young adults. Study design Reliability study. Methods Twenty-seven healthy university students completed four trials of the LOS in each of two testing sessions one week apart. Relative reliability was measured within each session with an intraclass correlation coefficient (ICC[3,k]) for Session 1 and Session 2, respectively, on each of the five dependent variables (movement velocity [MVL], directional control [DCL], maximum excursion [MXE], endpoint excursion [EPE], and reaction time [RT]) provided by the Neurocom. Test-retest reliability was assessed using a repeated-measures analysis of variance along with an ICC (3,k) for relative reliability. An ICC value of 0.90 or higher was defined as having a high reliability, moderate reliability for ICC values between 0.80-0.89, and below 0.80 as questionable. Results The reliability within each session for LOS composite scores for MVL, DCL, and MXE was moderate to high (ICC[3,k]=0.89-0.95). These same three variables also had high levels of test-retest reliability (ICC[3,k]=0.95-0.96). EPE and RT had moderate reliability over time (ICC[3,k]=0.88) but differences for within session reliability. Conclusions LOS provides a reliable measure of dynamic postural control for young adults. Two trials are recommended at baseline with the first being an adaptation trial to ensure accuracy of findings. Care needs to be taken when interpreting EPE and DCL scores on post-injury tests due to a learning effect for those variables. Level of evidence 2c.

Context: Evidence suggests that doctoral education is incongruent with faculty positions, but this has yet to be specifically examined in athletic training. Objective: To gain understanding of the alignment of doctoral education and faculty workload, including institutional characteristics, from the perspectives of junior faculty members. Design: Qualitative, phenomenological research. Setting: Higher education institutions with Commission on Accreditation of Athletic Training Education–accredited programs. Patients or Other Participants: Twenty athletic training faculty members (14 women and 6 men) who were 32 ± 3 years of age and averaged 10 ± 4 years of experience as athletic trainers and 2 ± 2 years as a full-time faculty member. Main Outcome Measure(s): We developed, peer-reviewed, and piloted 2 semistructured interview guides to obtain participants' perspectives on their doctoral preparation, entrance into higher education, and faculty workload. We completed telephone interviews with each participant over the course of 4 months. Transcribed interviews were analyzed by 2 investigators using a phenomenological approach, then reviewed by 2 additional qualitative researchers. Mechanisms of trustworthiness included member-checking, multianalyst triangulation, and peer review. Results: Two themes emerged from this study: (1) workload and (2) congruency. Faculty workload was dominated by teaching, but faculty had several demands on their time, including administration, service, and research. Most faculty positions focused on teaching, whereas their doctoral education was more focused on research, possibly because of a lack of congruency between doctoral education and faculty position institution types. Although mismatches occurred between doctoral education and faculty workload, participants were often aware of these differences and selected faculty positions aligned with their career goals. Conclusions: Faculty workload is generally teaching-focused and contains additional demands that are often not included in doctoral education programs. Doctoral advisors should promote adequate socialization to these characteristics of faculty positions, and doctoral students should consider their interests and faculty workload when searching for faculty positions.

Context: Patient ventilation volume and rate have been found to be compromised due to the inability to seal a pocket mask over the chinstrap of football helmets. The effects of supraglottic airway devices such as the King LT and of lacrosse helmets on these measures have not been studied. Objective: To assess the effects of different airway management devices and helmet conditions on producing quality ventilations while performing cardiopulmonary resuscitation on simulation manikins. Design: Crossover study. Setting: Simulation laboratory. Patients or Other Participants: Thirty-six athletic trainers (12 men, 24 women) completed this study. Intervention(s): Airway-management device (pocket mask, oral pharyngeal airway, King LT airway [KA]) and helmet condition (no helmet, Cascade helmet, Schutt helmet, Warrior helmet) served as the independent variables. Participant pairs performed 2 minutes of 2-rescuer cardiopulmonary resuscitation under 12 trial conditions. Main Outcome Measure(s): Ventilation volume (mL), ventilation rate (ventilations/min), rating of perceived difficulty (RPD), and percentage of quality ventilations were the dependent variables. Results: A significant interaction was found between type of airway-management device and helmet condition on ventilation volume and rate (F12,408 = 2.902, P < .0001). In addition, a significant interaction was noted between airway-management device and helmet condition on RPD scores (F6,204 = 3.366, P = .003). The no-helmet condition produced a higher percentage of quality ventilations compared with the helmet conditions (P ≤ .003). Also, the percentage of quality ventilations differed, and the KA outperformed each of the other devices (P ≤ .029). Conclusions: The helmet chinstrap inhibited quality ventilation (rate and volume) in airway procedures that required the mask to be sealed on the face. However, the KA allowed quality ventilation in patients wearing a helmet with the chinstrap fastened. If a KA is not available, the helmet may need to be removed to provide quality ventilations.

Context: New faculty are expected to teach, be productive scholars, and provide service in order to earn tenure, but few experience the full spectrum of faculty responsibility during doctoral preparation. Recent evidence suggests mentorship and orientation are important during role transition. However, how employers facilitate role transition for new faculty remains unclear. Objective: Examine the perspectives of junior faculty members' organizational socialization into higher education, specifically focusing on mentorship and orientation sessions. Design: Qualitative study. Setting: Fourteen higher education institutions. Patients or Other Participants: Sixteen junior faculty (7 male, 9 female; age = 32 ± 3.5 years) representing 7 National Athletic Trainers' Association districts participated. At the time of the interview, all participants were within their first 3 years of a full-time faculty position. Main Outcome Measure(s): All participants completed a semistructured telephone interview. The interview guide was focused on the experiences of junior faculty and was developed based upon the literature and purpose of the study. We analyzed the transcribed interviews using a general inductive approach. Results: Mentors provided support to assist in the transition to faculty positions on a variety of topics, although formal mentoring programs are identified as helpful only if a relationship develops. Regarding the second theme, participants noted orientation sessions organized by the institution or department that provided a clear overview of the position. However, despite their use, many described the orientation sessions as not providing essential information that would have been helpful. Additionally, tenure and promotion processes often had purposefully vague criteria regardless of how thorough the explanation, leading to stress. Conclusions: Our findings suggest that higher education administrators help new athletic training faculty transition by providing mentors and orientation sessions. Findings also suggest that these experiences, at times, are not comprehensive and caused the transition to academe to be stressful.

Context: It is important to understand the process whereby athletic trainers learn about their future roles, particularly when the roles can be complex and demanding. Little is known about the experiences of athletic training doctoral students, including facilitators and barriers to socialization as aspiring faculty members. Objective: To investigate factors influencing the anticipatory socialization of athletic training doctoral students into future faculty roles. Design: Qualitative study. Setting: Universities with athletic training doctoral students. Patients or Other Participants: We recruited 28 students (19 women, 9 men, age = 28 ± 3 years) with a minimum of 1 year of doctoral coursework completed and participating in an assistantship at the time of the study to reach data saturation. Participants were certified for 6 ± 3 years and represented 5 National Athletic Trainers' Association districts and 9 institutions. Data Collection and Analysis: We completed semistructured, 1-on-1 telephone interviews with participants. We transcribed each interview verbatim and analyzed the data using an inductive approach. Peer review, multiple-analyst triangulation, and member checks ensured trustworthiness. Results: We uncovered 4 themes from our analysis related to facilitators and barriers to professional socialization. Participants described comprehensive autonomous experiences in research that allowed them to feel confident they could sustain a scholarly agenda. Independent experiences and lack of pedagogy training yielded mixed preparedness relative to teaching responsibilities. Limited formal experience led to incomplete role understanding related to the service component of the professoriate. Finally, with regard to the administrative duties associated with athletic training faculty positions, participants noted a lack of direct exposure to common responsibilities. Conclusions: Role occupation in various aspects of the professoriate helped doctoral students prepare as future faculty members, although full role understanding was limited. Intentional exposure to research, teaching, service, and administrative expectations during doctoral experiences may facilitate the socialization of future athletic training faculty into academic roles.

Context:Educational reform is occurring again in athletic training. The profession, at this time, should reflect on the structure of clinical education, particularly with direct supervision. Clinical education plays a critical role in the development of future practitioners and should provide students with a chance to gain autonomous experience, with appropriate feedback and discourse.Objective:In this commentary, we discuss direct supervision and present an alternative model for supervision (graduated supervision) in athletic training.Background:Currently, there are concerns regarding the readiness of students to transition to independent practice. These trepidations are centered on the policies related to direct supervision and chances for students to gain autonomous experiences needed to prepare them to make clinical decisions.Synthesis:Graduated supervision may provide an alternative lens for athletic training to regulate clinical education, while facilitating experiences that can assist in student development and preparedness to transition into independent, credentialed patient care.Results:Athletic training supervision policies do not align with other health care professions, yet a major impetus for educational reform was founded on the premise that we should model our degree level more comparably.Recommendation(s):Programs should allow for supervision that encompasses a trusting relationship between preceptors and students. Supervision can be modified (more versus less constant interactions) based upon the students' performance, knowledge, and skills. Shifting the way supervision is implemented can still allow for ensuring patient and student safety, but also allow for students to become critical thinkers.Conclusion(s):Direct supervision policies should be updated to allow students to develop confidence, competence, and critical thinking abilities as well as to better align the athletic training profession with other health care programs.

Context:Athletic training students' ability to transition into professional practice is a critical component for the future of the profession. However, research on professional master's students' transition to practice and readiness to provide autonomous care is lacking.Objective:To determine professional master's athletic training students' perceptions regarding how they were prepared to transition to practice as clinicians.Design:Qualitative study.Setting:Professional master's athletic training programs.Patients or Other Participants:Sixteen students, 8 program directors, and 5 faculty members from professional master's athletic training programs.Main Outcome Measure(s):An online questionnaire was distributed via Qualtrics and analyzed using an inductive technique. Participants responded to a series of open-ended questions related to the structure and curricular offerings of their respective programs. We secured trustworthiness through multiple analyst triangulation and peer review.Results:We found that both students and faculty identified clinical education as the major facilitator in the socialization process used to prepare students for the transition into clinical practice. Three further subthemes emerged: (1) Both stakeholder groups felt that students gained experience through diverse and immersive clinical education experiences; (2) Preceptors provided mentorship; and (3) Students developed confidence to enter clinical practice as a result of these supported experiences.Conclusions:Professional master's programs provide clinical education experiences designed to help athletic training students gain the skills and confidence necessary to become autonomous practitioners. The diversity and mentorship contained within these experiences facilitates confidence and preparedness.

The commissioners of the Commission on Accreditation of Athletic Training Education (CAATE) and the Board of Directors of the National Athletic Trainers’ Association (NATA) have acted to move the professional degree in athletic training from a bachelor’s degree to a graduate degree. The decision was largely based upon growth of the profession and aligning with the face of healthcare education. Therefore, we wanted to understand the perceived benefits of the graduate model. Using a qualitative paradigm, we electronically interviewed 29 students and faculty members (13 athletic training faculty and program directors, 16 students) currently in Professional Masters Athletic Training Programs (PM ATP). These represented 13 of the 29 (45%) CAATE-accredited PM ATPs. Five themes emerged from the data: (1) engagement and time spent in clinical education allows students to prepare for their roles as athletic trainers, (2) faculty stress the importance of interprofessional education, (3) expecting prior foundational knowledge allows focused education training at the graduate level, (4) increased professional commitment to stay in athletic training rather than use the training/education as a stepping-stone to other career paths, and (5) higher student maturity facilitates deeper learning. Based on these results, the perceived benefits of the PM ATP model are multifactorial.

Background Head impacts have been studied extensively in football, but little similar research has been conducted in men's lacrosse. It is important to understand the location and magnitude of head impacts during men's lacrosse to recognize the risk of head injury. Methods Descriptive epidemiology study set on collegiate lacrosse fields. Eleven men's lacrosse players (age=20.9±1.13years, mass=83.91±9.04kg, height=179.88±5.99cm) volunteered to participate. We applied X2 sensors behind the right ear of participants for games and practices. Sensors recorded data on linear and rotational accelerations and the location of head impacts. We calculated incidence rates per 1000 exposures with 95% confidence intervals for impact locations and compared the effect of impact location on linear and rotational accelerations with Kruskal-Wallis tests. Findings We verified 167 head impacts (games=112; practices=55). During games, the incidence rate was 651.16 (95% confidence interval=530.57–771.76). The high and low incidence rates for head impact locations during games were: side=410.7 (95% confidence interval=292.02–529.41) and top=26.79 (95% confidence interval=3.53–57.10). For games and practices combined, the impact locations did not significantly affect linear ( χ 2 3 =6.69, P =0.08) or rotational acceleration ( χ 2 3 =6.34, P =0.10). Interpretation We suggest further research into the location of head impacts during games and practices. We also suggest player and coach education on head impacts as well as behavior modification in men's lacrosse athletes to reduce the incidence of impacts to the side of the head in an effort to reduce potential injury.

Objective: To describe the challenges of service coordination through the National Disaster Medical System (NDMS) for Hurricane Maria evacuees, particularly those on dialysis.Design: Public health report.Setting: Georgia.Report: On November 25, 2017, there were 208 patients evacuated to Georgia in response to Hurricane Maria receiving NDMS support. Most were evacuated from the US Virgin Islands (97 percent) and the remaining from Puerto Rico (3 percent); 73 percent of these patients were on dialysis, all from the US Virgin Islands. From the beginning of the evacuation response through November 25, 2017, there were 282 patients evacuated to Georgia via NDMS, with a median length of coverage through NDMS for those on and not on dialysis of 60 and 16 days, respectively. Conclusion: The limited capacity and capability of dialysis centers currently in the US Virgin Islands are delaying the return to home of many Hurricane Maria evacuees who are on dialysis.

Context: Recent literature has focused on reasons for athletic training student persistence and departure. However, accredited professional bachelor's athletic training program (ATP) directors' opinions regarding student retention have yet to be studied, to our knowledge.Objective: To determine reasons for athletic training student persistence and departure from professional bachelor's ATPs across the United States from the program directors' (PDs') perspective.Design: Two-part qualitative study.Setting: Commission on Accreditation of Athletic Training Education professional bachelor's ATPs.Patients or Other Participants: For Part 1 of this study, we asked PDs of all 343 ATPs to complete an online survey, gathering responses from 177 (51.6%). Using data saturation as a guide, Part 2 included performing follow-up telephone interviews to gain further understanding, clarity, and triangulation with 16 randomly selected PDs.Main Outcome Measure(s): During Part 1, participants chronicled responses to open-ended questions as part of the online survey. For the second part of the study, the telephone interviews followed a semistructured format and were recorded to facilitate transcription. We analyzed data using grounded theory and secured trustworthiness by using multiple-analyst triangulation, member checks, and a peer review.Results: Program directors reported athletic training students persist due to their career goals, the personal relationships they create, and because they enjoy and are dedicated to athletic training. The respondents stated that athletic training students leave ATPs because of the academic rigor, the program not meeting expectations, a loss of interest, career considerations, and financial reasons.Conclusions: Program directors should educate prospective athletic training students about athletic training by providing a realistic explanation of the roles and responsibilities of the profession. Selecting clinical education sites with preceptors who enjoy their career choice and good working conditions may help solidify athletic training student commitment to the ATP and the athletic training profession.

Context: Some athletic training program (ATP) directors use direct admit, where students are admitted into the ATP directly out of high school. Other ATP directors admit students into the program after a set time period on campus through a secondary admissions process. It remains unknown why ATP directors use various admissions practices. Objective: To determine why ATP directors use a secondary admissions process. Design: Qualitative study. Setting: Professional bachelor's ATPs. Patients or Other Participants: We asked ATP directors from all 343 professional bachelor's ATPs to participate in an online survey. We received responses from 177 (51.6%). Main Outcome Measure(s): The survey asked participants both when students are first eligible for admission into their ATP and to explain the rationale behind their specific admissions process. We used grounded theory to analyze the data and maintained the trustworthiness of the analysis via multiple-analyst triangulation, member checks, and a peer review. Results: The majority (92.1%) of respondents used a secondary admissions process to formally select students into their ATP. The ATP directors stated that opportunities for socialization, the ability to maintain quality control, and the chance to complete general education requirements were important reasons to admit students into the ATP after they have been on campus for at least 1 semester. Conclusions: The use of a secondary admissions process appears to help ATPs provide a glimpse of the profession through observation and introductory coursework. The secondary admissions process also allows faculty and staff to evaluate student potential, while students are given time to focus on their transition to college life. We believe the timing of formal admittance to the ATP is an important decision that warrants thought and discussion between the program faculty and staff to provide curricular sequencing that works for both prospective students and the ATP faculty and staff.

Research has identified that learning in the clinical education setting can be reciprocal between preceptors and athletic training students. However, the frequency of and the potential benefits to reciprocal learning are not fully understood. The purpose of the current study was to explore the frequency and perceived value of reciprocal learning in clinical education from both the athletic training student and preceptor perspective. Reciprocal learning was identified by preceptors and athletic training students as occurring frequently during clinical education. Preceptors and athletic training students valued the opportunity to learn from one another.

Context: Retaining athletic training students has been identified as problematic by approximately half of athletic training program (ATP) directors. It is unknown what ATP directors do to improve athletic training student retention.Objective: To identify initiatives that ATP directors use to improve the retention rates of athletic training students in their programs.Design: Qualitative study.Setting: Undergraduate ATPs.Patients or Other Participants: We asked directors of ATPs across the nation to complete an Internet questionnaire. We obtained responses from 171 out of 343 ATP directors (51.6%). In addition, we completed follow-up interviews with 16 randomly selected ATP directors.Main Outcome Measure(s): During the online questionnaire, we asked ATP directors to describe any specific initiatives they or their ATP used that were aimed at retaining athletic training students and ideally what they would like to do to improve athletic training student retention at their institution. During the follow-up telephone interviews, we asked participants to further describe their retention strategies and other techniques not already mentioned in their questionnaire responses to gain further insight. We used a general inductive approach to analyze the data and performed multiple-analyst triangulation, member checks, and a peer review to ensure the trustworthiness of the analysis and results.Results: During data analysis, we identified 3 themes that highlight the ATP directors' initiatives to retain athletic training students. Directors discussed fostering a family atmosphere, strategic planning, and having resources available to support students as ways to improve retention.Conclusions: Athletic training program directors are encouraged to integrate students into their programs early through informal and formal participation opportunities, evaluate student potential prior to formal admissions, plausibly through an interview process, and educate students on scholarship opportunities to help offset tuition and fees associated with program completion.

The National Operating Committee on Standards for Athletic Equipment (NOCSAE) has developed impact attenuation thresholds that protective helmets worn in sport must meet to be commercially available in an attempt to prevent injury. It remains unknown how normal helmet use in athletic activity alters the force attenuation ability of lacrosse helmets. We tested 3 new and 3 randomly selected used helmets from 2 popular lacrosse models (Cascade Pro7, Cascade CPXR). All used helmets had been worn for 3 collegiate seasons prior to testing and had never been refurbished. Helmets were drop-tested using 3 prescribed impact velocities at 6 locations according to the NOCSAE lacrosse helmet standard, and we compared the Gadd Severity Index (GSI) scores between new and used helmets using a repeated measure ANOVA with location as the repeated variable and data separated by impact velocity. All 12 helmets passed the NOCSAE GSI threshold for all testing conditions; however 1 used helmet shell cracked resulting in a failed test. We found a significant main effect for helmet age at the low (F5,50=2.98, P=.02), medium (F5,50=3.71, P=.006), and high (F5,50=2.70, P=.03) velocities. We suspect that helmet use can degrade materials under some conditions, but improve performance in others due to changes in helmet composition from use. The clinical implications of the differences in GSI scores noted remain unclear. Because one helmet shell cracked resulting in a failed test, used helmets should be regularly inspected for cracks or other signs of mechanical fatigue that may weaken helmet integrity.

Facemask removal (FMR) is crucial for immediate treatment of helmeted athletes. The purpose of this study was to determine the effect of practice on the time required for lacrosse helmet FMR. Participants removed the facemasks of two helmet models (Cascade CPXR and Warrior Trojan) four times over four weeks with either a cordless screwdriver or pruner. We found a significant interaction for removal tool and time (p < .001). Participants became faster at FMR across the 4 weeks of data collection. We recommend three consecutive weeks of practice to improve FMR speed, though depending on FMR tool, an individual could benefit from additional sessions.

Context Graduates of athletic training programs (ATPs) have identified factors contributing to their persistence through professional education. However, program directors have yet to elaborate on programmatic attributes that might contribute to athletic training student retention in their respective ATPs. Objective To determine program directors' perceptions of ATP strengths and areas for improvement regarding athletic training student retention. Design Qualitative study. Setting Bachelor's ATPs. Patients or Other Participants Sixteen ATP directors with 6.0 ± 4.0 years of experience in their current positions. Main Outcome Measure(s) The participants completed audio recorded telephone interviews. We analyzed the data using principles of grounded theory and maintained trustworthiness using multiple-analyst triangulation, peer review, and member checks. Results We found 2 themes to describe the strengths of bachelor's ATPs. Our participants thought that they provided a student-centered approach and diverse clinical education experiences leading to a supportive and exciting environment to foster athletic training student learning. We categorized the student centered approach theme into 3 subthemes: program size, student engagement and program atmosphere, and academic and clinical cohesion. Conclusions Program directors should strive to provide athletic training students with individual attention to help them feel welcomed, valued, and important. A small program size or adequate personnel can foster interpersonal relations which can provide athletic training students with mentoring opportunities. Improving ATP cohesion can provide learning opportunities which assist students in making connections and promote the importance of the academic and clinical education components of the ATP. Engaging athletic training students early through a variety of clinical education experiences can assist professional socialization and foster excitement for the profession.

Context Choosing to pursue an advanced degree in athletic training appears to indicate professional commitment and passion for the profession. Currently, there is a paucity of information regarding why some athletic trainers pursue enrollment in a postprofessional athletic training program (PPATP), indicating commitment to the profession, but later depart for another primary role outside of athletic training. Objective To understand why athletic trainers invested in advanced training via a PPATP but then decided to leave the profession. Design Qualitative study. Setting Online data collection. Patients or Other Participants Twelve graduates (8 women [67%], 4 men [33%], age = 31.58 ± 3.06 years) from PPATPs who no longer had primary employment as an athletic trainer. Data Collection and Analysis Recruits responded to an e-mail invitation to participate by completing a confidential online questionnaire. We analyzed data using a general inductive approach and secured trustworthiness using multiple-analyst triangulation, peer review, and member checks. Results Two higher-order themes emerged regarding the career commitment of former athletic trainers who were PPATP graduates: (1) departure from an athletic training career and (2) partial continuance in athletic training. Two second-order themes emerged from the reasons for departure: (1) decreased recognition of value and (2) work-life imbalance. Finally, we identified 2 third-order themes from the participants' reasons for departure because of a perceived lack of value: (1) low salary and (2) long, inconsistent hours worked. Conclusions Most of our participants intended to stay in the profession when they chose to attend a PPATP. However, during role inductance in either the clinical experience of the PPATP they attended or early in their careers, they began to have thoughts of leaving mainly because of inadequate financial compensation, challenging work schedules, or both.

Football helmet certification tests are performed without a facemask attached to the helmet; however, the facemask is expected to contribute substantially to the structure and dynamics of the helmet through the effects of added mass and added stiffness. Facemasks may increase the peak acceleration and severity index; therefore, as-used helmets may not mitigate head impacts as effectively as certification tests indicate. Furthermore, the effect is expected to depend on the helmet design as well as the orientation and speed of the impact. This study examined the influence of the facemask on impact behavior in a NOCSAE-style linear drop test and the interactions with location, velocity, and helmet model. Increases in peak acceleration and severity index of up to 36% were observed when helmets were tested with the facemask.

Context: Performance of quality cardiopulmonary resuscitation is essential for improving patient outcomes. Performing compressions over football equipment inhibits compression depth and rate, but lacrosse equipment has not yet been studied. Objective: To assess the effect of lacrosse shoulder pads on the ability to provide quality chest compressions on simulation manikins. Design: Crossover study. Setting: Simulation laboratory. Patients or Other Participants: Thirty-six athletic trainers (12 men: age = 33.3 ± 9.7 years; 24 women: age = 33.4 ± 9.8 years). Main Outcome Measure(s): No shoulder pads (NSP), Warrior Burn Hitman shoulder pads (WSP), and STX Cell II shoulder pads (SSP) were investigated. Outcomes were chest-compression depth (millimeters), rate (compressions per minute), rating of perceived exertion (0−10), hand-placement accuracy (%), and chest recoil (%). Results: We observed a difference in mean compression depth among shoulder-pad conditions (F2,213 = 3.73, P = .03, ω2 = 0.03), with a shallower depth during the WSP (54.1 ± 5.8 mm) than the NSP (56.8 ± 5.7 mm; P = .02) trials. However, no differences were found in mean compression rate (F2,213 = 0.87, P = .42, ω2 = 0.001, 1–β = .20). We noted a difference in rating of perceived exertion scores (F2,213 = 16.41, P < .001, ω2 = 0.12). Compressions were more difficult during the SSP condition (4.1 ± 1.3) than during the NSP (2.9 ± 1.2; P < .001) and WSP (3.3 ± 1.1; P = .002) conditions. A difference was present in hand-placement accuracy among the 3 shoulder-pad conditions (χ22 = 11.14, P = .004). Hand-placement accuracy was better in the NSP than the SSP condition (P = .002) and the SSP than the WSP condition (P = .001). Conclusions: Lacrosse shoulder pads did not inhibit the ability to administer chest compressions with adequate rate and depth. With appropriate training to improve hand placement, the pads may be left in place while cardiopulmonary resuscitation is initiated during sudden cardiac arrest.

ContextAthletic training programs (ATPs) are charged with meeting an increased demand for athletic trainers with adequate graduates. Currently, the retention rate of athletic training students in ATPs nationwide and the programmatic factors associated with these retention rates remain unknown.ObjectiveDetermine the retention rate for athletic training students nationwide and the programmatic factors associated with retention.DesignCross-sectional online survey.SettingUndergraduate ATPs.Patients or Other ParticipantsProgram directors (PDs) of all Commission on Accreditation of Athletic Training Education–accredited undergraduate ATPs were surveyed. We obtained responses from 177 of the 343 PDs (51.6%).Intervention(s)The survey asked PDs for information about their institution, ATP, and themselves.Main Outcome Measure(s)Self-reported retention rate.ResultsThe participants reported an average retention rate of 81.0% ± 17.9%. We found a significant prediction equation (F4,167 = 16.39, R2 = 0.282, P < .001), using the perceptions of student success factor (P < .001, R2 = 0.162), the timing of formal admission (P < .001, R2 = 0.124), the number of years the ATPs had been accredited (P = .001, R2 = 0.039), the number of students admitted to the ATP annually (P = .001, R2 = 0.037), and the number of years the PDs had held their position at their current institution (P = .03, R2 = 0.018).ConclusionsProgram directors should work to provide a stimulating atmosphere to motivate students. Delaying the formal admission of prospective students may allow athletic training students to make an informed decision to enter an ATP. A rich history of success and consistent leadership can provide an ATP environment that fosters retention. Program directors should carefully consider how many students to admit into the ATP annually, as individual attention may alter retention decisions of athletic training students.

Context Student retention is a key issue in higher education. With the increasing number of professional master's (PM) athletic training programs (ATPs), understanding student retention is necessary to maintain viable programs. Objective Explore program directors' perceptions of the reasons athletic training students persist and depart from PM ATPs. Design Qualitative study. Setting Professional master's athletic training programs. Patients or Other Participants We asked directors from all PM ATPs nationwide to complete an online survey. We obtained responses from 60.0% (15 out of 25) of the population. We also completed follow-up telephone interviews with directors from 8 PM ATPs. Main Outcome Measure(s) Directors of PM ATPs completed an online survey asking for reasons for student persistence and departure. We also conducted follow-up telephone interviews with randomly selected participants. During the telephone interviews, we asked participants for additional detail regarding the enrollment decisions of students. Results PM ATP directors stated that students persist due to their commitment to the profession and the interpersonal relationships they build with the program stakeholders. Conversely, students depart PM ATPs due to the rigor associated with completion, a change in career aspirations, and financial concerns. Conclusions Athletic training educators should strive to keep commitment and motivation levels high while fostering positive interpersonal relationships by providing a welcoming atmosphere and engaging clinical education experiences. Finally, mentors should be available to assist students with program completion, and students should have options available for defraying the cost associated with completing the PM ATP.

Context Clinical experiences help athletic training students gain real-time learning experiences by engaging in patient care. Observational learning has been identified as important to athletic training student development, yet little is known about its effectiveness. Objective To explore the athletic training students' perspectives on their experiences in the clinical education setting, particularly examining the effectiveness of observational learning. Design Qualitative study. Setting Commission on Accreditation of Athletic Training Education (CAATE)-accredited undergraduate programs. Patients or Other Participants Twenty-four athletic training students (7 juniors and 17 seniors) from 4 National Athletic Trainers' Association (NATA) districts volunteered to participant in our study. The average age was 21 years (range, 20–23 years). Main Outcome Measure(s) Participants responded to a series of open-ended questions by journaling their thoughts and opinions through the secure Web site QuestionPro. Questions examined clinical education experiences and learning preferences. The resulting data were analyzed using a general inductive procedure, and credibility was established by employing peer review, member checks, and multiple analyst triangulation. Results Our analysis revealed that observational learning can benefit students when academic standing is considered, the circumstances are right, and it allows for directed mentoring. Our participants valued opportunities to engage in observational learning, as long as it was limited and purposeful. Conclusions All 24 participants identified themselves as hands-on learners who preferred to be actively engaged during their learning experiences, but who also valued opportunities to observe their preceptors demonstrating and modeling appropriate skills and behaviors before engaging in the same practices themselves. Today's student, the millennial, appears to favor visual learning, which may partially explain why our cohort of athletic training students described observational learning as advantageous in certain situations.

Context Clinical integration impacts athletic training students' (ATSs) motivation and persistence. Research has yet to elucidate the manner in which different clinical placements can influence clinical integration. Objective To examine differences in the levels of clinical integration achieved by ATSs across various clinical sport assignments. Design Cross-sectional survey. Setting Thirteen undergraduate athletic training programs. Patients or Other Participants Questionnaires were administered to 169 ATSs previously engaged in clinical education experiences. One hundred twenty-nine participants completed the questionnaire, for a response rate of 76.33%. Participants completed an average of 4 ± 2 clinical rotations. Intervention(s) The 11-item clinical integration scale was administered either in-person or online methods. Responses were scored on a 6-point Likert scale (1 = strongly disagree to 6 = strongly agree). Main Outcome Measure(s) Mean clinical integration scores (potential minimum score of 11, maximum score of 66), were calculated for each clinical placement. One-way analysis of variance was used to identify differences in clinical integration achieved across clinical placements. Results We found differences in clinical integration achieved across various clinical assignments (F19,415 = 3.486, P < .001). Students completing a rotation with college football achieved the lowest levels of clinical integration (46.9 ± 9.1). Other sports rated higher, ranging from 51.6 ± 10.1 (baseball) to 57.8 ± 4.5 (lacrosse), with all reporting less anxiety and time wasting than were associated with football. The high school rotation was also rated highly (54.7 ± 6.4), with higher levels of learning reported and fewer concerns about anxiety, excessive hours, and wasting time. Conclusions There were clear differences in clinical integration achieved between sites. In particular, ATSs completing clinical rotations with college football reported the lowest levels of clinical integration. These low levels of integration stemmed from feelings of wasting time, completing menial tasks, excessive hours, and anxiety associated with the educational experience.

Context Professional master's (PM) athletic training programs (ATPs) are becoming more popular as the profession debates what the entry-level degree should be for athletic training. More information is needed related to the potential benefits of PM ATPs. Objective Describe the Commission on Accreditation of Athletic Training Education (CAATE) accredited PM ATPs including athletic training student retention rates and career placement rates as well as strengths and areas for improvement. Design Mixed-method study. Setting Professional master's ATPs. Patients or Other Participants We surveyed directors of all accredited PM ATPs and obtained responses from 15 out of the 25 directors (60.0%). Main Outcome Measure(s) We sent a link to an electronic survey to all directors. The survey asked background questions about the ATP, the institution, and the director. Using data saturation as a guide, we also performed follow-up telephone interviews with 8 directors to expand upon the data gathered in the survey, specifically related to aspects of their PM ATPs. We analyzed the data using grounded theory and maintained trustworthiness through multiple analyst triangulation, member checks, and a peer review. Results Our findings indicate an 88.7% retention rate and an 88.5% career placement rate for PM athletic training students. The directors responded very positively about their ATPs, particularly didactic education. The participants also felt they provide a positive environment which fosters student learning, excellent clinical education opportunities, and unique experiences beyond those typically offered at the undergraduate level. Many directors also noted they wanted to make personnel modifications to strengthen their ATPs. Conclusions We were able to provide descriptive information on PM ATPs. The participants described the didactic and clinical education experiences, social experiences, and overall ATP atmosphere as overwhelmingly positive. The small class sizes and involvement from faculty, staff, and preceptors helped create an environment, which fosters athletic training student learning.

Context: The Guardian Cap provides a soft covering intended to mitigate energy transfer to the head during football contact. Yet how well it attenuates impacts remains unknown. Objective: To evaluate the changes in the Gadd Severity Index (GSI) and linear acceleration during drop tests on helmeted headforms with or without Guardian Caps. Design: Crossover study. Setting: Laboratory. Patients or Other Participants: Nine new football helmets sent directly from the manufacturer. Intervention(s): We dropped the helmets at 3 velocities on 6 helmet locations (front, side, right front boss, top, rear right boss, and rear) as prescribed by the National Operating Committee on Standards for Athletic Equipment. Helmets were tested with facemasks in place but no Guardian Cap and then retested with the facemasks in place and the Guardian Cap affixed. Main Outcome Measure(s): The GSI scores and linear accelerations measured in g forces. Results: For the GSI, we found a significant interaction among drop location, Guardian Cap presence, and helmet brand at the high velocity (F10,50 = 3.01, P = .005) but not at the low (F3.23,16.15 = 0.84, P = .50) or medium (F10,50 = 1.29, P = .26) velocities. Similarly for linear accelerations, we found a significant interaction among drop location, Guardian Cap presence, and helmet brand at the high velocity (F10,50 = 3.01, P = .002, ω2 = 0.05) but not at the low (F10,50 = 0.49, P = .89, ω2 < 0.01, 1–β = 0.16) or medium (F5.20,26.01 = 2.43, P = .06, ω2 < 0.01, 1–β = 0.68) velocities. Conclusions: The Guardian Cap failed to significantly improve the helmets' ability to mitigate impact forces at most locations. Limited evidence indicates how a reduction in GSI would provide clinically relevant benefits beyond reducing the risk of skull fracture or a similar catastrophic event.

Context Clinical experiences are an integral part of athletic training education and are where students gain the hands-on, practical knowledge and skills necessary to provide quality patient care in the field. However, some clinical education experiences may not allow athletic training students to become clinically integrated. Objective To explore athletic training students' perspectives on their clinical learning experiences, specifically as they relate to an engaging learning environment. Design Qualitative study. Setting Commission on Accreditation of Athletic Training Education accredited undergraduate programs. Patients or Other Participants Twenty-one athletic training students (6 juniors; 15 seniors) with an average age of 22 years (20–23 years) from 4 National Athletic Trainers' Association districts volunteered to participate in our study. Data Collection and Analysis Participants responded to a series of open-ended questions by journaling their thoughts and opinions through the secure website QuestionPro. Data were analyzed using open coding that was guided by a general inductive procedure. Data credibility was established through peer review, interpretative member checks, and multiple analyst triangulation. Results Our cohort identified an engaging learning environment as one that allowed active learning and participation as an athletic trainer and included communication between the student and preceptor, patient interactions, and instructor feedback regarding development and application of skills and knowledge. Conclusions Athletic training students prefer a more active learning style and value observing their preceptor engage in patient care, but they also want the opportunity to practice their athletic training skills to gain competence and confidence.

Context Clinical education is an integral part of athletic training programs. This is where students should develop their professional identities and become socialized into the profession. Understanding the student and preceptor perspectives of the impact that clinical experiences have on students can provide valuable insight into this aspect of athletic training education. Objective To evaluate the impact of clinical education on the professional development of athletic training students from the student and preceptor perspective. Design Qualitative study. Setting Commission on Accreditation of Athletic Training Education–accredited undergraduate programs. Patients or Other Participants A total of 15 participants (7 athletic training students and 8 preceptors) from four schools enrolled in our study. Data Collection and Analysis One researcher conducted semistructured interviews over the phone or in person. Data analysis used a general inductive approach to reveal the dominant themes that related to our purpose. We achieved data credibility through multiple analyst triangulation, peer review, and member checks. Results Athletic training students and preceptors agree that clinical education is integral to the professional development process. Realistic and positive experiences and diversity in experiences were identified as factors affecting professional growth during clinical education experiences. Conclusions Athletic training students and preceptors have similar views on the importance of clinical placements on professional development. Clinical experiences provide students with the opportunity to learn more about the profession, affirm their career choice, practice knowledge and skills, and learn about themselves personally and professionally. The student and the fit/match of the placement directly impact the students' clinical experiences.

ContextProfessional socialization is a key process in the professional development of athletic training students. Literature has focused on many perspectives regarding socialization and has primarily focused on the undergraduate level.ObjectiveGain insights from the program director at professional master's (PM) athletic training programs on methods used to socialize students into programs and the profession.DesignQualitative study.SettingOne-on-one telephone interviews.Patients or Other ParticipantsA total of 8 PM program directors volunteered for our study. The Table provides information on the institutions represented by these participants. Our program directors had 8 ± 6 years of experience in their current roles and were 41± 4 years old.Data Collection and AnalysisWe conducted 1-on-1 phone interviews and transcribed the interviews verbatim. We performed a general inductive analysis of the data. We also completed member checks, multiple analyst triangulation, and peer reviews to establish data and methodological credibility.ResultsOur findings indicated that PM programs utilize a combination of formal and informal processes to orient the student, which is comparable to those processes used by undergraduate programs to socialize their students. The formal processes included orientation sessions and introductory courses. Social gatherings and program outings along with peer mentoring were also methods employed by PM programs to assist in socializing the student, but these methods were informal in nature.ConclusionsProgram autonomy allows for athletic training programs to personalize their tactics to socialize the student, but it does appear that the use of orientation sessions and introduction courses allows PM programs to formally introduce the profession and program. Less structured socialization strategies include peer-driven mentoring and social engagements that promote interaction and stress-relief. Programs are encouraged to evaluate their current socialization tactics and take advantage of the benefits of peer support and times to directly communicate with their students.

Context Preceptors play an integral role in training athletic training students (ATSs). Balancing roles as health care providers and educators can often be challenging. Role strain is a documented concern for the preceptor, yet limited information is available regarding other issues faced while supervising ATSs. Objective To explore preceptor challenges. Design Qualitative study. Setting Athletic training programs. Patients or Other Participants A total of 41 preceptors from 2 different data collection procedures (cohorts) participated in the study. Preceptors had an average of 6 ± 2 years (cohort 1) and 5 ± 3 (cohort 2) years of experience as clinical educators, respectively. The preceptors were distributed between college (25) and secondary school (16) settings. Data Collection and Analysis Data were collected via telephone interviews (cohort 1) and asynchronous online interviews using Question Pro (cohort 2). We used a combination of grounded theory and inductive procedures for data analysis. Credibility of the data was established by investigator and data analyst triangulation in addition to peer review. Results Role strain was reported by preceptors as they attempted to balance their responsibilities as health care providers and clinical educators. Working conditions characterized by long hours, high patient volumes, and inadequate compensation hindered preceptors' ability to foster a positive learning environment. Because of contrasting personalities and different expectations, some preceptors experienced challenges interacting with students. Conclusions The preceptor position involves meeting the high standards for education and health care simultaneously. Preceptor training does not often address the challenges of balancing multiple roles. It therefore becomes important for ATSs and preceptors to develop strong lines of communication and determine an appropriate schedule for educational activities. Clinical coordinators should consider both the personalities of preceptors and ATSs and the workload of the preceptor when determining clinical assignments.

Context Preceptors play a vital role in athletic training education as they mentor and socialize athletic training students into their professional role. Exploring the benefits to serving as a preceptor is important to secure appropriate professional role models for students. Objective To determine the benefits of serving as an athletic training preceptor. Design Qualitative study. Setting Undergraduate athletic training programs (ATPs). Patients or Other Participants Twenty-four preceptors (average age = 32 ± 7 years, 11 male, 13 female, average clinical experience = 9 ± 6 years, average preceptor experience = 5 ± 3 years) volunteered to participate in our study. Participants represented 7 undergraduate Commission on Accreditation of Athletic Training Education–accredited ATPs from the east coast. Data Collection and Analysis We asked participants to journal responses to open-ended questions through a QuestionPro online survey. We analyzed data using a general inductive approach. We secured credibility by using consistency and stakeholder checks and by having a peer review our work. Results Three main themes emerged from the data. Preceptors enjoy the personal relationships they build with students. The challenging atmosphere of supervising students while they gain knowledge to improve their skills also came through as a major benefit to serving as a preceptor. Finally, our participants enjoy teaching and mentoring the future members of the athletic training profession. Conclusions Our participants listed the relationships they build with students as rewarding, potentially leading to an improved professional commitment. Reciprocal learning between the preceptors and the students allows for a stimulating environment and has the potential to improve patient care. The enjoyment of teaching and mentoring students may aid in providing a dynamic atmosphere for students to learn.