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Context: Athletic trainers have expressed a lack of knowledge and a desire to learn more about the issues impacting lesbian, gay, bisexual, transgender, queer/questioning, pansexual, intersex, asexual/aromantic/agender, two-spirit, and additional community/identity (LGBTQPIA+) patients, yet little is known about how students are prepared. Objective: The purpose of this study was to explore educational experiences relative to LGBTQPIA+ patient care in Commission on Accreditation of Athletic Training Education-accredited, master's-level professional athletic training programs. Design: Cross-sectional study. Setting: Web-based survey. Participants: Students (N = 333) who were currently enrolled in the last 1 to 2 semesters of their respective programs or had recently graduated from a master's-level professional athletic training program within the last year. Main Outcome Measure(s): The survey asked participants to characterize and evaluate the effectiveness of their learning experiences, then rank their confidence in addressing the needs of LGBTQPIA+ patients. We used additional open-ended responses to characterize effective instructional strategies. Data were analyzed using statistics of central tendency and open-ended responses were inductively coded. Results: Participants reported that their learning experiences about LGBTQPIA+ patient needs were moderately effective for formal (38.2%), informal (42.2%), and clinical education (34.0%). Among the areas where participants reported wishing they had learned more were gender incongruence or dysphoria (39.6%), gender-affirming care (43.5%), and providing inclusive health care forms and documentation (38.4%). Participants reported about 15 6 37 hours (range, 0-500 hours) of time dedicated to LGBTQPIA+ patient issues, although only 23.2% indicated that this was enough time. Participants indicated that they were quite confident in addressing the needs of LGBTQPIA+ patients (mode = 3 ["quite confident"], 33.0%); however, 53.7% of participants were only somewhat, slightly, or not at all confident. In the open-ended responses, participants indicated that informal and clinical education experiences providing authentic interactions with LGBTQPIA+ patients were most meaningful. Conclusions: Professional athletic training programs should incorporate more educational experiences to better prepare students to meet the health care needs of LGBTQPIA+ patients. Participants in our study additionally indicated a strong desire to learn more about equitable patient care

Context: The "U.S. News & World Report" college ranking system is used to describe the best graduate programs in the country. Rankings of graduate programs are based solely on perceived ratings of quality by directors and/or deans. Athletic training is not listed by "U.S. News & World Report"; however, the Commission on Accreditation of Athletic Training Education (CAATE) reports key metrics such as the Board of Certification pass rate and program graduation rate, which could be helpful to create rankings. Objective: To evaluate and rank CAATE-accredited professional athletic training (PAT) programs using 2 models: (1) perceived rating of academic quality by program directors (PDs) and (2) CAATE outcome data. Design: Cross-sectional with survey and retrospective data. Setting: Web-based survey. Patients or Other Participants: One hundred fifty-five PDs and 230 CAATE-accredited PAT programs. Main Outcome Measure(s): The perceived rating survey for the PDs resembled the "U.S. News & World Report" system using a 5-point Likert scale to assess the academic quality of each program. For the CAATE outcome data, we used publicly available information for each PAT program on the CAATE website. We ranked all PAT programs using the data from each model. A Cohen [kappa] was performed to explore the agreement between the PDs' perceived ranking and the CAATE outcome data rankings. Results: No agreement was found between the perceived peer assessment and CAATE outcome data rankings ([kappa] = -0.003, P = 0.401). Conclusion: Perception by PDs did not align with objective data reported by CAATE. The lack of agreement between the 2 ranking systems highlights concerns about using the "U.S. News & World Report" system for graduate health programs. We suggest exploring a more robust and comprehensive formula including overall pass rate and graduation rate to identify top-ranked programs in athletic training.

Context: Research suggests that athletic training students lack knowledge and experience providing care to transgender patients. Additionally, research has identified a lack of comfort with sexual health screening in peer health professions. Objective: To assess how a curriculum, including a standardized patient (SP) encounter, influenced attitudes and skills in working with sexual health and gender minorities. Design: Prospective observational study. Setting: Simulation lab. Patients or Other Participants: Twenty cisgender postbaccalaureate professional athletic training students (females = 16, males = 4; age = 23 ± 2 years). Intervention(s): The intervention included a focused curriculum on transgender health care and sexual health. In a culminating SP encounter, one group (n = 10) interacted with a cisgender woman and the second group (n = 10) with a transgender woman. Main Outcome Measure(s): The students completed a postintervention survey. Instruments included the Attitudes Towards Transgender Patients tool, which is divided into 3 subscales: clinician education, transgender sport participation, and clinician comfort; and the the Sexual Health Knowledge and Attitudes and Sexual History--Taking instruments, which evaluated the effectiveness of the sexual health curriculum on knowledge, attitudes, and comfort. The investigator and SP actor evaluated the SP encounters. Data were analyzed using descriptive statistics, nonparametric Mann-Whitney U, and 1-way analyses of variance. Results: We identified a significant difference between those completing a transgender SP encounter (mean = 5.30 ± 2.11) and those completing the cisgender SP encounter (mean = 3.50 ± 0.97) on the clinician education subscale (P = 0.035). There were no differences between groups on the transgender sport participation (P = 0.70) and clinician comfort (P = 0.32) subscales. On the SP actor evaluation, we found no significant differences (P = 0.08). Conclusions: The curriculum and SP encounter influenced knowledge, attitudes, and comfort when working with gender minorities and screening for sexual health.

Context: The United States transgender patient population often suffers from insufficient health care and faces barriers to obtaining health care. Understanding the current classroom education provided in professional athletic training programs related to patient-centered and transgender patient care is necessary to foster improvements to the education of future health care providers. Objective: To explore the education, comfort, and experience of professional athletic training students and program directors (PDs) on patient-centered care (PCC) and transgender patient care. Design: Cross-sectional survey. Setting: Online survey. Patients or Other Participants: A total of 74 PDs of Commission on Accreditation of Athletic Training Education-accredited professional athletic training programs (age = 46 ± 9 years) and 452 athletic training students (age = 23 ± 3 years) responded to the survey. Data Collection and Analysis: Two surveys were created from literature and were reviewed by a committee of content experts. Participants were sent links to their respective survey in March 2020. Surveys contained questions on demographic information, PCC, and transgender patient care. Data were analyzed descriptively with follow-up X[superscript 2] analyses comparing athletic training students' comfort and competence between those who learned and did not learn about transgender patient care. Results: Most PDs reportedly felt comfortable (98.6%, n = 73) and competent (94.6%, n = 70) teaching PCC. Half (50% n = 37/74) of PDs include transgender health care in their program's curriculum but lacked competence (37.8%, n = 28) in teaching. All students felt comfortable (100%, n = 452) and competent (98.7%, n = 446) practicing PCC, but only 12.4% (n = 54) reported practicing it during clinical education. Less than half (43.1%, n = 195/452) of students learned about transgender patient care, yet most (78.3%, n = 354) felt comfortable but lacked competence (41.8% n = 189). Conclusions: Few students reportedly practice PCC during clinical education. Both groups perceived deficiencies in competence related to transgender patient care. We suggest PDs teach transgender health care in their curriculum and seek professional development to create meaningful educational experiences.

Recently, with discriminatory legislation efforts and changing participation policies in organized sports, media attention surrounding transgender and gender-diverse (TGD) individuals has increased. These changes and the historical lack of competence and education regarding the transgender patient population have resulted in subpar patient care and a misunderstanding of the athletic trainer's (AT's) role within the health care and compliance systems. This literature review is the second part of a 2-paper series, and our objective was to educate ATs on the processes relevant to medical affirmation, including compliance considerations regarding medical eligibility, and to establish the AT's role. The gender affirmation framework includes social and legal components, which are discussed in part 1 of this literature, and the medical component is thoroughly discussed in part 2. All health care providers involved in the care of TGD individuals should work collaboratively on an interprofessional care team and have a general knowledge of the gender-affirmation process, including gender-affirming hormone therapy, surgical options, known risks and complications, and the general health needs of TGD patients. With this knowledge, ATs, as point-of-care providers and members of the interprofessional care team, are uniquely positioned to help reduce health and health care disparities. Furthermore, ATs can use their knowledge to facilitate medical compliance and eligibility in the evolving policies of sporting organizations. [ABSTRACT FROM AUTHOR]

Transgender and gender-diverse (TGD) patients experience discrimination, harassment, marginalization, and minority stress at greater rates than their cisgender counterparts, leading to numerous health and health care disparities that negatively affect well-being and access to quality health care.1 Despite being in an opportune position to improve health equity for TGD patients under their care, many athletic trainers (ATs) report having little to no formal education on TGD patient care, leading to a reduction in self-reported competence. As such, to fill this knowledge gap, the purposes of the first part of this 2-part narrative literature review are to (1) provide readers with foundational information and terminology, (2) explore relevant health and health care disparities, and (3) identify the role of the AT within an interprofessional care team treating TGD patients. [ABSTRACT FROM AUTHOR]

The purpose of this study was to establish the level of ease of use and effectiveness of the Orchard Sport Injury Classification System (OSICS) 10.1 Plus for recording injuries and interventions. Three hundred and forty-two (males=148, females=192, no response=2; age=30.9±9.5y; experience=9.1±10.5y) athletic trainers (ATs) in the United States completed the survey. Participants were primarily employed in the secondary school (n=135) or collegiate setting (n=171). Participants entered system includes the OSICS 10.1 to catalog injuries and Current Procedural Terminology (CPT) codes to document interventions. Participants completed an 18-item end-user evaluation to assess the ease of use and effectiveness of the OSICS 10.1 Plus (5-point Likert scale). Participants indicated that the OSICS 10.1 Plus is overall easy to use (4.1±0.7pts), easy to enter an injury (4.1±0.8pts), and easy to enter the associated interventions (3.9±0.8pts). Respondents were neutral about whether the OSICS 10.1 Plus matched their current injury (3.5±1.0pts) or intervention (3.5±0.9pts) records. A majority of participants indicated that they could find the injury (281/342, 82.2%) and interventions (225/342, 65.8%) of interest. A majority of respondents (205/342, 60.0%) indicated they would consider using OSICS 10.1 Plus for injury surveillance in clinical practice. The OSICS 10.1 Plus could serve as an effective and useful mechanism for injury surveillance with minor modifications; however, we, as professionals in sports healthcare, need to improve regular medical documentation first so that we are better able to conduct injury surveillance among our patients. [ABSTRACT FROM AUTHOR]