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Teachers play an important role in facilitating a student's return to school after a concussion. Currently, there is limited evidence on teachers' experiences and their role in managing concussions in the classroom. This study investigated teachers' perceived knowledge and confidence regarding concussion recognition and management. A cross-sectional design was used for this online survey of secondary school teachers in the United States. Practicing teachers self-reported being moderately knowledgeable and confident in their knowledge of concussion signs and symptoms. Whereas teachers were moderately knowledgeable and confident in their knowledge of academic support strategies after a student's concussion, teachers were minimally knowledgeable and confident in their knowledge of the criteria for the student's return to school and activity. Personal history of concussion and participation in formal concussion education were associated with increases in teachers' perceived knowledge and confidence regarding concussion and its management process. Overall, teachers believed it was important to learn about concussions to support a student's return to school. Therefore, integration of concussion education into preservice teacher education programs and in-service trainings is recommended. Providing teachers with practical resources on academic adjustments can enhance the support provided to symptomatic students, reduce misconceptions about concussion, and facilitate dialogue among stakeholders involved in the management of concussions.

Context: Self-efficacy (SE) can affect athletic training students' progression during their professional education and transition to autonomous clinical practice. It is unclear how course delivery may affect athletic training students' SE in various injury evaluation courses. Objective: Determine the relationship of course delivery modality and athletic training students' injury evaluation SE. Design: Cross-sectional investigation. Setting: Web-based survey. Patients or Other Participants: Ninety-five noncertified National Athletic Trainers' Association student members (38/95 undergraduate athletic training students; 57/95 graduate athletic training students). Data Collection and Analysis: A 2-part survey including participant characteristic questions and piloted adapted General Self Efficacy (GSE) scales were distributed using the National Athletic Trainers' Association's Research Survey Service. The adapted GSE scales asked participants to rate their agreeance from 1 (not at all true) to 4 (exactly true) for 10 statements focused on injury evaluations in 6 areas. Descriptive statistics were calculated, and nonparametric tests were used to determine the differences in GSE scores based on course delivery modality (online model, hybrid model, and traditional face-to-face model). Measures of central tendencies were also calculated. Results: Only completed surveys (66.4%; 95/143) were included in the analysis (access rate = 14.3%). A significant difference existed between course delivery modality and upper extremity GSE scores (P = 0.001). No significant differences were found between GSE scores for courses with delivery modalities affected or not affected by the COVID-19 pandemic as well as between athletic training students who had or did not have previous online or hybrid course experiences. Conclusion(s): As health care education continues to shift toward technology-rich environments, educators can consider offering courses through various delivery modalities to promote didactic and clinical education. However, consideration of the content area and difficulty may be warranted while purposefully planning courses to best address learning objectives and students' SE.

Context: Induced mental fatigue negatively impacts sport performance and neurocognition. However, it is unclear how induced mental fatigue influences landing biomechanics. The purpose of this study was to examine the influence of mental fatigue on drop landing biomechanics in individuals with and without a concussion history. Design: Crossover design. Methods: Forty-eight (24 per group) recreationally active individuals were matched on age (±3 y), sex, and body mass index (±1 kg/m²). All participants completed an experimental (30-min Stroop task) and control (30-min reading magazines) intervention on separate days separated by a minimum of 24 hours. Drop landings were performed before and after both interventions. Outcomes included peak vertical ground reaction force (vGRF), vertical loading rate (VLR), knee flexion angle, knee abduction angle, external knee flexion moment, external knee abduction moment, and initial ground contact knee flexion and knee abduction angles. Separate 2 (group) x 2 (intervention) between-within analyses of covariance compared drop landing outcomes. Each group's average pre-Stroop and premagazine outcomes were covariates. Results: There was a significant interaction for vGRF (P = .033, ηp²=.097) and VLR (P = .0497, ηp²=.083). The vGRF simple effects were not statistically significantly (P range = .052-.325). However, individuals with a concussion history displayed a medium effect size for greater vGRF post-Stroop compared with their own postmagazine vGRF (mean difference (95% confidence interval [95% CI] = 0.163 (-0.002 to 0.327) bodyweight (BW), p =.052, ηp²=.081. In contrast, the control group displayed a small effect size (mean difference [95% CI] = 0.095 [-0.069 to 0.259] BW, p =.251, ηp²=.029). Individuals with a concussion history displayed greater VLR post-Stroop compared with controls (mean difference [95% CI], 26.29 [6.19 to 46.40] BW/s, P = .012, ηp²=.134) and their own postmagazine values (mean difference [95% CI] = 32.61 [7.80 to 57.42] BW/s, p =.011, ηp²=.135). Conclusion: Mental fatigue leads to greater VLR for individuals with a concussion history. Athletic competition and activities of daily living can increase mental fatigue. Training programs may seek to teach mental fatigue reducing strategies to athletes with a concussion history. [ABSTRACT FROM AUTHOR]

Athletic trainers (ATs) appreciate the accessibility of web-based continuing education (CE) opportunities. ATs describe needing more CE opportunities related to clinical documentation, but the effectiveness of CE in this content area has not been studied. Obtain ATs' perceptions of their experiences accessing web-based CE specific to clinical documentation. Qualitative study. Web-based audio interviews. Twenty-nine ATs, averaging 36.2 ± 9.0 years of age, including 16 women and 13 men who represented 8 different clinical practice settings. Participants previously completed 1 of 2 web-based CE modules specific to clinical documentation, a personalized learning pathway (PLP) or passive reading list (PAS). After completing the modules, 1 investigator interviewed each participant regarding their experiences accessing and completing the modules. Following the Consensual Qualitative Research approach, 4 investigators (3 primary coders and 1 internal auditor) inductively analyzed the interview transcripts. We completed 5 rounds of consensus coding and finalized themes and supporting categories. We identified 2 themes: (1) structure and (2) barriers to completing the modules. Although both groups were satisfied with the content of the modules, PLP participants were more satisfied with the structure and experience of accessing the resources than the PAS participants. PLP participants enjoyed the engagement of the variety of resources included, whereas PAS participants inconsistently accessed reading materials based on personal preference. Both groups described time as a barrier to completing the modules, and some participants experienced technology barriers. ATs value web-based CE opportunities that compile information related to a topic. Learners find a variety of learning formats, including videos, case studies, knowledge checks, and reflection prompts, to be more engaging than only reading materials. Although time continues to be a barrier to completing CE, offering accessible and engaging learning opportunities improves satisfaction with completing CE. [ABSTRACT FROM AUTHOR]

Context: Athletic trainers (ATs) who serve as preceptors for athletic training students must model, facilitate, and guide professional skills and behaviors, including medical documentation. Preceptors have the unique ability to combine skill practice with real-time patient encounters for athletic training students. Objective: To describe the frequency of preceptors who allow athletic training students to complete medical documentation and rationale for their decisions. Design: Cross-sectional. Setting: Qualitative study. Patients or Other Participants: Of 9578 ATs, 1150 responded to an electronic survey (access rate = 12.0%), and 385 of 1150 respondents who completed an electronic survey (33.5%) indicated being a preceptor for a professional athletic training program. Respondents (age = 34 [plus or minus] 11 years, clinical practice experience = 11 [plus or minus] 10 years) were predominantly female (53.8%, n = 207) and held a master's degree (67.3%, n = 259). Main Outcome Measure(s): A 3-member data analysis team coded the open-ended responses following the consensual qualitative research approach. Each member coded 50 responses and a consensus codebook was created. The principal investigator coded the remaining responses, and the data analysis team confirmed the findings. Data were organized into emergent domains and categories. Frequency counts were calculated for each category. Results: A majority of preceptors (81.8%, n = 315) allowed their athletic training students to document patient care. Respondents indicated an intention for student involvement (domain 1), whereby they wanted students to engage in learning and develop knowledge (43.4%, n = 167) or practice and gain experience (41.3%, n = 159). However, others discussed deterrents (20.0%, n = 77) working against the preceptor's intentions. Respondents also indicated a need to mentor (domain 2). Specifically, they reported needing to manage the logistics of documentation (63.6%, n = 245) and the degree of oversight (48.8%, n = 188) needed during practice (either direct [79.8%, n = 150 of 188] or indirect [20.2%, n = 38 of 188]). Conclusions: Although preceptors intend to integrate students into medical documentation, they may benefit from formal guidance from the academic program on how to best integrate athletic training students into documenting day-to-day patient care.

The transition to autonomous clinical practice for early professionals (EPs) has been found to be a stressful time, but no studies with multiple stakeholder groups have been completed. To examine the perceptions of EPs' integration during role transition from multiple stakeholder groups. Qualitative study. Online interviews. Seventeen EPs in the first 2 years of their first job postcertification (9 women, 8 men, age = 26 ± 5 years, experience = 9.5 ± 5 months), 16 supervisors and mentors of EPs (6 women, 10 men, age = 52 ± 11 years), and 10 faculty members and 8 preceptors (11 women, 7 men, age = 43 ± 10 years). Semistructured interviews using a validated interview guide based on the current literature were conducted. We analyzed data using consensual qualitative research principles. Multiple-analyst triangulation (n = 3), member checking, and peer review served as trustworthiness strategies. We identified 4 themes that defined the integration of EPs during role transition. The integration of EPs was facilitated through role inductance and mentoring. Early professionals struggle finding balance to avoid burnout as they are new to the profession and feel obligated to exceed expectations from a coverage standpoint rather than focusing on the quality of care delivered. Finally, stakeholders suggested a timeline by which EPs become fully integrated into autonomous professional practice and understand all aspects of their role that typically takes anywhere from 1 to 3 years. Early professionals benefited from appropriate graded autonomy during clinical education to develop their clinical reasoning skills, confidence, and mentoring network with past preceptors. Ongoing personal and professional support are needed during the initial few years to ease EPs' role inductance while they gain more experience and establish their clinician identity. Expectations for EPs should be reasonable to allow for the provision of quality care, adequate work-life balance, and integration into the profession without guilt. [ABSTRACT FROM AUTHOR]

Athletic trainers (ATs) have self-reported inadequate documentation of patient encounters and a desire for more educational resources to inform their documentation practices. However, continuing education opportunities regarding clinical documentation are limited and not easily accessible by all ATs. To develop and validate a comprehensive educational resource on clinical documentation using an established personalized learning pathway (PLP) framework. Multiphase development process consisting of consensus development, subject matter expert content validation, and pilot implementation. Asynchronous, web-based educational resource. Three subject matter experts thoroughly reviewed the educational resource for face and content validity. Ten ATs and 23 professional athletic training students participated in pilot implementation. Through a consensus process, the research team developed a comprehensive educational resource regarding clinical documentation in athletic training. The clinical documentation PLP includes 7 overarching topic areas that are necessary for a comprehensive understanding of clinical documentation. A variety of learning formats were used to help engage learners, and content was curated and delivered by members of the research team, 14 practicing ATs, and 2 content area experts. Subject matter experts considered the content of the Clinical Documentation PLP and the delivery mechanism of the learning resource to be excellent; minor feedback to enhance the overall face and content validity was implemented as suggested by the subject matter experts. All 10 ATs and 23 professional athletic training students completed the PLP in its entirety. Minor feedback to enhance the overall user experience was implemented as suggested by the pilot participants. The Clinical Documentation PLP was developed based on central principles of adult learning theory and cognitive load theory to provide comprehensive knowledge and best-practice recommendations regarding clinical documentation to ATs. The PLP is relatable, cost-free, continuously available, and conveniently accessible from any location or device. [ABSTRACT FROM AUTHOR]

Context: Engaging clinical experiences that allow extensive active learning and patient care interactions are important for the professional development of athletic training students. Understanding students' use of clinical time is important when attempting to improve these experiences. Objective: To gain participants' perspectives on active learning during clinical education both with and without the use of bug-in-ear technology. Design: Qualitative. Setting: Three high schools, 2 rehabilitation clinics, 1 university, and 1 community college clinical sites within 3 Commission on Accreditation of Athletic Training Education--accredited undergraduate athletic training programs. Patients or Other Participants: Thirteen athletic training students (11 female, 2 male; 22 ± 2 years old, 2 ± 1 years enrolled in the current accredited athletic training program) and 8 preceptors (5 female, 3 male; 35 ± 10 years old, 3 ± 3 years of experience as a preceptor) volunteered for this study. Main Outcome Measure(s): After observation of the participants' clinical education experiences, individual in-person interviews were audiorecorded and transcribed verbatim. We used an inductive process of open, axial, and selective coding to identify themes. Trustworthiness was established with member checking, multiple-analyst triangulation, and data source triangulation. Results: Three themes emerged from the data. Participants recognize that students spend much of their clinical time interacting with patients, completing administrative tasks, and doing custodial work. Participants noted their awareness of student activities increased after using the active learning assessment instrument. Lastly, participants perceived that bug-in-ear technology improved the efficiency of task completion but not the actual tasks completed. Conclusions: Since several factors influence the amount of active learning time spent during students' clinical education, athletic training programs may benefit from looking at their own students' time spent during clinical education. Asking students and preceptors to assess active learning time may help them and clinical education coordinators identify ways to increase active learning and decrease unengaged and managerial time.

Context: Clinical education experiences that actively engage students in patient care are important to the development of competent clinicians. It is important to assess athletic training students' time spent clinically and explore new technology that may facilitate more active learning during clinical education. Objective: To assess athletic training students' active learning time with and without the use of bug-in-ear technology. Design: Cross-sectional. Setting: High school, rehabilitation clinic, and college/university clinical sites affiliated with 3 Commission on Accreditation of Athletic Training Education--accredited undergraduate athletic training programs. Patients or Other Participants: Thirteen athletic training students (11 females, 2 males; 22.0 ± 1.8 years old, 1.8 ± 0.9 years enrolled in the current athletic training program) and 8 preceptors (5 females, 3 males; 35.4 ± 10.4 years old, 3.5 ± 2.9 years of experience as a preceptor) volunteered for this study. Intervention(s): The principal investigator observed preceptor-student interactions on 2 control days and 2 days using bug-in-ear technology. Participants and the principal investigator assessed students' active learning time at each observation period using the Athletic Training Clinical Education Time Framework. Main Outcome Measure(s): Minutes spent on instructional, clinical, managerial, engaged waiting, and down time as recorded on the Athletic Training Clinical Education Time Framework. Parametric (analysis of variance) and nonparametric (Wilcoxon signed-rank and Kruskal-Wallis) tests compared the perceived amount of time spent in each category between technologies and roles. Results: Bug-in-ear technology resulted in less time on managerial tasks (8.2% ± 5.1% versus 14.6% ± 9.8%; P < 0.01) and instruction (10.7% versus 12.7%, P < 0.01). The researcher observed significantly more unengaged waiting time than both the students and preceptors (both P < 0.01) perceived. Conclusions: Bug-in-ear technology may decrease managerial time and spoken instruction during clinical experiences. Preceptors and students significantly underestimate the amount of unengaged time spent during clinical education, which is of concern. Athletic training programs may also benefit from assessing and improving students' time spent actively learning during clinical education.

Research has identified an increased risk of lower extremity injury postconcussion, which may be due to aberrant biomechanics during dynamic tasks. The purpose of this study was to compare the drop landing biomechanics between individuals with and without a concussion history. Twenty-five individuals with and 25 without a concussion history were matched on age (±3 y), sex, and body mass index (±1 kg/m²). Three-dimensional landing biomechanics were recorded to obtain dependent variables (peak vertical ground reaction force, loading rate, knee flexion angle and external moment, knee abduction angle and external moment, and knee flexion and abduction angle at ground contact). A 1-way multivariate analysis of variance compared outcomes between groups. There was no difference in drop landing biomechanics between individuals with and without a concussion history (F10,39 = 0.460, P = .877, Wilk Λ= .918). There was an effect of time since concussion on knee flexion characteristics. Time since most recent concussion explained a significant amount of variation in both peak (ΔR² = .177, β = -0.305, ΔP = .046) and initial ground contact (ΔR² = .292, β = -0.204, ΔP = .008) knee flexion angle after covarying for sex and body mass index. Therefore, time since concussion should be considered when evaluating biomechanical patterns. [ABSTRACT FROM AUTHOR]

Context: High-quality patient care documentation is an essential component of any health care professional's daily practice. Whereas athletic trainers (ATs) recognize the importance of patient care documentation, several barriers may prevent them from producing high-quality patient care documentation. Objective: To explore beneficial strategies and techniques that ATs perceived would enhance the quality of patient care documentation in the secondary school setting. Design: Qualitative study. Setting: Individual telephone interviews. Patients or Other Participants: TenATswhowere members of the Athletic Training Practice-Based Research Network and employed in the secondary school setting were interviewed (4 men, 6 women with 7.1 ° 7.8 years of athletic training experience). Data Collection and Analysis: An individual telephone interview was conducted with each participant. Once transcribed, data were analyzed into common themes and categories per the consensual qualitative research tradition. Trustworthiness of the data was achieved through triangulation strategies: (1) the inclusion of multiple researchers to ensure accuracy and representativeness of the data and (2) participant member checking. Results: Participants identified several documentation strategies they perceived would be helpful to improve the quality of patient care documentation, including mode and consistency of documentation and the need for a standardized process as well as the need for system standardization. In addition, participants discussed the need for more education on patient care documentation. Specifically, they identified ways of learning and strategies for future education to enhance patient care documentation across the profession. Conclusions: As athletic training continues to evolve, it is crucial that ATs are well educated on how to produce high-quality patient care documentation as a part of routine practice. Continuing professional development opportunities are needed to promote lifelong learning in the area of patient care documentation. [ABSTRACT FROM AUTHOR]

This study examined factors that predicted the existence and comprehensiveness of w ritten concussion management policies in secondary schools. A purposeful sample of athletic trainers employed in secondary schools was requested to complete an online survey (1,124 of 3,943 [28.5% response rate]). Most athletic trainers (968 of 1,112 [87.1%]) reported having a written concussion management policy, which included background information (883 of 968 [91.2%]), immediate treatment (902 of 968 [93.2%]), and return to play criteria (933 of 968 [96.4%]). Strongest predictive variables of an existing concussion policy included athletic trainers who were: primarily paid via school/ district (odds ratio [OR] = 2.1,95% confidence interval [Cl] = 1.4 to 3.3), hired full-time (OR = 1.7,95% Cl = 1.1 to 2.7), and evaluation of more concussions annually (OR = 1.6,95% Cl = 1.3 to 2.0). Employment characteristics may influence the existence of a concussion management policy; however, additional research is needed to understand athletic trainers' ability to navigate school systems and implement a school-based concussion policy. [ABSTRACT FROM AUTHOR]