Perceived frequency of peer-assisted learning in the laboratory and collegiate clinical settings.

CONTEXT: Peer-assisted learning (PAL) has been recommended as an educational strategy to improve students' skill acquisition and supplement the role of the clinical instructor (CI). How frequently students actually engage in PAL in different settings is unknown. OBJECTIVE: To determine the perceived frequency of planned and unplanned PAL (peer modeling, peer feedback and assessment, peer mentoring) in different settings. DESIGN: Cross-sectional study. SETTING: Laboratory and collegiate clinical settings. PATIENTS OR OTHER PARTICIPANTS: A total of 933 students, 84 administrators, and 208 CIs representing 52 (15%) accredited athletic training education programs. INTERVENTION(S): Three versions (student, CI, administrator) of the Athletic Training Peer Assisted Learning Survey (AT-PALS) were administered. Cronbach α values ranged from .80 to .90. MAIN OUTCOME MEASURE(S): Administrators' and CIs' perceived frequency of 3 PAL categories under 2 conditions (planned, unplanned) and in 2 settings (instructional laboratory, collegiate clinical). Self-reported frequency of students' engagement in 3 categories of PAL in 2 settings. RESULTS: Administrators and CIs perceived that unplanned PAL (0.39 ± 0.22) occurred more frequently than planned PAL (0.29 ± 0.19) regardless of category or setting (F(1,282) = 83.48, P < .001). They perceived that PAL occurred more frequently in the collegiate clinical (0.46 ± 0.22) than laboratory (0.21 ± 0.24) setting regardless of condition or category (F(1,282) = 217.17, P < .001). Students reported engaging in PAL more frequently in the collegiate clinical (3.31 ± 0.56) than laboratory (3.26 ± 0.62) setting regardless of category (F(1,860) = 13.40, P < .001). We found a main effect for category (F(2,859) = 1318.02, P < .001), with students reporting they engaged in peer modeling (4.01 ± 0.60) more frequently than peer mentoring (2.99 ± 0.88) (P < .001) and peer assessment and feedback (2.86 ± 0.64) (P < .001). CONCLUSIONS: Participants perceived that students engage in unplanned PAL in the collegiate clinical setting with a stronger inclination toward engagement in peer modeling. Educators should develop planned PAL activities to capitalize on the inherent desire of the students to collaborate with their peers.

National collegiate athletic association division and primary job title of athletic trainers and their job satisfaction or intention to leave athletic training.

CONTEXT: Membership in the National Athletic Trainers' Association (NATA) has declined in recent years, generating much debate about professional commitment. OBJECTIVE: To compare the contributing factors of job satisfaction and intention to leave athletic training of certified athletic trainers (ATs) employed in National Collegiate Athletic Association (NCAA) institutions. DESIGN: Cross-sectional study. SETTING: A link to a Web-based questionnaire containing the Spector Job Satisfaction Survey (JSS) and an original Intention to Leave Survey (ITLS) was distributed by e-mail to 1003 certified members of the National Athletic Trainers' Association. PATIENTS OR OTHER PARTICIPANTS: A total of 191 certified members of the NATA employed in a college or university setting in a primarily clinical capacity; representing all NCAA divisions; and having the job title of head athletic trainer, associate/assistant athletic trainer, or graduate assistant/intern athletic trainer. MAIN OUTCOME MEASURE(S): We used separate 3 x 3 factorial analyses of variance to compare the mean scores of each JSS subscale and of the ITLS with NCAA division and job title. A stepwise multiple regression was used to determine the strength of the relationships between the JSS subscales and the ITLS. RESULTS: We found differences for job title in the subscales of Fringe Benefits (F(2182) = 7.82, P = .001 ) and Operating Conditions (F(2,182) = 12.01, P < .001). The JSS subscale Nature of Work was the'greatest indicator of intention to leave (ß = -0.45). CONCLUSIONS: We found a strong negative correlation between various facets of job satisfaction and intention to leave athletic training. The NCAA division seemed to have no effect on an individual's job satisfaction or intention to leave the profession. In addition, only Fringe Benefits and Operating Conditions seemed to be affected by job title. The ATs had similar levels of job satisfaction regardless of NCAA division, and their job titles were not a major factor in job satisfaction.

Accuracy and reliability of peer assessment of athletic training psychomotor laboratory skills.

CONTEXT: Peer assessment is defined as students judging the level or quality of a fellow student's understanding. No researchers have yet demonstrated the accuracy or reliability of peer assessment in athletic training education. OBJECTIVE: To determine the accuracy and reliability of peer assessment of athletic training students' psychomotor skills. DESIGN: Cross-sectional study. SETTING: Entry-level master's athletic training education program. PATIENTS OR OTHER PARTICIPANTS: First-year (n  =  5) and second-year (n  =  8) students. MAIN OUTCOME MEASURE(S): Participants evaluated 10 videos of a peer performing 3 psychomotor skills (middle deltoid manual muscle test, Faber test, and Slocum drawer test) on 2 separate occasions using a valid assessment tool. Accuracy of each peer-assessment score was examined through percentage correct scores. We used a generalizability study to determine how reliable athletic training students were in assessing a peer performing the aforementioned skills. Decision studies using generalizability theory demonstrated how the peer-assessment scores were affected by the number of participants and number of occasions. RESULTS: Participants had a high percentage of correct scores: 96.84% for the middle deltoid manual muscle test, 94.83% for the Faber test, and 97.13% for the Slocum drawer test. They were not able to reliably assess a peer performing any of the psychomotor skills on only 1 occasion. However, the φ increased (exceeding the 0.70 minimal standard) when 2 participants assessed the skill on 3 occasions (φ  =  0.79) for the Faber test, with 1 participant on 2 occasions (φ  =  0.76) for the Slocum drawer test, and with 3 participants on 2 occasions for the middle deltoid manual muscle test (φ  =  0.72). CONCLUSIONS: Although students did not detect all errors, they assessed their peers with an average of 96% accuracy. Having only 1 student assess a peer performing certain psychomotor skills was less reliable than having more than 1 student assess those skills on more than 1 occasion. Peer assessment of psychomotor skills could be an important part of the learning process and a tool to supplement instructor assessment.

Role strain in collegiate athletic training approved clinical instructors.

CONTEXT: Certified athletic trainers who serve as Approved Clinical Instructors (ACIs) in the collegiate setting are balancing various roles (eg, patient care and related administrative tasks, clinical education). Whether this balancing act is associated with role strain in athletic trainers has not been examined. OBJECTIVE: To examine the degree of, and contributing factors (eg, socialization experiences, professional and employment demographics, job congruency) to, role strain in collegiate ACIs. DESIGN: Cross-sectional survey design. SETTING: Geographically stratified random sample of ACIs affiliated with accredited athletic training education programs at National Collegiate Athletic Association (NCAA) Division I, II, and III institutions. PATIENTS OR OTHER PARTICIPANTS: 118 collegiate ACIs (47 head athletic trainers, 45 assistant athletic trainers, 26 graduate assistant athletic trainers). MAIN OUTCOME MEASURE(S): The Athletic Training ACI Role Strain Inventory, which measures total degree of role strain, 7 subscales of role strain, socialization experiences, professional and employment characteristics, and congruency in job responsibilities. RESULTS: A total of 49% (n = 58) of the participants experienced a moderate to high degree of role strain. Role Overload was the highest contributing subscale to total role strain. No differences were noted between total role strain and role occupant groups, NCAA division, or sex. Graduate assistant athletic trainers experienced a greater degree of role incompetence than head athletic trainers did (P = .001). Division II ACIs reported a greater degree of inter-role conflict than those in Division I (P = .02). Female ACIs reported a greater degree of role incompetence than male ACIs (P = .01). Those ACIs who stated that the ACI training provided by their institution did not adequately prepare them for the role as an ACI experienced greater role strain (P < .001). CONCLUSIONS: The ACIs in the collegiate setting are experiencing role strain in balancing their roles as health care providers, clinical educators, and administrators. Methods to reduce role strain need to be considered.

Peer-assisted learning in the athletic training clinical setting.

CONTEXT: Athletic training educators often anecdotally suggest that athletic training students enhance their learning by teaching their peers. However, peer-assisted learning (PAL) has not been examined within athletic training education in order to provide evidence for its current use or as a pedagogic tool. OBJECTIVE: To describe the prevalence of PAL in athletic training clinical education and to identify students' perceptions of PAL. DESIGN: Descriptive. SETTING: "The Athletic Training Student Seminar" at the National Athletic Trainers' Association 2002 Annual Meeting and Clinical Symposia. PATIENTS OR OTHER PARTICIPANTS: A convenience sample of 138 entry-level male and female athletic training students. MAIN OUTCOME MEASURE(S): Students' perceptions regarding the prevalence and benefits of and preferences for PAL were measured using the Athletic Training Peer-Assisted Learning Assessment Survey. The Survey is a self-report tool with 4 items regarding the prevalence of PAL and 7 items regarding perceived benefits and preferences. RESULTS: A total of 66% of participants practiced a moderate to large amount of their clinical skills with other athletic training students. Sixty percent of students reported feeling less anxious when performing clinical skills on patients in front of other athletic training students than in front of their clinical instructors. Chi-square analysis revealed that 91% of students enrolled in Commission on Accreditation of Allied Health Education Programs-accredited athletic training education programs learned a minimal to small amount of clinical skills from their peers compared with 65% of students in Joint Review Committee on Educational Programs in Athletic Training-candidacy schools (chi2(3) = 14.57, P < .01). Multiple analysis of variance revealed significant interactions between sex and academic level on several items regarding benefits and preferences. CONCLUSIONS: According to athletic training students, PAL is occurring in the athletic training clinical setting. Entry-level students are utilizing their peers as resources for practicing clinical skills and report benefiting from the collaboration. Educators should consider deliberately integrating PAL into athletic training education programs to enhance student learning and collaboration.

Sex-specific abdominal activation strategies during landing.

CONTEXT: Control of the trunk segment in landing has been implicated as a contributing factor to the higher incidence of anterior cruciate ligament injuries in females than in males. Investigating the sex-specific abdominal activation strategies during landing lends insight into mechanisms contributing to control of the trunk segment. OBJECTIVE: To examine the abdominal activation strategies used by males and females during a landing task. DESIGN: Mixed-model (between-subjects and within-subjects) design. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: Healthy, recreationally active males (n = 20, age = 23 +/- 4.8 years, height = 1.8 +/- 0.1 m, mass = 79.6 +/- 9.9 kg, body mass index = 24.8 +/- 2.7 kg/ m (2)) and females (n = 22, age = 20.8 +/- 4.8 years, height = 1.7 +/- 0.1 m, mass = 64.1 +/- 9.2 kg, body mass index = 22.9 +/- 2.6 kg/m (2)). INTERVENTION(S): Subjects performed 5 double-leg landings from a box height of 60 cm. MAIN OUTCOME MEASURE(S): Male and female activation amplitudes for the rectus abdominis (RA), external oblique (EO), and transversus abdominis and lower fibers of the internal oblique (TrA-IO) muscles during preactivation (150-millisecond interval just before landing) and after impact (150-millisecond interval immediately after ground contact). RESULTS: Males had greater TrA-IO activation than females ( P < .05). Males preferentially activated the TrA-IO muscles relative to the RA and EO, whereas females demonstrated no significant muscle differences. Males and females also differed by phase, with males having more TrA-IO activation than females during the preactivation landing phase ( P < .05) but not during the postimpact phase. The TrA-IO was the only muscle to significantly differ by landing phase, decreasing from preactivation to postimpact ( P < .05). CONCLUSIONS: Males used different abdominal muscle activation strategies than females in landing. The efficacy of these muscle activation strategies to control the trunk should be assessed through trunk kinematic and kinetic measures in future studies.

Importance and applicability of approved clinical instructor standards and criteria to certified athletic trainers in different clinical education settings.

CONTEXT: For optimal clinical education of athletic training students, Clinical Instructor Educators and program directors need to proactively select, train, and evaluate their Approved Clinical Instructors (ACIs). OBJECTIVE: To assess the relative importance and applicability of ACI standards to certified athletic trainers employed in different athletic training clinical education settings. DESIGN: Respondents rated and ranked the importance and applicability of the 7 standards presented by Weidner and Henning. Crucial standards to warrant dropping an ACI from the clinical education program were also listed. SETTING: Mailed questionnaire. PATIENTS OR OTHER PARTICIPANTS: A total of 55 program directors invited their ACIs, representing different types of clinical settings, to complete the questionnaire. Of the 399 ACIs who responded, 30 (8%) worked in clinics, 50 (13%) in high schools, and 319 (79%) in colleges or universities. MAIN OUTCOME MEASURE(S): We compared the mean scores of the importance and applicability ratings and rankings by employment setting. Chi-square analyses were calculated to measure associations between employment settings and whether a standard was crucial. Respondents' comments were also assessed. RESULTS: No significant differences were noted among employment settings for overall importance and applicability ratings. A difference was seen for only interpersonal relationships, with clinic and high school respondents giving this standard higher importance and applicability ratings than college/university respondents. No associations were shown between the settings and whether a standard was marked as crucial. The importance of a standard and barriers to implementing a standard (particularly ACI role strain) were the most common themes. CONCLUSIONS: The Weidner and Henning standards are considered to be important and applicable across a variety of athletic training clinical education settings. Legal and ethical behavior was considered the most crucial standard. The ACIs seemed to be encountering role strain in their dual roles as clinicians and clinical instructors, a problem warranting further investigation.

Development of Standards and Criteria for the Selection, Training, and Evaluation of Athletic Training Approved Clinical Instructors.

OBJECTIVE: To develop standards and associated criteria for the selection, training, and evaluation of athletic training approved clinical instructors (ACIs). DESIGN AND SETTING: A previously developed set of 7 physical therapy clinical instructor standards/criteria and 2 additional standards/criteria developed through a review of the literature were systematically adapted, judged, and revised through a Delphi technique. SUBJECTS: Athletic training education experts currently employed as program directors for entry-level Commission on Accreditation of Allied Health Education Programs-accredited athletic training educational programs and who had the following: a doctoral degree, at least 5 years of supervising athletic training students, and familiarity/experience with clinical instruction in various athletic training clinical education settings. MEASUREMENTS: We used panelists' critiques and ratings to make sequential revisions in a series of 3 Delphi rounds. Standards were rated as to whether they were clear, necessary, and appropriate. We rated criteria for the associated standard as to whether they were useful, helpful, clear, specific, and consistent. RESULTS: We developed a final set of 7 standards and 50 associated criteria to measure these standards. The accepted standards include the following: legal and ethical behavior, communication skills, interpersonal relationships, instructional skills, supervisory and administrative skills, evaluation of performance, and clinical skills and knowledge. CONCLUSIONS: The 7 standards and associated criteria developed in this research project could be used not only for selecting, training, and evaluating an ACI but also for developing an understanding of the requirements of clinical education in general. Further research should include validating these standards/criteria among athletic training ACIs representing different types of clinical settings.

Historical Perspective of Athletic Training Clinical Education.

OBJECTIVE: To present a historical perspective of the development and evolution of clinical education in the medical and allied health professions, with a special interest in athletic training; to gain a better understanding and appreciation of the depth and breadth of the structured and formal clinical education needed in athletic training, for both the present and the future. DATA SOURCES: Information was drawn from the Educational Resources Information Center (1966-2001), MEDLINE (1966-2001), SPORT Discus (1830-2002), and CINAHL (1982-2002) searches of historical literature relating to the development of medical, allied health, and athletic training clinical education. Key words searched were clinical education, clinical instruction, medical education, allied health education, history of medical education, athletic training education, and history of clerkships. We also used reference materials cited in historical textbooks on medical education. DATA SYNTHESIS: Clinical education in American medical schools evolved from a primarily didactic process to the clinical-clerkship model. In contrast, athletic training professional preparation was initially more steeped in clinical experiences and less in didactic instruction. CONCLUSIONS/RECOMMENDATIONS: Reviewing medical education over the past century and allied health clinical education over the past 30 years provides interesting insights about the past, present, and future of athletic training professional preparation. Athletic training clinical education is undergoing reform and development, which will subsequently enhance the profession. Athletic training has entered an exciting era in its history.