Rehabilitative Health Care Professionals' Perceptions of Appearance-Based Professionalism.

CONTEXT: Professionalism has been discussed and defined in a variety of ways, including attire and other forms of self-expression. OBJECTIVES: To determine athletic trainer (AT), physical therapist (PT), and athletic training or PT students' perceptions of appearance-based professionalism in the workplace and, secondly, to ascertain how perceptions differed across professions. DESIGN: Cross-sectional study. SETTING: Web-based survey. PATIENTS OR OTHER PARTICIPANTS: Athletic trainers, PTs, and athletic training and PT students who were predominantly White, non-Hispanic, female, aged 30 ± 9 years, and recruited via listservs and social media. DATA COLLECTION AND ANALYSIS: The independent variables were participant demographics. The dependent variables were self-reported perceptions of professionalism for each photo. The survey consisted of 3 sections: demographics, 8 photos of ATs or PTs with depictions of patient-provider interactions, and open-ended responses. For each photo, participants selected yes, no, or unsure regarding the photo. An open-ended response was prompted with a no or unsure selection. The participant further described the reason for that choice. RESULTS: Most participants determined the health care provider depicted in 7 photos appeared professional. Only 1 photo was deemed unprofessional by the professional majority. Significant differences existed between students and professionals for 5 photos. The proportion of participants who reported the photos were unprofessional differed among professions for 2 photos. From our qualitative analysis, we found 6 domains: (1) unprofessional attire and hair, (2) situation-dependent attire, (3) role confusion and health care employer or employee identification, (4) nonappearance related, (5) tattoo-related bias, and (6) rethinking after question is displayed. CONCLUSION: What is considered appropriate and professional is not concrete. Differing concepts of professionalism generated biased judgments and criticisms. CLINICAL RELEVANCE: Our findings should lead providers to reexamine the definition of professionalism. The past should not dictate the future, and today's social mores can help shape the definition as it should be considered in today's settings.

Athletic Trainers' Beliefs Regarding Professionalism.

CONTEXT: Limited research exists regarding athletic trainers' (ATs') perceptions of professionalism. OBJECTIVE: To explore the lived experiences of ATs and their perceptions of professionalism. DESIGN: Qualitative study. SETTING: Participants were ATs who completed a semistructured interview protocol via audio-only recording conferencing. PATIENTS OR OTHER PARTICIPANTS: Seventeen participants (age = 33 ± 8 years; range = 25-56 years) who were certified ATs with an average of 10 years of experience (SD = ±8; range = 1-33 years) were interviewed. DATA COLLECTION AND ANALYSIS: Individuals self-identified their interest in participating in a follow-up interview recruitment located within a survey. Interviews occurred until saturation was met and included a variety of participants. Demographic information was gathered from the survey for each person. All transcripts were audio recorded, transcribed verbatim, and coded using a 3-person coding team following the consensual qualitative research protocol. Member checking, auditing, and triangulation established trustworthiness and credibility in the data-analysis process. RESULTS: A total of 4 domains with supporting categories were identified. Athletic trainers spoke of the employee environment that affected perceptions of what was determined to be professional, specifically in various settings or situations. They shared their personal determination of outward appearance and expression when differentiating what was deemed professional, including references to cleanliness, judgment of self-expression, and implicit bias. Whether intentional or unintentional, participants made comments that demonstrated a bias toward sex or race and ethnicity when determining outward appearance appropriateness. They noted various cultural awareness situations, including progression of perceptions over time, external pressure, and internal dialog. Respondents shared discourse regarding an internal struggle of what was right and wrong in their responses. They discussed professionalism based on the provider's conduct, mainly in terms of communication and patient care. Participants shared that communication occurring through both verbal and nonverbal means is vital to the perceptions of professionalism for ATs. CONCLUSIONS: Current views of professionalism in athletic training were shaped by various lived experiences. With the movement toward athletic training becoming more diverse, equitable, and inclusive, antiquated professionalism ideals need to shift to provide a better work environment for all.

Transition to Practice Among Diverse Early Professional Athletic Trainers.

CONTEXT: Early professional (EP) Athletic Trainers (ATs) may encounter adjustments and develop individual identities to master a new role, which can be difficult while transitioning from student to autonomous professional. Previous literature lacks content about the transition to practice of credentialed ATs who identify as Black, Indigenous, or People of Color (BIPOC). OBJECTIVE: Identify challenges during professional education and transition to practice of EP ATs identifying as BIPOC. DESIGN: Qualitative study. SETTING: Virtual interview. PATIENTS OR OTHER PARTICIPANTS: 15 recently credentialed athletic trainers (13 female, 2 male, age=26.73±1.41 years, experience=13.80±4.03 months) who self-identified as BIPOC. DATA COLLECTION AND ANALYSIS: We used an interview guide, validated by peer (n=1) and expert (n=3) review, to structure data collection sessions. Data saturation guided recruitment and we obtained theoretical redundancy after the final interview. We analyzed data with a phenomenological approach and used multianalyst triangulation (n=2) and peer review (n=2) as credibility strategies. RESULTS: Every participant mentioned they were victims of microaggressions during either their professional preparation and/or work environment because of their race. Those who chose to report the incidents felt a lack of support from work supervisors, faculty, peers, and preceptors. Participants noted a preference for racially concordant mentoring to facilitate talking to someone who could better understand BIPOC EPs' experiences. Participants also relied on outside support from friends and family as coping mechanisms. Finally, participants experienced perceived incompetency from supervisors due to their limited work experience as early professionals and felt their professional preparation was stunted by the COVID-19 pandemic. CONCLUSIONS: Participants perceived that their transition to practice was stressful due to microaggressions encountered, a lack of support, and a lack of racially concordant mentoring. Diversity, equity, and inclusion training should be included in athletic training education and workspaces to assist in providing more welcoming environments for BIPOC EP ATs and students.

The Role of the Athletic Trainer in Providing Care to Transgender and Gender Diverse Patients: Considerations for Medical Affirmation - Part II.

Recently, there has been an increase in media attention surrounding transgender and gender-diverse (TGD) individuals between discriminatory legislation efforts and changing participation policies within organized sports. These changes and the historical lack of competence and education regarding the transgender patient population have resulted in sub-par patient care, and a misunderstanding of the athletic trainer's (AT) role within the healthcare and compliance systems. This literature review is the second part of a two-paper series and the objective of this paper 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 one of this literature, and the medical component is thoroughly discussed in part two. AT's and all health care providers involved in the patient care of TGD individuals should work collaboratively on an interprofessional care team and have a general knowledge of the gender affirmation process including GAHT, surgical options, known risks and complications, and the general health needs of TGD patients. By being more knowledgeable, ATs are uniquely positioned to help reduce health and healthcare disparities as they are point-of-care providers as well as members of the interprofessional care team. Furthermore, ATs can use their knowledge to facilitate medical compliance and eligibility within the evolving policies of sporting organizations.

The Role of the Athletic Trainer in Treating Transgender and Gender Non-Conforming Patients: Foundational Knowledge and Disparities - Part I.

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 healthcare disparities that negatively impact wellbeing and access to quality healthcare.1 While 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 purpose of the first part of this two-part narrative literature review is to 1) provide readers with foundational information and terminology, 2) explore relevant health and healthcare disparities, and 3) identify the role of the AT within an interprofessional care team treating TGD patients.

Direct Access Dental Hygienists' Perceptions Concerning Geriatric Curriculum in Entry-Level Dental Hygiene Programs.

Purpose: The growing geriatric population has unique and often complex oral health care needs. The purpose of this study was to explore the perceptions regarding direct access dental hygienists (DH) regarding the geriatric curriculum needed in dental hygiene education programs to prepare DHs to provide direct access care for geriatric populations.Methods: Purposive and network sampling strategies were used to recruit eligible direct access DHs from across the United States for this qualitative study. Semi-structured telephone interviews were conducted until was met. Demographic data were analyzed using descriptive statistics. Open coding techniques were used to identify themes.Results: Ten direct access DHs agreed to participate. Nine themes emerged from the data analysis: combining didactic and hands-on experience, how direct access differs from traditional practice, importance of a standardized course in entry-level programs, need for a specialty course in geriatrics, understanding the geriatric patient, understanding direct access settings, modifications to treatment modalities, process of care, and interprofessional knowledge. Participants indicated that entry-level dental hygiene students should be exposed to hands-on clinical rotations, have a standardized aging and geriatrics course, and potentially incorporate geriatrics as a specialty tract within dental hygiene programs.Conclusion: Geriatrics may not be covered in sufficient depth to prepare entry-level dental hygiene students for work with these populations in direct access settings. Findings from this study may be used to support improvements in geriatric curriculum for entry-level dental hygiene programs. Future research is needed to determine necessary focus and most effective way to disseminate this curricular content.

Perceptions of Sexual Misconduct and the Overall Role of Peer Athletic Training Students, Athletes, Preceptors, and Coaches.

Sexual misconduct in society is found throughout the literature. In healthcare, there is a paucity of research in regard to the understanding of what constitutes sexual misconduct, especially when examining the thoughts of students who are required to be a part of a clinical rotation. The purpose of this study was to examine athletic training students' perceptions of sexual harassment and to determine whether role (i.e., peer student, athlete, preceptor, coach) influenced their determination of what constitutes sexual harassment. A 21-item scenario questionnaire was sent to the 460 professional and post-professional Commission on the Accreditation of Athletic Training Education (CAATE) program directors with a link to forward to the current students. The scenarios were used to understand the students' level of where an action by a peer athletic training student, athlete, preceptor, or coach might fall on the sexual misconduct continuum. Results demonstrated that athletic training students tended to be more for-giving toward peers or athletes than preceptors or coaches. In order for clinical students to feel safe in their rotations, a greater understanding of what constitutes sexual misconduct must occur.

Digit ratios and motor and health-related fitness in pre-adolescent females.

Background: Assessing different aspects of physical fitness in children whose abilities are undeveloped and their associations with second-to-fourth digit ratio (2D:4D) may better determine the potential athleticism of an individual.Aim: The purpose of the study was to examine relationships between the digit ratios and selected motor and health-related fitness parameters in a large sample of pre-adolescent females.Subjects and methods: Participants included 8-12 year old Iranian and Afghan girls. The length of the left and right second and fourth digits was measured by scanning and computer-assisted image analysis. Motor- and health-related fitness tests were evaluated.Results: No significant correlations were noted between right 2D:4D ratio and physical fitness components. Left 2D:4D and physical fitness components were not correlated, with the exception of handgrip strength (r = -0.193). However, right and left second digit lengths were negatively correlated with predicted VO2max (p ≤ 0.01). In addition, right-left 2D:4D was significantly negatively correlated with flexibility, and significantly positively correlated with height and body fat percentage.Conclusion: In contrast to previous investigations, it seems that left 2D:4D is a predictor of strength, but not aerobic exercise. It is suggested there may be a potential relationship between prenatal androgen exposure and high flexibility, low body fat percentage and the generation of muscular strength in pre-adolescent females.

Current Use of Technology in Athletic Training Education.

Technology education in higher education and the health care professions is found throughout the literature. Athletic training education (ATE) should mirror that of other health care professions. The purpose of this study was exploratory in nature to determine a) how ATE faculty are integrating technology into their classrooms, b) which they find to be most effective and why, and c) which technologies they hope to use in the future. A 16-item online survey regarding technology use in their ATE classrooms was sent to professional and post-professional degree CAATE-accredited programs soliciting participants from ATE educators. Four themes were found as to why educators use technology: management of information, supporting a variety of learning styles, provide visual examples, and engage and prepare students. Three categories were found as to the most effective technologies being used: specific technologies, general technology, and technology-related practices for the classroom. Technology for ATE is being used to enhance education in the classroom; there are opportunities to further develop what is used in both didactic and clinical education.

The association between athleticism, prenatal testosterone, and finger length.

Research suggests that prenatal levels of testosterone are related to finger length development and traits beneficial to athletic skill, such as power, endurance, visual-spatial skills, or sensation seeking and dominance behavior. In men, the second digit to fourth digit ratio (2D:4D) has been shown to correlate with success in competitive levels of football (soccer), which suggests that the 2D:4D ratio is a possible marker for level of attainment in sport. The purpose of this study was to explore the 2D:4D relationships between sports and make comparisons with nonathletes. A multiple group posttest-only design was used. Participants included 138 male volunteers with 92 intercollegiate National Collegiate Athletic Association division I athletes and 46 nonathletes who were not varsity athletes. The independent variable was group (crew, football, gymnastics, soccer, nonathlete). The dependent variable was the 2D:4D ratio. No significant differences were noted between the athletes and nonathletes (p = 0.182). Significant differences were found among the different groups (p = 0.000), with significantly lower ratios between football and crew (p = 0.000), football and nonathletes (p = 0.030), and gymnastics and crew (p = 0.001). This research provides a stronger level of evidence that the 2D:4D ratio may help indicate potential athleticism or competition-level achievement, but the external validity may be limited to only specific sports.

Stiffness regulation and muscle-recruitment strategies of the shoulder in response to external rotation perturbations.

BACKGROUND: The complex interactions between capsuloligamentous structures and muscle-recruitment strategies that maintain glenohumeral stability remain unclear. The purposes of the present study were to determine whether stiffness regulation and muscle-activation strategies differed under varying joint positions and levels of contraction in the shoulder and to determine the relationship between generalized joint laxity, glenohumeral joint laxity, and joint stiffness. METHODS: Forty healthy, physically active subjects with a mean age (and standard deviation) of 25.2 +/- 4.6 years, a mean height of 174.7 +/- 6.7 cm, and a mean mass of 73.1 +/- 13.8 kg were tested. Shoulder stiffness and the activation of muscles (including the rotator cuff and the anterior deltoid) were measured at two levels of internal rotation torque (0% and 50% of maximum) and two joint positions (0 degrees and 90% of maximum external rotation) before and after a 5 degrees external rotation perturbation. Generalized laxity and glenohumeral joint laxity (in the anterior, posterior, and inferior directions) were also assessed. RESULTS: Stiffness was 77% greater at 50% of maximum internal rotation torque than at 0% of maximum internal rotation torque (p < 0.001) but was not significantly different between joint positions (p = 0.73). From 0% to 50% of maximum internal rotation torque, preparatory and reactive recruitment of the subscapularis increased significantly more (p < 0.05) than those of the other muscles. Also, subscapularis preparatory activity was 36% greater in 0 degrees of external rotation than in 90% of maximum external rotation (p < 0.01). Generalized joint laxity (as indicated by a score of >/=4) was present in 20% of the subjects. Glenohumeral joint laxity (as indicated by a grade of >/=2) was present in the anterior, posterior, and inferior directions in 13%, 15%, and 15% of the subjects, respectively. No correlation existed between passive stiffness and generalized or glenohumeral laxity (r = -0.12 to 0.29; p = 0.08 to 0.48). CONCLUSIONS: Moderate levels of muscle contraction can significantly increase glenohumeral joint stiffness and stability. Preactivation of the subscapularis appears to be the primary dynamic stabilizer with the arm in 0 degrees of external rotation. However, with the arm in 90% of maximum external rotation (the apprehension position), less subscapularis activity is observed and the maintenance of stability may shift toward other musculoskeletal structures because joint stiffness does not change. A relationship between generalized joint laxity, glenohumeral laxity, and stiffness was not observed in healthy subjects.