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.

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Context: Appropriate methods for evaluating clinical proficiencies are essential in ensuring entry-level competence.Objective: To investigate the common methods athletic training education programs use to evaluate student performance of clinical proficiencies.Design: Cross-sectional design. Data Collection and Analysis: The institutional survey consisted of 11 items regarding institutional and program demographics. The 14-item Methods of Clinical Proficiency Evaluation in Athletic Training survey consisted of respondents' demographic characteristics and Likert-scale items regarding clinical proficiency evaluation methods and barriers, educational content areas, and clinical experience settings. We used analyses of variance and independent t tests to assess differences among athletic training education program characteristics and the barriers, methods, content areas, and settings regarding clinical proficiency evaluation.Results: Of the 3 methods investigated, simulations (n 5 191, 95.0%) were the most prevalent method of clinical proficiency evaluation. An independent-samples t test revealed that more opportunities existed for real-time evaluations in the college or high school athletic training room (t 189 5 2.866, P 5 .037) than in other settings. Orthopaedic clinical examination and diagnosis (4.37 6 0.826) and therapeutic modalities (4.36 6 0.738) content areas were scored the highest in sufficient opportunities for real-time clinical proficiency evaluations. An inadequate volume of injuries or conditions (3.99 6 1.033) and injury/condition occurrence not coinciding with the clinical proficiency assessment timetable (4.06 6 0.995) were barriers to real-time evaluation. One-way analyses of variance revealed no difference between athletic training education program characteristics and the opportunities for and barriers to real-time evaluations among the various clinical experience settings.Conclusions: No one primary barrier hindered real-time clinical proficiency evaluation. To determine athletic training students' clinical proficiency for entry-level employment, athletic training education programs must incorporate standardized patients or take a disciplined approach to using simulation for instruction and evaluation.Key Words: standardized patients, clinical competence, clinical instruction, evaluation barriers Key Points N Of 3 commonly used evaluation methods for student performance of clinical proficiencies (real time, simulations, standardized patients), simulations were used most frequently.N Opportunities for real-time evaluation were greater in high school and collegiate athletic training rooms than in other settings. Orthopaedic clinical examination and diagnosis, therapeutic modalities, conditioning and rehabilitative exercise, and risk management were the content areas most often evaluated in real time.N Athletic training education programs should either incorporate the use of standardized patients or take a disciplined approach to using simulation in clinical proficiency instruction and evaluatio...

Context Simulations and standardized patient (SP) encounters are used to provide clinical experiences for students. In athletic training, no research has examined the perceived educational benefits of these interventions. Objective To explore athletic training students' perceptions regarding small group SP encounters and individual case-based simulations (CBSs). Design Grounded theory. Setting One midwestern university. Patients or Other Participants Nine athletic training students (3 males, 6 females; 20 ± 0.833 years old) who enrolled in a lower extremity orthopaedic evaluation course during their first or second semester in an athletic training program. Main Outcome Measure(s) Semistructured interviews were recorded, transcribed verbatim, and analyzed using open coding and axial and selective coding (ie, to develop themes/threads). To ensure trustworthiness, we used member checks and peer debriefing. Results For both the small group SP counter and individual CBS, 2 themes emerged: (1) reflection-on-specific action and (2) increased confidence. Participants reflected on both experiences when providing patient care. Participants felt that both encounters could improve their confidence with regard to future clinical evaluations. Specific to the small group SP encounters, peer-assisted learning emerged as a theme. Participants felt they learned from and with each other when performing the evaluation together. Specific to the individual CBS, organization of thoughts emerged as a theme. During the individual CBSs, participants felt they developed, controlled, and organized their thoughts during the evaluation. Conclusions Both teaching encounters can be integrated into the curriculum of an athletic training program. Each strategy provides students with a nonthreatening educational experience with no harm to patients. In addition, each encounter can correspond to content taught in the classroom or laboratory. The long-term benefits of small group SP encounters and CBSs are unclear, and more research is needed.

Few studies have examined fast-pitch softball pitchers and associated injuries. The aim of this study was to investigate injuries occurring to collegiate softball pitchers and associated influential factors. A web-based survey of 181 Division I (n = 45), II (n = 30), and III (n = 54) collegiate softball pitchers was conducted. The survey involved self-reported data from the previous year that addressed (a) demographic information, (b) pitching and game data, (c) training program information, and (d) injury reporting. Demographic information, pitching and game data, and training program information were not statistically significant (p < 0.05) in relation to injury. Descriptive statistics were used to report totals and percentages of pitchers surveyed. Among 131 reported injuries, 36 were acute, 92 chronic/overuse, and 3 unspecified. Of the total injuries, 80 were directly from pitching, with 33 shoulder-related and 16 related to the lower back. Among injured pitchers, 109 took nonsteroidal anti-inflammatory drugs, 140 used modalities, 11 received surgeries, and 95 saw additional specialists. Pitchers are at a risk for injury, with 72.8% of surveyed pitchers being injured during the 2001-02 year.