Diagnostic Problem Solving in Male Collegiate Athletic Trainers

Abstract

Context: Knowledge and experience may be important factors for understanding expertise based upon a clinician's ability to select and execute an appropriate response as a clinician during injury evaluation.Objective: To describe how collegiate male certified athletic trainers represent injury-evaluation domain knowledge during a situational interview using a think-aloud protocol.Design: Qualitative. Setting: National Collegiate Athletic Association Division I and II colleges in National Athletic Trainers' Association District 3.Patients or Other Participants: A total of 20 male certified athletic trainers (n ¼ 10 with less than 2 years of experience in the college setting and n ¼ 10 with at least 10 years of experience in the college setting) participated in the study.Data Collection and Analysis: We collected data using a situational interview and questionnaire. Data were transcribed, reduced to meaningful units, and analyzed using verbal analysis procedures. Member checks, triangulation of data, field journaling, and peer-debriefing techniques were used to ensure trustworthiness of the data. Knowledge concepts were enumerated to describe differences between experts and novices.Results: Compared with novices, experts had more knowledge concepts of patient history and predictions and fewer concepts of situation appraisal.Conclusions: Expertise in athletic training shares traits with other areas in health care. Athletic training education and professional development may benefit from our understanding which cognitive processes differentiate expert practice. Future investigators should attempt to describe other settings and study diagnostic problem solving in a natural environment.

Exploration of Factors Perceived to Influence Development of Diagnostic Reasoning in Athletic Trainers and Athletic Training Students

“…Dual processing posits that although experts primarily use nonanalytic CPRbased approaches to diagnostic reasoning in familiar cases, they must also think flexibly by using HDR in the presence of unusual information or atypical cases in order to avoid overlooking important signs and symptoms and making a diagnostic error. 5,27 These findings coincide with Gardin and Mensch's 16 findings that athletic training experts use more than 1 type of thought process when making diagnostic decisions, depending upon the context.…”

“…Recent research by Gardin and Mensch 16 in athletic training has begun to demarcate expert diagnostic reasoning through experimental and qualitative research. 17 However, the complex nature of diagnostic reasoning expertise requires further research before we are able to truly label an individual as an expert or novice, especially in athletic training contexts, as the topic has largely been ignored to date.…”

“…However, the multifaceted mental processes involved in establishing and defining expertise complicate the ability to objectify this inherently qualitative trait of the mind. 15 In athletic training literature, there are even greater gaps between what we know and don't know about clinical expertise, as there currently are only 2 reports focusing on expertise in athletic training, both published by Gardin et al 16,17 Given this significant gap in understanding, studies capable of exposing the presence and nature of diagnostic reasoning in athletic training, as well as those designed to ascertain how it can be developed or stunted, are warranted.…”

Athletes’ Emotional Determinants Accordingly Reflected in Their Personal Lives

“…Highlighting the sequence of complex cognitive processes involved critical thinking and reasoning that influenced appropriate responses and execution within a practice domain. Critical thinking behavior in individual-and team-athletes had been established as the process of skillful matter of knowledge and experience in making discriminating judgments and evaluations [24]. Effective problem-solving process was realized in five steps, namely: believing in solving and adapting to problem, defining the problem approximately and deciding achievable targets, forming different alternatives to clear the block, predicting how positive and negative results of alternatives and how maximum efficiency was obtained with the lowest cost, and creating a plan and trying it elite athletes' real lives.…”

Challenges Facing New Educators: Expanding Teaching Strategies for Clinical Reasoning and Evidence-Based Medicine

“…Such examples are valuable for all faculty, preceptors, and students in learning how to apply these concepts. Numerous authors 13,30,[34][35][36] have stated that uncertainty is part of clinical practice; faculty and preceptors must not shy away from sharing that fact with students. By applying the principles of EBM, the student will realize that existing evidence is often insufficient to direct a clinical decision.…”