Perceptions of Approved Clinical Instructors: Barriers in the Implementation of Evidence-Based Practice

Abstract

Context: As evidence-based practice (EBP) becomes prevalent in athletic training education, the barriers that Approved Clinical Instructors (ACIs) experience in implementing it with students need to be understood.Objective: To investigate barriers ACIs face when implementing EBP concepts in clinical practice and in teaching EBP to professional athletic training students and to investigate the educational emphases to improve the barriers.Design: Qualitative study. Setting: Telephone interviews.Patients or Other Participants: Sixteen ACIs (11 men, 5 women; experience as an athletic trainer ¼ 10 6 4.7 years, experience as an ACI ¼ 6.81 6 3.9 years) were interviewed.Data Collection and Analysis: We interviewed each participant by telephone. Interview data were analyzed and coded for common themes and subthemes regarding barriers and educational emphases. Themes were triangulated through multipleanalyst triangulation and interpretive verification.Results: Barriers to EBP incorporation and educational emphasis placed on EBP were the main themes reported. Resources, personnel, and student characteristics were subthemes identified as barriers. Resource barriers included time, equipment, access to current literature, and knowledge. Coworkers, clinicians, and coaches who were unwilling to accept evidence regarding advancements in treatment were identified as personnel barriers. Programmatic improvement and communication improvement were subthemes of the educational emphasis placed on EBP theme. The ACIs reported the need for better integration between the clinical setting and the classroom and expressed the need for EBP to be integrated throughout the athletic training education program.Conclusions: Integration of the classroom and clinical experience is important in advancing ACIs' use of EBP with their students. Collaborative efforts within the clinical and academic program could help address the barriers ACIs face when implementing EBP. This collaboration could positively affect the ability of ACIs to implement EBP within their clinical practices.Key Words: education, curricular integration, collaboration Key PointsResources, opportunities, and integration should be provided to Approved Clinical Instructors (ACIs) to help create an educational program that focuses on valuing the best evidence, patient values, and clinical expertise. A culture of evidence-based practice (EBP) needs to be promoted in clinical practice. Understanding the barriers that ACIs face while implementing EBP within their clinical practices and with students can help athletic training education programs better prepare ACIs to incorporate EBP. Collaboration between the clinical and academic programs could help ACIs address barriers and improve their abilities to implement EBP in their clinical practices.

Athletic Trainers' Current Knowledge and Envisioned Use of Foundational Evidence-Based Practice Concepts

“…Participants in this study specifically identified perceived barriers in the areas of knowledge related to EBP, time, accessibility of evidence, and the culture of their clinical practice environment. These results are consistent with barriers cited within athletic training [16][17][18][19][20]27 as well as other health care professions. [28][29][30][31][32][33] Although these barriers are not novel, thought and reflection should be given to if and when we can anticipate changes to these barriers, particularly now that all ATs are required to obtain 10 EBP CEUs every 2 years.…”

“…12,14 In addition to knowledge, information has been previously disseminated regarding barriers to use and implementation of EBP. [16][17][18][19][20][21] Although valuable in content, these previous studies were conducted before the implementation of the BOC requirement regarding EBP continuing education. There is a structured process to obtaining these EBP-category CEUs through the BOC, but little information is available regarding the outcomes of EBP-approved CPE programs on ATs' knowledge and subsequent implementation of skills into practice.…”

“…17,18,20,21,35 The acknowledged lack of accessibility, availability, and applicability of evidence is also supportive of previous findings. [16][17][18][19][20][21] Participants within this study addressed resources within both the barriers question and the envisioned-use question, thus suggesting that resources are a barrier to envisioned use of EBP. Although the short 5-hour course did not demonstrate change in specific resources used by ATs, participants did indicate that as a result of the workshop they learned how to better access and streamline information in a manner that is easier to process.…”

Use of Evidence-Based Practice Among Athletic Training Educators, Clinicians, and Students, Part 1: Perceived Importance, Knowledge, and Confidence

“…35 Both groups indicated that their own lack of knowledge was a barrier to implementing EBP with students. Ultimately, the goal of EBP is to help improve patient care through combined best evidence, clinician expertise, and the patient's goals and values.…”

Evidence-Based Practice or Practice-Based Evidence: What’s in a Name?

“…Developing a spirit of inquiry about the best available external evidence is essential; 7 however, time constraints on athletic trainers, lack of mentorship in evidence-based practice, and the limited availability of sources of external evidence present some major barriers for its acceptance as part of the necessary skill set for making clinical decisions. [8][9][10][11] Additionally, for many of the assessment and intervention techniques that athletic trainers use, high-quality sources of external evidence are not yet available. This unavailability actually reinforces the resistance against evidence-based practice gaining traction for inclusion in the necessary skill set.…”