Jan 29, 2015Teaching & Treating
Athletic training students’ best clinical experiences are with instructors who know how to balance their teaching of students with their treating of athletes.
By Dr. Kent Scriber & Courtney Gray
Kent Scriber, EdD, ATC, PT, is a Professor and the Clinical Education Coordinator for the Athletic Training Education Program at Ithaca College. He can be reached at: [email protected]. Courtney Gray, MS, ATC, is a Clinical Assistant Professor and Athletic Trainer at Ithaca. She can be reached at: [email protected].
Athletic trainers are constantly striving to find balance. Many of us balance our teaching loads with the time we spend providing coverage to athletic teams, and almost all of us try to balance long hours at work with our personal lives. But athletic trainers who are also clinical instructors face another balancing act: Providing excellent care to their athletes while also guiding athletic training students’ learning experiences during clinical assignments.
Clinical instructors should never sacrifice an athlete’s care in order to give an athletic training student more clinical experience. But they should also allow the athletic training student to get as much hands-on experience as possible. These sometimes opposing objectives provide challenges that clinical instructors must anticipate and plan for.
One of our goals in the Athletic Training Education Program (ATEP) at Ithaca College is to make sure that our students get useful, educational experiences during their clinical assignments, whether they are on or off campus. Therefore, we put many strategies in place to set up and then foster this type of balanced environment.
To get both the clinical instructor and the athletic training student off on the right foot, we require that they meet before the student’s clinical experience begins. Whether the student will be working on or off campus, this meeting gives the clinical instructor the opportunity to communicate their expectations and sets the proper tone for the experience.
We have found that most problems between students and clinical instructors result from a lack of clear communication, so we try to foster good communication early on. For example, a student may have looked at the game schedule they were given by their clinical instructor and assumed they were done after the last regular season game because the possibility of postseason participation was not discussed. Then when the team makes it into the postseason, the student assumes they aren’t expected to attend practices, and the clinical instructor ends up upset because the student doesn’t seem to want to finish the season.
All clinical instructors have their own approaches to student supervision, so this initial meeting is a good time for them to let the student know how “far” they may go in terms of performing an injury evaluation or providing treatment under their watchful eye, when it is appropriate to ask questions, and when they should just observe. Some clinical instructors want students to learn more by doing and being directly involved, whereas others prefer to perform their jobs and let students observe and model after them. Both approaches can be effective depending on the situations and people involved. The key is that they are discussed up front.
For example, some clinical instructors may tell a student they should handle any injury that doesn’t appear life threatening. Then the instructor can provide feedback as the student gains the valuable experience of performing important skills or making clinical decisions somewhat on their own. Other clinical instructors may want students to observe for the first few weeks, and start doing hands-on work only after the instructor deems that they are ready.
Though gaining hands-on experience by performing evaluations, administering treatments, and planning rehabilitation programs is a main goal of the clinical experience, students must also be made aware that they are still students and will be closely supervised while performing their duties. Both our students and clinical instructors are aware that state practice acts make it illegal for students to provide treatments, conduct rehabilitation exercises, or make return-to-play decisions without a certified or licensed professional directly supervising.
At this point, students are not the decision makers, but they can discuss their thoughts and recommendations with their clinical instructor. For example, a student may be able to recommend that an athlete would benefit from a particular treatment based on what they have been taught, but the supervising athletic trainer will ultimately make the decision. We encourage our clinical instructors to have the students assist to their level of knowledge and experience so they can develop their clinical reasoning and decision making skills. As the semester progresses, the clinical instructor usually lets the student provide more of the patient’s care while guiding them through the process, but the clinical instructor always has the final say.
Supervisors and students should also discuss when the student may not be included in certain aspects of an athlete’s care. For example, a soccer player who has just suffered a season-ending ACL tear and is in emotional and physical pain may not tolerate a knee evaluation performed by a student. It is up to the clinical instructor to determine which instances are hands-on teachable moments, and when the student should observe and wait for guidance.
This may also be the case when it involves something that the athlete wants kept confidential, such as personal issues like eating disorders, sexual health, or mental illness. Although our students are taught and adhere to the laws and rules regarding patient privacy, in many cases the student and athlete may be peers, and the athlete’s right to privacy should be respected.
We have had the good fortune to work with several off-campus sites on fieldwork experiences for many years. In fact, over the past six years, more than 90 percent of our program graduates have completed at least one off-campus fieldwork assignment. Utilizing off-campus sites allows our students to:
• Work with different patient populations (adolescent athletes at area high schools, NCAA Division I athletes at Cornell University, or a more general population at clinics)
• Work with different clinical instructors (athletic trainers, physical therapists, physicians, and surgeons) to extend students’ knowledge and professional networks beyond their experience at Ithaca College
• Work with different sports not offered at Ithaca College
• Be exposed to different facilities, treatment equipment, and rehabilitation protocols.
Because we don’t want there to be a severe distinction between our on- and off-campus fieldwork opportunities–both are great experiences–it is very important that all of the clinical instructors at these sites are just as familiar with our program expectations as the clinical instructors here on campus. There are several ways that we make sure all of our clinical instructors are on the same page.
We take advantage of regularly scheduled clinical instructor workshops every three years to disseminate pertinent information to both our on- and off-campus clinical instructors. This allows ATEP administrators to ensure that all clinical instructors are up to date on national accreditation and program requirements set forth by the Commission on Accreditation of Athletic Training Education (CAATE).
The workshops are also valuable for providing a model for the consistent delivery of athletic training clinical education while promoting autonomy among the institution, clinical instructors, and students. Program expectations and relevant policies and procedures for students and clinical instructors are reviewed, and this makes the clinical instructors aware of the sequence of competencies and proficiencies that should be covered for each particular semester’s clinical coursework.
It also shows the off-site clinical instructor the sequence of academic courses the athletic training students are taking (which varies based on year in school), the clinical skills the students should already have, and the clinical skills the students are expected to learn during their particular clinical experience assignment. This ensures that the instructors have the correct expectations for students regarding their clinical decision making.
For example, we are well aware that a student may see a knee joint injury at a team practice before we have covered the topic in the classroom. If a student has not yet learned a particular technique, they should only observe the clinical instructor. The clinical instructor should not expect a student to assess an athlete’s injured ankle until they have learned and practiced the skill in class, just as they should not have a student select parameters for an electrical stimulation treatment until they have learned about it in their therapeutic modalities course. This ensures that students are not practicing skills that they don’t have a sound background in.
FEEDBACK & ASSESSMENT
Clinical skills must be taught, practiced, and mastered with appropriate and timely feedback. We encourage our clinical instructors to provide regular feedback throughout each student assignment.
Students typically seek constant feedback and assessment of how they are doing, so we also discuss the timing of these assessments. One student might find it valuable to be given feedback immediately while performing a technique on an athlete, while another may dislike being corrected in front of a patient.
Additionally, written student evaluations for clinical and professional performance are completed a minimum of two times during each of their assigned clinical experiences. Approximately halfway through each assignment, the student is required to do a self- evaluation and review it with the clinical instructor. This completed form is sent to the program director or clinical education coordinator and placed in the student’s permanent file. Then at the completion of each assignment, the clinical instructor completes the form, reviews it with the student, and sends it to the ATEP administrators.
Verbal and written comments are invaluable for assisting the student in improving their overall performance. Regular meetings also ensure that the student and clinical instructor talk face-to-face and discuss any concerns or problems that may have surfaced.
The program director and clinical education coordinator also communicate regularly with all the clinical instructors throughout the semester via site visits, telephone conversations, and various electronic mediums. In addition to monitoring a student’s clinical and professional progress, this practice of regular communication has the added benefit of preventing potential problems and making sure the clinical experience is meeting our program objectives.
It should be clear that a great deal of effort, cooperation, and communication goes into the academic and clinical preparation of athletic training students. When the clinical instructor finds the right balance between providing care to their patients and guiding students’ learning, they become a key to helping them progress to entry-level professionals.
Sidebar: STUDENT TIPS
The following is a list we put together for athletic training students about to embark on their first clinical assignment. We hope it helps them understand what will be expected of them and how they can get the most out of this valuable experience.
• Communicate early and often. Talk to your clinical instructor about your expectations and what you hope to get out of the internship. This way, they can better guide your experience.
• Discuss what the clinical instructor’s expectations are regarding travel, days off, school holidays/breaks, etc.
• Be professional. Approach your internship the same way you would approach your first job. Be on time and dress professionally.
• Get involved. You may be hesitant and understandably nervous, but you are going to learn more by doing.
• Be enthusiastic. Clinical instructors are passionate about what they do and appreciate your energy.
• Respond to feedback. If your clinical instructor makes a suggestion, listen to them. They are trying to help you do better.
• Do things without being asked. If you know what needs to be done, don’t be afraid to take initiative.
• Ask questions. If you face something you haven’t seen before or you aren’t sure, just ask.
• Don’t be afraid to be wrong. You are there to learn and no one expects you to get it right all the time–just that you try.
• Make suggestions. If you have an idea or remember something you learned in class that is related to the case, ask the clinical instructor if it makes sense to try it.
• Have fun! Athletic trainers love what they do and want to share their passion with you.
Sidebar: INSTRUCTOR TIPS
A main goal of our Athletic Training Education Program is to help our students get the best clinical experiences possible. Here are some of the tips we pass along to the clinical instructors who are guiding our students through clinical learning.
• In addition to hands-on assessment and treatment, students should also be mentored in regard to professional attitudes and behaviors, ethical practices, interactions with coaches and physicians, and administrative responsibilities.
• Try to maximize potentially idle or “free” time. For example, students can practice and review clinical skills like assessment, taping, functional training activities, or other skills, or become involved in the on-field rehabilitation of a student-athlete who may be returning after a surgery and not yet participating in official practices. This time can also be a great opportunity for upperclassmen to mentor younger students by reviewing and teaching skills they may be starting to learn in their athletic training courses.
• Our students are placed in various settings to learn and practice in an environment where they will be prepared to perform as future professionals. It is paramount that the students are not viewed as an inexpensive labor force.