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Context: Health care education needs to include methods of teaching and evaluation that are realistic and mimic patient care. Objective: To follow up on previous research regarding the methods athletic training educators use to evaluate and teach athletic training students' clinical skills during clinical experiences and in the classroom/laboratory. Design: Cross-sectional. Setting: Public and private institutions. Patients or Other Participants: Program directors of all accredited professional athletic training programs as of November 2015 (N=372) were asked to participate; a total of 90 participated. Data Collection and Analysis: The electronic survey consisted of 6 demographic questions, 6 questions regarding methods used to teach and evaluate clinical skills, and 6 items regarding barriers, educational content areas, and practice settings for real-time patient encounters. The Cronbach [alpha] determined internal consistency, [alpha]=0.784. Descriptive statistics were computed for all items. An analysis of variance and independent "t" tests analyzed differences among institutions/programs with different demographic characteristics with regard to methods, barriers, educational content areas, and settings used for teaching and evaluating skills. The [alpha] level was set at 0.05. Results: Simulated patients and real-time evaluations were the most prevalent methods of teaching and evaluating clinical skills in the classroom/laboratory and during clinical experiences, respectively. Students' lack of self-confidence (4.10 ± 0.835) was the most common barrier during clinical experiences. The clinical examination and diagnosis (4.54 ± 0.656) and acute care of injury and illness (4.39 ± 0.775) content areas ranked highest for sufficient opportunities for real-time skill evaluation. One-way analysis of variances revealed no significant differences related to institutional/program demographics regarding opportunities for or barriers to teaching and evaluating skills. Conclusions: Ten years after our previous research, athletic training students' skills are still primarily taught and evaluated via simulated patients, with a slight increase in real-time patient encounters. Professional programs should continue using simulations and consider real-time encounters to provide additional patient care experiences.

Context: Athletic trainers provide psychological support, counseling, intervention, and referral to patients during clinical practice. However, students are rarely exposed to real-life opportunities to develop these skills. Objective: To determine if a small-group standardized patient (SP) encounter improved athletic training students' interpersonal communication, psychosocial intervention, and referral skills. Design: Cohort. Setting: One Midwestern university. Patients or Other Participants: Thirty-nine (14 male, 25 female; age = 22 ± 1.0 years) senior athletic training students. Intervention(s): The experimental group (n = 20) engaged in a small-group SP encounter to teach interpersonal communication, psychosocial intervention, and referral skills, in addition to normally scheduled classes and clinical education. The control group (n = 19) engaged only in routine classroom and clinical education. Both groups participated in an individual SP encounter to assess skills. Main Outcome Measure(s): A 19-item dichotomous checklist (yes/no) assessed participants on their interpersonal communication, psychosocial intervention, and referral skills (eg, listened with interest, asked about eating habits and menstrual period) during the individual SP encounter. A Fisher exact test evaluated differences between the experimental and control group scores for each checklist item. Mann-Whitney U tests were used to compare combined checklist scores between the experimental and control groups. A Bonferroni correction was performed to control for multiple comparisons. Results: The experimental group experienced a significant increase in psychosocial intervention and referral skills (U = 77.5, P = 0.001), but there was no difference between the 2 groups on interpersonal communication skills (U = 138, P = 0.149). Participants in the experimental group asked the SP about coping strategies for stress more often than the control group (Fisher exact test P < 0.001). Conclusions: A small-group SP encounter improved the participants' psychosocial intervention and referral skills but not their interpersonal communication skills. These results suggest a small-group SP encounter can provide learning experiences to better prepare athletic training students for clinical practice.

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.

Context: Standardized patients are more prominently used to both teach and evaluate students' clinical skills and abilities. Objective: To investigate whether athletic training students perceived an encounter with a standardized patient (SP) as realistic and worthwhile and to determine their perceived comfort in future lower extremity evaluations with standardized and actual patients. Design and setting: Cross-sectional. Athletic Training Research and Education Laboratory, on-campus athletic training room, and Clinical Proficiency Evaluation Room. Subjects: Twenty-nine undergraduate athletic training students (17 female, 12 male) at a Midwestern CAATE-accredited institution who had completed a lower extremity orthopedic evaluation course in the past 12 months. Measurements: A Standardized Patient Encounter Feedback Form consisting of 5 Likert scale items (1 = strongly disagree; 5 = strongly agree) regarding the participants' perceptions of SP encounters with foot/ankle and knee orthopedic cases (eg, worthwhile, realistic, confidence with future SPs and actual patients). Data was analyzed using descriptive statistics. Written comments regarding the strengths and weaknesses of the encounters were analyzed inductively. Results: The participants indicated (90%-100% of the time) that: they agreed or strongly agreed that the encounters were worthwhile and realistic; the cases presented were appropriate; they were provided with adequate performance feedback by the SPs; and that their lower extremity evaluation skills were helped by the experiences. The participants indicated (86%-93% of the time) that they agreed or strongly agreed that the encounters made them feel more comfortable about future evaluations with standardized and actual patients. Conclusions: It appears that SPs provide realistic and worthwhile experiences for athletic training students. Thus, cases could be developed to evaluate athletic training clinical proficiencies in the future. (Contains 3 tables.)

Objective: To examine the occurrence, benefits, and preferences for peer assisted learning (PAL) in medical and allied health clinical education, and to identify areas in athletic training which need further research. Data Sources: Using relevant terms, five databases were searched for the period 1980-2006 regarding literature on the use of PAL in medical and allied health education programs. Data Synthesis: We reviewed over 40 articles on the use of PAL in nursing, physical therapy, occupational therapy, medicine, athletic training, and higher education. It is apparent that PAL is a commonly used educational strategy that offers mutual benefits to participating students. Conclusions/Recommendations: Research is warranted regarding the preferences for and occurrence and benefits of planned and unplanned PAL from the perspective of program administrators, clinical instructors, and students. These multiple perspectives will allow for a more complete understanding of PAL in athletic training clinical education, laying the groundwork for future studies comparing student learning outcomes in ATEPs with planned PAL to those with unplanned PAL.

Compared the perceptions of students athletic trainers and their clinical instructors regarding helpful clinical instructor characteristics. Surveys of undergraduate students and instructors indicated that both groups considered modeling professional behavior the most helpful category of clinical instructor characteristics in student learning. Other important areas were teacher attitude toward teaching, problem solving, instructional strategy, humanistic orientation, and self-perception. (SM)

Context: Standardized patients are widely used in health care programs to both teach and evaluate the communication and clinical skills of students. Although athletic training education programs (ATEPs) commonly use simulations, little information exists related to the use and implementation of standardized patients (SPs). Objective: To provide strategies to use SPs with athletic training students and limited resources. Background: Standardized patient encounters differ from simulations. Simulations require students to perform clinical skills on a mock patient or athlete who has no training to consistently portray a particular injury or illness. SP encounters are consistent, carefully crafted portrayals of injuries or illnesses by trained individuals. Synthesis: A feasible way to use SPs in an ATEP is the time in-time-out method which allows students to not only examine a SP, but also interact with and obtain immediate feedback from their instructor. Research with athletic training students has revealed that SP encounters are both realistic and worthwhile. Many resources exist to initiate the use of standardized patients in ATEPs, including various research publications, and online resources such as "MedEd Portal and the Association of Standardized Patient Educators". Results: The use of SPs enhances learning opportunities for students and provides a format for real-time evaluation for instructors. Recommendation(s): Educators should consider using athletic training students and/or theater students to serve as SPs. Also, a local hospital or other SP programs at a local university may offer the use of their facilities or resources to initiate the use of SPs in your ATEP. Conclusion(s): Many resources are needed to implement the use of standardized patients into an ATEP, but the experience can be well worth the expense to provide a realistic and worthwhile learning experience for students.

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. KEY WORDS. shoulder, overuse, training

Initial investigation into the demographic and employment characteristics of entry-level athletic trainers and their perceptions of the adequacy of their preparatory training was done. Both the standard curriculum and internship adequately prepared students to function as athletic trainers. Most of the respondents felt that the clinical hour requirements were inadequate and completed more than the required minimum. However, the additional hours did not have an impact on certification or perceptions of adequacy of preparation. No significant differences in perception were seen for trainers employed in either traditional or non-traditional settings.