EVIDENCE BASED PRACTICE AND ITS IMPACT ON THE BOC

EXAMINATION

Athletic Training Educators’ ConferenceWashington D.C.

February 25, 2011

Susan McGowen, PhD, EMT, ATCUniversity of New Mexico

Bernadette Olson, EdD, ATCSouth Dakota State University

DRIVING CHANGE IN ATHLETIC TRAINING PRACTICE:

Implementing Evidence Based Practice Skills into Athletic Training Education Curriculum

Educate future practitioners, students should successfully demonstrate: Use of evidence based practice during didactic/clinical

experiences. Implement EBP strategies into their own entry level practice

careers. Stretch:

As new practitioners, students will participate/drive change in the organizations for which they work to advance EBP environments.

Educate current practitionersEducate the educators:

Are we ready to serve as role models?

And the survey says…

72% of participants completed the survey…

Program Directors (51%)

Faculty (41%)Clinical Instructors

(8%)

Need participation from all in curriculum to integrate EBP

Why We Should Care - Improving Patient Outcomes

(1) It is ethical: Care about patients/do no harm(2) Smarter patient(s): We are in an information era –

patient advocacy(3) It is legal: We are held to a standard of care...(4) It’s contemporary: Everyone else is doing it…

“The train is leaving the station…”(5) Profession Integrity: Making our mark as experts…(6) It is a competitive market: If you don’t get

participants back faster, then someone else will.(7) Cost Effectiveness: We can’t afford to continue

treating conditions the same way.(8) How the public views continuing competence:

From seat time to demonstrating a change in patient outcomes.

7

Barriers to EBP (in the classroom & practice)

Knowledge base of educators and practitioners… Do we know enough to be teaching practices? Where do we get our information from?

How much EBP is out there?... Is the research available for us to answer our clinical

questions?Relationship to theoretical research…Time to…

learn practice disseminate

Clinical Expertise √ Clinical Skills/Past

Experience√ Rapidly identify each

patient’s unique health state and diagnosis, individual

risks and benefits of potential interventions, and

personal values and expectations.

Patient Values/Patient Circumstances

√ Unique preferences, concerns and

expectations that each patient brings to a clinical encounter and that must be integrated into clinical

decisions if they are to serve the patient.

Evidence-based practice is the integration of best research evidence with clinical expertise and patient values to improve

patient outcomes.

Crossing the Quality Chasm: A New Health System for the 21st Century (IOM, 2001)

Best Research Evidence√ Clinically relevant research - patient-centered clinical

research√ Diagnosis, Prognosis, Therapy, Rehabilitation, Prevention.

Clinical Decision Making

Improved Patient Outcomes

9

Crossing the Quality Chasm: A New Health System for the 21st Century (IOM, 2001)

Critical Appraisal…Best

Research Evidence

Clinical Expertis

e

Patient Values

10

Be Consumers…Be Consumers… Be Producers…Be Producers…

Inquisitive practitioners/lifelong learners

Effectively locate and analyze literature

Making decisionsCollaborating with

other practitioners Communication networks, Site

practice guidelines, Practice patterns, Journal Clubs

Is it time to participate in a study design? Randomized control trials Cohort Studies Case Studies

Disseminate information to benefit other providers Via publications Via presentations

Teaching others how to participate in EBP practice

What are we preparing our students to do?

11

At minimum, an entry-level clinician should be able to…

Formulate sound clinical questionsLocate literature relevant to questionCritically appraise literature:

A single article/study or arranged around a topic Quantitative or Qualitative

Reflect and determine if this affects practice

Others…

Take (10)

How are you starting the conversations in your programs…

HOW DOES EBP INFLUENCE THE “BUSINESS” OF THE BOC?

ReferencesRole Delineation Study / Practice Analysis

Entry-Level Examination

REMEMBER – THE BOC EXAMINATION DOES NOT DRIVE CHANGE, EDUCATION DRIVES CHANGE

Evidence used in the BOC examination reflects what is currently accepted as common practice in athletic training.

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What conversations is the BOC having?

BOC References

How is the BOC Examination Reference List determined?

Program Director Reference Survey

January 2011

Survey Purpose: To determine references most commonly used by

entry-level ATEPs To determine preferred references when writing,

reviewing and validating items within exam development process by BOC Exam Development Committee (EDC)

Overall: program director references coincided with what EDC members preferred

Program Director Reference Survey Summary

Educational Content Areas as determined by the NATA ECE

% Used by PDs

% Preferred by EDC

Risk Management and Injury Prevention 87.5% 96.3%

Pathology of Injuries and Illnesses 74.4% 85.45%

Orthopedic Clinical Examination and Diagnosis 73.7% 70.91%

Medical Conditions and Disabilities 64.0% 61.54%

Acute Care of Injuries and Illnesses 82.6% 85.45%

Therapeutic Modalities 69.5% 74.55%

Conditioning and Rehabilitative Exercise 62.2% 77.78%

Pharmacology 58.4% 64.44%

Psychosocial Intervention and Referral 39.0% 36.54%

Nutritional Aspects of Injuries and Illnesses 52.0% 46.94%

Health Care Administration 80.3% 86.54%

Professional Development 81.8% 86.27%

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Relationship between EBP and RDS

Role Delineation/Practice Analysis

The RD/Practice Analysis is: A review of existing RD/Practice Analysis material Subject matter expert knowledge A large scale survey

Findings are used to evaluate and support an entry level athletic trainer competency test

RD/Practice Analysis 6

Example from Domain 3: Immediate and Emergency Care

How EBP affects the Exam Process

24

Reflected in current 6th Role

Delineation Study (RDS)

BOC Examinatio

n

What does an evidence

based practice

environment look like NOW?

Design of the BOC Examination…25

Multiple Choice Item Development

Triangulation

Subject Matter Experts

Double Reference

Statistical Analysis

Multiple Choice Item Development

Subject matter experts

Represent 5 domains

Items based on: Importance Criticality Frequency

Importance Is competence in a domain essential for a minimally

competent certified athletic trainer?

Criticality Can adverse effects result if the certified athletic

trainer is not competent in a domain?

Frequency What percentage of time does the certified athletic

trainer spend performing duties associated with the performance domain?

Multiple Choice Item Development

Breakout Session29

Divide into groups

Construct 3 multiple choice items Recall Analysis Application

Include question, correct answer and four distracters (incorrect responses)

Multiple Choice Item Principles

Entry-levelClear and conciseWritten in question formThird personStem (question) stated in a positive matterDistracters clearly wrong, but plausibleDouble referenceBe aware of state/local/regional differences

Adapted from the BOC Style Guide

INITIAL ITEMINITIAL ITEM REVISED ITEMREVISED ITEM

According to Richard Ray, there are specific budget types used by athletic training facilities to project future incomes and track expenses. Which of the following budget type requires an athletic trainer to list anticipated expenditures for specific categories of program functions, including equipment repair, insurance, and expendable supplies? Choose only one.

Fixed Line-item Lump-sum Performance Zero-based

What budget type requires an athletic trainer to list anticipated expenditures for specific categories of program functions? Choose only one.

Fixed Line-item Lump-sum Performance Zero-based

MC Item Examples: Recall

(clear and concise stem)

INITIAL ITEMINITIAL ITEM REVISED ITEMREVISED ITEM

ABC Athletic Training Clinic Anywhere, USABudget: First Quarter 2014 Expenditures by Type

Section A

2” white tape 10 cs

Rub. alcohol 8 pt

2” ACE wraps 10/box

Section B

Staff meeting refreshments Varies by week

Copy costs when copier is broken Variable

Immediate purchase of expendable supplies Variable

Section C

Taping/treatment tables 4 tables

Treadmill for rehabilitation room 1 unit

ABC Athletic Training Clinic Anywhere, USABudget: First Quarter 2014 Expenditures by Type

Section A

2” white tape 10 casesRubbing alcohol 8 pints

2” elastic wraps 10/box

Section B

Staff meeting refreshments Varies by week

Copy costs when copier is broken Variable

Immediate purchase of expendable supplies Variable

Section C

Taping/treatment tables 4 tables

Treadmill for rehabilitation room 1 unit

MC Item Examples: Analysis

(use of abbreviations and trademarked terms)

Section C of the budget shown below includes which type of expenditures? Choose only one.

Capital Line item DepartmentalCash Operating

INITIAL ITEMINITIAL ITEM REVISED ITEMREVISED ITEM

A patient presents to the athletic trainer with pain, moderate effusion, and instability of their left knee after experiencing an incident where they felt a “pop” while making a quick lateral movement about a planted foot. Which of the following structures are MOST likely affected? Choose only one.

ACL MCL LCL ATF CF

A patient presents to the athletic trainer with pain, moderate effusion, and instability of their left knee after experiencing an incident where they felt a “pop” while making a quick lateral movement about a planted foot. Which of the following structures are MOST likely affected? Choose all that apply.

  Anterior cruciate ligament Medial collateral ligament Lateral collateral ligament Meniscus Patella Tendon

MC Item Examples: Application

(length of distracters, wrong but plausible, abbreviations)

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What does an evidence

based practice

environment look like in

5 years?

Reflected in 7th

(RDS)/PracticeAnalysis

Influenced by Professional Development

we seek…

Influenced Changes in Professional

Education (4th Competencies

and Proficiencies)

*Influence of Vision for the

Profession (what do we want to look like in 5 yrs /

10 yrs)

*Influence of Educators –

Drive Change in Practice and Culture

*Influence of Current

Practitioners

Closing Comments…35

The BOC does not create evidence

The examination reflects what is currently accepted as common practice in athletic

training

Discussion

THANK YOU!