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Keywords

Clinical Practice in Athletic Training

Abstract

Introduction: Immediate and emergency care is essential to athletic training education and clinical practice. Athletic training students (ATS) may have limited exposure to emergencies during their clinical experiences, which can undermine their confidence. AT educators can improve ATS confidence and clinical reasoning using a simulation-based, learner-centered SNAPPS approach. SNAPPS consists of Summarizing the history and findings, Narrowing and Analyzing the differential diagnoses, Probing peers about uncertainties or confusion, Planning management, and Selecting case-related knowledge gaps for self-directed learning. This empowers students to control the learning environment while adding realism to encounters. The purpose of this pilot study was to determine changes in student confidence following a simulation-based, learner-centered advanced emergency care course. Methods: This study was conducted in an accredited entry-level MSAT program with 15 2nd-year students who had completed an introductory emergency care course 1 year prior. Before class, students created a simulated patient (SP) case that included relevant details of a critical illness or injury, including but not limited to MOI, signs and symptoms, vital signs, medical moulage (e.g., pallor, bruising, bleeding), and emergency equipment (e.g., AED, supplemental oxygen, medications). During class, students rotated through three primary roles: SP, ATS, and proctor. The SP acted out their prepared case; the ATS provided assessment, management, and referral; and the proctor reported case-specific vital signs and observed both peers to ensure the accuracy and appropriateness of their actions. Furthermore, students participated in 2 mini-cases and 1 large case each week. Mini cases consisted of one SP managed by a single ATS. Large cases were more complex, involving at least 2 SPs and a sports medicine team of 4 or more ATSs, requiring teamwork and communication to manage all patients. Immediately after a simulation, students engaged in a SNAPP debriefing, and faculty offered additional insights. After class, students Selected a case-related issue for self-directed learning on an asynchronous discussion board using peer-reviewed research to address a knowledge gap identified during the SP encounter. To assess confidence changes, Likert-style surveys were administered at the beginning and end of the semester, gauging confidence in 19 areas of emergency care, developed following the CAATE 2020 Professional Standards. Survey response options ranged from 1=Not confident at all to 5=Very confident. The median and interquartile range (IQR) were calculated for each item-level and total confidence score. Wilcoxon signed-rank tests were used to compare item-level and total confidence scores from pre- to post-semester using SPSS. Alpha was set a priori at p≤0.05. Results: Students created 8 critical incident cases and self-directed learning assignments. Students served as ATS 2-3 times per class, providing a minimum of 16 unique exposures to simulated emergencies. Significant improvements in item-level (all p<0.05; Table 1) and total confidence (p<0.001, Table 1) scores were observed. Translation to Practice: This study demonstrates a positive first step in better understanding how a learner-centered approach with SPs improves student confidence. AT educators should create opportunities for self-directed learning to allow students to take ownership of their education and to develop confidence. Future research should examine changes in students' knowledge alongside increases in confidence to ensure they are prepared for autonomous clinical practice.

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