Date of Award

2019

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Education

Abstract

Athletic trainers (ATs) have stated that medical documentation is a weakness in clinical practice citing lack of time to document, lack of knowledge regarding what to include in documentation, and lack of oversight and review as reasons for the poor quality of their medical documentation. ATs serving as preceptors have additional responsibilities to engage athletic training students in best practices for medical documentation. The purpose of this study was to engage preceptors in an Educational intervention to teach best practices for medical documentation and evaluate perceived and actual knowledge and clinical practice behaviors before and after the Educational intervention. This study used a single-cohort design of 11 athletic training preceptors for professional master's athletic training programs (age = 34 ± 15y; males = 5, females = 6; years of clinical experience = 13 ± 12y; years as a preceptor = 5± 8y; secondary school = 2, 18.2%, college/university = 9, 81.8%) that were recruited through e-mail communication from program administrators. The research team used a web-based platform for data collection and an Educational intervention. Initially, each participant provided consent, a de-identified medical chart for one patient, and completed perceived knowledge (PK) and actual knowledge assessments (AKA). Next, each participant engaged in a Board of Certification (BOC) approved continuing Educational intervention delivered asynchronously with interactive modules. The modules focused on mechanics and best practices of medical documentation, quality improvement strategies, and avenues to engage athletic training students in medical documentation. Participants completed a follow-up PK and AKA immediately following and four weeks post-intervention, in addition to providing another de-identified medical chart. The principal investigator evaluated both charts using a validated tool. All data were analyzed using SPSS® for measures of central tendency and a 2X3 repeated-measures analysis of variance for knowledge (PK and AKA) and time (pre-intervention, post-intervention, follow-up). Mauchly's test indicated violations of sphericity, indicating Greenhouse-Geisser corrections for within-subjects effects were necessary. Post-hoc comparisons were conducted as needed and paired-samples t-tests were used to compare pre and follow-up chart review scores. Significance was set at p < 0.05 a priori. A significant knowledge by time interaction ( F 2,20 = 6.610, p = 0.016) and significant effects for knowledge ( F 1,10 = 619.56, p < 0.001) and time ( F 2,20 = 5.771, p = 0.029) was found. There was a significant difference in the PK scores from pre-intervention to post-intervention ( t 10 = -2.425, p = 0.036), and from pre-intervention to follow-up assessment ( t 10 = -4.812, p < 0.001), yet no significant differences in actual knowledge were identified at any point. A significant improvement in chart review scores was identified from pre-intervention to follow-up ( t 10 = -4.437, p < 0.001). ATs' perceptions about and their abilities to perform medical documentation significantly improved as a result of the Educational intervention, yet no change occurred in their actual knowledge. While improvements occurred, participants still scored poorly on the follow-up chart review indicating that continuous quality improvement is vital for professional development regarding medical documentation.

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