5th Annual MoATA Educator’s and Athletic Training Student ......•However, there may still be new knowledge and skills to learn 1. Get out of your routine and expose yourself to

5th Annual MoATA Educator’s and Athletic Training Student

Leadership Conference

Enhancing Transition to Practice

By

Michael Hudson, PhD, LAT, ATC

Associate Professor, Missouri State University

Let’s Take a Poll

2

Athletic Training Strategic Priorities1

Professional Education

• Learning to be an athletic trainer

Transition to Practice

• Supportive processes that mentor new professionals

Clinical Expertise

• Career enrichment and advancement beyond minimal competence

Advanced Practice Leadership

• Clinical leaders who have a deep understanding of quality improvement and patient-oriented outcomes

Stewards of the Profession

• Scholars who maintain historical knowledge and create new knowledge

3

Transition to Practice In the Literature• Nursing

• Hospital-based internships for newly registered nurses help with transitional shock2

• Provide benefits such as improved patient care, confidence, reduced stress, and reduced

turnover3

• Occupational Therapy

• Transition for OT (also included PT) student to first year of practice is one of constant stress and

professional development, but the process seems predictable so that intervention programs

may be used4

• Physical Therapy

• Novice PTs were strongly influenced by their work place and they experienced increases in

confidence and independence through the first year while they transitioned and formed their

professional identity5

4

Story Time

• My Transition

• High Hispanic population

• High school athletics, but

different

• It’s a desert, so it’s hot!

5

Transition to Practice- NURSING

Pass NCLEX/Newly Credentialed

Nurse

Workforce Orientation

This individual is an

employee with

commensurate pay and

benefits

Transition Modules:

• Patient-centered

care

• Communication &

teamwork

• EBP

• Quality improvement

• Informatics

Ongoing Org.

Support

Adapted from the National Council

of State Boards of Nursing6

Transition to Practice- MEDICINE 7-9

Transition to Practice- ATHELTIC TRAINING

• Historically

• Non-credentialed individuals providing

unregulated and/or unsupervised AT

services

• (e.g., “First Aider/Responder” for an athletic

event)

• Graduate Assistant

• Internships

• Self-directed Learning (sink-or-swim)

• Mentored Employment

• Future Processes

• CAATE Residencies

• No purpose is to develop clinical expertise

• Graduate assistantship

• What will this look like?

1. Internships

• Know what you are getting into

2. Self-Directed Learning with Decision

Making

• Sink-or-swim vs. a prepared self-learner

3. Mentored Employment

• My guess where AT will go

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Internships


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What is an Internship?

• National Association of Colleges and Employers • Position Statement: US Internships. A definition and criteria to assess

opportunities and determine the implications for compensation.10

• “An internship is a form of experiential learning that integrates knowledge

and theory learned in the classroom with practical application and skills

development in a professional setting. Internships give students the

opportunity to gain valuable applied experience and make connections in

professional fields they are considering for career paths; and give

employers the opportunity to guide and evaluate talent.”(p1)

10

What are AT Internships?

• NO

• “Internship programs”

• Not a program, but…

• Process to become eligible

for the Board of

Certification (BOC) exam11

• Ended January 1, 2004

• Professional education

• NOT REALLY

• Professional AT

student internships

• Example: NFL Training

Camp/Summer

Internship12

• Also professional

education

11

A Preliminary Definition of the AT Internship

• Athletic Training Internship: Credentialed

• A paid, but temporary, employment position for providing athletic training

services. The athletic trainer in this position is credentialed to provide these

services by a legally authorized state or national body. This position may or

may not include employee benefits; however, payment for these services and

other duties of this employment comply with current labor legislation. The

primary objective of this position is to provide the athletic trainer with

practical experience after graduating from an accredited professional

athletic training program. Conclusion of the internship does not guarantee

employment with the organization

(from the Internship and the Inter-Agency Terminology workgroups)

Internship Work Group of the NATA Executive Committee for Education

Work Group Membership

1. Michael B. Hudson, PhD, LAT, ATC

• Executive Committee for Education

2. John J. Barrett, MS, LAT, ATC, CES

• College/University Athletic Trainers’ Committee

3. Todd Evans, PhD, LAT, ATC, CSCS

• Post-Professional Education Committee

4. Shone Gipson, MS, LAT, ATC

• Professional Football Athletic Trainers’ Society

5. Kysha Harriell, PhD, LAT, ATC

• Ethnic Diversity Advisory Committee

6. Lisa Kluchurosky, MEd, ATC

• Committee on Practice Advancement

6. Wes Mallicone, MS, LAT, ATC

• NATA At-Large Member

7. Stephanie Mazerolle, PhD, ATC, FNATA

• Commission on Accreditation of Athletic Training

Education

8. Alan Reid, LAT, ATC, PES

• Professional Education Committee

9. Kyle Turner, ATC

• Professional Baseball Athletic Trainers’ Society

10. George Wham, EdD, ATC, SCAT

• Secondary School Athletic Trainers’ Committee

11. Sam Zuege, MS, LAT, ATC

• Young Professionals’ Committee

Work Group Charge

• Charge

1. Describe the purpose and structure of the athletic training

internship employment model.

• We surveyed13 NATA membership

2. Determine potential advantages and disadvantages of this

practice.

3. Make recommendations to the NATA Board of Directors based on

the data analyzed and literature reviewed.

• Reason for this Charge

1. Athletic training has minimal formal knowledge on the purpose,

structure, and practices of this employment model.

Key Background Literature

• Fair Labor Standards Act

• “Establishes minimum wage, overtime pay, recordkeeping, and child

labor standards affecting full-time and part-time workers in the private

sector and in federal, state, and local government.”14(pC2)

16

Survey Methods• Intern Survey

• NATA members (certified regular and career starter)

• 196 submitted surveys; 98 partially or fully (90) useable surveys (46.6%

completion rate)

• Of the incomplete surveys, 32 did not pass screening [completed education &

credentialed] questions (54.9% completion rate)

• Employer Survey

• Invitation sent to contact person for internship positions in NATA Career Center

• Years 2010-2015

• 180 subjects surveyed; 68 submissions with 60 partial or fully useable

surveys (33.3% response rate)

Basic Demographics

Interns Employers

Sample Size 98 60

Gender

Male 35 --

Female 54 --

Current Mean Age 26.2 --

Mean Age When Completed Internship 24.1 --

Range of Internships Offered -- 1-20

Number of Internships Completed

1 94 --

2 3 --

3 1 --

Internship Work Setting

College/University 86 53

Secondary School 3 5

Professional Sports 7 1

Hospital/Clinic 0 3

Others 1 3

What Did we Learn?1. AT Internships are NOT internships as described in the Fair Labor Standards Act15

• 6 tests used to identify the unpaid internship; must pass all tests

• “AT interns” do not pass all tests

• Example: Test 1 Training similar to education, but…

• AT Interns are credentialed health care providers

2. The credentialed AT is a learned professional, exempt employee16,17

• But must pass all tests, one of which is the salary test

• Required salary test is $455 per week/$23,660 per year16 (proposed change is $913 per week/$47,476 per year18)

• If not paid this salary, must be paid hourly wage as well as overtime if work over 40 hours per week.19,20

3. AT internships do provide a transition to practice

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Career Development: Intern Survey- Need more real-world experience before full-time employment

Career Development: Intern Survey- Need to build self-confidence as an independent practitioner

Career Development: Employer Survey- Create positions to help interns transition to real-world practice

Job-Specific: Intern & Employer Survey- Interns and employers agree the intern’s role is to make clinical decisions

Interns Employers

Job-Specific: Intern Survey & Employer Survey- 10-month positions and exempt employee pay test (10 month = 43 week and cut off salary of $19,565)

EmployersInterns

Self-Directed Learning: Learning How to Make Decisions


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Evidence-Based Practice

• What are the 3 parts of EBP?

• Why was EBP created?

• Develop and promote rational clinical

decision making that deemphasized

intuition and expertise.21

• Problems:

• Humans are not rational thinkers

• Decisions are not independent of the

environment

(Not addressed today because of time)

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Quick Quiz22

Learning and Decision Making

• Take Away from Quick Quiz

• Factual and experiential knowledge affects learning and decisions

• A key element of effective learning…

• Humans have an innate desire to make order and meaning of our

experiences23

• What directs your clinical decisions more?

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Two Ends of Decision Making

Analytical (logical) Non-analytical (intuitive)

https://www.youtube.com/watch?v=7PUN3fkQfcE

Blending Your Decision Making

• Your professional growth…

• Novice learner more analytical with decisions

• As you start to acquire experience, decisions

become more intuitive

• More skilled decision makers learn to blend

analytical and non-analytical reasoning24,25

• This may improve your diagnostic accuracy26

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Your Professional

Growth

Decision Making and Reflection

• Blending your decision making starts with your ability

to reflect on your non-analytical reasoning24

• Recognition-Primed Decision Model27

• Non-analytical decision making process used by experts

• Fire fighters, chess players, navy commanders, and others

• Model is the fusion of 2 processes

• Diagnosing the situation and recognizing the most appropriate

action

• Mentally evaluating the action before implementing

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Recognition-Primed Decision Model

• Variation 1- Simple Match27

•Situation is typical and familiar

“textbook”

1.Goals make sense

2.Key cues present

3.Expectations clear

4.Typical responses correct, so

decision already known

• Our mental models make it difficult to

reflect on these decisions

Experience the Situation in a

Changing Environment

Perceived as

Typical

Recognition has 4 by-products:

Expectancies, Relevant Cues,

Plausible Goals, Typical Action

Implement

Action

Reflecting on the Simple Match Variation

• If a true typical case, little-to-no information to reflect on

• However, there may still be new knowledge and skills to learn

1. Get out of your routine and expose yourself to new/different experiences28

2. Seek out a respected devil’s advocate who can teach you something new29

3. Explore what are the underlying assumptions you base your decisions on27


• Variation 2- Diagnose

Situation30

•More needed with

diagnosing the

situation

1.More info needed for

diagnosis

2.Misdiagnosis that

violates recognition



Is the Situation

Typical?




Implement

Action

Diagnose the

issues:

- More data?

- Clarify?

- Anomaly?

Reflecting on the Variation 2 Issues

• If the situation is not prototypical or very comparable, explore why

• Expectancies

• According to Klein30, this is main by-product to explore for Variation 2

• For AT, we may need to learn more about etiological factors and symptoms (pathology) for the

situation

• Plausible Goals

• For AT, we may need to learn more about the prognosis of the situation (short and long term)

• Relevant Cues

• For AT, we may need to learn more about signs (physical presentation, diagnostic tests)


• Variation 3- Evaluate

Action30

•Typical responses to the

decision do not fit

1.Adjust course of action

2.Outright reject action; re-

examine diagnosis



Perceived as

Typical




Implement

Action

Evaluate the Action

- Will it work?

- Modifications needed?

Reflecting on Variation 3 Issues

• Learn/adjust your

actions/management

• Diagnosis may be correct,

but...

• Are there other management

techniques to use for this

case?

• If you need to reject the

actions/management:

• The initial diagnosis may be

wrong

• Re-examine the variation 2 issues

• This may be a new case

• Re-examine the variation 1 issues

Also Reflect on How You Think and Learn…

• Metacognitive Awareness30

1. Metacognitive Knowledge knowing about specific ways you

think and learn

• How, when, and why to use specific learning strategies (e.g., When do you use

a mnemonic device?)

• How does a certain task influence thinking (e.g., use an app to identify drug

interactions vs. trying to remember all of them)

• Your and your peers’ strengths and weaknesses with thinking and learning

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2. Metacognitive Judgment consciously assessing your thinking

and learning

• Judge how easy/difficult a task is before starting it

• Judge how much learning occurred after completing a task

• Judge your ability to perform the task

• Judge your confidence in the correctness of an action

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3. Self-regulation purposefully transforming thinking into learning

behaviors

• Establish goals to regulate your learning

• Determine the appropriate strategies to use to successfully learn

• Control learning resources (e.g., time, effort)

• Control emotions and motivation to learn

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Mentored Employment: What is your Role as the Mentee?


41

What is Mentoring?

• “This is how we do things

around here.”

• Derived from the character

“Mentor” in the Greek poem The

Odyssey

• Mentor was an older man and friend

of Odysseus

• Mentor guided Odysseus’ son

Telemachus through adulthood

42

What is Mentoring?

• Many definitions

• A nurturing process where a more skilled

person serves as role model, teacher, and

sponsor who encourages, counsels, and

befriends a less skilled person with the goal

of promoting the less skilled person’s

professional and/or personal development31

• Mentors help with transition because they

interpret how personal and environmental

factors influence learning and decision making

• Many forms

• Classic/formal

• Situational

• Group

• Team

• Peer

• Digital

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What a Mentor Does

• Mentoring Behaviors32

1. Relationship Emphasis

• Conveys genuine understanding

• Purpose create trust

2. Information Emphasis

• Request for detailed information of the

mentee

• Purpose establish a profile for advising

3. Facilitative Focus

• Explore the mentee’s interests, ideas, and

beliefs

• Purpose consider alternative views and

options

• Mentoring Behaviors32

4. Confrontive Focus

• Challenges the mentee’s decisions and actions

• Purpose see unproductive behaviors; gauge

ability to change

5. Mentor Model

• Mentor assumes responsibility for his/her role;

active role model

• Purpose motivate to grow, change; take risks

6. Mentee Vision

• Stimulate the mentee to critically think about

his/her futre

• Purpose be more self-reliant (i.e., adulting)

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What is your Role?33

• Prepare what you want to share

about yourself

• Identify your goals professionally

and for the relationship

• Reflect on and communicate your

personal and professional

interest and beliefs

• Reflect on how you and your mentor

compare

• Mentors may not fulfill all roles

• Be active in the relationship

• Set regular meeting times

• Prepare for meetings; show you

want to learn

• Seek balance (show what you seek)

and be adaptable

• Ask your mentor to help build

your network of support

• Inside and outside the workplace

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What is your Role?33

• When presenting problems you

are having…

• Describe issue objectively; focus

on facts vs. emotions, but …

• Be honest with self-assessments of

your feelings

• Be cooperative and open-minded

to solutions offered, but…

• Its okay to offer your own

perspectives and solutions

• If you need to confront your

mentor

• Before confrontation

• Work on developing trust first

• Analyze your strengths and

weaknesses regarding the issue

• When addressing the problem,

• Present facts, not emotions

• Begin and end with positive

comments

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Questions?

• Thank you for this opportunity

• E-mail:

[email protected]

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