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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…
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.
14
What conversations is the BOC having?
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%
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
24
Reflected in current 6th Role
Delineation Study (RDS)
BOC Examinatio
n
What does an evidence
based practice
environment look like NOW?
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)
34
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