Jeremy Hawkins, PhD ATC

1. Take a Page from Your Coach’s Playbook: Teaching of Technical and Tactical Skills in Athletic Training Jeremy Hawkins, PhD ATC

2. Acknowledgements • Elizabeth Sharp, PhD • Colorado Mesa University • Skip Williams, PhD • Illinois State University

3. Overview • Provide context and objectives for the presentation • Discuss the importance of teaching clinical decision-making • Discuss background associated with the different techniques • Include sport examples and athletic training examples for clarification as we go • Apply methods to athletic training • Discuss implementation of this approach

4. Context • As athletic trainers we need to be able to make a correct clinical decision • Clinical reasoning • Question how well clinical decision-making is being taught

5. Objective • To provide an overview of how to teach technical and tactical skills, using both a traditional and a non-traditional approach • Apply these teaching methods to athletic training education

6. Opening Scenario This past spring you graduated with your degree in athletic training and passed your certification exam. Your first job is at the high school in your home town. The first few weeks have been a bit rocky, but you are managing because you are doing what you love. You are in the athletic training room taping players for football practice when a volleyball player is carried in by two of her teammates. The teammates set her on a treatment table and head back to practice. What do you do?

7. Decisions • So, what decisions is this new athletic trainer faced with? • Possible answers: • Ignore and continue taping • But what about the injured patient? • Stop taping and see the patient • But what about the football player and football practice? • Some combination of the two

8. Background • Fictional scenario • Some are concerned whether newly certified athletic trainers have the decision-making skills to handle these situations1,2 • Others attribute a lack of decision-making skills to inexperience in situations where a student was asked to make a decision1,3 • Lack of autonomy under direct supervision • The medical field has questioned how well decision-making skills are taught1,4,5

9. Background • Geisler and Lazenby (2009)6 • Discussed “the need to develop and implement a pedagogy of thinking that’s capable of bridging classroom knowledge to clinical education through experiential thinking.” • Elaborate on the concept of clinical reasoning by using Groopman’s4 definition of clinical reasoning: “A multi-factorial and complex mental process inclusive of multiple methods of diagnosis formulation; each with their own strengths, limitations, and applications depending upon the individual context under study.”

10. Background • Geisler and Lazenby (continued) • Introduce two methods to reason clinically • Hypothetico-deductive reasoning • Case pattern recognition

11. Background • Others have also presented ideas to facilitate learning how to reason critically • Sibold7 • Speicher, et al.8 • Inherent in all three approaches is foundational knowledge with is used to reason clinically • Little is said about how to build this foundation

12. Background • Coaches routinely teach technical and tactical skills to enhance success • Technical skills: specific procedures to move one’s body to perform an action9 • E.g., dribbling, passing, and shooting in basketball • E.g., taping, performing special tests, and splinting in AT • Tactical skills: putting technical skills in to action to give one team an advantage over another9-12 • E.g., basketball – types of defense, offensive schemes/plays, whom to guard on a fast break • E.g., AT – how to tape one injury vs. another, what special tests to perform in a given situation, applying different splints with different injuries • Can be used to build a foundation

13. Purpose • Two fold • Provide an overview of how to teach technical and tactical skills following a traditional approach and non-traditional approach • Basketball examples will be used throughout for clarity • Use the opening scenario to demonstrate how these skills can be applied to prepare athletic training students for clinical practice, following both the traditional and non-traditional approaches • Intent is to introduce educators to a new or different way to prepare ATS for decision-making situations

14. Teaching Technical Skills • The techniques or technical skills of AT are foundational just as dribbling, passing, and shooting are central to basketball • Both require the learner to go through 3 stages9,13 • Mental (Cognitive) Stage • Practice (Associative) Stage • Automatic (Autonomous) Stage

15. Teaching Technical Skills • Mental Stage • Performer relies heavily on the cognitive understanding of what they are to do • Brain actively seeks connections with previously learning activities

16. Teaching Technical Skills • Practice Stage • Less mental energy is used • Performer focuses on refining of timing, coordination, and quality of feedback • Sensory feedback, both visual and kinesthetic, is important

17. Teaching Technical Skills • Automatic Stage • Performance becomes reliable • Mental capacity is freed up to focus on more critical elements or tactical application

18. Teaching Technical Skills • Basketball example • When first learning to shoot a basketball, focus on many cues (Mental Stage) • Feet placement, hand positioning on ball, eyes on basket, and correct form • Brain constantly sending signals • Once form is learned, refinement can be made (Practice Stage) • Bend knees, hold follow through • Eventually able to perform the task without much mental input (Automatic Stage) • Athlete can shoot with proper form in multiple situations

19. Teaching Technical Skills • AT example • When first learning how to evaluate an injury, trying hard to remember all of the history questions to ask and what to inspect and palpate (Mental Stage) • Once they get down the pattern of an evaluation, able to recognize which questions are important and become more guided in their inspection and palpation (Practice Stage) • Process becomes automatic and are able to follow same steps on injuries they are not as familiar with (Automatic Stage)

20. Teaching Technical Skills • There are 4 steps to teaching a new technical skill that help the transition through the stages of learning • Introduce the technical skill • Demonstrate and explain the technical skill • Practice • Error correction

21. Teaching Technical Skills • Introduce the technical skill • Be brief • Include how the skill will be used • Demonstrate and explain the technical skill • Demonstrate several times from different angles • Give 1 – 2 cues during demonstration • Relate the technique to previously learned skills

22. Teaching Technical Skills • Practice • Keep practices short and frequent when the skill is new • Practice in game-like or tactical situations as soon as possible • Have students experience success • Error correction • How performance compares to desired outcome • Provide tips on how to improve • Only correct one error at a time • Keep feedback simple and precise

23. Teaching Technical Skills • The approach outlined is a common approach in traditional classrooms • Students are given information • Asked to apply that information to a task • Given feedback • Cycle repeats as more information is given • As information is added to the student’s content knowledge, they move between mental, practice, and automatic stages • Important for them to learn how and when to perform skills

24. Teaching Tactical Skills • Technical skills are foundational, but without the tactical ability of applying those skills, they become useless and mundane • To teach tactical skills, 3 components are involved • Tactical Triangle • Reading the Situation • Knowledge • Making decisions

25. Teaching Tactical Skills • Tactical Triangle • Reading the Situation • Gather information • Assemble the information meaningfully • Focus on relevant cues • Knowledge • Rules • Game plan • Strengths and weaknesses of opponent • Determine what tactical options available • Making decisions • Teach decision making using different types of practice, teaching tactics, questioning techniques • Questioning techniques is particularly helpful

26. Teaching Tactical Skills • Basketball example • During a basketball game athletes are constantly using the tactical triangle to make decisions on the information they receive • When bringing the ball up the court, the PG reads the situation by seeing how the other team is placed on the court and what the score is • Keeps dribbling (games rules) until they get it to the post player for a layup (game plan) • Makes the decision to pass to the post player or to another player if the post player is covered • Without practicing these skills, while receiving appropriate feedback, the guard may be overloaded and make an incorrect decision

27. Teaching Tactical Skills • AT example • ATS must make decisions based on the information they receive • What is the mechanism of injury? • To what extent is the ankle injured? • If there is an open fracture, the ankle should be properly splinted (game rules) and the emergency action plan (game plan) implemented • Regularly practicing these skills with feedback at the appropriate time can help an ATS know what decision to make, when

28. Teaching Tactical Skills • Tactical Skill Plan • Requires educator to • Identify the decision to be made • Determine what knowledge is needed to make a good decision • Identify cues that should or should not be attended to, and ensure that the cues are interpreted correctly • Determine appropriate tactical options • Design an opportunity to practice reading the situation and choosing appropriate tactics9 • Allows the instructor to determine sequential teaching of tactical skills within a course and across the curriculum

29. Tactical Games Approach • Teaching of technical and tactical skills as outlined is a common approach in gyms and classrooms • Instructors drill athletes and students on technical skills • Then apply the skills to tactical situations • Refer to this as the Traditional Approach

30. Tactical Games Approach • Non-traditional Tactical Games Approach teaches and develops technical skills at the same time as tactical skills • Allows for athletes and students to better understand how technical and tactical skills fit together • Helps with decision making

31. Tactical Games Approach • Purpose: Link tactics and skills through emphasis on the appropriate timing of skill practice and application while in the tactical game framework • Start with a game (typically modified) • Students are asked questions about tactical problems within the game • Through questioning students identify needed skills and then practice those skills • Game is played again with the opportunity for the students to apply their newly learned skills

32. Tactical Games Approach • Basketball example • Skill of how to maintain a basketball • Questions • How do you keep the ball safe? • When is the best time to pass? • Which is the best choice between passing and dribbling? • Through discussions students identify that they need to work on passing and ball control • Instructor would lead the students through drills to practice these skills • Play the game again, noting skill improvement

33. Tactical Games Approach • AT example • An athlete has a sprained ankle • Questions you may ask: • What would you do first? • How would you perform that special test on the field versus off? • Which special test would you perform if you only were going to do one special test? • Educator leads the discussion while the students determine what needs worked on • Students practice the necessary skills • Another scenario is presented and progress is noted

34. Tactical Games Approach • Quality of the questions is a critical part of making the Tactical Games Approach work11,12 • Plan your questions so that they lead towards the focus for the day

35. Tactical Games Approach • 5 question types: • Tactical awareness (What do you …?) • Skill and movement execution (How do you …?) • Time (When is the best time to …?) • Space (Where is …?) • Risk (Which is the best choice between …?) • A combination of these 5 questions types allows for a stronger association of the technical and tactical skills

36. Application • Traditional method • Open scene would not be presented until foundational technical skills have been taught and practiced • Initially present the basics of the evaluation process (history, inspection, palpation, ROM, special tests, etc.) • During Mental Stage the ATS may experience cognitive overload as they learn what to look for and process what steps to take • Common for the educator to quiz the student over these things and review repeatedly until the ATS is ready to practice

37. Application • Traditional method • Open scene would not be presented until foundational technical skills have been taught and practiced • In Practice Stage the students begin to apply the information to case studies and clinical practice • Still use resources to get satisfactory outcomes • A tactical plan would be implemented at this stage, helping the students to know what to apply when • Plan helps the transition to Automatic Stage

38. Application • Traditional method • Open scene would not be presented until foundational technical skills have been taught and practiced • During Automatic Stage the ATS reads the situation, paying attention to the aspects of the evaluation process that helps them to understand what to do next (hypothetico-deductive reasoning, case pattern recognition) • With the foundational knowledge they have, ATS will determine the best approach to take with the patient • A clinical decision will be made, allowing them to tactically balance the evaluation of the injury and the pre-practice preparation

39. Application • Non-traditional Tactical Games Approach • Opening scenario presented at the beginning • Presented as a real or fictional case study or by an actor playing the role • ATS attempts to solve the case study • Educator poses questions, such as: • When is the best time to evaluate this athlete? • How would you evaluate this particular patient? • What is the best approach to take with your injured VB player at this time? • Through the discussion the students would seek more information and the educator gives them the information (technical skills) as well as skill practice (tactical skills) to manage the situation • Repeat with similar case study

40. Application • Challenges with the Tactical Games Approach • Can seem daunting • Foundationally is not unlike how patients present daily • Hopefully a preceptor wouldn’t shy away from having an ATS do what they can in an injury evaluation and then guide them through the rest • With this approach we begin with the end in mind (patient walking into ATR) and ask ATS to do what they can

41. Application • Challenges with the Tactical Games Approach • True challenge comes from asking students to reason with knowledge they may or may not have (i.e., critically think) and utilize technical and tactical skills that they may or may not have been introduced to • Key: adjusting the depth or thoroughness of the questions according to the level of the ATS • Helps the ATS discover what to do to manage the scenario correctly • Once on the right track, the educator must be ready to walk the ATS through the mental, practice, and automatic stages associated with acquiring technical and tactical skills • Prepares students in the same way they will practice

42. Conclusions • In discussing clinical reasoning, Geisler and Lazenby6 stated • “there is significant debate as to the precise mental process involved, how to best teach students, and how to evaluate this requisite ability in objective matters.” • Approach presented is a viable option to “best teach students” • Ideas presented initially fit into this approach

43. Conclusions • Tactical Games Approach is the ideal • Inherent within is the need to reason clinically throughout, fostering critical thinking skills • Can help students learn to think through cases, just as they would as a clinician • Can help them prepare to do so as a clinician

44. Questions?

45. References • Knight KL. Hyposkillia and critical thinking: What’s the connection? Athl Train Educ J. 2008;3(3):79-81. • Carr WD, Volberding J. Employer and employee opinions of thematic deficiencies in new athletic training graduates. Athl Train Educ J. 2011;7(2):53-59. • Scriber K, Trowbridge C. Is direct supervision in clinical education for athletic training students always necessary to enhance student learning? Athl Train Educ J. 2009;4(1):32-37. • Groopman J. How Doctors Think. Boston: Houghton Millfin Co, 2007. • Fred HL. Hyposkillia – Deficiency of Clinical Skills. Texas Heart Institute Journal. 2005;32(3):255-257. • Geisler PR, Lazenby TW. Clinical reasoning in athletic training education: Modeling expert thinking. Athl Train Educ J. 2009;4(2):52-65. • Sibold J. A three-question framework to facilitate clinical decision making. Athl Train Educ J. 2012;7(1):11-17.

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