Athletic Training Clinical Proficiencies

1. Athletic Training Clinical Proficiencies By Sue Shapiro, Ed.D.,L/ATC Clinical Coordinator/Assistant Professor Barry University Miami Shores, Florida

2. Objectives • Implementation of clinical proficiencies • Linking the didactic and clinical components • Clinical proficiency delineation • Integrative evaluation strategies/tools

3. Competency-Based Objectives

4. Nothing becomes real for the student until it is EXPERIENCED

5. CROSSING THE BRIDGE COMPENTENCY BASED HOURLY BASED

6. Competency-Based Instruction • Identifies the professional roles students will assume upon completion • Determines what constitutes effective performances within these roles

7. Learning Cognitive Information in Isolation

8. Merging of Didactic and Clinical Components DIDACTIC CLINICAL

9. Flexible Clinical Scheduling is a Prerequisite toCompetency-BasedProgression

10. Flexible Clinical Scheduling Should: • Provide open laboratory practice • Encourage advanced students to practice and teach fellow students in a controlled environment other than the clinical setting

11. Clinical Proficiency Preparation First Phase • Formulate a student portfolio

12. Student Portfolio Matrix

13. Clinical Proficiency Preparation Second Phase • Formulate a matrix of the didactic courses in the athletic training program

14. Didactic Course Matrix

15. Didactic Course Matrix

16. Clinical Proficiency Preparation Third Phase • Formulation of Clinical Hours Matrix

17. Clinical Hours Matrix

18. Clinical Proficiency Preparation Fourth Phase • Clinical Proficiency Matrix

19. Clinical Proficiency Matrix

20. Clinical Proficiency Matrix

21. Clinical Proficiency Matrix

22. Clinical Proficiencies • Individual skills • Subset skills taught together

23. Individual Subset Skills: Pelvic obliquity Tibial torsion Hip anteversion and retroversion Genu valgum,varum, and recurvatum Rearfoot valgus and varus Forefoot valgus and varus Pes cavus and planus Foot and toe posture Grouped Subset Skills: Lower Extremity Postural Deviations and Predisposing Conditions Lower Extremity Clinical Proficiency

24. Good Posture Part Faulty Posture I NI l. Legs are straight up and down. Knees and legs 1. Knees touch when feet are apart (genu valgum) 2. Patellae face straight ahead when feet are in good position 2. Knees are apart when feet touch (genu varum) 3. Looking from the side the knees are straight (i.e. neither bent forward nor “locked” backward) 3. Knee curves slightly backward (hyperextension knee or genu recurvatum) 4. Knee bends slightly forward or not as straight as it should be (flexed knee) 5. Patellae facing slightly toward each other (medial rotated femurs and/or snake eyes) 6. Patellae facing slightly outward (lateral rotated femurs and/or frog eyes) l. In standing, the longitudinal arch has the shape of a half dome Feet l. Low medial longitudinal arch or flatfoot (pes planus) 2. Barefoot or in shoes without heels, the feet toe-out slightly 2. High medial longitudinal arch (pes cavus) 3. In shoes with heels, the feet are parallel 3. Weight borne on the inner side of the foot making ankle roll in (pronation)

25. 4. In walking the feet are parallel and the weight is transferred from the heel along the outer border to the ball of the foot 4. Weight borne on the outer border of the foot or the ankle rolls out (supination) 5. In running, the feet are parallel or toe-in slightly. The weight is on the balls of the feet and toes because the heels do not come in contact with the ground 5. Toeing-out while walking or standing (forefoot valgus, outflared or slue-footed) 6. Toeing-in while walking or standing ( forefoot varus or pigeon-toed) 7. Posterior calcaneus rolls inward ( rearfoot valgus) 8. Posterior calcaneus rolls outward (rearfoot varus) 1. Toes should be straight, neither curled downward nor bent upward Toes l. Toes bend up at the first joint and down at middle and end joints so that the weight rest on the tips of the toes (hammer toes) 2. Toes should extend forward in line with the foot and not be squeezed together or overlap 2. Big toe slants inward toward the midline of the foot (hallus valgus) 3. Second toe longer than 1st toe (morton foot)

26. Pelvic Obliquity • Purpose: To identify abnormal pelvic alignment that can lead to leg length discrepancies. • Proper Identification Procedures for Pelvic Obliquity: • The ACI will observe the student athletic trainer performing a pelvic obliquity check. Patient should be bare foot with the knees fully extended and the feet together. The ASIS and iliac crest should be exposed for viewing Ask the athlete to stand facing away from the examiner Examiner places a finger or two of each hand on each of the athlete’s iliac crests and imagines a line drawnbetween the two crest Pelvic obliquity is present when this imaginary line is not parallel to the floor Leg length discrepancies should be investigated at this point Completed Pelvic Obliquity Observation Pass Fail

27. Hip Anteversion and Retroversion • Purpose: To identify abnormal rotational malalignments of the femur in relation to the femoral neck. • Proper Testing for Femoral Rotation The ACI will observe the student athletic trainer performing observational and orthopedic testing of the hip for anteversion and retroversion. • P NP The athlete should be viewed from the front with the knees facing forward. The examiner should observe abnormal toeing in or toeing out of the feet. An athlete with increased femoral anteversion tends to stand with the limb in an internally rotated position, producing in- toeing. While the athlete with decreased femoral anteversion or femoral retroversion tend to stand with the limb in an externally rotated position, producing out-toeing. Next, perform a Craig’s Test to estimate the amount of femoral anteversion present. The athlete is placed prone with the ipsilateral knee flexed to 90 degrees. The examiner palpates the lateral prominence of the greater trochanter with one hand while controlling the rotation of the limb with the other. An imaginary vertical line serves ad the reference for this test. The limb is then rotated until the lateral prominence of the greater trochanter is felt to be maximal. The angle made between the axis of the tibia an the vertical is considered an approximation of the femoral anteversion. Normal anteversion is between 8 degrees and 15 degrees. Completed Testing for Anteversion and Retroverson Pass Fail

28. Important Aspects of Proficiency Delineation l. The process is descriptive and not prescriptive 2. Assignment of importance of each subset in the delineation

30. Important Aspects of Proficiency Delineation 3. Assignment of Successful Mastery of Clinical Skill • % of Mastery needed to pass • Particular subsets that must be completed • # of times a student can attempt test • Should students be allowed to progress to next level if he/she doesn’t successfully complete proficiencies at one level

31. Integrating Components INTEGRATED COMPONENTS

32. INTEGRATING COMPETENCY BASED CLINICAL EDUCATION • Competency based clinical education is a group effort • Don’t want student to become check off artist

33. Team Teaching The coordinated and cooperative planning, teaching, supervision, and evaluation of a group of learners by 2 or more instructors, each having special competencies and knowledge in a specialized area.

34. Success of Team Teaching Depends on • Instructors working in cooperation and communicate as allies • Everyone involved is responsible for developing the objectives, instructional methodologies and evaluation • Multiple instructors can evaluate clinical competencies with high degree of consistency

35. INTEGRATING COMPETENCY BASED CLINICAL EDUCATION • Competency based clinical education is a group effort • Don’t want student to become check off artist • Student’s need to be able to THINK-IN-ACTION

36. Students need to learn to THINK -IN-ACTION & REASON-IN TRANSITION

37. LINKAGE OF EVALUATING SKILLS Real World Setting CLINICAL Setting

38. Experiential learning does not occur without active participation It requires: Engagement in the situation

39. Problem Solving Integrative Evaluation Tools • NARRATIVES • ALGORITHM

40. Algorithm Evaluation Blueprint or diagrams that lead a student through a step by step process of how to perform a certain set of tasks in an organized fashion taking into account that the procedure will change or take a different path based on the finding at any giving point

43. INTEGRATING COMPETENCY BASED CLINICAL EDUCATION • Don’t want student to become check off artist • Student’s need to be able to THINK-IN-ACTION • Emphasizing linking process and content

44. LINKING PROCESS AND CONTENT CONTENT PROCESS

45. INTEGRATING COMPETENCY BASED CLINICAL EDUCATION • Don’t want student to become check off artist • Student’s need to be able to THINK-IN-ACTION • Emphasizing linking process and content • Individualization is very important in competency based programs

46. INDIVIDUALIZATION Individual Abilities + = CLINICAL COMPONENT Learning Styles

47. Individualization Allows each student to go through the integrative process: • At his/her own content level • Pace the learning at their own rate of speed.

48. The Sculpturing of a Professional