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

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

Competency-Based Objectives

Nothing becomes real for the student until it is EXPERIENCED

CROSSING THE BRIDGE HOURLY BASED BASED COMPENTENCY BASED

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

Learning Cognitive Information in Isolation

Merging of Didactic and Clinical Components

Flexible Clinical Scheduling is a Prerequisite to Competency-Based Progression

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

Clinical Proficiency Preparation First Phase Formulate a student portfolio

Student Portfolio Matrix

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

Didactic Course Matrix

Clinical Proficiency Preparation Third Phase Formulation of Clinical Hours Matrix

Clinical Hours Matrix

Clinical Proficiency Preparation Fourth Phase Clinical Proficiency Matrix

Clinical Proficiencies Individual skills Subset skills taught together

Lower Extremity Clinical Proficiency 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

l. Legs are straight up and down.Knees and legs1. 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) Good Posture Part Faulty Posture I NI

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 Toesl. 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 1 st toe (morton foot)

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 drawn between 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

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

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

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

INTEGRATED COMPONENTS Integrating Components

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

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. Team Teaching

 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 Success of Team Teaching Depends on

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

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

LINKAGE OF EVALUATING SKILLS

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

 NARRATIVES  ALGORITHM Problem Solving Integrative Evaluation Tools

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 Algorithm Evaluation

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

LINKING PROCESS AND CONTENT CONTENTPROCESS

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

INDIVIDUALIZATION CLINICALCOMPONENT = IndividualAbilities Learning Styles +

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

The Sculpturing of a Professional