athletic training clinical proficiencies by sue shapiro, ed.d.,l/atc clinical coordinator/assistant...

Athletic Training Clinical Athletic Training Clinical Proficiencies Proficiencies

ByBySue Shapiro, Ed.D.,L/ATCSue Shapiro, Ed.D.,L/ATC

Clinical Coordinator/Assistant ProfessorClinical Coordinator/Assistant ProfessorBarry UniversityBarry University

Miami Shores, FloridaMiami Shores, Florida

ObjectivesObjectives

Implementation of clinical Implementation of clinical proficienciesproficiencies

Linking the didactic and Linking the didactic and clinical components clinical components

Clinical proficiency delineation Clinical proficiency delineation Integrative evaluation Integrative evaluation

strategies/toolsstrategies/tools

Competency-Based Competency-Based ObjectivesObjectives

Nothing becomes real for the Nothing becomes real for the studentstudent

until it is EXPERIENCEDuntil it is EXPERIENCED

CROSSING THE CROSSING THE BRIDGEBRIDGE

HOURLYHOURLY BASEDBASED

COMPENTENCY COMPENTENCY BASEDBASED

Identifies the professional Identifies the professional roles students will assume roles students will assume upon completionupon completion

Determines what constitutes Determines what constitutes effective performances within effective performances within these rolesthese roles

Competency-Based Competency-Based InstructionInstruction

Learning CognitiveLearning CognitiveInformation in IsolationInformation in Isolation

Merging of Didactic andMerging of Didactic andClinical ComponentsClinical Components

Flexible Clinical SchedulingFlexible Clinical Scheduling is a Prerequisite tois a Prerequisite toCompetency-BasedCompetency-Based

ProgressionProgression

Provide open laboratory Provide open laboratory practicepractice

Encourage advanced students Encourage advanced students to practice and teach fellow to practice and teach fellow students in a controlled students in a controlled environment other than the environment other than the clinical settingclinical setting

Flexible ClinicalFlexible ClinicalScheduling Should:Scheduling Should:

Clinical Proficiency Clinical Proficiency PreparationPreparation

First Phase

Formulate a student portfolio

Student Portfolio MatrixStudent Portfolio Matrix

Clinical Proficiency Clinical Proficiency PreparationPreparation

Second Phase

Formulate a matrix of the didactic courses in the athletic training program

Didactic Course MatrixDidactic Course Matrix

Didactic Course MatrixDidactic Course Matrix

Clinical Proficiency Clinical Proficiency PreparationPreparation

Third Phase

Formulation of Clinical Hours Matrix

Clinical Hours MatrixClinical Hours Matrix

Clinical Proficiency Clinical Proficiency PreparationPreparation

Fourth Phase

Clinical Proficiency Matrix

Clinical Proficiency MatrixClinical Proficiency Matrix

Clinical Proficiency MatrixClinical Proficiency Matrix

Clinical Proficiency MatrixClinical Proficiency Matrix

Clinical Proficiencies Clinical Proficiencies

Individual skillsSubset skills taught together

Lower Extremity Clinical Lower Extremity Clinical ProficiencyProficiency

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 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)

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

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)

•Pelvic ObliquityPurpose: 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 RetroversionPurpose: 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 Important Aspects of Proficiency Delineation Proficiency Delineation

l. The process is descriptive and not prescriptive

2. Assignment of importance of each subset in the delineation

Subset SkillsSubset Skills

Lachman’s Test Subtasks Pts.– Patient position - moderate 0-3– Amount of knee flexion - moderate 0-3– Patient relaxation - extreme 0-5– Hand placement - moderate 0-3 – Application of force - extreme 0-5– Translation determination - extreme 0-5– Determination of end-feel - extreme 0-5– Comparison to opposite - extreme 0-5

extremity

Total 34 pts.

Important Aspects of Important Aspects of Proficiency DelineationProficiency Delineation

3. Assignment of Successful Mastery of Clinical Skill

% of Mastery needed to passParticular subsets that must be completed# of times a student can attempt testShould students be allowed to progress to

next level if he/she doesn’t successfully complete proficiencies at one level

INTEGRATED INTEGRATED COMPONENTSCOMPONENTS

Integrating Integrating ComponentsComponents

INTEGRATING COMPETENCY INTEGRATING COMPETENCY BASED CLINICAL EDUCATIONBASED CLINICAL EDUCATION

Competency based clinical education is a group effort

Don’t want student to become check off artist

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

Team TeachingTeam Teaching

Instructors working in cooperation and Instructors working in cooperation and communicate as alliescommunicate as allies

Everyone involved is responsible for Everyone involved is responsible for developing the objectives, developing the objectives, instructional methodologies and instructional methodologies and evaluationevaluation

Multiple instructors can evaluate Multiple instructors can evaluate clinical competencies with high degree clinical competencies with high degree of consistencyof consistency

Success of TeamSuccess of TeamTeaching Depends onTeaching Depends on

INTEGRATING COMPETENCY INTEGRATING COMPETENCY BASED CLINICAL EDUCATIONBASED 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 toStudents need to learn to

THINK -IN-ACTIONTHINK -IN-ACTION

&&

REASON-IN TRANSITIONREASON-IN TRANSITION

LINKAGE OF LINKAGE OF EVALUATING SKILLSEVALUATING SKILLS

Experiential learning does Experiential learning does not occur without active not occur without active

participationparticipation

It requires:It requires:

Engagement in the situationEngagement in the situation

NARRATIVESNARRATIVES ALGORITHMALGORITHM

Problem SolvingProblem SolvingIntegrative Evaluation Integrative Evaluation

ToolsTools

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

Algorithm EvaluationAlgorithm Evaluation

INTEGRATING COMPETENCY INTEGRATING COMPETENCY BASED CLINICAL EDUCATIONBASED 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 LINKING PROCESS AND CONTENTAND CONTENT

CONTENTCONTENT PROCESSPROCESS

INTEGRATING COMPETENCY INTEGRATING COMPETENCY BASED CLINICAL EDUCATIONBASED 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 contentIndividualization is very important in

competency based programs

INDIVIDUALIZATIOINDIVIDUALIZATIONN

CLINICALCLINICALCOMPONENTCOMPONENT

==

IndividualIndividualAbilitiesAbilities

Learning StylesLearning Styles

++

Allows each student to go Allows each student to go through the integrative through the integrative process:process:

At his/her own content At his/her own content levellevel Pace the learning at Pace the learning at their their own rate of speed. own rate of speed.

IndividualizationIndividualization

The Sculpturing of a The Sculpturing of a ProfessionalProfessional