Sports Medicine Research: In the Lab & In the Field: Challenges Incorporating Evidence-Based Practice with Athletic Training Students (Sports Med Res)


Wednesday, March 27, 2013

Challenges Incorporating Evidence-Based Practice with Athletic Training Students

Perceptions of Approved Clinical Instructions: Barriers in the Implementation of Evidence-Based Practice

Hanekmeier DA, Van Lunen BL. J Athl Train. 2013. Online ahead of print.

Take Home Message: Time, financial cost, availability of literature, lack of knowledge, and working relationships with other health care professionals are common barriers to incorporating evidence-based practice for a clinician.

Evidence-based practice (EBP) has become increasingly important as health care professions have evolved. Athletic training has been no exception, as the release of the fifth edition of the Athletic Training Educational Competencies has placed specific emphasis on incorporating EBP in curriculums. Clinicians in a variety of health care professions have reported challenges in using EBP. This struggle, coupled with the importance of students interacting with their clinical preceptors to learn EBP, is why the authors of this qualitative study wanted to identify common barriers that clinical preceptors encounter when trying to implement EBP in clinical practice and teach EBP to athletic training students. The authors identified 16 clinical preceptors who had at least one year of experience with an undergraduate athletic training education program and indicated that they utilized the five steps of EBP. The interviewer used a semi-structured set of questions during the phone interviews, which were recorded and transcribed. The authors identified two main themes regarding the barriers to clinical integration of EBP and how preceptors view the emphasis placed on EBP in educational curriculum. With regards to barriers to clinical integration of EBP, preceptors noted that time, financial restrictions, availability of relative information, and lack of knowledge kept them from using EBP both clinically and with students. Additionally, preceptors identified personnel challenges as a barrier; meaning preceptors felt their working relationships with other staff, coaches, physicians, etc. impeded them from implementing EBP. Furthermore, preceptors indicated that older students (junior, senior level) were more receptive to implementing EBP as a result of their improved clinical experience. From an educational perspective, preceptors noted that improvements to academic programs and communication could help EBP become a more substantial part of the curriculum. More specifically, the authors noted that a better connection between clinic and classroom, as well as improved communication between clinical staff and education faculty, may be beneficial.

There is disconnect between the increased emphasis of EBP in athletic training educational curricula and its integration by clinical preceptors; apparent even among clinicians who were chosen because they utilized EBP. Of specific concern is that these clinicians cited working relationships with other health care professionals as a barrier to their own EBP. The entire sports medicine team must support the use of EBP for it to be fully integrated into our medical practice. However, it is understandable that these preceptors struggle with colleagues to implement EBP when their colleagues and they have limited resources (time and money) to access the latest evidence. Additionally, the authors noted that preceptor training appears to be a common place where EBP is discussed but a better connection needs to be made between clinic and classroom.  As athletic training education continues to make a shift to separate clinical staff and educational faculty, and as the diversity of practice settings outside the traditional college athletic training room evolve, it will be imperative that communication remains consistent between those teaching EBP in the classroom and those integrating it into students’ clinical experiences. What methods/habits do you use to incorporate EBP into your own practice or with your students? What challenges do you face with attempting to utilize EBP?

Written By:  Laura McDonald
Reviewed by: Jeffrey Driban

Related Posts:

Hanekmeier DA, Van Lunen BL. J Athl Train. 2013. Online ahead of print. (2013). Perceptions of Approved Clinical Instructions: Barriers in the Implementation of Evidence-Based Practice Journal of Athletic Training, Online ahead of print.


Jeffrey Driban said...

Laura, thanks for the great post. It makes me wonder if local journal clubs, hosted by the education programs, would be a good way to help improve communication between the clinical staff and classroom faculty. Furthermore, opening up the journal clubs to other healthcare providers in the local sports medicine community might help address the personnel challenges the authors describe. When I was working in a clinic we did a monthly journal club before office hours and I think it was a good opportunity for us to discuss the selected studies and also for us to discuss what we were doing in clinical practice and to share ideas.

If there's concerns about finding an hour or two at a set time each month then perhaps an online journal club could be another option. This would allow people to join in the discussion on their own schedule. To alleviate the cost issues, the articles could be open access articles so that everyone can download the article for free. SMR would be glad to set up a page if there's interest in 1-2 articles being selected each month for an online journal club.

The barriers the authors describe will be challenging to overcome but we'll be able to overcome them.

James Nelson MSAT,ATC,CSCS.CES said...

I would've firstly be interested in getting an online journal club up and running.

Laura M. McDonald, PhD, ATC said...

Thanks Jeff and James for your comments. @James - I see SMR as a online journal club of sorts. Is there a certain format you have in mind or that you'd like to see?

Jason said...

Great post Laura! I am in the middle of writing a research paper on EBP, is it OK if I use you as a source and reference this article?

Laura M. McDonald, PhD, ATC said...

Thanks for your comment, Jason. Please feel free to reference as necessary. The link/citation for the original article is at the top as well! Thanks for reading!

Jason said...

That's great! Thank you so much. I love your posts, I have a few in my bookmarks to read later when I'm not so busy! Thanks again!

Jay Wilton said...

Terrific post. I love the ideas that Jeffery is bringing to the table and hope too that these issues are soon resolved. I (like Jason) would like to reference this article in a paper I will be writing and hope to also be granted the same permissions. Thank you!

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