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.

Questions for Discussion

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

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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.