Energy Balance, Eating Disorder Risk, and Pathogenic Behaviors Among Athletic Trainers

Context Research exists on energy balances (EBs) and eating disorder (ED) risks in physically active populations and occupations by settings, but the EB and ED risk in athletic trainers (ATs) have not been investigated. Objective To assess ATs' energy needs, including the macronutrient profile, and examine ED risk and pathogenic behavioral differences between sexes (men, women) and job statuses (part time or full time) and among settings (college or university, high school, nontraditional). Design Cross-sectional study. Setting Free living in job settings. Patients or Other Participants Athletic trainers (n = 46; male part-time graduate assistant ATs = 12, male full-time ATs = 11, female part-time graduate assistant ATs = 11, female full-time ATs = 12) in the southeastern United States. Main Outcome Measure(s) Anthropometric measures (sex, age, height, weight, body composition), demographic characteristics (job status [full- or part-time AT], job setting [college/university, high school, nontraditional], years of AT experience, exercise background, alcohol use), resting metabolic rate, energy intake (EI), total daily energy expenditure (TDEE), EB, exercise energy expenditure, macronutrients (carbohydrates, protein, fats), the Eating Disorder Inventory-3, and the Eating Disorder Inventory-3 Symptom Checklist. Results The majority of participants (84.8%, n = 39) had an ED risk, with 26.1% (n = 12) engaging in at least 1 pathogenic behavior, 50% (n = 23) in 2 pathogenic behaviors, and 10.8% (n = 5) in >2 pathogenic behaviors. Also, 82.6% of ATs (n = 38) presented in negative EB (EI < TDEE). Differences were found in resting metabolic rate for sex and job status (F1,45 = 16.48, P = .001), EI (F1,45 = 12.01, P = .001), TDEE (F1,45 = 40.36, P < .001), and exercise energy expenditure (F1,38 = 5.353, P = .026). No differences were present in EB for sex and job status (F1,45 = 1.751, P = .193); χ2 analysis revealed no significant relationship between ATs' sex and EB (\(\def\upalpha{\unicode[Times]{x3B1}}\)\(\def\upbeta{\unicode[Times]{x3B2}}\)\(\def\upgamma{\unicode[Times]{x3B3}}\)\(\def\updelta{\unicode[Times]{x3B4}}\)\(\def\upvarepsilon{\unicode[Times]{x3B5}}\)\(\def\upzeta{\unicode[Times]{x3B6}}\)\(\def\upeta{\unicode[Times]{x3B7}}\)\(\def\uptheta{\unicode[Times]{x3B8}}\)\(\def\upiota{\unicode[Times]{x3B9}}\)\(\def\upkappa{\unicode[Times]{x3BA}}\)\(\def\uplambda{\unicode[Times]{x3BB}}\)\(\def\upmu{\unicode[Times]{x3BC}}\)\(\def\upnu{\unicode[Times]{x3BD}}\)\(\def\upxi{\unicode[Times]{x3BE}}\)\(\def\upomicron{\unicode[Times]{x3BF}}\)\(\def\uppi{\unicode[Times]{x3C0}}\)\(\def\uprho{\unicode[Times]{x3C1}}\)\(\def\upsigma{\unicode[Times]{x3C3}}\)\(\def\uptau{\unicode[Times]{x3C4}}\)\(\def\upupsilon{\unicode[Times]{x3C5}}\)\(\def\upphi{\unicode[Times]{x3C6}}\)\(\def\upchi{\unicode[Times]{x3C7}}\)\(\def\uppsy{\unicode[Times]{x3C8}}\)\(\def\upomega{\unicode[Times]{x3C9}}\)\(\def\bialpha{\boldsymbol{\alpha}}\)\(\def\bibeta{\boldsymbol{\beta}}\)\(\def\bigamma{\boldsymbol{\gamma}}\)\(\def\bidelta{\boldsymbol{\delta}}\)\(\def\bivarepsilon{\boldsymbol{\varepsilon}}\)\(\def\bizeta{\boldsymbol{\zeta}}\)\(\def\bieta{\boldsymbol{\eta}}\)\(\def\bitheta{\boldsymbol{\theta}}\)\(\def\biiota{\boldsymbol{\iota}}\)\(\def\bikappa{\boldsymbol{\kappa}}\)\(\def\bilambda{\boldsymbol{\lambda}}\)\(\def\bimu{\boldsymbol{\mu}}\)\(\def\binu{\boldsymbol{\nu}}\)\(\def\bixi{\boldsymbol{\xi}}\)\(\def\biomicron{\boldsymbol{\micron}}\)\(\def\bipi{\boldsymbol{\pi}}\)\(\def\birho{\boldsymbol{\rho}}\)\(\def\bisigma{\boldsymbol{\sigma}}\)\(\def\bitau{\boldsymbol{\tau}}\)\(\def\biupsilon{\boldsymbol{\upsilon}}\)\(\def\biphi{\boldsymbol{\phi}}\)\(\def\bichi{\boldsymbol{\chi}}\)\(\def\bipsy{\boldsymbol{\psy}}\)\(\def\biomega{\boldsymbol{\omega}}\)\(\def\bupalpha{\bf{\alpha}}\)\(\def\bupbeta{\bf{\beta}}\)\(\def\bupgamma{\bf{\gamma}}\)\(\def\bupdelta{\bf{\delta}}\)\(\def\bupvarepsilon{\bf{\varepsilon}}\)\(\def\bupzeta{\bf{\zeta}}\)\(\def\bupeta{\bf{\eta}}\)\(\def\buptheta{\bf{\theta}}\)\(\def\bupiota{\bf{\iota}}\)\(\def\bupkappa{\bf{\kappa}}\)\(\def\buplambda{\bf{\lambda}}\)\(\def\bupmu{\bf{\mu}}\)\(\def\bupnu{\bf{\nu}}\)\(\def\bupxi{\bf{\xi}}\)\(\def\bupomicron{\bf{\micron}}\)\(\def\buppi{\bf{\pi}}\)\(\def\buprho{\bf{\rho}}\)\(\def\bupsigma{\bf{\sigma}}\)\(\def\buptau{\bf{\tau}}\)\(\def\bupupsilon{\bf{\upsilon}}\)\(\def\bupphi{\bf{\phi}}\)\(\def\bupchi{\bf{\chi}}\)\(\def\buppsy{\bf{\psy}}\)\(\def\bupomega{\bf{\omega}}\)\(\def\bGamma{\bf{\Gamma}}\)\(\def\bDelta{\bf{\Delta}}\)\(\def\bTheta{\bf{\Theta}}\)\(\def\bLambda{\bf{\Lambda}}\)\(\def\bXi{\bf{\Xi}}\)\(\def\bPi{\bf{\Pi}}\)\(\def\bSigma{\bf{\Sigma}}\)\(\def\bPhi{\bf{\Phi}}\)\(\def\bPsi{\bf{\Psi}}\)\(\def\bOmega{\bf{\Omega}}\)\({\rm{\chi }}_{1,46}^2\)= 0.0, P = 1.00) and job status and EB (\({\rm{\chi }}_{1,46}^2\) = 2.42, P = .120). No significant relationship existed between Daily Reference Intakes recommendations for all macronutrients and sex or job status. Conclusions These athletic trainers experienced negative EB, similar to other professionals in high-demand occupations. Regardless of sex or job status, ATs had a high ED risk and participated in unhealthy pathogenic behaviors. The physical and mental concerns associated with these findings indicate a need for interventions targeted at ATs' health behaviors.

Using Social-Situational Learning to Create Career Pathways Into Community College Leadership

This chapter describes a partnership created between a community college and a university designed to create pathways into community college leadership. The program used social-situational approaches to learning, placing students enrolled in the university's higher education graduate programs into graduate assistant positions that had defined responsibilities for the college's key strategic priorities. The program introduced students to multiple leadership pathways through participation in a community college environment. Students engaged in work that significantly advanced the college's strategic initiatives. The program centered social-situational leadership development on multiple levels and circulated through the shared priorities of social justice and inclusive excellence across the community college and the university. The partnership viewed graduate student development through the lens of transformative leadership, focusing on equity, access, diversity, ethics, critical inquiry, transformational change, and social justice. These principles underlie in the mission of both institutions.

Exploring Best–Worst Scaling for Communication Sciences and Disorders

Purpose The primary purpose of this study is to introduce the method of best–worst scaling (BWS) and explore how it can be applied to the field of communication sciences and disorders. Method Two hundred thirty-six participants (156 students and 80 instructors) responded to a survey using BWS to identify the most and least preferred features of a speech-language pathology graduate program. Results were analyzed with Sawtooth Software and best–worst values were transformed into a standardized ratio scale. Results The number one attribute that students were most concerned with when choosing a graduate program was clinical placements followed by financial aid/scholarships/graduate assistant positions, highly ranked/reputation of program, updated resources available in clinic, reputation of professors, elective coursework available in an interest area, proximity to home, research opportunities, completion of an undergraduate degree at the same institution, and, finally, the availability of online courses. Five of the 10 factors were statistically different from the adjacent factor as evidenced by nonoverlapping confidence intervals. The faculty accurately predicted the top three and bottom two attributes but distinguished less between the factors as evidenced by overlapping confidence intervals in eight of the adjacent pairs. Conclusions BWS is able to provide nuanced information relative to the strength of the preference over other types of importance measures. It has many applications in the field of communication sciences and disorders, and this pilot study revealed one way it can be utilized. Knowing what students most desire in a graduate program allows universities to tailor their marketing to highlight the attributes of highest importance to future applicants.

Students’ Reflections on an Experiential Learning Rotation With the Peer-Education About Weight Steadiness Club Program

Overview. Experiential learning has become a common pedagogical approach to provide university students an opportunity to apply classroom-acquired knowledge and skills in real-world settings. Evaluation of such experiences from a student perspective is needed to improve experiential learning opportunities offered in higher education settings. Purpose. The purpose of this qualitative study was to evaluate the experience of 13 university students who rotated with a healthy lifestyle program for middle schoolers. Method. The Peer-education About Weight Steadiness Club program was implemented by peer or adult educators, as a healthy lifestyle after-school intervention. Trainees participated in a learning rotation with the program for 16 weeks and were exposed to research coordination and implementation of the nutrition and healthy lifestyles program. After finishing their rotation, trainees completed a structured elicitation interview conducted by a faculty member and a graduate assistant. The 11-question individual elicitation interview, ranging from 16 to 40 minutes, queried trainees on elements of the learning experience. A grounded theory approach was used to guide data coding and analyses, which led to formulation of themes. Results. Forty codes were assigned to segments of the interview responses, which were then coalesced to formulate six themes and 16 subthemes. Identified themes include (1) program context, (2) roles and responsibilities of trainees, (3) professional development of trainees, (4) overall program implementation, (5) factors influencing implementation, and (6) health and behavioral outcomes. Conclusions. Student trainees gained program content knowledge, acquired skills transferable to their careers, valued this learning experience, and planned to apply lessons learned.

Supervisor Perceptions of Newly Credentialed Athletic Trainers' Transition to Practice

Context Transition to practice for newly credentialed athletic trainers (ATs) has been described through the perspective of educators, supervisors of graduate assistant ATs, students, and recent graduates; however, the opinion of supervisors of full-time ATs has not been thoroughly investigated. Objective (1) Describe supervisor perceptions of the transition to full-time practice for newly credentialed ATs and (2) describe current onboarding processes used by employers. Design Phenomenological qualitative study. Setting Semistructured interviews. Patients or Other Participants Purposive sample of 10 (4 men, 6 women) supervisors of newly credentialed ATs. Supervisors reported an average of 13.5 years of supervisory experience (range, 5–26 years). Data Collection and Analysis Questions addressed supervisor expectations, strengths and weaknesses of newly credentialed ATs, and the organization's onboarding process. The primary researcher transcribed audio recordings and each participant reviewed transcripts. Two researchers coded themes using an inductive process; a peer auditor completed an independent review. Disagreements were negotiated until consensus was reached. Results Two categories emerged: (1) characteristics of newly credentialed ATs and (2) onboarding strategies. The first category was organized into 2 subcategories: (1) knowledge, skills, and abilities (KSAs) and (2) unrealistic job expectations. The majority of supervisors felt that newly credentialed ATs were knowledgeable; however, the translation of knowledge into practice was viewed as an area requiring mentorship. Participants also reported that newly credentialed ATs often were poorly informed of the work schedule and time demands. In regard to onboarding processes, the researchers identified 7 different strategies reported by supervisors. Conclusions Newly credentialed ATs were perceived as knowledgeable but struggling to transition knowledge to clinical practice and often did not understand the work demands. Seven onboarding strategies were reported by participants; each of these can be used to develop KSAs of newly credentialed ATs. The KSAs should be addressed through a yearlong process consisting of orientations, shadowing, mentorship, seminars, and skill assessments.

Sports Medicine Staffing Patterns and Incidence of Injury in Collegiate Men's Ice Hockey

Context The relative availability of clinicians as well as the types and training of health care providers have been associated with morbidity and mortality in non-athletic health care settings. Whether staffing variations are associated with injury incidence in collegiate athletes is unknown. Objective To evaluate whether the institutional ratio of athletes to athletic trainers (patient load) or the ratio of staff to nonstaff (graduate assistant and certified intern) athletic trainers or both is associated with the incidence of injuries sustained by male ice hockey athletes at the school. Design Descriptive epidemiology study. Setting National Collegiate Athletic Association (NCAA) men's ice hockey teams. Patients or Other Participants Collegiate men's ice hockey athletes. Main Outcome Measure(s) The NCAA Injury Surveillance Program collected data from collegiate men's ice hockey athletes. Staffing patterns were obtained through telephone interviews. Injury counts, injury rates per 1000 athlete-exposures, and injury rate ratios with 95% confidence intervals were calculated and compared between the following groups: (1) schools with high (versus low) patient load and (2) schools with high (versus low) ratio of staff to nonstaff (graduate assistant and certified intern) athletic trainers. Results Both the patient load and relative number of staff athletic trainers were associated with variations in the incidences and types of diagnosed injuries in male ice hockey players. Specifically, fewer injuries were diagnosed by clinicians at institutions with high patient loads. The rates of injury overall and non–time-loss injuries were lower in the high patient-load group. Time-loss injury rates, severe injury rates, concussion rates, and overall rates of injury during competition were greater in the group with a higher proportion of staff athletic trainers, whereas non–time-loss injury rates were lower. Conclusions In this study of collegiate men's ice hockey players, athlete health outcomes were directly related to the number and types of clinicians available. Future researchers should evaluate whether this finding extends beyond men's ice hockey.

Using Social-Situational Learning to Create Career Pathways Into Community College Leadership

This chapter describes a partnership created between a community college and a university designed to create pathways into community college leadership. The program used social-situational approaches to learning, placing students enrolled in the university's higher education graduate programs into graduate assistant positions that had defined responsibilities for the college's key strategic priorities. The program introduced students to multiple leadership pathways through participation in a community college environment. Students engaged in work that significantly advanced the college's strategic initiatives. The program centered social-situational leadership development on multiple levels and circulated through the shared priorities of social justice and inclusive excellence across the community college and the university. The partnership viewed graduate student development through the lens of transformative leadership, focusing on equity, access, diversity, ethics, critical inquiry, transformational change, and social justice. These principles underlie in the mission of both institutions.

Newly Credentialed Athletic Trainers' Perceptions of Professional Preparation for Their Role as Collegiate Graduate Assistants

Context: The professional preparation of newly credentialed athletic trainers (ATs) has been passionately debated. Understanding how newly credentialed ATs feel they are prepared will help enhance professional preparation. Objective: Explore newly credentialed ATs' perceptions of their professional preparation for their role. Design: Phenomenological qualitative. Setting: Phone interviews with graduate assistant ATs in the collegiate setting. Patients or Other Participants: Nineteen collegiate graduate assistants (15 female, 4 male; average age = 23 ± 0.15 years; National Collegiate Athletic Association Division I: 13, II: 3, III: 2, National Association of Intercollegiate Athletics: 2; postprofessional athletic training program: 6). Main Outcome Measure(s): Participants were recruited via an e-mail from the National Athletic Trainers' Association database sent to all certified students. Data were collected via phone interviews, which were recorded and transcribed verbatim. Interviews were conducted until data saturation occurred. Data were analyzed through phenomenological reduction, with data coded for common themes and subthemes. Credibility was established via member checks and peer debriefing. Results: Two themes emerged: facilitators and barriers. Overall, participants felt academically prepared for their role, but preparedness was often dependent on the facilitators of academic rigor, hands-on opportunities in clinical education, and their preceptor. Barriers included a lack of rigor in the academic setting, lack of active opportunities in clinical education, the culture of clinical experiences, and incongruence. Incongruence existed when students were exposed to all the competencies during didactic education, but never gained experience with some skills (eg, rehabilitation, documentation, communication) if situations never arose or they were not actively involved clinically. Conclusions: Athletic training students are being exposed to a variety of learning experiences academically, but often do not gain clinical experience if situations do not arise or preceptors do not allow active participation. To ensure new ATs are prepared, academic programs need to ensure rigor and place students with preceptors who provide active learning opportunities.

Transition to Practice for Graduate Assistant Athletic Trainers Providing Medical Care in the Secondary School Setting

Context: Transition to clinical practice can be challenging for newly credentialed athletic trainers (ATs), who are expected to immediately step into their roles as autonomous clinicians. For those providing care in the secondary school setting, this transition may be complicated by the fact that many practice in isolation from other health care providers. Objective: To explore the transition to practice of newly credentialed graduate assistant ATs providing medical care in the secondary school. Design: Phenomenologic qualitative study. Setting: Secondary school. Patients or Other Participants: The 14 participants (2 men, 12 women; age = 23.3 ± 2.0 years) were employed in the secondary school setting through graduate assistantships, had been credentialed for less than 1 year, and had completed professional bachelor's degree programs. Data Collection and Analysis: We completed 14 semistructured phone interviews. Interviews were recorded and transcribed verbatim. A general inductive approach was used for data analysis. Trustworthiness was established through multiple-analyst triangulation, peer review, and member checks. Results: A period of uncertainty referred to a time during which participants were anxious as they began practicing independently. Legitimation through role engagement signified that as the period of uncertainty passed, participants developed more confidence in themselves and legitimation by engaging in their role. Acclimation through physician communication and professional relationships highlighted the importance of developing a relationship with the team physician, which provided a source of feedback and support for continued growth and confidence. Conclusions: To prepare for this period of uncertainty, educators and preceptors should encourage students to interact with members of the health care team and communicate with parents and coaches. Employers should implement initiatives to orient newly credentialed ATs to their roles, provide clear job expectations, and assign or assist with identifying mentors. Newly credentialed ATs should seek support from many different individuals, including the team physician, who can provide support, feedback, and encouragement.

Curation of a Simulation Experience by the Clinical Scholar: An Educational Technique in Postprofessional Athletic Training

Context: Postprofessional athletic training programs continue to prepare advanced-practice leaders in the profession. As part of being leaders and clinical scholars within the field, it is important that students pursing postprofessional graduate education be exposed to curriculum and instructional theory, practice, and strategies. Objective: To describe an education technique focused on the curation of a simulation assignment as part of a postprofessional athletic training course as a means to develop an appreciation of instructional strategies as a clinical scholar. Background: The postprofessional athletic training student (PP-ATS) may be working as a full-time clinician, graduate assistant, or novice educator, or as an intern within an athletic training clinic. Regardless of employment status, PP-ATSs engage with several key stakeholders, ranging from parents and legal guardians to coaching staff and professional athletic training students. The PP-ATS may be tasked to provide education to these stakeholders in the form of patient participation status to a coach, describing the pathogenesis of a condition to a patient, and rationale for care to professional athletic training students. Description: The PP-ATSs were placed in learning communities of 3 to 5 students. The learning communities were tasked with the development of high- and low-fidelity simulations for learners (the other PP-ATSs in the course) to engage in during an intensive and focused learning session, facilitation of the experience, and a debrief encounter. Clinical Advantage(s): A 2-fold benefit exists. First, PP-ATSs are engaged in the design and development of a simulation experience as an instructional intervention. Second, simulation learners are gainfully engaged in low-stakes patient encounters that promote professional growth. Conclusion(s): Developing and implementing learner-curated simulation experiences exposes PP-ATSs to an innovative instructional strategy in athletic training.