Over the past two months, I have been asked on several occasions why I had chosen to attend Indiana State University when I had just graduated from a large FBS Division I University. For some reason, people are under the impression I took a step down when I decided on ISU, so here are my top 3 reasons why I chose ISU and why it was a great decision.

1.     The history of Athletic Training and Indiana State University are closely tied. Indiana State was one of the first universities to offer a Post-Professional Athletic Training Program, and it has a fantastic reputation for graduating competent, and passionate evidenced-based clinicians.

2.     ISU trusts its Graduate Assistants (GAs). On campus, there are four GAs who work independently with their respective sports teams and, most of the time, he or she is the only Certified Athletic Trainer at an event. The other two teams (football and track and field/cross country) have larger athlete populations, and therefore, multiple GAs are assigned along with two and one staff athletic trainers, respectively. At the high schools, there are anywhere from one to two GAs in addition to a Head Athletic Trainer (two exceptions, see 9/19/14 blog post). Even with multiple Athletic Trainers at a given site, the autonomy given is unlike what I have seen previously, which allows each GA to develop his or her clinical decision skills independently.

3.     You are a result of your experiences. I felt going to a smaller university, in a different conference and in a completely different location with different environmental concerns (snow) would help me to become a more aware, practiced and, in the end, a better athletic trainer. To stay in too familiar a setting would be easy. I wanted to be challenged because how do you know how good you are if you always do things the same way?

Post-graduate education is about progress and for each of us, progress comes in different forms.  Sometimes I wish people would ask me, how did you learn about ISU, considering it’s so far away from where you come from?  It would give me a better opportunity to tell people how great Indiana State is in the Athletic Training community.


Kelly Brock, LAT, ATC

My thesis examines the ImageJ software program to determine if it a valid and reliable tool for range of motion measurements at the hip.  The basis of this project is to provide Athletic Trainer’s with a more accurate and reliable range of motion measurement tool that can be used during clinical practice.  Data collection in the study is ongoing but we are looking forward to analyzing the data in the coming weeks.  The ImageJ software program was originally developed by the National Institutes of Health (NIH) to provide accurate digital measurements and has since been utilized in many interesting ways including digitizing information for accurate joint measurements.  To utilize ImageJ for a goniometric measurement tool, the practitioner simply takes a picture with an iPhone, iPad, digital camera, or any other digital recording device in line with the axis of motion.  The picture is then examined using the ImageJ on a tablet or computer.

The second part of my study utilizes handheld dynamometry to measure strength at the hip.  We are comparing traditional manual muscle testing techniques with handheld dynamometry (clinician providing the resistance) to manual muscle testing techniques with handheld dynamometry against an immovable brace.   The aim of this study is to determine a more reliable MMT technique to provide objective measures of strength.

This is important for Athletic Trainers because as we continue to lobby for insurance reimbursement we need to have specific and accurate patient outcome measurements.  Without these specific measurements we have no record of patient improvement during the rehabilitation process.  The current methods we utilize (standard goniometry and grading on a 1-5 strength scale) can be subjective and may not have strong inter- and intra-rater reliability.  If we can demonstrate that we are providing more accurate and reliable measurements of range of motion and strength we can provide insurance companies the objectivity which they are looking for in patient outcome improvements.

The underlying theme of my thesis is that the profession should continue to adapt and utilize technology to improve patient care.  Both of the aforementioned techniques help us move in that direction.  When the technology is available and empirically examined, we need to adapt and give ourselves the best opportunity to provide the best patient care.  I hope that this research lead to more clinicians utilizing technology appropriately in patient evaluation to improve and measure patient progress.

Justin Police, LAT, ATC

This past weekend, I visited a fellow certified Athletic Trainer at Boise State University which has an entry-level CAATE accredited program. I was able to meet with an undergraduate student at BSU who was interested in pursuing her Masters in a post-professional athletic training program (PP-ATP). I shared with her my experience at Indiana State University and provided her with more of the specifics about attending a PP-ATP… something I had never discussed before searching masters degree programs myself.

The fact of the matter is that our profession of athletic training is made up of such a varied dynamic in terms of education. We have practicing certified Athletic Trainers who have their entry-level degree only, some who became certified under the internship model, others with advanced practice degrees in everything from kinesiology to theology. Is any of this bad? Not at all. I am a strong supporter of expanding yourself and narrowing our circle of ignorance… to really find out the things you don’t even know you don’t know.

I believe PP-ATPs have strong supporters and firm opponents. This is my side of the story.

In entry-level programs, students dabble in clinical assignments and study immense amount of information to become proficient medical professionals. Then what? For those who pursue jobs or non-athletic training programs, the continued learning is happening clinically – like on-the-job training. But, evolving through trial and error should not defined advanced practice education.  It is likely that you will begin practicing just as the preceptors you had before and believe all that you have been told is true, despite information in textbooks being antiquated and lacking current evidence-based medicine. Entry-level programs teach you content and hopes to help you gain decision making skills that both help you to pass the certification exam, but also to provide proficient patient care; post-professional programs emphasize critical thinking to decide… to decide what kind of clinician you want to be and gives you the tools to analyze the evidence and how to apply it...  PP-ATPs teaching you how to keep learning and evolving.

Educators and preceptors should refrain from telling students “you need to diversify” and “it doesn’t matter what your Masters is in”. It does matter! We are the profession. Why would you want to diversify if you are going to be working in Athletic Training?  Would you tell a Social Worker to diversify and become and Occupational Therapist?  As the profession begins to distinguish itself as a credible medical profession following current evidence-based medicine, we have a responsibility to read and apply research. This is can often be de-emphasized in a professional program because the focus is on learning how to be an athletic trainer. Post-professional courses are unlike anything from my professional preparation. The design of every class can be summed up into one word; CHALLENGE. Yes, the course material is difficult, but the real challenge comes when you examine the evidence for credibility and applying it to your daily practice in athletic training. We are expanding the body of knowledge and learning how to share it with the profession.

Often, PP-ATPs come with both the consumption and dissemination of research…. And with this students begin to say “I don’t like research” or “I don’t know if I have what it takes to do research”. If you have not done research before, KEEP AN OPEN MIND! Research is varied and you have to find your niche. Practicing clinicians who aren’t in academia can contribute to the literature too… through case studies and critically appraised topics.   Researchers in athletic training will complete randomized controlled studies which results that can be applied to a larger population. Research comes in many forms such as measuring clinical outcomes, surveying the profession, completing educational assessments and conducting laboratory research. You have to find your interest! I am currently completing two research projects which are vastly different, while taking athletic training courses and working clinically as a division 1 men’s basketball athletic trainer. If I can do it… you can too! Do not doubt yourself.

The profession needs leaders who are skilled and equipped to continue building our infrastructure. But that means we need motivated and excited students to STAY in the profession and to help it evolve through enrolling in a PP-ATP.  Find the program that aligns with your interests or lack of knowledge to close the gap!

I hope this post brings awareness to what PP-ATPs do… they are not a continuation of professional studies… they are an expansion of mind and skills as a future leader in Athletic Training.  This is not to say that those out there with masters degrees in other areas are leaders or don’t have the potential to lead.  But, today, in the current Athletic Training climate, we have to come together.  We have to specialize in our own discipline.   

So those of you considering graduate education… ask yourselves these questions?

-What’s my goal…? Am I looking solely for clinical experience, or do I want my educational degree to help me gain new, advanced, specialized Athletic Training skills too?

-What’s my niche, and what programs are available to help me improve those skills?

Interested in Indiana State's PP-ATP? Check it out below!

Link to CAATE Accredited Post-Professional Program search tool: http://caate.net/find-programs

Zachary Winkelmann, ATC, LAT

One of the most unexpected things for me starting my transition from a student to an Athletic Trainer is the pressure I feel to represent the profession. This includes representing us to student-athletes, parents, and even other health care professionals.

Being in a small rural high school for my graduate assistantship, I am the first Athletic Trainer many freshman or their parents have ever dealt with. For some, the concept of having a health care provider at their practices and games is an unusual idea. I need to make sure I always am advocating for the profession in everything I do, including how I talk, how I dress, and how I communicate with them. A lot of this is putting in the extra work to show that I truly am there for the health and well-being of the student athletes and that I care about their future whether it be health related, academic related, or sport related.

Demonstrating “going the extra mile” is a challenged I faced earlier this year after a student-athlete concussion.  At first a parent was angry that I was withholding her son for having concussion symptoms, but after explaining the risks of continuing to play and how it could affect his grades in the classroom and his performance on the football field, the mother was extremely grateful and thanked me for looking out for her son. A great quote that comes to mind when I reflect on that incident and think about health care professionals in general is “people don’t care how much you know until they know how much you care,” by Theodore Roosevelt.

Additionally, the burden placed on a young professional to be an advocate to other health care professionals is difficult. There are physicians and other health care professionals in my county who have never heard of Athletic Trainers. A few weeks ago I was talking to a nurse practitioner over the phone who was confused as to what my position was. She had called to clarify what concussion return to play protocol we were using for the physician she worked with. When I explained in detail which one we use and why, she seemed confused. Not because of the content I had said but because she said she thought I was just a coach. After our conversation on concussions, I explained to her what my role is as an Athletic Trainer at the high school. She seemed surprised yet pleased that the high schools in the area had someone there looking out for the students, and seemed to greatly respect my input about the return to play protocol. This was exciting, but at the same time was the first time it hit me that with every phone call or interaction with another health care discipline, I could be helping them formulate an opinion of our entire profession, good or bad. That’s a scary thought for a graduate assistant who has a lot of other things on their plate to worry about. 

I will do my best to represent Athletic Trainers because I chose this profession because I love what we do. It is everyone in the profession’s responsibility to show others how great of a profession we truly are.

 WHO KNEW . . . that the transition between an Athletic Training Student and an Athletic Trainer would come with a new understanding of my responsibilities. I am a graduate assistant Athletic Trainer at a local high school and even though I have a full year of high school undergraduate experience there are many things that I did not expect as I began my clinical practice.

Perceptions as an Athletic Training Student come from what experiences we have.  As a student I may have done all of the things listed below, but I was not expected to work independently. The following things are what I wish I knew as I transitioned into professional practice.

#1 - Who knew there would be so much paperwork?

As an undergraduate student you are fully immersed in the in the clinical realm doing evaluations and treatments where you learned documentation is important. Although we learned documentation, I never really knew how much documentation was actually required. It is not until you are practicing independently and on your own when you realize that time spent on documentation is about the same as the time spent with patients.

#2 - Who knew you have a limited time for treatments and rehabilitation?

As a student you are often given time to work with a certain athlete during a rehabilitation or treatment period. Working with one athlete at a time is not realistic as an Athletic Trainer at a high school when you only have a short period of time before practice begins. Time management and multitasking are skill required for a successful Athletic Trainer to be able to see many athletes in a short period of time.

#3 - Who knew school administration could be helpful?

School administration is key to your success as an Athletic Trainer. As an undergraduate student this experience of creating relationships is not utilized, thus as a professional these relationships must be created. Administrators can help with advocacy, creating and enforcing policies and procedures, and connecting you with additional resources.

#4 - Who knew you would get to know your athletes?

Your athletes look up to you in ways that you may not expect. As an Athletic Trainer you are a role model for healthy behavior in a more social setting than a teacher or administrator. Patients trust you to discuss personal issues which may be unrelated to participation in athletics. It is important to relate to your athletes, but also to maintain a professional relationship.

#5 - Who knew you are always advocating for your position and profession?

Athletic Training is a field that not everyone understands. Thus, every interaction that you have with an athlete, parent, coach, or doctor reflects back on your profession. It is your duty as a professional to advocate for your profession and to educate others about your scope of practice and skills.

I urge all Athletic Trainers to reflect on their transition to professional practice and share with undergraduate students your experience so that they can be fully prepared in their transition to professional practice. Join the conversation! Share what you have learned so that others can share your success.

-Jerrod Harrison ATC, LAT

Recently, the NATA and BOC released statements in regards to the proposed rule change to Medicare beneficiaries and their access to orthotic services. CMS-1614: Medicare Program; End-stage Renal disease prospective payment system, quality incentive program and durable medical equipment, prosthetics, orthotics and supplies does not include athletic trainers as a medical profession with specialized training to provide custom fitting services.  If you would like to read the full letter from the BOC and NATA which provides justification for our ability to serve in this capacity, please click the links below!

http://www.bocatc.org/images/stories/boc_newsletter/boc_cms_1614P_09_02_2014.pdf

http://www.nata.org/sites/default/files/NATA_%20Comment_DME_Proposed_Rule.PDF

I am not going to go back and forth on our qualifications. As an athletic trainer, we know we are fully capable of custom orthotic fitting. We are skilled in gait analysis, anatomy and biomechanics to suffice the required training set by the CMS. The fact of the matter is that by limiting our fully capable scope of practice through Medicare and the CMS because athletic trainers cannot bill nationwide is where the burden comes on us as a profession. A few years ago, NATA pushed legislation for third-party reimbursement to include services to Medicare beneficiaries. Throughout the process, APTA , OPTA and other like organizations were concerned that we do not have the job specific training to be able to provide healthcare to this population sub-group. This proposed rule changed is the reason why we needed this legislation to pass. Typically, private insurance companies will base what they cover and exclude off government regulated healthcare such as Medicare. If athletic training was able to successfully obtain this niche with Medicare billing, we may be at the point that we could bill nationally for our services.

As an athletic trainer, I feel limited by the choice to bill for my services while other professions are able to do so. If this proposed rule change happens to go into effect, this will severely hurt the profession by limiting the number of clinics and doctors’ willing to hire an athletic trainer because they aren’t “capable” to do some of the required tasks and lack of reimbursement from insurance companies. It will also affect the athletic trainers working in emerging settings like military and industrial in which patients could be on Medicare.

Though you may think this change does not directly target me, please keep in mind AT THIS TIME. Be cautious of the implications of this rule change on our profession moving forward. The Affordable Care Act which opens access to healthcare is now being limited with this rule change. Yes, the person who wrote this rule change may have forgot us and we should give them the chance to edit the document. Yes, we could have been omitted on purpose for lack of specialized training. Now, it is your job to spread the word. I challenge you every time you fit someone for orthotics to snap a quick picture (as long as you follow HIPPA guidelines) and tag it on social media. Use the hash tag #at4at #at4all and #CMS to spread the word about the skills we can provide as athletic trainers.

-Zach Winkelmann ATC, LAT

It is half way through the election month for the new NATA president and there is just two weeks left until the polls are closed. Russell Richardson EdD, ATC is an Athletic Trainer and Associate Professor at University of Montana-Western, Chair of NATA’s Executive Committee of Education, and President of Northwest Athletic Trainers’ Association. If elected president, Richardson plans to raise awareness for athletic trainers within the health care profession and build interprofessional education. He believes that the best way to improve job opportunities and pay is by advocating for compensation through the medical model. Richardson also wants to advance the association’s position in youth sports safety, specifically concussions in sport. Richardson aims to continue the expansion of athletic trainers in secondary schools.

Scott Sailor EdD, ATC is the Chair of the Department of Kinesiology and Program Director for the Athletic Training Program at California State University, Fresno.  He also serves as the Vice President of NATA, District VIII Director and Vision Quest Workgroup Chair. Sailor’s main focus for his presidency is access, awareness, and allies. Access is in regards to giving the public access to athletic trainers, not just in athletic settings.  He believes in bringing awareness and advocating for athletic training. He wants us, as a profession, to build allies with the companies and organizations that use’s athletic trainers like the NFL, and to use these allies to further our profession.

To learn more about the candidates, visit the Presidential Election Webinar link, here, and listen to each candidate address pressing issues that athletic trainers are facing today. Voting for the next NATA President is done through a web-based poll, which has been emailed out to NATA members with further instructions. Results will be announced in October and the new President will be inaugurated at the 2015 NATA Clinical Symposia & AT Expo for a three-year term.

Shannan Rowe LAT, ATC

The transition from an undergraduate athletic training student to an athletic trainer can strike anxiety in even the most confident person. The responsibility that an athletic trainer has over the health and safety of an athletic team and patients can be overwhelming. This is only exacerbated with the addition of being a graduate student. So how do we solve this predicament? With time management.

Time Management is one of the best qualities an athletic trainer can possess. The ability to balance work, school, and life can be very difficult for young athletic trainers transitioning into the practice as both athletic trainers and graduate students. With so many responsibilities and activities going on at one time, it is difficult for young professionals to give one hundred percent of themselves toward any given task.

Personally, the biggest struggle that I faced in my transition was how to balance my time. Jumping into being a graduate assistant athletic trainer working with football, in addition to classes and other graduate school duties, was a lot to take on. I struggled with balancing all these activities in the beginning and still struggle with this some days. Working thirteen hours, six day a week, as well as trying to be a student at the same time, is a constant struggle. However, after finding a rhythm to this new and busy routine, I have gotten better at understanding my role as a graduate student and using my time in an efficient manner in order to complete my duties without so much anxiety. I am now able to balance my time and plan ahead, which even leaves enough time to have a social life.

I would say that I have definitely learned from my past experiences. As an undergraduate student I learned the hard way what having poor time management skills can do to a student. It can create unnecessary stress and doesn’t help students be the best that they can be. The biggest change that I have made in my organization of time has been making lists of tasks. This helps me to plan ahead and accomplish the goals I have for the day. It is also very reinforcing to cross off an item on my to-do list and even more motivating when I have finished all my tasks for the week, which creates availability for entertainment on the weekend.

Ethan Roberts LAT, ATC

Relationships play a huge role in Athletic Training as a healthcare profession. Athletic Trainers communicate with doctors, coaches, athletes, fellow athletic trainers, and even parents on any given day. Athletic trainers need to write reports, read doctor’s notes, talk with coaches about the status of the athletes, and be able to refer an athlete when the situation calls for it. Being a good communicator is an essential skill for an Athletic Trainer.

            In my undergraduate education I would work with my preceptor to communicate with doctors and coaches. Although I was able to engage in communication with athletes, particularly during injury evaluations, I was never able to make the final call for referral or return to play. The Athletic Trainer and I would discuss the injury and possible next steps, yet he or she was the final decision maker for further evaluation. When transitioning to practice, that role of decision maker, comes fast and without warning.  Last week, I referred my first patient. 

            I was covering an away volleyball game when one of the girls exited play with a potentially sprained thumb. She had a previous history of bilateral thumb sprains, but felt more pain with this injury. After an initial evaluation, I decided that it could be a severe sprain or a possible fracture. Although I know I have a support network of classmates, faculty, and supervisors, it was time for me to make a crucial clinical decision.  I had to make the correct referral decision. This situation is what I prepared for in my professional program. I have read the material, I have practiced the skills of an injury evaluation, but now it was time to put what I had learned into practice.

            The most important thing I learned through this experience is that I’m not alone. That night at the game I was able to contact other Athletic Trainers and seek affirmation. The next day I was able to talk with my supervisor about the decision. I have always been afraid that once I became certified, my colleagues will leave me out to dry, but that is not the case. They want to see me succeed just as much as I want to succeed. I can still ask for advice and affirmation as I transition into the professional world. The relationships I form with colleagues are important to the success of my career. I may still be in the transition phase, but I know that I am not alone. Oh, and in case you’re wondering, I did send the athlete for a radiograph.

-Marissa Yorgey, ATC