Continuing Education in Athletic Training: Mapping a Plan ... · Continuing Education in Athletic...

Continuing Education in Athletic Training:Continuing Education in Athletic Training:Mapping a Plan That Is Right For YouMapping a Plan That Is Right For You

David C. Berry, PhD, ATCDavid C. Berry, PhD, ATCSalem State CollegeSalem State College

January 9, 2005 2005 EATA

Workshop Objectives

1. Define continuing professional education (CPE) and discuss its importance in maintaining professionalism in athletic training.

2. Develop a professional learning plan (PLP) to optimize and document a practitioner’s continued learning in a more meaningful manner.

3. Examine the use of portfolios to assist in planning and documenting the learning experiences undertaken by practitioners when creating the PLP.


What is continuing professional education? • Functions to maintain or renew certification,

protect the public, and generally preventprofessional obsolescence.1

• Believed to play a critical role in providing quality healthcare delivery by insuring clinical competence and preventing outdated clinical practice.2


CPE In Athletic Training• The literature in athletic training examining CPE is

limited and includes:– Two needs assessments3,4

– One learning style study5,– A literature review2

– An editorial6 and– A qualitative perceptions and beliefs study7


CPE In Athletic TrainingNeeds Assessments

• A focus group investigation suggests that the CPE needs of individuals attending NATA district conferences were not being addressed.4

• Participants prefer more thematic approaches to presentations and learning activities (e.g., interactive learning) and less traditional learning strategies.


CPE In Athletic TrainingNeeds Assessments

• A study of self-perceived CPE needs of ATC suggested that CPE participants perceived “some to moderate need” for CPE within each of the Role Delineation domains.3

• Rehabilitation of athletic injuries was identified as the highest need for CPE.


CPE In Athletic TrainingLearning Strategies

• Most CPE participants are learners who prefer auditory-visual-kinesthetic learning modes.5 However, most annual meetings offer a significant amount of “seat-time”8

• CPE activities should2,5,8

– Utilize active learning environments,– Offer a variety of visual aid and instructional strategies,– Award CEUs for independent study,– CPE in athletic training could integrate the use of these adult

learning strategies to facilitate self-directed learning


CPE In Athletic TrainingAttitudes and Perceptions7

• Practitioners value CPE, however learning must have meaning and it must be applicable.

• CPE works if practitioners strive to make it work.• Practitioners are frustrated with the other practitioners who

show up and don't participate in CPE.• Selecting CPE is based on various factors including cost and

geography


Efficacy of CPE

• Literature presented in the health professions provides varied evidence regarding the efficacy of CPE. 9-16

• Determining the effectiveness of CPE is complicated for two reasons.

1. Variations in credentialing agency, individual state, and certification board requirements

2. Several methodologies have been employed to measure the effectiveness of CPE- Participant satisfaction, testing, observation, chart audits, and patient

care outcome measures.


Efficacy of CPE Nursing

• Through the use of either examinations and/or self-reports, studies have indicated that CPE is effective at increasing participant knowledge.9-10

• Studies have revealed improved skills, behaviors, or practice post continuing education activity as identified through observation, chart audit, and/or self-reports 11-12

others have identified no significant differences.13-14

• A few studies have examined the efficacy of continuing education to impact practice changes.17


Efficacy of CPE Medical Education

• Davis18 found that 70% of the studies examined demonstrated a change in physicians’ clinical performance as a direct result of attending continuing medical education (CME).– The most effective methods included community-based

strategies, practice-based methods, patient-mediated strategies, and multiple-intervention.

– Least effective included formal CME courses without enabling or practice reinforcing strategies.


Efficacy of CPE Medical Education

• A meta-analysis examining whether CME was effective, in what conditions it was effective, and what was effective in changing performance found:19

– Didactic CME courses did NOT alter physician performance. – Interactive CME, or didactic mixed with interactive CME, resulted in

performance change.– CME credit earned over time demonstrated noticeable results.– Interactive CME courses focusing on centering, engaging and

reinforcing the learner appeared more successful. – Physicians themselves must determine what they want to achieve

through CME to positively change their performance when serving patients.


Problems With CPE

• When mandated, CPE participants tend to resent the process and often DO NOT believe that educational programs will change nor enhance professional practice or learning.22

• CPE courses are often seen as being of poor qualityand promote only passive and reactive learning.23

• Obstacles such as time, inadequate funding, and distance all affect a participants attitude toward CPE.7,24-25


Problems With CPE• CPE activities are selected at random, often without

any thought towards a practitioners development of continued professional competence.19

• 45% of ATCs reported obtaining more than 30 CEUsfrom the annual meeting, while 22% earned 60 CEUs from other sources.3


Modern Practitioner

• Despite the abundance of literature related to CME, very little change has occurred in response to research findings.26-27

• Even today, most professions have a CPE system that rewards credit for “seat time” rather than learning or improved patient care.8,26


Modern Practitioner• Many considerations must be taken into account

to develop effective CPE programs:27

- Learning style differences;- Practitioner’s individual needs;- Financing;- Proper evaluative tools; and most importantly; and- Need for learner involvement in planning

educational events to make them more effective.26,28


Modern Practitioner

Initial assessment of learning needs

Reflecting on the plan Development of a learning plan

Demonstrating &evaluating competence

Implementation of the plan

Documenting the learning activities


Self-Directed Learning

• Adult self-directed learning is grounded in the idea that adults are INDEPENDENT beings capable of taking CONTROL of their learning process.


Self-Directed Learning

• Learners are able to contextualize and reflect on individual learning needs29 (based upon past experiences), select learning activities related to those needs, participate in the learning activities, make meaning of and implements learned behaviors into practice, and then reassess the learning processto assess competence.30-31


Self-Directed LearningSelf-Reflection

• Westberg & Jason’s32 writing on-reflection focuses on developing of a framework that encompasses life-long, self-assessment and reflection at the beginning, during, and end of major learning experiences.

• Their framework includes elements such as:– Clear goals, time and privacy, reflection with peers, feedback,

ensuring trust, and being patient.

• Creating a “roadmap”, provides a learner with clear and realistic behaviors and goals.



• Increasing effectiveness of self-reflection requires22,32-34

– Setting aside quiet time in a private location;– Critically analyzing professional and personal experiences;– Sharing learning experiences with other;– Critical feedback from peers and mentors;– Documenting experiences; and

• Short narratives of meaningful events – Taking OWNERSHIP for individual learning and practice

changes



• The understanding and interpretation of past experiences also helps to bring about changes in a participants professional and personal behaviors 35-36

which helps to protect all stakeholders, particularly the public, which is the reason why CPE is often mandatory.


Mapping Your CPEProfessional Learning Plan (PLP)

Step 1: Reflect on and assess learning needs

Step 2: Create a personal learning plan

Step 3: Clarify preferred learning strategies

Step 4: Select & document appropriate continuing education courses

Step 5: Reflect upon continuing education programs and PLP


Mapping Your CPEStep 1 – Goals of Self-Reflection

• To assure a minimum level of continued professional competency is maintained as set fourth by the BOC Role Delineation Study (RDS) 4th edition.

• To increase practitioner’s responsibility for individual self-assessment within the context of a specific framework in an attempt to motivate and engage individuals in self-directed learning designed to foster an increase in professional competence and reflective professional practice.


Mapping Your CPEStep 1 - Objectives of the Self-Reflection Process

1. Identify individual job roles and responsibilities, educational activities, or learning situations to help to promote life-long learning and professional competence.

2. To identify individual gaps in cognitive, psychomotor, and affective knowledge relevant to the RDS 4th edition.

3. To critically self-reflect on an individual’s professional practice to promote professional behavior changes and improve the quality of patient care.


Mapping Your CPEStep 1 - Objectives of the Self-Reflection Process

4. To identify strengths and weaknesses of certain CPE activities relevant to an individual’s goals and learning style.

5. To allow individuals to maintain a sense of autonomy & creativity while engaged in learning and professional development.


Mapping CPEStep 1 – Self-Reflection

Self-Reflection may be accomplished via:

• Identifying:– Current level of professional

competence?– Current & future

professional responsibilities?

– Current and future personal responsibilities?

– Learning resources?– Other interests and future?

• Completing:– Continuing Professional

Competence Reflective Self-Assessment Instrument

or– BOC Online Self

Assessment Examination


Mapping CPEStep 2 – Creating your PLP

• After the initial assessment or self-reflection is completed and weaknesses (if any) are determined, the practitioner must – Reflect on his/her weaknesses and professional/personal

needs.

• Goals/objectives should not only be directed toward the learning needs but also on how they plan to implement these learning needs through the selection of future continuing education activities.


Mapping CPEStep 2 – Creating your PLPLearning Objective Example

• I am an ATC working in the collegiate setting, primarily with track. My self-refection, identifies a weakness in Domain I, Prevention, particularly task D,– “Apply appropriate prophylactic/protective measures using

commercial products or custom made devices to minimize risk of injury.”39

• Therefore, one learning objectives may read:– “At the completion of the current CPE cycle I will be able to

describe, fit, and maintain protective equipment used in equipment intensive sports (football, lacrosse, hockey) to minimize the risk of injury.”


Mapping CPEStep 2 – Creating your PLP

• Meeting the learning objective– “As a way to ensure competency, I will assist the equipment

manager at our institution in the fitting, distribution, and reconditioning of the protective equipment for the above sports during the next academic year. A letter of completion will be used to document my success.”


Mapping CPEStep 3 - Clarifying Learning Strategies

• For adult education to be successful it needs to be centered on the learner’s NEEDS, ENGAGING, and REINFORCING. This then requires meeting the learners preferred learning styles.

• Continuing medical education has suggested that traditional didactic lectures are ineffective16, and that interactive meetings and multiple educational events are more effective.16,35



• Draper and Young5 found that the majority of athletic trainers in their study were learners who preferred auditory-visual-kinesthetic learning modes.



ATLAS Learning Styles

• ATLAS: Assessing The Learning Strategies of AdultS– http://www.conti-creations.com/atlas.htm

• They have designed 3 learning strategy profiles – Navigators– Problem Solvers– Engagers

http://www.conti-creations.com/atlas.htm

http://www.conti-creations.com/atlas.htm



ATLAS Learning Styles• Navigators

– Like to follow a course of learning, particularly in a structured learning environment.

• Problem Solvers– Rely heavily on critical thinking and are concerned with

planning and the utilization of the right learning tools.

• Engagers– Passionate learners who love to learn, learn with feeling, and

learn best when the learning activity is constructed in a meaningful manner.



ATLAS Learning Styles

National Meeting Third Party Seminars

District Meeting

State Meeting Practicum by Design

Case studies

Scholarly activityStudy

groups

Professional reading

Home studyNavigatorsWorkshops

Interactive

Engagers Problem Solvers



Gregorc Style Delineator

• Gregorc Style Delineator37

– Concrete-sequential (CS)• Direct hands on activities, step-by-step-instruction

– Abstract-sequential (AS)• Highly verbal, logical, and analytical approach to learning (Lectures,

reading, asynchronous learning)– Concrete-random (CR)

• Trial-error approach, stimulus rich environment (software, independentstudy)

– Abstract-random (AR)• Focus on relationships and emotions, respond to visual instruction,

group discussions, time for reflection



The Learning Profile Indicator

• The Learning Profile Indicator (LPI)38

– Instrument designed to identify an individual’s learning profile based on how individuals collect information, make judgments about significance, process data, and come to conclusions (Hanson)

• Realist (ST’s)• Communicators (SF’s)• Theorists (NT’s)• Creators (NF’s)


Mapping Your CPEStep 4 – Documenting Learning

• In this step you record the CPE activities that directly relate to your identified learning needs, maybe using a portfolio.



• Portfolios are used to promote professional learning through the collection of exhibits and work samples which provide evidence of learning and professional growth.35-36



• Portfolios provide ownership and allow practitioner to feel a sense of belonging and accountability in learning as well as allowing for the opportunity to reflect on day-to-day activities and practices.40-41



* Complete a collegelevel course

Category E* Complete a college level

course

* Publish an abstract,

manuscript, book chapter or

book* Present

scholarly work

* Attend a local, state, district,

national workshop* Attend a local,

state, district, national meeting

* Complete a BOC approved home study course or

journal quiz

Category CCategory BCategory A


Mapping Your CPEStep 5 – Reflection

• In this step practitioners should focus their reflection on their CPE plan and the programs selected in this plan.



• Revisit step 1– Reevaluate individual weaknesses and determine

whether or not you feel that your continuing education has allowed you to become competent.



• Revisit step 2 – reflect upon each of your learning needs, ask

yourself, were my interests met, did the selected CPE work for my type of learning style, how could changes be woven into my learning plan to meet my CPE goals?



• If the Learning goals were not accomplished, or you still have identifiable weaknesses these should now be the goals of the next CPE cycle.


Conclusion• The advancements in healthcare related knowledge makes

maintaining a minimal level of competence a continuous responsibility for every practitioner regardless of employment location.

• The pubic and profession expects credentialed practitioners to maintain a minimal level of competency through active participation in CPE. However, CPE is only effective if practitioners make a concerted effort to make learning meaningful.

• A Professional Learning Plan, (including the use of a portfolio) where practitioners have the opportunity assess learning needs, develop a learning plan, implement the plan, document the learning activities, and reflect upon learning is one way to make learning meaningful. We owe this to ourselves, as well as the individuals we SERVE and PROTECT.


References1. Pitney WA. Continuing education in athletic training: An alternative approach based

on adult learning theory. J Athl Train. 1998;33:72-76.2. Thurston HI. Mandatory continuing education: what the research tells us. J Contin

Educ Nurs. 1992;23:6-14.3. Cuppett MM. Self-perceived continuing education needs of certified athletic

trainers. J Athl Train. 2001;36:388-395.4. Weidner TG. Athletic training continuing education needs assessment: Pilot study.

J Athl Train. 1994;29:67-69.5. Draper DO, Young W. Continuing education for athletic trainers based on learning

style research. J Contin Educ Health Prof. 1989;9:193-197.6. Thompson C. Once certified, always competent? J Athl Train. 2000;35,17-18.7. Walker, S, Pitney, W, Lauber, C., & Berry, D. (2004). Certified athletic trainers

perceptions and attitudes of continuing professional education. (Unpublished data). 8. Pitney WA. Continuing education in athletic training: Visions for the future and

alternative models for professional learning. Proceedings of the NATA 53rd Annual Meeting and Clinical Symposia. Dallas, Tx. Champaign, IL: Human Kinetics. 152-154


References9. Bell DF, Chelf, JH, Geerdes P. An outcomes model prototype: integrating continuing

education learning into practice. J Contin Educ Nurs. 2000;31:111-115. 10. Berarducci A, Lengacher CA, Keller, R. The impact of osteoporosis continuing

education on nurses' knowledge and attitudes. J Contin Educ Nurs. 2002;33:210-216. 11. Connors HR. Impact evaluation of a statewide continuing education program. J

Contin Educ Nurs 1989;20:64-69.12. Czurylo K, Gattuso M, Epsom R, Ryan C, Stark B. Continuing education outcomes

related to pain management practice. J Contin Educ Nurs. 1999;30:84-87. 13. Ferrell MJ. The relationship of continuing education offerings to self-reported change

in behavior. J Contin Educ Nurs. 1988;19:21-24.14. Prater L, Neatherlin JS. (2001). Texas nurses respond to mandatory continuing

education. J Contin Educ Nurs. 2001;32:126-132. 15. Jerin JM, Ansell BA, Larsen MP, Cummins R O. Automated external defibrillators:

Skill maintenance using computer-assisted learning. Acad Emerg Med 1998:5:709-717.


References16. Losek JD, Szewczuga D, Glaeser PW. Improved prehospital pediatric ALS care after

an EMT-Paramedic clinical training course. Ann Emerg Med. 1994;12:429-432. 17. Gill KP, Ursic P. The impact of continuing education on patient outcomes in the

elderly hip fracture population. The . J Contin Educ Nurs. 1994;25:181-185. 18. Davis D. Does CME work? An analysis of the effect of educational activities on

physician performance or health care outcomes. Problem oriented medical records: some reservations. Int J Psychiatry. 1998;28:21-29.

19. Davis D. O’Brien M, Freemantle N, Wolf F, Mazmanian P, Taylor-Vaisey A. Impact of formal continuing medical education: Do conferences, workshops, rounds, and other traditional continuing medical education activities change physician behavior of health care outcomes? JAMA. 1999;282:867-74.

20. Little CD. Mandatory continuing education: What the research tells us. J Contin EducHealth Prof. 1993;13:159-167.

21. Cervero RM. Continuing professional education in transition, 1981-2000. Int J Lifelong Educ. 2001;20:16-30.


References

22. Lenburg CB. Promoting competence through critical self-reflection and portfolio development: The inside evaluator and the outside context. Tennessee Nurs. 2000;63 (3):11,14,15,18,20.

23. Mathers NJ, Challis MC, Howe AC, Field NJ. Portfolios in continuing medical education: Effective and efficient? Med Educ. 1999 ;33(7):521-30.

24. Harrell KA. A rural report: Services struggle to overcome distance, recruitment, and funding problems in an ever changing profession. Texas EMS Magazine 1993.

25. Heimback L. Keep the ball rolling. Emergency, 1993;25(6):9.26. Pijanowski K. Continuing Professional Education in Continuing Medical Education in

Transition: The Education of a New Paradigm. In W.H. Young’s [Ed.] Continuing Professional Education in Transition: Visions for the Professions and New Strategies for Lifelong-Learning. Malabar, FL. Krieger, 1998.

27. American Academy of Pediatrics. (2000). The Future of Pediatric Education II: Organizing Pediatric Education to Meet the Needs of Infants, Children, Adolescents, and Young Adults in the 21st Century. Pediatric. 105. pp. 200-3.


References28. Citizen Advocacy Center. (2004). Maintaining and improving health professional

competence: The citizen advocacy center roadmap to continuing competency assurance. Washington, DC: Citizen Advocacy Center.

29. Freidman BD, Davis MH, Harden RM, Howie PW, Ker J, Pippard MJ. AMEE Medical Education Guide No. 24: Portfolios as a method of student assessment. Med Teah. 2001;23:535-551.

30. Knowles MS. Self-directed learning. New York:Association Press, 1975.31. Merriam, S. B. (1996). Updating out knowledge of adult learning. Journal of

Continuing Education in the Health Professions, 16, 136-143.32. Westberg J, Jason H. Fostering learner’s reflection and self-assessment. Family

Med. 1994;26:278-282.33. Driscoll J. Reflective practice for prasctise. Senior Nurs. 1994;13(7):47-50.34. Schon D. The reflective practitioner (2nd ed.). San Francisco, CA: Jossey Bass

Publishing, 1991.


References35. Grant A, Dornan TL. What is a learning portfolio? Diabet. Med. 2001;18(Suppl.1):1-3.36. Melograno VJ. (2000). Designing a portfolio system for K-12 P. E.: A step-by-step

process. Meas Phys Educ Exerc Sci. 2000;4(2):97-115.37. Gregorc AF. Gregorc style delineator. Development, technical and administration

manual. Maynard, MA: Garbriel Systems, Inc; 1982.38. Hanson, RJ. The learning profile indicator: A self-diagnostic tool for adults to use in

identifying their learning style and profile. Institute for Phenomenological Studies of Learning and Teaching. Pownal, ME.

39. National Athletic Trainers’ Association Board of Certification. Role delineation study (4th ed.). Omaha, NE: National Athletic Trainers’ Association Board of Certification.

40. Cantilon, P. (1999). Does CME in general practice make a difference? BMJ. 1999;318, 7193.

41. Berry DC, Pitney WA. Continuing education in athletic training: The promise of portfolios for guiding and documenting earning. NATA News. 2004;11:44-45.

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