Context Previous research from a sample of US secondary schools (n = 10 553) indicated that 67% of schools had access to an athletic trainer (AT; 35% full time [FT], 30% part time [PT], and 2% per diem). However, the population-based statistic in all secondary schools with athletic programs (n = approximately 20 000) is yet to be determined. Objective To determine the level of AT services and employment status in US secondary schools with athletics by National Athletic Trainers' Association district. Design Cross-sectional study. Setting Public and private secondary schools with athletics. Patients or Other Participants Data from all 20 272 US public and private secondary schools were obtained. Main Outcome Measure(s) Data were collected from September 2015 to April 2018 by phone or e-mail communication with school administrators or ATs and by online surveys of secondary school ATs. Employment categories were school district, school district with teaching, medical or university facility, and independent contractor. Data are presented as total number and percentage of ATs. Descriptive statistics were calculated for FT, PT, and no AT services data for public, private, public + private, and employment type by state and by National Athletic Trainers' Association district. Results Of the 20 272 secondary schools, 66% (n = 13 473) had access to AT services, while 34% (n = 6799) had no access. Of those schools with AT services, 53% (n = 7119) received FT services, while 47% (n = 6354) received PT services. Public schools (n = 16 076) received 37%, 32%, and 31%, whereas private schools (n = 4196) received 27%, 28%, and 45%, for FT, PT, and no AT services, respectively. Most of the Athletic Training Locations and Services Survey participants (n = 6754, 57%) were employed by a medical or university facility, followed by a school district, school district with teaching, and independent contractor. Combined, 38% of AT employment was via the school district. Conclusions The percentages of US schools with AT access and FT and PT services were similar to those noted in previous research. One-third of secondary schools had no access to AT services. The majority of AT employment was via medical or university facilities. These data depict the largest and most updated representation of AT services in secondary schools.

Context Conflict between athletic trainers (ATs) and other stakeholders can occur because of competing interests over medical decisions regarding concussion. However, we are unaware of any studies specifically exploring these situations across various collegiate athletic affiliations. Objective To investigate the challenges faced by ATs when treating concussed student-athletes. Design Qualitative study. Setting Online questionnaire. Patients or Other Participants A total of 434 ATs (267 women, 166 men, 1 missing data; age = 27.73 ± 3.24 years, experience = 5.17 ± 2.67 years) completed the questionnaire (response rate = 14.47%). Our participants represented multiple employment settings within intercollegiate athletics. Data Collection and Analysis We sent an online questionnaire to 3000 ATs working in the collegiate and university setting across the United States. A survey expert verified face, content, and construct validity of the questionnaire in 2 rounds of review, and 3 ATs completed a content-validity tool before we finalized the survey. We analyzed the qualitative data using a general inductive approach and ensured trustworthiness through multiple-analyst triangulation and peer review. Results When we examined the responses from our participants regarding their work with student-athletes who had sustained concussions, we found 2 major themes, each with subthemes. First, educational efforts appeared to be only modestly effective because of a lack of honesty, noncompliant actions, and coach interference. Second, return to learn was challenging because of a lack of communication among stakeholders, athletes being anxious about needing accommodations, and difficulty convincing faculty to provide reasonable accommodations. Conclusions Based on our findings, we recommend continued efforts to improve the culture surrounding concussion in collegiate athletes. Athletic trainers should include key stakeholders such as coaches, student-athletes, parents, faculty, and other educational administrators in their educational efforts to improve the policies and culture surrounding concussion treatment.

Context Organizational conflict, particularly between coaches and medical professionals, has been reported in collegiate athletics. Different values create room for conflict between coaches and athletic trainers (ATs); however, ATs' experiences when making medical decisions are not fully understood. Objective To investigate the presence of organizational conflict regarding medical decision making and determine if differences exist across athletic affiliations. Design Cross-sectional study. Setting Collegiate athletics (National Collegiate Athletic Association [NCAA], National Association of Intercollegiate Athletics [NAIA], National Junior College Athletic Association [NJCAA]). Patients or Other Participants A total of 434 ATs responded (age = 27.7 ± 3.2 years, years certified = 5.2 ± 2.7), representing the NCAA Division I (DI; n = 199), Division II (DII; n = 67), Division III (DIII; n = 108); NAIA (n = 37); and NJCAA (n = 23) settings. Main Outcome Measure(s) The survey instrument contained quantitative measures and open-ended questions, with affiliation as our primary independent variable. Responses to Likert-scale questions (1 = strongly agree, 5 = strongly disagree) regarding organizational pressures within athletics served as the dependent variables. Kruskal-Wallis analysis-of-variance and Mann-Whitney U post hoc tests assessed differences in organizational conflict across affiliations. Open-ended questions were analyzed inductively. Results We obtained a 14.47% (434 of 3000) response rate. National Collegiate Athletic Association DI ATs disagreed less than NCAA DII and DIII and NJCAA ATs that they would worry about job security if turnover in the head coaching position occurred (P < .05). Regarding the influence of coaches on job performance, differences were found between NCAA DI and DIII and between DI and NJCAA ATs (P < .01). Visibility of the injury and situational factors influenced the level of perceived pressure. Conclusions Athletic trainers perceived pressure from coaches regarding medical decision making. Division I ATs placed greater emphasis on the role that coaches played in their job performance and job security. Athletic departments should consider transitioning to patient-centered models of care to better align values and reduce the external pressures placed on ATs.

Context Legislation has played a role in advancing the athletic training profession and improving the health and safety of student-athletes. However, few researchers have examined state legislators' perceptions and awareness of the skills and qualifications accompanying the athletic trainer (AT) role. Objective To explore state legislators' perceptions of the athletic training profession and knowledge related to qualifications and responsibilities of ATs. Design Cross-sectional study. Setting Web-based questionnaire. Patients or Other Participants State legislators representing 34 states (N = 143; 67.13% male, 32.87% female). Their average age was 58.7 ± 11.7 years, and they had served 7.4 ± 6.9 years in their current role. A majority served as members of the state house or assembly (n = 98, 68.5%), and 31.5% served in the state senate. Main Outcome Measure(s) Quantitative data were analyzed using descriptive statistics. Spearman ρ correlations assessed relationships between perceptions and knowledge of the profession. Stepwise regression analysis determined predictors of knowledge and perceived value of athletic training. Qualitative data were analyzed inductively. Results Approximately 69% of respondents considered an AT to be a trusted source of medical information, and 16% considered an AT as the most appropriate individual to provide medical care to an injured athlete on a daily basis. Thirty percent of state legislators selected AT employed at the school as a top sports safety measure. Three themes emerged from the inductive analysis: (1) recognition of the prevention domain, (2) misconception of ATs as personal trainers or strength and conditioning coaches, and (3) lack of knowledge regarding ATs' educational requirements. Conclusions Legislators demonstrated limited knowledge of the AT profession. When legislator knowledge of AT qualifications and responsibilities was high, value of the AT profession also significantly improved. Future efforts should focus on enhancing legislators' knowledge to increase the value placed on the athletic training profession and improve health and safety for secondary school athletes.

As the athletic training profession continues to embrace evidence-based practice, athletic trainers should not only critically appraise the best available evidence, but also effectively translate it into clinical practice to optimize patient outcomes. While previous research has investigated the effectiveness of educational interventions on increasing knowledge of critical appraisal of evidence, little attention has been given to strategies for both researchers and clinicians to effectively translate evidence into clinical practice. The use of knowledge translation strategies has potential to bridge the knowledge-to-practice gap, which could lead to reduced health costs, improved patient outcomes, and enhanced quality of care. The purpose of this paper is to 1) highlight current challenges prohibiting successful translation of evidence into practice, 2) discuss knowledge translation and describe conceptual frameworks behind effectively translating evidence into practice, and 3) identify considerations for athletic trainers as they continue to provide high quality patient care in an evidence-based manner.