The DPA is a reliable, valid, and responsive instrument.

Context: Patient-rated outcome measures (PROMs) are important for driving treatment decisions and determining treatment effectiveness. However, athletic trainers (ATs) rarely use them; understanding why may facilitate strategies for collection of these outcomes. Objective: To identify the benefits of and barriers to using PROMs in athletic training. Design: Cross-sectional study. Setting: Web-based survey. Patients or Other Participants: A total of 1469 randomly sampled ATs (age = 36.8 ± 9.8 years; 48% female) working in the college/university, 2-year institution, secondary school, clinic, hospital, or industrial/occupational setting. Intervention(s): An e-mail was sent to ATs inviting them to complete a survey regarding the use, benefits, and barriers of PROMs. Athletic trainers who indicated they used PROMs (AT-PRs) completed 65 questions about the benefits of and barriers to their use. Athletic trainers who indicated no use of PROMs (AT-NONs) completed 21 questions about barriers of use. Main Outcome Measure(s): Dependent variables were the endorsements for the benefits of and barriers to the use of PROMs. Results: A total of 458 ATs initiated the survey and 421 (AT-PR = 26%, AT-NON = 74%) completed it (response rate = 28.7%). The most frequently endorsed benefits by AT-PRs were enhancing communication with patients (90%) and other health care professionals (80%), directing patient care (87%), and increasing examination efficiency (80%). The most frequently endorsed barriers by AT-PRs were that PROMs are time consuming (44%), difficult (36%), and confusing (31%) for patients and time consuming for clinicians to score and interpret (29%). The most frequently endorsed problems by AT-NONs were that PROMs are time consuming for clinicians to score and interpret (31%), time consuming (46%) and irrelevant to patients (28%), and lacking a support structure for clinicians (29%). Conclusions: These results suggest that, although benefits to using PROMs exist, there are also barriers. Barriers are similar for AT-PRs and AT-NONs. Strategies to decrease barriers and facilitate the use of PROMs warrant investigation.

Our results will help clinicians understand how disablement is described by the physically active. The findings also have implications for how disablement outcomes are measured.

Context: Providing opportunities to develop clinical decision-making skills, including clinical reasoning, is an important aspect of clinical education. The learner-centered technique of summarizing the history and findings, narrowing the differential, analyzing the differential, probing the instructor about uncertainties, plan management, and selecting an issue for selfdirected study (SNAPPS) is used in medicine to express clinical reasoning.Objective: To investigate the effects of SNAPPS on the clinical reasoning, reflection, and 4 case presentation attributes (length, conciseness, case summary, and expression of clinical reasoning) in athletic training students.Design: Randomized controlled clinical trial. Setting: Three undergraduate programs accredited by the Commission on Accreditation of Athletic Training Education.Patients or Other Participants: We randomly assigned 38 athletic training students (17 men, 21 women; age ¼ 21.53 6 1.18 years, grade point average ¼ 3.25 6 0.31) who had completed at least 1 year of clinical education and all orthopaedic evaluation coursework to the SNAPPS group or the usual and customary group using a stratification scheme.Intervention(s): The SNAPPS group completed four 45-minute clinical reasoning and case presentation learning modules led by an investigator to learn the SNAPPS technique, whereas the usual and customary group received no formal instruction. Both groups audio recorded all injury evaluations performed over a 2-week period.Main Outcome Measures: Participants completed the Diagnostic Thinking Inventory and Reflection in Learning Scale twice. Case presentations were analyzed for 4 attributes: length, conciseness, case summary, and expression of clinical reasoning.Results: Case presentations were longer (t 18.806 ¼ À5.862, P , .001) but were more concise (t 32 ¼ 11.297, P , .001) for the SNAPPS group than for the usual and customary group. The SNAPPS group performed better on both the case summary subscale (t 32 ¼ 2.857, P ¼ .007) and the clinical reasoning subscale (t 25.773 ¼À14.162, P , .001) than the other group. We found a time effect for Diagnostic Thinking Inventory scores (F 1,34 ¼ 6.230, P ¼ .02) but observed no group effects (F 1,34 ¼ 0.698, P ¼ .41) or time-by-group interaction (F 1,34 ¼ 1.050, P ¼ .31). The Reflection in Learning Scale scores analysis revealed no group-by-time interaction (F 1,34 ¼ 1.470, P ¼ .23) and no group (F 1,34 ¼ 3.751, P ¼ .06) or time (F 1,34 ¼ 0.835, P ¼ .37) effects.Conclusions: The SNAPPS is an effective and feasible clinical education technique for case presentations. This learnercentered technique provides the opportunity for the expression of clinical reasoning skills.Key Words: learning styles, metacognition, clinical education Key PointsThe expression of clinical reasoning and uncertainties is possible in the athletic training environment with the learner-centered technique of summarizing the history and findings, narrowing the differential, analyzing the differential, probing the instructor about uncertainties, plan ...

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