Objective: To address the need for a more definitive approach to critical thinking during athletic training educational experiences by introducing the clinical reasoning model for critical thinking. Background: Educators are aware of the need to teach students how to think critically. The multiple domains of athletic training are comprehensive and complex. Thinking is the fundamental connection between didactic and experiential components. Therefore, clinical thinking must be viewed as a critical part of experiential education in athletic training. Description: Research from educational journals in medicine, physical therapy and athletic training, as well as relevant texts, were searched to investigate the theoretical and practical underpinnings of clinical thinking models. Definitions, applications, and the historical underpinnings of the clinical thinking processes in allied health were reviewed and presented to highlight the need for athletic training educators to better appreciate the thinking processes of students and practitioners. Practical suggestions for the implementation of clinical reasoning in athletic training are presented. Application: Athletic training requires clinically based decision-making and problem solving skills. Medical educators recognize differences between the thinking of novice and expert practitioners, and have investigated the nature of clinical cognition as part of their formal curriculum. As AT's professional scope and credibility expand, the process of teaching, fostering, and evaluating clinical reasoning is paramount for AT educators.
Context:Successful treatment of nonarthritic hip pain in young athletic individuals remains a challenge. A growing fund of clinical knowledge has paralleled technical innovations that have enabled hip preservation surgeons to address a multitude of structural variations of the proximal femur and acetabulum and concomitant intra-articular joint pathology. Often, a combination of open and arthroscopic techniques are necessary to treat more complex pathomorphologies. Peri- and postoperative recovery after such procedures can pose a substantial challenge to the patient, and a dedicated, thoughtful approach may reduce setbacks, limit morbidity, and help optimize functional outcomes.Evidence Acquisition:PubMed and CINAHL databases were searched to identify relevant scientific and review articles through December 2014 using the search terms hip preservation, labrum, surgical dislocation, femoroacetabular impingement, postoperative rehabilitation, peri-acetabular osteotomy, and rotational osteotomy. Reference lists of included articles were reviewed to locate additional references of interest.Study Design:Clinical review.Level of Evidence:Level 4.Results:Hip preservation procedures and appropriate rehabilitation have allowed individuals to return to a physically active lifestyle.Conclusion:Effective postoperative rehabilitation must consider modifications and precautions specific to the particular surgical techniques used. Proper postoperative rehabilitation after hip preservation surgery may help optimize functional recovery and maximize clinical success and patient satisfaction.
Context: The cognitive process of making a clinical decision lies somewhere on a continuum between novices using hypothetico-deductive reasoning and experts relying more on case pattern recognition. Although several methods exist for measuring facets of clinical reasoning in specific situations, none have been experimentally applied, as of yet, to the profession of athletic training. The Diagnostic Thinking Inventory (DTI) has been used with medical doctors and medical students to determine their level of clinical reasoning as it applies to diagnosis making. Objective: To validate the DTI for Athletic Training (DTI-AT) and associated interview questions for use in the field of athletic training. Design: Mixed methodology. Setting: Online inventory and Skype-based interviews. Patients or Other Participants: Convenience sample of 25 senior-level athletic training students. Main Outcome Measure(s): Participants completed an online version of the DTI-AT which rated clinical reasoning tendencies on a 6-point Likert-type scale. Quantitative analysis consisted of determining means and ranges of scores along with reliability of total scores and subset scores. Randomly selected participants were interviewed online in order to provide validity of interview questions that were used to determine personal and professional activities that are either thought to enhance or hinder clinical reasoning. A secondary purpose was to solicit specific feedback that may enhance our understanding of the modified DTI. Results: A strong reliability was found for total DTI (r(41) = 0.846) and an acceptable reliability for flexibility in thinking (r(21) = 0.731) and structure of memory (r(20) = 0.771). Conclusions: The modifications of the DTI-AT demonstrated strong reliability and face validity. The DTI-AT may be an effective tool for determining clinical reasoning of athletic training students.
Context: As athletic training continues to evolve as a profession, several epistemological considerations must be considered. These include how we generate professional knowledge and how we secure and legitimize it in both professional and public spheres.Objective: The purpose of this commentary is to provide an overview of how athletic training has defined its body of knowledge. By contrasting our professional knowledge with recent advancements in medical cognition and epistemology, we aim to provide a more robust definition of professional knowledge for our profession.Background: A profession is defined as an occupation that has a unique knowledge base and skill set that, when wielded, fulfills an ethically founded social contract with the public. One of the greatest challenges for the profession of athletic training as we move into the future is securing a knowledge base that is uniquely our own.
The current paradigm of insidious lateral knee pain involving the iliotibial band (ITB) in repetitive knee-flexion activities has been termed ITB friction syndrome since 1975. The original model for ITB pain was based on a limited or incorrect understanding of the relevant anatomy, biomechanics, and tissue science, which gradually led to a plethora of frustrating and ineffective interventional strategies. Mounting evidence from arthroscopic, cadaveric, and biomechanical studies, as well as from diagnostic imaging and histologic reports, has helped deconstruct this long-held paradigm for ITB-related pathology and treatment. By outlining the historical paradigm for our understanding of ITB pain and gathering newer evidence through extensive research, I will synthesize the available data in this clinical update to present an updated, more informed model for understanding insidious-onset ITB-related pathology and treating patients. The result is called ITB impingement syndrome.
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