Challenges Faced by Collegiate Athletic Trainers, Part II: Treating Concussed Student-Athletes

Abstract

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.

Collegiate Athletic Trainers' Experiences With External Pressures Faced During Decision Making

“…Medical care decisions, especially regarding a studentathlete's readiness to return to play, are often the impetus for conflict between coaches and ATs. 1,2,4,5 Our findings, in conjunction with other literature, 4,5 showed that coaches were eager for their student-athletes to return from injury as soon as possible; however, for ATs in the collegiate setting, the eagerness was viewed at times as pressure. Our participants considered this was an inherent part of their job and expected it from coaches whose goals were successful programs.…”

“…Our primary focus was to explore the ATs' experiences regarding medical care decision making, particularly as it pertains to return to play. Growing evidence 1,2,4,5 has indicated that ATs face pressure from coaches and other athletic administrators to return athletes to play, possibly before they are ready. Recognizing that ATs face such pressure, we also sought to better understand how ATs cope with these situations.…”

“…Furthermore, clinicians (ATs and team physicians) employed in the NCAA Division III setting reported less pressure than those employed in Divisions I and II. 1 More recent evidence 4,5 supported the finding that ATs felt pressure from coaches to return athletes from injury sooner than medically appropriate. Although the injury might play only a small role, athletes with concussions or other less visible injuries may experience more pushback from the coaching staff.…”

“…4 Much of the focus, both anecdotally and empirically, regarding the AT-coach relationship has been examined within the context of the NCAA football culture and at higher levels of competition, due to the associated pressures to ''win at all costs'' and the harsh reality that the jobs of coaches and athletic administrators often depend on team success. The Chronicle of Higher Education article 2 and the findings of Kroshus et al, 1 Pike et al, 4 and Bowman et al 5 highlight the need to better explore the dynamic between coaches and medical personnel, particularly as it relates to medical care decisions and returning athletes to sport after a concussion. However, much of the research 1,2,4,5 on the topic has explored the relationships by simply quantifying the extent of conflict and pressures experienced by collegiate ATs.…”

Secondary School Athletic Trainers' Experiences With Organizational Conflict: A Comparison Across Employment Models

“…Conflict between medical and nonmedical personnel in athletic environments is not novel and often manifests as pressure to prematurely return an athlete to play. 2,3 Anecdotal 3-5 and empirical 2,[6][7][8][9] evidence has highlighted this concern for years.…”