Athletic Training and Sports Health Care

Original Research 

Athletic Trainers' Perceptions of Interprofessional and Collaborative Practice

Dorice A. Hankemeier, PhD, LAT, ATC; Sarah A. Manspeaker, PhD, LAT, ATC

Abstract

Purpose:

To determine athletic trainers' perceptions of interprofessional and collaborative practice (IPCP) in the clinical setting.

Methods:

Clinicial perspectives of IPCP were assessed in a stratified random sample of 2,761 certified members of the National Athletic Trainers' Association through an online survey (response rate: 9.8%).

Results:

Participants who worked in an environment that employed a full-time physician and those who had the opportunity to collaborate with other health care professionals in the same location rated influences on collaborative practice significantly higher than those who did not. Only 47.33% of individuals indicated that their patient care occurred in an interprofessional manner. Athletic trainers identified perceived challenges to IPCP to be time, knowledge, opportunities to participate, and collaborative team factors. Drawbacks included communication and IPCP team roles, whereas benefits to patient care and resources were viewed as helpful to IPCP.

Conclusions:

Athletic trainers should conduct a self-assessment of their work environment to determine how best to improve their role in a collaborative practice team.

[Athletic Training & Sports Health Care. 2017;9(5):203–216.]

Abstract

Purpose:

To determine athletic trainers' perceptions of interprofessional and collaborative practice (IPCP) in the clinical setting.

Methods:

Clinicial perspectives of IPCP were assessed in a stratified random sample of 2,761 certified members of the National Athletic Trainers' Association through an online survey (response rate: 9.8%).

Results:

Participants who worked in an environment that employed a full-time physician and those who had the opportunity to collaborate with other health care professionals in the same location rated influences on collaborative practice significantly higher than those who did not. Only 47.33% of individuals indicated that their patient care occurred in an interprofessional manner. Athletic trainers identified perceived challenges to IPCP to be time, knowledge, opportunities to participate, and collaborative team factors. Drawbacks included communication and IPCP team roles, whereas benefits to patient care and resources were viewed as helpful to IPCP.

Conclusions:

Athletic trainers should conduct a self-assessment of their work environment to determine how best to improve their role in a collaborative practice team.

[Athletic Training & Sports Health Care. 2017;9(5):203–216.]

The National Athletic Trainers' Association (NATA) Athletic Training Education Competencies, 5th ed. identifies a “team approach” to patient care as an essential component for optimal patient outcomes in athletic training.1 Working with other health care professionals requires individuals to recognize and understand the scope of practice of others. Because each profession has a unique set of skills and abilities, patient outcomes can potentially be improved when each health care profession is represented in an appropriate manner during care.2,3 Interprofessional education (IPE) has been defined as “when students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes (p. 13).”3 The desire to educate students in IPE has been highlighted as a goal for athletic training education.4,5 Although it is not currently a specific requirement in athletic training curricula, IPE is an educational requirement for professions including medicine, nursing, and physical and occupational therapies.6 The goal of IPE is to provide students with the skills and collaborative abilities to enter a more patient-centered and collaborative workforce.7

Building on the foundation of IPE, interprofessional and collaborative practice (IPCP) occurs when health care professionals from different backgrounds work together with patients, families, and communities to deliver quality care.3 IPCP is an important aspect of health care and has been defined as a “process for communication and decision making that enables the separate and shared knowledge and skills of care providers to synergistically influence the client/patient care provided.”8

In 2003, the Institute of Medicine (currently the National Academy of Medicine) released a report indicating that “all health care professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics (p. 3).”9 This recommendation has led to an emphasis on IPE within health care professions during the past decade and is included as part of the Patient Protection and Affordable Care Act.10 A component of the Patient Protection and Affordable Care Act approved a coordinating center (the National Center for Interprofessional Practice and Education), supported by the Health Resources and Services Administration, to establish a foundation for IPE and IPCP among health professions.11 As athletic trainers continue to expand their ability to complete direct billing and third party reimbursement, practicing in an IPCP manner will likely become more of a necessity. Additionally, the increase in diagnoses of chronic conditions has expedited the need for preventative care and treatment across disciplines.7,12,13 The Patient Protection and Affordable Care Act increased societal demands, and the push to provide quality health care has brought IPCP to the forefront of health care delivery.11,12

To enhance the ability of health care teams to work together, the Interprofessional Collaborative Practice Core Competencies14 were established in 2011. These included: (1) values/ethics for interprofessional practice, (2) roles/responsibilities, (3) interprofessional communication, and (4) teams and teamwork.14,15 These competencies were implemented broadly within health care education programs to establish common accreditation standards and best practices in curricular development and were identified as necessary skills and tenets for practicing clinicians.16 In regard to practicing clinicians, the core competencies call for a foundation of lifelong learning across professions and dialogue between health care professionals.15,16

Although IPCP is second nature to many health care professionals due to working in close proximity with differing disciplines, many athletic trainers do not have the same opportunities to practice collaboratively on a daily basis. To become more relevant among other health care professions, athletic trainers need to integrate toward interprofessional health care teams.17,18 Breitbach and Richardson17 identified the potential impact of interprofessional practice on clinical outcomes as an increase in patient-centered care due to the collaboration of highly integrated teams. Research on IPCP and IPE in athletic training is minimal, but a recent study showed little teamwork between other health care professions and athletic training students.18

Although there is little literature to document the official process of IPCP in athletic training, athletic trainers have practiced in this manner since the profession's conception.4,17 Our history in working with multiple health care professionals, the stated relevance of interprofessional socialization and learning opportunities from the 2012 Future Directions of Athletic Training document, and the current push toward inclusion of IPE in the professional education of athletic trainers establishes a need to evaluate the current state of IPCP among practicing athletic trainers. Therefore, the purpose of this study was to understand the perceptions of athletic trainers in regard to IPCP and to determine perspectives on practice patterns in a clinical setting. We also aimed to determine whether the perceptions of IPCP differed among individuals who had prior formal IPE or worked directly with other health care providers or with a physician at their same clinical site.

Methods

Participants

A stratified random sample e-mail list of 2,761 certified athletic trainers was purchased from the NATA. The requested membership categories included: college/university, secondary school, clinic, hospital, professional sports, industrial/occupational/corporate, health/fitness/sports clubs/performance enhancement clinics, amateur/recreation/youth sports, military/law enforcement/youth sports, and other. These particular categories were requested in an attempt to create a sample of the entire population of practicing athletic trainers. Exclusion criteria were individuals not currently employed as an athletic trainer in the selected settings and athletic trainers not currently credentialed by the Board of Certification. We received approval from the Ball State University Institutional Review Board for exempt research, and completion of the online survey served as the participants' consent to participate.

Instrumentation

Several instruments have been developed in health care fields to assess IPCP and IPE.19–22 However, each of these instruments is specific to a health care field other than athletic training. Due to the lack of an athletic training–focused interprofessional assessment tool, the research team modified existing validated surveys19–22 to establish the Clinician Perspectives of Interprofessional Collaborative Practice (CPICP). Permission for modification of the Collaborative Practice Assessment Tool,20 Readiness for Interprofessional Learning Scale questionnaire,19,23 Interdisciplinary Education Perception Scale,22 and Student Perceptions of Interprofessional Clinical Education-Revised21,24,25 was sought and obtained during the fall of 2014.

A blueprint/table of specifications was developed by the research team following the recommendations described by Turocy.26 The table of specifications delineated the goals of the survey, potential constructs to be evaluated, questions from other surveys that were dedicated to those constructs, correlating question adaptation on the CPICP, and a general comment area. The constructs of the survey were designed to align with the Interprofessional Education Collaborative Core Competencies.14,15 The survey was then reviewed by a panel of two athletic trainer clinician experts and one expert in survey research. The clinicians were asked to evaluate the instrument for face and content validity, and the survey expert was asked to assess construct validity in addition to the face and content validity. Following initial feedback from the reviewers, the survey was edited for minor wording changes, removal of one construct, and reorganization of questions and construct classification. The edited survey was then sent to the survey expert two additional times to finalize the content and construct validity.

In addition to several demographic questions, the CPICP instrument comprised two sections aimed to create inferences regarding athletic trainer perceptions' and perspectives of IPCP. Section 1 (Perceptions of IPCP) of the survey used Likert scale items to evaluate athletic trainers' broad perceptions of four constructs: (1) working with other health care professionals, (2) athletic trainers engaged in collaborative practice, (3) influences on collaborative practice, and (4) influences on roles, responsibilities, and autonomy in collaborative practice. Several statements were given for each construct and were rated on a 5-point Likert scale of strongly disagree (1), disagree (2), agree (3), strongly agree (4), and unfamiliar with this concept (5). Sample statements for Section 1 can be found in Table 1.

Highest and Lowest Rated Statements for Sections 1 and 2

Table 1:

Highest and Lowest Rated Statements for Sections 1 and 2

Section 2 (Clinical Setting Perspectives) of the survey also used Likert scale items to gain insight from participants regarding perspectives on the current practice patterns of IPCP in their employment setting. Two constructs were evaluated in this section: (1) impact of communication on collaborative practice and (2) patient involvement in collaborative practice. Participants rated statements on a 4-point Likert scale as the statement related to their current clinical practice: this statement is always true in regard to my clinical setting (1); this statement is sometimes true in regard to my setting (2); although I am familiar with this concept, this statement is not reflective of activity in my setting (3); and I am not familiar with the concept in this statement (4). Sample statements for Section 2 can be found in Table 1. The final section of the instrument included four open-ended questions targeted to establish challenges, resources, benefits, and drawbacks to participation in IPCP.

Procedures

A recruitment e-mail was sent in the spring of 2015 to potential participants explaining the purpose of the study, the informed consent information, a link to the online survey instrument, and the contact information for the researchers. Reminder e-mails were sent at 2 and 4 weeks following the initial recruitment e-mail, reminding participants to complete the survey and thanking those who had already completed the survey instrument. Due to a low response rate, an additional data collection period occurred 2 months after the initial recruitment e-mail with additional reminder e-mails sent again at 2 and 4 weeks. Participants recruited to participate who were not currently practicing clinically were asked to only complete Section 1 and the demographics portion of the survey because Section 2 specifically asked about current practices occurring in the clinical setting. Data from each participant were collected in Qualtrics (Qualtrics, Provo, UT) and stored on a university server.

Data Analysis

Data were downloaded from Qualtrics and analyzed using SPSS software (version 23.0; IBM Corp., Armonk, NY). Descriptive statistics were used to establish the mean, standard deviation, and frequency of the data within each statement and section. Cronbach's alpha was used to determine the reliability of each construct. A Mann–Whitney U test was calculated to detect differences for the ordinal perceptions data among differing demographic characteristics such as previous experience in IPE, presence of a physician on staff, and whether participants have access to collaborate with other health care professionals in their same physical location. The a priori alpha level was set at a P value of .05 or less.

Due to the connection between the study findings and research questions used in this survey, open-ended responses were analyzed through a general inductive qualitative approach.27 Content analysis was conducted to consolidate the raw data into summary format through a constant comparative process including open, axial, and selective coding.28 Following an initial reading of all responses and creation of a list of key words, similar words (codes) were combined and participant responses were then textually coded by assigning conceptual labels to all responses. Coded concepts were then subjected to groupings (thematization) via placement into common sub-themes.27,29,30 As the data analysis process evolved through continued review of the data, sub-themes were restructured, as appropriate, to establish higher level themes. Reevaluation and reorganization continued until all appropriate data had been thematically catalogued into higher level themes, sub-themes, and categories.29–32 Following thematization, the second researcher served as the peer debriefer and performed content analysis based on the initial researchers' findings. Discrepancies between researchers were discussed until consensus regarding the framework of thematization was reached.

Several steps were initiated to establish trustworthiness of the data. During construction of the instrument, multiple reviewers, including a survey research expert, were enlisted to ensure a lack of bias in the instrument. The sampling method of e-mailing a stratified random sample of all certified athletic trainers provided a range of perspectives on IPCP, thus improving the potential transferability of the findings. Furthermore, the previously described peer review and data triangulation aided in determining trustworthiness. Triangulation was accomplished through the mixed-methods collection of quantitative and qualitative data, which highlights complementary aspects of IPCP knowledge and experiences.28,29

Results

Of the 2,761 recruitment e-mails sent, a total of 246 individuals (gender: 112 male, 133 female, 1 preferred not to disclose; duration of Board of Certification status: 11.78 ± 9.27 years; duration of clinical practice: 9.20 ± 8.69 years) completed the survey, resulting in a 9.8% overall response rate. Of the 246 participants, 24 individuals indicated that they were not practicing clinically, so they were not asked to complete Section 2 of the survey. Additional information regarding participants' employment and educational backgrounds is listed in Table 2.

Participant Demographics

Table 2:

Participant Demographics

We examined the reliability of the CPICP instrument using Cronbach's alpha. The CPICP demonstrated good reliability in Section 1 with 35 items and in Section 2 with 13 items (alpha = .884 and .866, respectively). The reliability values for each construct of the instrument can be found in Table 3.

Clinician Perspectives of Interprofessional Collaborative Practice Reliability Data

Table 3:

Clinician Perspectives of Interprofessional Collaborative Practice Reliability Data

On average, participants reported that 47.33% ± 29.49% of their patient care was spent in interprofessional collaboration. We asked participants to rate how often they approached patient care from a collaborative practice standpoint (Figure 1). Of our 246 participants, 146 (59.3%) indicated that they had prior formal IPE and most of those individuals reported having 3 to 5 (n = 48) or more than 10 (n = 50) previous IPE opportunities.

Frequency of collaborative patient care.

Figure 1.

Frequency of collaborative patient care.

In Section 1 of the CPICP, participants agreed with the statements in each of the four constructs: (1) working with other health care professionals (3.58 ± 0.34), (2) athletic trainers engaged in collaborative practice (3.42 ± 0.48), (3) influences on collaborative practice (3.49 ± 0.39), and (4) influences on roles, responsibilities, and autonomy in collaborative practice (3.17 ± 0.34). The statements that participants most strongly agreed or disagreed with for each construct of Section 1 are reported in Table 1. In Section 2, participants reported that the statements were “sometimes true in their work setting” for each construct: (1) impact of communication on collaborative practice (1.99 ± 0.47) and (2) patient involvement in collaborative practice (1.89 ± 0.55). Table 1 includes the statements reported as most frequently true in their own clinical setting and those that happened less frequently.

Participants who worked in an environment that employed a full-time physician on staff (U = 5,003, Z = −2.047, P = .041) and those who had the opportunity to collaborate with other health care professionals in the same physical location (U = 4,283, Z = −2.997, P = .003) rated influences on collaborative practice significantly higher than those who did not. Additionally, individuals who worked alongside other health care professionals rated the impact of communication on collaborative practice higher than individuals who were not able to physically collaborate with other health care providers (U = 4,210, Z = −3.156, P = .002). Finally, individuals who had previous formal IPE opportunities indicated that they experienced more regular patient involvement in collaborative practice than participants who had not had formal IPE (U = 5,043, Z = −2.00, P = .045). No other significant differences in constructs based on participant demographic characteristics were found (P > .05).

Analysis of the qualitative data obtained via the four open-ended questions regarding perceptions of IPCP resulted in identification of themes and sub-themes for each question. Figure 2 depicts the conceptual framework of overall themes. For each question, the themes are defined, supported with participant responses, and discussed in the following sections.

Conceptual framework of themes by question. IPCP = interprofessional and collaborative practice

Figure 2.

Conceptual framework of themes by question. IPCP = interprofessional and collaborative practice

Challenges to IPCP

We asked athletic trainers to identify common challenges to IPCP. Participant responses reflected that athletic trainers perceive several areas as challenging to their participation in IPCP. Specifically, four primary themes were identified: time, knowledge, opportunities for IPCP, and collaborative team factors. Within the theme of knowledge, two sub-themes were identified: other professionals' lack of knowledge of the athletic trainer profession and the general lack of knowledge regarding other health care professions among all professions. Many responses within the theme of opportunities for IPCP were related to specific factors, including access to other health care professionals and communication. Therefore, sub-themes were created in these areas. The theme of collaborative team factors also resulted in sub-themes because participants identified the structure of a team and professional relationships as challenges to IPCP. Table 4 depicts the resulting themes, sub-themes, and categories as related to challenges of IPCP.

Challenges to IPCP

Table 4:

Challenges to IPCP

Drawbacks to IPCP

Participants acknowledged perceived drawbacks to participating in IPCP that were divided into two themes: roles within the IPCP team and communication factors (Table 5). Participants stated that the positions within the interprofessional health care team were perceived as drawbacks to IPCP when a team lacks defined roles and/or the role of the athletic trainer on the team is uncertain. Additionally, specific communication factors were identified in the following areas: the increased number of health care professionals needed to accomplish IPCP, disagreements or turf wars within the team, and a general lack of effective communication strategies.

Drawbacks to IPCP

Table 5:

Drawbacks to IPCP

Benefits to IPCP

Athletic trainers clearly identified two thematic benefits regarding IPCP: patient care and the team approach to health care (Table 6). Sub-themes relating to patient care were classified as either directly improving patient care or approaching patient care from a comprehensive standpoint rather than an injury-focused standpoint. Perceived specific improvements in patient care were presented through statements related to enhancing patient outcomes, efficiency of care, and a more holistic approach. Participants also stated that the collaborative effort of different health care providers was beneficial to patient care and outcomes. Furthermore, this overall team approach was identified as a benefit to learning and understanding the roles of others, allowing athletic trainers to learn from/about other professions and vice versa, and providing opportunities to collaborate and communicate with other health care professionals.

Benefits to Participation in IPCP

Table 6:

Benefits to Participation in IPCP

Resources Helpful to IPCP

Participants were asked to indicate what items or resources would be helpful to improve collaborative practice within their individual employment setting. Responses were divided into two themes: communication mechanisms and educational opportunities (Table 7). Specific to the theme of communication mechanisms, participants acknowledged that increased accessibility to the interprofessional health care team, designated meeting times/spaces, a common documentation system for all members of the IPCP team, more defined guidelines, and better communication in general would be helpful to IPCP participation. Regarding the theme of educational opportunities, participants suggested that more education about the athletic trainer profession provided to members of other health care professions in addition to education about the IPE process would be helpful in improving participation in IPCP.

Resources Helpful to IPCP

Table 7:

Resources Helpful to IPCP

Discussion

The purpose of our study was to understand the perceptions of athletic trainers regarding IPCP and determine perspectives on practice patterns in clinical settings as they relate to IPCP. Because no singular discipline can effectively respond to growing patient expectations and the increasing number of patients with chronic and preexisting conditions,33 athletic trainers need to function in a collaborative environment. Participants in our study who worked in an environment with a physician or other health care providers in the same physical location had a stronger and more positive perspective on the influence of IPCP. Overall, participants agreed with the statements related to all four constructs of Section 1, although they reported that less than half of their patient care time was spent in interprofessional collaboration. It may be theorized that these findings toward agreement may be indicative of a favorable view of IPCP despite a lack of ability to engage in IPCP on a regular basis, although more research would be needed to confirm this notion. Furthermore, these findings may demonstrate support that initiatives developed by the NATA have helped frame the need and importance of IPCP.4,17

Current research regarding IPCP relates more to education and less to clinicians who are currently practicing.18,19,21–25 When the Institute of Medicine introduced the need for interdisciplinary education for all health care providers, many professions began to implement competencies and accreditation standards to address the need for IPE. In a recent comparative analysis of IPE standards in the health care professions, the accrediting documents for 10 health care professions were analyzed.6 The findings of this analysis demonstrated that, although IPE statements regarding structure and process of IPE and student competence required for IPCP were present, there was a lack of a collective mandate for IPE.6 Unfortunately, the authors of this systematic review6 did not include athletic training as one of the professions analyzed and therefore omitted the NATA competencies and the Commission on Accreditation of Athletic Training Education accreditation standards from their study.1,34

The foundational components of IPCP include the idea that nonhierarchical teams focused on communication and cooperation are beneficial to patient care.14,15 These two core competency areas are vital to the preparation of health care professionals.15 Teamwork in collaborative practice is beneficial in health care because it leads to a potential decrease in health care costs and improved patient outcomes.35–37 Although research in IPE in athletic training is minimal, it has been suggested that there is little teamwork between athletic training students and other health care professions.18 In an effort to address the involvement of athletic trainers, Perrin38 postulated that “athletic trainers must become a player on these interprofessional health care teams.” The perceptions provided in the results of this study illustrate that athletic trainers think that our profession has yet to reach full integration on interprofessional health care teams.

As health care professionals grow and expand the skillset for their specific profession, it becomes more difficult to gain knowledge and an understanding of other professions.39 This lack of knowledge of other professions, specifically other professionals' knowledge of athletic training, was described by participants in this study as a perceived challenge to participation in IPCP. It has been shown that members of each health care profession know little about the expertise, skill set, responsibilities, and practices of other health care professionals, although they often communicate and work alongside each other.40,41 When health care providers communicate regarding their roles, many individuals prefer to discuss similarities among the team rather than share what makes each profession unique.42 Operating in this manner may lead to confusion among team members regarding their role and leave ambiguity as to what each team member can contribute to the case. Because athletic trainers work with many different providers,43 they have a unique position to share their knowledge and skill set with their team members. Many times, the athletic trainer serves as the primary point of contact for the patient, thus bridging the gap between providers and the patient and potentially leading to improved outcomes.

Chiocchio et al.39 suggested that a conscious effort must be made to stimulate team discussion and share information regarding team roles regularly to improve quality and quantity of provider interactions. Participants in our study noted that ambiguity in the roles of individual team members hindered effective teamwork. Perhaps earlier discussions reviewing the roles and responsibilities of athletic trainers and other members of the IPCP team during patient care could help to bridge the gap in knowledge with other health care professionals. Additionally, improved role delineation has the potential to reduce the negative stereotypes often associated with health care professions and increase trust among providers and patients.40,44

One of the most significant findings of this study was the role of communication because it emerged as both a benefit and drawback to IPCP. Effective IPCP often relies heavily on how well members of the team communicate. To improve communication between providers, the use of electronic health records may be of interest. Specifically, computer-based record keeping improves readability of documentation and the communication between primary and secondary care providers.45 In support of electronic health records, Ammenwerth et al.46 found that communication improved between nurses and physicians when using electronic records. Our findings are supportive of the use of electronic health records because athletic trainers identified resources helpful to IPCP to be inclusive of better access to patient care documents and the IPCP team, and a forum for all parties to communicate. Although the integration of electronic health records can improve communication, it is only as successful as the system itself. Careful consideration should be taken when choosing an electronic health records system to ensure that it takes into account the multi-disciplinary nature of care and includes different standardized instruments specific to each profession involved in IPCP built into the system.47 Electronic health records that are focused solely on one profession make it difficult to include all members of the health care team.

Individuals who had previous formal IPE experience indicated that they had more patient involvement in collaborative practice. It may be that, through previous IPE, participants learned the value of involving the patient with other health care professionals to achieve better patient outcomes. Additionally, participants in this study indicated that more comprehensive care was one of the benefits of IPCP. In practicing collaboratively, athletic trainers may also be addressing two of the core competencies of patient-centered care: interprofessional teamwork and communication.7,15 To effectively deliver patient-centered care, communication between health care team members and the patient is essential to best understand and accomplish patient goals and values.48,49 IPE initiatives focus specifically on teaching students how to effectively communicate among team members and with patients.11 In support of these communication mechanisms, the implementation of electronic health records allows patients to be strategic partners in their health care.50,51 As clinical practice continues to evolve, there will likely be an increasing demand for graduates from all health care professions to enter practice ready to collaborate and work together.52

Athletic trainers perceived IPCP as a benefit to patient care, but they also believed that they were not viewed as a consistent and valued member of the IPCP team. Individuals who had the opportunity to work with physicians and other health care providers in their primary clinical location found practicing in a collaborative manner much easier. Clinicians who do not work alongside other health care providers on a daily basis should develop strategies to collaborate with an interprofessional health care team.

The current study has limitations that should be considered when interpreting the results. This study was limited by the length of the survey because it may have influenced those who chose not to complete the survey and response fatigue may have affected the participants who did choose to finish. The lack of completion led to a low response rate and the opportunity for non-response bias. It is also possible that participants who are not able to consistently practice in an interprofessional manner felt uncomfortable with the survey because it was asking their perspective on something they do not regularly experience. Even with the lower response rate, we think that we received responses that represent the current demographic make-up of the NATA membership, which improves the external validity of the study. Additionally, it was assumed that participants were truthful about their experiences with IPCP, but the self-report nature of these responses may be a limitation. Further research in individualized practice settings will help gain a better understanding of the level of interprofessional practice and challenges specific to those settings. Finally, further research is needed on the implementation of IPE as it relates to IPCP and patient outcomes.

Implications for Clinical Practice

The perceptions of athletic trainers who participated in this study may be helpful in evaluating personal opportunities for participation in IPCP and overcoming the associated challenges. Effective IPCP will not happen with only good intentions; intentional and planned initiatives are also needed to increase collaboration.33 Athletic trainers should conduct a self-assessment of their own work environment and determine how best to improve their role in a collaborative practice team. For athletic trainer clinicians who work directly with other health care providers, an aim to better explain their skill set while also seeking to understand the roles of the other individuals on the team may be beneficial to establishing improved team communication, trust, and potential patient outcomes. This emphasis on IPCP may benefit from overall acceptance from health care administrators through the implementation of initiatives that create an environment of collaboration. Specific initiatives that foster teamwork and communication may include the availability and use of shared space, electronic health records, or weekly collaborative meetings between all team members.52,53 For those athletic trainers who work alone and do not have regular interactions with other health care providers, it is important to seek out opportunities for collaboration and communication. An evaluation of the resources available locally or remotely may be beneficial to improving the interprofessional nature of practice.

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Highest and Lowest Rated Statements for Sections 1 and 2

PerceptionsAverage Score
Construct 1a: AT perceptions of working with other health care professionals
   Highest: Teamwork between ATs and other health care professionals is an essential component of effective patient centered practice3.84
   Lowest: Individuals in other health care professions respect the work done by ATs2.68
Construct 2a: AT perceptions of ATs engaged in collaborative practice
   Highest: ATs are willing to share information and resources with other health care professionals on interprofessional health care teams3.48
   Lowest: ATs strive to understand the abilities and skills that other professionals can contribute to interprofessional health care teams3.27
Construct 3a: AT perceptions of influences on collaborative practice
   Highest: Working alongside other health care professionals enhances my continued professional growth and learning3.71
   Lowest: Interprofessional communication skills are best learned during entry-level education alongside other health care professionals2.96
Construct 4a: AT perceptions of influences on roles, responsibilities, and autonomy in collaborative practice
   Highest: When engaging in collaborative practice, athletic trainers and all other medical and health care professionals' roles and expertise should be valued3.75
   Lowest: During collaborative practice, it is clearly defined as to which health care professional is responsible for specific aspects of the patient care plan2.64
Construct 5b: Impact of communication on collaborative practice
   Highest: When engaging in collaborative practice, there is an established process for conflict management2.60
   Lowest: When engaging in collaborative practice, the final decision rests with the patient and physician1.47
Construct 6b: Patient involvement in collaborative practice
   Highest: When engaging in collaborative practice, health care professionals meet as a group in face-to-face meetings with patients2.39
   Lowest: During collaborative practice, information relevant to health care planning is shared with the patient or client1.68

Participant Demographics

VariableNo. of Patients
Gender
  Female133
  Male112
  Prefer not to answer1
Employment setting
  Collegiate73
  Secondary school40
  Clinic or hospital32
  Secondary school and clinic25
  Other (3+ settings)13
  Other (2 settings)11
  Secondary school and middle school10
  Professional sports10
  Industrial10
  Military/law enforcement8
  Other7
  Performing arts2
  Middle school and clinic2
  Collegiate and clinic2
  Junior high/middle school1
Highest degree earned
  Other master degree107
  Master degree–CAATE accredited program64
  Bachelor degree53
  PhD or EdD18
  DAT2
  MD1
  DPT1

Clinician Perspectives of Interprofessional Collaborative Practice Reliability Data

SectionCronbach alpha
Section 1: Perceptions of IPCP
   Construct 1: AT perceptions of working with other professionals.830
   Construct 2: AT perceptions of ATs engaged in collaborative practice.854
   Construct 3: AT perceptions of influences on collaborative practice.758
   Construct 4: AT perception of influences on roles, responsibilities, and autonomy in collaborative practice.698
Section 2: Clinical setting perspectives
   Construct 5: Impact of communication on collaborative practice.784
   Construct 6: Patient involvement in collaborative practice.823

Challenges to IPCP

ThemeSupporting Quotations
TimeTrying to schedule a time for physician, patient, ATC, and other health care workers to be present at the same time. Since we work with so many different doctors and physical therapists it can be hard to meet and set a plan together.
Knowledge
   Other professionals' knowledge of ATMany health care professionals still do not understand the scope of practice of an AT. Physicians who do not understand the education and training that goes into the AT curriculum. Those that work regularly and closely with ATs know. . . but many middle level providers do not.
   General knowledge of other health care professionsMisconception among practitioners as to professional capabilities.
Opportunities for IPCP
   Access to other health care professions
    General accessMy industrial setting has little, if any, collaboration with other health care professionals. Very limited options of actual health care professionals—we have two ATCs on staff and a registered nurse, but our physicians, nurse practitioners, and physical therapists are all contracted in.
    Geographic locationWe are in a small rural area with few health care professionals. Finding professionals willing to collaborate with is a big issue. Distance of travel. Located in a small rural area and have to travel up to two hours to see MD.
   CommunicationCommunication, we are not in the same building. E-mail and text can become misunderstood. Lack of communication between health care professionals.
Collaborative team factors
   Structure of the team
    Final decisionToo many health care professionals to consider when making a decision.
    IPCP processI don't think all parties are fully engaged in this concept (IPCP) and taking the patient's goals into consideration, which may be different than the health care provider's goals. Getting everyone to buy into the concept and willing to try interprofessional collaboration.
   Professional relationships
    Strained relationshipsThe Occupational Medicine Doctor does not see me as an asset to his team. The nursing staff feel I am taking over their job. Overcoming the barrier of staff AT's attitudes and their willingness to work collaboratively with other health professionals.
    RespectLack of mutual respect, politics. Probably respecting/recognizing each individual's strengths in being able to help out the patient.
    EgosIndividuals set in their ways and unwilling to change. A few of our doctors take the “my way or the highway” approach.

Drawbacks to IPCP

ThemeSupporting Quotations
Roles within the IPCP team
   Lack of defined rolesSometimes, different professionals do not know where the line ends with their care. I find myself covering too much or not covering enough information, going on the assumptions that another professional had addressed the issue. The only drawbacks of working in a collaborative practice is when the roles are not clearly defined which could lead to confusion for the medical team and/or patient.
   Defined place for AT within the IPCP teamThe drawbacks I see are related to other disciplines not recognizing the benefits of having an AT involved. In the experiences I have been exposed to, some health care professionals are not accustomed to working in conjunction with an athletic trainer. They are unfamiliar with where our expertise lies, and even the vast array of things we have been trained and educated to do.
Communication factors
   Number of health care professionals on teamToo many cooks in the kitchen could make it difficult to [identify] what methods are the most successful. We may get too much outside noise and opinions when we over-collaborate.
   Disagreements/turf warsContinued “turf-wars” between health professions who believe autonomy in practice is the best form of patient care. From the interaction with EMS to the collaboration with physicians I regularly encounter “turf war” attitude from other health care professionals. This is a sad state of affairs and I do believe integrating medical professionals from the level of EMS all the way through Sports Medicine MD would improve this philosophy.
   Lack of communicationThe biggest drawback I have experienced is when the athlete is seeing multiple practitioners and getting information from one that is different from another. The larger a team gets, if people aren't effective with communication, can mean things “fall through the cracks” or get missed regarding patient care.

Benefits to Participation in IPCP

ThemeSupporting Quotations
Patient care
   Improved patient careImproved patient outcomes. Patients perceive that everyone is working hard for them and that generally improves their outlook. We currently work in a collaborative-heavy workplace in that we frequently talk with PTs, physicians, surgeons, RNs, etc. Overall patient care is definitely improved with collaborative practice.
   Comprehensive patient careA more holistic approach to providing the patient with the best care possible. Better able to consider the whole person and their needs. Maximize the level of health care for the patient, providing completely comprehensive care.
Team approach to health care
   Learning and understanding the roles of othersAnother benefit is the knowledge ATs can gain from other professionals. When an AT is open to learning and collaborating the educational benefits are tremendous. Engaging in collaborative practice can also advance the athletic training profession, especially when started during entry-level education. Some health care professionals do not fully understand the role athletic trainers play in the care of the physically active. Other health professions learn the education and training athletic trainers receive and have a better understanding of what we do.
   Collaboration and communicationEach profession has different areas of expertise, and by working together we can provide more comprehensive care. Two minds are generally better than one. And having someone else who is an expert in the area you are treating is beneficial for differential diagnosis and seeing signs or symptoms you may have missed. The opportunity to get multiple eyes, ears and hands on a patient allows multiple perspectives on the problem to be discussed and addressed. Ultimately, the patient benefits from having experts in all areas.

Resources Helpful to IPCP

ThemeSupporting Quotations
Communication mechanisms
   Accessibility to the interprofessional teamMore structure within our system. . . . I am working on creating a more recognized network. More access to specialists in the area that we can refer an athlete to so that they are not tempted to go to another physician or specialist that I have little ability to collaborate with. If the individuals involved in the patient(s) care worked in close proximity.
   Time/spaceSet time weekly to collaborate more. In-house offices for collaborative health care and professional team members. Integrate ATC in physician meetings.
   General improved communicationA forum where all parties involved can communicate effectively. Face-to-face meeting with other local health care providers.
Educational opportunities
   Education about athletic training to other health care professionsAthletic trainers continuing to work on [public relations] and get the word out nationally and individually in our communities about what we do and can offer. Regular flyers on behalf of local/state athletic training organization promoting current/newest standard of practice for injuries commonly seen by athletic trainers in order to educate nearby health care providers on current research and practice standards. Educating other health care professionals about the profession (of athletic training) and our qualifications.
   IPE opportunitiesI think it would be helpful to implement collaborative education between [health care providers]. Different [health care providers] would have a better understanding of the skills and limitations of different professions.Education about professions amongst health care professionals. Encouragement and respect for athletic trainers in clinic/hospital health care settings. Making sure all health care professions understand each other's roles.
Authors

From the School of Kinesiology, Ball State University, Muncie, Indiana (DAH); and Rangos School of Health Sciences, Duquesne University, Pittsburgh, Pennsylvania (SAM).

The authors have no financial or proprietary interest in the materials presented herein.

The authors thank Dr. Paula Turocy for contributing her expertise to the development of this survey instrument.

Correspondence: Dorice A. Hankemeier, PhD, LAT, ATC, Ball State University, HP 328, Muncie, IN 47306. E-mail: dahankemeier@bsu.edu

Received: December 05, 2016
Accepted: December 28, 2016
Posted Online: July 05, 2017

10.3928/19425864-20170612-01

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