Context: Athletic trainers (ATs) must be equipped with evidence to inform their clinical practice. A systematic, inclusive, and continuous process for exploring research priorities is vital to the success of ATs and, more importantly, their patients' positive outcomes. Objective: To identify research priorities and unify research with clinical practice to improve patient care and advance the profession. Design: Mixed-methods study. Setting: Focus groups and a Web-based survey. Patients or Other Participants: A total of 87 ATs (43 men [49.4%], 44 women [50.6%]; age = 40 ± 11 years; experience = 18 ± 11 years) participated in focus groups. Of the 49 332 e-mails sent, 580 were undeliverable, 5131 ATs started the survey (access rate = 10.5%), and 4514 agreed to participate (response rate = 9.3%). Main Outcome Measure(s): Our study consisted of 6 focus-group sessions, a content-expert review, and a Web-based survey. Themes from the focus groups were used to develop the research priorities and survey instrument. We used the 25-item validated survey to determine whether the research priorities and findings of the focus groups were generalizable. Endorsement of research priorities and recommendations was achieved when respondents indicated they agreed or strongly agreed. Results: Respondents endorsed 5 research priorities: health care competency (n = 4438/4493, 98.8%), vitality of the profession (n = 4319/4455, 96.9%), health professions education (n = 3966/4419, 89.8%), health care economics (n = 4246/4425, 96.0%), and health information technology (n = 3893/4438, 87.7%). We also made the following recommendations: (1) develop funding initiatives that align with the agenda, (2) develop postdoctoral fellowships focused on clinical research, (3) facilitate collaborative relationships between clinicians and researchers, and (4) make research evidence more readily available and more applicable. Conclusions: Using a systematic and inclusive process, we developed a prioritized research agenda for the athletic training profession. The agenda was endorsed by the leaders of each Strategic Alliance organization and adopted as the Athletic Training Research Agenda.

Context: Life-work balance may be one reason for retention concerns among athletic trainers (ATs), yet evidence does not exist to support the supposition. Objective: To assess the perceptions of ATs regarding life-work balance, specifically on parenting issues. Design: Survey. Setting: Online survey at www.surveymonkey.com. Patients or Other Participants: A random sample of National Athletic Trainers' Association members (N = 9516) received the survey; 20.6% (n = 1962; male = 954, female = 816; age = 37 ± 10 years, experience = 13 ± 9 years) completed any portion of the survey. Most respondents worked in the college/university (34.5%, n = 657 of 1908) and secondary school settings (25.9%, n = 476 of 1908). A majority of participants (50.7%, n = 898 of 1770) were parents. Intervention(s): We calculated frequencies and percentages and used Mann-Whitney U tests and Kruskal-Wallis tests to identify the differences between sexes and among job settings on life-work balance measures among parents. Main Outcome Measures: The questionnaire included 8 life-work balance items, 7 parenting challenge items, and 3 nonparent items. Results: The results indicate that sex and setting significantly affected perceptions about parenting. Males articulated a stronger sense of difficulty in finding balance as a working parent (P < .001; 1.95 ± 1.98). Females felt more strongly than males that managing work and family was stressful (P = .04; 3.86 ± 1.13) and caused burnout (P = .004; 3.50 ± 1.24), and that their energy tended to fall short of their needs (P < .001; 3.74 ± 1.15). The decision not to have children was strongly affected by the work setting (P = .014; 3.37 ± 1.42). Both college/university (4.14 ± 0.85) and secondary school (4.03 ± 0.90) ATs would prefer to spend more time at home, as compared with ATs in other settings (P < .001). College/university ATs (P = .025; 3.17 ± 1.23) felt most strongly that their families were neglected because of work. In none of the settings did ATs feel that their employment settings were particularly tolerant of their parenting responsibilities (P = .027; 1.72 ± 1.97). Conclusions: Male and female employees had similar perceptions of life-work balance, but occupational setting may affect these perceptions.

Context: Medical documentation is a required component of patient care in all health care professions. Objective: To evaluate athletic trainers' perceived behaviors toward, barriers to, and confidence in their medical documentation. Design: Cross-sectional study. Setting: Web-based survey. Patients or Other Participants: We purchased a list of randomly selected e-mails from the National Athletic Trainers' Association. Of the 9578 participants, 1150 accessed our questionnaire (12.0% access rate), 1053 completed at least 1 portion, and 904 completed the questionnaire in its entirety (85.8% completion rate). Of the participants, 60.1% (n = 569/947) were female, 66.6% (n = 632/949) held a master's degree, 39.3% (n = 414/1053) worked in a collegiate or university setting, and 36.1% (n = 381/1053) worked in a secondary school setting. Main Outcome Measure(s): We used a 31-item questionnaire with demographics (12 items), medical documentation behaviors (16 items), barriers (2 items), and perceptions (1 multipart item) sections. The questionnaire explored athletic trainers' behaviors as well as confidence in, comfort with, and concerns about their documentation practices (Cronbach α = 0.887). We used descriptive statistics to identify characteristics of central tendency (mean, standard deviation, mode, frequency). Results: Participants always (45.7%, n = 478/1046) or very frequently (39.0%, n = 408/1046) used a double documentation system consisting of electronic and paper records (50.4%, n = 523/1038). They most often documented to provide legal protection (86.8%, n = 914/1053), because it is a legal obligation (79.1%, n = 833/1053), or to track patient progress (83.9%, n = 883/1053). The most frequently cited barriers to medical documentation were time (76.5%, n = 806/1053), managing too many patients (51.9%, n = 547/1053), technological concerns (17.2%, n = 181/1053), and software limitations (17.2%, n = 181/1053). Respondents believed they were competent, comfortable, and confident in their documentation practices. Conclusions: We were able to evaluate the generalizability of previous research while adding to the understanding of the behaviors toward, barriers to, and perceptions about medical documentation. We confirmed that time and patient load affected the ability to perform high-quality medical documentation.

Context: Collegiate student-athletes (SAs) experience psychological stressors due to rigid schedules, team conflict, and injury. These factors can result in symptoms of mental health conditions, decreased daily functioning, and suicidality. Objective: To explore National Collegiate Athletic Association Division I SAs’ experiences with mental health and access to and experiences with mental health resources at their university. Design: Consensual qualitative research study. Setting: One-on-one interviews. Patients or Other Participants: Twenty-three Division I SAs (18 women, 5 men; mean age = 20 ± 2 years). Main Outcome Measure(s): Participants completed a semistructured interview that focused on their experiences with mental health. The interviews were audio recorded and transcribed verbatim via Zoom. Credibility and trustworthiness were established via member checking, triangulation, and peer discussion among a 3-person coding team. Results: Two domains, increased expectations and resources and management, were identified. The participants shared how they balanced life as a college student, academic stressors, performance expectations, and a sport-first mindset they perceived from coaches and support staff. They discussed their experience with the internal support network of coaches, the athletic department, and sport psychology. Participants remarked on their external support network, which included their family, friends, and psychological services. The resources available at their institutions and their accessibility were perceived both positively and negatively. Some collegiate SAs described resources as helpful, whereas others portrayed a lack of timeliness for appointments, lack of advertisement, incomprehension by counselors of athlete demands, and no sport-specific counseling as barriers. Conclusions: Collegiate SAs expressed mental health concerns due to stress and the demands of sport participation. Self-regulated coping strategies and support networks continue to be powerful and helpful resources for mental health, with or without a diagnosed condition. Barriers to mental health service use were a lack of sport specificity and lack of access. Institutions need to focus on creating athlete-centered mental health resources with annual advertisements to increase use.

Context: Transgender student-athletes are increasingly participating in sport, requiring athletic trainer (AT) preparedness to care for their needs. Objective: To measure ATs' (1) perceived definition of transgender, (2) comfort and competence working with transgender student-athletes, (3) sources of education, (4) perceived legal concerns, and (5) perception of competitive advantage. Design: Cross-sectional study. Setting: Mixed-methods survey. Patients or Other Participants: Collegiate or university ATs (n = 5537) received an email invitation to participate; the data of 667 ATs were included in the analysis. Main Outcome Measure(s): A multipart 43-item questionnaire addressing the primary objectives of the study, with other factors that were explored in relation to these objectives to uncover potential influences on their responses. We calculated descriptive statistics, and for open-ended responses, we used the consensual qualitative research tradition. Results: About half (48.1%, n = 321) of the participants agreed they were competent in treating transgender patients, but only 36.0% (n = 240) believed they were competent in practicing collaboratively with an endocrinologist in the drug-screening processes. Fewer than half (45.6%, n = 304) of participants felt they were competent in using appropriate terminology relating to transgender patients. The ATs disagreed when asked if they were competent regarding counseling transgender patients about the effects of hormone replacement therapy on sport participation (48.1%, n = 321) or on mental health concerns (40.3%, n = 269). Participants learned most frequently from media outlets (35.2%, n = 235) or personal experiences with family, friends, or themselves (33.7%, n = 225), yet 35.1% (n = 243) received no education in caring for transgender patients. Many ATs (41.2%, n = 278) believed that transgender female student-athletes had a competitive advantage. In contrast, 6.6% (n = 44) of participants indicated that transgender male student-athletes had a competitive advantage. Conclusions: Although collegiate ATs generally felt competent in treating transgender patients, they did not feel capable of addressing specific aspects of transgender patients' health care needs. Regardless of the resulting perceived unfair advantage, ATs must be aware of the regulations and therapeutic effects associated with hormone-related therapy for transgender student-athletes.

Context: Standardized patient (SP) encounters have been incorporated into many healthcare education programs, including professional athletic training programs, yet there is little exploration about the use of SP encounters in postprofessional programs and continuing education opportunities. Objective: To explore athletic trainers' translation of skills and reflections in clinical practice after an SP encounter and debriefing session. Design: Qualitative action research. Setting: One-on-one interview. Patients or Other Participants: Fifteen learners from the same postprofessional athletic training degree program (males = 3, females = 12; age = 25 ± 5 years; certified experience = 3 ± 3 years) without previous SP experience participated in this study. All learners had to be employed full or part-time in a clinical setting. Main Outcome Measure(s): Sixty days after an SP encounter related to patient-centered care during an orthopedic evaluation and subsequent debriefing session, participants completed an online, audio-only interview after a 10-question, semistructured interview protocol. A 3-person primary coding team identified domains and categories using the consensual qualitative research tradition. Results: Three main domains emerged from the study: (1) limitations of a novice SP experience, (2) practice transformation, and (3) promoting self-reflection. Participants reported that the initial SP encounter in their postprofessional education was a new experience through which they were able to implement new skills learned in their previous courses. Translation of newly learned ideas or ways of thinking to clinical practice varied among clinicians and their job settings. Collaborative thinking and self-reflection were key components. Participants were able to identify with their classmates' struggles and triumphs and to take away new learning experiences. Conclusions: SP encounters are a useful instructional and assessment technique for athletic trainers in a postprofessional athletic training degree program to promote self-reflection and to translate newly learned skills to their clinical practice, while nerves and anxiety influenced the learners' ability to suspend reality.