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Athletic Training Skill Check Off - PowerPoint

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					Athletic Training Clinical
      Proficiencies
                   By
        Sue Shapiro, Ed.D.,L/ATC
Clinical Coordinator/Assistant Professor
            Barry University
          Miami Shores, Florida
              Objectives
   Implementation of clinical
    proficiencies
   Linking the didactic and clinical
    components
   Clinical proficiency delineation
   Integrative evaluation
    strategies/tools
Competency-Based Objectives
Nothing becomes real for the student
      until it is EXPERIENCED
   CROSSING THE
      BRIDGE



HOURLY   COMPENTENCY
BASED       BASED
Competency-Based Instruction

    Identifies the professional roles
     students will assume upon
     completion
    Determines what constitutes
     effective performances within
     these roles
   Learning Cognitive
Information in Isolation
Merging of Didactic and
 Clinical Components
Flexible Clinical Scheduling
     is a Prerequisite to
    Competency-Based
         Progression
         Flexible Clinical
       Scheduling Should:
   Provide open laboratory practice
   Encourage advanced students to
    practice and teach fellow students
    in a controlled environment other
    than the clinical setting
        Clinical Proficiency
            Preparation
First Phase



Formulate    a student portfolio
Student Portfolio Matrix
       Clinical Proficiency
           Preparation
Second Phase


Formulate  a matrix of the
 didactic courses in the athletic
 training program
Didactic Course Matrix
Didactic Course Matrix
        Clinical Proficiency
            Preparation
Third Phase


Formulation   of Clinical Hours
 Matrix
Clinical Hours Matrix
        Clinical Proficiency
            Preparation
Fourth Phase



Clinical      Proficiency Matrix
Clinical Proficiency Matrix
Clinical Proficiency Matrix
Clinical Proficiency Matrix
     Clinical Proficiencies

Individual skills
Subset   skills taught together
        Lower Extremity Clinical
              Proficiency
Individual Subset Skills:       Grouped Subset Skills:
   Pelvic obliquity             Lower Extremity
   Tibial torsion
                                  Postural Deviations
   Hip anteversion and
    retroversion                  and Predisposing
   Genu valgum,varum, and        Conditions
    recurvatum
   Rearfoot valgus and varus
   Forefoot valgus and varus
   Pes cavus and planus
   Foot and toe posture
Good Posture                               Part               Faulty Posture                    I   NI
l. Legs are straight up and down.         Knees and legs   1. Knees touch when feet are apart
                                                           (genu valgum)


2. Patellae face straight ahead when                       2. Knees are apart when feet
feet are in good position                                  touch (genu varum)

3. Looking from the side the knees                         3. Knee curves slightly
are straight (i.e. neither bent forward                    backward (hyperextension
nor “locked” backward)                                     knee or genu recurvatum)
                                                           4. Knee bends slightly forward
                                                           or not as straight as it should be
                                                           (flexed knee)
                                                           5. Patellae facing slightly
                                                           toward each other (medial
                                                           rotated femurs and/or snake
                                                           eyes)
                                                           6. Patellae facing slightly
                                                           outward (lateral rotated femurs
                                                           and/or frog eyes)
l. In standing, the longitudinal arch         Feet         l. Low medial longitudinal arch
has the shape of a half dome                               or flatfoot (pes planus)

2. Barefoot or in shoes without                            2. High medial longitudinal arch
heels, the feet toe-out slightly                           (pes cavus)

3. In shoes with heels, the feet are                       3. Weight borne on the inner
parallel                                                   side of the foot making ankle roll
                                                           in (pronation)
4. In walking the feet are parallel              4. Weight borne on the outer
and the weight is transferred from               border of the foot or the ankle
the heel along the outer border to the           rolls out (supination)
ball of the foot
5. In running, the feet are parallel or          5. Toeing-out while walking or
toe-in slightly. The weight is on the            standing (forefoot valgus,
balls of the feet and toes because the           outflared or slue-footed)
heels do not come in contact with
the ground
                                                 6. Toeing-in while walking or
                                                 standing ( forefoot varus or
                                                 pigeon-toed)

                                                 7. Posterior calcaneus rolls
                                                 inward ( rearfoot valgus)

                                                 8. Posterior calcaneus rolls
                                                 outward (rearfoot varus)

1. Toes should be straight, neither       Toes   l. Toes bend up at the first joint
curled downward nor bent upward                  and down at middle and end
                                                 joints so that the weight rest on
                                                 the tips of the toes (hammer
                                                 toes)
2. Toes should extend forward in                 2. Big toe slants inward toward
line with the foot and not be                    the midline of the foot (hallus
squeezed together or overlap                     valgus)

                                                 3. Second toe longer than 1st toe
                                                 (morton foot)
                        •Pelvic Obliquity
  Purpose: To identify abnormal pelvic alignment that can lead to leg length discrepancies.

  Proper Identification Procedures for Pelvic Obliquity:
  The ACI will observe the student athletic trainer performing a pelvic obliquity check.


 Patient should be bare foot with the knees fully extended and the
 feet together.

 The ASIS and iliac crest should be exposed for viewing


 Ask the athlete to stand facing away from the examiner


 Examiner places a finger or two of each hand on each of the
 athlete’s iliac crests and imagines a line drawn between the two
 crest
 Pelvic obliquity is present when this imaginary line is not parallel
 to the floor

 Leg length discrepancies should be investigated at this point

Completed Pelvic Obliquity Observation                                   Pass    Fail
 •Hip Anteversion and Retroversion
 Purpose: To identify abnormal rotational malalignments of the femur in relation to the femoral neck.

 Proper Testing for Femoral Rotation The ACI will observe the student athletic trainer performing
 observational and orthopedic testing of the hip for anteversion and retroversion.

                                                                                               P     NP
The athlete should be viewed from the front with the knees facing forward. The
examiner should observe abnormal toeing in or toeing out of the feet. An athlete
with increased femoral anteversion tends to stand with the limb in an internally
rotated position, producing in- toeing. While the athlete with decreased femoral
anteversion or femoral retroversion tend to stand with the limb in an externally
rotated position, producing out-toeing.
Next, perform a Craig’s Test to estimate the amount of femoral anteversion present.
The athlete is placed prone with the ipsilateral knee flexed to 90 degrees.
The examiner palpates the lateral prominence of the greater trochanter with one
hand while controlling the rotation of the limb with the other.

An imaginary vertical line serves ad the reference for this test. The limb is then
rotated until the lateral prominence of the greater trochanter is felt to be maximal.

The angle made between the axis of the tibia an the vertical is considered an
approximation of the femoral anteversion. Normal anteversion is between 8 degrees
and 15 degrees.
Completed Testing for Anteversion and Retroverson                                       Pass       Fail
      Important Aspects of
     Proficiency Delineation
l. The process is descriptive and not
    prescriptive
2. Assignment of importance of each subset
    in the delineation
      Important Aspects of
     Proficiency Delineation
3. Assignment of Successful Mastery of
  Clinical Skill
 % of Mastery needed to pass
 Particular subsets that must be completed
 # of times a student can attempt test
 Should students be allowed to progress to
  next level if he/she doesn’t successfully
  complete proficiencies at one level
Integrating Components



    INTEGRATED COMPONENTS
INTEGRATING COMPETENCY
BASED CLINICAL EDUCATION
 Competency    based clinical
  education is a group effort
 Don’t want student to become
  check off artist
           Team Teaching
The coordinated and
cooperative planning,
teaching, supervision,
and evaluation of a
group of learners by 2
or more instructors,
each having special
competencies and
knowledge in a
specialized area.
        Success of Team
      Teaching Depends on
   Instructors working in cooperation and
    communicate as allies
   Everyone involved is responsible for
    developing the objectives, instructional
    methodologies and evaluation
   Multiple instructors can evaluate clinical
    competencies with high degree of
    consistency
INTEGRATING COMPETENCY
BASED CLINICAL EDUCATION
 Competency    based clinical
  education is a group effort
 Don’t want student to become
  check off artist
 Student’s need to be able to
  THINK-IN-ACTION
Students need to learn to

    THINK -IN-ACTION
            &
  REASON-IN TRANSITION
LINKAGE OF EVALUATING
        SKILLS
Experiential learning does not
    occur without active
        participation
          It requires:
   Engagement in the situation
      Problem Solving
Integrative Evaluation Tools


       NARRATIVES
       ALGORITHM
  Algorithm Evaluation
Blueprint or diagrams that lead a
student through a step by step
process of how to perform a
certain set of tasks in an organized
fashion taking into account that
the procedure will change or take
a different path based on the
finding at any giving point
INTEGRATING COMPETENCY
BASED CLINICAL EDUCATION
 Don’t want student to become check off
  artist
 Student’s need to be able to THINK-IN-
  ACTION
 Emphasizing linking process and content
  LINKING PROCESS
    AND CONTENT



CONTENT    PROCESS
INTEGRATING COMPETENCY
BASED CLINICAL EDUCATION
 Don’t want student to become check off
  artist
 Student’s need to be able to THINK-IN-
  ACTION
 Emphasizing linking process and content
 Individualization is very important in
  competency based programs
INDIVIDUALIZATION
                  Individual
                   Abilities

 CLINICAL   =        +
COMPONENT
                Learning Styles
       Individualization
Allows each student to go
through the integrative process:

     At his/her own content level
     Pace the learning at their
      own rate of speed.
The Sculpturing of a
   Professional

				
DOCUMENT INFO
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