Article reposted from iPetitions
Author: Paul Geisler
Date: July 19, 2016
To: NATA Board of Directors, NATA Executive Committee for Education, NATA Education Advancement Committee, and NATA Professional Education Committee
Re: Grave Concerns for the future of the Athletic Training Profession
From: Concerned Athletic Training Professionals
Given the current events and conversations regarding the transition to the master’s degree and the newly proposed CAATE Standards and educational content, we the undersigned wish to take this opportunity to express our collective concerns and apprehension for the future of our educational organization, programs and larger profession.
Specifically, we wish to bring to your attention that we are troubled by some of the recent practices employed and working documents intended to direct and structure our impending transformation to the professional master’s degree in Athletic Training and the future of our profession.
SYNOPSIS of KEY POINTS:
1. It is our opinion that many of the newly proposed standards for educational content far exceed most, if not all state practice act guidelines and specifications, and if approved establishes a dramatically new professional scope of practice and body of knowledge for athletic training, without compelling evidence or rationale to do so and without full consideration of the many legislative, professional and interprofessional domino effects likely to occur as a result.
2. Many of the newly proposed skills and knowledge standards clearly “belong” to other healthcare practices (mostly medicine), and bring with them drastic increases in both responsibility and liability for athletic trainers. If accepted/implemented, they indicate a clear and aggressive expansion of our “claimed” body of knowledge and professional practice, all without the disciplinary or professional legacy for doing so.
3. Some of the mechanisms and positions projected by the CAATE have been poorly communicated and authenticated to the larger professional body, especially as it has regarded seeking, implementing and reporting relevant evidence or professional consensus and insight from interested and vested parties (on a large and representative scale). It is not “change” and progress that concerns us, but rather we are deeply concerned with “how” future change has and is being implemented by a very small minority of professionals working on behalf of us all, the larger profession.
Detailed Issues of Concern:
A. Directionally, we are at a minimum concerned with the following issues, proposals or intentions inherent within the 2 CAATE standards documents (SD1 =Operational, SD2 = Curricular Content) currently open for review and commentary by the professional body:
1. Significantly expanded Clinical Education Standards (#22, 23, 24 in SD1) that not only significantly stretch program resources and potentialities, but also greatly expand our professional domains and practice. Requiring AT programs to provide clinical experiences for all students in occupational, leisure, military, industrial settings (23), and to provide “sufficient experiences” in a truly authentic medical rotation/location (24) further implies a stretching of our domain of practice and expertise and infringes upon other health care professionals and their well established scopes and professional bodies of knowledge, and target patients. In order for those myriad experiences to be of authentic value and meaning for our students, the educational components required to prepare students for more intense general medical and occupational medicine (for example) are significant and for the most part prohibitive, given the existing depth and breadth of the requirements. As an aside, the central job of entry-level education is to create competent clinicians that can quickly progress to greater levels of expertise and acquire job specific skills and knowledge germane to the setting and expectations; and to prepare them for “post professional” or “advanced” education in chosen domains of practice. These new standards go well beyond our basic and traditional scope of practice and place significant and undue burdens on educational programs and educators. Competent clinicians are competence clinicians—they are capable of performing the skills sets and have the knowledge to effectively carry out the domains of practice in which they are trained (i.e., low back pain in an athlete requires the same base and applied skill set to manage low back pain in a military athlete or industrial patient, only with a different context and the application of sound clinical reasoning); on the job training is different than entry-level training and competent clinicians can adapt and transform their skills and knowledge for various populations upon graduation. In short, the entry-level education system cannot possibly educate all students for all possible jobs, all possible skills sets, or an ever increasing and expansive body of medical knowledge. Ironically, the NATA continues to support specialty certifications and the CAATE continues to accredit specialized residencies, indicating a clear need, time and place for more specific and advanced skill sets for athletic trainers interested in, or needing such skills for their vocational settings and aspirations.
2. Standard 35 (in SD2) calls for competence and decision making skills with “…blood work, urinalysis, and EKG/ECG” diagnostics. The amount of time and practice it takes to become “competent” in these skills far surpasses the structure and scope of entry-level athletic training. Further, it is yet another example of propositionally expanding far beyond our professional borders and into territories of other, established and legally entitled professions with FAR more education than ATs. In short, many of these are skills and knowledge central to medical practice writ large; and medicine, nursing and PA are sure (and right) to have serious concerns and complaints with this proposed expansion of scope of practice at both state and federal levels. At a time in which we are also asking for our healthcare colleagues to work with us on IPE and IPP initiatives and training, we find it problematic that on one hand we want to cooperate with them, and on the other we want to “do what they do”.
3. In our opinions, proposing that we teach future ATs to “ID and select appropriate pharmacological agents…” (39) and to “give medications…” (40) (both in SD2) effectively equates the prescribing and administration of OTC and/or prescription medicines, or in other words,practicing medicine. The medical, pharmacology, nursing (NP) and physician assistant (PA) associations and professions and state legislative bodies will be extremely (if they already are not) disturbed to see that we are intending to venture into these practice domains (not to mention the FDA, or the DEA). Not only will these standards open up the existing 48 AT state practice acts with contentious challenges and opposition from other professional and legislative bodies, costing hundreds of thousands of dollars per state, but it will also put the entire AT educational process and mechanism under intense pressure and scrutiny by our healthcare colleagues and elected officials (and with good reason). Further, even if it were professionally appropriate for ATs to be choosing and administering prescription medications, there is a practico-educational component that bears attention, as well—AT programs don’t have the time or space to adequately and competently educate “entry-level athletic training students” in the knowledge required to be proficient in these 2 Pharm standards, as this would clearly require AT LEAST 8-12 credit hours of chemistry pre-requisite coursework (Gen Chem, BIOChem, OrgChem), and likely another 8-12 credit hours of actual pharmacology knowledge and practice in the professional phase.
4. Standard 41 (SG2) calls for the inclusion of cardiovascular pharmacology skills, joint reductions, and suturing to be added to our educational package. This too would create additional professional domains of practice for AT that far exceed current practice, and if required, these would demand extensive knowledge and training that most AT programs would find very difficult to implement or do well. Knowing and using drugs for the myriad cardiac conditions is indeed a dangerous and high-risk arena to be in without adequate training and expertise. Performing reductions without pre/post imaging is dangerous and problematic with many joints (elbow, hip, ankle, knee), and suturing without pain reducing medication (injections) is inhumane, introduces serious risk of infection and tissue damage and can be accompanied by serious cosmetic issues in aesthetically pertinent areas and contexts. All of these proposed new skills are clearly outside the current scope of practice for most Entry-level athletic training contexts (except for those ATs working under the supervision of an MD who has taught and authorized them to perform, and if they are in a state whose practice act allows such practice) and are clearly strong and legitimate points of conflict for many state practice acts. Further, they place at risk our established but tender “interprofessional relations” with PT, medicine, PA and nursing (at least). At the risk of repetition, skills like these that happen legally and under MD supervision are further examples of advanced or specialty training, and in our opinion do not belong under the banner of entry-level athletic training.
5. Together, the proposed “content” standards in SD2 (and highlighted above) represent a fairly radical expansion of skills, knowledge and practice for athletic training—both educationally and professionally. We are not opposed to logical and strategic growth for the profession and are not advocating for stagnation, but this expansion of our professional “body of knowledge” into other professional domains, across many boundaries and well beyond our legal, established and historical scope represents to us a shortsighted and dangerous attempt to expand our profession, to become “something else”, something that we are not. At best, these proposals are clearly blurring the lines between “entry-level practice” and “advanced practice”, calling for ALL future athletic trainers to become competent with ALL possible job settings, tasks and domains of practice (a futile effort). At worst, they are calling for a completely new scope of professional practice, one that dangerously embarks into much deeper and more expanded exercises associated with the larger practice of “medicine”. In fact, it can even be said that these collective proposals (both documents) are passive calls for athletic trainers to completely remove their selves from the “under the supervision of a physician” clause that constitutes and undergirds at least 48 different state practice acts (thus becoming an NATA Code of Ethics issue?). For representatives of the CAATE and its various subcommittees to ignore or dismiss legislative concerns over our current and future practice acts, and how or if they will be impacted is in our view, short sighted, naïve and disrespectful to our health care colleagues, our legislative bodies and our public with which we have a social contract. Not only do we question the proposed and vast expansion of domain strategy in the name of “why not”, but the practical and legal aspects are equally troubling, as well. If approved and put into motion, all 48 state practice acts will be open for considerable scrutiny and debate, which can very likely turn into an extremely costly and vulnerable risk for our profession. It is conceivable that in the end, this multipronged border crossing will backfire upon the athletic training profession and its many dedicated and highly competent practitioners. We find it ironic that our profession has debated on several occasions now, and has subsequently put to bed the argument over our professional “name”, yet here we are now considering to add additional amounts of “medical” skill and knowledge to our educational and professional bodies; all without any sort of evidence or compelling rational for doing so. Further, in this evidence-based culture that we are actively embracing, we find it bothersome that very few of the proposals under discussion can be considered as “evidence-based” or informed.
B. Operationally, we are also concerned with the following issues surrounding the communication, construction and proliferation of the new and proposed direction for the MS degree requirements and construction:
1. Once the decision to transition to the MS degree was made and despite the various exigencies related to that process, it was widely promoted to the professional body that doing so would in sentiment and practicality a) respect program autonomy and creativity, b) allow us to slow down our educational processes in order to “educate better”, c) have more time to fill in some gaps in our curricula and procedures, and d) do a better job of producing more expert clinicians. Yes, there were inevitably going to be some additions, some professional growth (like clinical research and immersive clinical education), but nowhere was there widespread or open discussion of an impending or desired significant expansion in content or scope. Nowhere do we recall seeing or hearing a conversation about changing who we are, or what we do. The promise of moving to an MS degree was largely sold upon the idea that “we could have more mature students for a longer time”, “we could develop ‘slower’ and deeper curricula”, “we could provide room for program creativity and marks of distinction”, and “to increase retention and professional commitment”; all so that we could do a better job of educating future athletic trainers with all that we require now (plus a few additions). Given the concerns outlined with the new knowledge and skills being proposed in SD2, and the expanded policies for clinical & didactic education proposed in SD1, we feel as though we are not currently being presented with what was promised once the MS degree transition was announced, but rather a whole new degree, curricular structure, and professional vision and scope, one being articulated seemingly and more disturbingly by a very small groups of individuals in our profession. Our stance is that all programs need to make the transition to the MS degree level and have time and autonomy to fine tune our programs BEFORE we start making multiple and significant changes to the content and structure of our professional curriculums.
2. After the degree decision was made by the Strategic Partners the subsequent stages of decision making are less clear to the membership. To our knowledge, not very many established professional educators and programs were consulted to ascertain what the new MS degree should do, and not do; to ascertain what works, and what does not work; to find out what we should keep and what we should leave behind; to help paint the picture of what the new MS degree in AT could look like. To our knowledge, large, representative samples of established EL educators or scholars were not consulted about new directions, effective methods, or critical gaps that need to be filled; nor are we aware of any kind of self-study conducted to first see how we might best go about transitioning in an evidence-informed, consensual manner. Further, we don’t recall seeing or receiving an open call, ballot process or distributed volunteer process for interested and qualified education professionals to get involved in the work that needed to be done, or for opinions to be sought and assessed (before the 2 standards documents appeared). In short, we are disappointed that this entire process is apparently being driven by what amounts to a couple of “ghost” committees within the CAATE, that to be frank and with no disrespect directed at those involved in the process, most people have no idea about the constitution or make-up of those committees, or how or when they came to be. It may just be the “optics” of it all, but even then it is safe to say that very few AT educators were brought into the loop on this process and thus, we are largely feeling as though we are not “part of the process”, at least not from the ground up.
3. Intentionally or not, the CAATE effectively employed a “divide & conquer” strategy at the most recent 2016 NATA Convention by failing to set, notify and advertise the meeting times, places, and details of opens sessions that were promised to be part of the “democratic process” on the transformation issue. Emails were not received by MANY AT educators regarding the time, day, or location of open CAATE sessions, the details were not printed in the Convention manual (as it always has been), sessions were limited to 1-2, 60’ on the admin standards and 2, 60’ sessions on the content standards, a registration process was required, the room chosen was small with limited seating available, and the events were not even held in the Convention Hall (preventing passerby and drop in awareness). For the magnitude and depth of the issues at hand, the opportunities to communicate with CAATE on the MANY complex and bothersome issues was woefully conceived, communicated and conducted. In the end, FAR too many athletic trainers were denied ample opportunity to be heard, or to listen to the critical issues at hand; to take part in the conversation.
4. Given that the larger professional body of athletic trainers was not privy to all of the commentary submitted to the CAATE during their open comment on the MS Degree or how that data was processed (precedent), we are now concerned with what will happen with commentary provided for SD1 and SD2, and quite frankly do not fully trust what will transpire with the subsequent commentary data that is/will be provided by the professional body on version 1 of the standards, and how that data will be tabulated and incorporated into subsequent steps. Because of the gravity of the situation, the implications for our collective future practice, and because of the considerable vested interests we posses as professionals and educators, we feel that this critical data should be made available in some form to the public (professional body of ATs) as soon as it has been tabulated and condensed into such a format.
Given these considerable concerns and perspectives, we the undersigned ask that the members of the NATA Board of Directors, the ECE, EAC and the PEC take into consideration the concerned voices of the many, of the hundreds of dedicated and committed professionals that make up the athletic training profession, and that you seriously ponder what our collective futures might look like before allowing the CAATE to move forward with its current proposals and the future it has tentatively chartered. We hereby ask that the NATA BOD take up this petition for conversation and consideration, and that subsequently the BOD consider both the sentiment and content of this petition in immediate conversations with any and all professionals currently engaged with the transition process.
Respectfully signed and submitted, Athletic Trainers Concerned for our Future