Athletic Training Preceptors' Perceived Learning Needs Regarding Preceptor Development

Study Design

This cross-sectional study used an online survey, the Preceptor Needs Assessment, to ascertain preceptors' development and learning needs. The university's institutional review board approved the study.

Participants

A total of 79 preceptors (age = 31.66 ± 8.63 years, male = 32, female = 47, years certified = 9.46 ± 8.27, years as a preceptor = 6.08 ± 5.88) affiliated with professional level programs in National Athletic Trainers' Association District 4 completed this study. All participants who responded were athletic trainers and supervised 2 or 3 students on average at one time. Information regarding the participants' current practice settings and educational background can be found in Table 1. To recruit participants, all athletic training program directors in the district (N = 80) were contacted via e-mail and asked if they would be willing to disseminate the survey to their program's current preceptors. The e-mail included the following information: the purpose and importance of the research study, a request for participation, and a Web link to the online survey. We asked program directors to respond to the initial e-mail with the number of preceptors to whom they forwarded the information to help calculate a response rate. Eighteen program directors (22.5%) indicated they would pass the information on to 323 preceptors. Reminder e-mails were sent to all program directors and subsequently forwarded to the preceptors every 2 weeks for a total of 6 weeks. The 79 respondents represent a 24.5% response rate.

Table 1.  Participant Practice Settings and Educational Background

Abbreviation: AT, athletic training.

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Instrumentation

The research team developed the Preceptor Needs Assessment using current research that assessed preceptor development to guide the conceptual framework.^7,9,11 In the Preceptor Needs Assessment, we included items preceptors identified as important to discuss during preceptor development,⁹ as well as items identified by athletic training program directors as important to consider when selecting and developing preceptors.⁷ We created the Preceptor Needs Assessment to identify topics preceptors perceived to be most helpful if they were to be included in a preceptor development workshop. The survey included 5 sections: (1) Teaching and Learning in the Clinical Setting, (2) Evaluating Students, (3) Communication, (4) Student Development, and (5) Mentorship. Each section had numerous statements (ranging from 3 to 22) related to topics that could be included in a preceptor development session. Preceptors were asked to rate each topic using a 3-point (1 = not helpful, 2 = somewhat helpful, 3 = very helpful) Likert scale on how helpful that topic would be to them if it were included in a preceptor development session. In addition to the Likert scale items, preceptors were asked to identify any other topics they felt would be helpful to add to preceptor development. Preceptors also answered a variety of demographic questions at the end of the survey.

Once the Preceptor Needs Assessment was developed, we sent it to a panel of 5 athletic training preceptors (3 female, 2 male) to evaluate the content validity, comprehensiveness, and completion time. Members of the panel represented both the college/university and high school settings, and had 1 to 20 years of experience as a preceptor. Panelists were asked to rate each item of the survey on a scale of 1 to 3, with 1 indicating the item is clear and relevant to the instrument, 2 indicating the item is not relevant to the instrument, and 3 indicating the item is unclear/I don't understand this item. Scale items that were rated 2 by more than 1 panelist were removed, and items rated 3 by more than 1 panelist were revised and amended as necessary. The panel recommended 10 of the items be clarified using examples or altered wording, and 1 item was deleted entirely because it was deemed redundant with another statement. Some concepts within the sections of the survey were reorganized based on preceptor feedback to help improve the continuity of the survey. Internal consistency for each section of the survey was established with a Cronbach α, with resulting values ranging from α = 0.720 to α = 0.932 (Table 2). Standards published by Bland and Altman¹² indicate reliability for all sections is considered acceptable.

Table 2.  Internal Consistency Values for Each Survey Section

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Data Analysis

The Preceptor Needs Assessment was delivered online via Qualtrics (Provo, UT), and all responses were collected within the software and stored on a university server. At the completion of data collection, survey responses were generated in IBM SPSS for Windows (version 22; IBM Corp, Armonk, NY). Descriptive statistics were used to examine the data through means, SDs, and frequency values. Means were calculated for each section of the survey and for each individual topic. Differences in perceived need of preceptors of various demographic variables including work settings, gender, years of clinical experience, and number of students supervised at one time were assessed with a χ² analysis. Statistical significance was set a priori at P ≤ .05. Responses to the open-ended question were tallied, categorized by concept, and then recorded.

Teaching and Learning in the Clinical Setting

The individual topics rated most helpful, developing students' critical thinking skills and teaching clinical decision making, each came from the Teaching and Learning in the Clinical Setting section of the survey, indicating preceptors would find information regarding different instructional methods and strategies helpful. Preceptors should be prepared to serve as teachers, and research suggests that they already use a variety of teaching strategies.^13,14 The results from our study support the idea that the ability to teach is important to preceptors, and that they are interested in strategies to further develop their abilities to promote critical thinking, develop their students, and teach clinical decision making. This finding is further supported in pharmacy education, as residents reported teaching ability as a central component of serving as a preceptor.¹⁵ Similarly, athletic training preceptors often use a variety of teaching strategies with their students in the clinical setting, including hands-on activities and asking a variety of clinical questions.¹³ Additionally, clinical case discussions,¹⁶ encouraging student reflection,¹⁷ and questioning have been used as methods of developing critical thinking skills.¹⁸ Providing preceptors with specific strategies to help develop their students' critical thinking skills could help them better understand the techniques they already incorporate into their clinical teaching and provide additional methods for developing students.

By creating a supportive, dialogic learning environment, preceptors are able to provide students with opportunities to engage their knowledge and skills in a way that allows them to develop critical-thinking and decision-making skills.^16–18 Preceptors can guide discussions about patient cases with their students,¹⁶ as well as pose questions regarding those cases that encourage students to analyze the information and come to a decision.¹⁸ One suggested method for facilitating discussion between preceptor and student is the One-Minute Preceptor method.^19,20 This teaching method is designed for preceptors to use with their students and uses 5 microskills (ie, encouraging students to commit to a diagnosis early in the conversation, asking specific questions regarding the support the student used to come that decision, teaching general rules, reinforcing what the student did correctly, correcting student mistakes).^19,20 As the preceptor-student interaction continues, preceptors are encouraged to provide students with positive reinforcement regarding appropriate behavior (eg, acknowledging when a student performs an evaluation correctly), as well as to correct other mistakes, such as improper hand placement during a selective tissue test.^19,20 Teaching preceptors this One-Minute Preceptor behavior model can help them use their time efficiently, have more effective student interactions, and improve their overall teaching behaviors.²⁰

Participants also rated “teaching students to incorporate evidence-based practice in patient care during clinical experiences” as a helpful topic in the Teaching and Learning in the Clinical Setting section. Previously, athletic training preceptors have reported that they use techniques such as encouraging critical thinking to help students implement evidence-based practice concepts to defend the choices they make in the clinical setting by examining and applying the information they had previously learned.¹⁴ Furthermore, encouraging preceptors and students to answer clinical questions together may increase student motivation to incorporate evidence-based clinical decision making in their practice.²¹ We recommend including content in a preceptor development session that provides preceptors with examples of how to incorporate both clinical decision making and the use of evidence-based practice in their approaches to educating students. This content could include information on how to use questioning in the clinical setting and how to facilitate discussions that require students to critically reflect on the information they are learning in the classroom. Similarly, content might include principles from the previously mentioned One-Minute Preceptor teaching method in which preceptors are taught to question the student as to his/her thought processes more so than specific content knowledge (ie, probing for specific evidence).^19,20

Evaluating Students

Our participants rated Evaluating Students as the overall most helpful section of the survey, and within that section, “judging a student's readiness to handle different situations” and “formally evaluating students' clinical skills and professional behaviors (ie, end of the semester evaluations)” were the topics rated as most helpful. Because student evaluation strategies can vary by program, assessing student competence and skill can be complicated²² and somewhat subjective.²³ For this reason, we recommend program administrators ensure their preceptors understand the evaluation procedures and the purpose of those evaluations. Altmann²⁴ reported that “student performance evaluation methods” was the topic most commonly addressed in nursing education preceptor development sessions. She suggested that because patient education principles are taught throughout professional nursing education it may be assumed preceptors already understand the basics of teaching.²⁴ Preceptors may feel they can teach but are less confident in their ability to evaluate performance. This may explain why our participants rated student evaluation as the most helpful section of the survey. Similarly, 57% of respondents in a survey of respiratory therapy program directors rated “assessment/evaluation of clinical performance” as the most important need in preceptor development.²⁵ Athletic training program directors also believe a preceptor's ability to evaluate students is of great importance.²⁶ Both program administrators and preceptors see student evaluation as an important component of serving as a preceptor,²⁶ but program administrators may value it more highly than preceptors. This could be due to the link between student evaluations and overall education program assessment, which may hold greater value to program administrators than preceptors.²⁶ Therefore, collaboration and communication between preceptors and faculty are imperative²⁶ to ensure preceptors fully understand the purpose of student evaluations to effectively evaluate student performance. Because the evaluation process can vary greatly across institutions, continual education on a program's evaluation process is necessary to ensure that students are receiving appropriate feedback and the program is obtaining the desired data to assess student progress through the clinical component of the program.

Also in the Evaluating Students section of the Preceptor Needs Assessment, our participants indicated “judging a student's readiness to handle different situations” as being helpful. There is no current standard method to judge a student's readiness to progress in athletic training education. One emerging strategy in medical education for gauging student readiness is an entrustable professional activity (EPA). An EPA is an activity of daily practice that medical residents are expected to successfully perform throughout their residency.^27,28 In athletic training education, EPAs could be used throughout clinical experiences as students are exposed to new concepts in the classroom to determine if a student can be trusted to successfully complete a task or handle a situation (eg, perform an orthopaedic evaluation of a knee). Entrustable professional activities follow 8 specific characteristics that help differentiate them from traditional competencies.²⁷ Three of these characteristics are that EPAs “must lead to recognized output of professional labor,” “should be executable within a time frame,” and “should be observable and measurable in their process and their outcome, leading to a conclusion (‘well done' or ‘not well done').”^27(p1177) Although competencies tell us whether or not a student can perform a certain skill correctly, EPAs can provide more information regarding a student's ability to apply those skills in real-time situations. In this regard, they are like the current clinical integration proficiencies used in athletic training education. However, EPAs can be also used to determine if a student can be trusted to perform a skill independently, whereas clinical integration proficiencies are typically assessed during real-time patient encounters.²⁷ Entrustable professional activities are potential tools for athletic training educators and preceptors to use to help determine student competence and readiness to handle clinical situations. Further research is necessary to determine which EPAs would be needed for athletic training students before allowed to complete a skill independently. Before their implementation in clinical education, preceptors should receive thorough training on the use and assessment of EPAs.

Communication and Student Development

Preceptors also identified “building student confidence,” “helping students develop meaningful goals,” “providing constructive feedback to students,” and “challenging students while being supportive” as moderately helpful. Communication and promoting student development are the underlying themes of these topics. It is possible that preceptors rated these concepts not as helpful as others because they are similar to interpersonal skills athletic trainers use during daily patient interactions. Developing goals, providing feedback, being challenging as well as supportive, and helping patients build confidence are all integral components of clinical practice for athletic trainers. One of the most integral components of the preceptor/student relationship is feedback, which can be both complex and dependent on the situation.^29,30 Athletic training students have reported that feedback from preceptors regarding their performance and skills was one of the most helpful preceptor behaviors during their clinical education.³¹ The importance of providing student feedback has also been documented in education programs in pharmacy,^15,30,32 respiratory therapy,²⁵ medicine,³³ and nursing.³⁴ The topics these participants indicated would be moderately helpful are largely rooted in providing feedback in many of its forms. Each time a preceptor provides a student with feedback it can be considered as a feedback encounter. These encounters are made unique by several characteristics, including the purpose of providing the feedback, the timing, the content and specificity of the feedback provided, and the level of privacy of the encounter.²⁹ Helping preceptors understand feedback and develop the ability to provide feedback by including discussions and/or scenarios during preceptor development sessions could help preceptors implement more effective approaches to providing student feedback during clinical education.²⁹

Mentorship

The Mentorship section of the survey was rated the lowest of all sections. Why preceptors rated this section lower than any of the others could be due to the variety of statements within the section, as some of the concepts specifically referred to the preceptor serving as a mentor whereas others addressed concepts related to the preceptor finding his/her own mentor. Omansky³⁵ described the role of a preceptor as guiding students from theory to practice, promoting critical thinking skills, and serving as a role model. Preceptors in our study indicated that they would find topics on “how to serve as a positive role model” and “being a mentor versus being a supervisor” as somewhat helpful. These are important concepts to nurture, because athletic training students have previously indicated providing support and interacting in a positive, confidence-building manner were helpful preceptor characteristics.³¹ Additionally, students were more likely to rate preceptors who served as a role model and were interested in teaching as excellent.³² Clinical education experiences and the preceptors who facilitate them can have a significant impact on an athletic training student's career decisions and desire to persist in the athletic training profession.^13,36 Preceptors mentor students through their communication, providing a realistic picture of the profession of athletic training, and modeling excitement and dedication to the field.³⁷ Mentorship has also been shown to be an integral part of students' developmental process.^13,36,37 Therefore, when creating preceptor development sessions, it is important to discuss the impact they have on students' professional development and growth with preceptors.

Preceptors also indicated in their open-ended responses that they would find a few items, such as understanding this generation of students, helpful if included in a preceptor development session. Because preceptors have been identified as important individuals in an AT student's education,^1,3 we recommend providing preceptors with information regarding the educational program's structure, goals, and objectives to better allow them to help students connect what they are experiencing clinically with the knowledge and skills they are learning in the classroom. This generation of students, primarily millennial students, is comfortable with technology, desires immediate feedback, and has learned to multitask from a young age.³⁸ Therefore, discussing ways preceptors can engage these students by incorporating technology into clinical experiences or how to provide student feedback could prove helpful for preceptors, as well as help students connect their didactic coursework in different ways.

This study included some inherent limitations. The participants were limited to those preceptors in National Athletic Trainers' Association District 4, and the results of the study may not be generalizable to preceptors in other districts. The small number of respondents may have contributed to the inability to see differences in relation to demographic characteristics. Additionally, the reported response rate could be inaccurate because we relied on the program directors to report the number of preceptors to whom they forwarded information regarding the survey. Program directors could have sent the survey to their preceptors but not responded to our request for confirmation, or they could have not sent the request for participation when they indicated they would do so. An additional limitation could be the variability of the numbers of items in each section of the Preceptor Needs Assessment. We designed the survey to be as concise as possible, but the range in topics per section could have impacted our results. Although the scale of the Preceptor Needs Assessment was reliable, the 3-point Likert scale may not have allowed for adequate variation in participant responses. Future researchers should consider exploring the perceived learning needs of preceptors in other districts to determine if the needs are similar in different geographic regions of the country. Finally, although understanding what preceptors need for their development is important, future research should also assess whether preceptor development sessions are effective at educating and elevating the skills of a preceptor.