Archive for October, 2015

VIDEO: BOC Town Hall Meeting – CE Requirements, Common Reporting Errors and Avoiding Audit Pitfalls

Thursday, October 29th, 2015

In the latest virtual Town Hall Meeting, BOC Executive Director Denise Fandel answers questions CE requirements, common reporting errors and avoiding audit pitfalls.  The questions discussed in the meeting are listed below.  Tune in and Be Certain ™ your questions are answered!


Questions Answered in Virtual Tour Hall Meeting

1. If I was certified in 2014, do I need to pay the 2014 certification maintenance fee?

2. Can I pay both NATA and BOC fees together?

3. Why are our state licenses so expensive?

4. Why are CEUs so expensive?

5. Can ATs take an online ECC course?

6. Does being an instructor of a CPR course count for my ECC requirement?

7. Do ATs earn CEUs for taking a CPR instructor course?

8. Do ATs earn CEUs for ACLS certification?

9. What should an AT do if they have lost their ECC card?

10. What happens if an AT has a lapse in their ECC certification?

11. How do ATs enter their ECC cards onto their reporting form?  Do we need to continue to send in our updated ECC card every two years?

12. What is a contact hour?

13. How was the number of 50 CEUs decided on?

14. If I have recently become certified (in 2015), how many CEUs do I have to complete and by when?

15. How was the number 10 determined for required EBP CEUs?

16. How do you balance time dedicated to being an AT versus time that is needed to get required CEUs?

17. Can ATs carry over extra CEUs to the next CE reporting period if they earn more than the required number of CEUs for the current reporting period?

18. How do ATs know what category to report CEUs in?

19. Do ATs earn CEUs for teaching courses about athletic training?

20. Do ATs earn CEUs for speaking?

21. Do ATs earn CEUs for writing articles related to athletic training?

22. What type of college courses are acceptable for BOC CEUs?  Do ATs need to submit their official transcript?

23. Do non-approved CEUs count towards the 50 total required CEUs?

24. How does the BOC’s continuing education requirements compare to similar professions?

25. Do you recommend specific online organizations to obtain CEUs from?

26. I attended a CE course that was not great quality, or I am concerned that they wasted my time.  What do I do?

27. I would like to see more CE programs available for ATs that work in non-traditional fields that could include industrial and ergonomic topics.

28. I would like to see more local providers approved in my area.  What can I do to encourage CE providers to apply?

29. Please elaborate on the EBP requirement and why it is now a requirement.

30. My concerns relate to the amount of opportunities for learning related to the evidence based requirement.

31. Where can a NATA member find free CEUs in EBP?

32. How do you know if a course meets the EBP requirement or if it is approved for EBP CEUs?

33. If I took a program that is not on the EBP approved list, can I submit it for consideration?  My program title includes the word “evidence.” Does it count for the EBP Category?

34. I have taken EBP college courses at my university.  Will these count for EBP CEUs?

35. I am a retired AT. Do I need to complete the EBP requirement?

36. Will the NATA clinical symposium in 2016 offer live EBP CEUs?

37. I attended a district meeting that had EBP sessions.  What’s the best way to report these?   Is there a specific code?

38. Should ATs submit all of their CEUs at once?  Can ATs report them as they are earned throughout the 2-year period?  Are ATs required to enter a specific number of CEUs each year?

39. Where do ATs look to see how many CEUs they have entered?

40. I want to report a college course that meets the requirements for Category C.  What is my date of completion?

41. I have graduated from a post professional CAATE accredited program.  Can I count both EBP CEUs and individual courses in Category C?

42. I have recently changed my name. Will a name change this late in the reporting year cause problems?

43. What documentation should I keep in case I am audited?

44. What is the most common mistake ATs make when reporting CEUs?

45. How are ATs selected for the audit?

46. I have had a few life changes occur over the last two years and I would like to request an extension.  What is the process to do so?

47. Will I lose my certification if I don’t get my requirements completed by December 31, 2015?

48. If you are currently not working as an Athletic Trainer, can you put a hold
on your credentials?

49. Can ATs retire their certification and come back at a certain point and practice as a BOC Certified Athletic Trainer?

50. Looking ahead to the 2016-2017 reporting period, will there be any changes?

The Yin to my Yang: Privacy and Confidentiality in the Athletic Training Facility

Thursday, October 22nd, 2015

By Adaeze Teme, JD, PE-ATC

If home is really where the heart is, then the athlete is certainly at home in an athletic training facility.  The notoriety of the facility rivals that of a panic room because of its ability to shelter the athlete’s health information against third parties.  The facility is not merely a functional hub for information gathering; indeed, it is the epicenter of the athlete’s pertinent health history.  Whether it is discussing injury status, treatment or surgery updates, the facility possesses content that must be kept confidential to maintain its integrity and to protect the privacy of the athletes and the Certified Athletic Trainer (AT) in the facility.

In so many ways, confidentiality is the yin to privacy’s yang, and though used interchangeably, they could not be more different in application.  At first glance, the 2 terms seem similar, but understanding confidentiality and privacy is appreciating the legal significance of both terms.

Confidentiality is a core ethical duty in the athletic training profession that is essential to the athlete and AT relationship.  Confidentiality, in this setting, refers to personal information shared between an athlete and AT that cannot be disclosed except by the express consent of the athlete.  Essentially, confidentiality between the athlete and the AT is perpetual or until otherwise agreed to or breached.  Although courts do not expressly recognize a confidentiality privilege between athletes and ATs, they will, however, uphold confidentiality agreements between the 2 parties.

On the other hand, privacy is not just a prerogative, but a protected Constitutional right that grants freedom from interference into a person’s personal affairs.  For instance, there is a reasonable expectation of privacy during pre-participation physicals, as they are conducted in seclusion and away from the public view.  Privacy, as it relates to the athletic training profession, is an obligation to protect the athlete, while maintaining their dignity during evaluation, treatment and rehabilitation.

If you have any concerns about privacy and confidentiality in your athletic training facility, then take a look at the BOC Facility Principles document and Facility Principles Assessment Tool.  There you will find easy-to-use checklists with more information on accessibility, privacy and confidentiality, employee safety, safe handling of hazardous materials, emergency preparedness and more.

*This blog only reflects the author’s views on this subject and not the confidentiality or privacy agenda of the US FDA.

Adaeze Teme, JD, PE-ATC is an orthopedic physician extender and certified athletic trainer.  She serves as Regulatory Counsel at the U.S. Food and Drug Administration (FDA) in the Center for Devices and Radiological Health (CDRH).


1. Gary Stuart, The Ethical Duty of Confidentiality, ETHICS LAW.COM, (last visited Aug. 24, 2015).

2. OHIO REV. CODE ANN. §1347.15 (A)(1) (West 2009); Is there a Difference Between Confidentiality and Privacy? THOMSONREUTERS.COM, (last visited Aug. 24, 2015).

3. Jere Webb, A Practitioner’s Guide to Confidentiality Agreements, STOEL.COM, (last visited Aug. 24, 2015).

4. “[T]estimonial privilege, is a concept from the law of evidence and present in common law and statutes of the fifity states . . . [that] appl[ies] in judicial and other proceedings in which a lawyer may be called as a witness or otherwise required to produce evidence concerning a client.” Sue Michmerhuizen, AMERICANBAR.COM, (last updated May 2007).

5. Eric Weiss and Debra Slifkin, Enforceability of Rule 26(c): Confidentiality Orders and Agreements, FEDERATION.ORG, (last visited Aug. 24, 2015).

6. Griswold v. Connecticut, 381 U.S. 479, 483 (1965).  Right to privacy as a right to "protect[ion] from ... in the "penumbras" and "emanations" of other constitutional protections.

7. Sanchez Scott v. Alza Pharmaceuticals, Cal.Rptr. 2d 410, 414 (Cal. Ct. App. 2d 2001) (“ [R]easonable expectation of privacy in the medical examination room . . .”).



Did your state make the Top 10 list?

Wednesday, October 21st, 2015

During the election for BOC Athletic Trainer Director, we have been keeping track of the percentage of Athletic Trainers in each state who voted during the election.  Online voting closed on Thursday, October 15, 2015 at 11:59pm CT.

Congratulations to Montana for taking first place!  Louisiana was in second place, and Oregon was close behind in third place.  Nebraska, Wyoming, Arkansas, Oklahoma, Hawaii, North Dakota and Kentucky all made the Top 10 list.  Thank you to everyone who voted in this election!

The BOC is also pleased to announce the election of a new Athletic Trainer Director to the Board of Directors.  Kimberly Detwiler, MS, LAT, ATC, CSCS, will take office January 2017, following a year of mentorship and learning as an AT Director-elect. Detwiler, who serves as Assistant Athletic Trainer at the University of Texas at Austin, said she is honored to have been elected to the board and is excited to be part of the BOC.  Learn more at




Our Brain is the Key to Longevity: Sub-concussive Force and Chronic Trauma

Friday, October 16th, 2015

By Desi Rotenberg, MS,  LAT, ATC

The human brain is one of the most studied aspects in existence today, and yet, we are only able to scratch the surface of how it really works.  With its overwhelming complexity, researchers are constantly on the lookout for methods to understand, treat and predict the various symptoms that can be associated with disruption of normal cerebral and neurological functioning.  What we do know is the human brain is vulnerable and fragile.  While the brain may hold the secrets to our existence and can take a lifetime to develop into its full potential, it only takes a momentary physical trauma for everything to change.

Concussions and traumatic brain injuries continue to be a hot topic amidst the athletic population and will continue to be on the forefront of research and medicine, as long as human beings strive to test the limits and durability of the human body.  The ugly truth about athletics and sports as a whole is the risk of altered cognitive functioning following a hit to the head. While most athletes will tell you the consequences of brain damage are unlikely, as a professional, I believe is it our responsibility to educate and prepare for these unlikely events.

I am reminded of the story of Pat Grange, a professional soccer player who was diagnosed with Chronic Traumatic Encephalopathy (CTE) at age 29, and subsequently lost his life to amyotrophic lateral sclerosis (ALS).  His brain was later donated to the Boston University VA.  Analysis revealed stage 2 (out of 4) on the CTE Severity Scale.  Up until his death, no one really considered soccer a high-risk sport when it came to chronic brain injuries.  From this examination and that of the countless others who donated their brains to science, medical research continues to raise the understanding that the human brain can only handle a certain amount of trauma on a day-to-day basis before it begins to degenerate from the inside out.

Occasionally, a player will suffer a concussion from knocking into an opponent’s head while going up for a ball.  However, what we seem to overlook is the number of times soccer players may use their heads during a single practice.  Is it possible that sub-concussive, low-force hits to the head may cause CTE?

A soccer player practicing headers through the course of a single season may have knocked their head over a thousand times.  Similarly, an offensive lineman who undergoes sub-concussive hits to the head for 4 straight months may not understand the damage that is occurring.  While these blows to the head may not produce clinically positive concussive symptoms, further research may reveal sub-clinical, chronic trauma to the head that could elicit long-term breakdown and scarring of brain tissue.  While correlation does not equal causation, we cannot overlook the fact that the human brain may be susceptible to long-term, low-force trauma.

As Athletic Trainers working at the high school level, we simply cannot take any chances when it comes to the developing brain.  Student athletes have their whole lives ahead of them, and while athletic competition is important, we must always remember the future of our athletes should never be sacrificed for a single practice or game.

Source: Johna Register-Mihalik, PhD, ATC, LAT

Instead, when it comes to head injuries, we must take into account the aspects of life that are going to be affected by the injury.  While the academic and extracurricular effects are obvious, we must not overlook the social and behavioral changes that also can occur.

Behavioral changes can affect interactions with family and friends and can often affect an individual’s ability to feel connected at home, at school and in the locker room.  Additionally, if an individual has any type of anxiety disorder or cognitive disorder, the individual’s recovery time may be slowed, or even negatively affected.

As medical professionals on the front lines, we are the first line of defense when it comes to protecting the futures of young athletes.  If a student athlete were to come to me in the middle of a game and say, “I was hit in the head and I have a headache,” concussion protocol states  the athlete should be removed from play.  However, I would continue to hold the athlete out of the game, regardless if the athlete were to tell me that their headache has remitted.

The brain is malleable and delicate, and we must do our part to ensure young athletes are not being exposed to chronic, sub-concussive blows to the head at a time when the brain is still developing.  As we saw in the case of Pat Grange and many other individuals before him, long term, low-force trauma to the head may prove to be disastrous later in life.


Branche, J. (2014, February 26). Brain Trauma Extends to the Soccer Field. The New York Times. Retrieved from

McKee, A. C., Cantu, R. C., Nowinski, C. J., Hedley-Whyte, E. T., Gavett, B. E., Budson, A. E., ... & Stern, R. A. (2009). Chronic traumatic encephalopathy in athletes: progressive tauopathy following repetitive head injury. Journal of neuropathology and experimental neurology, 68(7), 709.

Register-Mihalik, J., Guskiewicz, K. M., Mann, J. D., & Shields, E. W. (2007). The effects of headache on clinical measures of neurocognitive function. Clinical Journal of Sport Medicine, 17(4), 282-288.

Transition to Practice Series: Challenges, Decision-Making and Confidence

Wednesday, October 14th, 2015

By: Stacy Walker, PhD, ATC

Ashley Thrasher, EdD, LAT, ATC, CSCS

The purpose of this series is to provide information about transition to practice to new Athletic Trainers and those who work with them. We hope our information will help with the transition for any new employee.

Our first post addressed the question: What is transition to practice?

The purpose of this post is to discuss 2 of the challenges new Athletic Trainers face, decision-making and confidence.

We have interviewed new Athletic Trainers regarding their experiences and feelings during their transition. The below quote speaks to the challenges new Athletic Trainers face when transitioning.

“I would have to say it’s the decision making.  Being in charge.  Not that I don’t enjoy that role, it’s just that it’s a little bit of a reality check.  It’s a little more frightening that I’m the one making the decisions. [In undergraduate] there was always someone over my shoulder and you know, even though it seemed annoying at the time it was like a security blanket.”

The participants felt they were knowledgeable. However, they reported that during their bachelor’s and master’s level education, they never had the opportunity to make the final decision regarding patient care.  Final decisions were made by the preceptor, especially decisions related to return to play.  As new ATs made the transition, they were anxious about having the ultimate authority to make decisions.  Confidence was also a challenge because they hadn’t made many decisions, were unsure of themselves and often second-guessed themselves.  They were not very confident in making the final decision.

Believe it or not, this challenge is prevalent with novice healthcare providers.1-3 Educational preparation can only provide so many opportunities and situations from which the new clinician can draw.  Between being placed in a new environment with new people, policies and cultures and being in a new situation, such as working with an upset parent or coach, a novice clinician has no working memory to draw from during that situation.  Some research on nurses, for example, suggests that new nurses be placed in less complex decision-making clinical placements at the beginning of their new employment because of their difficulty with making decisions.1,3

So what does this mean for new Athletic Trainers?  They should know they are not alone in these feelings of second guessing themselves.  Many new healthcare professionals experience these same feelings when they make independent decisions for the first time.  Supervisors of graduate assistant Athletic Trainers have acknowledged that new Athletic Trainers have the knowledge; they just need to gain confidence in their decisions.4

“Having moments where I’m right has helped me develop confidence. Being able to make a decision and go out on a limb, and for my treatment or for my diagnosis to be accurate,  I think that has really impacted my confidence."

While the transition is difficult and making the decision independently is challenging for new Athletic Trainers, making decisions helps increase confidence.

There are many ways to support employees during this transition.  This topic will be addressed in future iterations of this series.


1. Dyess SM, Sherman RO. The first year of practice: new graduate nurses' transition and learning needs. J Contin Educ Nurs. 2009;40(9):403-10.

2. Kaddoura MA. New graduate nurses’ perceptions of the effects of clinical simulation on their critical thinking, learning, and confidences. J Contin Educ Nurse. 2010;41(11):506-516.

3. Phillips C, Kenny A, Esterman A, Smith C. A secondary data analysis examining the needs of graduate nurses in their transition to a new role. Nurse Educ Pract. 2014;14(2):106-11.

4. Thrasher, AB, Walker, SE, Hankemeier, DA, Pitney, WA. Supervising athletic trainers perceptions of preparation of graduate assistant athletic trainers in the collegiate setting. Athl Train Educ J. In press.