Athletic Trainers

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Many Steps and Many Voices Along this Journey

AT Driven Research and Development Phase Continues

The research and development phase of the Continuing Professional Certification (CPC) concept started in 2022 continues to move forward with voices of Athletic Trainers (ATs) being integrated every step of the way. Response from ATs to date indicates that they want impactful learning and continuing professional development built through hands-on and structured learning tools that allow for a flexible, individualized approach. The ultimate goal is continued competence that ensures consistent, quality patient care.

Focus Group Results

During April 2022, eight AT focus groups, representing varied practice settings, took place. Results from these groups helped to define plans and next steps for ongoing work groups.

The main objectives of these research discussions were to define meaningful and impactful activities for learning and professional development, as well as identify any challenges specific to practice setting that could impede completion of any proposed certification maintenance activities.

Key Takeaways

Work Group Phase – QI

The CPC work groups launched in June and will continue through 2023, based on input gathered during earlier research and ongoing work group results.

One of the first work groups centered around the concept of Quality Improvement (QI). QI is a component of CPC under consideration, based on previous results of a QI pilot (conducted from January to August 2020) involving nearly 250 ATs, as well as positive input around this educational tool received during the AT focus groups for CPC.

This group was charged with sharpening an existing template for QI to allow ATs to create their own projects, providing a directly applicable and individualized approach. In addition, the group provided several recommendations for the technology and facilitation of these components as well as discussed methods for QI project collaboration among ATs. During discussion, the group defined Quality Improvement as it relates to the athletic training profession:

Quality improvement provides the framework to continuously and systematically evaluate Athletic Trainer’s health care delivery to improve their practice and quality of service for patients.

The QI work group consisted of six ATs and one outside expert who specializes in quality improvement. All AT participants had QI experience, and some are currently teaching QI to ATs and other health care professionals. This group met over six weeks during July and August. Additional work groups, including a second QI Work Group, are currently meeting and will continue into 2023.

Power Panel

The BOC Power Panel, a large group of ATs and other stakeholders, provides input during CPC development through online survey feedback. Most recently, the Power Panel was surveyed about frequency of educational activities and its impact on learning.


When asked “How often should ATs engage in continuing education during any given month?” more than 80% responded monthly, while nearly one-fifth responded that multiple times per month was ideal. In a follow-up question, results showed that this group of ATs felt that integrating new knowledge into their practice, they needed to engage with the material an average of 47 times.

“Frequency of learning and application leads to competence and eventual reflection. Reflection on practice creates advanced knowledge and skill that drive the profession forward.” – Power Panel participant

Within the open-ended portion of the survey results, the following key learning themes emerged related to effective learning for ATs:

Next Steps

Results such as those outlined, in addition to outcomes from ongoing efforts, will be continuously analyzed and reviewed by the CPC Task Force. This volunteer group of ATs and experts will make recommendations for any actions to the BOC Board of Directors. This progression will continue over the next two to three years until CPC is finalized and implemented to meet the needs of ATs, while fulfilling the level of certification required to enhance our profession and protect the public.

Stay current on CPC developments and look for future updates here.

Visit our History page for the background on CPC and past work.

Concept of Continuing Professional Certification

AT Driven Research and Development Initial Work

At the end of 2021, the BOC Board created a new Continuing Professional Certification (CPC) Task Force comprised of volunteers to drive future efforts, integrate feedback and provide recommendations on the future of AT certification renewal. To date, the BOC Board, this designated task force and more than 1,400 ATs have weighed in to help shape the CPC Concept over the past several years - all before the open comment period held last fall. The new CPC Task Force, along with the input of hundreds to thousands more ATs, will further define CPC. By the time this is final, it will have been shaped, by and for ATs.

To begin the research and development phase, a call out for volunteers was made to allow for the BOC to gain perspectives and input from a wide cross section of ATs and other experts to shape program design. We had hundreds of ATs, and other experts, raise their hands.

Efforts for this phase, which began in March 2022 will continue for the next two to three years as AT volunteers participate in various roles to help further define and shape development of CPC to be:

• An AT-centric certification renewal program that is: relevant, flexible, equitable, inclusive, affordable, effective and easy to manage...for all practice settings, including ATs who are PRN
• A certification renewal program that protects the public and meets the needs of ATs as health care professionals
• A certification renewal program that provides a better way for ATs to map their own development path

2021 Open Comment Results

Data collected during the 2021 CPC open comment period, from both Survey Monkey and Miro Board, was assimilated and analyzed. Based on feedback, four main messages were expressed that are shaping ongoing development of CPC. These data points were used to define action steps for the research and development phase.


“Continuing Professional Certification (CPC) Concept Q&A” webinar held Oct. 20, 2021

Overview and Explanation of Proposed Concept

Recertification is changing in health care. The BOC is shaping a new recertification concept - the BOC, with input from ATs in all settings, is shaping a new recertification concept designed to offer a more customized and efficient professional development program. The concept is meant to provide ATs the flexibility to map out an individualized professional development plan based on their preferred learning style, professional goals and practice setting. The ultimate goal of the final concept is to provide consumers the comfort of knowing all ATs are staying current with cutting edge knowledge and skills in the field of athletic training.

Staying at the top of our game as a profession is critical. The BOC has been working on a better approach to ongoing continuing education for the past 11 years for several reasons. We are looking to meet ATs where they are. Giving ATs choices and flexibility for equitable and affordable continuing education is our goal.

Evidence through the Institute of Medicine (IOM) (now the National Academy of Medicine (NAM) has shown that across the health care professions, continuing education units alone aren’t as effective or practical as they could be, and much of the medical field is moving away from this approach, including nursing, occupational therapy, physician assistants and dietetics. Overall, recommended guidance for health care professionals is to have requirements for continued competence and maintenance of certification that are grounded in the IOM/NAM’s Core Competencies:

• Provide patient-centered care
• Work in interdisciplinary teams
• Employ evidence-based practice
• Apply quality improvement
• Utilize informatics

Executive Summary: Institute of Medicine. 2003. Health Professions Education: A Bridge to Quality. Washington, DC: The National Academies Press. https://doi.org/10.17226/10681.
Executive Summary: Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. https://doi.org/10.17226/12704.

FAQs

General CPC Questions

Q: Has the CPC plan already been finalized?
A: No. There has been and will continue to be opportunities for Athletic Trainers (ATs) to help shape the final result.

Q: When will the changes be implemented?
A: No sooner than 2024, and potentially not until 2026. We anticipate a slow and gradual roll out.

Q: If CPC is a recertification program, does that mean taking an exam to recertify?
A: No. Recertification is the renewal of one’s certification based on a set of requirements. For example, the requirements ATs met at the end of the last reporting period were recertification requirements.

Q: Why is the BOC in the CEU business?
A: The BOC is not in the CEU business, rather the certification business. The BOC is accredited by a third party (National Commission for Certifying Agencies) and an overarching standard that we must meet includes: The certification program must require periodic recertification. BOC’s current recertification requirements include a set number of CEUs that are provided by BOC Approved Providers and other CE organizations.

Q: Why are we changing how ATs recertify?
A: Staying at the top of our game as a health care professional is critical. We’ve been working on a better approach to ongoing continuing education (CE) for the past 11 years for several reasons:

• To meet ATs where they are, and in their practice settings. Giving ATs choices and flexibility for equitable and affordable CE is our goal.
• ATs have suggested over the years that the current approach to CE could be more relevant, useful and efficient.
• Research has supported this notion (see below).

Q: What evidence suggests that current CEUs aren’t the optimal way?
A: Continuing Professional Certification (CPC) is overall guidance for health care professionals’ requirements for continuing competence and maintenance of certification that are grounded in the core competencies identified in the Institute of Medicine (IOM), now the National Academy of Medicine (NAM) report “Health Professions Education: A Bridge to Quality” (2003) and reiterated in other IOM/ NAM reports, such as “Redesigning Continuing Education in the Health Professions” (2010), as well as the latest edition of the Institute of Credentialing Excellence (ICE) “Certification: The ICE Handbook” (2019).

• Provide patient-centered care
• Work in interdisciplinary teams
• Employ evidence-based practice
• Apply quality improvement
• Utilize informatics

Evidence has shown that across the health care professions, CEUs alone aren’t as effective or practical as they could be, and much of the medical field is evolving their approach, including nursing, occupational therapy, physician assistants and dietetics.

Executive Summary: Institute of Medicine. 2003. Health Professions Education: A Bridge to Quality. Washington, DC: The National Academies Press. https://doi.org/10.17226/10681.
Executive Summary: Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. https://doi.org/10.17226/12704.
Institute for Credentialing Excellence. 2019. Certification: The ICE Handbook. Washington, DC: Institute for Credentialing Excellence. Chapter 24: Reframing Recertification for Continuing Competence, p559-578.

Other Health Care Professions

Q: What other health care profession’s certification agency requires CEUs?
A: Most accredited certification agencies for other health care professions currently require CEUs for recertification (e.g, National Board of Certification for Occupational Therapy, National Board of Certification and Recertification for Nurse Anesthetists, National Board for Respiratory Care, etc.).

State Licensure

Q: Shouldn't CE be tied to our state license?
A: Your state license and BOC certification are two distinct, separate things and vary by state. Some states recognize BOC certification for license renewal. Other states align their renewal requirements with those of the BOC and some states have their own renewal requirements. And one state does not have state licensure. Again, BOC certification is separate from licensure and how they work together can vary considerably, depending on where the AT practices.

Promoting the Athletic Training Profession

Q: Why doesn't the BOC put their efforts into widespread promotion of the profession?
A: The BOC is a credentialing agency, and our mission is to provide exceptional credentialing programs for health care professionals to assure protection of the public. While the BOC promotes the profession when possible, its priority must be public protection and the CPC concept is an initiative that does both protect the public and promotes the profession. The NATA is the primary organization promoting the athletic training profession. BOC encourages all ATs to be engaged members of the NATA and explore the numerous NATA benefits.

CPC Requirements

Q: What will the requirements be to maintain my certification?
A: This has yet to be determined.

Q: Will there be the opportunity for growth to make sure change in clinical practice happens?
A: Yes, that is the idea. CPC would address both continued competence across the domains of athletic training, but also provide activities that promote growth and clinical expertise to enhance patient outcomes.

Q: Does the CPC align with the Accreditation Council for Continuing Medical Education (ACCME) standards and processes?
A: There may be some alignment, but ACCME standards address continuing medical education (CME). There is more alignment with ACCME standards and BOC Approved Provider standards for CE, which has been in place since 2016.

Professional Goals Appraisal (PGA)

Q: How will the PGA continue to be effective with the high turnover in athletic training settings?
A: The PGA is meant to be dynamic to adapt to the AT and will need to have the ability to make updates to goals if necessary.

Q: If the PGA says I'm supposed to do more work with modalities to maintain my certification, I don't have modalities at my school to use aren't I still just "checking the box"?
A: Because the goals you develop in the PGA should take into consideration your weaknesses and strengths, as well as your environment and other factors (such as whether you plan to stay in that environment) addressing modalities may not be part of your professional development or you may want it to be because you plan to change jobs. The PGA is dynamic and not solely focused on weaknesses.

Q: Will an AT be penalized if a suggested CE activity is not utilized?
A: While the details of the CPC concept are to be determined, it is not the intent of the PGA for an AT to be penalized for not taking suggested activities.

Q: Will the PGA limit what an AT can do for CEUs?
A: No. The PGA will produce recommended development activities that are relevant to your interests, practice setting and strengths. It produces a recommended pathway, not a concrete road. Think of the PGA as a blueprint for the individual AT. If your practice setting or interests change, and consequently your plan changes, that’s ok. Your CE should reflect that change.

In addition, we’ve received comments that indicate the PGA sounds like an exam. While the AT is asked questions in the early stages of a PGA, the purpose of the questions is to identify where the AT’s development should or could be. It is certainly not anything to be stressed about, quite the opposite. The PGA only helps ATs to customize their learning path and identify learning activities or interventions that suit their own needs.

Q: How does PGA work with the non-practicing AT?
A: Ultimately, you develop the goals in the PGA. Your goal may be to maintain your credential and/or your license, or maybe you plan to return to practice. Your goal may be to focus on what knowledge and skills you want or need to return to practice safely.

Competence Assessment Modules (CAMs) and Quality Improvement (QI)

Competence Assessment Modules (CAMs): Mental Health Pilot
774 ATs from 14+ different practice settings completed the CAMs – Mental Health pilot. In a post-pilot survey, participants agreed the CAMs improved their knowledge of mental health as well as their awareness of strengths and weaknesses in this area. Specifically, over 92% of participants “Agreed” or “Strongly Agreed” the CAMs “Improved my knowledge of mental health.”

Quality Improvement (QI) Projects
QI: Facility Principles Pilot
115 ATs from a variety of practices settings completed the QI - Facility Principles Pilot. In a post-pilot survey, participants indicated the process improved their awareness of areas for improvement, strengths and/or compliance and ultimately enhanced patient outcomes. Specifically, over 70% of participants “Agreed” or “Strongly Agreed” the project “Enhanced my patients’ outcomes.”

QI: Hand Hygiene Pilot
127 ATs from a variety of practices settings completed the QI – Hand Hygiene Pilot. In a post-pilot survey, participants indicated the process improved their awareness of areas for improvement, strengths and/or compliance and ultimately enhanced patient outcomes. Specifically, nearly 80% of participants “Agreed” or “Strongly Agreed” the project “Enhanced my patients’ outcomes.”

Q: What examples can you provide of a QI project?
A: Example 1 - Documentation
After a review of charts, we found that our staff is inconsistent in completing discharge summaries in our electronic health care records. We need to have 100% of charts complete and currently only 70% of charts have discharge summaries completed.

Our plan is to initiate a staff education program. After four weeks, we’ll do a chart review and assess how many charts have completed discharge summaries.

Example 2 – Infection Control (see optional Hand Hygiene QI project coming in 2022)

According to the CDC and WHO, hand hygiene is an important practice to reduce the spread of infection. After conducting a brief patient survey, we found that staff’s compliance with appropriate hand hygiene occurred only 50% of the time. Our goal is to increase hand hygiene compliance to 100%.

Our plan is to educate staff and place poster reminders in common places to help AT remember to wash their hands. After two weeks, we’ll conduct another patient survey to assess hand hygiene compliance.

Example 3 – Facilities (see optional Facilities Principles QI project coming in 2022)
Upon review of the BOC Facility Principles and completing the corresponding online Facilities Principles Assessment, we found that our facility only met 40 of the 57 requirements.

We identified three requirements that we could address in the short-term and more in the long-term with the help of appropriate personnel. Following are the three short-term requirements we will address first:

1. Properly display Material Safety Data Sheets (MSDS) within our facility
2. Post egress and exit routes in the facility
3. Display current state licenses and certification of all employees within the facility

At the end of the year, we’ll complete the online Facilities Principles Assessment again to measure the number of requirements our facility now meets, as a comparison.

Q: Can QIs be done with athletic training program students to improve program outcomes?
A: The AT credential is a practice credential. Therefore, QIs in CPC should link to patient outcomes not education outcomes. If the QI can be built to focus on patient outcomes, then it could be counted.

Q: For those of us who participate in clinical research, could we use our research question and our research to fulfill our QI requirement?
A: Of course! If the goal of the research includes improvement of patient outcomes, then yes it could fulfill the requirement.

Q: Can you provide some examples of how an athletic training educator can complete a QI?
A: Athletic training educators in professional programs are well positioned to participate because programs are already required to have students engage in a QI project. (See Standard 63: Use systems of quality assurance and quality improvement to enhance client/patient care.) The athletic training educator could work as a member of a student’s QI team to help with the Plan-Do-Study-Act cycle seen below associated with a specific effort. For example, maybe a student notices that individuals with ankle injuries are routinely referred for imaging and wants to test a change to reduce the number of unneeded imaging. The QI team, then, plans the change, actually tests the change in real life, examines the results, and then determines any needed changes that result.

Q: How does a non-practicing AT do the QI?
A: The required and optional activities for CPC have not been determined, including QI. That said, it depends on your situation. For example, if an AT is in an administrative position and no longer practicing, there are other projects that would ultimately improve patient care, such as a review of policies and procedures, where they can assess a process, identify gaps or inefficiencies, craft and implement a solution, monitor the outcomes and reflect to determine if the solution worked or if a different solution is needed. In fact, the BOC has a tool, Policy and Procedure Development, to help assess policies and procedures on employee safety, facility, risk and crisis management, privacy/confidentiality, disposal of medical sharps, EAPs, exertional heat illness, health records, infection prevention and control, and lightning safety.

Q: Will the CAM topics be prescribed, or will ATs be responsible to create our own and gather all the resources?
A: The CAMs would be developed by the BOC or perhaps another third party, and the idea is to have a library for ATs based on their needs.

Q: Will QIs and CAMs eventually become mandatory to maintaining our certification?
A: We don’t know. However, we do anticipate that CPC will likely evolve over time.

Q: How will each QI or CAM be measured as CEUs?
A: In the short-term (2022-2023 reporting period), BOC is using a flat number for QI projects of 10 Category A CEUs (hand hygiene and facility principles) which is based on data from the pilot. CAMs will be based on the number of questions in the assessment - this too is based on data from the pilot. In the long-term (2024 and beyond), it is to be determined.

Q: How will a QI be reviewed?
A: Details on QI projects have not been determined for CPC.

Q: For the QI projects, do they have to be started and completed within the 2-year report year or can there be an overlap as long as there is an updated report submitted?
A: While not determined at this point, if we align with current practice, any QI projects or other CPC activities would receive credit for the period in which they are completed.

Q: Who develops QIs? Will some of these be provided by the BOC or are they things that we, as individual practitioners, develop and implement?
A: QIs could be developed by anyone, but the BOC plans to have “canned” QI projects available to ATs. This is also a space where BOC Approved Providers could be involved.

Q: How would we report the QI component?
A: BOC would provide technology for reporting.

Q: Does every QI have to have a quantitative component, or can it be qualitative?
A: While the logistics of a QI have not been determined, typically QI can use quantitative and/or qualitative data.

Q: Can a QI be done with other health care professional credentialed people and/or non-health care professionals such as educators? It seems like there are opportunities with concussion protocols to include teachers with the return to class activities.
A: While the logistics of QI have not been determined, QI typically encourages interdisciplinary collaboration and including other related staff may be ideal for the success of a QI. Many considerations would go into QI development such as limitations and/or dependencies from others and how that might affect successful completion of a QI.

Continuing Education

Q: Do you anticipate updated CE opportunities to be available?
A: Please contact individual BOC Approved Providers for more information on updated CE opportunities.

Q: Will there be any conversations about getting CEUS or “Credits” for being an athletic training educator?
A: You can receive credit for attending programs that teach you how to teach skills such as cupping, joint mobilizations, IASTM, etc. If the program is provided by a BOC Approved Provider it will qualify for Category A, and if not, Category D. The following explanation is provided in the BOC Certification Maintenance document:

If the program/activity content incorporates tasks from the current Practice Analysis in a substantive manner or has a focus of health care education, it may qualify for CEUs. If the content of the program/activity addresses pedagogy or improving the skill of teaching, or assessing participant learning outcomes, it does not qualify for CEU. For example, programs related to teaching a clinical skill, documentation or communication involve tasks in the Practice Analysis and qualifies for CEUs. Curriculum design, however, does not represent tasks incorporated in the Practice Analysis and does not qualify for CEUs

Q: Will there be maximums on the number of CEUs obtained within each CE category? For example, 40 is the maximum CEUs in category A when 50 CEUs are due.
A: The details of CE requirements for CPC have not been determined.

Fees

Q: Will this program require more of an AT’s time and money to fulfill CE requirements?
A: No. We know ATs carry more than a full load, and the time you spend in professional development should be time well-spent. The new system is being designed to:

• Give you more flexibility - Autonomy and ability to incorporate the material that will advance your own practice and goals, best adapted to your practice setting.
• Be more efficient - We heard the question, “Will it take more time and money?” and the answer to that is “no”. The concept does not include an increase in required CE; in fact, the number of required CE may decrease. Our goal is to make CE count, not count CEU’s. We are looking for ways we can make use of what you already do day to day that may contribute to CE. (Meanwhile, it is difficult to estimate the exact amount of time and dollars recertification will take, as each AT would be making choices about their individualized plan, but it should not cost more).
• Add more value - With new approaches that help ATs actually focus your learning on what you need and want to learn to increase your knowledge, skills and abilities. The PGA is an excellent example of how this can be done at a low cost. ATs who complete the PGA earn 10 Category B CEUs for $65.

Q: My school doesn’t fund my professional development and this new program sounds expensive. Am I going to be asked to pay more out of my own pocket annually with CPC?
A: Making recertification more costly is not the plan. We want to make it more effective, which doesn’t have to mean more expensive. The concept does not include an increase in required CE; in fact, the number of required CEUs may decrease. We are looking for ways that we can make use of what you already do day to day that may contribute to your continuing education. A QI project could be an example of this.

BOC Guiding Principles for AT Policy and Procedure Development Document

The BOC Guiding Principles for AT Policy and Procedure Development document provides a template to guide the development of policies and procedures. In addition, the template provides a recordkeeping function to demonstrate that training and retraining are a part of policy implementation. This document was created by the Facility Standards Work Group in 2016. Their goal was to develop educational materials to assist ATs and other appropriate individuals in the development of policies and procedures for the delivery of healthcare in their organization. Click below to download the PDF version of the Guiding Principles for AT Policy and Procedure Development document.

Guiding Principles for AT Policy and Procedure Development Online Resource

The Guiding Principles for AT Policy and Procedure Development online resource helps in the development and implementation of policies and procedures. This online tool includes interactive checklists on employee safety, facility management, patient safety, privacy/confidentiality, risk management and more. It also allows you to generate reports. Click below to begin and generate a report for your own use.