Research Training for Clinicians: The Crucial Link Between Evidence-Based Practice and Third-Party Reimbursement

The past decade has seen a tremendous increase in the research culture within the athletic training profession. A growing critical mass of athletic training scholars is contributing to the advancement of the profession. Clear examples of this trend include the increasingly sophisticated work being published in the Journal of Athletic Training, the dramatic increase in the number of research abstracts presented at the NATA annual meeting, the growing number of our scholars presenting and publishing their work in venues other than those solely targeted at athletic trainers, and the development of more doctoral programs with athletic training faculty members serving as mentors to aspiring scholars. These achievements should provide considerable professional pride, but every day, as I lug my way up the steps of the ivory tower, I ask myself if something is awry.

Is the clinical practice of athletic training improving because of this increase in scholarship? On more than one occasion as a member of the committee that provides the educational programming for the NATA Annual Meeting and Clinical Symposia, I was disheartened to hear feedback from attendees who said that the programming consisted of presentations by “too many academic types” and not enough “real (athletic) trainers,” or that attendees wanted to “hear about new clinical techniques” and “not listen to speakers talk about all the research they've done.” The reasons for this disconnect are not straightforward, but the solutions may be. Admittedly, many research articles are not easy to read or interpret and may not have immediately apparent clinical application, but authors must accept the responsibility of making their work understandable and meaningful to clinicians. Research presentations and publications aimed at practitioners must address clinical applications, and likewise, clinical presentations must be based on the best available research. Educators need to ensure that undergraduate and graduate students are being equipped with the skills necessary to consume, critique, and summarize research findings so that they may be capable lifelong learners and use new findings to refine and improve their clinical practice. The importance of these skills to athletic trainers pursuing continuing education must also be emphasized.

As health care professionals, we should ask ourselves, “What are the benefits of enhanced research training?” I believe the benefit is a strengthened link between two important professional movements: evidence-based practice and third-party reimbursement. Third-party reimbursement is a challenge facing athletic trainers in numerous practice settings. The stark reality is that without documented evidence showing the effectiveness of clinical interventions rendered by ATCs, reimbursement is a pipe dream. In the past, traditional practice settings have not demanded this type of accountability from ATCs, but many practice settings now require this for financial viability. And from an altruistic perspective, accountability for services rendered cannot be a bad thing for the patients of any health care provider.

If there is a silver lining to the black cloud created by the insurance industry's stranglehold on the health care industry, it is the evolution of evidence-based practice.¹ The tenets of evidence-based practice call for the “integration of the best research evidence with clinical experience and patient values to make clinical decisions”² and deem the retention of clinical practices that fail to survive the critical scrutiny of controlled study unacceptable. Operating in this environment points to the obvious need for more studies of the clinical outcomes of patients treated by athletic trainers. But perhaps more subtly, it elucidates the need for enhanced research training of athletic trainers. Such training should address traditional research design and inferential statistics but must also include the emerging discipline of clinical epidemiology.³ The ability to objectively critique original research and interpret results for statistical and, more importantly, clinical significance is vital to successful evidence-based practice. Likewise, so is the capacity to interpret summaries of original research such as meta-analyses and systematic reviews, because these are becoming the gold standards to determine the effectiveness of clinical interventions.

To advance the standards of clinical practice, both scholars and clinicians must strive to understand each other. Scholars must write about and present their research in ways that are usable and understandable to clinicians. Similarly, clinicians must acquire, retain, and use the requisite skills to interpret research, so that we are proactive as a profession in advancing our standards of clinical care.