Have you ever noticed that in sports and athletic medicine, a catastrophic event is frequently required to prompt change? How paradoxical that we heavily emphasize prevention yet often fail to implement appropriate measures for minimizing risk. For example, how can we truly state that our interventions prevent injury if we aren’t even counting exposures and tracking injury rates over time? Instead, we are frequently forced to respond reactively which in turn, often creates more of a mess. The case I am trying to build extends beyond routine injury prevention initiatives and into the administrative aspects of athletic training. The national attention attributed to the University of Maryland, not just the devastating news of the heat-related death of a student-athlete, but also for the aftermath circus of firing, re-hiring and firing again should make every one of us cringe. This situation could easily happen to any athletic medicine program (regardless of setting) who fails to follow professional practice standards. As the independent review of the death of Jordan McNair illustrate, failure to comply with professional standards, resulting in a tragic outcome, may result in litigation as a response to falling short in ethical standards of making the patient the primacy of their care. Principle I of the NATA Code of Ethics is dedicated to making the individual patient the focus of the athletic trainer’s ethical obligation.
Several years ago, in the Journal of Athletic Training, colleagues and I published an editorial titled, “The Need for Accountability and Transparency in Intercollegiate Athletic Medicine.” We promoted the idea of the development of an athletic medicine review board (AMRB) to assist in the oversight of all health-related programs and services for student-athletes. After much consideration of an AMRB, and after serving on one at the University of Georgia for the past 4 years, I am even more convinced of the critical and beneficial role that such a board plays in promoting transparency of operational procedures and best practices. I have even changed my position since co-writing the editorial in that I advocate for such oversight for athletic medicine programs in all settings, not just intercollegiate.
One would be hard pressed to come up with a more effective way for a well-intended, but overwhelmingly busy athletic training staff to ensure that the existing policies, procedures and protocols are up-to-date, than to put them before an AMRB for their expert and analytical review. The Board serves as another safeguard to ensure that the AT staff adhere to professional practice as required by the NATA Code of Ethics. Such a practice can transform weak programs into strong, and help strong programs become even stronger as I have witnessed firsthand at U. Georgia. Not all programs can afford the travel expenses of bringing in the Board every year, however experts for your Board may already exist in your own back yard. Consider who works in your community. Certainly there are individuals with the necessary expertise (legal, ethical, medical, administrative, etc.) who would be willing to volunteer their time to review materials and meet as a group at least once a year. The athletic medical review board should be empowered to raise concerns and recommendations on care and services based on professional standards and mitigation of risk. These recommendations are communicated to the top executive of the school and the athletic director, as well as the sports medicine staff. The message this sends to the administration, athletes, parents, and to the community is that you are dedicated to providing the best level of care to such a high level that you are willing to open up all aspects of your athletic medicine program to an outside review process.
Finally, let’s consider the alternative, which is to maintain the status quo and take the chance of being the next national news story. Any cultural shift must obtain a critical mass for change to take place. If we sincerely embrace patient-centered care, we cannot continue to function within the same culture that has failed to adequately protect student-athlete health and welfare in far too many cases.
A special acknowledgment of appreciation to Gretchen Schlabach and Tim Neal for their review and feedback of this blog.