Knowledge, Experience and Support: They All Matter for Skilled Recognition of Concussion in Youth Sports

Research Objectives: 1. Describe how coaches and athletic trainers (ATC) perceive the influence of evidence-based recommendations (EBR) when recognizing sport-related concussion (SRC).
2. Appraise coach and ATC perceptions of SRC decision-making environment.

Design: Convergent mixed methods.

Setting: Community.

Participants: 8 coaches, 3 high school ATCs and 1 athletic administrator.

Interventions: No Intervention. Study

Methods: Focus groups were conducted using semi-structured interviews; recordings were transcribed and qualitatively analyzed using an iterative, constant comparative method with consensus regarding themes and codes. Results are framed using Dreyfus model of skill development to describe skill acquisition for coach recognition of SRC.

Main Outcome Measures: N/A

Results: Coaches use knowledge, experience, and support to recognize SRC.
Knowledge: Coaches identified 14 knowledge-related EBRs including understanding terminology and definitions consistent with concussion/mild TBI and limitations of protective equipment. These types of EBRs are characterized by facts and learning within a context-free environment.
Experience: Nine EBRs were identified as skills including communication with players and parents and sideline evaluation. These skills, such as processes for completing a sideline evaluation, are characterized by situational experiences utilizing guiding principles. Personal experience is an important factor for EBRs that require knowledge and skill such as “when in doubt sit them out.”
Support: Two themes related to environmental support for decisions emerged. Infrastructure: Participants described an environment without consistent regulations or guidelines, expressed a desire for simplified decision-making resources and development of incident reporting procedures. Managing conflicts of interest: Participants expressed conflicts in decision-making with some describing “always err on the side of caution” and another referencing “competitive emotions” when deciding if a player needs to be removed from activity.

Conclusions: EBRs related to knowledge and experience help coaches learn to recognize SRC. Knowledge-related EBRs focused on facts that did not require context, aligning with Dreyfus’ novice stage of being a coach. Experience-related EBRs focused more on using situational perspective and salience to determine how and when to modify maxims. Lastly, two themes emerged highlighting the need for more decision-making support. Current EBRs for training support novice coaches in knowledge acquisition. Future development of SRC training should address experience and a supportive decision-making environment.

Author(s) Disclosures: There are no known conflicts of interest for any authors.