Taming The Unknown

What to do when you don’t know what to do.

By Kenny Berkowitz

Kenny Berkowitz is an Assistant Editor at Training & Conditioning.

Training & Conditioning, 13.4, May/June 2003, http://www.momentummedia.com/articles/tc/tc1304/unknown.htm

No matter how hard you study to become an athletic trainer, you’re going to run into situations where you’re not sure what to do. But don’t let pride get in the way of serving your athletes effectively.

“If you’re stumped, go to the full-time people who have more experience,” advises Tim Neal, ATC, MS, Head Athletic Trainer at Syracuse University.

“Seek assistance,” agrees Chad Starkey, ATC, PhD, Associate Professor of Athletic Training Education at Northeastern University. “If you don’t know what to do, don’t do anything until you’ve gotten help.

“You have to be honest with yourself in identifying exactly how much you know about the situation in front of you,” continues Starkey. “I’d rather have somebody tell me they don’t know what to do, than have them do the wrong thing because they don’t know as much as they thought.”

Starkey encourages students to be ready for some confusion as they encounter new injuries and to take an active role in their education by asking questions. “Not knowing all the answers is a normal part of learning,” he says. “Don’t expect to get everything right the first time.”

Preparing Yourself
Both Neal and Starkey emphasize the importance of using your instructors as resources, learning to communicate effectively, and getting help whenever you’re confused. If you think a situation looks like an emergency, you need to get help immediately from a nearby staff member. But in most cases, you should be able to start on your own, and the best place to begin working is with yourself.

“Think,” says Starkey. “Be patient. Take your time.”

“Don’t rush into anything, and don’t let your emotions affect your decisions,” agrees Neal. “It’s normal to have some anxiety. We’ve all had it, and we’ve all found a way to work through it.

“When people get scared, I try to be very positive and keep encouraging them,” continues Neal. “I tell them, ‘You know this material, you’ve got good grades, and we know you’re going to become a really good athletic trainer. Once you overcome this anxiety, you’ll realize it’s the only thing holding you back.’”

Identifying the Problem
Before you can solve a problem, you need to identify it, says Neal. And before you can identify the problem, you need to closely examine the injury. For example, “There are certain signs and symptoms that you expect to see in a typical sprained ankle,” he says. “You look for cues, trying to decide, ‘Is this typical or atypical?’ Because maybe it’s not a typical sprained ankle, maybe it’s a fractured fifth metatarsal. Look for confirmation of whether or not this is a typical sprain, reexamine the ankle to make sure you know what you’re dealing with, and reflect.”

“Identify what is known and what is unknown, then reconcile the two parts,” agrees Starkey. “Call upon your coursework and past experience and try to make sense out of the senseless. The answer lies in your problem-solving abilities.”

In trying to identify an injury, it’s crucial to listen closely to the athlete and thoroughly examine all the information presented to you. “You have to ask the right questions and be careful not to dismiss anything that might be a red flag,” Neal says. “Let’s say someone has an abrasion and it’s got pus coming out of it. That’s a red flag. Don’t dismiss it, even if the athlete thinks it’s not a big deal. Use your critical thinking and act on it.”

To help his students examine the identification process, Starkey encourages them to review the literature before and after implementing a new treatment, especially the Journal of Athletic Training, which has case reports and articles about a wide range of topics. For Starkey, that kind of research is another sign that athletic training students are taking their work seriously and carefully evaluating their knowledge of the course material.

Solving the Problem
Whether an injury appears typical or atypical, both Neal and Starkey emphasize the importance of consulting with full-time staff members before beginning any treatment. But before you ask for help, advises Neal, try to come up with a preliminary plan on your own, detailing how you’re going to resolve the problem in front of you.

“That shows you’re thinking critically and reflecting on what’s going on, which is what the athletic training staff needs to see,” Neal says. “That way, you’re not just implementing someone else’s ideas. You’re actually providing care by thinking your way through the process.”

The most common mistakes are caused by a lack of knowledge or a lack of experience, says Neal. His solution: Pay attention to every athlete who comes into the athletic training room. Work closely with the full-time staff on rehabs, taking full opportunity to utilize the resources around you. Learn from other people’s experiences, and watch staff members as they work on injuries you haven’t seen before.

“When somebody comes to the door, get over there and help them,” offers Neal. “That’s another chance for you to enhance your experience and your people skills. We encourage everybody to study all ongoing injuries and be prepared for anyone who walks into the training room for a re-check, because it’s important to deal with a diverse group of situations to build your knowledge base.”

Preparing for the Next Time
Exposing yourself to a wide variety of injuries is an important part of preparing yourself to face any situation. However, developing your knowledge and experience is only part of the process. To ultimately succeed, you need to keep mentally preparing for the next surprise.

“Critical thinking is the keystone to making effective decisions,” says Neal. “You need to take charge of a situation, properly assess it, and come up with a course of action, taking advantage of the full-time staff around you. To do that, you need to keep thinking.

“Come to the athletic training room every day knowing that there’s going to be a new problem to be solved,” he continues. “Anticipate what might happen. And keep asking the full-time staff to talk about the situations they’ve been in, because I think the old axiom is very true: Prudent people learn from experience; wise people learn from the experience of others.”

“To me, the students who don’t ask questions, and don’t know the limits of their knowledge and ability are the dangerous ones,” says Starkey. “Becoming an athletic trainer is a learning process. It takes practice to become proficient.”