In 2020 COVID-19 is not the only challenge that athletic trainers have faced. Discussions of inequality and social justice have also dominated the news cycle nearly as much as COVID-19. It seems, more than anytime I can recall college and professional athletes are using their positional power and fame to bring attention to the inequities that they and/or their teammates may face. During all this, athletic trainers have had a front row seat. This has made me consider two things, 1) has sports always been a major avenue to social change and 2) how can athletic trainers as professionals demonstrate cultural competence, inclusion and mitigate bias while providing patient care?
Sports and Social Justice
“The lesson to take from the riots are not that violence is effective--it is not and never will be--but rather that politics and sports have never been mutually exclusive spheres. They have always been intimately connected. Athletic competition … remain direct lines for speaking to politicians through the proxy of the athlete … because fame provides these individuals with unique voices that can speak to the discontent of millions who feel unheard, invisible and oppressed.” - The Sports Arena Has Always Been A Venue For Protest (Forbes, 2017)
When I think about why I played sports and then became an athletic trainer, it was not because I saw it as an avenue for activism, it was for the challenge, the competition, and ultimately the ability to help people. The reality is sports has been an avenue for change since sports existed. The first known demonstration of activism was in Constantinople in 532 at a chariot race. More recently, athletes, teams, and leagues have pointedly brought attention to topics of inequality and racism along with appropriate safety measures as it relates to competing during the COVID-19 pandemic.
Professional leagues such as the WNBA, NBA, NWSL, MLS and NFL have made concerted efforts towards supporting social justice as teams returned to competition during the pandemic. Alternatively, college athletes have focused more on safely returning to campus amid the pandemic with #BigTenUnited and #WeAreUnited. Ultimately, athletic trainers are at the center of the action in more ways than one. Whether you as an athletic trainer choose to take a personal stand on a given social justice issue, you're in the center of athlete advocacy because you work in an industry that often finds itself in the cross hairs of social change. Minimally, it is important to be educated, to understand the issues and why they are important to the athletes you work with, but should you choose, it could be a bigger than patient care.
Recommended Readings – Sports and Social Justice
Agyemang, K. J. A., Singer, J. N., & Weems, A. J. (2020). ‘Agitate! Agitate! Agitate!’: Sport as a site for political activism and social change. Organization. https://doi.org/10.1177/1350508420928519.
George B. Cunningham, Marlene A. Dixon, John N. Singer, Kristi F. Oshiro, Na Young Ahn & Anthony Weems (2019) A Site to Resist and Persist: Diversity, Social Justice, and the Unique Nature of Sport, Journal of Global Sport Management, https://doi.org/10.1080/24704067.2019.1578623.
Kaufman, P., & Wolff, E. A. (2010). Playing and Protesting: Sport as a Vehicle for Social Change. Journal of Sport and Social Issues, 34(2), 154–175. https://doi.org/10.1177/0193723509360218.
Wolf, S. (January 30, 2019). Athletes and activism: The long, defiant history of sports protests. The Undefeated. Available at https://theundefeated.com/features/athletes-and-activism-the-long-defiant-history-of-sports-protests/
Providing Inclusive Care
To quote the NATA Code of Ethics, “1. Members shall practice with compassion, respecting the rights, well-being and dignity of others.” Section 1.1 states, “Members shall render quality patient care regardless of the patient’s race, religion, age, sex, ethnic or national origin, disability, health status, socioeconomic status, sexual orientation, or gender identity.” To that end, this is where the concepts of diversity, inclusion and social justice may impact your work as a professional.
One way to provide compassionate, inclusive care to invest in identifying your unconscious bias. Unconscious bias (aka: implicit bias) is defined as “social stereotypes about certain groups of people that individuals form outside their own conscious awareness." These unconscious beliefs result based on the brain's tendancy to organize the world based on categories. Unconscious bias is more common than conscious prejudice. Whether you realize it or not, you are potentially exercising unconscious bias in both your personal and professional life. The good news is you can address your unconscious bias by becoming aware of it and learning tools to counteract it.
Reflect on your education and training as an athletic trainer and learning to describe things like bruises and common skin conditions. How often were you asked to describe what these may have looked like on someone with brown or black skin? If you’re like me, probably almost never. The trick is that these physical signs do not look the same on darker skin as they do on lighter skin, so how are you supposed to be prepared to effectively evaluate your patients with dark skin? A young medical student wondered the same thing and now he’s written a book. Check out his story here.
Another tool for providing inclusive care is being able to recognize and call out microaggressions. Microaggressions are defined as “the everyday, subtle, intentional — and oftentimes unintentional — interactions or behaviors that communicate some sort of bias toward historically marginalized groups. The difference between microaggressions and overt discrimination or macroaggressions, is that people who commit microaggressions might not even be aware of them (Kevin Nadal). The entire NPR interview with Kevin Nadal is available here.
To better understand the concept of microaggressions and how these “small” actions can deeply impact the people who experience them, check out this video from MTV:
Recommended Resources - Implicit Bias
American Academy of Family Physicians (AAFP) – Eight Tactics to Identify and Reduce your Implicit Bias
Project Implicit Harvard University – provides a brief bias assessment on a range of topics
Stanford University – Unconscious Bias in Medicine
UCSF – Strategies to Address Unconscious Bias
Recommended Resources - Microaggressions
University of Nebraska Medical Center - The Impact of Microaggressions – An Introductory Training
IUPUI – Division of Diversity, Equity and Inclusion
Looking to take a deeper dive? Book search on topic of microaggressions
There is so much more to diversity and inclusion than just implicit bias and microaggressions, but they are some of the most important beginnings for each of us as we work to become more self-aware about how our thoughts and words can impact the patients we care for. If after reading this blog to you want to get involved in promoting the larger concepts of diversity and inclusion in your workplace and/or the profession of athletic training, then I encourage you to engage with the NATA Ethnic Diversity Committee (EDAC). The committee is active on several topics related to supporting diversity in the profession of athletic training and the patients we care for. To learn more about the EDAC checkout their website, this video and their resource page.
As I have worked to understand what it’s like to be an athletic trainer and part of an underrepresented group I have begun searching for small groups of people who share a common identity. To date, I’ve found one - LatinX Athletic Trainers (Facebook Page). Most recently their group has posted several patient care resources in Spanish to support their Spanish speaking patients. I have yet to find other groups centered around people of color, LGBT or other groups, but I suspect given the current climate that these groups may soon emerge.
In closing, I would like to acknowledge the research and efforts the profession has made to develop highly competent, diverse and inclusive professionals. Here is some of the research that has been published in the last few years as it relates to cultural competence and other related topics by the Journal of Athletic Training in the last five years:
Mazerolle SM, Eason CM. Perceptions of National Collegiate Athletic Association Division I Female Athletic Trainers on Motherhood and Work-Life Balance: Individual- and Sociocultural-Level Factors. J Athl Train. 2015;50(8):854-861. https://doi.org/10.4085/1062-6050-50.5.02.
Ensign KA, Dodge BM, Herbenick D, Docherty CL. Development of an Instrument to Assess Athletic Trainers' Attitudes Toward Transgender Patients. J Athl Train. 2018;53(4):431-436. https://doi.org/10.4085/1062-6050-496-16.
Kutz, MR. Athletic Training Education Journal (2019) 14 (4): 241–242. https://doi.org/10.4085/1404241
Nye EA, Crossway A, Rogers SM, Games KE, Eberman LE. Lesbian, Gay, Bisexual, Transgender, and Queer Patients: Collegiate Athletic Trainers' Perceptions. J Athl Train. 2019;54(3):334-344. https://doi.org/i:10.4085/1062-6050-260-17
Crossway A, Rogers SM, Nye EA, Games KE, Eberman LE. Lesbian, Gay, Bisexual, Transgender, and Queer Athletic Trainers: Collegiate Student-Athletes' Perceptions. J Athl Train. 2019;54(3):324-333. https://doi.org/10.4085/1062-6050-259-17
Grove, DH and Mansell, J. Cultural Competence: Where are We as Athletic Training Educators. Athletic Training Education Journal (2020) 15 (1): 49–54. https://doi.org/10.4085/150119041
Scarneo-Miller SE, DiStefano LJ, Singe SM, Register-Mihalik JK, Stearns RL, Casa DJ. Emergency Action Plans in Secondary Schools: Barriers, Facilitators, and Social Determinants Affecting Implementation. J Athl Train. 2020;55(1):80-87. https://doi.org/10.4085/1062-6050-484-18
Disclaimer: The content contained in this blog is for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician, athletic trainer, or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately.