Purpose: Rectal thermometry has been the best practice for recognizing exertional heat stroke (EHS) since 2015, but many certified athletic trainers fail to utilize this technique. Recent studies identified a barrier to implementation is a lack of self-confidence due to not having hands-on practice opportunities. To improve the adoption of rectal thermometry, the Commission on Accreditation of Athletic Training Education (CAATE) began requiring athletic training programs to train students in rectal thermometry in 2020. Providing authentic practice opportunities for low-incidence conditions such as EHS poses a challenge to some athletic training programs. Therefore, the purpose of this study was two-fold: 1) to identify the effect of high-fidelity simulation vs. mid-fidelity simulation on athletic training students’ self-confidence when performing rectal thermometry; 2) to determine if there were any differences in self-confidence between genders. Method: This study used an explanatory, mixed methods, two-group repeated measures research design. Participants were thirty-nine first-year professional Master of Athletic Training students. These students completed a simulated EHS encounter with either a high-fidelity simulation manikin (HFSM) (n=19) or a standardized patient (SP) (n=20). The outcome measures were The Athletic Trainer’s Self-Confidence Scale (ATSCS) and qualitative semi-structured open-ended interviews. Eight participants from each group (n=16) participated in qualitative interviews. Results: A repeated measures ANOVA with one within-subjects factor and two between-subjects factors revealed a statistically significant improvement from participants’ pre-intervention ATSCS score to the post-intervention ATSCS score regardless of group assignment. There were no statistically significant differences between groups or genders. We identified three major themes of athletic training students’ self-confidence that align with three sources of self-efficacy in Bandura’s Social Cognitive Theory: 1) past performance accomplishments, 2) verbal persuasion, and 3) imaginal future experiences performing rectal thermometry. Conclusions and Recommendations: A simulated EHS encounter with a standardized patient or a high-fidelity manikin is equally effective for improving first-year athletic training students’ self-confidence with performing rectal thermometry. Future research is needed to determine the effect of these encounters on a larger population and the long-term adoption of rectal thermometry in clinical practice.

Author Bio(s)

Hannah L. Stedge, MS, LAT, ATC is an instructor of athletic training at Weber State University in Ogden, Utah. She is also a Ph.D. candidate at Rocky Mountain University in Provo, Utah.

Valerie W. Herzog, EdD, LAT, ATC is the chair of the Department of Athletic Training at Weber State University in Ogden, Utah.

Beth Kinslow, Dsc, ATC is the Health Science and Wellness Program Director and Athletic Training faculty at University of Wisconsin - Stevens Point. She also serves as an adjunct faculty member at Rocky Mountain University of Health Professions in Provo, Utah.

Malissa Martin, EdD, ATC is the Interim Executive Vice President of Academic Affairs and Vice Provost of Academic Affairs at Rocky Mountain University of Health Professions in Provo, Utah. She also serves as the Athletic Training Concentration Track Director for the Ph.D. program at Rocky Mountain University of Health Professions.


We would like to acknowledge Christine Reyes for her service as an external qualitative reviewer for the qualitative data analysis of this study.



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