Context: Increased prevalence of mental health conditions has exposed gaps in the educational preparation of athletic training students. Identifying effective pedagogical strategies to increase knowledge and confidence in the recognition and referral of mental health conditions is imperative. A standardized curriculum, such as Mental Health First Aid (MHFA) training, is promising, as is the use of standardized patient (SP) encounters and case-based learning (CBL); however, there is a lack of evidence to determine best practice for achieving these learning goals. The purpose of this study was to examine the effect of MHFA training on students’ knowledge and confidence and compare the use of CBL and SP encounters following MHFA training. Further, we sought to explore students’ perceptions of the CBL and SP encounters. Methods: This study used a sequential, explanatory mixed-methods design with 2 phases: 1) randomized controlled trial with pre-test, post-test design, and 2) individual interviews. The study was set in an online learning environment using Zoom. A convenience sample of 70 students from graduate level CAATE-accredited professional athletic training programs participated in this study. Twenty-two participants were interviewed. All participants completed MHFA training followed by no intervention, and SP encounter, or CBL activity. A validated electronic knowledge assessment and self-reported confidence scale measured knowledge and confidence with mental health recognition and referral at the study’s commencement and after intervention. A mixed-model ANOVA with an a priori alpha level set a p<.05 was used to analyze differences between groups. Analyses were conducted with Intellectus Statistics. Interviews were recorded using Zoom and then transcribed. The Qualitative Analysis Guide of Leuven (QUAGOL) method was used to identify emergent themes. Strategies to enhance trustworthiness included an audit trail, member checks, and peer debriefing. Results: A mixed-model ANOVA showed significant improvement between pre-test and post-test scores for knowledge and confidence. This result was similar among all three groups. No significant change in knowledge or confidence was found between the control, SP and CBL groups. Five higher order themes emerged from the interview data: 1) perceived value of MHFA training, 2) engaged learning and facilitated feedback, 3) capability, 4) comfort/confidence, and 5) authentic experience. These were organized into three overarching dimensios: knowledge, skills, pedagogy. Participants described how the opportunity to apply their knowledge and practice their skills with an athletic training specific scenario helped them feel more equipped future patient care. In line with the significant difference in knowledge and confidence scores following the training, students perceived MHFA training as a beneficial method to acquire knowledge as it provded a valuable strategy for approaching mental health challenges and distinguishing crises from noncrises. Simulation activities (SP and CBL) were perceived to increase students’ capability, comfort and confidence in mental health recognition and referral. Engaged learning via peer interactions and facilitated feedback through real-time debriefing were key facilitators of student learning in these simulated activities. Conclusions: In order to meet the 2020 CAATE Standards for behavioral and mental health content, programs should incorporate MHFA training to improve student content knowledge and confidence in skills. While this study showed no numerical difference between the groups, the opportunity to practice via simulation with CBL or SP influenced participants’ knowledge and feelings of confidence and capability. To better prepare students for clinical practice, MHFA training should be followed by athletic training specific simulated encounters.
