











































MANUSCRIPT TYPE


QUALITY IMPROVEMENT (PDSA) CYCLES 

 

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Copyright © Indiana State University   Clinical Practice in Athletic Training 
ISSN Online 2577-8188    Volume 2 – Issue 3 – November 2019 

 

Optimizing Return to Learn Following a Sport-Related Concussion: A 
Quality Improvement Project 
Dawn Ranns, DAT, ATC1,2 & Tamara Valovich McLeod, PhD, ATC, FNATA2,3 
1Limestone College, Gaffney, SC; 2Athletic Training Programs, and 3School of Osteopathic Medicine in Arizona, A.T. Still University, 
Mesa, AZ 
 

 
ABSTRACT 

Sport-related concussion (SRC) has been at the forefront of 
the sports medicine literature and media; however only 
recently has return to learn (RTL) been recognized as an 
important piece of a concussion management plan (CMP). A 
student’s successful transition back to the classroom following 
SRC depends on the support, resources, and effective 
communication among the multidisciplinary team. This project 
focused on the assessment of current faculty knowledge, 
attitudes, and beliefs about concussion, the development of 
an RTL policy, and implementation of educational resources 
at a Division II institution. This project ran for 6 months, using 
2 cycles of the plan, do, study, act (PDSA) methodology. An 
initial survey demonstrated faculty have a poor 
understanding of the behavioral and emotional signs and 
symptoms of concussion and that there was insufficient 
communication regarding student-athletes with concussion 
between faculty, staff, student-athlete, and administration.  
Initially, a RTL plan was developed and added to the existing 
concussion management plan (CMP), followed by the 
formation of a multidisciplinary concussion management plan 
(CMT).  Finally, a one time in-person concussion education 
presentation was provided to faculty. Quantitative results 
from the post survey and semi-structured face-to-face 
interviews revealed improved communication among CMT 
members. One-hundred percent of faculty believed the 
brochure and presentation were helpful when managing a 
student with SRC. Faculty felt more knowledgeable and 
confident about academic adjustments and communicating 
with the CMT. Similarly, qualitative results from the in-person 
interviews with 8 faculty members revealed knowledge, 
confidence, and communication greatly improved; however, 
participants recommend additional education and a faculty 
resource page for concussion materials. This project 
demonstrated improvement in communication and efficiency 
in notifying faculty following injury minimizing time lag in 
academic adjustments. The RTL policy and faculty concussion 
education represents a simplistic, sustainable resource that 
could be replicated to other colleges. 
 
Key Phrases 
Policy and Procedure Development, Risk Management 
Mitigation, Collegiate and University Patient Population, 
Sport-related concussion, Return-to-Learn 
 
 
 

Correspondence 
Dr. Tamara C. Valovich McLeod, A.T. Still University, 5850 E. 
Still Circle, Mesa, AZ 85206. 
E-mail: tmcleod@atsu.edu  
Twitter: @TamaraCVMcLeod 
 
Full Citation 
Ranns D & Valovich McLeod TV. Optimizing Return to Learn 
Following a Sport-Related Concussion: A Quality 
Improvement Project. Clin Pract Athl Train. 2019;2(3):1-15. 
https://doi.org/10.31622/2019/0003.1.  
 
Submitted: May 23, 2019 Accepted: July 23, 2019 
 

CURRENT MODEL 

In 2017, the Center of Disease Control reported 
the incidence of sport-related concussion (SRC) as 
2.5 million a year.1 This injury is most common in 
persons ages 15-24 with a prevalence rate 
ranging from 16-24%.2 Although SRC 
management has significantly improved in the last 
decade, return to learn (RTL) is a relatively new 
piece to concussion recovery. Presently, only 
Division I institutions are required to submit a 
formal written concussion management plan (CMP) 
to the NCAA that includes both RTL and return to 
play criteria (RTP). To date, RTL protocols have 
been based on limited consensus driven empirical 
data and their effectiveness and clinical 
implementation has not been widely assessed.  
 
This quality improvement project took place at a 
small private college, with an undergraduate 
enrollment of 2,595 students and approximately 
850 student-athletes. The college is located in a 
suburban area that sponsors intercollegiate 
athletics at the NCAA Division II level. With large 
roster sizes, the addition of several new sports in 
the last five years, and a number of at risk sports 
including football, men’s and women’s soccer, 
men’s and women’s basketball, wrestling, 
acrobatics and tumbling, and men’s and women’s 
lacrosse, there was an increase number of 

https://doi.org/10.31622/2019/0003.1


Optimizing Return to Learn Following a Sport-Related Concussion: A Quality Improvement Project 
 

 

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Copyright © Indiana State University   Clinical Practice in Athletic Training 
ISSN Online 2577-8188    Volume 2 – Issue 3 – November 2019 
 

reported SRC. In 2015-2016 there were 14 
reported SRC, 2016-2017 12 reported SRC, 
2017-2018 36 reported SRC, and 2018-2019 
58 reported SRC’s.  In the previous CMP, when a 
student-athlete suffered a concussion, the athletic 
training staff notified the academic dean who 
then informed the student-athlete’s professors a 
concussion had occurred; however, communication 
was often delayed or omitted either by athletic 
training staff or by an academic dean’s office.  

Collegiate student-athletes often identify 
themselves directly by their achievements on the 
field as well as in the classroom, therefore the 
faculty perception is vital in identifying the 
recovery from SRC.3 Faculty have the ability to 
positively or negatively impact a student’s 
recovery depending on whether they will provide 
classroom support. The willingness of the faculty 
may be subjective by their preexisting knowledge 
of concussion, cognitively, physically, and 
behaviorally, and their beliefs about concussion.  

While there is some evidence to suggest that 
short-term academic dysfunction occurs following 
sport-related concussion,4-7 these seem to resolve 
and not impact long-term academic outcomes, as 
reported through end of year grade point 
average.8 Specifically, Wasserman et al5 noted 
higher academic dysfunction scores in the initial 
week following concussion compared to peers with 
extremity injuries and Swanson et al7 reported 
academic difficulty among students with vision 
symptoms, hearing difficulty, and concentration 
issues.7,9 Furthermore, surveys of student-athletes 
found that 27-90%5 of students and parents 
reported difficulty completing homework or 
classwork during the recovery time following 
concussion.5 When recovery is prolonged, there is 
a greater impact on perceived health status, with 
adolescent athletes reporting deficits in health-
related quality of life related to school and 
cognitive functioning.10  

During this quality improvement project the 
athletic training staff noticed once an initial e-mail 
was sent to an academic dean following a SRC 
there was no further communication with anyone 
about the academic performance of the student-

athlete. During the 2017-2018 academic year 
there were 36 SRC reported to the athletic 
training staff. Thirty-three percent (n = 12/36) of 
student-athletes became ineligible for their sport 
during the recovery semester and 72% (n = 
26/36) had a decrease in grade-point-average 
from Fall 2017 to Spring 2018.  Sixteen percent 
(n = 6/36) of student-athletes were placed on 
academic suspension or withdrew from the 
institution. This data is consistent with the 
literature.5,11 Over the course of the year, no 
faculty reached out to athletic training staff 
concerning a student’s concussion or classroom 
needs. In addition, in reviewing the college policy 
for concussion management there was no 
information provided regarding RTL. Therefore, 
an initial survey was conducted of the college 
faculty in regard to understanding of concussion. 

When the faculty were surveyed, 40% (n = 
22/53) of respondents never received notification 
when a student-athlete they taught was 
diagnosed with an SRC (Table 1). This lack of 
communication between faculty, administration, 
and/or healthcare providers does not follow best 
practices.  In addition, student-athletes seldom 
received guidance and resources upon returning 
to the classroom nor does a healthcare provider 
follow-up with the student-athletes to assess 
progress in the classroom.  Faculty perception of 
student’s class attendance, quality of class 
participation or attentiveness, effort put forth on 
exams and assignments as well as not knowing a 
student has suffered an SRC could affect the 
recovery and the academic success of students. 
Therefore, this quality improvement project 
focused on the assessment of current faculty 
knowledge, attitudes, and beliefs about 
concussion, the development of a RTL policy, and 
implementation of educational support to all 
stakeholders involved with the management of a 
student-athlete following SRC.    



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Copyright © Indiana State University   Clinical Practice in Athletic Training 
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PDSA CYCLE 

Initially the author assessed the college faculty 
through the use of the University Faculty 
Knowledge, Attitudes, and Beliefs about Academic 
Adjustments for Students with Concussion survey to 
identify gaps in faculty knowledge about 
concussion and the academic adjustments. The 
survey is a modification from the validated 
beliefs, attitudes, and knowledge of pediatric 
athletes with concussion for (BAKPAC–AT).12 
Written permission was given from the original 
authors of the survey. The survey was available to 
the faculty for 19 days, April 23 to May 9, 2018. 
Following the completion of the survey the 
investigator analyzed the survey data to identify 
problems with the current system to facilitate the 
first PDSA cycle.   

The project team consisted of one author, who was 
a full-time faculty member of the institution and 
the faculty athletic representative, with 
perspectives of key figures academically with the 
faculty and athletically with the athletic 
department. Following the assessment of the 
survey the plan was three-fold: 1. Develop a 
standardized institution CMP, 2. Develop a 
multidisciplinary CMT, and 3. Disseminate the 
results of the baseline survey and implement 
concussion education to the faculty. Following the 
development of standardized form for return to 
learn, a one-time concussion education 
presentation was developed for faculty, athletic 
staff, athletic training staff, student-athletes and 
the medical director for athletics. For the purposes 
of this QI project only faculty were assessed 
following the presentation. A cause and effect 
diagram illustrated in Figure 1 was constructed 
based on the investigators’ assessment of faculty 
knowledge from the baseline survey. A process 
diagram was developed to capture the current  

Table 1. Faculty Demographics Baseline Survey  
 N % 
Gender (n=52) 
     Male  
     Female 
     Did not respond 

 
21 
26 
5 

 
40 
50 
10 

Age (years) (n=42) 
     20-29 
     30-39 
     40-49 
     50-59 
     60-69 
     70-79 

 
5 
10 
10 
9 
6 
1 

 
12 
24 
24 
23 
14 
2 

Highest Level of Education (n=52) 
     Bachelor’s degree 
     Master’s degree 
     Doctoral degree 

 
3 
24 
23 

 
6 
50 
46 

Years of Teaching Experience (n=43) 
     0-9 
     10-19 
     20-29 
     30-39 
     40+ 

 
17 
12 
6 
4 
1 

 
40 
28 
14 
9 
2 

Level of Schooling Taught* (n=50)  
     Undergraduate 
     Post-baccalaureate – Master’s level 
     Post-baccalaureate – Doctoral level 
     Not a teacher 

 
33 
7 
4 
5 

 
66 
14 
8 
10 

Academic Division (n=49) 
     Arts and Letters 
     Social and Behavioral Science 
     Natural Sciences 
     Professional Studies 
     Education and Physical Education 

 
18 
11 
10 
6 
4 

 
37 
23 
20 
12 
8 

Additional Roles Filled (n=24) 
     Academic Advisor 
     Dean 
     Department Chair 
    Coach 
     School Counselor  

 
21 
1 
6 
1 
1 

 
88 
4 
25 
4 
4 

*Some Faculty Have Taught in Multiple Levels  



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Copyright © Indiana State University   Clinical Practice in Athletic Training 
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Figure 1. Cause and Effect (“Fishbone”) Diagram



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Copyright © Indiana State University   Clinical Practice in Athletic Training 
ISSN Online 2577-8188    Volume 2 – Issue 3 – November 2019 

 

concussion management procedure for a student-
athlete who suffers a SRC. An additional process 
diagram was developed including the ultimate 
goal of operation following a SRC and the RTL 
that is currently used when a student-athlete 
suffers a concussion. Both current and future 
institutional process diagrams are displayed in 
Figure 2 and Figure 3. Implementation of the new 
flow chart in August 2018 has made the process 
more efficient by streamlining a student-athletes 
RTL and RTP, ultimately eliminates faculty’s need 
to reach out to someone at the intuition when a 
student-athlete returns to the classroom.  

It was clear by the initial assessment that faculty 
knowledge on concussion, academic adjustments, 
and collaboration between faculty and staff is 
limited. Most faculty recognized a concussion is 
serious; however, they lacked knowledge about 
cognitive rest and limitations following a SRC or 
the ability to provide appropriate academic 
adjustments for students. It was hypothesized 
improving faculty communication with various 
stakeholders and identifying their role on the CMT 
and providing academic adjustments for students, 
faculty would be more likely to provide assistance  

Figure 2. Previous SRC Flowchart 

to students and student overall success will 
improve when returning to the classroom (Figure 
1).  

PDSA CYCLE 1 

Following the baseline data collection from the 
initial University Faculty Knowledge, Attitudes, and 
Beliefs about Academic Adjustments for Students 
with Concussion survey and the cause and effect 
diagram it was identified that faculty lacked 
overall basic knowledge on concussion and 
applicable academic adjustments for students 
returning to the classroom following a SRC.   

Plan 

In August 2018, all faculty attended a single 
concussion education presentation and received a 
brochure about the new RTL policy for student-
athletes following a SRC. During the Fall 2018 
semester all student-athlete’s suffering a SRC 
reported to the CMT to be assessed for their 
individual RTL plan. Faculty were informed via e-
mail of student-athletes who suffered a SRC within 
24-hours of injury on the institutions concussion 
awareness form. Student-athletes reported to the 
CMT bi-weekly for re-assessment until they are 
discharged from any RTL classroom adjustments. 
Faculty received updated information via e-mail 
within 24-hours following each student-athlete’s 
appointment with the CMT as well as a discharge 
letter when the student no longer required 
adjustments in the classroom.  From September to 
October 2018 faculty completed a post survey. 
Pre- and post-survey results were then compared 
to asses any changes in the faculty’s knowledge, 
attitudes, and beliefs of SRC and academic 
adjustments.  

Do 

The initial intervention incorporated a single 
concussion education presentation and brochure to 
the faculty that included information related to 1. 
Basic concussion knowledge, 2. Appropriate 
academic adjustments for the classroom, 3. 
Personnel involved in the multidiscipline CMT, and 
4. The eight stages of the RTL policy for the 
institution. In August 2018, all faculty at the 



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Copyright © Indiana State University   Clinical Practice in Athletic Training 
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institution were presented the concussion 
education and a concussion awareness brochure. 
From September 25 - October 12, 2018 faculty 
completed the survey with modifications to the 
original University Faculty Knowledge, Attitudes, 
and Beliefs about Academic Adjustments for 
Students with Concussion survey to determine if 
change occurred. The results were analyzed to 
evaluate the effectiveness of the educational 
presentation and brochure.  

Study 

A total of 157 faculty were e-mailed the survey, 
45 responses, and 24 individuals completed the 
entire survey for a 15% response rate. 
Generalized analysis of results considered only 
the results of the 24 complete surveys; however, 
individual question analysis assessed all available 
information. All faculty agreed the educational 
presentation was beneficial. A majority of faculty 
would prefer a variety of alternative education 
mode such as links associated to concussion, 
recorded webinars, live webinars, and in-person 
presentations. Oddly, 43.48% (n = 10/23) of 
faculty would prefer not to receive any more 
information on concussion.  

Faculty knowledge of symptoms associated with 
concussion improved in 11 of 22 symptoms, only 4 
symptoms scored worse on the post survey. 
Symptoms related to emotions conveyed the 
greatest improvement of all symptoms. Faculty 
recognition of signs and symptoms of concussion is 
illustrated in Figure 4.  

Faculty knowledge on prevention, physical and 
cognitive sign and symptoms, treatment and 
management, RTL, and RTP increased in all 
categories. Results of improvement for physical 
and cognitive signs and symptoms and RTL are 
illustrated in Figure 5. More faculty were 
extremely knowledgeable and moderately 
knowledgeable in these areas than found in the 
baseline assessment. Faculty knowledge about 
concussion and a better understanding of 
academic adjustments were the greatest 
improvement. When asked how often the care of 
concussed student-athletes were discussed 

between the faculty and the CMT 65% (n = 
17/26) of faculty reported always, 23.08% (n = 
6) almost always, and 26.92% (n = 7) often. This 
was a significant increase from 33% (n = 11/27) 
of faculty reporting in the same categories. 
Communication improved between the faculty and 
the CMT. Faculty indicated that they received 
information on injured or ill students more often in 
the post survey, 77% (n = 22/24), than reported 
at baseline 36% (n = 8/22) resulting in a 41% 
increase in communication.  

Familiarity with academic adjustments also 
improved. Initial baseline results indicate that 9% 
(n = 5/53) of faculty were not familiar, 43.40% 
(n = 23/53) minimally familiar, 35.85% (n = 
19/53) were moderately familiar, and 11.32% 
were extremely familiar with academic 
adjustments. Post-survey results found all faculty 
(n = 24) were either moderately familiar 58% (n 
= 14/24) or extremely familiar 42% (n = 10/24) 
with academic adjustments.  

There was a 10% increase of faculty who 
recognized the institution has an academic support 
team. Faculty were also more likely to recommend 
academic adjustments to a student after the 
educational presentation. At baseline 33% (n = 
17/53) of faculty responded they rarely to never 
recommended academic adjustments; however; in 
the post-survey, all faculty (n = 23) responded 
they always, almost always, often, or sometimes 
recommend academic adjustments.  

There continues to be a variety of responses in the 
post-survey when faculty (n = 16) were asked 
who is involved in the academic support team for 
concussion students. However, 100% of faculty 
surveyed recognized the CMT was part of the 
academic support team. Some of the weakest 
areas of recognition were the nurse 44% (n = 
7/16), team physician 25% (n = 4/16), teachers 
and disability services each at 44% (n = 7/16). 
Faculty still do not fully know who the point person 
is to manage academic adjustments. Percentages 
on the baseline and post-survey improved by 8%, 
only raising the score to 52%. This is an area that 
indicates further education and growth.  



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Copyright © Indiana State University   Clinical Practice in Athletic Training 
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Act 

Over the course of the Fall semester there were 
36 total SRC. With a large number of SRC in 
future PDSA cycles there needs to be more than 
one person in the CMT that facilitates concussion 
assessment following injury. Initial, follow-up, and 
discharge paperwork to the faculty was time 
consuming and difficult to keep up with. Allowing 
more individuals in the CMT to contribute to the 
assessment and documentation in the Fall 2019 
semester will allow some of burden to be lifted 
and more efficient communication may occur. 
Continuing to educate the athletic trainers, 
coaches, and other healthcare providers on the 
institutions RTL policy will also improve awareness. 
In the Fall semester student-athletes who suffered 
a SRC were still going to study hall, film, athletic 
practices, and weight lifting. Continued education 
will improve faculty and staff awareness of 
student-athletes with increased symptoms during 
various activities and allow them to more 
confidently adjust activities that could hinder 
recovery.  

PDSA CYCLE 2 

Plan 

Following the results of the post-survey the plan 
was to assess 8-10 faculty member’s comfort and 
satisfaction with: 1. The educational presentation, 
2. The concussion awareness brochure, 3. The 
CMT, and 4. The eight stage RTL policy using a 
semi-structured face-to-face interview. The 
interview questions were a modification from the 
interview protocol used for the Perceived 
Outcomes of Web-based Modules Designed to 
Enhance Athletic Trainers Knowledge of Evidence 
Based Practice (Table 2).13 Written permission 
was given from the original author of the interview 
questions. The aim was to recruit 8-10 faculty 
members to achieve saturation. Faculty members 
were selected for an interview if they had one or 

more student-athletes who sustained a SRC in a 
course Fall 2018.   

Do 

There were 18 SRC reported August - October 
2018 that impacted 28 individual faculty 
members at the institution. A total of 8 faculty 
members volunteered to be interviewed (males 3, 
females 5).  All faculty members were given 
pseudonyms to maintain participant anonymity. 
Demographics on the faculty interviewed are 
illustrated in Table 3. 

The purpose of the in-person interview was to 
determine the effectiveness of an educational 
presentation and brochure on concussion 
management and academic adjustments following 
the RTL from a SRC. Specifically, the aim was to 
assess faculty perceptions of whether the 
implementation of educational presentation 
promoted immediate changes in a classroom.  

Study 

The results of the interviews revealed four 
underlining themes; 1. The knowledge gain and 
transfer from the presentation and brochure, 2. 
Increased communication and positive impact for 
the students, 3. Barriers in implementing academic 
adjustments, and 4. Suggestions for future 
improvements.  

Overall the faculty were pleased with the 
presentation and brochure. The majority thought 
that the education was eye opening when thinking 
about concussion and RTL. One faculty responded, 
“having the presentation in a handout so that 
individuals who are visual learners can follow 
along while the presentation is going can be 
helpful. Additionally, having the brochure 
available both in a paper format and a digital 
format to refer back to, whether that’s an e-mail 
or on the website could be helpful for faculty for 
a quick reference.”  

 

 



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Copyright © Indiana State University   Clinical Practice in Athletic Training 
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Figure 4. Baseline and post-survey faculty knowledge of concussion symptoms 

Figure 5. Knowledge of physical and cognitive signs and symptoms and return to learn at the initial survey 
and following the educational intervention.

  

0%

20%

40%

60%

80%

100%

120%

Pe
rc

en
ta

ge
 o

f 
Re

sp
on

de
nt

s

Baseline Faculty Knowledge of Concussion Symptoms Post Survey Faculty Knowledge of Concussion Symptoms

0 10 20 30 40 50 60 70 80 90 100

Pre Physical Signs/Symptoms

Post Physical Signs/Symptoms

Pre Cognitive Signs/Symptoms

Post Cognitive Signs/symptoms

Pre RTL

Post RTL

Percentage of Respondents

Extremely Knowlegeable Moderately Knowledgeable

Minimally Knowledgeable Not Knowledgeable



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Table 2. Interview Protocol Questions With Probes 
1. Tell me a little about your background as a faculty 

member? 
2. In what ways, if any, do you feel the presentation 

and brochure can be improved? 
3. Did the concussion presentation and brochure 

change your perception about concussion in any 
 way? 

4. Do you feel that the concussion presentation and 
brochure had a positive or negative impact when 
a student returned to the classroom with a 
concussion? Please explain.  

5. What concepts, if any, did you take from the 
concussion presentation and brochure that you      
implemented in your classroom with students 
returning to school from a concussion? 

a. Are there concepts you feel like you need 
more information on before you can 
implement? 
b. Are there any barriers preventing you 
from implementing adjustments into your 
classroom?  

6. Do you feel that the communication has improved 
between various personnel when a student in you 
class has sustained a concussion? 

a. What about the return to learn process do 
you feel need to be improved? 
b. Do you feel there are ways to further 
improve the communication between 
personnel and student? 
c. Do you feel that you receive sufficient and 
timely information on the student who 
sustained a concussion as well as continued 
follow-up information throughout the process? 
d. Do you feel confident in the students Stage 
of RTL and the adjustments for the student 
each day? 
e. Is there anything that you would improve 
or change in the RTL policy or communication? 

7. Are there any questions or topics I have not asked 
about that you would like to discuss? 

 

Overall a majority of the faculty agreed they 
were more comfortable with making decisions in 
the classroom when one or more students returned 
following a SRC. The educational presentations 
made them more aware of the symptoms a student 
could experience in the classroom and the role of 
the faculty necessary for student with 
accommodations. Faculty recognized that small 
adjustments to the classroom such as; turning the 

florescent lights down, providing paper copies of 
the notes, and closing the door to decrease 
outside noise increased the student’s attendance 
to class. One faculty states, “I think the biggest 
impact that I’ve benefited from is getting the 
update for each of my students so that if I have 
information that a student has to take short 
breaks, or if I need to dim the lights, or if a student 
has to wear sunglasses or a hat within the class to 
help them manage their symptoms.”  

Communication among medical personnel, faculty, 
staff, students, and administration was recognized 
as a barrier when students are injured or ill. 
Interview Question 6 focused on faculty 
perception of communication across the institution. 
All agreed that communication among faculty, the 
CMT, and students has increased this year. Faculty 
felt that students were being more proactive with 
their professors and notification of injury was 
being e-mailed with 24 hours of injury. Faculty 
were more aware of student injury and 
recognized the need to provide academic 
adjustments. Half the faculty agreed some sort of 
electronic information site would be helpful 
especially for faculty who only have 1 to 2 
students return to their classroom following a SRC. 
One faculty agreed, “Communication has 
increased tremendously. We were getting nothing 
before. I didn’t know who had a concussion. The 
new formula for getting those periodic reports is 
much improved.” Most faculty agreed they were 
more aware of the student’s injury and received 
timely updates on the students throughout the 
process; however, they were not confident about 
academic adjustments with all courses they teach 
and would like to see more information related to 
RTL.  

All faculty members agreed the educational 
presentation and brochure had a positive effect 
on their ability to recognize the seriousness of 
concussion. One faculty responded “it helped 
more faculty members to realize that they needed 
to take concussion seriously. I think it helped to 
realize more of the symptoms that go with 
concussions, as well as some of the signs to look 
for. What I really appreciate is the increase in 
communication that’s come from the CMT because 
now I know more about those students that have  



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Table 3. Participants Demographics 

Participant 
Pseudonym Sex 

Experience as a 
Faculty Member 

at Limestone 
Primary Teaching Role Method of Instruction 

Julian Bailey Male 1 year Literacy library On-line Classroom 
Lora Lane Female 7 years Computer Science On-line/Traditional 
Vicky Perkins Female 16 years Athletic Training Traditional Day 
Cheryl Raines Female 1 year English Traditional Day 
Eva Moore Female 5 years English Traditional Day 
Sara Martin Female 18 years Biology/HS On-line/Traditional 
Alex Lamb Male 6 years Strength & Conditioning Traditional Day 

concussions as well as how they are progressing 
through the stages of RTL and RTP.”  

Half the faculty interviewed found at least one 
barrier to implementing academic adjustments in 
a classroom this year when a student returned 
following a SRC. Non-traditional courses that 
included science labs, discussion classes, activity 
classes, and on-line classes experienced that most 
difficulty with providing the student with academic 
adjustments necessary to attend classes.  

Faculty agreed the educational presentation and 
brochure was a great first step to student success 
in the RTL following a SRC. However, the majority 
of faculty interviewed agreed it would be 
beneficial to have some sort of faculty resource 
page online they could refer to periodically.  

Act 

The faculty interviews revealed that 
communication had improved however, faculty 
are still not comfortable with classroom 
adjustments. Barriers to implementation included 
limited time and not knowing how to provide 
adjustments for course that are not taught as 
traditional day classes. Improvements for future 
PDSA cycles will include education on additional 
resources available for faculty that teach non-
traditional courses such as discussion class, on-line 
classes, and science labs.  

LESSONS AND LIMITATIONS 

During the 40 weeks of this QI project there were 
several changes occurring at the institution. The 
inauguration of a new president and a complete 

football staffing change both took place mid-year 
in January 2018.  Additionally, acrobatics and 
tumbling was added as a new NCAA sport for the 
Fall 2018 and the athletic training staff were in 
the process of transitioning from paper files and 
Sportswear to NExTT software system. One lesson 
that was learned was that the timing of the survey 
is extremely important to have a good response 
rate from the faculty. Unfortunately, the baseline 
survey was available to the faculty at a time when 
several other surveys were circulating through 
faculty e-mail. It also occurred at the end of the 
semester just before final exams.  

Because faculty were not required to return to 
campus until the annual faculty staff meetings on 
August 16, 2018 the presentation was given after 
all Fall sport student-athletes had already been 
practicing. However, the presentation was held 
before the first traditional day courses started. 
Additionally, it was difficult to educate all faculty 
at one meeting because there are three methods 
of education at the institution; the traditional day 
program, on-line program, and off campus sites. 
Most of the student-athletes take courses in both 
the traditional day and on-line program. There 
were only a few problems with academic 
adjustments for the traditional day program in 
discussion based classes and biology lab. 
However, it was difficult to provide academic 
adjustments for students that took on-line course 
that required the student to use their cell phone or 
computer to complete all homework, assignments, 
projects, and exams for the course. This is an issue 
that is still not resolved especially when a student-
athlete had prolonged symptoms beyond the two-
week period.  



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Finally, faculty attendance at the concussion 
presentation and acceptance and implementation 
of the new RTL policy may be a limitation of this 
project. Academic freedom in higher education 
protects the faculty in the classroom. Faculty have 
the freedom to express their views through 
speech, written, or electronic communication 
without reprimand. Academic freedom also 
protects faculty and students from punishment for 
disagreeing with administrative policies or 
proposals.14 Faculty have the freedom to 
disagree with the new RTL policy for student-
athletes returning to the classroom following a 
SRC. Fortunately, concussion and mTBI fall under 
the Americans with Disabilities Act which also 
protect the  student.15 Future education will 
provide faculty with additional long-term effects 
from SRC and the importance in providing 
students with academic adjustments as they 
recover. However, because of the high volume of 
stunt-athletes at the institution some faculty may 
become frustrated with the increased workload of 
accommodating a large number of concussed 
students.    

CONCLUSIONS 

Return to learn is still a relatively new addition to 
the concussion management plan with limited 
empirical evidence to support it. Although it is 
unclear if concussion education has sustainable 
long-term effects on knowledge, attitude, and 
beliefs, there have been short-term preliminary 
results of knowledge gains. This QI project 
identified a lack of a standardized CMP that 
included RTL. This QI project identified a lack of a 
standardized CMP that included RTL. This problem 
has been identified in the literature at other NCAA 
institutions and has led to an increase awareness 
and recognition for the importance of cognitive 
rest following injury as well as quick notification of 
injury and academic adjustments for successful 
student outcomes upon return to class.3 At the 
college, this has hindered the development of a 
CMT, communication and notification to key 
stakeholders following injury, education about 
concussion to the staff, faculty, and administration, 
and proper academic accommodations necessary 
for student success. A University Faculty 

Knowledge, Attitudes, and Beliefs about Academic 
Adjustments for Students with Concussion survey 
was used initially to determine gaps with the 
faculty. Following the survey results a new CMP 
was drafted including a RTL plan. These changes 
were implemented in Fall 2018. In addition, an 
educational concussion presentation and brochure 
was provided to each faculty member. In October, 
8 faculty members were interviewed to assess 
effectiveness of the educational concussion 
presentation and the user friendliness of the 
brochure and RTL plan in the classroom. Finally, a 
post-survey was provided to determine 
improvements in the QI project.  

Return-to-learn is a relatively new term in 
concussion management of student-athletes. This 
QI project provides insight related to faculty 
knowledge, attitude, and beliefs about SRC and 
suggests that a short-term education intervention 
can influence the level of communication across the 
campus. By providing an effective policy and line 
of communication and minimal changes to the 
environment we saw a culture shift among student-
athlete’s faculty, and administration relationships 
related to classroom support.  We are 
incorporating the new policy into daily practice 
and are sharing ideas and methods via e-mail, in-
person, and during faculty meetings. During the 
2018-2019 academic year there were a total of 
58 SRC. These student-athletes will to be re-
assessed in the 2019-2020 academic year and 
monitored for any classroom support still needed. 
This QI project will continue to educate faculty on 
SRC and student-athletes classroom 
accommodated. Further investigation could 
include evaluation of will look at improving 
student-athlete, athletic staff, and medical 
professional knowledge, attitude, and belief of 
SRC to improve the CMP with regards to the RTP 
and student success.  

REFERENCES 

1. McAvoy K, Eagan-Johnson B, Halstead M. 
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ISSN Online 2577-8188    Volume 2 – Issue 3 – November 2019 
 

NeuroRehabilitation. 2018(Preprint):1-6. 
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2. Heaps A. Knowledge and experience of in-
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https://doi.org/10.3233/NRE-172381
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https://doi.org/10.1542/peds.2013-2867


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Copyright © Indiana State University   Clinical Practice in Athletic Training 
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Figure 3. Current SRC Flowchart  



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Copyright © Indiana State University   Clinical Practice in Athletic Training 
ISSN Online 2577-8188    Volume 2 – Issue 3 – November 2019 
 

Figure 3. Current SRC Flow Chart (cont.) 

  



Optimizing Return to Learn Following a Sport-Related Concussion: A Quality Improvement Project 
 

 

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Copyright © Indiana State University   Clinical Practice in Athletic Training 
ISSN Online 2577-8188    Volume 2 – Issue 3 – November 2019 
 

Figure 3. Current SRC Flow Chart (cont.)  


