Standards for BOC Approved Providers
Purpose of Standards
The BOC Approved Provider Standards (to include all elements of this document: General Standards, Standards, Essential Elements, and Commentary) provide clear requirements for BOC Approved Providers to ensure an educational quality Athletic Trainers can expect from the BOC. BOC Approved Providers must adhere to all outlined standards and guidelines.
Introduction of Terms
General Standards: There are seven general Standards expressed in roman numerals I-VII. These are areas that group like-minded Standards together and provide general high-level key points in the development of an activity.
Standards: There are 21 Standards. Each Standard is a specific requirement associated with a General Standard.
Essential Elements: These directly relate to a Standard and specify what a certification program must do to fulfill the Standard requirements.
Commentary: These explain the applications of the Standards and their inter-relationships. They also clarify terms, provide examples of practice that help explain a Standard, or offer suggestions regarding evidence that may be provided to demonstrate compliance.
Download Standards for BOC Approved Providers Effective Jan 2022
Download Standards for BOC Approved Providers Effective Jan 2026
Development and Structure
Evidence:
All activities must be based on evidence.
Commentary:
Evidence Based Practice (EBP) – The most common definition of EBP is taken from Dr.
David Sackett, a pioneer in evidence-based practice. EBP is “the conscientious, explicit and judicious
use of current best evidence in making decisions about the care of the individual patient. It means
integrating individual clinical expertise with the best available external clinical evidence from
systematic research.” EBP is the integration of clinical expertise, patient values and the best
research evidence into the decision-making process for patient care.
Essential Element A: Practice Gap: Identify the professional practice gap and/or educational need the content addresses that describes both current practice (what needs to be changed) and best practice (optimum evidence for patient care).
Commentary A:
Identify the professional practice gap and/or
educational need the content addresses that describes both current practice (what needs to be
changed) and best practice (optimum evidence for patient care).
Essential Element B: References: Activities must cite 2-3 scholarly recent EBP references to support
the practice gap.
Commentary B:
EBP scholarly references support the two parts of a practice gap:
1) current practice (what needs to be changed) and
2) best practice (optimum evidence for patient care).
Knowledge-based level: Activities based on the acquisition of knowledge.
Essential Element C: Learning Activity Level: Identify the learning level(s) for each activity as also
described in the practice gap.
Commentary C:
Learning Activity Level: The learning activity level(s) are as follows:
a. Knowledge-based level: Activities based on the acquisition of knowledge.
b. Competence-based level: Activities aimed at providing the experience or ability to apply
knowledge in the context of practice to describe “how to.”
c. Performance-based level: Quality and/or performance improvement-based activities that
measure and make changes in practice, to systems, organizations, communities, etc.
Learning Objectives:
Essential Element A: Learning Objectives: Develop measurable learning objectives that define and align
with the chosen knowledge, competence or performance level that the AT is expected to acquire
through the completion of the activity.
Commentary A:
For example, a learning activity that is targeted at the knowledge and competence levels should include ONLY learning objectives at the knowledge and competence levels.
Essential Element B: Learning Objective Verbs: Learning objectives articulate the cognitive level targeted using Bloom’s Taxonomy-aligned verbs.
Commentary B:
For example, a knowledge-based learning objective would incorporate a Bloom’s Taxonomy-aligned verb such as “recall.” A competence-based learning objective would incorporate a Bloom’s Taxonomy-aligned verb such as “application” or “analyze.” And a performance-based learning objective would incorporate a verb such as “create” or “evaluate.”
Content Structure:
Activities must be presented at or above the entry level of a Certified AT and fall within at least one of the five domains of athletic training and/or of a specialty.
Athletic Training Domains
I. Risk Reduction, Wellness and Health Literacy
II. Assessment, Evaluation and Diagnosis
III. Critical Incident Management
IV. Therapeutic Intervention
V. Health Care Administration and Professional Responsibility
Specialty Domains Orthopedics
I. Medical Knowledge
II. Procedural Knowledge
III. Professional Practice
Commentary:
Review the most current BOC Practice Analysis Content Outline and/or BOC Orthopedic Practice Analysis for a more detailed explanation of each domain, as well as the tasks that fall within each domain.
Delivery:
The delivery shall be appropriate given the objectives.
Commentary:
Activities can be delivered in a variety of formats:
a. Face to face (F2F) vs Virtual:
i. F2F = delivered in person
ii. Virtual = delivered via the internet
iii. Blended= F2F and Virtual
b. Asynchronous vs Synchronous:
i. Asynchronous = not at the same time (on demand)
ii. Synchronous = at the same time (live)
iii. Hybrid= Synchronous-Asynchronous Learning
Activity Materials:
Utilize educational materials to enhance learning during and after the activity (for reference, review, and/or as a practice aid).
Essential Element: Activity Materials: Offer educational materials for each activity that will enhance learner understanding of the content and foster application to clinical practice.
Commentary:
Examples of educational materials include handouts, slide decks, recordings, websites, memory aids, and/or other print or digital supplemental materials.
Assessment
Learner Assessment:
An assessment of the learning objectives must be provided to the learner for every activity offering.
Commentary:
A learner assessment is a tool that allows the learner to demonstrate or confirm their learning relative to stated learning objectives.
Essential Element A: Assessment: Every activity should include at least one competence-level assessment that allows learners to explain how they plan to incorporate the new skill and/or knowledge into their clinical practice to improve patient outcomes. (E.g. asking “how will you
change your practice as a result of this activity?”).
Commentary A:
Knowledge-based and performance-based assessments may be incorporated as appropriate.
Essential Element B: Alignment: Alignment of learning objective(s) and assessment(s) shall be clearly articulated in writing and documented for learners.
Commentary B1:
Competence and Performance-based learning objectives must have an appropriate, corresponding (competence or performance) strategy to assess learning. Knowledge-based learning objectives may also be assessed as appropriate.
Commentary B2:
Simply asking the learners if the learning objective(s) were met is NOT compliant.
Essential Element C: Formal Measurement: Measure the extent to which learning objectives have been accomplished. The BOC Approved Provider must use formal techniques for assessment of learning.
Commentary C:
Formal measurement techniques, such as tests, quizzes, structured observation and self-reports are typically individualized, written and assessed. A methodical review will be required to aggregate and evaluate the data.
Feedback:
The BOC Approved Provider shall give feedback about the assessment to the learner in an appropriate, timely and constructive manner.
Essential Element: Feedback: Feedback from the assessment must be appropriate for the type of
assessment given.
Facilities & Faculty
Facilities:
Ensure the facilities are appropriate for proposed educational activities and that they are conducive to meeting activity learning objectives.
Faculty:
Select faculty based on subject matter knowledge; experience and teaching ability; and ability to meet AT educational needs.
Commentary:
Activity faculty refers to the instructor, presenter, patient voice co-instructors, evaluator or author of an activity.
Essential Element A: Faculty Qualifications: Faculty must provide documentation highlighting pertinent education information, professional training and experience, publication and/or presentation history (e.g. curriculum vitae). If patient voice co-instructors are utilized, they should
provide documentation such as a short bio-sketch describing the patient’s relevant experience.
Essential Element B: Ratio of Faculty to Students: For hands-on clinical training activities, maintain a faculty to learner ratio of a minimum of 1:25 to ensure adequate interaction.
Commentary B:
Hands-on clinical training. The faculty to participation ratios is due to the need for direct observation, individualized feedback and real-time assessment of performance.
Activity Evaluation and Review
Evaluation:
BOC Approved Providers must develop and conduct evaluations of each activity that solicit learner feedback.
Commentary:
An activity evaluation is an appraisal tool that enables learners to provide activity feedback to help BOC Approved Providers determine the effectiveness of an activity and/or the administration of an activity.
Essential Element A: Target Areas: The evaluation questions shall be solicited in the following areas:
a. Activity content was practically useful, appropriate and adequately in-depth
b. Achievement of stated learning objectives
c. Effectiveness of teaching and learning methods
d. Effectiveness of faculty/patient voice instructors
e. Usefulness of educational materials
f. Perception of bias or commercialism
Activity Review and Improvement:
Data collected is thoroughly evaluated and used to make improvements in future activities.
Essential Element A: Internal Annual Review: An independent or internal review shall be conducted no less than annually to determine activity effectiveness. The review should evaluate
overall goal achievement of the activity, taking into consideration all elements of the evaluations and learning assessment results.
Commentary A:
The purpose of the annual report is to reduce the BOC Approved Providers’ administrative burden, capture key data necessary for cyclical activity reviews, and provide data to the BOC for the support of the BOC Approved Provider Program. Most importantly, it allows
BOC Approved Providers the opportunity to engage in self-reflection and continuous improvement. The BOC reserves the right to conduct an activity review at any time.
Essential Element B: Annual Report: Provides required data to the BOC including, but no limited to, the following annual statistics:
a. Number of activities administered
b. Number of total learners
c. Target audiences
d. Joint Accreditation or other interprofessional collaborations
e. Reflections on the BOC Approved Provider’s quality improvements related to BOC standards
f. Key contact/liaison for BOC Approved Provider status
g. Conflict of Interest mitigations (if any)
Essential Element C: Faculty Feedback: Activity faculty are informed of feedback to improve teaching and learning methods, as well as activity quality and effectiveness.
Professional Conduct
Conduct:
BOC Approved Providers are guided by the following principles of professional conduct as they interact with ATs. BOC Approved Providers will:
a. Be truthful in statements to the BOC, ATs and the public.
b. Provide equal and fair treatment to all activity learners.
c. Comply with the BOC audit system.
d. Uphold and enhance public appreciation and trust for the profession of athletic training.
e. Maintain the confidentiality of all learner information.
f. Fulfill financial obligations for all BOC billable goods and services provided.
g. Use inclusive language that avoids discrimination and refrains from imposing personal, ability-based, professional, or cultural bias.
h. Ensure that activities are available and accessible to all appropriate learners.
i. Include a diversity of patients and backgrounds in the educational content, representative of the populations served.
j. Maintain the integrity and copyright of all proprietary BOC and other proprietary documents and materials.
k. Comply with all applicable business, employment and copyright laws within your activities.
l. Provide appropriate credit to other content creators, avoiding plagiarism and acknowledging sources shared/used.
Commentary A:
Copyright is a form of protection provided by the laws of the United States (title 17, U. S. Code) to the authors of “original works of authorship,” including literary, dramatic, musical, artistic and certain other intellectual works. This protection is available to both published and unpublished works. Visit COPYRIGHT.gov for more information.
Commentary B:
Ensure that copyright permission of materials used by activity developers, presenters or others are identified on all activity materials, including audio-visual and activity-related materials. Ownership of the copyright, license or permission must be documented for any
protected materials used within an activity.
Renewals, Annual Reports and Accreditation:
Provide an annual report to maintain BOC A proved Provider status and continue to provide Category A activities. Renewal consists of an annual renewal fee and annual report. Provide a cyclical re-accreditation report and application to continue to serve as BOC Approved Providers, offering Category A activities.
Integrity and Independence in Continuing Education
Prevent Commercial Bias and Marketing in BOC Accredited Programming
Essential Element A: BOC Approved Provider ensures that all decisions regarding the planning, faculty selection, delivery and assessment of CE is independent and not made with biased or commercial interests.
Essential Element B: BOC approved education must be free from products or service commercials (marketing/sales). CE planners may not promote or sell anything that benefits themselves during BOC approved CE.
Essential Element C: BOC Approved Provider respects learner’s privacy and does not share names or contact information with external entities without the explicit consent of the learner.
Identify, Disclose and Mitigate Relevant Conflicts of Interest (COI)
Essential Element A: COI Review: BOC Approved Providers ensure that conflicts of interest (COI) are identified prior to designing accredited educational activities. Processes collect disclosures of any relevant financial relationships involving individuals controlling or presenting educational content from the past two years, regardless of the amount.
Commentary A1:
A COI is a situation in which social, professional or financial considerations have the potential to compromise or bias objectivity. An apparent conflict of interest is one in which a reasonable person would think that the BOC Approved Provider’s objectivity is likely to be compromised. A conflict of interest exists whether or not decisions are affected by a personal
interest; a conflict of interest implies only the potential for bias, not a likelihood.
Commentary A2:
BOC Approved Providers ensure that commercial support does not interfere with the independence and objectivity of the activity and/or faculty. Activities cannot explicitly promote goods or services to the learners.
Commentary A3:
A specific COI disclosure process gathers adequate information before designing or delivering education to assess the relevance of financial relationships. Relevant relationships include those where the educational content pertains to the business income,
products, services, etc. of a commercial entity.
Essential Element B: COI Record Keeping: BOC Approved Providers maintain COI disclosure records for a complete accreditation cycle.
Commentary B:
COI forms collect pertinent information regarding the nature of the relationship, the role the individual played in affecting the educational activity/activities and other related details.
Essential Element C: COI Mitigation: Relevant financial relationships are mitigated, documented and in place before the design or delivery of education.
Commentary C:
Careful consideration is given to those involved to mitigate COI. It may be necessary to adjust or remove the roles of certain individuals to ensure that the content remains free from commercial bias.
Essential Element D: Disclosures: Disclose all relevant financial relationships and conflicts of interest or the lack thereof, to learners before delivering the content.
Commentary D:
All BOC accredited programming requires a COI disclosure statement at the beginning of any provided educational offering (e.g. written content, presentation, etc.)
Administration
Audience:
Activities must be appropriate for ATs or for ATs with other credentialed health care and/or wellness providers.
Commentary:
ATs must be included in the target audience. Activities targeted at non-credentialed fitness or wellness professionals and lay persons, such as patients, parents, coaches, administrators or educators, do not meet BOC standards.
Calculate Continuing Education Units (CEUs):
Assign CEUs based on contact hours. A contact hour is the time actually spent in the educational portion of the activity. One contact hour equals 1 CEU, rounded to the nearest quarter hour. The number of CEUs that can be offered for each Category A activity will be determined by the BOC Approved Provider.
Activity Directory Updates:
Enter all continuing education (CE) activities offered to ATs into the activity directory prior to the event. Activities include all asynchronous, synchronous, hybrid, virtual, F2F and blended events.
Commentary:
BOC activity directory content is maintained by BOC Approved Providers and reflects upon the professionalism and reputation of the BOC Approved Provider. The BOC activity directory is integrated with BOC discovery platforms that match ATs to relevant programming. The BOC Approved Provider is responsible for inputting the necessary details for all activities into the BOC activity directory and maintaining the content as updates are made. (E.g. make sure contact information is provided, hyperlinks are active, titles are descriptive, content is posted in a
timely manner, and changes and cancellations are immediately posted, etc.) The more precise BOC
Approved Providers are with this information, the more discoverable their offerings will be to ATs and other potential learners.
Operations Manual:
Establish and maintain processes for developing, administering,
delivering and documenting activities.
Essential Element A: Non-Discrimination Policy: Policies and procedures that ensure that no individual should be denied participation in CE activities offered by BOC Approved Providers based on protected classes.
Essential Element B: Copyright Policy: Operations manual includes a policy ensuring that U.S. federal copyright law is followed in relation to all content created, disseminated, and used by the BOC Approved Provider.
Essential Element C: Conflict of Interest Policies: Operations manual includes policies and procedures describing the identification, mitigation, and disclosure of COIs, in accordance with the BOC Independence and Integrity standards.
Commentary:
Ensure that commercial support does not interfere with the independence and objectivity of the activity and/or faculty. The sole purpose of an activity cannot be the promotion of goods and services to the learners.
Essential Element D: Fees Policy: Operations manual includes a policy for cancellations and refunds for instances when a fee is charged for activities.
Essential Element E: Providership Policy: Operations manual includes a policy regarding joint providership. The policy must indicate whether the provider currently participates in joint providership. Providers retain the flexibility to modify their participation status at any time.
If the provider engages in joint providership, the policy must clearly define the working relationship between parties, including the documentation of tasks completed by each party. Additionally, the policy must include a formal agreement statement defining the working relationship between joint providers.
Commentary:
The BOC AP must take responsibility for the CE activity’s compliance of the BOC provider standards.
Essential Element F: Record Keeping Policy: Operations manual includes a policy regarding the maintenance of cumulative records, specifically, a roster of all learners who were awarded credit and CEU certificates, for a period of five years.
Essential Element G: Faculty Payment Policy: Operations manual includes a policy regarding faculty/presenter honoraria and expense reimbursements.
Promotional Materials:
Provide information prior to registration to allow
prospective learners to judge the value and appropriateness of the activity. Materials must
include:
a. Learning objectives
b. Schedule and format
c. Fee(s)
d. Cancellation/refund policy
e. Activity faculty and credentials
f. Number of contact hours/CEUs that will be made available
g. Required materials and equipment (if appliable)
h. Sponsors (if any)
Certificate:
Provide each learner, in a timely fashion, with a certificate of completion, in a digital
or print format, upon successful completion of the activity. Each certificate shall include:
a. Learner’s name
b. Title of the activity
c. Completion date
d. Statement of credit
This is the statement that must appear on certificates disseminated to ATs: