18.2 BOC Standards, Ethics, EBP & Interprofessional Care

Quick Answer: The BOC Standards of Professional Practice are mandatory for every ATC® holder and applicant. BOC currently implements the SOPP effective February 2026 (successor to SOPP 2024 v3.5, implemented January 2024). Practice Standards 1–8 and Codes 1–6 below are the numbered ATC duties used for certification and discipline. NATA’s Code of Ethics (BOD approved March 2018) adds four membership principles. Evidence-based practice (EBP) is best research + clinical expertise + patient values, moved through the 5A cycle. Trap: posting remembered exam questions in a group chat (Code 3.9) or dating a current patient (Code 1.6).

Task 0503 is not only “get a state license.” It is also professional standards: the SOPP you attest to at renewal, the NATA Code if you are a member, EBP as a clinical duty (Code 1.3), and interprofessional practice so the patient is not trapped in the athletic training room when the problem belongs to another profession.

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Practice Standards 1–8 (mandatory ATC duties)

The Practice Standards preamble: they establish essential duties imposed by holding the ATC® credential; compliance is mandatory. The BOC does not warrant job performance, but every AT and applicant agrees to comply at all times. Standard 1’s physician language still yields to state statutes (section 18.1).

Culturally congruent practice (SOPP glossary) is patient-centered care in which patient and family preferences are addressed by including cultural values, beliefs, influences, worldview, and practices. It is a Practice Standard, not optional courtesy. It pairs with Code 1.1 (non-discrimination, including gender identity) and Code 1.4.1 (respect for cultural diversity).

BCS-O is not Standard 1–8. The SOPP’s specialist chapter is a voluntary orthopedic specialty: the specialist must maintain the ATC® and also meet specialty practice-analysis duties (medical knowledge, procedural knowledge, professional practice). BCS-O is not required to sit the BOC exam, to hold ATC®, or to practice as an AT. Do not tell a hiring principal that entry-level practice requires BCS-O.

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Code of Professional Responsibility (high-yield numbers)

The Code binds credential holders and applicants. The BOC may discipline, revoke, or take other action. Learn the numbers the exam writes into stems.

Code 1 — Patient care

• 1.1 Renders quality care regardless of age, gender, sex, race, religion, disability, sexual orientation, gender identity, or any other characteristic including those protected by law.
• 1.2 Protects the patient from undue harm, acts always in the patient’s best interest, and advocates for welfare—including action to protect patients from providers or AT students who are impaired or engaged in illegal or unethical practice.
• 1.3 Sound clinical judgment based on current knowledge, evidence-based guidelines, and thoughtful, safe use of resources and therapies.
• 1.4 Communicates effectively and truthfully while maintaining privacy and confidentiality per law.
• 1.5 Develops trust with the patient and/or parent/guardian of a minor; does not exploit the relationship for personal or financial gain.
• 1.6 Does not engage in intimate or sexual activity with a patient and/or the parent/guardian of a minor patient. This is not “wait until the season ends.” A current patient (or that minor’s parent/guardian) is off-limits. Dual-relationship cleanup after the fact does not make the conduct ethical at the time.
• 1.7 Informs the patient (or minor’s parent/guardian) of risks in the treatment plan; 1.7.1 no unsupported safety or efficacy claims.
• 1.8 Does not practice, or otherwise render patient care, while under the influence of alcohol, drugs, or any substance that may impair skilled care.

Code 2 — Competency: 2.1 lifelong learning for continued competence and culturally congruent practice; 2.2 current BOC recertification policies (CE/CPC, ECC, fees, SOPP attestation).

Code 3 — Professional responsibility

• 3.1 Practice in accordance with the current Practice Standards.
• 3.2 Practice in accordance with local, state, and/or federal rules, including state licensing and ethical requirements.
• 3.3 Collaborate when warranted; respect others’ expertise and medico-legal responsibility.
• 3.4 Provide services only when there is a reasonable expectation of benefit.
• 3.5 Does not misrepresent skills, training, credentials, identity, or services. 3.5.1 Provides only services for which prepared and permitted by applicable law.
• 3.6 Does not guarantee results.
• 3.9 Does not possess, use, copy, access, distribute, or discuss certification exams, self-assessment and practice exams, score reports, answer sheets, certificates, files, or other materials without proper authorization. Remembered SAE or BOC items in a group chat, Discord, or Quizlet deck are 3.9—and typically copyright infringement—whether or not money changes hands.
• 3.11 Reports suspected or known violations of law committed by themselves or another AT that relate to athletic training or may affect the ability to practice.
• 3.13 Complies with mandatory reporter / responsible-employee laws.
• 3.14 Cooperates with BOC investigations.

Code 4 — Research: accepted ethical standards, protect participants, research aimed at improving knowledge, practice, education, outcomes, or health-system policy.

Code 5 — Social responsibility: serve the profession and community; advocate for appropriate health care for societal needs.

Code 6 — Business: no deceptive or fraudulent practice; charge only for services rendered (6.2); 6.3 maintains adequate and customary professional liability insurance; 6.4 acknowledges and mitigates conflicts of interest.

Exam traps in one line: practicing in a new state on BOC cert alone (3.2 / 3.5); posting exam questions (3.9); dating a current patient (1.6); covering a shift after drinks at the booster barbecue (1.8); calling yourself “licensed in every state” or “BCS-O equivalent” (3.5); skipping malpractice insurance because “the school covers me” without confirming 6.3.

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NATA Code of Ethics — four principles

NATA membership is not required to hold ATC®, but the Code is the association ethics document the exam still expects. Updated and BOD approved March 2018. When the Code and the law conflict, the law prevails. NATA’s Committee on Professional Ethics (COPE) adjudicates member complaints; BOC discipline is a separate process.

Principle 1.1 matches BOC 1.1 on non-discrimination, including gender identity. Principle 2.1 is the practice-act sentence again. Principle 3.1–3.2 forbid credential misrepresentation and out-of-scope practice. Principle 4.3 forbids placing financial gain above the patient’s well-being; 4.4 forbids using AT information to influence a contest or to gamble; 4.5 forbids false or misleading communications, including social media, that negatively reflect the profession.

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EBP: three pillars, 5A, levels of evidence (without GRADE theater)

Evidence-based practice is the integration of (1) the best available research evidence, (2) clinical expertise, and (3) the patient’s values, preferences, and circumstances. Drop any pillar and you are not doing EBP. “I have always done it this way” is expertise without evidence. “The RCT said so, the patient refuses” is evidence without values. “The athlete wants a steroid injection I cannot and should not give” is values without scope (refer).

5A cycle (the operational habit):

1. Ask — a focused clinical question (often PICO: patient/problem, intervention, comparison, outcome).
2. Acquire — search (NATA position statements, PEDro, PubMed, Cochrane, team-physician protocols).
3. Appraise — validity, impact, applicability. You need the idea of a hierarchy, not a memorized GRADE table for every modality.
4. Apply — in this patient, in this state scope, with this physician plan, after informed consent.
5. Assess — did outcomes move (PROs, re-exam)? Adjust or discontinue (Standard 6).

Levels of evidence (concept): synthesized high-quality systematic reviews and meta-analyses of clinical trials sit above individual randomized trials, which sit above cohort and case-control studies, which sit above case series and uncontrolled observations, which sit above expert opinion and uncontrolled tradition. A well-done observational study on exertional heat stroke may beat a tiny off-topic RCT. Position statements are appraised syntheses, not holy writ, but ignoring a current NATA or AMSSM statement without a documented reason is hard to defend as Standard 5 care. You do not withhold indicated first aid because no GRADE table exists for a vacuum splint.

Code 1.3 already makes EBP a professional duty. Quality-improvement projects and competence assessment modules (Chapter 17’s neighbor, Domain V administration) are how many ATs assess after they apply.

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Interprofessional care, referral, and the NPI on the team

IPEC Core Competencies Version 3 (November 2023) still organize collaborative practice under four domains. Teach the 2023 stems:

Your role is the AT role defined by education + BOC Standards + the state practice act—not the role of physician, physical therapist, registered dietitian, licensed mental-health provider, or pharmacist. Standard 1 is physician direction or collaboration. Code 3.3 is cooperation when warranted. Referral is mandatory when the condition is outside scope (intra-abdominal emergency, suspected frank fracture you cannot image, psychosis with a plan, disordered eating needing a full care team, a medication question that belongs to a licensed prescriber). Staying past your scope to “protect the starter” is a 3.5.1 and Principle 3.2 failure, not loyalty.

On the operational team: team physician (or school medical director), school nurse, EMS, PT/OT, strength staff as allowed, counselor/psychologist, and—when the record system asks—your NPI. Taxonomy 2255A2300X, Athletic Trainer, sits under NUCC grouping 22 Respiratory, Rehabilitative & Restorative Service Providers. BOC and NATA urge every certified AT to enumerate through NPPES. The NPI tells the rest of the system which profession rendered the care. It still does not replace the state credential in section 18.1.

Put the three traps away: (1) a new-state job on BOC cert alone; (2) SAE items in the group chat; (3) dating a current patient. Those are not gray areas. They are 3.2, 3.9, and 1.6.