Michael S. Ferrara, Ph.D., Interview Transcript

The following is a transcript of my interview with Michael S. Ferrara, Ph.D. To find links to the audio files and more information about the interview, please click here.

These transcripts are made possible by a gift from the NNEAHE.

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Bonica:	Welcome to the Forge, Dean Ferrara. I thought we'd start by talking about your career background, how you got involved in sports medicine, and what was it that interested you about it. Did you play a lot of sports in high school? Played in college? What was it that brought you to the field?
Ferrara:	Actually, I was a pretty decent athlete growing up. I played hockey, baseball, and football as at that time, we did three sports instead of specializing as a lot of kids do today. My best sport was ice hockey. I actually got recruited to Ithaca College to play hockey there. Then, I played some. Actually, I didn’t play hockey. Actually, I went and played football for a year. I played baseball for a couple of years and I got involved in the injury side of it, and I went to a meeting.
	That was about the time in the 1970s where athletic training is really starting to develop as a profession. At the time, there were two routes to credentialing your certification. One route was an internship route where you mostly learned on the job. The other route was an academic route or a curriculum route where you took courses plus learned on the job, and that’s good. I went into a few programs in athletic training that had the curriculum route.
Bonica:	At the undergraduate level?
Ferrara:	At the undergraduate level. Of course, you fast forward that 30 years to now, and everything is a curriculum. Everything is an academic major. We have one here, an Athletic Training at UNH which is an undergraduate major in our Department of Kinesiology. Nationally, there’s probably about 350 or 360 accredited athletic training education programs.
Bonica:	If a student was to come here and go to Kinesiology, majored in Kinesiology, majored in Athletic Training, they would get a Bachelor’s Degree in Athletic Training?
Ferrara:	Correct.
Bonica:	Then, go on. Is that a career entry level education or do you still need to get a masters?
Ferrara:	It depends on what level you want to work. If your goal is to work in a college university, typically you have to have a master’s degree. Like myself, a lot of people we hire is graduate assistant athletic trainers. You do your education while you’re gaining more clinical experience. Then, you would move right into the work force. High school levels can be either bachelors and masters, and same thing in the clinical field. If you’re working for a hospital, sports medicine center, et cetera, it can be either bachelors or masters.
Bonica:	As an undergrad, you made that decision. Did you see a mentor or somebody that you really said, “Wow, this guy is doing something really cool,” or “Gal is doing something really cool?”
Ferrara:	I had a lot of great mentors. Kent Scriber who was the Director of Athletic Training at Ithaca College was a great mentor and a wonderful friend. He’s, in fact, retiring this year from Ithaca after a long and storied career.
Bonica:	They were doing it and you got interested?
Ferrara:	Right. I knew at that time I wanted to work in a college university setting. I had to go get my master’s degree. I chose Michigan State. It’s an interesting story. I was a senior at Ithaca and I wanted to go to the national meeting for the National Athletic Trainers Association. That year, they held their meeting in Philadelphia. As a young student, I didn’t have much money, and I drove down to Philadelphia, and had a place to live. I met students from Michigan State. We hit it off. They introduced me to their staff. Then, we hit it off. It ended up working out. I actually applied to five different schools for my master’s degree. My top choice was always Michigan State. I had a great experience there. One year, I worked at the high school as an athletic trainer. The second year, I did soccer and lacrosse at MSU. My wife and I got married on the campus of MSU.
Bonica:	Is that right? All right. Wow, that’s a new connection back to the school. You were there in the early ‘80s and you were the athletic trainer for several major festivals. Then, you were the trainer for the US National Ice Hockey Team in ’82-’83. It sounds pretty exciting.
Ferrara:	Yeah, it was a great trip. You remember, we won some medal in 1980 in Lake Placid.
Bonica:	I heard about that, that miracle on ice story. Yeah.
Ferrara:	Yeah. The ’83-’84 team, the goal was to get ready for the ’84 Olympics. As a preparatory tour. We had a lot of the same folks from the ’80 team like Craig, and Verchota, and Harrington, Wells, and the list goes on and on. It was really a wonderful team. Won the gold medal in the World Championships in Tokyo. It was a neat experience. Especially, I was just a young athletic trainer at the time. I was only 25. Here I am and had won marquee experiences. It was a right place, right time thing. As I mentioned, I was at Michigan State.
Bonica:	How did you get there?
Ferrara:	When I was at Ithaca, I went to a meeting, and I met another athletic trainer who told me about his experience at Colorado Springs at the United States Olympic Training Center. I said, “How do you do that?” He said, “You got to submit this application and do all that,” and so I did. In between the summer before I started at Michigan State, I got called to do my two-week internship in Colorado Springs. During that time, I had men’s water polo and men’s field hockey. They evaluate you during that time for your clinical skills, your ability to work with people, ability to work in crisis situations, and all those kinds of different attributes. I got selected to work the ’82 Olympic Festival.
	The Olympic Festival at the time was an Olympic-style games. It was north, south, east, and west. They would just compete in various things. During that time, I had the men’s gymnastics team and worked with them. Actually, during that time, they were doing very well in gymnastics. ’83, I got to go to the World University Games in Edmonton, Canada. Again, I had men’s gymnastics. During that time, I got the call from OTC and said, “Would you be willing to do it?” I was actually at Michigan State at grad school. Fortunately, they were on quarters. I took the winter quarter off. I left on Christmas Day and came back in April 1st. I just overloaded my credits to graduate on time.
Bonica:	You’re the athletic trainer for a variety of different teams. I’m not a clinician. Just tell us a little bit about what does an athletic trainer do, especially at that level of performance?
Ferrara:	Essentially, we’re responsible for the prevention, the treatment care, and rehabilitation of injuries. If you would injure your ankle or your knee, we would do the initial assessment. We would probably provide the initial treatment, make a decision if it needs referral to a physician or if we can handle it internally, and to start the rehabilitation program to get you on the road to recovery.
Bonica:	It’s a mixed skill set that you need to have.
Ferrara:	It’s right. You got to be able to work with people. You’re working with coaches. You’re working with athletes. You’re working with administrators and parents. It’s a challenging position but it’s a ton of fun. I’ve had a …
Bonica:	You probably got great seats.
Ferrara:	Yeah, right in the sideline. You’re exactly right. As long as you pay attention because those seats come out fast on the football field or, say, for any sport.
Bonica:	Sure. Yeah, neat. After you finished your time at Michigan, you got a job at Ball State as a Professor of Physical Education, and to be the Coordinator of the Athletic Training, and the Director of the Athletic Training Laboratory. You went there in ’85, stayed there until ’98. What was that like?
Ferrara:	At that time, I made the switch from the clinical side to the teaching side. I come from a family of teachers. My dad was a music teacher. I wanted to try the teaching side of it. Ball State had a position open for a Program Director of Athletic Training, and I applied for it, and got it. That’s how I embarked on my academic career. At the time, I only had my master’s degree. I was getting their program. I was working through accreditation to make sure we were accredited in doing the day-to-day things on the program. One of my passions is just working with students. That was a good. I also had a clinical assignment with baseball at the time in addition to running the AT Program.
Bonica:	Neat. During this time, you mentioned you had your master’s but you started a PhD at Penn State.
Ferrara:	Right.
Bonica:	Now, what did you actually get your PhD in?
Ferrara:	I got in Sport Epidemiology. Way back in the ‘70s, there’s a program called NAIRS, National Athletic Injury Reporting System. It’s a reporting system that was used for the NCAA. Penn State was one of the leaders in sport epidemiology which is what I wanted to study. I worked under Dr. Bill Buckley. He was my major professor.
Bonica:	During this time, while you were at Ball State, you got really involved in athletic events for disabled athletes, and you were involved in a whole slew of interesting sounding events. You were the co-director of the National Wheelchair Athletic Association Elite Training Camp, athletic trainer for the World Championships in Games for the Disabled. You were ultimately the Director of Medical Services for the US Disabled Sports Team in the 1992 Paralympic Team. Then, during this period, you had and much of your early published research was concerned with athletes with disability. You published somewhere around 19 peer-reviewed articles which is huge. Why are athletic programs for the disabled important?
Ferrara:	It actually developed. I was chair for search committee for Adapted PE position at Ball State.
Bonica:	What does that mean, adapted PE?
Ferrara:	Physical education for people with disabilities. They were training teachers on how to teach physical education. The person we hired was Dr. Ron Davis who is very involved in sports for people with disabilities. We formed that relationship and that’s how I ended up in sports for people with disabilities. My dissertation was doing the injury epidemiology study on athletes with disabilities. We did first a retrospective six-month study. Then, we did a prospect three-year study Athletes with Disabilities Injury Registry which was funded by the USOC. I had the research side going.
	During my dissertation research, the United States Cerebral Palsy Association said, “We’re happy to participate in your research but we want you to present to our Sports Medicine Committee.” Up I flew from Penn State to Detroit, Michigan to meet with their Sports Medicine Committee, and they found out about my previous experience with the Olympics. Working with the Olympic Sports Festival, the Pan Am Games, the World University Games that we talked about before, and they asked, “Would you be interested in going to the World Championships in Austin?” I said, “Sure, I’d love to go.” Off I went.
	For sports for athletes with disabilities, there was five different organizations. Just blind and visually impaired, the cerebral palsy, spinal cord injured, amputee, and dwarf were the five major groups. What it turned out when I got to Austin is each group had their own medical staff and this group treated their own athletes. Being a newbie on the block, I said, “This doesn’t make sense. We should integrate our services. We can provide much greater services together rather than trying to do things …”
Bonica:	They’re siloed.
Ferrara:	Exactly. That’s how I ended up in those leadership positions. We’re able to integrate some of those services in the 1990 games. We did the same thing with the Paralympic Trials in ’91 and the ’92 games in Barcelona. Barcelona, we were a medical staff of 25 to 30 people for close to a team size of 600 altogether.
Bonica:	That’s a fairly unequal ratio.
Ferrara:	Yeah. It’s a lot of people.
Bonica:	You must have been very busy.
Ferrara:	We had physicians. We had athletic trainers. We had physical therapists. We had people in wheelchair, orthotic repair. We brought a sports psychologist with us. We were all part of the medical team. We had somebody at every sport and then spread out.
Bonica:	You were actually the director of the whole operation.
Ferrara:	Right. I was in charge in administration, overseeing the entire operation. Dr. Greg Palutsis who is from Northwest University Chicago was our medical director. He and I would work together in putting together a plan. Then, when we had things that happened which we did, we worked together in solving the problems from a health care perspective.
Bonica:	This interesting observation about the silos. That’s a common organizational problem as people get siloed in, and they fail to take advantage of these synergies that are obviously there. Did you have any resistance to that?
Ferrara:	Of course, there is. Again, you talk through the issues. My philosophy, and again I was a neophyte at the time, if you know injuries, you can treat anybody. Yes, you need to know specifics for disability but we could teach you that. For example, cerebral palsy had certain types of things. Those with spinal cord injury had certain types of problems. You would work through. We actually developed a booklet that was written by the team in terms of training others so they can work from a cross disability perspective.
Bonica:	Are there specializations now in athletic training programs for working with people with disabilities?
Ferrara:	Not specifically.
Bonica:	Not specifically, but is it something that’s part of a curriculum generally speaking?
Ferrara:	It was part of the units but it’s not a specific focus.
Bonica:	Okay, just curious. What do you think in terms of research? You did a lot of research in dealing with injuries for people with disabilities, performance issues. How did understanding of athletes with disabilities changed during this period? I think there was a lot of change going on and probably always.
Ferrara:	There’s sociological changes. There’s societal changes. I think basically, what we’re trying to promote is sports is safe. You can develop the paradigm in order for everybody to participate in sport and participate safely. What we did was a couple of our projects was just describe, what are some of the common injuries that you would expect to see in certain populations?
	For example, some of our blind and visually impaired athletes tend to have lower extremity problems. If you think about it, if you take vision away, what do you have to rely upon to help you as your navigate walking and running? It’s your feet, your proprioceptive system. The way you hit the ground biomechanically changes a little bit versus those who have vision. It changes the focus a little bit. Obviously with those spinal cord injured, there’s a lot of upper extremities. A lot of shoulder, or elbow, a lot of risks. It makes sense, doesn’t it?
Bonica:	Sure, sure.
Ferrara:	What we’re able to do is actually put data to show what we thought was actually happening in the field. We had a series of, I think, three or four papers on the epidemiology of sport injuries.
Bonica:	How has that affected the field? How has that affected training since that research was done?
Ferrara:	I think, again, working with our coaches, you can design safe training programs and you can begin to emphasize what groups you should strengthen from an injury prevention standpoint. If you know or expect a certain population to have upper extremity shoulder issues, then we can work on an upper extremity program as part of the normal training to reduce the injury.
Bonica:	The vision of the IPC was to enable Paralympic athletes to achieve sporting excellence, and inspire, and excite the world. What do you think of that mission?
Ferrara:	I think it’s great. The International Paralympic Committee is the sister organization to the IOC and actually service on the IPC Sports Science Committee for eight or nine years, I can’t remember which, and trying to promote sports for people with disabilities. That’s one of the great things about UNH is we have the Northeast Passage which is very much the same thing promoting sport and physical activity for people with disabilities. Promoting a healthy lifestyle across the spectrum. It doesn’t always have to be a lead sport. It could be just participating in regular recreational activities, the whole spectrum, because health and physical activity is so important to our health.
Bonica:	What we learned with elite athletes helpful to just the ordinary [crosstalk 00:16:55]?
Ferrara:	If you think of it globally, not just with people with disabilities but globally, a lot of times, elite sport trickles down to college and high school sport or recreational participants. It works for some and it doesn’t work for others because pro athletes are different. They’re bigger, faster, stronger. To be a pro athlete, you have to be a motor genius.
Bonica:	What does that mean?
Ferrara:	A pro athlete puts their bodies in places and space the rest of us can’t do. We can’t throw a fast ball 95 miles an hour. They have the gifts to coordinate all of the different actions to be able to do that. For a person to run a 4240 has the gifts to do that. Your pro athletes have made their way upwards and essentially, they’re a motor genius. They’re able to put their bodies in places …
Bonica:	[Crosstalk 00:17:45].
Ferrara:	Right. They put their bodies in places and space that the rest of us can’t. I could throw a fast ball. I can’t do it more than 80 or 85 miles an hour. I just don’t have the motor pattern and the ability to fire my muscles in sequence in order to make that happen. Yes, there’s some training to make it better but you got to have, to some degree, the genetic to make to work. If you look at pro football to be a lineman, you got to be 6’5”, 6’4”, or whatever, and you’re 300 pounds, and be able to run fast.
Bonica:	If you’re 5’8” like me, you cannot probably be a lineman.
Ferrara:	Right, you’re not. Right, exactly.
Bonica:	No matter how much practice.
Ferrara:	Exactly. Then, if you take it down each level, everything moves down sequentially.
Bonica:	You worked with disability. Then, in 1998, you moved to the University of Georgia to be the Professor Program Head and Director of the St. Mary’s Hospital Athletic Training Research and Educational Laboratory. Was Georgia a big change from Indiana?
Ferrara:	It was a big change. Let’s back up a second. In 1995-’96, I was Director of Medical Operations for the Atlanta Paralympic Organizing Committee. If you remember, we talked earlier about ’92 where I was with Team USA. In ’96, Atlanta was hosting the Olympics and Paralympic Games. My charge was to develop the health care plan or medical plan for the entire games. I was working. My cohort was Dr. Robert Wells who was the Medical Director and I was the Director of Medical Operations. We had to put together not only a plan for our athletes but for spectators, for VIP, for guests, the entire plan. We had some 35 to 40 venues.
Bonica:	It’s not just athletes. This was the whole medical.
Ferrara:	Yes. We went through disaster training with FEMA and GEMA, at the Federal Emergency Management Association and Georgia Emergency Management Association. We actually did a drill prior to the games where they brought in all the different functional groups, and they put us in this big room, and they put each in the functional areas in the room, and they ran a disaster scenario through to see how everybody would react, how the systems would communicate. During the ‘90s, this was pre-cellphone era. The cellphones were just starting to come in. My cellphone has probably a flip and a half high.
Bonica:	Yeah, the bricks.
Ferrara:	Yeah, and the battery is maybe 20 minutes which is way different than what we have now. Communication was always a challenge. We had to do everything from a disaster planning mass casualty event to simple sprain and strain that somebody may get or some burn from sitting in the bleachers. We staff all the different competition and training venues. We have ambulance that are high profile or high risk events. We developed a hospital support network. We had hospitals that adopt venues. We use them to help provide equipment supply, as well for their staff and volunteer. It’s a great event to participate in. That’s the neatest part which is meeting all of the different people from across the world but just all folks from Atlanta.
	During my time there, I got to know some of the people from the University of Georgia, specifically Ron Courson who is the Director of Sports Medicine Program. He called me up one day and said, “We’re starting an athletic training education program. Would you be interested?” I said, “Sure.” Threw my name in ahead. They offered us the position. We all liked our time in Atlanta. We made the move to Athens in ’98.
Bonica:	Great. Before we talk a little more about your Georgia experience, let’s talk a little bit about your Georgia experience being at the Paralympics. You were talking about a couple of times now about the roles of the director, the administrative director and the chief medical officer or medical director. This is a common matrix issue that shows up in a lot of medical organizations. You have a co-lead. Talk a little bit about what makes a relationship like that effective? When does it work? What has to be done to make sure that …
Ferrara:	I was lucky in both situations. Dr. Palutsis in ’92 and Dr. Wells in ’96 both were outstanding people who were grounded in doing the best thing for the athlete or for the population. Because we both came from similar philosophies and trying to do the same thing, there’s very, very little conflict. Our goal was to provide the best medical environment whether it’d be the ’92 or the ’96 games, and just figuring out, how do we get there? What do we need to put in place in order for that to happen?
	In ’92, one of the things that we did no one ever done for the games before, a pre-medical history because each of the groups, again, took care of themselves. There’s never a coordinated event. By doing that, we had a medical history in all 500 plus athletes. It actually helped us in a couple of cases where we had injuries or in identifying potential problems.
Bonica:	You can anticipate it.
Ferrara:	Anticipate things. In fact, I can’t remember specifically but I think there’s one case we ruled out. Because of a variety of mitigating circumstances, we deemed them not medically eligible to participate.
Bonica:	They could have come and been injured but you were able to do a prescreening.
Ferrara:	Right. Through the prescreening, we’re able to alleviate those problems. I think the bottom line is just working with people, having that common vision of where you want to go, and then figure out the path to get there.
Bonica:	You must have invested a fair amount of time in developing that common vision to make sure that you …
Ferrara:	Exactly.
Bonica:	You both sought the way together.
Ferrara:	As a unit, and then that vision has to fit into the bigger unit which is either the ’92 games, or Paralympic Team, or the Paralympic Games in ’96.
Bonica:	You did eventually take the job at the University of Georgia. I saw in your CV a fairly major shift in the research. You went from looking at disability and athletes with disability. You started looking at the issue of concussion. You published about, I thin, 24 peer-reviewed articles on concussion which is, again, a huge amount of research. I am curious, how did you get interested in this topic and why is it important?
Ferrara:	In 1998, concussion wasn’t what it is in 2015. Now, you look at the papers every day and you can read some about concussion. Back in 1998, it wasn’t as big an issue as it was at the time. Working with Rob Courson and I, we decided we want to pursue this with our student athletes at the University of Georgia. How can we do a better job of evaluating sport related to concussion because at the time, it’s all very subjective?
	A head injury is much different than an ankle and knee injury. An ankle and knee injury, I can put my hands on you. I can feel or palpate the ligament structure and muscle structure. I can do an MRI in you. I can do a variety of different things. I could see the damage. I can see if you’re limping or not limping. With the head, it’s much different. The physical signs and symptoms are masked to a degree. They’re not as outward. We rely much more on subjective response, what you tell me. I can’t measure if you have a headache. You have to tell me you have a headache. You have to tell me how bad it is.
Bonica:	When I think it’s terrible may not be as bad for somebody else.
Ferrara:	Obviously, if someone is knocked out, it’s pretty straightforward.
Bonica:	That’s pretty straightforward
Ferrara:	If someone has amnesia or the inability to remember events, that’s pretty straightforward. A lot of times in boxing or MMA, you’ll see people get hit in the head. Just look at their eyes, and you know nobody is home. Those are fairly straightforward but what do you do with the, I don’t say minor, but lesser injuries which are not as overt and how do you assess those? We went down a path of developing a paradigm of assessing our concussions.
	We did it with a three-step approach. One is we draw out the symptom inventory. We borrowed from the University of Pittsburgh’s inventory at the time. We did a bunch of neuropsychological tests which, at the time, were dumped by pen and paper. We had a neuropsychology student who was working with us in that. Then, we did balance measures using something called neural count. We put those three pieces of the puzzle together and help us make better return-to-play decisions. A lot of it at the time was just we were learning as we go.
Bonica:	When you say return-to-play, you mean …
Ferrara:	Getting back to the field.
Bonica:	When you get hit on the head somehow, can you go back?
Ferrara:	When is it safe for you to go back to play. We were trying to piece all that together. The three pieces always stayed the same. The testing model, when we did things, the different types of tests evolved over time. We got more sophisticated the more we learned over time.
Bonica:	Recently, obviously in the last couple of years, we’re hearing a lot about NFL players. Talk a little bit about that and how is your research reflected in that [crosstalk 00:27:17]?
Ferrara:	Again, the NFL, the lawsuit, the NFL and the NCAA lawsuit, and all the stuff, I think we’re doing a better job of recognizing and evaluating concussion. The big question out there is what do you do with sub-concussive blows?
Bonica:	What is that?
Ferrara:	A sub-concussive blow is something that doesn’t give you outward symptoms. Taking offense or defense of lineman, every play, they’re banging heads. They’re hitting and they’re hitting. That’s just part of the play. What do you do? Does it have any long term …
Bonica:	When you say sub-concussive, you mean it’s not quite a concussion but you’re getting whacked on the head?
Ferrara:	Correct.
Bonica:	Repeatedly.
Ferrara:	You have no signs or symptoms, at least not one that you’re reporting but you keep getting these blows, and you hit your head every day. Every day, you have contact practice, every game that you have, et cetera. If you think of an NFL athlete, you think they started in grade school, elementary school, high school, whatever, you just take the number of exposures. They’ve been exposed eight, ten, twelve, fifteen, twenty years. That’s a long time of exposure of hitting your head.
Bonica:	Repeatedly.
Ferrara:	Repeatedly.
Bonica:	Before I get something.
Ferrara:	Right. Obviously, when you get to the pro level, it’s faster speeds, more velocity, a variety of different …
Bonica:	Compared to a low speed collision in your car.
Ferrara:	Right. There’s some devices out there that measure the actual forces for contact. One of the new things is here Dr. Erik Swartz in our Kinesiology Department has come up with a program or is taking the head out of contact. He is teaching our athletes not to make your head the point of contact but rather your shoulder. From a preventative measure, because ten years ago we’re taught to hit what you see, you stick your head, and you lean forward with it, and now we’re saying don’t do that and hit with the shoulder. Everybody is trying to do that over all the years not to hit with your head and to lean with your shoulders. Erik devised this program. We took the helmet off the players and taught them proper tackling and techniques, or blocking techniques, eliminating the head from the force.
Bonica:	What are you seeing with the long term effects?
Ferrara:	There’s some studies that suggest a relationship to dementia, to Alzheimer’s disease, to a variety of other long-term chronic diseases. The research is moving. It’s a neat study that I believe, I can’t remember who is doing it, were looking at the same thing from the NFL study where they showed depression and Alzheimer’s disease that the same thing happen in the college population. We know there’s some linkage or potential linkage here. It’s that same linkage at the high school or at the college population. That will be something that will be coming out in the next five to seven years or so, or maybe even sooner.
Bonica:	This is a great example of how research actually changes policy and changes [crosstalk 00:30:23].
Ferrara:	Exactly. Right now, all 50 states have a concussion policy. It’s mostly geared at the high school and lower athlete but mostly the high school athletes. Three basic premises behind the policy. It’s called Zackery Lystedt Law which is named after a football player from the State of Washington.
	Step number one is you have to educate everybody about concussion, athletes, coaches, parents. Step two, if you have a concussion, you’re removed from play at the same day. You can’t return on the day that you’re injured. Step three is you have to be cleared by a health care provider whether that’s a physician, athletic trainer, physician assistant. There’s needs to be some evaluation that says, “Yes, Mark, you’re cleared. You’re recovered. You can go back and return to play.” All 50 states have the same basic premises for the concussion law.
Bonica:	I am curious, would you support something or a policy that says it can’t be the team trainer that says you’re cleared to go back but somebody who is an independent of the team? You’ve signed the law. It’s a conflict of interest into letting the …
Ferrara:	I don’t believe so. I don’t think there’s a professional …
Bonica:	You wouldn’t say, “We really need you at this game and get back out there.”
Ferrara:	No. Our goal is the student athlete or whatever level is their health and safety. I don’t see that conflict of interest. I think the biggest thing is just identification. If you don’t happen to see the hit, someone has tapped you on the shoulder and said, “Mike, number 50 got really hard. You need to evaluate.” That’s where I think things are moving along positively where you can’t have the eye in the sky, if you will. That can help you see things that you may not see when you’re on the sideline. The bottom line for athlete trainers and for all health care professionals is that student athlete.
Bonica:	You started to do some other research. You mentioned this to me the other day. I bring this up because I did army basic training at Fort Benn in Georgia in July and August of 1989. I came from New Hampshire directly off the plane into Atlanta. Then, trucked out to Fort Benn. That was a new and unique experience to experience the heat and humidity of midsummer Georgia.
	What you were looking at was the effects of exertional heat illness on high school preseason acclimatization rules. Obviously this research, much like the concussion research that you’re doing, would be of interest to the military because clearly, we deal with this climate issue and taking people from, say, New York State and rapidly drop them into a very hot climate, for example. This research would be useful there. Can you talk about your research on this and where did they go in terms of policy advocacy?
Ferrara:	Essentially started with doing four years of research for the NCAA. We started with college football and tried to look at where EHI or exertional heat illnesses occur and what is the pattern with them. What we found from the NCAA study is most of them occur in the first week. A lot of them occur on the first couple of days where you’re just down in the field, and then it spikes down, ebbs and flows for two days, and then goes away. Really, it’s the first two to three weeks is the most critical in the sport of football.
	When you think about EHI, it’s not just a one-to-one relationship between the weather and you have a heat illness or not. There are many other things that go into it like nutrition, your sleep, how much acclimatization you had, the intensity of the activity. That’s why I think we see that big spike in the beginning is because that’s the first day you’re in front of coaches. You may train all summer, and you run all summer, you do all the stuff, but as soon as you step on a field, and your head coach and your assistant coaches are there, it’s just a different intensity. You work harder. That’s why I hypothesized why we see that spike. Granted, new environment is part of it but we saw that big spike there.
	When we took that NCAA study, we went to the State of Georgia because Georgia had a number of heat stroke tests and nobody should die from sport. Heat stroke is 100% preventable with proper and efficient recreation treatment and an essential ice bath tub. You put them in a big Rubbermaid tub filled with ice water, and you got to cool the body down because someone with heat stroke has a high body temperature and you need to get it back down quickly as possible.
	We worked with the State of Georgia. We talked about my studies with athletes with disabilities around injury epidemiology. All I did here was take those same injury epidemiology principles and applied it to a different population with a different condition. It’s basically figuring out what’s your definition of injury, who is your recorder, and what data do you need, what are the variables of interest, and to look at all of the potential factors that went into it.
	In working with the Georgia High School Association, we partnered with them for three years, and we measured what happened with EHI in football. It’s really cool. After three years of data, we looked at the first week of practice. what you saw if you took on the X  axis, the duration of practice, and you put on the Y axis, the injury, how many injuries you would get. For the first two hours, it’s pretty much a flat line. Then, after two hours, it started to spike up. What’s the policy? Two hours. You limit the first week to two hours and then you go. With the second week, we look at it. It was a flat line for almost two and a half hours, but then, it spiked up. The really neat thing there is you showed a half hour acclimatization.
Bonica:	For a week?
Ferrara:	Right, from first week to second week. You saw the athletes. We built a policy around that. We actually extended to three hours because that was the national standard. W build a policy based on data and then, based upon the sport of football, based upon what we can do in high school, and their calendar, and came up with a great policy. The thing that Georgia really did need, the Georgia High School Association says, “Mike, we want to measure what the world do.” We just finished three years of post-data collection and we’re just starting an analysis now. Did the policy make a difference?
Bonica:	Obviously, no doubt about that.
Ferrara:	Did the injury rate stay the same? Did it not stay the same? Were you able to make a difference? The one thing I can say is we had no deaths in the State of Georgia. 2011 was the last one.
Bonica:	That’s good.
Ferrara:	Yeah, that’s very good but, at least, since the rule has been changed, there had been no fatalities related to EHI.
Bonica:	That’s great. That’s a hope or sign for something.
Ferrara:	Yeah, if we’re talking again about it a year from now, I can tell you what the post-data shows and where it’s going.
Bonica:	All right, very good. Shifting gears here a little bit, I saw in 2010, you were a Fullbright Scholar. I know I’ve heard this phrase and I don’t really know much about it. What is a Full Bright Scholar and what did you do?
Ferrara:	Again, back up a step. From 1998 on, I got recruited by the National Athletic Trainers Association to head their international efforts. Through that, we started the World Federation of Athletic Training and Therapy which was a global organization for those involved in athletic training, athletic therapy, sport biokinetics, a whole variety of things that worked with athletes. In the world, all does it differently.
	Athletic training is, as we think about it, mostly a North American phenomena. At the time, it’s only US and Canada that had athletic training. Now, it’s expanded. You’ll see it in China … Not China. Japan, Taiwan, Ireland. We’re seeing some programs growing in UK. You’re seeing the profession grow out. Most in the world uses sport physios or other types of folks to provide athletic training services to their athletes. By being present in the World Federation, I’ve done a lot of travel. In fact, worked with a university in Island, Dublin City University. As a matter of fact, I was the first athletic training person with a Fullbright Scholarship and I did it at DCU, the Dublin City University in Ireland. It was a great learning experience.
Bonica:	What is that scholarship? How does one get picked?
Ferrara:	It’s a national competition, student government. You submit your application.
Bonica:	How many go a year? How many get?
Ferrara:	Nationally, wow, that’s a lot. In Ireland, there’s about a dozen faculty and students on both levels. Mine was a research and teaching Fullbright. I taught athletic therapy program and did concussion research with them with some of their Gaelic sports.
Bonica:	Really? Some other ..
Ferrara:	Right. Again, same thing.
Bonica:	Had you worked these kinds of sports before?
Ferrara:	No.
Bonica:	It’s all new to you.
Ferrara:	It’s .
Bonica:	Neat.
Ferrara:	I’ve worked with Hurling and Gaelic Football. Again, taking the epidemiology and what does it show us? What are the trends for those particular sports? We played with a few other evaluation models with them. It was a combination of teaching and research.
Bonica:	How long have you been doing that?
Ferrara:	About five months. I started in January and finished the end of May. It was tremendous.
Bonica:	What did you learn from that experience that affected your future research and thinking about sports, academics?
Ferrara:	I think for me, it’s more of a personal perspective. I traveled a lot internationally but I never lived in another culture. It was neat to become part of the fabric of the culture and of the talents.
Bonica:	Passing through, you really became …
Ferrara:	Right. We lived in a town called Clontarf which is about a half hour north of Dublin and became involved in the different things going on in the community, became involved in the things that were happening at the university. Then, working with the faculty from DCU. They were teaching me things that they were doing. I teach them things that we were doing and just blending all of that together. I had a great relationship with their students because it was a different perspective. That was good to hear.
	I actually a year later, we brought students from Georgia over. We did a study abroad at DCU with them. DCU actually every year sends their students to North America as part of their academic program which I think is a brilliant model because there’s a semester immersion in clinical activities.
Bonica:	That sounds fascinating. Shortly after you got back then, I guess, you switched roles or maybe added a role. I am not sure which it was but you became the Associate Dean for Research in the College of Education. Was that a switch or was that yet another thing you were doing.
Ferrara:	I was in the Department of Kinesiology which was in the College of Education. I got a call from the dean and asked me if I’d be interested in being Associate Dean for Research at the time I was the Associate Department Head for Kinesiology. I said, “Sure, we’ll give it a go.” Let’s see what happens and see what it’s like on the administrative side of things because as Director of Athletic Training, I’ve been involved in administration and leadership for most my career. This is taking it to a different level working with the college.
Bonica:	Shift in emphasis more towards administration now.
Ferrara:	Right, exactly. Much less than the athletic training realm and some of the things I was doing previously.
Bonica:	You are now the Associate Dean for Research. What does that mean? That’s, I think, a common position in colleges. What does that mean? What are some of the things that …
Ferrara:	Basic coordinating of our research efforts. Providing support services for our faculty and our staff in terms of grant writing, grant support, submission of applications to various agencies. We have folks who help proofread grants to assist our faculty. We would help on identification of grant agencies either from the public or private sector and nonprofit sector. Just trying to build that research mission up within the college. Actually, I worked with the Senior Vice President for Research and making sure our mission met up with the university mission.
	The College of Education, we have nine different departments. Everyone did something a little bit differently, different styles of research, different topics of research. At the College of Education, we’re very involved in educational-based research which, for me, was a new topic. I learned a ton about it. It was fascinating and working with our faculty and our staff.
Bonica:	I am guessing that led to the next thing that happened to your career which was you became an administrative fellow with the Associate Provost of the University of Georgia and you’re involved in an academic leadership development program for fellow. What were these programs and how did you get involved?
Ferrara:	This was a program ran by the Southeastern Conference and it’s to develop the next generation of academic leaders, if you will. Each school would identify two or three of their emerging leaders. I was selected from UGA as one of those folks. It was a year-long program where the campus would be responsible for the majority of the education that was teaching about what happens in the senior administrative side of the university, how budgets work, how the Office of Legal Affairs and Public Relations development, et cetera. Getting a good overview of the university from a much bigger perspectives than what you would see in a college or department level.
	Then, once each semester, we would visit as a group. All of the fellows from all the universities would converge on a campus. We were in Auburn and University of Kentucky. They would focus and do topic, and teach us about their campus. Obviously, the most important thing was the networking and getting to meet others who in similar situations. Most of the people who are involved were associate deans, or department chairs, faculty senate presidents, those types of things. Again, for me, it was a nice view to have the bigger picture of a university rather than seeing …
Bonica:	Having been in a university for a long time, you gleaned some of this.
Ferrara:	Of course.
Bonica:	What were the big eye-opening moments of that experience for you?
Ferrara:	I think one was just is the budgeting process from a university perspective was the public relations communications. One of the things when we did the Auburn trip is Toomer’s Tree which is the big tree that Auburn would go around and would paper the tree following a football win. That was a time where somebody poisoned the tree. It was a big public event.  How do you deal with that? How does it work? Messaging to the public and whatnot. That whole scenario was really interesting.
	We did a big part which is fascinating. They gave us hypothetical case studies. We have to work as a group on a case study. What are the facts? Then, what are the potential outcomes? Everything usually has two or three paths that you can choose. Why do you choose path A versus B and C? What are some of the rationale? Then, talking through that with the group.
Bonica:	That appears to have been a useful step in your career because in 2013, the University of New Hampshire recruited you to come up here where you are currently, as I mentioned, earlier Kent P. Falb Professor of Kinesiology and the Dean of the College of Health and Human Services. Universities use a bunch of funny titles like provost and dean that they probably have something that correlates with them outside but people don’t use those terms outside of academia. Talk a little bit about what a dean is, what a college is, and how does that fit into the bigger picture of the university?
Ferrara:	Essentially, a college is a collection of departments. In our college, in the College of Health and Human Service, we have eight different departments, we have two institutes, and we have a number of different centers. In our college, we have Department of Kinesiology, Human Development, and Family Studies. We have Social Work. We have Nursing, Health Management Policy, Rec Management and Policy, Occupational Studies, and Communication Sciences and Disorders. Then, we have two institutes, the Institute of Disability and Student Health Policy and Practice. Essentially, our college is made of that and we have a few other parts that are a part of the number of centers as well. Essentially, the college is all those different departments, institutes, and centers.
	As dean, I’m the administrator of the unit. We have a great team of department chairs from each of our eight departments and two institutes. We have some folks who works in the dean’s office. Again, together we help the college to move forward and continue to be in the forefront of teaching our students.
Bonica:	One of the priorities that you’ve established here as dean is to work with the external stakeholders which goes back to what you’re talking about messaging. You’re working hard to develop partnerships both with government agencies in the area, as well as industry. Can you talk a little bit about your other fascinating area?
Ferrara:	I think it’s so important that we’d be a partner with the community across all different sectors, the profit, nonprofit, the hospitals, et cetera. Bottom line is when somebody has an issue or problem they want solved, I want them to think of the College of Health and Human Services first because, again, we have tremendous faculty and staff that can help solve those problems. I want to think of us so when they pick up the phone and call us, and say, “Hey, can you help us?” In some cases, we’ll say yes. Some cases, we can’t. We don’t have the expertise to do everything.
	It’s important for us to be good partners in the state. It’s also important for all of our clinical internships, all of our clinical education. For example, on nursing and occupational therapy to have those relationships. Life is about those personal relationships where you and I can sit together and we can work through issues and problems. By developing those relationships and developing those synergies, because I was new to the state, and I wanted to learn the most I can from all of our different partners, and to reach out to folks and say, “We want to work with you. We want to be collaborators and partners in a variety of different projects, endeavors, et cetera.”
Bonica:	Do you have an example of anything that’s particular and have been successful at all?
Ferrara:	I think we’ve developed a nice relationship with the Law School for the Health Law and Policy Program. That’s another part of us which is a way. That’s an example of leveraging our expertise in health policy and practice, health management and policy in a law school, and working together to create that synergy. We worked last year in developing a trustees training and working with our hospital associations, doing some basics around hospital trustee training, and some issues surrounding that. We’re doing some other stuff with our different departments around nursing occupational therapy and because of my background of sports safety with New Hampshire Athletic Association.
Bonica:	Why is it important for the State of New Hampshire to have a research university like UNH, and not just New Hampshire but Georgia or so forth? Why is it important?
Ferrara:	Sure. I think we play an important economic piece for the state. (A), we’re training the next generation workforce. Our student s going out there. Then, again, our knowledge that we create through our research, and taking that knowledge and translating it into practice, whatever, whether it’d be a treatment procedure, a new way of analyzing data, a new mechanical design for some piece of equipment. Whatever it may be, those partnerships between the education industry are so important in generating and furthering our knowledge, again, whether it’d be engineering business or even health.
	One of the new programs we’re just starting here is the analytics program. That’s an example for how that partnerships worked. One of the things I heard is we need help in data science. We have all these data. How do we analyze it? Who’s the person that does that? In response to that, we created the Masters in Science in Analytics here on the Durham campus and our Manchester campus created an undergraduate program in analytics. It’s creating data scientists to work with big data sets to help identify and solve problems. We’re watching data.
Bonica:	Right, absolutely.
Ferrara:	The cellphones have changed the volume of data that we produce. I think the current status is every two years, we double our data which is a staggering amount.
Bonica:	That’s a great example of an interaction with the community. What are the interesting things that are going on in the College of Health and Human Services that you’re excited about right now?
Ferrara:	I think that’s key. We’re working down a number of different initiatives. (A), is to make sure our academic programs are strong and that our graduates are job-ready day one. When they leave and graduate from our programs, and they go into a hospital, they go into a clinic, wherever they happen to go that they’re able to do the job right away. We want our kids, our students to be ready from the day they go. One example of that is with our nursing programs. This past year, we’ve invested in our simulation lab. We have these mannequins, if you will, that are all controlled by computers, and you can run a case on there. You can do any type of injury, illness, and have it changed real time, and the students will have to respond to these changes.
Bonica:	These are not like the rest of the thing.
Ferrara:	No, no, no, no, no.
Bonica:	Those of us that did the CPR training some time ago.
Ferrara:	These are things that we can run from a full cardiac arrest to a stomach ache.
Bonica:	Yeah, yeah. There are programs for all kinds of things.
Ferrara:	Right. The neat thing that we do is in these rooms, we have cameras. We videotape the student performance while they’re doing their case. At the end, you can say, “You did this really well. This, you didn’t do so well.” We correct mistakes here under our supervision. This way, when they get out into the clinical setting, they’ve already learned what to do and how to address those issues. That would be an example of having our students job-ready day one.
Bonica:	Switching gears just a little bit, we continue to see health wellness going through major changes in our society both from a policy side, as well from things like big data. We’re running around with [crosstalk 00:54:09] around our arms like this. what do you as big trends? Then, we’re also seeing really negative things like an obesity crisis, rising levels of lifestyle-created illness. What trends do you see is important? As the lead educator for the State of New Hampshire, what …
Ferrara:	Sure. I think you touched on the second thing. It was chronic disease. A lot of those chronic diseases may not be eliminated but they can be mitigated. How do we reduce the severity? How do we reduce the frequency whether it’d be obesity, diabetes, and a whole spectrum of them? A lot of times, it starts in early childhood education. Can we teach and train people as they move along through the spectrum? This way, ever since then, they have that knowledge.
	I think we have to keep our eye on chronic diseases and not only from a health perspective, just from a cost perspective as well because we’re seeing increase health care cost within our system. I think the Affordable Care Act is changing with some of those cost and the cost structures. Again, how do we respond to that? How do we respond to inner professional education which is another common topic for us? That’s getting different health care practitioners working together.
	I think one of the things we’ll see over the next decade is health care become “more of a team sport.” If you were to go to see a physician, you will go see a physician, and your physician will visit, meeting one on one with the doctor, with the nurse practitioner, with the PA, or whoever, and then you would walk out. If we take diabetic care, for example. , why can’t we do diabetic care with ten people in the room with one nurse practitioner? It forms a team and a bond among the patients. Usually, it’s a very simple check and you can be much more efficient with it.
	I think the efficiencies can improve over time. I think it’s just bridging and bringing everything together. It’s an exciting time in health care because you’re going to see these changes. From an academic institution, how do we respond to that? We want to be in the frontend of the paradigm shift and not on the backend of the paradigm shift. That’s why it’s important to do visits with our external people to know what’s on their mind and what they see is on the horizon. This way, we can take that information back to our programs and say, “Hey, here are some of the things that we’re seeing. How can we adapt that from a curricular perspective with our students?”
Bonica:	You have an advisory board for the college, right?
Ferrara:	We have an advisory board but it’s more of a development board.
Bonica:	Development board?
Ferrara:	Right. Really, our leadership is our department chairs, and our faculty, and our staff.
Bonica:	They’re reaching out and talking to these …
Ferrara:	Right. We share information. Again, we look at what’s in the horizon and we want to be in the frontend of that paradigm shift. We don’t want to be the responders. We’d rather be the leaders in doing what we can.
Bonica:	Let me close on some thoughts on leadership and mentorship which I mentioned to you is an area that I’m interested in and that we’ll be talking a lot about here on the Forge. Let me start with one question. It would be, you mentioned you’ve got eight departments, two institutes. Yes, they all share a common interest in health but they’re very different animals. You got everything from social work, clinical, mental health, to kinesiology, primary physical health to administration, and they’re all teaching students who have different interest. You’re an expert in kinesiology and sports medicine. You probably have some knowledge of all these things, but you’re the leader for the whole organization. You aren’t an expert in all those fields. How does that affect your leadership? What’s the challenge there?
Ferrara:	The fun part is learning. To me, that’s the joy of what I do is learning about all the different fields, the different professions, learning the nuances, the issues that are facing everybody, and then trying to figure out how we can solve those, and working together. A lot of times, as I mentioned earlier, there’s usually more than one solution. How do we work together finding the best solution for whatever that problem may be? It’s sitting down, analyzing, talking through the different issues, and figuring out what is a good path to get where we need to get? I think one of the biggest things with leadership is just communication. Everything can’t be done by email. You need to pick up the phone.
Bonica:	Right, exactly.
Ferrara:	You need to pick up the phone or you need to walk over because you can’t get into detail on email. You just can’t get to the depths of the conversations; where if you sit face-to-face with somebody or you’re on the phone with somebody, you can move in into those different levels of detail to have a better understanding of the issues.
Bonica:	What have you learned about leadership, particularly in the academic environment? What do you think most non-academics don’t understand about working in an academic environment or being a leader in an academic environment?
Ferrara:	I think one of the biggest key is collaboration, the ability to work across different departments, different colleges. When you think about the analytics program, it’s an interdisciplinary program. It involves all the different colleges and bridge all that together. I think very much so in academics, and industry and business as well is collaboration. It’s a cross-pollination of bringing people’s expertise together because everyone is not an expert on all topics.
Bonica:	Right, it can’t be.
Ferrara:	Right. You have your expertise but if you could bring experts across five topics into one room, you can really develop something great. That’s the fun part about it. A lot of parts of being an administrator, no matter organization, is being the matchmaker, figuring out what parts do go together to make something happen. Sometimes, it doesn’t. That’s fine but you want the opportunity to try and trying to figure out those pieces to move your organization forward.
Bonica:	You’re the leader of the college as the dean. How do you see your role in terms of mentorship? How do you see mentorship happening? In the college, how important is mentorship? Two zones, one would be mentoring our students but also within the college, within the faculty, within the staff, the mentoring relationships that are going on there. How do you encourage it? How is it happening? Is there formal mentoring in the college? Is it informal? Your thoughts.
Ferrara:	I think mentoring is an important thing. I think having those relationships and having those opportunities where if you will come to me and say, “I have this problem” or “I’m thinking about this thing or this program.” You brought the program forward and we thought this is a great idea. It’s a way of sharing our knowledge with the public. Seeing those opportunities and working with our faculty and staff, and promoting where we can, and supporting where we can.
	To me, that’s the joy of what we do in terms of leadership is developing opportunities for our faculty and our staff to be successful and to do the things that they’re passionate about. What do you really love? Obviously, this is a program that you’re devoted to and that you love to do. If I ask you to do something else, you’re going to look at me, and you’d probably do it because I asked you to do it, but there’s not the passion behind it. That’s the fun part about mentoring and leadership is finding that passion, lighting that fire, and allowing it to glow.
Bonica:	Do you say you’ve had mentors in your past that did that for you?
Ferrara:	As mentioned, Kent Scriber was one. The name of my professorship, Kent Falb, was another. A variety of people throughout my career have played good mentoring. Probably the biggest are just my parents, mom and dad as I was growing up. It’s a series of learning lessons. Everyone makes mistakes, and it’s learning from those mistakes, and moving forward, and being honest about it. It makes no sense if you make a mistake not to admit it. I’ll be the first one to say, “I messed up, and here’s why I mess up, and we’ll try and rectify the issue.”
Bonica:	Excellent. What advice would you give to someone considering a career in athletic training, sports medicine, or academia?
Ferrara:	Again, I’ll go back to what I just said, passion. I feel like I’m the luckiest guy in the world. I love coming to work every day. I enjoy what I do and I’ve enjoyed every step of my journey from my time at Michigan State, to Penn State, to Georgia and now here at UNH. It’s having that passion, and having that fire and the love for generally what you do. That’s what makes life fun. Then, so is relationships and those things that you build around it that makes it thrilling. Whether it’d be an athletic training or whether it’d be as a faculty or a staff member, or in business, or industry, having a passion for your profession is the biggest thing.
Bonica:	Great. Any final thoughts that you might want to share with the college or?
Ferrara:	Again, I applaud you for doing the program. I think it’s a great way of educating our students and educating the broader community. Health and health care is such a big topic.
Bonica:	Yeah, it is.
Ferrara:	There’s so many different ways that we can take. Like I said, my way has just been around sports safety which is really a very small piece of the big picture. All of us have these small pieces and by doing this program, joining all those small pieces to meet together a bigger picture which I think would be great for students and others to learn from.
Bonica:	Let’s hope so. Thank you so much for the interview today, sir. I appreciate it. Hopefully, we’ll have another follow up at some point in the near future. You can tell me about your concussion research and how it worked out.
Ferrara:	Sounds good.
Bonica:	All right. Thank you.
Ferrara:	Thank you.