Implementing Green Zone Training into an Athletic Training Curriculum

Context Professional identity development in professional master's (PM) athletic training students occurs over time and is influenced by numerous socializing factors. Although socialization processes of athletic training students have been examined, professional identity development related to the Weidman et al graduate and professional student socialization framework [Weidman JC, Twale DJ, Stein EL, et al. Socialization of Graduate and Professional Students in Higher Education: A Perilous Passage? ASHE-ERIC higher education report. Vol 28, No. 3. Jossey-Bass Higher and Adult Education Series; 2001] has never been examined in athletic training. This model values the multiple networks, individuals, and experiences that influence graduate students throughout their program. Objective To assess the lived experiences of 1 cohort of students enrolled in a PM athletic training program and determine what curricular and clinical education factors influence the development of professional identity. Design Qualitative study. Setting Focus group interview. Patients or Other Participants Ten of 12 (83%) students (5 females and 5 males) from a single PM athletic training cohort program participated. Data Collection and Analysis We conducted a focus group interview, which we transcribed verbatim, with participants during the last week of their last semester in the PM athletic training program. Data analysis was deductive and then inductive throughout the coding process, and we reached data saturation at the individual participant and cohort levels. We ensured trustworthiness through multiple analyst triangulation, peer expert review, and multiple data sources. Results Three factors influenced the development of the PM athletic training student's professional identity: (1) their clinical education experiences, (2) the cohort experience, and (3) their school/life balance. Within the clinical education experience, the immersive experience, clinical setting, and patients and preceptors were also influential. Conclusions This study used the Weidman et al socialization model. The experiences of PM athletic training students and their professional identity development are inclusive of the relationship with others throughout the educational experience, as well as their self-reflective practices within the field. It is important for stakeholders to understand the many factors that influence professional identity development.

Context: Changes in commitment and the predictors of commitment to an athletic training program (ATP) across the academic 4-year program is important for facilitating students' continued success in ATPs and on the Board of Certification (BOC) exam. Objective: The purpose of this study was 2-fold: (1) examine changes in 1 cohort's perceptions of commitment across 4 academic years, and (2) to determine if commitment constructs could predict BOC scores. Design: Longitudinal and cross-sectional survey. Setting: Commission on Accrediting Athletic Training Education accredited ATP at a midsize Division I University. Patients or Other Participants: For purpose (1), 24 ATP students (male = 12, female = 12) participated, and ranged in age from 21–23 years (mean = 21.50 ± 0.59). For purpose (2), a total of 75 male and female senior ATP students participated. Main Outcome Measure(s): Repeated measures analyses of variance were conducted on each predictor of commitment and ATP commitment to determine significant changes in scores from 1 year to the next. A multiple regression analysis was conducted to determine if commitment constructs could predict BOC scores. Lastly, a multivariate analysis of variance compared successful and unsuccessful first attempt BOC candidates on the commitment constructs. Results: Commitment, enjoyment, and benefits decreased significantly from the first year in the ATP to the second year in the program. Attractive alternatives and investments significantly increased during this same timeframe. No significant changes occurred in students' perceptions of perceived social constraints or support from professors, parents, peers, or best friends. Lastly, commitment constructs failed to predict who would pass the BOC exam, and no differences emerged for commitment constructs between students who passed the BOC exam on the first attempt and those who did not. Conclusions: Athletic Training Program students' commitment, enjoyment, investments, attractive alternatives, and perceived benefits fluctuate throughout their time enrolled in an ATP.

Context Immersive clinical education experiences (ImCEs) are a recent addition to the Commission on Accreditation of Athletic Training Education standards. As such, there is little information on how athletic training programs design and implement ImCEs into the curriculum. Objective The purpose of this study was to explore the structure of ImCEs among athletic training programs and practices relating to identifying and developing ImCEs. Design Cross-sectional study. Setting Web-based survey. Patients or Other Participants A total of 103 of 265 Coordinators of Clinical Education for Commission on Accreditation of Athletic Training Education-accredited professional programs participated (women = 69, men = 29, 4 = prefer not to disclose, 1 = unanswered). Main Outcome Measures Coordinators of Clinical Education provided information about their program, timing and length of ImCEs, and the settings used. Program practices for preceptor selection and development, curricular design for simultaneous didactic coursework, and resources available to students were also investigated. Results The average number of ImCEs was 1.9, with a length of 4 to 28 weeks. Most programs have the first ImCE in the second year and primarily rely on college/university and secondary school settings. Programs reporting ImCEs less than 4 weeks in length and those requiring synchronous coursework during clinical immersion are of concern. Conclusions Athletic training programs are integrating ImCEs in a variety of ways. There may be confusion as to best practices and Commission on Accreditation of Athletic Training Education requirements for ImCEs.

ContextAs the professional degree in athletic training transitions to the master's level, a growing concern for programs is enrollment. Understanding the factors that influence a student's choice of a graduate program in athletic training will provide institutions with vital information for marketing and enrollment management.ObjectiveTo explore factors that influence a student's choice of a professional graduate athletic training program.DesignCross-sectional.SettingOnline survey.Patients or Other ParticipantsA total of 52 participants from a convenience sample of 140 graduate students enrolled in a graduate professional athletic training program completed the survey: 43 females (82.7%) and 9 males (17.3%).Data Collection and AnalysisData collection took place over 4 weeks between April and May 2019. Participants completed an online questionnaire that consisted of 11 demographic items, 6 Likert-scale items about factors that may have influenced school choice, and 2 open-ended questions about career goals and pursuing a doctoral degree. We calculated descriptive statistics, frequency distributions, and percentages.ResultsFactors ranked as very important in influencing a student's choice fell within the categories of athletic training program and athletic training program faculty. Those ranked as not important were related to ethnicity and gender. Additionally, over half of the participants indicated an intended career path within the college or professional setting.ConclusionsAlthough a variety of factors can influence a student's choice of graduate school, today's consumer seems mostly interested in program factors such as Board of Certification pass rate, accreditation status, and clinical sites. As programs transition to the graduate level, marketing and recruitment strategies should be designed around these factors to ensure enrollment.

Context Graduates of athletic training programs (ATPs) have identified factors contributing to their persistence through professional education. However, program directors have yet to elaborate on programmatic attributes that might contribute to athletic training student retention in their respective ATPs. Objective To determine program directors' perceptions of ATP strengths and areas for improvement regarding athletic training student retention. Design Qualitative study. Setting Bachelor's ATPs. Patients or Other Participants Sixteen ATP directors with 6.0 ± 4.0 years of experience in their current positions. Main Outcome Measure(s) The participants completed audio recorded telephone interviews. We analyzed the data using principles of grounded theory and maintained trustworthiness using multiple-analyst triangulation, peer review, and member checks. Results We found 2 themes to describe the strengths of bachelor's ATPs. Our participants thought that they provided a student-centered approach and diverse clinical education experiences leading to a supportive and exciting environment to foster athletic training student learning. We categorized the student centered approach theme into 3 subthemes: program size, student engagement and program atmosphere, and academic and clinical cohesion. Conclusions Program directors should strive to provide athletic training students with individual attention to help them feel welcomed, valued, and important. A small program size or adequate personnel can foster interpersonal relations which can provide athletic training students with mentoring opportunities. Improving ATP cohesion can provide learning opportunities which assist students in making connections and promote the importance of the academic and clinical education components of the ATP. Engaging athletic training students early through a variety of clinical education experiences can assist professional socialization and foster excitement for the profession.

Context Preceptors play a vital role in athletic training education as they mentor and socialize athletic training students into their professional role. Exploring the benefits to serving as a preceptor is important to secure appropriate professional role models for students. Objective To determine the benefits of serving as an athletic training preceptor. Design Qualitative study. Setting Undergraduate athletic training programs (ATPs). Patients or Other Participants Twenty-four preceptors (average age = 32 ± 7 years, 11 male, 13 female, average clinical experience = 9 ± 6 years, average preceptor experience = 5 ± 3 years) volunteered to participate in our study. Participants represented 7 undergraduate Commission on Accreditation of Athletic Training Education–accredited ATPs from the east coast. Data Collection and Analysis We asked participants to journal responses to open-ended questions through a QuestionPro online survey. We analyzed data using a general inductive approach. We secured credibility by using consistency and stakeholder checks and by having a peer review our work. Results Three main themes emerged from the data. Preceptors enjoy the personal relationships they build with students. The challenging atmosphere of supervising students while they gain knowledge to improve their skills also came through as a major benefit to serving as a preceptor. Finally, our participants enjoy teaching and mentoring the future members of the athletic training profession. Conclusions Our participants listed the relationships they build with students as rewarding, potentially leading to an improved professional commitment. Reciprocal learning between the preceptors and the students allows for a stimulating environment and has the potential to improve patient care. The enjoyment of teaching and mentoring students may aid in providing a dynamic atmosphere for students to learn.

Context: Some athletic training program (ATP) directors use direct admit, where students are admitted into the ATP directly out of high school. Other ATP directors admit students into the program after a set time period on campus through a secondary admissions process. It remains unknown why ATP directors use various admissions practices. Objective: To determine why ATP directors use a secondary admissions process. Design: Qualitative study. Setting: Professional bachelor's ATPs. Patients or Other Participants: We asked ATP directors from all 343 professional bachelor's ATPs to participate in an online survey. We received responses from 177 (51.6%). Main Outcome Measure(s): The survey asked participants both when students are first eligible for admission into their ATP and to explain the rationale behind their specific admissions process. We used grounded theory to analyze the data and maintained the trustworthiness of the analysis via multiple-analyst triangulation, member checks, and a peer review. Results: The majority (92.1%) of respondents used a secondary admissions process to formally select students into their ATP. The ATP directors stated that opportunities for socialization, the ability to maintain quality control, and the chance to complete general education requirements were important reasons to admit students into the ATP after they have been on campus for at least 1 semester. Conclusions: The use of a secondary admissions process appears to help ATPs provide a glimpse of the profession through observation and introductory coursework. The secondary admissions process also allows faculty and staff to evaluate student potential, while students are given time to focus on their transition to college life. We believe the timing of formal admittance to the ATP is an important decision that warrants thought and discussion between the program faculty and staff to provide curricular sequencing that works for both prospective students and the ATP faculty and staff.

The goal of this study was to analyze the alteration of young boxers’ athletic and special physical fitness during the annual cycle of their initial training. Research methods: literature review, experiment, testing, comparative analysis, and mathematical statistics. The sample consisted of 14 persons, who were training boxing for one year. The average age of the boxers was 14.9 ± 0.6 years. The duration of the experiment was 10 months (from September till June). The young boxers were training 1—1.5 hours 5 times per week according to the program which was made for them. The training program of one alternative was applied in the experiment. The initial training program contained 24.6% of athletic training, 27.6% of specialphysical training, 28.5% of technical training, and 19.3% of tactical training. The testing of the boxers was performed three times: the first testing was in October, the second one — in February, and the third one — in June. The following training means were used for the young boxers’ athletic training program: physical exercises on the special equipment, exercises with partner, exercises with weights (dumbbells), short distance running, point-to-point running, various jumps, throwing of the stuffed ball, various games. The main means for the young boxers’ special training were imitation exercises, exercises with a rope and lawn tennis balls, exercises at the boxing bags, straight and side thrusts to the boxing bag, defense exercises, thrust imitation using the dumbbells and the stuffed balls. During the annual cycle of the initial training there was a minor alteration in the indexes of the young boxers’ body composition: their height, body weight and Ketle index increased (p < 0.05), while the amount of the fat (%) within the body and the body weight index changed very little (p > 0.05). The strength of the sportsmen’s right hand palm was always bigger than the strength of the left hand palm. The boxers’ athletic and special physical fitness improved (p < 0.05) during one year of their initial training. The boxers’ speed, explosive strength, anaerobic glicolitic endurance, hand strength endurance and flexibility indexes increased significantly (p < 0.05). The strength of the single side thrusts with the front hand to the boxing bag increased from 106.3 ± 7.5 kg to 127.6 ± 8.15 kg (p < 0,05). The strength of the single thrusts with the straight hand increased from 135.2 ± 7.43 kg to 158.5 ± 6.74 kg (p < 0.05). The amount of the thrusts of the examined boxers during the period of 8 sec increased (p < 0.05) in each testing period and at the end of the experiment, the average amount of the boxers’ thrusts in 8 s was 43.5 ± 2.9. The training program, determined for one alternative experiment significantly improved the preparation of young boxers and did not harm their health. During the annual preparation cycle the athletic and special physical fitness of the boxers improved. The implementation of this experimental program made a positive influence on the alteration of the body composition indices of the young boxers.Keywords: athletic training, special physical training, boxing bag, energy input, total energy, total strength

Health care research evidence suggests that early patient encounters (PEs), as well as the purposeful implementation of professional core competencies (CCs), for athletic training students (ATSs) may be beneficial to their ability to provide care. However, no investigators have related facets of the clinical education experience with CC implementation as a form of summative assessment of the clinical experience. To determine the relationship between the frequency and length of PEs, as well as the student's role and clinical site during PEs, and the students' perceived CC implementation during these encounters. Cross-sectional study. Professional athletic training program, National Collegiate Athletic Association Division I institution. We purposefully recruited 1 athletic training program that used E*Value software; 40 participants (31 females, 9 males) enrolled in the professional phase (12 first year, 14 second year, 14 third year) participated. Participants viewed a 20-minute recorded CC educational module followed by educational handouts, which were also posted online for reference throughout the semester. The E*Value software was used to track PEs, including the type of encounter (ie, actual patient, practice encounter, didactic practice scenario), the type of site where the encounter occurred (university, high school), and the participant's role (observed, assisted, performed), as well as responses to an added block of questions indicating which, if any, of the CCs were implemented during the PE. Variables per patient were PE length (minutes), participant role, site at which the encounter occurred, and whether any of the 6 CCs were implemented ( yes/ no). Variables per participant were average encounter length (minutes), encounter frequency, modal role, clinical site assignment, and the number of times each CC was implemented. Separate 1-way analyses of variance were used to examine the relationships between role or clinical site and implementation of total number of CCs. Multiple linear regressions were used to determine how the average length and frequency of PEs were related to the average and total number of implemented CCs. Binary logistic regression models indicated how the length of each encounter, role of the participant, and type of clinical site related to the implementation of each CC. The roles of participants during PEs were related to their ability to implement the total number of CCs ( F = 103.48, P < .001). Those who observed were likely to implement fewer total CCs than those who assisted (M diff = -0.29, P < .001); those who assisted were likely to implement more total CCs than those who performed (M diff = 0.32, P < .001). Frequency of encounters was the only significant variable in the model examining all independent variables with CC implementation ( b4,32 = 3.34, t = 9.46, P < .001). The role of the student, namely assisting during PEs, and the volume of PEs should be considered priorities for students to promote greater CC implementation.

Context: Mentorship has been identified as a contributor to the socialization of athletic training preceptors. Understanding how mentorship occurs and contributes to preceptor development may help athletic training educators facilitate effective mentorship within their athletic training programs. Objective: Examine preceptors' perceptions of mentoring as part of their socialization into this role. Design: Qualitative study. Setting: Commission on Accreditation of Athletic Training Education programs. Patients or Other Participants: Twelve athletic trainers representing 4 National Athletic Trainers' Association districts, including 5 men and 7 women, average age = 32 ± 10.5 years, and average of 5 ± 5.0 years' experience as a preceptor. Main Outcome Measure(s): Participants responded to 14 interview questions regarding their perceptions of mentoring. Two researchers analyzed data using an inductive approach to identify themes and supporting categories. Trustworthiness was established by piloting the interview, using multiple analyst triangulation, and peer review. Results: Four themes emerged from the data: (1) characteristics, (2) processes, (3) mentoring by emulating, and (4) roles of mentoring. Participants identified that communication and commitment are characteristics of effective mentorship. Preceptors learn to mentor by emulating other preceptors, and mentoring relationships develop through both formal and informal processes. Mentoring serves multiple roles for preceptors, including providing a support system and facilitating reciprocal learning for both mentors and protégés. Conclusions: Participants perceive mentoring as beneficial to their initial and ongoing development as preceptors. Preceptors learn to mentor by emulating current and past mentors, emphasizing the importance of modeling for both preceptors and students. Clinical education coordinators can facilitate the mentoring of preceptors by educating them on the benefits of engaging in it as well as connecting experienced preceptors with newer preceptors.

Purpose: The demands of athletic training students are substantial between academic and clinical responsibilities creating problems with commitment and retention. Grit and growth mindset have been associated with academic achievement and success; however, little research has assessed the presence of grit and growth mindset within athletic training students. Therefor the purpose of this study was to investigate the differences in grit and growth mindset between athletic training students and non-athletic training students majoring in general health sciences and to assess the relationship between grit and growth mindset in both athletic training students and non-athletic training students. Methods: A cross-sectional study was conducted utilizing a web-based survey to assess demographics, grit and growth mindset in undergraduate students. Univariate analyses and correlations were conducted to determine group comparisons and relationships between variables. Results: A total of 96 undergraduate students participated. Of the respondents 56% were athletic training students, 75% were female, and 83% were Caucasian. There was a significant difference in grit (U=800.50, p=.014) between groups with athletic training students (M=3.70, SD=.408) reporting lower levels of grit than non-athletic training students (M=3.93, SD=.413). Intelligence and talent growth mindset yielded no significant differences. A weak, positive correlation was found between grit and intelligence growth mindset (r=.341, p=.001) as well as between grit and talent growth mindset (r=.342, p=.001). Conclusion: The current study indicated differences in grit between athletic training and non-athletic training students, but not in growth mindset. Further research is needed to identify how these factors influence success and retention within athletic training programs.

Background: Cannabis is the most commonly used illicit drug in the U.S. and its use is becoming more popular with the legalization of medical marijuana. Currently, 36/50 states and the District of Columbia have legalized marijuana for medical purposes. These changes have allowed for more cannabis-related research to be conducted. It is unknown how health professional education programs such as physical therapy and athletic training have integrated cannabis-related curriculum into their students’ training. This study aimed to identify how physical therapy and athletic training education programs are approaching teaching students about cannabis-related topics. Methods: There were 111 individuals from 40 states who responded to the survey (Males=53; Female=58), including 88 athletic training and 23 physical therapy faculty. Methods: An email was sent to all program directors of athletic training and physical therapy programs in the US with a Qualtrics survey link for faculty to complete. The 23-item questionnaire included closed-ended questions on demographics, where they sought cannabis-related information, and whether program curriculum includes cannabis-related topics. Frequencies were computed for sources of cannabis-related information and whether program curriculum includes cannabis-related topics. Results: Sixty (53.5%) participants stated they have not received information or completed any training related to cannabis. Of those receiving information or completing training (n=51), the most common sources of information were live lectures (n=23), peer-reviewed manuscripts (n=24), and social media/news (n=21). Also, 43 (38%) participants noted teaching cannabis-related topics in their curriculum. However, 33 participants reported either not completing training related to cannabis or being self-educated through the current literature. Conclusions: These results suggest program faculty may benefit from formal cannabis education in an effort to adequately integrate the content into curriculums.

Context:The Examination of Professional Degree Level document presented to the National Athletic Trainers' Association Board of Directors states that research in athletic training education has not investigated differences in the critical-thinking skills of professional athletic training students.Objective:Investigate the differences in critical thinking and other demographic variables across first-year athletic training students enrolled in professional bachelor's- and master's-degree programs.Design:Quantitative study.Setting:District 10 athletic training programs.Patients or Other Participants:Students (N = 40) enrolled within their first 6 months of a professional athletic training program were asked to complete the California Critical Thinking Skills Test (CCTST). Twelve first-year master's-degree students (8 female, 4 male) and 28 bachelor's-degree students (18 female, 10 male) completed the CCTST (age = 20.73 ± 3.09 years).Main Outcome Measure(s):Athletic training students in District 10 were asked to complete the CCTST during the first 6 months of their respective programs. Independent t tests were used to evaluate the difference in critical-thinking scores between professional master's- and bachelor's-degree athletic training students. A 1-way analysis of variance was conducted to determine differences in critical-thinking skills with regard to gender, age, and parental educational level.Results:There were no statistically significant differences in critical-thinking skills between bachelor's- and master's-degree athletic training students enrolled in a professional athletic training program (P = .991). Additionally, there were no statistically significant differences in critical-thinking skills with regard to gender (P = .156), age (P = .410), or parental education level (P = .156).Conclusions:The results suggest master's students do not have greater critical-thinking skills than professional bachelor's students before engaging in athletic training education. Therefore, as the professional degree of athletic training transitions to the graduate level, athletic training educators may need to investigate and use pedagogical practices that will graduate critically thinking athletic trainers.

ContextThe United States transgender patient population often suffers from insufficient health care and faces barriers to obtaining health care. Understanding the current classroom education provided in professional athletic training programs related to patient-centered and transgender patient care is necessary to foster improvements to the education of future health care providers.ObjectiveTo explore the education, comfort, and experience of professional athletic training students and program directors (PDs) on patient-centered care (PCC) and transgender patient care.DesignCross-sectional survey.SettingOnline survey.Patients or Other ParticipantsA total of 74 PDs of Commission on Accreditation of Athletic Training Education-accredited professional athletic training programs (age = 46 ± 9 years) and 452 athletic training students (age = 23 ± 3 years) responded to the survey.Data Collection and AnalysisTwo surveys were created from literature and were reviewed by a committee of content experts. Participants were sent links to their respective survey in March 2020. Surveys contained questions on demographic information, PCC, and transgender patient care. Data were analyzed descriptively with follow-up χ2 analyses comparing athletic training students' comfort and competence between those who learned and did not learn about transgender patient care.ResultsMost PDs reportedly felt comfortable (98.6%, n = 73) and competent (94.6%, n = 70) teaching PCC. Half (50% n = 37/74) of PDs include transgender health care in their program's curriculum but lacked competence (37.8%, n = 28) in teaching. All students felt comfortable (100%, n = 452) and competent (98.7%, n = 446) practicing PCC, but only 12.4% (n = 54) reported practicing it during clinical education. Less than half (43.1%, n = 195/452) of students learned about transgender patient care, yet most (78.3%, n = 354) felt comfortable but lacked competence (41.8% n = 189).ConclusionsFew students reportedly practice PCC during clinical education. Both groups perceived deficiencies in competence related to transgender patient care. We suggest PDs teach transgender health care in their curriculum and seek professional development to create meaningful educational experiences.

Context International topics in athletic training are gaining recognition. Particularly interesting are opportunities for athletic training students to gain international experiences and develop cultural competence through study abroad. However, little is known about current international experience opportunities for these students. Objective To identify international experience opportunities for athletic training students, investigate student and faculty participation, and describe characteristics of institutions and programs offering such experiences. Design Survey. Setting Online. Patients or Other Participants All directors of Commission on Accreditation of Athletic Training Education–accredited professional athletic training programs were recruited. The response rate was 41.9% (163/389). Data Collection and Analysis An e-mail soliciting participation was sent in January 2019. The online survey had 4 sections: (1) questions about athletic training–related international experiences, (2) questions about discipline-related international experiences, (3) questions about athletic training faculty or student participation, and (4) demographic questions about the program or institution. Data were analyzed descriptively. The characteristics of programs offering athletic training–related international experiences were compared with programs offering discipline-related international experiences using χ2 tests for degree level, institution type, and athletic division. Results Twenty-nine programs (17.8%) offered athletic training–related international experiences and 68 programs (41.7%) offered discipline-related experiences. Private universities were more likely to offer an athletic training–related experience, and public universities more likely to offer a discipline-related experience (χ2 = 4.197, df = 1, P = .04). There were no other differences between institution types, program degree levels, or athletic divisions (all P &amp;gt; .05). Some programs reported no recent athletic training student (44%) or athletic training faculty (58%) participation in any international experience. Conclusions A minority of programs currently offer either athletic training–related or discipline-related international experiences. Characteristics of available programs vary widely. To keep pace with professional globalization, future work should identify ways to develop international experiences.