Program Directors' Perceptions of Programmatic Attributes Contributing to Athletic Training Student Persistence

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.

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 Clinical education is an integral part of athletic training programs. This is where students should develop their professional identities and become socialized into the profession. Understanding the student and preceptor perspectives of the impact that clinical experiences have on students can provide valuable insight into this aspect of athletic training education. Objective To evaluate the impact of clinical education on the professional development of athletic training students from the student and preceptor perspective. Design Qualitative study. Setting Commission on Accreditation of Athletic Training Education–accredited undergraduate programs. Patients or Other Participants A total of 15 participants (7 athletic training students and 8 preceptors) from four schools enrolled in our study. Data Collection and Analysis One researcher conducted semistructured interviews over the phone or in person. Data analysis used a general inductive approach to reveal the dominant themes that related to our purpose. We achieved data credibility through multiple analyst triangulation, peer review, and member checks. Results Athletic training students and preceptors agree that clinical education is integral to the professional development process. Realistic and positive experiences and diversity in experiences were identified as factors affecting professional growth during clinical education experiences. Conclusions Athletic training students and preceptors have similar views on the importance of clinical placements on professional development. Clinical experiences provide students with the opportunity to learn more about the profession, affirm their career choice, practice knowledge and skills, and learn about themselves personally and professionally. The student and the fit/match of the placement directly impact the students' clinical experiences.

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.

Approved Clinical Instructors (ACIs; now known as preceptors) are expected to provide feedback to athletic training students (ATSs) during clinical education experiences. Researchers in other fields have found that clinical instructors and students often have different perceptions of actual and ideal feedback and that several factors may influence the feedback exchanges between instructors and students. However, understanding of these issues in athletic training education is minimal. To investigate the current characteristics and perceptions of and the influences on feedback exchanges between ATSs and ACIs. Qualitative study. One entry-level master's degree program accredited by the Commission on Accreditation of Athletic Training Education. Four ACIs and 4 second-year ATSs. Individual, semistructured interviews were conducted with participants and integrated with field notes and observations for analysis. We used the constant comparative approach to inductively analyze data and develop codes and categories. Member checking, triangulation, and peer debriefing were used to promote trustworthiness of the study. Participants described that feedback plays an important role in clinical education and has several purposes related to improving performance. The ACIs and ATSs also discussed several preferred characteristics of feedback. Participants identified 4 main influences on their feedback exchanges, including the ACI, the ATS, personalities, and the learning environment. The ACIs and ATSs had similar perceptions of ideal feedback in addition to the actual feedback that was provided during their clinical education experiences. Most of the preferences for feedback were aligned with recommendations in the literature, suggesting that existing research findings are applicable to athletic training clinical education. Several factors influenced the feedback exchanges between ACIs and ATSs, which clinical education coordinators should consider when selecting clinical sites and training ACIs.

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.

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.

Objective: To present an alternative model of supervision within clinical education experiences. Background: Several years ago direct supervision was defined more clearly in the accreditation standards for athletic training education programs (ATEPs). Currently, athletic training students may not gain any clinical experience without their clinical supervisors being physically present so that the supervisors may intervene at any point if necessary. Although we do not disagree with the spirit of this requirement, we present information regarding the changing generation of students and the importance of developing strong professionals who will represent our field in the ever-changing allied health care arena. Clinical Advantages: We believe student learning may take place without direct supervision and that a system of guided autonomy with meaningful and dynamic reflection may better prepare the student for the future. W e feel that limited aspects of an athletic training student's clinical experience may not always need direct supervision. If students are performing skills that are not in violation of any professional practice acts, their interest and learning may increase with a guided autonomy model, as opposed to direct supervision. For example, once an athletic training student has mastered skills like taping, stretching, and initiating an emergency action plan, they should be able to effectively and safely perform these aspects without direct supervision. We suggest that students may continue to learn, and benefit from an educational standpoint, while gaining a limited portion of their experiential learning requirement without direct supervision.

Background: Burnout is linked to various adverse outcomes (i.e., thoughts of dropout, depression, unprofessional behaviors) in healthcare students (i.e., nursing students, medical students). However, potential adverse outcomes associated with burnout in athletic training students, a subset of healthcare students, have yet to be identified. Objective: To adapt a previously tested theoretical model to explore relationships between student workload, burnout, and potential adverse outcomes in a sample of graduate athletic training students. Methods: An online survey assessing the variables of interest and study information was sent to program directors of graduate-level athletic training programs at their publicly accessible email addresses with a request to forward the opportunity to their students. This was a nationwide sample of graduate athletic training students with 320 graduate athletic training students completing the survey. Descriptive statistics and structural equation modeling was used in our analysis. Results: Structural equation modeling confirmed that our hypothesized model successfully described relationships between academic workload, burnout, and adverse outcomes in athletic training students. Specifically, academic workload predicted burnout, and burnout in turn predicted various adverse outcomes (i.e., thoughts of dropout, depression, unprofessional behaviors) in athletic training students. Educators should be aware of the potential adverse outcomes identified in this sample of athletic training students that have also been reported in other healthcare students. Conclusions: Methods to combat symptoms of burnout to enhance student well-being and avoid potential adverse outcomes should be identified. Future research should use the adapted theoretical model discussed in this article within other healthcare students' samples to understand further the complex network of relationships between academic workload, burnout, and adverse outcomes in the educational environment.

Context The increased prevalence of mental health conditions and athletic training education’s heightened focus on behavioral and mental health necessitate an examination of teaching techniques for this material. This study explores the impact of virtual pedagogical strategies on athletic training students’ knowledge and confidence with mental health recognition and referral to help educators determine best practices for content delivery. Objective This study examined the effect of Mental Health First Aid (MHFA) training on students’ knowledge and confidence in mental health recognition and referral. The impact of group allocation (standardized patient [SP] encounters, case-based learning [CBL], and control) on these outcomes was also assessed. Design Randomized controllled trial portion from a sequential, explanatory mixed-methods design. Setting Online learning environment. Patients or Other Participants Convenience sample of 70 students (25 men, 44 women, 1 nonbinary; aged 23.38 ± 2.27 years) from Commission on Accreditation of Athletic Training Education-accredited graduate-level professional athletic training programs. Intervention(s) All participants completed MHFA training followed by either no intervention, an SP encounter, or CBL activity. Main Outcome Measure(s) Mental health recognition and referral skills as measured by an electronic knowledge assessment and self-reported confidence scale whose content validity were established by an expert panel. Results A mixed-model analysis of variance showed significant improvement from pretest to posttest for both knowledge and confidence [knowledge: F(1,67) = 70.31, P &amp;lt; .001; confidence: F(1,67) = 206.41, P &amp;lt; .001]. This relationship was similar among all 3 groups. No significant difference in knowledge or confidence was found between the control, SP, and CBL groups. Conclusions With the increased need to care for patients’ behavioral and mental health, professional athletic training programs and continuing education should consider incorporating MHFA training to improve content knowledge and confidence in skills. While no numerical difference between the groups was shown by this study, supplementation with simulation through CBL or SP encounters provides an opportunity for application specific to athletic training practice, which may help reinforce concepts and enhance clinical readiness.

Context: The professional preparation of newly credentialed athletic trainers (ATs) has been passionately debated. Understanding how newly credentialed ATs feel they are prepared will help enhance professional preparation. Objective: Explore newly credentialed ATs' perceptions of their professional preparation for their role. Design: Phenomenological qualitative. Setting: Phone interviews with graduate assistant ATs in the collegiate setting. Patients or Other Participants: Nineteen collegiate graduate assistants (15 female, 4 male; average age = 23 ± 0.15 years; National Collegiate Athletic Association Division I: 13, II: 3, III: 2, National Association of Intercollegiate Athletics: 2; postprofessional athletic training program: 6). Main Outcome Measure(s): Participants were recruited via an e-mail from the National Athletic Trainers' Association database sent to all certified students. Data were collected via phone interviews, which were recorded and transcribed verbatim. Interviews were conducted until data saturation occurred. Data were analyzed through phenomenological reduction, with data coded for common themes and subthemes. Credibility was established via member checks and peer debriefing. Results: Two themes emerged: facilitators and barriers. Overall, participants felt academically prepared for their role, but preparedness was often dependent on the facilitators of academic rigor, hands-on opportunities in clinical education, and their preceptor. Barriers included a lack of rigor in the academic setting, lack of active opportunities in clinical education, the culture of clinical experiences, and incongruence. Incongruence existed when students were exposed to all the competencies during didactic education, but never gained experience with some skills (eg, rehabilitation, documentation, communication) if situations never arose or they were not actively involved clinically. Conclusions: Athletic training students are being exposed to a variety of learning experiences academically, but often do not gain clinical experience if situations do not arise or preceptors do not allow active participation. To ensure new ATs are prepared, academic programs need to ensure rigor and place students with preceptors who provide active learning opportunities.

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.

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.

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.

Appropriate methods for evaluating clinical proficiencies are essential in ensuring entry-level competence. To investigate the common methods athletic training education programs use to evaluate student performance of clinical proficiencies. Cross-sectional design. Public and private institutions nationwide. All program directors of athletic training education programs accredited by the Commission on Accreditation of Allied Health Education Programs as of January 2006 (n = 337); 201 (59.6%) program directors responded. The institutional survey consisted of 11 items regarding institutional and program demographics. The 14-item Methods of Clinical Proficiency Evaluation in Athletic Training survey consisted of respondents' demographic characteristics and Likert-scale items regarding clinical proficiency evaluation methods and barriers, educational content areas, and clinical experience settings. We used analyses of variance and independent t tests to assess differences among athletic training education program characteristics and the barriers, methods, content areas, and settings regarding clinical proficiency evaluation. Of the 3 methods investigated, simulations (n = 191, 95.0%) were the most prevalent method of clinical proficiency evaluation. An independent-samples t test revealed that more opportunities existed for real-time evaluations in the college or high school athletic training room (t(189) = 2.866, P = .037) than in other settings. Orthopaedic clinical examination and diagnosis (4.37 +/- 0.826) and therapeutic modalities (4.36 +/- 0.738) content areas were scored the highest in sufficient opportunities for real-time clinical proficiency evaluations. An inadequate volume of injuries or conditions (3.99 +/- 1.033) and injury/condition occurrence not coinciding with the clinical proficiency assessment timetable (4.06 +/- 0.995) were barriers to real-time evaluation. One-way analyses of variance revealed no difference between athletic training education program characteristics and the opportunities for and barriers to real-time evaluations among the various clinical experience settings. No one primary barrier hindered real-time clinical proficiency evaluation. To determine athletic training students' clinical proficiency for entry-level employment, athletic training education programs must incorporate standardized patients or take a disciplined approach to using simulation for instruction and evaluation.