The Role Mentoring Plays in the Transition to Practice of Newly Credentialed Athletic Trainers

ContextMentoring has been identified as an important method of supporting newly credentialed athletic trainers (ATs) during their transition to practice. Gaining a better understanding of this relationship could provide valuable insights that may assist employers and professional programs in developing a plan to better facilitate the transition.ObjectiveTo examine which aspects of the mentoring relationship provided the most benefit during the transition to practice of newly certified ATs.DesignQualitative study.SettingIndividual phone interviews.Patients or Other ParticipantsA total of 13 ATs who graduated from a professional master''s program, were certified from February through July 2016, and obtained employment from July through August 2016 participated in this study (6 women, 7 men; age = 26 ± 3 years; work settings included professional sports, college, secondary and middle school, and clinic). Data saturation guided the number of participants.Data Collection and AnalysisPhone interviews using a semistructured interview guide were conducted at 3, 8, and 12 months of work experience. Data were analyzed using a constant comparative approach. Credibility was established via investigator triangulation, peer debriefing, and member checks.ResultsParticipants recognized the mentoring relationship as a foundational aspect of the transition to practice. Mentors should be available by phone, email, or text to answer questions, provide feedback, or discuss ideas. Respondents wanted honest feedback, even when that feedback was constructively critical. Feedback was sought regarding topics such as patient care, communication, and networking. Participants needed reassurance and support from their mentors to help validate and improve their self-confidence.ConclusionsNewly credentialed ATs should seek mentors who will be available to communicate in various ways and will provide regular and constructive feedback. Future researchers should investigate how mentoring relationships influence other aspects of the transition to practice, such as patient care, overall job performance, turnover, and satisfaction.     

Exploring the Transition to Practice for the Newly Credentialed Athletic Trainer: A Programmatic View

Context Some newly credentialed athletic trainers (ATs) pursue a postprofessional degree with a curriculum that specifically advances their athletic training practice. It is unknown how those postprofessional programs assist in their transition to practice.Objective To gain an understanding of initiatives used by postprofessional athletic training programs to facilitate role transition from student to professional during their graduate degree programs.Design Qualitative study.Setting Semistructured telephone interviews.Results Three facilitators of transition to practice emerged: orientation sessions, mentoring, and assistantship. Participants used orientation sessions ranging from a few hours to more than 1 week to provide and discuss program polices and expectations and to outline roles and responsibilities. Faculty, preceptors, and mentors were integrated into the orientation for the academic and clinical portions of the program. All participants described a mentoring process in which students were assigned by the program or informally developed. Mentors included the assigned preceptor, a staff AT, or peer students in the program. The clinical assistantship provided exposure to the daily aspects of being an AT. Barriers to transition to practice included previous educational experiences and time management. Participants reported that students with more diverse didactic and clinical education experiences had easier transitions. The ability to manage time also emerged as a challenge.Conclusions Postprofessional athletic training programs used a formal orientation session as an initial means to help the newly credentialed AT transition into the role. Mentoring provided both more informal and ongoing support during the transition.Key Words: mentoring, orientation, time management

Key Points

• Program directors used orientation sessions and mentoring to help support the transition from student to credentialed athletic trainer.
• The clinical assistantship provided the foundations for transition, as it conveyed role engagement.
• Mentoring was mostly informal but provided the ongoing support needed during the transition from student to credentialed athletic trainer.

Recent debate and anecdotal evidence have suggested that newly credentialed athletic trainers (ATs) are not as prepared for the demands of professional practice as they once were.^1–6 However, these ATs still are expected to be completely autonomous practitioners and provide safe patient care. Most of these newly credentialed ATs are employed in graduate assistantship positions and are navigating workloads comparable with those of full-time staff members and associated expectations of patient care.⁷Whereas new ATs have met all credentialing requirements and are viewed as being able to function as ATs, having complete autonomy and ultimate decision-making power is a new experience. In fact, many recent graduates who gain certification seek positions that will provide support while they build confidence with decision making.^8–11 Many of these positions are as graduate assistants, which allow for continued clinical experience coupled with didactic learning. Clinical independence combined with mentoring has emerged as not only an attractor to the graduate-student role¹¹ but also an expectation for socializing them into their roles as graduate students.^9,10 Athletic trainers who become graduate assistants are placed in a unique situation, as they are expected to juggle roles as students; health care providers; and in some cases, preceptors or classroom instructors. Role strain and burnout are likely to manifest, especially due to the demands placed on them at such an early stage in their careers as they attempt to gain role inductance and experience as ATs.^7,12The ability to provide safe patient care is a concern for many health care providers but is of great concern for newly credentialed ATs. During this period, they are attempting for the first time to make decisions regarding patient care without clinical supervision and feedback. A high rate of medical errors and burnout occurs among newly credentialed health care providers.¹³ Graduate assistants, who are often newly credentialed ATs, do experience burnout,⁷ and if medical errors result because of burnout, they are likely to affect the ATs'' professional development and clinical competence. The National Council of State Boards of Nursing issued an initiative to begin exploring transition-to-practice techniques to formalize the transition to practice for new nurses.¹⁴ This initiative aims to reduce medial errors, reduce turnover, and enhance patient safety and care. Recently, the National Athletic Trainers'' Association (NATA) Executive Committee for Education recommended exploring the employer''s responsibility to provide development and supervision for newly credentialed ATs to create effective support models for their transition to practice.¹⁵ Attending a postprofessional athletic training program is one model that can help newly credentialed ATs transition to practice. Currently, 16 postprofessional athletic training programs are accredited by the Commission on Accreditation of Athletic Training Education (CAATE),¹⁶ and a host of other programs offer comparable curriculums but are not accredited to date. These programs lead to a master''s or doctorate degree for learners who are already credentialed as ATs and expand the depth and breadth of the applied, experiential, and propositional knowledge and skills of ATs through didactic, clinical, and research experiences. Most often, students in these postprofessional programs have recently completed their undergraduate athletic training education, have no work experience, and are transitioning from student to newly credentialed AT. Furthermore, individuals enrolled in these postprofessional programs are looking for experiences that will nurture their growth as ATs from both clinical and didactic standpoints.¹¹ The graduate-assistant role is recognized as a “rite of passage” used to acclimate the AT and allow for improved decision making¹⁷; however, the initiatives that postprofessional programs use to assist the student transitioning into this role are unknown. By identifying these initiatives, educational models that support transition to practice can be identified. Therefore, the purpose of our study was to gain an understanding of initiatives used by postprofessional athletic training programs to facilitate role transition from student to professional during their graduate degree programs. Little information exists from the program viewpoint; thus, we need to gain a comprehensive understanding of the role-transition process for the AT, which includes facilitators and barriers that may exist in the transition. Facilitators¹⁸ are likely those factors that are supportive, ongoing, and viewed as a positive aspect of role transition. Conversely, barriers¹⁸ are factors that may hinder transition or cause a delay in transition; these likely include lack of confidence and unawareness of their new role.     

Practice Patterns of Athletic Trainers Regarding the On-Site Management of Patients With Joint Dislocations

ContextAs part of clinical practice, athletic trainers (ATs) provide immediate management of patients with acute joint dislocations. Management techniques may include on-site closed joint reduction of the dislocated joint. Although joint reduction is part of the 2020 educational standards, currently practicing ATs may have various levels of exposure, knowledge, and skills.ObjectiveTo capture AT self-reported knowledge and practice patterns concerning closed joint reductions.DesignCohort study.SettingOnline survey (Qualtrics).Patients or Other ParticipantsThe survey link was emailed to 5000 certified ATs. A total of 772 responses were completed by certified ATs with clinical practice experience (15.4% response rate).Main Outcome Measure(s)Participants were asked to complete a survey about their practice patterns concerning patients with closed joint reductions, which included questions about the types of closed reductions ATs performed most commonly, the frequency of on-site reduction by ATs, and participants'' demographic information. Additionally, the survey addressed the ATs'' training and comfort level in performing closed reductions and knowledge of standing orders and the state practice act.ResultsNinety percent (n = 694) of ATs reported ever performing a closed reduction (either with or without a physician present), with 10% (n = 78) stating they had never performed a joint reduction. The interphalangeal joint of the finger (73.2% of ATs), shoulder (63.3%), and patella (48.2%) were cited as the 3 most common reductions performed without a physician present. Only 46.5% (n = 359) of ATs indicated receiving training in joint-reduction techniques as part of their precertification athletic training curriculum or program; a greater percentage (64%) said they learned directly from a physician. Fewer than 60% of ATs reported having standing orders related to joint reductions.ConclusionsConsidering the high percentage of ATs who reported performing closed joint reductions and the low percentage with formal training, further development of joint-reduction training and standing orders is warranted.     

Work-Family Guilt: The Perspective of Secondary School Athletic Trainers With Children

ContextThe literature in athletic training has consistently demonstrated evidence of work-family-life conflict and the potential consequences of that conflict among athletic trainers (ATs) employed in the clinical setting. Parental responsibilities have been suggested to increase the conflict among work, family, and life. The emotions that occur because of this conflict have received little attention and warrant further study.ObjectiveTo investigate perceptions and antecedents of work-family guilt (WFG) among secondary school ATs with children.DesignPhenomenological qualitative study.SettingSecondary schools.Patients or Other ParticipantsTwenty (13 women, 7 men) ATs with children (range = 1–3) employed in the secondary school setting. All but 3 were married (n = 17) at the time of the study. Their average age was 37 ± 11 years, and they were certified as ATs for 14 ± 11 years.Data Collection and AnalysisParticipants completed one-on-one semistructured phone interviews. Multiple-analyst triangulation and peer review were used to establish data credibility.ResultsGeneral inductive analysis revealed that men and women participants experienced feelings of WFG despite having supportive work environments. The guilt for both sexes stemmed from work interfering with family and an altruistic mindset. Women indicated they felt pressure from their husbands that contributed to feelings of guilt.ConclusionsSecondary school ATs experienced WFG. Trying to balance parental and athletic training duties can cause an emotional response, and ATs'' giving and caring nature may be a precursor to guilt.     

Documentation Practices of Athletic Trainers Employed in the Clinic,Physician Practice,and Emerging Clinical Settings

ContextThe documentation practices of athletic trainers (ATs) employed in the secondary school setting, including their strategies for, barriers to, and perceptions of documentation, have been characterized in previous research. The documentation practices of ATs employed in other settings have yet to be studied in depth.ObjectiveTo examine the documentation practices of ATs employed in the clinic, physician practice, and emerging clinical settings.DesignQualitative study.SettingWeb-based interviews.Patients or Other ParticipantsA total of 22 ATs: 11 employed in the clinic or physician practice setting and 11 employed in an emerging clinical setting.Data Collection and AnalysisThe ATs employed in the settings of interest were recruited with purposeful, convenience, and snowball sampling. Participants were interviewed using a Web-based platform so that we could learn about their behaviors and perceptions of documentation. Data were analyzed using the consensual qualitative research approach, followed by a thematic analysis. Trustworthiness was addressed using data source triangulation, multiple-analyst triangulation, and an established interview guide and codebook.ResultsParticipants described following clear guidelines for documentation established by regulatory agencies, employers, and electronic medical record templates. They were motivated to document for patient safety and to demonstrate value. Participants typically documented in real time and continuously, which was facilitated by employer requirements. The ATs described experiencing a learning curve for documentation due to the unique requirements of their settings, but learning was facilitated by employer guidance and mentorship.ConclusionsEmployer guidelines, training, and ongoing support facilitated effective and thorough documentation in these clinical settings. Athletic trainers and employers in a variety of settings should consider establishing clear guidelines to promote thorough and effective documentation.     

Recently Certified Athletic Trainers' Undergraduate Educational Preparation in Psychosocial Intervention and Referral

Context:

“Psychosocial Intervention and Referral” is one of the 12 content areas established by the National Athletic Trainers'' Association Education Council and is required to be taught in athletic training education programs (ATEPs). The perceived preparation of athletic trainers (ATs) in this content area has not been evaluated.

Objective:

To explore the preparation level of recently certified ATs within the content area of “Psychosocial Intervention and Referral.”

Design:

Qualitative design involving semistructured, in-depth, focus group interviews.

Setting:

Interviews were conducted at 2 National Collegiate Athletic Association Division I institutions in 2 regions of the United States.

Patients or Other Participants:

A total of 11 recently certified ATs who met predetermined criteria were recruited. The ATs represented a range of undergraduate ATEPs and current employment settings.

Data Collection and Analysis:

Focus group interviews were transcribed verbatim and analyzed deductively. Peer debriefing and member checks were used to ensure trustworthiness.

Results:

The ATEPs are doing an adequate job of preparing ATs for many common communication and interpersonal issues, but ATs report being underprepared to deal with athlete-related issues in the areas of motivation and adherence, counseling and social support, mental skills training, and psychosocial referral.

Conclusions:

Limitations of undergraduate ATEPs regarding preparation of athletic training students within the “Psychosocial Intervention and Referral” content area were identified, with the goal of improving athletic training education. The more we know about the issues that entry-level ATs face, the more effectively we can structure athletic training education.     

Barriers and Facilitators Faced by Athletic Trainers Implementing National Athletic Trainers' Association Inter-Association Task Force Preseason Heat-Acclimatization Guidelines in US High School Football Players

ContextThe aim of the National Athletic Trainers'' Association Inter-Association Task Force (NATA-IATF) preseason heat-acclimatization guidelines was to acclimatize high school athletes to the environment during the first 2 weeks of the preseason and reduce the risk of exertional heat illness.ObjectiveTo identify barriers and facilitators that high school athletic trainers (ATs) encountered when implementing the NATA-IATF guidelines.DesignQualitative study.SettingIndividual phone interviews with all participants.Patients or Other ParticipantsThirty-three ATs (16 men, 17 women; age = 36.0 ± 12.0 years, athletic training experience = 12.9 ± 10.5 years) representing 19 states (4 with state mandates) were interviewed before data saturation was achieved. Participants were purposefully sampled from a larger investigation based on stratification of US Census region and preidentified high school compliance with the NATA-IATF guidelines.Main Outcome Measure(s)A cross-sectional, semistructured phone interview (6 steps) was conducted with each participant and then transcribed verbatim. A 7-person research team (5 coders, 2 auditors) coded the data into themes and categories, focusing on consensus of data placement to reduce bias and ensure accuracy.ResultsFacilitators and barriers that influenced successful guideline implementation were (1) perceived stakeholder access, (2) perceived stakeholder role, (3) capability and capacity, (4) school culture, (5) logistical support, (6) resources, (7) physical environment, and (8) consistency of the guidelines. Overall, participants discussed facilitators and barriers within each category based on their experiences and circumstances.ConclusionsAthletic trainers faced numerous concerns regarding compliance with the NATA-IATF preseason heat-acclimatization guidelines. Multiple levels of influence should be targeted to improve implementation. These include intrapersonal factors by giving ATs the education and self-efficacy to support advocacy for implementation, interpersonal components by establishing strong collaborative networks for change, community and environmental factors by optimizing school culture and community resources for implementation, and policy aspects by establishing consistent guidelines across all bodies.     

Future Directions of Evidence-Based Practice in Athletic Training: Perceived Strategies to Enhance the Use of Evidence-Based Practice

Context:

The shift to a culture of evidence-based practice (EBP) in athletic training is a necessary step in both the optimization of patient care and the advancement of athletic trainers (ATs) as health care professionals. Whereas individuals have gained knowledge in this area, most ATs still are not practicing in an evidence-based manner. Exploring perceived strategies to enhance the use of EBP will help to determine the best approaches to assist ATs in applying EBP concepts to practice to improve patient care.

Objective:

To explore beneficial strategies and techniques ATs perceived would promote successful implementation of EBP within athletic training education and clinical practice.

Design:

Qualitative study.

Setting:

Individual telephone interviews.

Patients or Other Participants:

Twenty-five ATs (12 educators, 13 clinicians; athletic training experience = 16.00 ± 9.41 years) were interviewed.

Data Collection and Analysis:

One phone interview was conducted with each participant. After the interview was transcribed, the data were analyzed and coded into common themes and categories. Triangulation of the data occurred via the use of multiple researchers and member checking to confirm the accuracy of the data.

Results:

Participants identified several components they perceived as essential for enhancing the use of EBP within the athletic training profession. These components included the need for more EBP resources, more processed information, focused workshops, peer discussion and mentorship, and continual repetition and exposure. Participants also indicated that ATs need to accept their professional responsibilities to foster EBP in their daily practices.

Conclusions:

The proper shift to a culture of EBP in athletic training will take both time and a persistent commitment by ATs to create strategies that will enhance the implementation of EBP across the profession. Researchers should focus on continuing to identify effective educational interventions for ATs and to determine successful strategies to implement EBP into didactic curricula and clinical practice. Additional focus should be given to which strategies most effectively produce changes in clinical practice.Key Words: professional responsibility, mentorship, evidence-based medicine, qualitative research

Key Points

• Participants perceived that certain strategies might enhance the inclusion of evidence-based practice concepts throughout athletic training.
• Researchers should continue to identify effective educational interventions for athletic trainers and determine successful strategies to implement evidence-based practice into didactic curricula and clinical practice.
• Focus also needs to be placed on strategies that most effectively achieve knowledge translation to effect change in clinical practice.

The athletic training profession has begun to place greater emphasis on evidence-based practice (EBP) to align with the 2003 recommendations from the Institute of Medicine.¹ These recommendations focus on the inclusion of 5 core competencies: (1) delivering patient-centered care, (2) working as part of interprofessional teams, (3) practicing evidence-based medicine, (4) focusing on quality improvement, and (5) using information technology. While focusing on the EBP competency, researchers have reported that athletic training students, educators, and clinicians believe that EBP is an important shift for the profession,^2–6 but barriers, including time, accessibility to resources, and knowledge of EBP concepts, are preventing athletic trainers (ATs) from applying this paradigm to clinical practice.^6–9 The release of the fifth edition of the Athletic Training Education Competencies,¹⁰ which includes an EBP focus, has provided a preliminary mechanism for helping future generations of ATs overcome some of these barriers at the professional education level. The hope is that the inclusion of EBP concepts within curricula will promote a new generation of clinicians who will translate the concepts of EBP into their daily clinical practices. The incorporation of EBP will require ATs to understand and teach the principles of EBP didactically and to be familiar with and willing to implement these concepts into clinical practice.As athletic training education moves toward EBP, practicing clinicians also must embrace and adopt this paradigm shift. The approach to creating a culture of EBP needs to be multifaceted^7,11 and must be targeted at all ATs, including those who have been reared in a culture of tradition. Overall, one of the main goals of athletic training is to improve the outcomes of the care provided to patients.¹² However, until all members of the profession are willing to accept this paradigm shift, athletic training may never fully embrace an EBP culture.Leaders in the profession recognize the need for change and are attempting to move in this direction.¹³ In addition to updating the educational competencies, more continuing education in the area of EBP has become available to ATs.¹⁴ The board of directors of the National Athletic Trainers'' Association (NATA) provided funding for the development and dissemination of educational EBP modules that were made available to the entire NATA membership free of cost.¹⁵ A randomized controlled trial on the ability of these modules to increase knowledge of EBP concepts revealed that they were an effective mechanism to teach these concepts to ATs.¹⁵ Only an immediate knowledge increase was assessed, and no authors of the current literature have explored long-term knowledge retention and translation among ATs or implementation practices resulting from the Web-based modules.Whereas education of current ATs is a vital step in shifting the culture of the profession, merely increasing knowledge cannot be assumed to correlate with an actual change in clinical practice. Researchers have conducted multiple systematic reviews in which they assessed the effectiveness of educational interventions on clinical practice changes. Forsetlund et al¹⁶ concluded that educational meetings elicit small improvements in professional practice and health care outcomes. Freemantle et al¹⁷ reported that printed educational materials, audit and feedback, and meetings or workshops had little to no effect on clinical practice. Most investigators^16–20 have determined that multifaceted educational interventions (eg, didactic lecture combined with interactive discussion) and active rather than passive interventions are most effective in changing professional behavior. Oxman et al²¹ and Foy et al²² found that interventions can only be effective in changing behaviors under ideal conditions, so multiple factors, including the condition and patient and clinician attributes, should be considered when developing an educational intervention. Overall, authors^19,23 of the majority of studies conducted to assess clinical practice changes after an intervention have indicated that most interventions are effective under some circumstances but that no single intervention is effective for all circumstances.The true shift to EBP in athletic training requires not only enhanced knowledge of EBP concepts but also a translation of this knowledge into practices that will improve patient care outcomes. Therefore, it is important not only to assess if a knowledge gain has occurred but also to determine if and how this knowledge has translated to clinical practice. Recently, researchers²⁴ have revealed that whereas ATs perceive they have retained knowledge gained from the Web-based modules, they have not shifted that knowledge to their daily practices in patient care. For this reason, it is necessary to seek strategies that will be most effective in bridging the gap between knowledge and practice. Qualitatively exploring the perceptions and experiences of ATs will lead to a rich perspective of which mechanisms they perceive will be most effective in shifting ideas and behaviors toward clinical practice and didactic education. A qualitative exploration allows participants to provide ideas that are not limited by the researchers'' opinions and biases and ideas that they believe will ultimately influence their behaviors. Therefore, the purpose of this qualitative study was to explore the experiences and theories ATs have toward identifying beneficial strategies and techniques to promote successful implementation of EBP within athletic training education and clinical practice.     

The importance of state regulation to the promulgation of the athletic training profession

States regulate professions to protect the public from harm by unqualified practitioners. Without regulation of athletic trainers (ATs), there is no legal way to assure quality health care to athletes because there is no legal definition as to what an AT can and cannot do. Problems exist, however; 1) ATs nationwide may not be adequately familiar with state regulations; 2) without regulation, legal support is given to high schools to use less qualified persons to care for student-athletes; 3) more education is needed to familiarize the public and the health care industry with the functions and qualifications of a certified AT; and 4) without uniformity of regulation, athletes may continue to suffer as untrained and/or unqualified persons continue to be perceived as members of the profession and as certified and noncertified ATs continue to practice without legal sanction, perhaps beyond their area of expertise. This article encompasses both a literature review and an opinion survey (of ATs) with regard to state regulation of the athletic training profession. The intent of this article is to help ATs understand the implications of state regulation on our profession. A survey was mailed to 500 ATs across the country soliciting opinions on state regulation and its implication of the profession of athletic training. The intent of the survey results are not to verify the literature review nor to infer information regarding other ATs, but merely to be a gathering tool to solicit information from fellow ATs.     

Methods of the National Athletic Treatment,Injury and Outcomes Network Surveillance Program (NATION-SP), 2014–2015 Through 2018–2019

BackgroundThe National Athletic Treatment, Injury and Outcomes Network Surveillance Program (NATION-SP) was established in 2011 to provide a comprehensive appraisal of injuries sustained by high school student-athletes who received services from athletic trainers (ATs). The purpose of this article is to update the surveillance methods of the NATION-SP for data reported during the 2014–2015 through 2018–2019 academic years.Surveillance System StructureThe NATION-SP used a rolling recruitment model to identify a convenience sample of US high schools with access to ATs. The ATs at participating institutions volunteered to contribute data via electronic medical records systems; common data elements were then pushed to and maintained by the Datalys Center for Sports Injury Research and Prevention. The ATs completed detailed reports on each injury, including the condition and circumstances. The treatments component was used to comprehensively assess the services provided to athletes by ATs. The outcomes companion component was developed to monitor patient-reported outcomes after athletic injury.SummaryThe NATION-SP continues to serve a critical purpose in informing injury-prevention and treatment efforts among high school athletes.     

Career Commitment of Postprofessional Athletic Training Program Graduates

Context:Choosing to pursue an advanced degree in athletic training appears to indicate professional commitment and passion for the profession. Currently, there is a paucity of information regarding why some athletic trainers pursue enrollment in a postprofessional athletic training program (PPATP), indicating commitment to the profession, but later depart for another primary role outside of athletic training.Objective:To understand why athletic trainers invested in advanced training via a PPATP but then decided to leave the profession.Design:Qualitative study.Setting:Online data collection.Results:Two higher-order themes emerged regarding the career commitment of former athletic trainers who were PPATP graduates: (1) departure from an athletic training career and (2) partial continuance in athletic training. Two second-order themes emerged from the reasons for departure: (1) decreased recognition of value and (2) work-life imbalance. Finally, we identified 2 third-order themes from the participants'' reasons for departure because of a perceived lack of value: (1) low salary and (2) long, inconsistent hours worked.Conclusions:Most of our participants intended to stay in the profession when they chose to attend a PPATP. However, during role inductance in either the clinical experience of the PPATP they attended or early in their careers, they began to have thoughts of leaving mainly because of inadequate financial compensation, challenging work schedules, or both.Key Words: retention, attrition, career inductance

Key Points

• Despite their initial intentions to remain in the profession, athletic trainers who departed cited low salaries and long, inconsistent hours as the main factors in their decisions.
• Also influencing the decision to leave athletic training were decreased perceived value as a health care provider and work-life imbalance.

On graduation from a Commission on Accreditation of Athletic Training Education–accredited athletic training program, many athletic training students (ATSs) opt to pursue a graduate degree, as indicated by the nearly 70% of all athletic trainers (ATs) who possess a master''s degree.¹ The decision to pursue a graduate degree is often fostered by the ATS''s desire to gain additional mentorship and training before assuming a full-time position as an AT.² Diversity exists, however, in the graduate degrees sought by ATs, which can include biomechanics, exercise science, physical therapy, sports or business administration, or athletic training.²Choosing to pursue an advanced degree in athletic training appears to indicate professional commitment and passion for the profession.³ Professional commitment is commonly designated by the strength of an individual''s identification with, and involvement in, a profession.⁴ Many factors affect one''s professional commitment; rewards, coworker support, and love of the job can positively influence that commitment,⁵ whereas organizational climate, low salary, and limited staffing can negatively influence it.⁶ Long-term professional goals that include a career in athletic training and pursuit of advanced skills in athletic training provide the experience necessary to reach that goal.³ Many factors contribute to the initial attraction of a degree from a postprofessional athletic training program (PPATP),^2,3 but the opportunity to gain formal socialization through a clinical assistantship appears to be a strong attractor for the ATS and can have a strong influence on the final selection of a graduate program and degree.³ Completion of a PPATP provides the AT with the chance to gain clinical autonomy while being mentored in a learning environment that helps develop an expert clinician.³ Moreover, unlike the traditional graduate assistantship position, which is modeled as an apprenticeship, attendance at a PPATP allows the AT to acquire advanced skills in athletic training while continuing to develop clinical competence. The choice to enter a PPATP may indicate a strong interest in the material, the desire to advance an entry-level skill set, and the intention to pursue a career in athletic training.As demonstrated in a recent study,⁷ ATs entering PPATP education were motivated to pursue careers in athletic training. This finding supports the research of Mazerolle and Dodge,³ who found that first-year ATs enrolled in PPATPs were motivated to pursue full-time athletic training positions after graduation. Despite the clear link between attending a PPATP and retention in the field, it appears many ATs may leave the profession of athletic training after completing their postprofessional athletic training degrees. The topic of retention within athletic training has received attention recently, as the profession looks to solidify its role in health care and the medical community. Although the literature is rich with information on retention and factors associated with it,^7–10 there is a paucity of information regarding why athletic trainers make the decision to pursue a degree from a PPATP, indicating commitment to the profession, but later depart for another primary role outside of athletic training. Consequently, the purpose of our investigation was to understand why ATs invested in advanced training via a PPATP but then decided to leave the profession. We were specifically concerned with which factors led to their departure, what they were currently doing professionally, and whether they had any plans to return to athletic training.     

The Professional Socialization of the Graduate Assistant Athletic Trainer

Context:

The graduate assistant athletic trainer (AT) position often serves as one''s first experience working independently as an AT and is also an important aspect of the professional socialization process. The socialization experiences of graduate assistant ATs have yet to be fully explored.

Objective:

To understand the socialization process for graduate assistant ATs during their graduate experience.

Design:

Qualitative study.

Setting:

We conducted phone interviews with all participants.

Patients or Other Participants:

A total of 25 graduate assistant ATs (20 women, 5 men) studying in 1 of 3 academic tracks: (1) accredited postprofessional athletic training program (n = 8), (2) postprofessional athletic training program (n = 11), or (3) a nonathletic training degree program (n = 6). The average age was 25 ± 5 years, and the median age was 24 years. Participants were certified by the Board of Certification for an average of 2 ± 0.4 years.

Data Collection and Analysis:

We analyzed the data using a general inductive approach. Peer review, field notes, and intercoder reliability established trustworthiness. Data saturation guided participant recruitment.

Results:

The ability to gain clinical independence as a practitioner was an important socialization process. Having the chance to develop a relationship with a mentor, who provided support, guidance, and more of a hierarchical relationship, was an important socializing agent for the graduate assistant AT. Participants used the orientation session as a means to understand the expectations and role of the graduate-assistant position. Academic coursework was a way to achieve better inductance into the role via the opportunity to apply classroom skills during their clinical practice.

Conclusions:

Socializing the graduate assistant blends formal and informal processes. Transition to practice is a critical aspect of the profession; thus, supporting autonomous practice with directed mentoring can promote professional maturity.Key Words: onboarding, clinical reasoning, independence, mentorship

Key Points

• Professional socialization of the graduate assistant athletic trainer occurs through a mix of formal and informal processes that promote role understanding.
• Graduate assistant athletic trainers sought clinical independence but also recognized the value of continuing education, feedback, and mentoring to improve their skills.

Socialization within athletic training has received increasing attention over the last decade, as it provides a foundation for understanding the recruitment and retention of athletic training students and professionals.^1,2 The socialization process starts early as an individual begins the process of career planning by fact finding, observing, and shadowing professionals holding positions of interest. This process is often referred to as anticipatory. The more specific, detailed portion of the socialization process occurs when the individual is engaged in specific training for the selected career; this, too, is referred to as anticipatory socialization. Once the individual completes the specific processes or requirements of the profession and enters the workplace, the organizational socialization process begins. This aspect of socialization is often referred to as onboarding.¹ Despite the knowledge and skills a person learns during educational training, organizational socialization is a specific mechanism that allows him or her to gain a detailed understanding of the roles and responsibilities related to the particular organizational environment.Most literature on socialization in athletic training has focused on a distinct point in time during which an individual is engaged in anticipatory socialization or an athletic trainer (AT) is being socialized into the workplace. Socialization encompasses a blend of formal and informal processes that are rooted in mentoring and general orientation sessions designed to create awareness of policies and expectations.² Interestingly, the graduate assistant AT appears to be engaged in both processes: as a student in an educational setting, possibly gaining more didactic knowledge, while practicing clinically and being socialized by the organizational process of providing patient care. Despite this, investigators have not evaluated the processes that help the graduate assistant AT gain role understanding and inductance, an important factor in reducing role complexity and ambiguity.³A graduate assistant serves in a supportive role as a way of gaining additional experience to increase future employment options. The graduate assistant model has been described as allowing for independence in clinical practice but involving mentoring for the development of advanced clinical practice.⁴ Furthermore, the role of the graduate student provides a small developmental step toward preparation for a future full-time role as an AT, especially in the National Collegiate Athletic Association Division I setting. Pitney⁴ found that the graduate-assistant position was helpful in preparing ATs for future roles in the collegiate setting, as it helped them to envision role responsibilities and expectations.Graduate assistant ATs have a choice of 3 academic program routes for an assistantship: (1) accredited postprofessional athletic training (APPAT), (2) postprofessional athletic training (PPAT), and (3) nonathletic training (NAT). The APPAT programs are accredited by the Commission on Accreditation of Athletic Training Education (CAATE) and are designed to prepare ATs for advanced clinical practice while exposing them to research and scholarship to enhance patient outcomes and quality of care.⁵ Postprofessional athletic training programs are not accredited by CAATE but do provide an educational degree that advances the AT''s knowledge and offers clinical practice experiences. Conversely, an NAT program allows a graduate assistant AT to major in almost any educational program the college or university offers, without a focus on the applied knowledge of athletic training concepts. Common graduate degree offerings include sports administration or management, allied health, and education. In most NAT programs, mentoring and communication do not occur between educational program administrators and athletic training supervisors (eg, head AT).Informal and formal socialization occurs in the educational and organizational settings, and often mentorship is the groundwork of these processes.⁶ Moreover, a graduate assistant athletic training position is viewed as a rite of passage to obtain a full-time position, particularly in collegiate athletics.² Scholars have examined socialization with the intent of using the findings to provide practical, viable practices that will better socialize ATs into their various roles. Because graduate assistant AT positions are essential in professional development and the next step in the learning process, it is important to understand the socialization experiences associated with them. The purpose of our study, therefore, was to obtain a better understanding of how graduate assistant ATs gain an appreciation of their role within their employment setting.     

Athletic Trainers' Perceptions of Accessibility to Necessary Resources for Those Working Per Diem Services

ContextAs the demand for athletic training services has grown, the per diem athletic training setting has expanded to fulfill this need. Per diem services are provided by athletic trainers (ATs) who are hired as independent contractors for short time periods. These service opportunities help to increase access to care for medically underserved populations; however, due to the transient nature of the work, the quality of care may be compromised.ObjectiveTo examine current practices in per diem services and evaluate ATs'' accessibility to resources.DesignCross-sectional study.SettingOnline survey.Patients or Other ParticipantsA total of 448 participants responded (access rate = 9.57%), of whom 210 were ineligible (46.9%). Of those who were eligible, 192 participants completed the entire tool (completion rate = 80.7%, age = 38 ± 12 years, years certified = 14 ± 11, years providing per diem services = 8 ± 8).Main Outcome Measure(s)The survey comprised 3 sections: (1) demographics, (2) accessibility to resources and influence on patient care, and (3) domains of athletic training while providing per diem services. Resources assessed included those that are relevant to ATs practicing in accordance with the Board of Certification “Standards of Professional Practice.” The final instrument included approximately 30 questions (depending on display logic) and took an average of 12 minutes to complete.ResultsOf the 11 primary resources assessed, participants had limited accessibility to 6. Critical resources related to informatics, legalities, and health care delivery were often not available, were seen as unimportant to providing medical services, or both.ConclusionsParticipants indicated varied perceptions about the need for and access to these resources. Yet such resources contribute to the creation of a safe infrastructure for providing medical services and should be part of the routine dialogue regarding independent contracting.     

Supervising Athletic Trainers' Perceptions of Professional Socialization of Graduate Assistant Athletic Trainers in the Collegiate Setting

Context:

Many newly credentialed athletic trainers gain initial employment as graduate assistants (GAs) in the collegiate setting, yet their socialization into their role is unknown. Exploring the socialization process of GAs in the collegiate setting could provide insight into how that process occurs.

Objective:

To explore the professional socialization of GAs in the collegiate setting to determine how GAs are socialized and developed as athletic trainers.

Design:

Qualitative study.

Setting:

Individual phone interviews.

Patients or Other Participants:

Athletic trainers (N = 21) who had supervised GAs in the collegiate setting for a minimum of 8 years (16 men [76%], 5 women [24%]; years of supervision experience = 14.6 ± 6.6).

Data Collection and Analysis:

Data were collected via phone interviews, which were recorded and transcribed verbatim. Data were analyzed by a 4-person consensus team with a consensual qualitative-research design. The team independently coded the data and compared ideas until a consensus was reached, and a codebook was created. Trustworthiness was established through member checks and multianalyst triangulation.

Results:

Four themes emerged: (1) role orientation, (2) professional development and support, (3) role expectations, and (4) success. Role orientation occurred both formally (eg, review of policies and procedures) and informally (eg, immediate role immersion). Professional development and support consisted of the supervisor mentoring and intervening when appropriate. Role expectations included decision-making ability, independent practice, and professionalism; however, supervisors often expected GAs to function as experienced, full-time staff. Success of the GAs depended on their adaptability and on the proper selection of GAs by supervisors.

Conclusions:

Supervisors socialize GAs into the collegiate setting by providing orientation, professional development, mentoring, and intervention when necessary. Supervisors are encouraged to use these socialization tactics to enhance the professional development of GAs in the collegiate setting.Key Words: professional development, orientation, mentoring, qualitative research

Key Points

• Supervisors believed graduate assistantships were important in the professional growth of new athletic trainers to help transition them into clinical practice.
• Several processes were used to socialize graduate assistants into their roles in the collegiate setting, including orientations and providing mentorship and support.
• Supervisors were responsible for professionally developing graduate assistants, but several supervisors had unrealistic expectations for graduate assistants to practice as full-time staff and experienced athletic trainers.

Graduate assistantships are an important part of the professional and educational development of athletic trainers (ATs) and, for many, are rites of passage into the collegiate setting.¹ Graduate assistant athletic trainers (GAs) have met all credentialing requirements to provide patient care, but having complete autonomy and decision-making power may be a new experience for them. As new professionals transition from being supervised students to autonomous clinicians, part of their success may depend on the way they are socialized into their new positions.² However, the socialization of GAs, as newly credentialed ATs, into their roles has not been described. More specifically, little is known about the role of the supervisor in providing development and supervision to the GAs throughout the socialization process or the tactics supervisors use to socialize the GAs into their roles as new practitioners. Recently, the National Athletic Trainers'' Association Executive Committee on Education recommended exploring the employer''s responsibility in the development of newly credentialed ATs.³ Insight into how employers help develop and support GAs could lead to models for transitioning new ATs into practice.One way to develop and support new GAs is through organizational professional socialization. Professional socialization is the process by which an individual learns the roles and responsibilities of the position while acquiring knowledge, skills, and attitudes associated with the profession.^4–6 Socialization is the method by which new employees or students are oriented into a new position and the experiences of socialization, which help foster the employees'' professional identity.⁷ Organizational socialization occurs after the individual enters the organizational setting in which the individual is able to learn and adapt to the position.¹ In the collegiate setting, organizational socialization can be very complicated because it involves learning the particular culture and roles within the organization, which vary depending on the setting.^1,6,8 Individuals learn and adapt to their positions through socialization and mentoring. Formal training can also facilitate that process.¹ Recently, a qualitative study² examining the role of clinical teachers in the professional socialization of newly graduated nurses found the success of socialization largely depended on the extent of mentoring and support the new nurses received from preceptors. Socialization can produce both positive (eg, success, growth, enrichment) and negative (eg, role instability) effects. These effects can determine the success or failure of that individual.¹Although a great deal of research has focused on professional socialization of experienced ATs in the collegiate and high school settings, it is unclear how GAs in the college/university setting are socialized into their roles. Our purpose was to explore the professional socialization of GAs in the collegiate setting to determine how GAs were socialized and how they developed as ATs. Our research questions were the following: (1) What processes are used to socialize GAs into the collegiate setting? (2) What are the expectations of GAs within the collegiate setting? (3) What is the supervisor''s role in developing the GA?