A Theoretical Model of Transition to Practice for Athletic Trainers

ContextThe transition to practice of newly credentialed athletic trainers (ATs) has become an area of focus in the athletic training literature. However, no theoretical model has been developed to describe the phenomenon and drive investigation.ObjectiveTo better understand the lived experience of the transition to practice and develop a theoretical model of transition to practice for ATs.DesignQualitative study.SettingTelephone interviews.Patients or Other ParticipantsFourteen professional master''s athletic training students (7 men, 7 women, age = 25.6 ± 3.7 years, from 9 higher education institutions) in the first year of clinical practice as newly credentialed ATs.Data Collection and AnalysisParticipants completed semistructured phone interviews at 3 timepoints over 12 to 15 months. The first interview was conducted just before graduation, the second 4 to 6 months later, and the third at 10 to 12 months. The interviews were transcribed and analyzed using a grounded theory approach.ResultsWe developed a theoretical model to explain the causal conditions that triggered transition, how the causal conditions were experienced, the coping strategies used to persist through the first year of practice, and the consequences of those strategies.ConclusionsThe model provides a framework for new athletic training clinicians, educators, and employers to better understand the transition process in order to help new clinicians respond by accepting or adapting to their environment or their behaviors.     

Employability in Academe for Athletic Trainers With the Doctor of Athletic Training Degree

ContextThe doctor of athletic training (DAT) degree has recently been introduced into academe. Limited literature exists regarding how individuals with this degree can become part of an athletic training faculty.ObjectiveTo identify department chairs'' perceptions of the DAT degree and determine whether they viewed the degree as viable when hiring new faculty within a postbaccalaureate professional athletic training program.DesignCross-sectional study.SettingOnline survey instrument.Patients or Other ParticipantsA total of 376 department chairs who had oversight of Commission on Accreditation of Athletic Training Education athletic training programs were invited to participate. Of these, 190 individuals (50.5%) accessed the survey, and 151 of the 190 department chairs (79.5%) completed all parts of the survey.Main Outcome Measure(s)A web-based survey instrument consisted of several demographic questions and 4-point Likert-scale items related to perceptions of the DAT degree. Independent variables were degree qualifications, advanced degree requirements, institutional control, student enrollment, current faculty with a clinical doctorate, and institutional degree-granting classification. The dependent variables were the department chairs'' responses to the survey items.ResultsMore than 80% of department chairs were moderately or extremely familiar with the concept of an advanced practice doctoral degree, and 64% believed it would be extremely to moderately beneficial to hire someone with this degree in the athletic training program. Furthermore, 67% of department chairs were very likely or likely to hire someone with a DAT degree and expected they would do so in the next 5 years. Characteristics associated with higher perception scores were lower institutional student enrollment, having more current faculty with an advanced practice doctoral degree, and a lower institutional degree-granting classification.ConclusionsDepartment chairs recognized the DAT degree as a viable degree qualification for teaching in professional athletic training programs. Future researchers should examine the need for athletic trainers with the DAT degree in clinical practice settings.     

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.     

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.     

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.     

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.     

High School Athletes' Parents' Perceptions and Knowledge of the Skills and Job Requirements of the Certified Athletic Trainer

ContextParents play a crucial role in determining medical services for their children, and it is important they understand the scope of practice and skills of the athletic trainer (AT).ObjectiveTo understand parents'' perceptions and knowledge of the skills and job requirements of the secondary school AT.DesignCross-sectional study.SettingSport meetings and banquets at 5 high schools in southwest Michigan during the fall, winter, and spring seasons.ResultsOf the 539 parents who responded, 28% responded yes, and 72% responded no to having experience with an AT for their own injuries. When asked if they had experience with an AT due to their child''s injuries, 60% responded yes. We found a difference among the 3 categories of experience for perception scores (P = .002) and knowledge scores (P < .001).ConclusionsIn the absence of past experience with an AT, parents'' perceptions and knowledge of the skills and job requirements of the secondary school AT are limited. Athletic trainers should educate parents on their professional roles, which may enhance their ability to provide better health care.Key Words: secondary schools, awareness, guardians

Key Points

• Parents have varying perceptions of athletic trainers based upon past experiences.
• Parents view the athletic trainer as a valued member of the secondary school health care team.
• Parents who have limited past experience with athletic trainers rate emergency care as the primary job responsibility.

Over the past 20 years, secondary school sport participation among students in the United States has consistently increased.¹ To ensure the proper care of these athletes, the American Medical Association recommended that all secondary schools provide athletic training services.² In addition to the athletic trainer (AT), the National Athletic Trainers'' Association has recommended that an athletic health care team (AHCT) be established that includes an AT, school nurse, physician, and other health care professionals.^3,4 The AHCT''s primary purpose is to work with the athletic director, coaches, and parents to ensure that appropriate medical care is provided for all athletes.To work congruently in providing the best possible care for secondary school student-athletes, members of the AHCT, along with athletic directors, coaches, and parents, must understand the variety of responsibilities of the AT. Previous investigations^5–7 showed that physicians and administrators have a basic understanding of the roles of ATs, but conversely, coaches did not fully recognize the scope of the ATs'' credentials or certification requirements. Additionally, when emergency medical service personnel were questioned, they too showed an incomplete comprehension of ATs'' roles as health care providers, predominantly in sport-related emergency care.⁸ These investigations led to a general consensus on misconceptions of ATs'' roles and responsibilities, likely stemming from a lack of experience with an AT in a secondary school setting.Less studied but perhaps one of the most important groups affiliated with the health care of the secondary school athlete is parents. Parents had a basic idea of the roles of an AT but lacked full understanding of the athletic training profession.⁹ Because parents play a crucial part in determining medical services for their children in the secondary school setting, they must have a thorough understanding of the scope of practice and skills of ATs in order for their children to receive the best medical care possible. Therefore, the purposes of our study were to further investigate parents'' overall perceptions and knowledge of the secondary school AT and to determine whether parents'' past experiences with ATs influenced their overall perceptions and knowledge of the athletic training profession and professional practice domains.     

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.     

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.     

Certified athletic trainers' knowledge of methicillin-resistant Staphylococcus aureus and common disinfectants

Context:

Methicillin-resistant Staphylococcus aureus (MRSA) infections are increasingly common in athletic settings. The MRSA knowledge and infection-control practices of certified athletic trainers (ATs) and the cleanliness of the athletic training room are important factors in preventing MRSA infections.

Objective:

To assess knowledge of MRSA and the use of common disinfectants among ATs and to explore their infection-control practices.

Design:

Cross-sectional study.

Setting:

High school and collegiate athletic training rooms.

Patients or Other Participants:

A total of 163 ATs from National Collegiate Athletic Association Divisions I, II, and III and high schools, representing all 10 National Athletic Trainers'' Association districts.

Main Outcome Measure(s):

Frequencies, analyses of variance, and χ² tests were used to assess current practices and opinions and relationships between factors.

Results:

Methicillin-resistant Staphylococcus aureus was perceived as a national problem by 92% of respondents; 57% perceived MRSA as a problem in their practice setting. Most respondents had treated general infections (88%), staphylococcal infections (75%), and MRSA infections (57%). Male sex was associated with treating all 3 types of infections (χ² test, P < .05). Noncurriculum education was associated with a lack of recognition of environmental issues as risk factors and with the use of isopropyl alcohol for disinfection (χ² test, P < .05). For example, 10% of respondents did not recognize that contaminated whirlpools can be a source of MRSA infection. Respondents also incorrectly identified effective cleaning solutions. Thirty percent of respondents cleaned their hands frequently or sometimes before treating each athlete and 35% cleaned their hands sometimes, occasionally, or never after seeing each athlete.

Conclusions:

The majority of ATs were informed about MRSA and made correct disinfection choices. However, improvements are still needed, and not all ATs were using proper disinfection practices.     

The Relationship Between Spiritual Well-Being and Burnout in Collegiate Athletic Trainers

ContextSpiritual well-being is the expression of one''s spirituality as measured in the dimensions of existential and religious well-being. The Smith Cognitive Affective Model of Athletic Burnout suggests that personality factors such as spiritual well-being and the use of religious coping methods may affect burnout as well as its causes and outcomes. This has not been examined in collegiate athletic trainers (ATs).ObjectiveTo investigate the relationship between spiritual well-being and burnout in collegiate ATs.DesignCross-sectional study.SettingWeb-based survey.Patients or Other ParticipantsA total of 783 certified ATs employed full time in the collegiate setting participated. Part-time employees (eg, graduate assistants, interns) were excluded.Main Outcome Measure(s)A 100-item online questionnaire was created for this study. It used items from previously developed scales, including the Spiritual Well-Being Scale, the Brief RCOPE, the Maslach Burnout Inventory, and substance-use questions from the Monitoring the Future study. Participants were able to complete the survey in approximately 10–15 minutes. Multiple regression analyses were used to analyze survey data. We mapped all independent (existential well-being, religious well-being, positive and negative religious coping) and dependent variables (situational variables, Maslach Burnout Inventory burnout subscales, substance use, and intention to leave) onto the Smith Cognitive-Affective Model of Athletic Burnout to determine which variables altered burnout levels, substance use, and intention to leave. Tests of mediation or moderation were conducted when appropriate.ResultsExistential well-being was a significant positive predictor of social support and a significant negative predictor of work-family conflict, decreased sense of personal accomplishment, emotional exhaustion, depersonalization, intention to leave the profession, and binge drinking. Existential well-being also served as a mediator or moderator in several components of the model.ConclusionsExistential well-being was a protective factor against burnout as well as some of the causes and effects of burnout in collegiate ATs.     

National athletic trainers' association-accredited postprofessional athletic training education: attractors and career intentions

Context

Anecdotally, we know that students select graduate programs based on location, finances, and future career goals. Empirically, however, we lack information on what attracts a student to these programs.

Objective

To gain an appreciation for the selection process of graduate study.

Design

Qualitative study.

Setting

Postprofessional programs in athletic training (PPATs) accredited by the National Athletic Trainers'' Association.

Patients or Other Participants

A total of 19 first-year PPAT students participated, representing 13 of the 16 accredited PPAT programs.

Data Collection and Analysis

All interviews were conducted via phone and transcribed verbatim. Analysis of the interview data followed the procedures as outlined by a grounded theory approach. Trustworthiness was secured by (1) participant checks, (2) participant verification, and (3) multiple analyst triangulations.

Results

Athletic training students select PPAT programs for 4 major reasons: reputation of the program or faculty (or both), career intentions, professional socialization, and mentorship from undergraduate faculty or clinical instructors (or both). Participants discussed long-term professional goals as the driving force behind wanting an advanced degree in athletic training. Faculty and clinical instructor recommendations and the program''s prestige helped guide the decisions. Participants also expressed the need to gain more experience, which promoted autonomy, and support while gaining that work experience. Final selection of the PPAT program was based on academic offerings, the assistantship offered (including financial support), advanced knowledge of athletic training concepts and principles, and apprenticeship opportunities.

Conclusions

Students who attend PPAT programs are attracted to advancing their entry-level knowledge, are committed to their professional development as athletic trainers, and view the profession of athletic training as a life-long career. The combination of balanced academics, clinical experiences, and additional professional socialization and mentorship from the PPAT program experience will help them to secure their desired career positions.Key Words: graduate education, professional socialization, mentorship

Key Points

• First-year graduate students in these postprofessional athletic training education programs sought to advance their entry-level knowledge and were enthusiastic about their futures as lifelong athletic trainers.
• Mentors were both critical links in the student''s decision to pursue postprofessional athletic training education and important influences in the selection of a specific program.
• As the numbers of expert athletic trainers increase, the role of athletic trainers within the health care system will be strengthened.

As the field of athletic training continues to grow, more and more athletic trainers (ATs) are pursuing postprofessional educational opportunities. Nearly 70% of all ATs possess at least a master''s degree.¹ Despite this large number of ATs with graduate degrees, a great amount of diversity exists as to the specific degrees possessed by ATs. Athletic trainers pursue master''s degrees in a number of areas, including advanced athletic training, exercise physiology, biomechanics, psychology, and business, as well as physical therapy, occupational therapy, or medical school. Although little has been reported about the decision processes of athletic training students (ATSs) selecting a particular postprofessional degree, we do know both anecdotally and empirically that those who opt to continue their studies are driven by passion, the need for continued education and work experience, and the desire to facilitate their careers as ATs.²One potential avenue for graduate study among ATs is a National Athletic Trainers'' Association (NATA)-accredited postprofessional program in athletic training (PPAT). The goal of these programs is to offer material beyond the entry-level athletic training education programs.³ Historically, these programs have offered a balanced curriculum consisting of clinical, academic, and research experiences designed to enhance the athletic training skills and expand the knowledge base of the student.^3,4 In essence, these programs are aimed at developing more skilled ATs. The PPAT-trained ATs who possess advanced clinical skills should, therefore, be capable of achieving more positive outcomes for their patients.⁵ Motivation behind a student''s decision to attend graduate study, and specifically a PPAT, has become an important topic for athletic training scholars and educators because it can help to recruit and retain quality students and aid program development.A recent study⁶ of ATs entering PPAT education indicated that those students were motivated to pursue careers in athletic training, a finding that supports the 2007 presentation by Sauers⁵ at the NATA Educator''s Conference, who noted that most ATs enrolled in PPAT programs pursue full-time athletic training positions. Organizational turnover continues to be an issue facing athletic training,⁷ but attending a PPAT program may indicate a person''s desire to stay in the athletic training field. Currently, only 15 PPAT programs exist (accredited programs are listed at http://www.nata.org/education/educational-programs/post-professional-education-programs); with more than 350 entry-level athletic training programs available, the number of PPAT programs does not match up well with the number of entry-level ATs graduating on a yearly basis. It has been argued⁸ that we need to develop more PPAT programs to accommodate the large number of entry-level ATs and therefore elevate the knowledge base of the profession as a whole. The standards and guidelines for postcertification athletic training graduate programs include 6 general principles of advanced education: facilitation of skills mastery, development of critical and independent thinking, theoretical understanding, proficiency with research and writing, opportunity to provide services to the community, and diversity in learning experiences.³ Programs have the autonomy to develop their curricula and clinical education experiences, but these often reflect the program''s faculty, philosophy of the program, and areas of distinction. Development of the program and subsequent accreditation of a program by the NATA is based on providing experiences that promote skill advancement as it pertains to clinical, teaching, and research abilities. The experience in a PPAT program can be starkly different from that of a traditional graduate assistantship with both academic and clinical responsibilities in the greater structure regarding academic offerings, research experiences, and clinical education opportunities. Many certified ATs have graduate degrees; however, at this time, our understanding of how an ATS selects which graduate path and why PPAT programs are more or less attractive is limited.The benefits of PPAT programs appear to be relatively clear and copious despite a lack of empirical data: PPAT education allows the student to develop knowledge specific to the practice of athletic training,³ which may not be the case for nonathletic training-focused degree programs, such as exercise physiology, sports management, or psychology.⁸ However, it appears that many students continue to receive differing opinions on the best options for graduate study from their mentors,⁶ and the decision process for these students is still not widely understood. Therefore, the purpose of our study was to investigate attractors to PPATs for athletic training students who were currently enrolled in such programs. Furthermore, we were interested in exploring the relationship between attending a PPAT and career intentions. This information will be useful for graduate programs in terms of recruitment, program development, and retention and useful for undergraduate program directors in counseling their students who are considering graduate school.     

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.     

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.     

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.