Psychosocial Aspects of Athletic Injuries as Perceived by Athletic Trainers

Context:

Despite the Psychosocial Strategies and Referral content area, athletic trainers (ATs) generally lack confidence in their ability to use this information.

Objective:

The current study''s primary purpose was to determine (a) perceived psychological responses and coping behaviors athletes may present to ATs, (b) psychosocial strategies ATs currently use with their athletes, (c) psychosocial strategies ATs deem important to learn more about, and (d) ATs'' current practices in referring athletes to counseling or sport psychology services.

Design:

 Mixed-methods study.

Setting:

Online survey containing both quantitative and qualitative items.

Patients or Other Participants:

  A total of 215 ATs (86 male, 129 female), representing a response rate of 22.50%.

Main Outcome Measure(s):

The Athletic Training and Sport Psychology Questionnaire.

Results:

Stress/anxiety (4.24 ± 0.82), anger (3.70 ± 0.96), and treatment adherence problems (3.62 ± 0.94) were rated as the primary psychological responses athletes may present upon injury. Adherence and having a positive attitude were identified as key determinants in defining athletes'' successful coping with their injuries. The top 3 selected psychosocial strategies were keeping the athlete involved with the team (4.57 ± 0.73), using short-term goals (4.45 ± 0.67), and creating variety in rehabilitation exercises (4.32 ± 0.75). The top 3 rated psychosocial strategies ATs deem important to learn more about were understanding motivation (4.29 ± 0.89), using effective communication (4.24 ± 0.91), and setting realistic goals (4.22 ± 0.97). Of the sample, only 59 (27.44%) ATs reported referring an athlete for counseling services, and 37 (84.09%) of those who had access to a sport psychologist (n = 44) reported referring for sport psychology services.

Conclusions:

 These results not only highlight ATs'' current use of psychosocial strategies but also their desires to increase their current knowledge and understanding of these strategies while caring for injured athletes.Key Words: psychology, clinical skills, professional preparedness, athletic training

Key Points

• • Athletic trainers appear to be mindful of the psychological ramifications that athletes often experience as a result of their injuries.
• • Although athletic trainers apparently used some psychosocial strategies within injury rehabilitation, they also stressed the importance of learning more about these strategies.

Traditional rehabilitation programs are designed to ensure an athlete''s full return to preinjury levels of physical fitness, but a growing body of research highlights the importance of also addressing psychological responses within the rehabilitation context.^1–6 One of the ways in which the injured athlete''s psychological response to sport injuries has been explained is through the Integrated Model of Response to Sport Injury Rehabilitation.⁷ According to the model, an individual athlete''s cognitive appraisal of the injury (ie, how the athlete views the situation), as well as the athlete''s emotional (ie, how he or she feels about the injury) and behavioral (ie, how he or she acts and reacts to the injury situation) responses are influenced by a range of personal (eg, injury characteristics and individual differences) and situational (eg, sport, social, and environmental influences, including social support and the sports medicine team) factors. The model recognizes the interaction among the cognitive appraisal and emotional and behavioral responses as a dynamic and bidirectional cyclic process, which in turn has an effect on both physical and psychological recovery outcomes.⁷Thus far, a wealth of evidence exists in support of the model. Most athletes appear to be psychologically affected (emotional response) when injured,^8–10 and these psychological responses can have a significant influence on the quality and speed of the sport-injury rehabilitation process.^3–5 Support for the use of psychosocial strategies (a behavioral response) during sport-injury rehabilitation has also been documented in the literature. For example, goal setting, imagery, positive self-talk, and relaxation strategies have been useful in helping athletes cope with pain, stress, and anxiety and address self-efficacy, self-esteem, and confidence-related apprehensions, as well as concerns with rehabilitation motivation and adherence.^5,11,12 In addition, the role of sports medicine professionals (a situational factor) in influencing injured athletes'' cognitive appraisal of the injury, emotional and behavioral responses, the rehabilitation process, and the physical and psychological recovery outcomes is also important.^13–18 Therefore, it has been suggested that sports medicine professionals, such as athletic trainers (ATs), play an integral part in the sport-injury rehabilitation process and that they are best suited to inform, educate, and assist injured athletes with the psychological and physical process of injury.^4,19,20 Indeed, many sports medicine professionals believe they must address psychological aspects of injuries in order for their work to be effective.^2,8,10,21Recognizing the importance of providing psychological support to injured athletes, the National Athletic Trainers'' Association (NATA) Executive Committee for Education has recently released the 5th edition of the Educational Competencies, which includes the Psychosocial Strategies and Referral (PS) content area.²² These competencies and clinical integration proficiencies were, in part, specifically designed to ensure that ATs are exposed to information and applied learning situations that will increase their ability to provide psychological support to injured athletes and ensure a holistic approach to injury rehabilitation. According to the PS competencies, all ATs “must be able to recognize clients/patients exhibiting abnormal social, emotional and mental behaviors.”²²(p116) This should be coupled with the ability to implement psychosocial strategies, intervene, and refer when necessary²² (for more details on the PS content area, see the aforementioned reference).As a result of changes to the educational content areas, it was believed that, with the addition of the Psychosocial Intervention and Referral content area²³ to athletic training education programs (ATEPs), ATs “would consider the psychological aspects of an injury within their scope of practice.”^1(p5) However, Stiller-Ostrowski et al²⁴ noted that, although the content is required by ATEPs, no specific and standardized guidelines are provided regarding the actual teaching of this information. As a result of the lack of consistent training, it can be presumed that ATs may lack confidence and readiness to address the psychosocial aspects of athletic injuries. Stiller-Ostrowski and Hamson-Utley¹ reported that ATs lacked confidence in their ability to make use of the techniques taught via the psychosocial content area within the context of injury rehabilitation. This lack of confidence, according to Kamphoff et al,²⁵ can be attributed to the fact that ATs perceive themselves to not be “fully trained in the implementation” of these skills within this context.^(p116) Additional research by Stiller-Ostrowski and Ostrowski²⁶ corroborated the above findings and revealed that ATs did not feel adequately prepared by their ATEPs to deal with psychological responses presented by injured athletes. Gordon²⁷ also noted that sports medicine professionals were concerned about their ability to deal with psychological responses, in addition to being able to use psychosocial strategies to address these responses, due to their lack of in-depth training in the area. Furthermore, Jevon and Johnston¹³ reported conflicts between formal and informal roles with regard to using psychosocial strategies as part of the rehabilitation process. Thus, it appears that, despite the stated intentions of the psychosocial content area, ATs still seem to lack knowledge and confidence in their ability to address some of the psychological responses with which injured athletes may present.Previous work gaining insight into sports medicine professionals'' views on the psychological content of their practice is limited.^2,8–10,28 Thus far, the only study in the United States addressing these issues was conducted by Larson et al.² They surveyed practicing ATs (n = 482) using the Athletic Training and Sport Psychology Questionnaire (ATSPQ). A total of 226 ATs (47%) perceived that the athletes they treat experience psychological trauma as a result of their athletic injuries. Moreover, according to Larson et al,² even though ATs used a variety of psychosocial strategies, they wanted more in-depth training to be better able to use these strategies within the context of sport-injury treatment and rehabilitation. Similar studies have recently been conducted with sports medicine professionals working with injured athletes in the United Kingdom,^8–10,28 but their findings may not be directly applicable to the US sample due to differences in professional training and professional titles. Because Larson et al² performed their research more than 15 years ago and given the recent inclusion of psychosocial content areas within ATEPs, further study is warranted to gain greater insight into ATs'' perceptions of the psychological aspects of athletic injuries in the United States.Thus, the aim of the current study was to extend the work by Larson et al² by surveying practicing ATs to determine (a) perceived psychological responses and coping behaviors athletes may present to ATs, (b) psychosocial strategies ATs currently use with their athletes, (c) psychosocial strategies ATs deem important to learn more about, and (d) ATs'' current practices in referring athletes to counseling or sport psychology services.     

Collegiate Student-Athletes' Satisfaction With Athletic Trainers

Context: In today's sport settings, the athletic trainer is often the first member or the health care team with whom the athlete interacts. Delivery of patient care can be improved by increasing patient/athlete satisfaction.Objective: To evaluate the satisfaction collegiate student-athletes had with their athletic trainer(s) and the athletic training services provided at their institutions.Design: A survey format was solicited to 40 randomly selected National Collegiate Athletic Association Division I and II athletic training programs in 4 regions across the United States.Setting: Collegiate athletic training environment.Patients or Other Participants: A total of 325 student-athletes from 20 of the programs solicited agreed to participate.Main Outcome Measure(s): The questionnaire was a variation on a previously used instrument developed for assessing athletes' perceptions of care. Validity and reliability analyses supported use of the instrument. A linear regression model was calculated to determine predictors of satisfaction score.Results: Significant differences in satisfaction scores were observed between athletes in high- and low-profile sports and between male and female athletes. When sex and sport profile were combined, differences in scores were noted between female athletes in high-profile sports and males in low-profile sports. Both sex and sport profile were predictors of satisfaction among the student-athletes who participated in the study.Conclusions: Female athletes and athletes in high-profile sports demonstrated greater satisfaction with their athletic trainer(s). Competitive level did not have a significant influence on satisfaction.     

Athletic Directors' Barriers to Hiring Athletic Trainers in High Schools

ContextIn its best-practices recommendation, the Inter-Association Task Force for Preventing Sudden Death in Secondary School Athletics Programs urged all high schools to have a certified athletic trainer (AT) on staff. Despite the recommendation, many high schools lack the medical services of an AT.ObjectiveTo examine the barriers that athletic directors (ADs) face in hiring ATs in public high schools and in providing medical coverage for their student-athletes.DesignQualitative study.SettingSemistructured telephone interviews.ResultsWe identified 3 themes. Lack of power represented the inability of an AD to hire an AT, which was perceived to be a responsibility of the superintendent and school board. Budget concerns pertained to the funding allocated to specific resources within a school, which often did not include an AT. Nonbudget concerns represented rural locations without clinics or hospitals nearby; misconceptions about the role of an AT, which led to the belief that first-aid–trained coaches are appropriate medical providers; and community support from local clinics, hospitals, and volunteers.ConclusionsMany ADs would prefer to employ ATs in their schools; however, they perceive that they are bound by the hiring and budgeting decisions of superintendents and school boards. Public school systems are experiencing the consequences of national budget cuts and often do not have the freedom to hire ATs when other school staff are being laid off.Key Words: medical care, secondary school, staffing

Key Points

• Budgeting concerns influenced the decisions of athletic directors about employing athletic trainers.
• The athletic director is only 1 member of the administration who can influence the hiring of athletic trainers.
• Misconceptions regarding the value and role of the athletic trainer in the secondary school setting were barriers to hiring.

Researchers have estimated that more than 7 million high school students currently participate in organized sports.¹ Approximately 1.4 million sport-related injuries occur among high school athletes each year.² American football alone has been projected to produce 12.04 injuries per 1000 exposures during competitions and 2.54 injuries per 1000 exposures during practices.³ Whereas most athletic injuries are relatively minor, potentially limb-threatening or life-threatening emergencies can occur. One medical emergency that can affect athletes is exertional heat stroke, which is consistently among the top 3 causes of death in sport.⁴ On October 12, 2010, Tyler Davenport died of exertional heat stroke that occurred during a football practice in August (Douglas J. Casa, oral communication, June 3, 2014). Although Davenport''s coaches provided assistance at practice before transporting him to the hospital, their level of emergency medical training was limited to basic emergency care and focused on cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) training. Several deaths are reported each year, and they often result from a failure to recognize or implement appropriate care.⁵ Prompt and appropriate management of these injuries is critical to the patient''s outcome and should be carried out by trained health care personnel, such as a certified athletic trainer (AT), to minimize the risk of further injury or death.⁶The Inter-Association Task Force for Preventing Sudden Death in Secondary School Athletics Programs urged all high schools to have an AT on staff to take charge of emergency situations and provide care for student-athletes.^7,8 The AT can evaluate and properly treat injuries, including sprains, strains, contusions, and abrasions, as well as more serious conditions, such as exertional heat stroke and hyponatremia. The AT can also facilitate and manage athletic health care at the high school, referring as needed and treating many patients in house. The presence of an AT can help reduce health care costs for the school and for the parents of student-athletes. In addition to heat illnesses, emergencies involving asthma, brain and cervical spine injuries, diabetes, sudden cardiac death, exertional illnesses, and environmental dangers have resulted in the deaths of athletes of all ages.⁴ In 1994, only 35% of high schools used the services of an AT, and in 1997, only 13 states reported employing ATs in greater than 50% of high schools.⁹ By 2009, the national average of schools employing ATs had risen to only 42%.¹⁰ Whereas the prevalence of ATs in high schools is improving, some high schools still lack the appropriate medical personnel to institute guidelines for preventing sudden death in youth athletics.¹¹ In these settings, the responsibility to save young athletes may fall to coaches, athletic directors (ADs), or bystanders who are not trained in discerning similar signs and symptoms of potentially fatal circumstances.⁷ Specific and prompt care is critical for a patient to have the best chance of a positive outcome. In some situations, waiting until emergency medical services arrive to provide care can result in catastrophic injury or death, as demonstrated in Davenport''s case. Having onsite medical coverage provided by an AT can in many cases reduce the number of deaths that occur in high school athletes; yet in some cases, an AT is not available to provide such care.The importance of having an AT onsite has been well documented by various outlets but most prominently in the best-practices recommendation of the Inter-Association Task Force for Preventing Sudden Death in Secondary School Athletics Programs.^7,8 However, many high schools do not meet this recommendation. The Collaboration for Athletic Training Coverage in High Schools–An Ongoing National Study (CATCH-ON) provided preliminary data on the prevalence of ATs in public high schools across the United States; this study was designed to gain a better understanding of the medical coverage provided by US high schools.¹¹ After attempting to contact every public high school in the United States, the researchers observed that 70% of public high schools, which account for 86% of all student-athletes at this level, have some access to an AT. As part of the CATCH-ON project, initial data emerged about reasons for not having an AT.¹¹ Those barriers included budgetary concerns and the belief that an AT was not needed, mostly due to the CPR, AED, and first-aid training of coaches.¹¹ Therefore, the purpose of our study was to focus on the barriers that ADs face in providing medical coverage for their student-athletes and hiring ATs for public high schools. By examining these barriers more thoroughly, we hoped to find ways to help ADs initiate positive change by seeking AT coverage.     

The Experiences of Female Athletic Trainers in the Role of the Head Athletic Trainer

Context:Very few women have leadership positions in athletic training (ie, head athletic training positions) in intercollegiate athletics. Research exists on the barriers to attaining the role; however, our understanding about the experiences of those currently engaged in the role is limited.Objective:To examine the experiences of female head athletic trainers as they worked toward and attained the position of head athletic trainer.Design:Qualitative study.Setting:National Collegiate Athletic Association Division I setting.Results:Six major themes emerged from our analysis regarding the experiences of female head athletic trainers. Opportunities to become a head athletic trainer, leadership qualities, and unique personal characteristics were discussed as factors leading to the assumption of the role of the head athletic trainer. Where women hold back, family challenges, and organizational barriers speak to the potential obstacles to assuming the role of head athletic trainer.Conclusions:Female head athletic trainers did not seek the role, but through persistence and encouragement, they find themselves assuming the role. Leadership skills were discussed as important for success in the role of head athletic trainer. Life balancing and parenting were identified as barriers to women seeking the role of head athletic trainer.Key Words: gender, leadership, socialization, career advancement

Key Points

• Female athletic trainers who assumed the role of the head athletic trainer did so because of persistence and strong leadership skills. Many were promoted to the rank of head athletic trainer within their own organizations due to strong job performance.
• Reluctance and life-balancing concerns emerged as barriers to female athletic trainers assuming the role of the head athletic trainer position. The increase in administrative responsibilities and resulting additional demands on their time were potential problems for female athletic trainers.

Since the passage of Title IX legislation, more women have assumed positions within athletic training at the intercollegiate level. Women represented 46.4% of graduate assistant athletic trainers and 47% of assistant or associate athletic trainers in 2010.¹ However, the number of women advancing in the field, specifically to head athletic trainer positions within Division I of the National Collegiate Athletic Association, has not increased significantly. Women held the fewest head and assistant athletic training positions at the Division I level,² only 17.5% of the head athletic trainer positions in 2012.¹ Scant research is available to address why so few women are in head athletic trainer positions. To date, only 1 author³ has examined the experiences of women in head athletic trainer positions at the Division I level.Outside the athletic training literature, gender stereotyping and factors limiting the advancement of women in administrative or leadership roles have been described.^4–8 Within the athletic training literature, scholars have examined how gender-role stereotyping and concerns about power have negatively influenced female athletic trainers, particularly when they are providing athletic training services to male sports or interacting with male coaches while providing athletic training services at the Division I level.⁹ Moreover, additional researchers have suggested that many women transition away from the Division I level to less demanding positions and careers as a result of kinship responsibilities,¹⁰ parenthood,¹¹ and life balancing,¹² which may preclude them from eventually assuming the role of head athletic trainer. Also, Gorant³ noted that female athletic trainers expressed an aversion to the role of head athletic trainer, as that person often assumes the position of lead athletic trainer in charge of football. Providing athletic training services at the Division I level is considered a daunting task requiring long hours; coupling those with the additional administrative responsibilities that accompany the role of the head athletic trainer and the responsibilities of a football sport assignment may deter an athletic trainer from pursuing the role. Gorant³ found that female athletic trainers were reluctant to assume leadership roles as a result of lack of confidence or self-identified lack of skill sets necessary to lead.³ Our purpose was to build upon the work of Gorant,³ as she was the first to examine the barriers female athletic trainers perceived to assuming the role of the head athletic trainer.

Challenges to Advancement to Head Athletic Trainer

Career advancement for female athletic trainers has been described as limited or difficult to achieve.³ Gender stereotyping has been anecdotally and empirically cited as a barrier to career advancement for female athletic trainers in the Division I setting.^3,9,13 Other barriers that have been examined within the athletic training literature include work-family conflict,^6,14,15 kinship responsibility,⁷ parenthood,³ incongruent role perceptions⁸ in collegiate athletic settings, and gender stereotyping of young female athletic trainers early in their careers.⁹ However, many women have been able to persist in athletic training despite these barriers.³ Specifically, a female athletic trainer is more likely to remain in a position that allows her to adequately and efficiently assume all her roles, which may include mother, caretaker, and spouse.¹⁵ Although data are limited on female athletic trainers and their decisions regarding leadership positions, the existing literature indicates some women report higher levels of job satisfaction in lower-ranking positions,^16,17 notably because of the ability to balance work and family obligations.^18,19 Work as an athletic trainer at the collegiate level is time intensive, which limits the ability to fulfill other roles and responsibilities, such as those of caregiver, spouse, or mom.²⁰Gender-role stereotypes are at times applied to women working in male-dominated areas,^21–23 especially in collegiate athletics. Ohkubo¹³ found that gender stereotypes existed within the Division I setting for the female athletic trainer, as student-athletes perceived them to serve in the role of nurturer or “mom.” Burton et al⁹ reported that young female athletic trainers were subject to informal work practices that prevented them from covering the higher-profile sports of men''s basketball and football. In addition, male coaches stereotyped young, female athletic trainers as potential sexual distractions to their athletes, which also served to minimize their professional competence and ability to work with high-profile men''s sports.⁹

Mentorship Support for Female Advancement in Athletic Training

Socialization is a process whereby individuals learn their professional roles and responsibilities through formal and informal training.^24,25 Mentorship has been identified as a necessary facilitator for professional development because the mentor provides guidance, context, and understanding regarding professional expectations, behaviors, and skills. In a recent study examining sex discrimination in the Division I setting, Burton and colleagues⁹ found that female athletic trainers were able to manage situations of sex discrimination because of professional role modeling or mentorship by a peer or supervising athletic trainer. Based on findings of recent investigations,^26,27 examining the balance between motherhood and the role of a Division I athletic trainer, mentorship has been viewed as a critical factor to help retain more women in the workplace. Also, role models and mentors can both assist athletic trainers in the Division I setting to navigate the bureaucratic and political environment of intercollegiate athletics²⁶ and advise young professionals on career advancement and how to improve job satisfaction.²⁷Given the low percentage of women working in head athletic training positions in Division I intercollegiate athletics (15.2%), the purpose of our study was to examine the experiences of women working in those positions. We hoped that by examining their experiences, we could develop a better understanding of what opportunities have led them to those positions, what personal characteristics and organizational contexts have supported their advancement, and what challenges and barriers they have overcome to reach the leadership level in athletic training.     

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.     

Self-Reported Health and Fitness Habits of Certified Athletic Trainers

Context:

As health care providers, certified athletic trainers (ATs) should be role models for healthy behaviors.

Objective:

To analyze the self-reported health and fitness habits of ATs.

Design:

A cross-sectional, cluster random sample.

Setting:

Online questionnaire.

Patients or Other Participants:

Of a sampling frame of 1000 potential participants, 275 ATs completed the questionnaire.

Main Outcome Measure(s):

Health habits and activity were based on a typical 7-day week.

Results:

A total of 41% of the participants met the exercise recommendations of the American College of Sports Medicine; 7% reported being sedentary. Differences were noted between the sexes for fitness habits (P < .035) and composite health score (P < .001). None of the ATs reported meeting the Daily Reference Intake for all 5 food groups. Seven percent of female ATs consumed more alcohol than recommended, compared with 2% of males. However, 80% of males and 93% of females reported consuming 5 or fewer drinks per week. Only 0.8% reported currently smoking.

Conclusions:

This sample of ATs had better health and fitness habits than the general population but did not meet professional recommendations set forth by the American College of Sports Medicine or the United States Department of Agriculture. Thus, these ATs were not ideal role models in demonstrating healthy behaviors.     

Self-Perceived Continuing Education Needs of Certified Athletic Trainers

OBJECTIVE: To determine the self-perceived continuing education needs of current certified athletic trainers and the factors that affect those needs. DESIGN AND SETTING: Self-reporting surveys using a Likert-type scale were sent to 2000 certified athletic trainers. SUBJECTS: All subjects were certified athletic trainers working in the United States. MEASUREMENTS: A 3-part survey of continuing education participation, continuing education needs, and demographic data was developed. Continuing education items were based on the domains of athletic training as defined by the Athletic Training Role Delineation Study, 3rd edition. RESULTS: The response rate was 52% (1040/2000). Athletic trainers in this study perceived "some to moderate need" for continuing education within each of the domains. Rehabilitation of Athletic Injuries (domain 3) was the area in which athletic trainers saw the most need for continuing education. The back and neck were specific anatomical areas perceived by the athletic trainers as needing the highest level of continuing education. Sex was a significant factor in the perceived importance of continuing education within all but domain 5, Professional Development and Responsibility. Other factors included employment setting and years of experience. CONCLUSIONS: Athletic trainers in this study perceived each of the tasks within the domains to be at least "somewhat important," with rehabilitation and specific continuing education programs for the back and neck being the most important. Sex, employment setting, and years of experience may influence what athletic trainers think is important. Therefore, continuing education providers should attempt to vary programs and tailor them to various audiences.     

The Development of Expert Male National Collegiate Athletic Association Division I Certified Athletic Trainers

OBJECTIVE: To identify the major influences in the development of expert male National Collegiate Athletic Association (NCAA) Division I certified athletic trainers. DESIGN AND SETTING: The participants were individually interviewed, and the data were transcribed and coded. SUBJECTS: Seven male NCAA Division I certified athletic trainers, who averaged 29 years of experience in the profession and 20 years at the Division I level. RESULTS: We found 3 higher-order categories that explained the development of the certified athletic trainers and labeled these meaningful experiences, personal attributes, and mentoring. The growth and development of the athletic trainers were influenced by a variety of meaningful experiences that began during their time as students and continued throughout their careers. These experiences involved dealing with challenging job conditions, educational conditions, and attempts to promote and improve the profession. The personal attributes category encompassed the importance of a caring and service-oriented attitude, building relationships with athletes, and maintaining strong bonds within their own families. Mentoring of these individuals occurred both inside and outside the athletic training profession. CONCLUSION: We provide a unique view of the development of athletic trainers that should be of interest to those in the field, regardless of years of experience.     

The Professional Socialization of Certified Athletic Trainers in the National Collegiate Athletic Association Division I Context

OBJECTIVE: To describe the professional socialization process of certified athletic trainers (ATCs) in National Collegiate Athletic Association (NCAA) Division I to guide athletic training education and professional development. DESIGN AND SETTING: We conducted a qualitative study to explore the experiences related to how participants were socialized into their professional roles in Division I. SUBJECTS: A total of 16 interviews were conducted with 11 male (68.75%) and 5 female (31.25%) participants who were either currently or formerly affiliated with an NCAA Division I athletic program. DATA ANALYSIS: The interviews were transcribed, coded, and analyzed inductively using a modified grounded theory approach. Trustworthiness was obtained by peer review, data source triangulation, and member checks. RESULTS: We identified a discernible pattern of socialization experiences and perceptions among the participants. The professional socialization processes of Division I collegiate ATCs is explained as a 5-phase developmental sequence: (1) envisioning the role, (2) formal preparation, (3) organizational entry, (4) role evolution, and (5) gaining stability. CONCLUSIONS: Examining the professional socialization process provides insights into the experiences of Division I collegiate ATCs as they prepare for their job responsibilities and develop professionally. Appropriate socialization tactics, such as the use of a structured mentoring experience, formal orientation, and staff development programming, can be implemented to promote effective professional development. Additionally, undergraduate students may be well served if they are educated to better use informal learning situations during their initial socializing events.     

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?     

Athletic Trainers as HIV/AIDS Educators for Athletes

HIV/AIDS continues to spread among the population at large. The age group 20 through 29 is the fastest growing demographic group in terms of AIDS diagnosis. This study examined a specific subgroup of that population: male and female college athletes. Subjects were 821 scholarship basketball players from 53 NCAA institutions across the nation. A survey instrument required respondents to identify common sources of HIV/AIDS information and preferred instructional formats for HIV/AIDS education. Mass media (92.4%), parents (62.2%), and teammates/peers (54.8%) were most commonly identified. Athletic trainers and team physicians were identified by 32.2% and 43.4% of the sample, respectively. The athletes indicated preference for video presentations (66.5%), small group discussions (58.8%), and question and answer sessions with expert panels (52.4%) as the most preferred instructional formats. Athletic trainers and team physicians can use the information presented in this paper to enhance their important roles in HIV/AIDS education for student athletes.     

Perceptions of Workplace Bullying Among Athletic Trainers in the Collegiate Setting

Context:

Bullying has received a vast amount of attention in the recent past. One form of bullying, workplace bullying (WPB), has been a substantial concern explored in many health professions that can negatively influence a health care provider''s role in an organization. To date, however, WPB has not been investigated in athletic training contexts.

Objective:

To examine the perceptions of certified athletic trainers who experienced or witnessed WPB during employment in the collegiate setting.

Design:

Qualitative study.

Setting:

College or university.

Patients or Other Participants:

Fifteen athletic trainers (7 women, 8 men) with an average age of 42 ± 12 years.

Data Collection and Analysis:

Data were collected via semistructured, in-depth phone interviews or asynchronous online interviews. Data were analyzed using an inductive content analysis. Trustworthiness was established with member checks and peer debriefing.

Results:

Four themes emerged from the analysis: (1) antecedents of WPB, (2) consequences of WPB, (3) coping with WPB, and (4) lack of workplace environment training. The antecedents of WPB involved the bully''s personality and perceptions of the athletic training profession as well as environmental factors including the pressure to win and a lack of administrative support. The consequences of WPB included increased stress, feelings of inadequacy, and increased distrust. Individuals coped with WPB by relying on emotional resilience and avoidance. A final theme, lack of workplace environment training, revealed that little attention was given to interpersonal issues and WPB in the workplace.

Conclusions:

Workplace bullying incidents occur when administrators tolerate bullying behaviors from controlling and manipulative individuals who lack respect for the athletic training professional. Several negative outcomes result from bullying interactions, including stress and anxiety; WPB is dealt with by learning to be more emotionally resilient and avoiding confrontations. Workplace training is needed to prepare athletic trainers for such negative experiences.Key Words: interpersonal conflict, workplace harassment, negative acts

Key Points

• The perceived antecedents of workplace bullying included not only the bully''s personality characteristics, such as being controlling, insecure, arrogant, and self-centered, but also a negative perception of the athletic training profession.
• Pressure to win from coaches and a lack of administrative support were identified as factors that led to bullying behavior.
• The consequences of being a bullying target included increased stress and anxiety, feelings of inadequacy, and increased distrust of others.
• Athletic trainers coped with bullying by being emotionally resilient and avoiding the bully.

As health care providers in a variety of settings, certified athletic trainers (ATs) must work closely with an array of individuals to provide quality health care. These interpersonal interactions can influence an AT''s ability to perform his or her role, especially if conflict arises. Although occasional interpersonal conflicts are not uncommon in a work environment, repeated subtle episodes affecting performance or outwardly hostile acts can create a negative workplace environment due to the presence of workplace bullying (WPB).Workplace bullying is explained by Maguire and Ryan¹ as

… a behavior that goes beyond simple rudeness and incivility. While WPB may include overt aggression or threat of violence, like other forms of aggression experienced … it frequently involves subtle or covert acts, rather than direct violence.^1(p120)

Another feature of WPB is that an individual repeatedly is the target of negative actions from 1 or several individuals in an organization² and a power disparity between the bully and the victim exists.^3–5 Some examples of WPB include intimidating behaviors, ridicule in connection with an employee''s work, withholding information that affects an employee''s job, gossiping, being condescending or patronizing, allocating unrealistic workloads, taking credit for others'' work without acknowledging their contributions, and blocking career pathways, just to name a few.⁶Harassment is commonly defined as “any unwelcome conduct based on a protected class under the federal civil rights laws that is severe, pervasive, or persistent and creates a hostile environment.”^7(p6) Both bullying and harassment involve actions that attempt to degrade, intimidate, or victimize an individual, but they are not one and the same—bullying is a relationship issue, whereas harassment is a human rights issue.^7(p6) Unfortunately, as Namie⁸ stated, “Bullying is nearly invisible. It is nonphysical, and nearly always sublethal workplace violence.”^(p2) Also contributing to the effect of WPB is that no current laws in the United States protect an individual from WPB, although several states have proposed legislation. In 2010, versions of the Healthy Workplace Bill were introduced but did not pass in New York and in Illinois.⁹ This was followed by versions of the bill being introduced in California, Connecticut, Hawaii, Kansas, Massachusetts, Maryland, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Jersey, Oklahoma, Oregon, Utah, Vermont, Washington, West Virginia, and Wisconsin.¹⁰ Although none of these states enacted the bill, the sheer volume of states examining the issue of WPB demonstrates how the effect of WPB is beginning to be noticed.This increase in attention to WPB may be because of previous research^11,12 on WPB illustrating a decrease in productivity, increased absenteeism, and greater attrition. Victims also reported both mental health problems, including posttraumatic stress disorder, anxiety, and depression,^4,5,13–15 and physical problems.^8,16,17 Previous research in nursing,^11–26 occupational therapy,^27–30 physiotherapy,^31,32 and medicine^33–36 illustrates how WPB is an emergent critical concern for a variety of health care providers.Organizational factors including burnout,³⁷ professional socialization,^38,39 work–family conflict,^40–43 and sexual harassment^44–46 have been widely investigated in athletic training, but to date, WPB is absent from the research. Unlike the other organizational factors, WPB research is still in its infancy. As a result, a greater understanding of prevalence, factors contributing to a WPB-conducive environment, and the effect of WPB on ATs is needed. Therefore, the purpose of our study was to explore ATs'' perceptions of WPB in the collegiate setting.     

A Survey of Physical Activity Levels of Certified Athletic Trainers

OBJECTIVE: To determine the self-reported physical activities of certified athletic trainers (ATCs), both at work and at leisure. DESIGN AND SETTING: We used the Baecke Questionnaire of Habitual Physical Activity and also asked for demographic information, including employment setting, years of experience, education level, and position. SUBJECTS: The questionnaire was sent to 1200 randomly selected ATCs in the Mid-America Athletic Trainers' Association; the return rate was 53%. MEASUREMENTS: We used means, standard deviations, and ranges to describe the age, total fitness index, work, and leisure and sport indexes of men and women subjects. Independent t tests were used to compare the mean total activity index between men and women within this study and with previous studies. We examined differences in activity indexes by employment setting, position, and age with one-way analysis of variance and Fisher pairwise comparison tests. Two-way chi(2) analysis was used to determine the relationship between activity level and employment setting and position. Statistical significance was set at P =.05 for all analyses. RESULTS: Certified athletic trainers who work in a clinical setting had the highest mean total activity score at 9.1 points. Clinic ATCs scored significantly higher than high school ATCs and college ATCs. When compared by position, there were no significant differences among the mean total activity indexes; however, the mean work index of program directors was significantly lower than all other positions and the mean work index of high school and clinic ATCs was significantly higher than all other employment settings. CONCLUSIONS: Female ATCs scored significantly higher in total activity levels on the Baecke Questionnaire than their male counterparts. This is in contrast to the general population, investigated by other authors, in which men scored significantly higher than women on the same scale. Additionally, we compared the total activity levels by age, position, and employment setting. There was a significant difference by position only in the work index. The mean total index activity of the over-36-years-old group was significantly lower than all other age categories. There was no significant difference in mean total activity levels by employment setting.     

Career and Family Aspirations of Female Athletic Trainers Employed in the National Collegiate Athletic Association Division I Setting

Context:Female athletic trainers (ATs) tend to depart the profession of athletic training after the age of 30. Factors influencing departure are theoretical. Professional demands, particularly at the collegiate level, have also been at the forefront of anecdotal discussion on departure factors.Objective:To understand the career and family intentions of female ATs employed in the collegiate setting.Design:Qualitative study.Setting:National Collegiate Athletic Association Division I.Results:Our participants indicated a strong desire to focus on family or to start a family as part of their personal aspirations. Professionally, many female ATs were unsure of their longevity within the Division I collegiate setting or even the profession itself, with 2 main themes emerging as factors influencing decisions to depart: family planning persistence and family planning departure. Six female ATs planned to depart the profession entirely because of conflicts with motherhood and the role of the AT. Only 3 female ATs indicated a professional goal of persisting at the Division I setting regardless of their family or marital status, citing their ability to maintain work-life balance because of support networks. The remaining 17 female ATs planned to make a setting change to balance the roles of motherhood and AT because the Division I setting was not conducive to parenting.Conclusions:Our results substantiate those of previous researchers, which indicate the Division I setting can be problematic for female ATs and stimulate departure from the setting and even the profession.Key Words: retention, attrition, work-life balance

Key Points

• Female athletic trainers decided to depart the Division I setting because the required hours of the job limited the time available for parenting.
• Female athletic trainers working in the Division I setting who were able to persist after having a family credit strong support networks and the development of effective work-life balance strategies.

Traditionally, working women endure more challenges balancing career demands and family responsibilities than working men, often because of their mothering philosophies and traditional gender stereotypes.¹ Surprisingly, gender differences have not been found in the occurrence of conflicts between work and life in the athletic training profession.^2,3 This finding is perplexing because female athletic trainers (ATs) continue to depart from the profession.⁴ Hypothetically, the decline in the number of female ATs in the profession has been linked to the desire to strike a balance among work responsibilities, personal interests, and family obligations.^1–3,5Concerns about work-life balance (WLB) and time for parenting have been found to influence decisions to persist within the collegiate levels, as the job responsibilities often include long hours (>40 h/wk) and travel, which can limit time spent at home with family.^1–3,5 It is an unfortunate reality that female ATs make up only approximately 28% of the full-time collegiate staff.⁵ This is especially concerning when the National Athletic Trainers'' Association indicates that more than 50% of its members are female.⁶ A relationship appears to exist between balancing professional responsibilities with parenthood and retention factors, especially for those who leave the collegiate clinical setting to work in clinical settings more favorable to family life.Female ATs in the National Collegiate Athletic Association Division I setting experience great challenges in maintaining WLB because of the demands of the setting.¹ In a recent study,¹ the primary reasons female ATs continued in the Division I setting were enjoyment of the job and atmosphere, increased autonomy, positive athlete dynamics, and the social support network. It is important for female ATs to have support at work and home to persist in the collegiate or athletic training clinical setting. However, long work hours and the inability to find WLB can stress this support network. Mazerolle and colleagues^2,3 first proposed that motherhood plausibly could lead to departure from the profession as the result of a myriad of factors but mostly because of a lack of time and control over work schedules. Further investigations have supported this theory and also have found that other reasons for leaving the profession are WLB concerns, supervisory and coach conflicts, caring for children, and role overload.^1,4,5Fulfillment of WLB is an important retention factor for female coaches within the collegiate setting,⁷ thus providing some supporting evidence to the suppositions that motherhood can be a mediating factor in the retention of female ATs in the collegiate setting. Additional support can be garnered from Mazerolle et al,² who found that only 22 female ATs with children were employed at the collegiate setting, a statistic supported by Kahanov et al,⁵ who reported that only about a quarter of all full-time ATs at the collegiate setting were female.Concerns about retention, particularly of female ATs, have become an increasingly popular topic within the athletic training literature, with attention focused on the collegiate clinical setting. This setting not only is one of the largest employment settings for the AT⁶ but is recognized as a time-intensive, demanding work environment.^2,3,8,9 Moreover, data suggest women are leaving this particular clinical setting to find a more family-friendly work environment, which may or may not be in the profession of athletic training.^10,11 Additionally, 2 recent studies^10,11 suggest that female athletic training students intend to pursue careers in athletic training, but as highlighted by Kahanov and Eberman,⁴ women are rapidly departing the profession for a variety of reasons. The emigration of female ATs from the profession has been theoretically associated with the desire to attain balance among family commitments, personal time, and work responsibilities.^1,2 Difficulties maintaining WLB and sufficient time for parenting shape decisions to continue at the collegiate level.^1,2Because of the concerning trend of female AT attrition, the purpose of our study was to understand the perspectives of female ATs, regardless of marital status, and to evaluate career and family intentions. Our objective was to gain a more thorough understanding of female ATs'' professional goals as they may be influenced by family planning. Our research questions included, “What factors influence the career intentions of female ATs regarding career longevity?” and “Do female ATs have intentions to remain in the NCAA Division I setting?”