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PROFESSIONAL SOCIALIZATION IN ATHLETIC TRAINING
EDUCATION AND ITS IMPACT ON THE DEVELOPMENT OF
EXCELLENT CLINICAL INSTRUCTORS

presented by

Joseph Dante Susi II

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Doctoral degree in Higher, Adult, and Lifelong
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PROFESSIONAL SOCIALIZATION IN ATHLETIC TRAINING EDUCATION AND
ITS IMPACT ON THE DEVELOPMENT OF EXCELLENT
CLINICAL INSTRUCTORS
By

Joseph Dante Susi II

A DISSERTATION

 

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY
Higher, Adult, and Lifelong Education

2010

 

 

ABSTRACT
PROFESSIONAL SOCIALIZATION IN ATHLETIC TRAINING EDUCATION AND
ITS IMPACT ON THE DEVELOPMENT OF EXCELLENT
CLINICAL INSTRUCTORS
By
Joseph Dante Susi II

Athletic training education program directors were asked to rank their on-campus
approved clinical instructors on their ability to teach athletic training students (ATS).
Those ACIs with the highest rankings were invited to participate in face-to-face
interviews to determine the socialization processes they underwent to be identified as

“excellent”. Seven individuals participated in this study and their socialization processes

entailed:
l) attending and internship undergraduate program where there were small ATC staff

Sizes, the students immediately received hands-on experiences which led to a large
accumulation of clinical hours; 2) the respondents received an advanced degree and had
to fimction on their own, gained teaching experience, became familiar with accreditation

standards and recognized a distinction between athletic training and sports medicine; 3)

 

the respondents had prior job experience; 4) the respondents believed that they were good
clinicians and 5) their primary responsibility is to athletics first and academics second.
When asked about the goals that the ACIs had for ATS, four ideas emerged: l) to
prepare ATS to pass the BOC examination; 2) to help ATS acquire relevant experiences;
3) to prepare ATS to enter the workforce and 4) to encourage ATS to value learning. The
ACIs thoughts regarding athletic training education were: I) the ACIs role was to bridge

the gap between the academic and real world; 2) that pro-active ATS get a better

 

 

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education than those who are passive; 3) ATS need more clinical experiences and 4) ATS
must see different aspects of athletic training.

The formal coursework for these individuals was very limited resulting in the
following desired experiences of the participants: 1) a desire for more formal academic
training as most only had two or three athletic training courses; 2) a desire to have
training in educational methodologies as athletic trainers have much content knowledge,
but limited exposure to pedagogical content knowledge and 3) to understand and gain

exposure to the new educational competencies as they are implemented in today’s athletic

training education.

 

 

 

DEDICATION

This dissertation is dedicated to my parents and my wife for their never ending
support and belief in me completing this endeavor. To my parents for instilling in me the
need to attend college and the sacrifices they made to make that happen. For supporting
me in my decisions and activities related to my education, the changing of schools, the

changing of majors, attending each of my games and plays and for the never ending

support that continues to this day.
To my wife for her support throughout this process, her understanding in the travels I

undertook to complete the coursework needed to obtain my Ph.D. and the financial

commitment it entailed, also for her help with computer issues that always seemed to

stump me.

iv

 

 

 

ACKN OWLEDGEMENT S

I would like to acknowledge the following individuals for their help and assistance in

this project:
Dr. John Dirkx, Dr. Marilyn Amey and Dr. John Powell for agreeing to sit on my

dissertation committee.
Dr. Ann Austin for agreeing to be my dissertation chair and the endless hours she spent in

reviewing, revising and discussing my revisions.

Dr. Richard Conboy for his support, ideas, and help in writing this document.

Ms. Linda Bovet for her assistance in editing this document.

Dr. Sally Childs for her continual support to complete this endeavor.

The respondents who participated in this research for their input and interest in the field

of athletic training education.
My wife for tolerating my mood swings and for her unconditional support in the whole

dissertation process.

 

 

 

 

TABLE OF CONTENTS

LIST OF TABLES .................................................................................... x
CHAPTER I: INTRODUCTION
Problem Statement ................................................................................. 2
Research Questions ............................................................................... 7
Theoretical Perspective .......................................................................... 9
Definition of Terms .............................................................................. 10
Summary ........................................................................................... 12
CHAPTER 2: LITERATURE REVIEW
Restructuring Athletic Training Education ........................................................ 13
History of Athletic Training ............................................................. 14
Relevance to the Study ..................................................................... 18
Professional Socialization ......................................................................... 18
Anticipatory Socialization ............................................................... 20
Organizational Socialization ............................................................ 23
Socialization Processes in Athletic Training Education ............................. 24
Athletic Training Student Socialization ................................................ 26
Relevance to the Study ................................................................... 29
Clinical Educators .................................. _ ............................................... 29
Doctoral-Educated Athletic Trainers ................................................... 30
Clinical Instructor Educator (CIE) Training .......................................... 31
Clinical Teaching Knowledge ........................................................... 33
Summary ........ _ ........................................................................... 35
Theory Application Gap .......................................................................... 35
Didactic Versus Clinical Instruction .................................................... 36
Role Conflict .............................................................................. 39
Relevance to the Study ................................................................... 40
Chapter 2 Summary ............................................................................... 40
CHAPTER 3: RESEARCH DESIGN
Sample ............................................................................................... 42
Instrumentation .................................................................................... 44
Procedure ............................................................................................ 45
Analysis ............................................................................................. 47
Demographic Results .............................................................................. 48
CHAPTER 4: FINDINGS
Research Question I .............................................................................. 50
Attending an Internship Undergraduate Program .................................... 5 I
Small Stafi‘ Sizes ................................................................. 51
Hands-On Experiences ......................................................... 52

 

  

Accumulation of Clinical Hours ............................................... 53

Summary .......................................................................... 54
The Acquisition of an Advanced Degree .............................................. 54
On Their Own .................................................................... 55
Gaining Teaching Experience ................................................... 5 6
Becoming Familiar with Accreditation Standards ........................... 5 8
Athletic Training versus Sports Medicine .................................... 5 8
Summary .......................................................................... 59
Prior Job Experience ...................................................................... 5 9
Being A Good Clinician .................................................................. 62
Athletics First, Academics Second ..................................................... 65
Research Question 1 Summary .......................................................... 68
Research Question 2 ............................................................................... 69
The Development of Educational Philosophies ....................................... 69
What Does Learning Mean to You ............................................ 69
Experiences Increase Competency ............................................ 71
Summary of the Development of Educational Philosophies ............... 72
Educational Goals of the Excellent Clinical Instructors ............................. 72
Goal 1: Prepare Athletic Training Students to Pass the Board of
Examination ...................................................................... 73
Goal 2: Help Athletic Training Students Acquire Relevant Experiences 74
Goal 3: Prepare Students to Enter the Workforce ........................... 78
Goal 4: Encourage Students to Value Learning .............................. 79
Excellent Clinical Instructors’ Thoughts Regarding Athletic Training
Education .................................................................................. 80
Belief 1: Bridging the Gap Between the Academic and “Real” World... 80
Belief 2: Pro-Active Students Get a Better Education ...................... 84

Belief 3: Athletic Training Students Need More Clinical Experiences... 86
Belief 4: Athletic Training Students Must See Different Aspects of

Athletic Training ................................................................. 90
Summary of Research Question 2 ...................................................... 93
Research Question 3 .............................................................................. 94
Professional Socialization ............................................................... 95
Anticipatory Socialization ...................................................... 95
Undergraduate Anticipatory Socialization ........................... 96

What Experiences Have Really Affected You ...................... 99

Formal Coursework .................................................... 101

Best Teacher in College ................................................ 102

Male Teachers and the Advent of Female Teachers: A Time of

Transition ........................................................ _ ........ 105

Organizational Socialization ................................................... 106
Organizational Socialization Experiences ........................... 107

Negative Organizational Experiences ................................ 109

Summary .......................................................................... 111

Desired Experiences ..................................................................... 112

A Desire for More Formal Academic Training .............................. 112

 

  

 

A Desire for Education Methodologies ....................................... 114
New Competencies Abound .................................................... l 16
Research Question 3 Summary ......................................................... 120
Chapter 4 Summary ............................................................................... 120
CHAPTER 5: DISCUSSION
Summary of Findings .............................................................................. 123
Findings for Research Question 1: Characteristics of ATCs Acting as
Clinical Instructors ....................................................................... 123
Fmdmgs for Research Question 2: Goals and Beliefs Regarding Athletic
Training Education ........................................................................ 124
Goals in Athletic Training Education ......................................... 124
Perceptions Regarding Athletic Training Education ........................ 124
Fmdmgs for Research Question 3: Socialization Processes Experienced by
Excellent Clinical Instructors ............................................................ 125
Summary ................................................................................... 125
Discussion of Key Points ......................................................................... 125
Hyposkillia ................................................................................. 127
Inadequate Preparation ................................................................... 132
Lack of Formal Coursework .................................................... 132
Coursework in Educational Methodologies .................................. 133
Additional Educational Competencies ........................................ 133
Implications/Recommendations For Practice .................................................. 134
Recommendations for the Commission on Accreditation of Athletic Training
Education (CAATE) ...................................................................... 135
Recommendation 1 .............................................................. 135
Recommendation 2 .............................................................. 137
Recommendation 3 .............................................................. 138
Recommendations for Athletic Training Educators ................................. 141
Recommendation 1 .............................................................. 141
Recommendation 2 .............................................................. 143
Recommendation 3 .............................................................. 144
Recommendation 4 .............................................................. 144
Recommendations for Athletic Training Students .................................... 145
Recommendation 1 .............................................................. 145
Recommendation 2 .............................................................. 147
Recommendation 3 .............................................................. 148
Future Research Suggestions ..................................................................... 149
Athletic Training Paradigms ............................................................. 150
Socialization of Athletic Training Education Faculty ............................... 150
Replication of the Current Study of the Socialization Processes of Athletic
Training Education Programs Program Directors ..................................... 151
Teaching Styles ........................................................................... 151
Results Across the Country .............................................................. 152
Entry-Level Master’s ..................................................................... 152
' 152

Entry-Level of the Professron ......................................................

 

 

Age as a Factor ............................................................................ 153

Roles Females Play and have Played in Athletic Training and Athletic

Training Education ........................................................................ 15 3
Conclusion ........................................................................................ 1 53
APPENDICES
Appendix A: Invitation Letter to Program Directors .......................................... 157
Appendix B: Ratings Letter and Ratings Instrument .......................................... 160
Appendix C: Invitation to Participate in F ace-to-F ace Interviews .......................... 167
Appendix D: Table 3: Responses from Program Directors and ACI/Cls .................. 170
Appendix E: Interview Protocol ................................................................. 172
Appendix F: Table 4a: Demographic Makeup of Respondents

Table 4b: Demographic Makeup of Respondents (continued) ............... 177

Appendix G: Respondent Profiles ............................................................... 180
REFERENCES
References .......................................................................................... l 86

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CHAPTER 1
INTRODUCTION
The discrepancy between the practitioner and the academician is an old one and one
that hasn’t been adequately addressed within the athletic training literature. An increase
in the professionalization of disciplines requires bachelor degrees for professions that
previously required no degree, master’s degrees for professions that had required
bachelor degrees, and doctorate degrees for those professions that had required master’ 3

degrees. The field of physical therapy exemplifies this trend. Until the late 19803, one

 

could easily enter the field of physical therapy with a bachelor’s degree. In the 19903,
entering the physical therapy profession involved having a four-year degree and earning
an entry-level master’s degree in physical therapy. Beginning in the 21St century, the
entry-level master’s degree requirement evolved into a doctorate in physical therapy. This
example illustrates the recent history of “professionalization” and the collateral effect that
more and more professionals within their respective disciplines are needed as educators
to teach the skills needed within the profession. However, the background these
individuals possess in educational theory and/or student development, on which they base
their presentation of the material, may be questionable as they have been trained as
clinicians and not educators.

This research project explored the current state of pedagogical knowledge of clinical
instructors in the field of athletic training. It identified those individuals who have been
described as excellent clinical instructors to serve as a sample for in-depth analysis.
Excellent clinical instructors identified by their respective program directors were

interviewed to determine the extent to which they have blended educational theory with

 

practical application, and how they came to know what they know and act the way they
act. The question is explored initially by describing the background of athletic training
education and its evolution from infancy roots in physical education to being recognized
by the American Medical Association (AMA) as an allied health profession.

In this chapter, I present the research questions and the need for answering those
questions. The current state of the literature regarding athletic training education is also
explored. Important terms are also defined. The theoretical perspective of socialization

was chosen as the framework for this study, with emphasis on professional socialization.

 

Research pertaining to clinical education in athletic training and related fields such as
nursing, occupational therapy, and physical therapy are also explored. Finally the
research design that was utilized to answer the research questions is described.
Problem Statement

Athletic Training has its roots in education, specifically health and physical education
(Delforge and Behnke, 1999). Delforge and Behnke (1999) described two important
characteristics that athletic training students should possess when the National Athletic
Trainers Association (N ATA) was founded in 1950. The first was the requirement to
attain a secondary level teaching credential. But aside from a class in advanced athletic
training and hands—on practice in skill development, the athletic training course of study
during that era was not substantially different from the typical major in physical
education. The second feature included courses that would fulfill the prerequisite

requirements for acceptance to physical therapy school.

 

 

The field of athletic training reached a milestone on June 22, 1990, when the AMA
officially recognized athletic training as an allied health profession. Robert Behnke
stated,

It is extremely gratifying that the nation’s largest medical organization has
recognized athletic trainers. We really haven’t had anyone formally acknowledge
us as an allied health profession before. Athletic trainers now have a professional
status in the health care field (Delforge and Behnke, 1999, p. 59).

This recognition by the AMA supported professionalization of the athletic training
field and acknowledged athletic training as an allied health profession, similar to nursing,
physical therapy, occupational therapy and other allied health professions.

The 1999 Athletic Training Educational Competencies identified 12 content areas that
comprised the role of the Certified Athletic Trainer (ATC) in the health care of physically
active individuals. These content areas included: Risk Management and Injury
Prevention, Pathology of Injuries and Illnesses, Assessment and Evaluation, Acute Care
of Injury and Illness, Pharmacology, Therapeutic Modalities, Therapeutic Exercise,
General Medical Conditions and Disabilities, Nutritional Aspects of Injury and Illness,
Psychosocial Intervention and Referral, Health Care Administration, and Professional
Development.

The competencies within each content area were divided into four behavioral
objectives: 1) Cognitive Domain- which encompassed knowledge and intellectual skills;
2) Psychomotor Domain- which encompassed manipulative and motor skills; 3) Affective

Domain- which encompassed attitudes and values; 4) Clinical Proficiencieso which

 

 

 

involved decision making and skill application (NATA Athletic Training Educational
Competencies, 1999).

The fourth edition competencies, implemented in 2006, still described 12 content
areas that were ftmdamental to an athletic trainer’s knowledge base. While the bulk of the
content areas remained the same, Assessment and Evaluation was changed to Orthopedic
Clinical Examination and Diagnosis; General Medical Conditions was changed to
Medical Conditions and Disabilities; and Therapeutic Exercise was changed to

Conditioning and Rehabilitative Exercise.

 

Another change was dropping the Affective Domain in the behavioral objectives. The
justification for dropping the Affective Domain was that the behaviors that comprised
this domain were embedded in the preparation of athletic training students as
professionals. This is supported in the following statement:

Because the entry-level credential signifies that the holder is a practitioner
prepared for entry into the practice of athletic training, behaviors should be
infused into every aspect of students’ education in order to prepare them for this
public trust (Athletic Training Educational Competencies, 4th edition. p. 3).

Nowhere in the third or fourth edition of the athletic training competencies are
educational theories, educational methods or student learning theories addressed. The
domains addressed what knowledge and skills are required for individuals to function as
ATCs, but not as athletic training educators. The emphasis of these domains is the

development of the athletic trainer as a clinician, not as an educator. The domains
identify the skills and knowledge necessary to provide healthcare services, but do not

address the skills and knowledge needed by educators. This movement away from

 

 

incorporating pedagogy into athletic training education is a major change fi'om athletic
training’s roots in physical education (Delforge & Behnke, 1999). The only domain
where the development of athletic training students as educators was slightly alluded to
was in the third edition competencies; Aflective Domain item 12, under the competency
of Professional Development Responsibilities, stated, “Accepts the responsibility to
enhance the professional growth of athletic training students, colleagues and peers
through a continual sharing of knowledge skills, values and professional recognition”
(National Athletic Trainers’ Association: Athletic Training Educational Competencies,
1999, p. 81). The Professional Development Responsibilities under the fourth edition
competencies addressed research and public service with no direct mention of athletic
training education. With more athletic trainers acting as educators in classrooms and at
clinical sites, a need in educational theory and student learning theories has emerged.

Until recently, the NATA employed two formats for professional education. The
Clinical Instructor Educator (CIE) Workshop is still in use today. The other format was
the NATA Board of Certification (BOC) Examiner Training Program, which has been
terminated as the BOC examination is now a computer—based examination.

The CIE workshop allows individuals to become qualified to hold an Approved
Clinical Instructor (AC1) workshop at their home institutions and credential Approved
Clinical Instructors (ACIs). The CIE workshop introduces the following topics: Learning
Styles and Clinical Education, Teaching Styles: Where Theory Meets Practice, and
Methods for Teaching Clinical Proficiencies (Clinical Instructor Educator Seminar,
2001). The CIBs then return to their individual institutions and devise a workshop for

their respective ACIs. This local workshop must contain the following information

 

 

 

 

aeaording to section BB .24 of the CAATB Standards for the Accreditation of Entry-Level

Athletic Training Education Programs:
33.241 learning styles and instructional skills,
33.242 review of the Athletic Training Educational Competencies,
BB .243 evaluation of student performance and feedback,
33.244 instructional skills of supervision, mentoring and administration,
33.245 program/institution-specific policies, procedures, and clinical

education requirements,

 

33.2246 legal and ethical behaviors,

33.247 communication skills,
B3.248 appropriate interpersonal relationships, and
B3249 appropriate clinical skills and knowledge (p. 4)

Upon completion, the ACI is permitted to evaluate the clinical proficiencies of athletic
training students. This training is only required of those who wish to become an AC1 and
is not required of a Clinical Instructor who provides supervision and instruction to
athletic training students during their clinical experiences.

The NATABOC examiner training program was a two-part process. The first part
required the ATC interested in becoming an examiner for the NATABOC certification
test to take a home study test. The interested ATC read information about the BOC
examination and took a written test. Upon successful completion of the written test, the
interested ATC then attended a workshop where information was presented in more

detail. The NATABOC examiner training program was discontinued when computer-

   

 

based testing was implemented, thereby eliminating the need for onsite examiners of the
BOC certification examination.

Research Questions
“Expertise in clinical practice does not imply expertise in clinical education.”
(Strobehein, Hagler & May, 2002, p.3).

This statement reflects this researcher’s view not only regarding athletic training
clinical education, but clinical education in general. Just as the best athletes do not always
make the best coaches, a person who can perform a skill cannot necessarily teach that
skill. The converse of this statement can be applied to the classroom; expertise in the
classroom does not imply expertise in clinical education or clinical practice. Educators in
the classroom may have to develop clinical skills and clinicians may have to develop
skills in educational methodology and theory.

Many clinical educators in the field of physical therapy lack education in the area of
becoming a clinical instructor and often learn the role primarily through trial and error.
Strohschein, Hagler & May (2002) expressed a concern in their research that students and
new practitioners often perceive an inconsistency between theory and practice in regard
to what is being taught in the classroom and what is being taught in clinical settings.
There needs to be an appropriate balance between educational theory and the
incorporating and reinforcing of the classroom material within the clinical experience.

Strohschein, Hagler & May (2002) cited an example of an additional dilemma: “As
education programs in the United States and Canada move toward graduate degree entry-
level, there may be some apprehension on the part of clinical educators with an

undergraduate degree who are expected to provide supervision for graduate students”

 

 

 

(p.4). Personal anecdotal observations support this concern in the field of athletic training
as well. Many times a practitioner with an undergraduate degree will decide to go back to
school to work on a master’s degree in athletic training. These programs are usually
taught by doctoral-educated individuals who possess the needed academic credentials,
but have not practiced outside the realm of academia. The teacher in this case is teaching
theory/book knowledge, but cannot relate to the real world of practical knowledge that
the student brings to the class. This situation illustrates the disconnect between theory and
practice.

Due to the dichotomy between theory and practice, it is imperative to examine
questions regarding clinical instructors’ knowledge of educational theory and the
socialization processes they experienced that led to their current beliefs and assumptions
regarding athletic training clinical education. Also information about how some clinical
instructors have successfully bridged the gap between theory and practice would be
helpful to the field. Thus, the following research questions guide this study:

I. What are the characteristics of ATCS acting as clinical instructors in
Commission on Accreditation of Athletic Training Education Programs
(CAATE) accredited institutions?

2. How is excellence achieved by clinical instructors in CAATE Accredited
Athletic Training Education Programs? What are the educational
backgrounds, educational beliefs and assumptions associated with excellent
clinical instructors?

3. What were the characteristics of the socialization processes they experienced

to become excellent clinical instructors?

 

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=3—

 

Theoretical Perspective

The accumulation of experiences, attitudes, reflective practices and interpersonal skills
is a lifelong and ever—changing process. Individuals who are excellent clinicians may not
be excellent clinical instructors, just as individuals who are excellent researchers, may not
be excellent teachers. How do individuals become excellent teachers, and how do
individuals acquire their knowledge and professional characteristics especially if they
were not prepared in an academic program? Thus, the theoretical framework of
“Professional Socialization” was chosen to frame this proposal.

Professional socialization is a process that involves learning particular skills, values,
attitudes and norms of behavior and is considered to be a key component of professional
preparation and continued development in health and allied medical disciplines (Pitney,
Iisley & Rintala, 2002, p. 63). Professional socialization can be divided into two aspects:
anticipatory and organizational. “Anticipatory socialization includes aspects of
socialization before entering a work setting or organization, whereas organizational
socialization entails prOcesses that occur after entering the work setting or organization”
(Pitney, Iisley & Rintala, 2002, p. 63).

“Although a person’s experiences coupled with his or her occupational interests are
socializing agents, the more formal anticipatory socialization process begins during an
undergraduate professional education” (Pitney, Iisley & Rintala, 2002, p. 65). Many of
the participants in the study by Pitney, Iisley & Rintala (2002) stated that once they
secured employment, they “leamed on the run”. The authors of this study explained:

Much of their survival in the organizational entry period was the by product of a

great deal of trial and error as they faced situations for which they felt ill

 

prepared, indicating that their formal education was inadequate. . . The
participants consistently identified a lack of formal induction processes. More
specifically, job responsibilities were described in writing, but no formal training,
orientation or learning processes apart from administrative tasks (eg, vehicle
requests, referral procedures, or travel requests), were implemented. When asked
about learning their role during the induction process, participants explained that
they learned by doing and relied informally on colleagues (Pitney, Iisley &

Rintala 2002, p. 66).

The processes that formed excellent clinical instructors, that is the anticipatory and

organizational socialization they experienced, need to be identified so that they can be

modeled and implemented within the field of athletic training education and other related

professions.

 

Definition of Terms
Certified Athletic Trainer (ATC): An individual who has successfully passed all
sections of the National Athletic Trainers’ Association Board of Certification
Examination. This individual must accrue 7S Continuing Education Units every
three years and must submit them to the Board of Certification for verification.
Clinical Instructor Educator (CIE): “The BOC Certified Athletic Trainer
recognized by the institution as the individual responsible for AC1 training. If
more than one individual is recognized as a CIE for an ATEP, then at least one of
those individuals must be a BOC Certified Athletic Trainer” (CAATE Standards

for the Accreditation of Entry-Level Athletic Training Education Programs, p.

16).

10

 

 

 

Approved Clinical Instructor (AC1): “An appropriately credentialed professional
identified and trained by the program CIE to provide instruction and evaluation of
the Athletic Training Educational Competencies and/or Clinical Proficiencies.
The ACI may not be a current student within the ATEP” (CAATE Standards for
the Accreditation of Entry-Level Athletic Training Education Programs, p. 15).
Clinical Instructor (CI): “An individual identified to provide supervision of
athletic training students during their clinical experience. An ACI may be a CI.
The ACI may not be a current student within the ATEP” (CAATE Standards for
the Accreditation of Entry-Level Athletic Training Education Programs, p. 16).
Excellent Clinical Instructor: For the purposes of this research study, the
“excellent clinical instructor” will be defined as the individual who, through the
eyes of their respective program director, has the highest rating on the “Selection,
Training, and Evaluation of Athletic Training Approved Clinical Instructors

(ACI) Clinical Instructor Educator Assessment Form”. (Retrieved online at:

www.nataec.org[l_itml/clinica1 evaluation _tools.html).

 

Athletic Training Student (ATS): “A student enrolled in the athletic training major
or graduate major equivalent” (CAATE Standards for the Accreditation of Entry-
Level Athletic Training Education Programs, p. 15).

Clinical Education: “The application of knowledge and skills, learned in
classroom and laboratory settings, to actual practice on patients under the
supervision of an ACT/CI” (CAATE Standards for the Accreditation of A Entry-

Level Athletic Training Education Programs, p. 16).

ll

 

 

a Clinical Experiences: “Those clinical education experiences for the Athletic
Training Student that involve patient care and the application of athletic training
skills under the supervision of a qualified instructor” (CAATE Standards for the
Accreditation of Entry-Level Athletic Training Education Programs, p. 16).

Summary
This study examines the background experiences that clinical instructors have had,
that have made them exemplary. It attempts to identify the socialization processes they

have encountered as well as identify any training that they have received in the area of

 

educational methodologies and strategies. Since athletic training clinical instructors not
only supervise athletic training students’ clinical experiences, but also provide skill
instruction and evaluation, it is important to determine how they came to know what they

know.

12

 

 

CHAPTER 2
LITERATURE REVIEW
The areas of review for this study include four topics: 1) The history of athletic
training education; 2) socialization theory; 3) clinical instruction; and 4) the theory
application gap believed to be present between didactic instruction and clinical
instruction. The history of athletic training education provides background information as
to the roots and evolution of athletic training education and its current state of affairs.

Socialization theory is defined and discussed, and will set the stage for the third section

 

on clinical instruction and how clinical instruction is performed in athletic training and
other professions. This section also presents research on clinical instructor selection,
preparation, and placement. The theory application gap paradigm explores the
discrepancy between didactic instruction and clinical instruction, and the struggles that
both students and educators have with bridging this gap.
Restructuring Athletic Training Education

The field of athletic training education recently underwent a drastic restructuring
process. January 1, 2004 marked the elimination of a dual route to National Athletic
Trainers Association Board of Certification (NATABOC) when it was mandated that any
individual who wishes to sit for the NATABOC examination must graduate from a
Commission on Accreditation of Allied Health Education Programs (CAAHEP)
accredited institution. This change eliminated the internship route which had previously
been allowed. The move to one route to certification caused much commotion iwithin the
field of athletic training education and forced universities to decide if they wanted to

offer an athletic training education program at all. This scrambling forced athletic

13

 

training education programs to find qualified faculty to teach within their athletic training
education programs. Many programs selected ATCs who have functioned as clinicians to
become faculty members in the classroom, often selecting individuals who may have had
no background in educational theory or methodology. In addition to this mandate, the
BOC examination changed its format to a computer-based examination, and CAAHEP
was dropped as the accrediting agency. It was replaced by the Commission on
Accreditation of Athletic Training Education (CAATE) effective July 1, 2006. With these
changes it is important to understand the evolution of the National Athletic Trainers
Association (NATA). The next section will focus on the evolution of the NATA from its
inception to its development and recognition as an allied health profession.
History of A thletic Training Education

The NATA was founded in 1950 to “build and strengthen the profession of athletic
training through the exchange of ideas, knowledge, and methods of athletic training”
(Delforge & Behnke, 1999, p. 53). As athletic training became a course of study in the
19503, two important features were emphasized to the athletic training student. The first
was to attain a secondary-level teaching credential. This was usually attained in either
health or physical education (Delforge & Behnke 1999). But, as Delforge & Behnke
(1999) pointed out, aside from a class in advanced athletic training and hands-on practice

in skill development, the athletic training course of study was not much different from the

typical major in physical education. The second feature was to include courses that

fulfilled the prerequisite requirements for acceptance to physical therapy schoo1.

It wasn’t until 1969 that the first undergraduate athletic training education programs

were officially recognized by the NATA (Delforge & Behnke, 1999). Graduate athletic

l4

 

 

training education programs did not emerge until 1972. The current clinical eXperience
requirements utilized by the NATABOC evolved fiom the first standards, which were
developed in 1969 (T urocy et al., 2000). These standards recognized four routes by which

athletic training students could gather clinical experiences to become eligible to sit for the

national certification examination.
The first route to BOC certification allowed athletic trainers already engaged in the

profession to be grandfathered in by providing proof of a minimum of five years
experience beyond that of a student athletic trainer at the high school level. The second
route to BOC certification allowed physical therapy degree graduates to become eligible

by completing two years of athletic training experience under direct supervision of a

certified athletic trainer.
The last two methods of BOC certification were in place until December of 2003. The

internship method, which was discontinued, allowed students to become eligible as
apprentice candidates. Very little has been written about the internship route to
NATABOC certification. Delforge & Behnke (1999) made small mention of it, as did
Peer & Rakich (2000) and Turocy et al. (1997). Internship candidates were to receive on-
the-job training for a minimum of 1,800 hours (reduced to 1,500 hours in the late 19803
or early 19903) under the direct supervision of a certified athletic trainer with prerequisite
courses and a four-year college degree (Turocy et al., 2000) (Delforge & Behnke, 1999).
These hours had to be supervised by an NATABOC certified athletic trainer and had to
be accrued in no less than two years and no more than five. It was required that 25

percent of all athletic training clinical CXperiences of curriculum and internship

candidates be acquired on location during practice or competition of a high-risk sport.

15

 

 

 

High—risk Sports included football, soccer, hockey, wrestling, basketball, gymnastics,

lacrosse, volleyball and rugby (Turocy et al., 2000).

The final avenue which eventually evolved into the one currently in place allowed
students who were enrolled in NATA-approved graduate or undergraduate programs to
acquire a minimum of 800 clinical experience hours in no less than two years and no

more than five under the direct supervision of certified athletic trainers.

In the 19703 and 19803, curriculum programs changed and moved away from their
roots in physical education. Athletic training students were advised to seek high school
teaching opportunities outside the field of health and physical education. Athletic training
was becoming its own discipline and was recognized as such by establishing its own
major, which soon became a requirement for schools that were seeking to offer an
NATA-approved curriculum program (Delforge & Behnke, 1999).

In early 1990, the American Medical Association (AMA) Council on Medical
Education (CME) determined that athletic training met all criteria established by the
AMA for recognition as an allied health profession. Athletic Training was officially
recognized as an allied health profession on June 22, 1990 (Delforge & Behnke, 1999).

The recognition of the AMA acknowledged athletic training as an allied health
profession, similar to nursing, physical therapy and occupational therapy. This
acknowledgement led to a decision by the NATA Board of Directors to seek
accreditation for its entry-level programs through the AMAs Committee on Allied Health
Education and Accreditation (CAHEA). Delforge & Behnke (1999) explained that the
NATA’s primary purpose in seeking AMA recognition was, in essence, to become

accredited through the CAHEA process. The first step in achieving CAHEA recognition

16

 

 

was to be recognized as an allied health profession by the AMA per its policy. As a result
of this work, February, 1994, saw the first two entry-level athletic training education
programs to be accredited by CAHEA.

CAHEA accreditation was short-lived. The AMA decreed that it wanted an
independent agency to perform the accreditation The CAHEA was disbanded, and the
Commission on Accreditation of Allied Health Education Programs (CAAHEP) was
recognized as the accrediting body for athletic training education. With this change, the
NATA Board of Directors recommended a requirement to take effect in 2004 “that in
order to be eligible for NATABOC certification, all candidates must possess a
baccalaureate degree and have successfully completed a CAAHEP accredited entry level
athletic training education program” (Delforge & Behnke, 1999, p. 60).

The two routes (internship and CAAHEP accredited programs) for NATABOC
certification prior to January 1, 2004, resulted in a lack of credibility for athletic training
professionals in the allied health care industry (Peer & Rakich, 2000). Because of the
variation between the tWO models, the athletic training profession fought constant uphill

battles due to this lack of standardization. Accreditation solved this dilemma. Peer &

Rakich (2000) stated:
Program accreditation serves as a stimulus for change as internal and external

pressures to provide quality education continue to increase. Athletic training is
feeling the effects of these pressures. . . Accreditation is a means of standardizing

athletic training educational programs that facilitates efforts to promote quality in

the athletic training profession as a whole” (p. 189).

17

 

 

Once implemented, the accreditation process brought athletic training education to a
standard equal to that of physical therapy education, nursing education and the education
of other allied health professions. In conjunction, the single route for athletic training
education preparation standardized the preparation of entry-level athletic trainers and

facilitated entrance into an already competitive allied health care job market.

Athletic training education continued to evolve with the development of the 4th edition
of the Athletic Training Educational Competencies to be used by institutions seeking
accreditation and re-accreditation in 2006. Additional changes included the NATA
leaving CAAHEP as its accrediting body and switching to the Commission on
Accreditation of Athletic Training Education (CAATE), and the transition to providing a
computer-based certification examination which eliminated the practical portion of the
BOC examination.

Relevance to the Study

It is important to understand the evolution of athletic training education during the
past 50 years. The route to accreditation has been challenged, with the most recent test
being the elimination of the internship route to accreditation and the establishment of a
single route in which students can become eligible to sit for the NATABOC certification
examination. An understanding of this history should explain the current state of affairs

regarding athletic training education as it evolved from four routes for one to become

eligible to sit for the BOC examination to the current single route through the CAATE.
Professional Socialization '

Socialization takes place from the womb to tomb. It is a recurrent and lifelong

18

 

 

process taking many forms and occurring across a wide range of settings. Exiting
one setting moves one into another, and socialization begins anew (Van Maanen,
1983, p. 213).

Tierney and Rhoads (1993) quoted Mertan’s 1957 statement that, “Socialization is the
process through which individuals acquire the values, attitudes, norms, knowledge, and
skills needed to exist in a given society” (p. 6). They continued by stating: “Socialization
involves learning the various roles one must enact in a multitude of complex social
settings” (p. 6). These sentiments were echoed by Sabari (1985) when she stated that
socialization is “the process by which individuals acquire and internalize the values,
norms, roles, and skills that enable them to function as members of their cultural group”

(p. 96). Sabari further explained: “Each time we join a new group, we must learn its
unique values, norms, and roles; we do so through a socialization process” (p. 96). With
each role comes scripts or clues about how to enact these roles.

Athletic training students aspire to enter what Bruffee (1999) described as a
“knowledge community”, specifically a “knowledge community” of the certified athletic
trainer. To do so, athletic training students need to know how to act, speak and think as
athletic trainers. The concept of the “knowledge community” is illustrated below:

From the very beginning of our lives we construct knowledge in conversation
with other people. When we learn something new, we leave a community that
justifies certain beliefs in certain ways with certain linguistic and paralinguistic
systems, to join instead another community that justifies other beliefs in other
ways with other systems. We leave one community of knowledgeable peers and

join another.

19

 

 

The community we join may of course be only slightly difi'erent from the one
we left. This is the case, for example, when we learn a new way to use semicolons
or steal second base. Or it may involve reacculturation to entirely new values,
habits, symbol systems, and expertise. This is the case when we first cross the
street alone, pass the bar exam, or learn Chinese. Kurt Lewin offers the example
of a group of watchmakers learning to become carpenters. To do that, Lewin says,
they have to do more than just learn to use a hammer and saw. They have to learn
to swear like carpenters, drink like carpenters, walk, eat, and tell jokes like
carpenters. Learning involves shifting social allegiances because knowledge
results from acknowledgement, the mutual agreement among knowledgeable
peers that a belief expressed by a member of that community has been socially
justified or is socially justifiable (Bruffee, 1999, pgs. 135-136).

The following section reviews the literature of professional socialization and examines
the components of anticipatory and organizational socialization. It describes the
socialization process as it relates to nursing students, as this process seems to parallel the
experiences of athletic training students. Finally anticipatory socialization practices

currently utilized in athletic training clinical education are described.

 

Anticipatory Socialization
Professional preparation is generally divided into two segments, formal academic
preparation and a period of clinical training (Sabari, 1985). Professional socialization is a
process that involves learning particular skills, values, attitudes, norms of behavior and is
considered to be a key component of professional preparation and continued development

in health and allied medical disciplines (Pitney, Iisley & Rintala, 2002, p. 63).

20

 

Professional socialization can be divided into two catagories, anticipatory and
organizational. “Anticipatory socialization includes aspects of socialization before
entering a work setting or organization, whereas organizational socialization entails
processes that occur after entering the work setting or organization” (Pitney, Iisley &
Rintala, 2002, p. 63).

“Anticipatory socialization occurs when people are able to anticipate what it would be
like as a member of a particular group or occupation to which they do not yet belong”
(Pitney, Iisley & Rintala, 2002, p. 68). This definition was expanded by Tierney and
Rhodes (1993) when they referred to anticipatory socialization as “how non-members
take on the attitudes, actions, and values of the group to which they aspire” (p. 23).
Anticipatory socialization serves four functions. It allows the individual to adOpt the
values of the group he or she wishes to join; second, it helps the individual advance
within the group, and, once a part of the group, helps to ease the adjustment to the group.
Finally, it allows new members to contribute to the group to which they will belong
(Tierney & Rhodes, 1993, p. 22).

In regard to collegiate athletic trainers, Pitney, Iisley & Rintala (2002) stated: “the
anticipatory phase extends into formal role preparation phase during the undergraduate
and graduate student experiences that can be viewed as a process of developing a stronger
vision about what it means to be a collegiate athletic trainer” (p. 68). The authors also
reported that, despite the effort put into undergraduate education, many individuals who
take National Collegiate Athletic Association (NCAA) Division I Level positions initially
have formidable challenges and adjustments while adapting to their roles. They

concluded by stating:

21

 

 

 

. . . undergraduate student athletic trainers may be well served if they are educated
about the initial entry into a professional role and how to better use informal
learning situations dining their initial socializing events. As such, facilitating self-
directed learning among undergraduate students can potentially better prepare
them for the independent learning required in the workplace. If practitioners are
learning through trial and error, then facilitating reflective practice with
undergraduate and graduate-level students becomes paramount. Furthermore,
because practitioners are ultimately expected to function independently in a work
environment, perhaps more attention should be given to progressing student
athletic trainers from a more dependent clinical education environment to a more
independent field experience environment during the anticipatory socialization
period. Other disciplines have used or required internships, preceptorships,
residencies, and fellowships to allow students to gain an appropriate level of
experience to prepare for a given professional role (Pitney, Iisley & Rintala 2002,
p. 68).

Pitney, Iisley, & Rintala (2002) continued by stating: “Although a person’s

experiences coupled with his or her occupational interests are socializing agents, the

 

more formal anticipatory socialization process begins during an undergraduate
professional education” (p. 65). If this is the case, then athletic training students must be
exposed to educational theories and methodologies during their formal undergraduate
education to plant the seed for future educators. This would help prepare athletic training
students to become educators, just like athletic training students are prepared to become

clinicians and administrators.

 

i

Organizational Socialization

process to firnction optimally. These criteria include:

a) the goals of the organization must be clearly defined;

 

understanding the norms and values of the professional culture. They divided
professional socialization into two approaches, the functionalist and interactionist
approach. The functionalist approach was basically exhibited by first-year nursing

Students and was generally considered to be a more passive institutionalized process of

23

 

 

  

SUpervising ATC can intervene on behalf of the athlete, should the need arise. Some
ATCs may feel this process limits the development of athletic training students, as they

know someone is always watching over them. The challenge for athletic training

_ 24

educators is to provide the required supervision, in a way that will allow athletic training
students to feel responsibility for their own decision making. The clinical instructor,
therefore, must structure clinical experiences in such a way as to allow athletic training
students the freedom to explore and at the same time, protect the interests of the patient.
The socialization process associated With the athletic training profession is not

addressed within the current Athletic Training Education Competencies (2006). Clinical
instructors incorporate anticipatory socialization into athletic training students’ field
experiences both formally and informally. Clinical and field experiences may be the
appropriate areas in which to develop these skills, as Miller and Berry (2002) found that
59 percent of an athletic training student’s time was spent unengaged within a clinical
placement. With so much time spent “unengaged,” the clinical instructor needs to
develop skills and strategies to better utilize athletic training students’ clinical time.
Traditional athletic training is a “feast or famine” profession, meaning that the ATC is
either very busy or not busy at all.

Berry, Miller and Berry (2004) refined Miller and Berry’s 2002 study and examined
athletic training students’ perceived time spent on active learning by sending survey
packages to all 131 schools accredited by CAAHEP as of January, 2001. They found that

51 percent of an athletic training students’ clinical experience times were engaged in
active learning, 9 percent in managerial activities, 17 percent in unengaged activities and
23 percent in waiting activities. The researchers noted that the perceived decrease in

unengaged activities may be due to differences in methodology and a “refinement of the

behavioral time framework used in each study” (p. 181).

25

 

According to leaders in the field, a key challenge must be addressed regarding
professional socialization in athletic training education:
The profession of athletic training has devoted significant effort to reforming
undergraduate athletic training education, but the professional socialization
process in athletic training education programs has been a neglected research area.
Therefore, it is advisable for firture researchers to investigate the development of
a professional orientation among student athletic trainers to understand the
specific professional values and attitudes to which they are socialized (Pitney,
Iisley & Rintala, 2002, p. 69).
While the previous quotation refers to investigating the professional socialization of
athletic training students, it does suggest the need to research socialization as it pertains
to athletic training education. Clinical instruction is a part of athletic training education.
Identifying clinical instructors who are “excellent” in the eyes of their program directors
is crucial for athletic training education. Once these excellent individuals have been
identified, the socialization processes they utilized need to be identified so that they can
be repeated in athletic training education. This in turn will provide opportunities to
athletic training students as they develop into athletic training professionals.
Athletic Training Student Socialization
What should the clinical educator expect from the athletic training student during the
student’s four-year college education? No studies specific to athletic training education
have been performed, but one study on the socialization of nursing students over a four-
year nursing education was identified. This study can be utilized by athletic training

educators to better understand the socialization process of students within an allied health

26

profession. Ruetter, Field, Campbell and Day (1997) found that nursing students during
their first year were oriented toward learning theoretical concepts, observing role models
(mainly their instructors in the classroom and laboratory settings), and practicing skills.
First-year nursing students placed high value on becoming comfortable communicating
with patients. The students also felt that, while norms, values, and even skills may be
learned in the classroom, the internalization of knowledge takes place when the skills are
practiced in the clinical setting.

Second-year nursing students placed a greater emphasis on applying theory to
practice. Second-year students had to cope with “real” rather than “ideal” situations. In
their interaction with patients, nursing students became aware of their limited knowledge
base, but also gained understanding of the responsibility attached to the performance of
skills they previously practiced in a structured laboratory setting. The researchers felt that
this awareness of limited knowledge and experience may lead to a feeling of inadequacy,
which is particularly stressful given the second-year nursing students’ perceptions of the
potentially serious consequences their lack of knowledge poses for patients. This may
cause students to hesitate when performing a skill on a “rea ” patient for fear of making a
mistake.

Ruetter, Field, Campbell and Day (1997) also mentioned that the second-year nursing
students’ conflict with the “real” versus “ideal” world was reflected in students’
observations that staff nurses did not always practice nursing as the students had been
taught. Students perceived that the ideals stressed to them in the classroom were not

always reflected in nursing practice. The values which students perceived from the

27

faculty may be discrepant with what they observed on the unit. Students perceived that
some nurses did not value the nursing student or the nursing education program.
Second-year nursing students began to process rather than merely imitate behaviors of
students, faculty and staff. Students began to critically evaluate their observations and to
discriminate between role models. At this point in their nursing education, students were
still very dependent on their instructors, because of their limited knowledge and limited
experience. The students were beginning to develop clinical judgment. They did not yet
trust their judgments however, and needed positive feedback at this point in time.
Third-year nursing students are “fine tuning,” which involves developing the art of
nursing by incorporating a variety of role models, critically analyzing their own and
others’ experiences and developing their own formulation and style. It was also during
this time that nursing students initiated clinical rotations, which required action as a
“liaison” between clinical rotations, and allowing for the sharing of information between
units. The rotation of clinical sites proved stressful for third-year nursing students as they
must adjust to a “new reality” every six weeks. Some students likened clinical rotations
to starting a new job every six weeks. Clinical rotations act as a continuous orientation
wherein students need to learn the formal and informal norms of the unit. They first
determine those staff nurses who are supportive of students, then seek them out.
Fourth-year nursing students took advantage of the “learner” role as they prepared for
their future as nurses. The student nurse status is seen as justification for being able to
admit that they do not know all the answers. Learning at this point is focused en the skills
needed for the “real” world. Overall fourth-year nursing students were less dependent on

instructors and more dependent on nurse preceptors in the field.

28

 

Relevance To The Study

Clinical instructors must be credentialed health care professionals as defined by the
AMA and the American Osteopathic Association. Additionally, they must be
appropriately credentialed for a minimum of one year (CAATE Standards for the
Accreditation of Entry—Level Athletic Training Education Programs, revised 2007).
These individuals work closely with athletic training students but are not required to have
any knowledge of educational theories, methodologies, or student learning theories.
Identifying the socialization process that clinical instructors have experienced is crucial
to understanding the formation of each clinical instructor’s beliefs and assumptions
regarding athletic training education. By identifying socialization processes of clinical
instructors, especially the good ones, this information can be implemented into athletic
training education programs so that athletic training students benefit and ultimately
become viable, contributing clinical instructors.

This section has examined professional socialization and its component parts,
anticipatory and organizational socialization. Studies of socialization of nursing students
and athletic training students were reviewed, setting the stage for the next discussion
concerning the clinical educator.

Clinical Educators
“Theory without practice is empty, and practice without theory is blind.”
K. Patricia Cross

Strohschein, Hagler and May (2002) stated “Expertise in clinical practice does not

imply expertise in clinical education” (p. 3). This statement asserts that both the didactic

and clinical education to prepare the athletic training student to be a good educator does

29

 

not always equate to being a good clinician and being a good clinician does not imply

that one is a good educator. Weidner & Henning (2004) supported this idea by stating:
Although the revised clinical education format is part of the evolution of
education reform, it has placed more clinical teaching and evaluation
responsibilities on certified athletic trainers who may not have had a pedagogic
focus in their professional preparation. Similar to the field of athletic training, it
is not uncommon to find that other allied health clinical instructors, in general,
have not had formal preparation in education and have been selected because of
their professional aptitudes rather than their teaching and student evaluation
skills. Clinical expertise as an athletic trainer is important, but it does not
guarantee expertise as a clinical instructor (p. 335).

It is the clinical educator who structures the transitional experiences between the
classroom and the clinical environment. Therefore, it is important to examine the input of
clinical instructors in the educational development of athletic training students. The

following section explores the history and competencies of “doctoral-educated” athletic
trainers and addresses the issue of training clinical instructors. Educational standards that
clinical instructors should strive to maintain are presented, followed by research on the

domains of clinical teaching knowledge. A brief review of the literature and how it

relates to the selection of clinical jsites is presented.

Doctoral-Educated Athletic Trainers
Hertal, West, Buckley, & Dengar (2001) looked at the educational history and
competencies of “doctoral-educated” athletic trainers and stated that, with the educational

reform process taking place in the field of athletic training, more “doctoral-educated”

30

 

Certified Athletic Trainers were needed to fill tenure-track faculty positions than were
being prepared. The authors cited three reasons for increasing the number of “doctoral-
educated” ATCs. First, if the athletic training profession is to affect higher education
policy, there must be “doctoral-educated” ATCs in senior faculty and administrative
positions. The CAATE Standards for the Accreditation of Entry-Level Athletic Training
Education Programs (revised 2007) stipulated that the program director must, “be a full-
time position of the sponsoring institution” (p. 3) and “have full faculty status, rights,
responsibilities and privileges as defined by institution policy and be consistent with
other similar positions at the institution”(p. 3). Second, doctoral programs are needed
because of the leadership required for providing research relevant to the advancement of
the athletic training profession. Lastly, the “doctoral-educated” will provide the next
generation of athletic training educators.

While it is important to identify the purpose of the “doctoral-educated” athletic

trainers and the role they play in athletic training education, the role of the clinical
instructor and the training that they have received is important to identify as well. The
following section describes the processes involved in becoming an Approved Clinical
Instructor (AC1).
Clinical Instructor Educator (CIE) Training
Many clinicians who function as clinical instructors have expressed the need for
formal preparation and training in educational theory to more adequately fill clinical
educator roles. The NATA has addressed this deficiency by developing a Clinical

Instructor Examiner (CIE) Workshop which provides information on how to instruct

 

clinical insuuctors in educational matters. Once individuals have completed the CIE

31

workshop, they can rettun to their respective institutions and direct Approved Clinical
Instructor (AC1) workshops. Once participants complete this AC1 workshop, they are
then eligible to determine if athletic training students have mastered the psychomotor
proficiencies necessary to become an ATC. While the implementation of the CIE and
AC1 programs is a step in the right direction, researchers need to identify the long-term
impact of ACI training on the perceived importance of clinical instructor behaviors
(Lauber, Toth, Leary, Martin & Killian, 2003).

This was recently done by Weidner and Henning (2004), who established research-
based standards with associated criteria for clinical instructors in the field of athletic
training. They identified seven standards appropriate and necessary for clinical educators.
The standards include: 1) legal and ethical behavior, 2) communication skills, 3)
interpersonal relationships, 4) instructional skills, 5) supervisory and administrative
skills, 6) evaluation of performance, and 7) clinical skills and knowledge.

Of particular importance to this proposed study is standard number four, instructional
skills, as this standard seeks to identify the traits of an ACl/CI who is aware of and
utilizes various educational methodologies. Weidner and Henning (2004) supported the
idea that clinical educators must not only have expertise with clinical skills, but also be
knowledgeable about basic educational principles. The clinical teacher is the vital link in
the teaching-learning process, for it is the clinical teacher who “facilitates the learning
process, motivates students with the desire to learn and encourages quality learning”

(N ahas, 1998, p. 663). Athletic training students involved in clinical experienCes have
already “acquired a level of knowledge and experience” (Weidner & Henning, 2004, p.

341), and should be treated as adult learners. Clinical instructors should, therefore,

32

“encourage a spirit of collaboration and fiiendly competition among student peers”
(Weidner & Henning, 2004, p. 341). To establish this atmosphere, “ACIS should
purposely plan opportunities for students to practice technical and problem-solving
skills” (Weidner & Henning, 2004, p. 341). Treating athletic training students as adult
learners may be a difficult concept for athletic training educators to fully accept, as most
athletic training students are right out of high school and sometimes lack the maturity of
an adult.
Clinical Teaching Knowledge
Weidner and Henning (2004) identified four domains of clinical teaching knowledge:
First, ACIs must be knowledgeable of the subject matter within their field
Second, ACIs need to be aware of their students’ current knowledge
Third, in addition to knowledge specific to clinical teaching, ACIs need to know
general teaching principles
Fourth, ACls must synthesize their knowledge to develop content-specific
pedagogy. When general content knowledge and general teaching methods are
transformed into content-specific instruction, new knowledge results for the ACI.
This knowledge, developed through teaching experience, is the essence of
content-specific pedagogy: content knowledge organized for teaching purposes
and comprehensible to particular learners. This is what separates clinical
instructors from mere content experts. (p. 341).
These domains correlate very well with the three most frequently-mentioned
dimensions of effective behaviors of teachers identified by Nahas (1998), “competence

and knowledge, interpersonal relationship and personal attributes” (p. 664) and by

33

Shulman (1986), “subject matter content knowledge, subject matter pedagogical

knowledge and curricular knowledge” (p. 13).
Clinical instructors must be able to develOp athletic training students’ critical thinking

and problem-solving skills. The clinical instructor should use clear educational objectives

to establish purposeful clinical instruction. Clinical instructors must be willing to share

their knowledge with athletic training students and also acknowledge their own personal

and professional weaknesses (Weidner & Henning, 2004).
Turocy et a1. (2000) declared that clinical sites should provide experiences in a variety

of environments with different types of populations that would be consistent with the
mission of the NATA. They further stated that efforts should be made to ensure that
education occurs formally and informally at all clinical sites.

Weidner and Laurent (2001) concluded by stating,
Although students may learn their responsibilities by observing athletic training

role models who are experienced professionals, formal and consistent clinical
education would help to ensure that all students are exposed to a comprehensive,
uniform clinical experience in their profession. A lack of formal emphasis on
clinical education settings promotes haphazard and coincidental learning during
students’ clinical experiences. . . The focus in clinical education settings must
include educational standards and experiences designed to augment students’

knowledge and to promote their professional maturity. . . .Ideal clinical
experiences are closely relevant and timely to what is being taught in Concurrent

courses and allow continued reinforcement and practice of what has been learned

34

Such experiences are vital to a students’ development of competence, self-
confidence, and flexibility in unfamiliar situations (p. 67).

Athletic trainers need these critical skills as they deliver health care in uncontrolled
environments. Athletic trainers typically have to provide health care under time
constraints and competitive pressures, not to mention unpredictable environmental
conditions such as rain, heat, and snow. The delivery of quality health care under these
conditions are not conducive to “cookbook” approaches and many times the athletic
trainer will indeed have to, as Oermann, Truesdell & Ziolkowski (2000) stated, “think-
on-your-feet” to arrive at a workable solution to a health care issue.

Summary

Being an effective clinical instructor involves more than just showing an athletic
training student how things are done. This section focused on five areas pivotal in clinical
instruction. First, the educational history and competencies of “doctoral-educated”
athletic trainers were discussed, followed by a discussion of the training that is currently
in place for clinical instructors. Standards that clinical educators should strive to reach
were introduced next, followed by domains of clinical teaching knowledge, followed by
items to consider for the selection of clinical sites.

Theory Application Gap

The educator (and the student) needs to understand the connection that exists between
the theoretical knowledge presented in the classroom and how that knowledge is actually
applied in the athletic training profession. When a student is not able to draw a
connection between the “theoretical” component and the “applied” component, a “Theory

Application Gap” develops (Carr & Drummond, 2002). The athletic training educator

35

 

must bridge this gap to clarify how the “theoretical” becomes the “applied.” By bridging
the gap between “theory” and “application,” the athletic training educator can help to
develop the athletic training students’ professional knowledge as described by Schon
(1983). Schon (1983) quoted Edgar Schein’s three components to professional
knowledge as:
1. An underlying discipline or basic science component upon which the practice
rests or from which it is developed.
2. An applied science or “engineering” component from which many of the day-
to-day diagnostic procedures and problem solutions are derived.
3. A skills and attitudinal component that concerns the actual performance of
services to the client, using the underlying basic and applied knowledge (p. 24).

Each of the above points is crucial to the education of young athletic training
professionals, but it is through Schein’s third point where the basic theoretical and
applied knowledge areas are combined to provide a better service to the client, be it a
patient or student of the profession. Mastery of the content becomes evident.

This section explores the division between didactic instruction versus clinical
instruction, followed by a discussion of role conflict and role ambiguity and concludes by
bringing to the forefront stresses and challenges faced by certified athletic trainers as they
transform from clinicians into clinical educators.

Didactic Versus Clinical Instruction
Schon (1983) described the physical structuring of the curriculum as being

dichotomous by stating:

36

 

The separation of the medical school curriculum into two disjunctive stages, the
preclinical and the clinical, reflects the division between theory and practice. The
division also appears in the location of the training and in medical school
facilities. The sciences of biochemistry, physiology, pathology and pharmacology
are learned from classrooms and laboratories, that is, in formal academic settings.
More practical training, in clinical arts such as internal medicine, obstetrics and
pediatrics, takes place in hospital clinics within actual institutions of delivery (p.
28).

Teaching roles tend to reflect the same division: “Medical school faculties tend to be
divided between the Ph.D.s and M.D.s, between teachers of basic science and those in
clinical programs” (Schon, 1983, p.28). This division between the Ph.D.s and the M.D.s
further expands the separation of the clinician and the educator.

Carr & Drummond (2002) believed that, when athletic training education programs
have instructors employed by different departments (academic and athletic) the
responsibility of athletic training education becomes a shared role. When there is wide
separation between the two departments in theory and practice, athletic training students
are exposed to a potential “theory-application” gap. This notion was reinforced by
Ruetter, Field, Campbell & Day (1997), who studied the socialization process of nursing
students. This study relates to athletic training education because both disciplines are
allied health professions with many of the same issues. Ruetter, Field, Campbell & Day
(1997) found that the “ideal” versus “real” was reflected in nursing students’ Observations
of staff nurses at work, in that the staff nurses often did not perform what the nursing

students had been taught as standard practice. The nursing students perceived that the

37

ideals taught to them in their nursing education classes were not always reflected in
nursing practice. Moreover, the nursing students perceived that some staff nurses did not
value them or their nursing program. The researchers then suggested that the “theory-
application” gap was not perceived by the nursing students as problematic, but more of a
stumbling block for the teachers rather than the students. They concluded: “The
ambiguity of the student role, brought about by differences in education and practice, is
essential and provides important learning opportunities for reflection and the
development of experiential knowledge” (Ruetter, Field, Campbell & Day, 1997, p. 10).

These sentiments are reflected in the research by Sabari (1985) where she explained
that faculty members, who strive to produce nurses who can function effectively as
innovators, often encounter conflicting messages from the clinical role models of nursing.
This coordination between faculty and clinicians supports the principle that, when the
socialization of the educational program’s members and the clinical setting’s members
are coordinated, students demonstrate the ability to shifi in both attitude and activity as
their professional role change. But when the educational program’s socialization is not
reinforced by the clinical setting, the educational program’s socialization input is
diminished (Sabari, 1985).

These examples support the need to coordinate educational program goals and clinical
site goals to reinforce their respective benefits. This means that faculty educators must
have clinical expertise and clinical educators must have knowledge of educational

methods and theories to best convey these skills to athletic training students. V

38

Role Conflict

Role conflict may become a reality for clinicians who become educators. Sabari
(1985) stated “Role stress will occur if the educationally defined role is incongruent with
the role defined by one’s employing organization” (p. 99). She divided role stress into
two types, role conflict and role ambiguity. Role conflict occurs when individuals are
required to perform roles that conflict with their personal value system or when they must
perform two or more roles that conflict. Role ambiguity occurs when the role that an
individual is to undertake is not “clearly articulated in terms of behaviors or performance
levels expected” (p. 99).

Strohschein, Hagler, & May (2002) expressed a concern that students and new
practitioners often perceived an inconsistency between theory and practice. Strohschein,
Hagler & May (2002) cited an example of a realistic dilemma; “As education programs in
the United States and Canada move toward graduate degree entry level, there may be
some apprehension on the part of clinical educators with an undergraduate degree who
are expected to provide supervision for graduate students” (p. 4). The same could be said
for new graduates who are functioning as clinical instructors or for the well-established
clinician who now finds him or herself in the role of an educator.

Strohschein, Hagler & May’s (2002) ideas on role ambiguity were reflected by
Tierney & Rhodes (1993) as they examined the impact of the socialization process on
faculty members. They found that the experiences one has prior to becoming a faculty
member “frame how an individual approaches his or her job” (Tierney & Rhodes, 1993 ,

p. 74). Such experiences are important for athletic training educators as their experiences

39

will frame how they select and present information to athletic training students. Tierney
& Rhodes (1993) further stated:
For faculty to place higher emphasis on teaching, for example, they must be
socialized in graduate school about the importance of teaching. The implications
of such an idea may be that all graduate students who intend to become faculty
need to take a course on teaching, or that a course might be co-taught with a
faculty member (p. 75).

The teaching experience in graduate school would allow graduate students to have
exposure to educational theories and methodologies and may better prepare them as
future athletic training educators.

Relevance T o The Study

Clinical instructors spend a great deal of time and energy with the athletic training
students they are assigned. However, the creation of an educational environment by
clinical instructors and how that environment came to be must be explored to make the
clinical assignment more conducive to the achievement of educational goals and
objectives. This may be achieved by recognizing the distinction between classroom
instruction and clinical instruction and identifying the stresses that face certified athletic
trainers during the metamorphosis from clinician to clinical educator.

Chapter 2 Summary
This literature review focused on four areas: 1) the history of the NATA, 2)

socialization theory, 3) clinical educators’ instruction, and 4) the ‘fieow-application”

gap.

40

The NATA was founded in 1950 with the first undergraduate programs recognized in
1969. January 2004 saw the implementation to a single route to NATA certification
which helped to standardize athletic training education. The knowledge of the
profession’s past has shaped the future. Professional socialization is composed of
anticipatory and organizational socialization. Anticipatory socialization contains
socialization aspects that are acquired prior to entering the work setting, while
organizational socialization includes those socialization processes that occur after
entering the work setting (Pitney, Iisley & Rintala, 2002).

A third point in the review stressed that a good educator is not necessarily a good
clinician and a good clinician is not necessarily a good educator. Strategies can be
implemented in athletic training education to make clinicians better educators.

Finally the literature review examined the “Theory-Application Gap” that exists
between information presented in the classroom and the clinical setting.

Therefore, because of the dynamics involved in athletic training education, it is
essential that the development of “excellent” clinical instructors be identified so that a

more thorough understanding of clinical instruction is developed.

41

CHAPTER 3
RESEARCH DESIGN
The purpose of this research was to answer questions regarding the socialization
processes experienced by excellent clinical instructors utilized by the Commission on
Accreditation of Athletic Training Education (CAATE) Accredited Athletic Training
Education Programs. The questions addressed include:

1) What are the characteristics of ATCs acting as clinical instructors in CAATE
accredited institutions?

2) How was excellence achieved by clinical instructors in CAATE Accredited
Athletic Training Education Programs? What were the educational
backgrounds, educational beliefs and assumptions associated with excellent
clinical instructors?

3) What were the characteristics of the socialization processes they experienced
to become excellent clinical instructors?

Sample

As of July 6, 2006, there were 353 CAATE Accredited Undergraduate Athletic
Training Education programs in the United States (www.caate.org, 9/06). These CAATE
Accredited Athletic Training Education programs operate in 48 states and the District of
Columbia. The two states which do not currently have an institution sponsoring a
CAATE Accredited Athletic Training Education program are Alaska and Rhode Island.
This resulted in the average number of CAATE accredited institutions per state that has a
sponsoring institution as 7.204 per state (353/49). The NATA has divided the United

States into 10 districts, with District IV consisting of Illinois, Indiana, Michigan,

42

Minnesota, Ohio, Wisconsin, Ontario and Manitoba. The Canadian provinces do not
sponsor CAATE accredited institutions. District IV sponsors 82 CAATE accredited
institutions. Therefore, the average number of CAATE accredited Athletic Training
Education Programs in states that comprise District IV is 13.66 (82/6). District IV
represents 23.22 percent of all the CAATE Accredited Athletic Training Education
Programs in the country (82/353) and can serve as a representative sample of the country
as a whole. In addition, the researcher resides in District IV and could easily interact with
a sample of universities from this district for this study.

Eight of the CAATE accredited public institutions within a District IV state served as
the purposeful sample. The researcher’s institution was omitted, but served as a pilot
study for the procedures and questions that were utilized in this research project. The
eight public institutions were placed into one of four different research quadrants. Large
NCAA Division I institutions accredited within the last five years; large NCAA Division
I institutions accredited longer than five years; NCAA Division II institutions accredited
within the last five years; NCAA Division II institutions accredited longer than five
years. The institutions were placed in their respective quadrants in Table 1 below.

Table 1: Duration of Accreditation and NCAA Division

 

 

 

 

 

 

NCAA Division I Schools NCAA Division II Schools
Newly Accredited University 1 University 6
Within the last 5 years University 2 University 7
University 3
Accredited University 4 University 8
l—Longer than 5 years University 5

 

 

 

43

This categorization was utilized as it differentiated the public CAATE accredited
institutions within the state surveyed based on the size of the institution and length of
accreditation. These two factors are likely to have an impact on the quality of instruction.
Institutional size was important as the larger institutions frequently have access to more
resources, training opportunities and credentialing. Length of time of accreditation may
potentially influence “excellent” clinical instruction as the longer a program has been
accredited, the longer the program has adhered to national guidelines and the concept of
accountability. This arrangement was useful to the researcher in that it grouped together
like schools in regard to resources and required credentialing of staff and time of
accreditation, and provided a good cross-sectional portrait of athletic training education.

Instrumentation

The current “state of affairs” in clinical instruction was outlined via survey research.
“Survey research allows an investigator to get a ‘snapshot’ of what is happening at a
given time or situation and then allows the investigator to determine how that snapshot
influences other behaviors or situations” (Turocy, 2002, p. S-174).

An existing survey instrument was identified. This instrument was developed by Dr.
Weidner with the purpose to “help select, train, and evaluate Approved Clinical
Instructors (ACIs) for athletic training”

(wwwnataec.orglhtml/clinical evaluation itoolshtml). This instrument was used by
program directors of the respective CAATE accredited programs in the selected state in
NATA District IV to rate their on-campus clinical instructors. A second instrument was
developed to collect demographic data from clinical instructors at the institutions selected

for this study. All data remained confidential and locked in a secure area.

44

Procedure

The researcher sent letters to program directors fiom eight CAATE accredited public
institutions within one state in NATA District IV inviting them to participate in the
research project. The letter also asked the program director to identify the number of full-
time, on-campus, non-faculty, non-graduate assistant ACI/CIs who were ATCs utilized
by their athletic training education program. If notification was not received by the
researcher, attempts were made to contact the program director by e-mail and phone.
Once confirmation to participate was received of the program director and the full-time
ACI/CIs were identified, the program directors were asked to rate their on—campus
ACI/CIs who were ATCs using the “Selection, Training, and Evaluation of Athletic
Training Approved Clinical Instructors” developed by Dr. Weidner at Ball State
University in Muncie, Indiana. Standard 4.0 dealing with effective instructional skills was
the standard that was utilized. This approach paralleled the work of Lauber, Toth, Leary,
Martin & Killian (2003). As compared to the Lauber, Toth, Leary, Martin & Killian
study, in this project, faculty members were not identified to be surveyed nor were
graduate assistants.

Upon receipt of the surveys from the respective program directors, the ratings forms
were tabulated to determine the clinical instructors receiving the highest ratings in each
research quadrant. The clinical instructors with the highest ratings in each research
quadrant were identified as “excellent”. The clinical instructors with the top two ratings
in each research quadrant were selected and asked to complete a demographic survey and

to participate in a face-to-face interview. This process constituted elite interviewing,

45

because the respondents were selected based on their excellence demonstrated as clinical

instructors at their respective clinical sites.

Modifications were made to the initial plan to accommodate a less than complete

response. Responses were only received from institutions in three of the quadrants. Table

3, in Appendix D, reveals the quadrant into which each institution fell with the associated

response from the respective institution’s program director and the clinical instructor’s

willingness to participate.

Table 2 displays the final participation sample:

Table 2: Program Directors Ratings of ACI/Cls

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Avg:7.84/2= 3.92]

CAA Division I Program 1 NCAA Division Program
Schools Director’s II Schools Director’s
Ratings of CIs Ratings of CIs
Newly University 2 4.69 University 6 I 3.125 I
Accredited 4.538 [ 2.63 1
Within the last 5 3.769 / Avg:5.755/2= ]
years 2.8775
Avg:12.997/3= / j ]
4.332
1 l 7
Accredited University 4 4.15 l N/A
longer than 5 3.769 This CI
years declined
participatin
3.69

 

 

 

 

 

l 1

Overall Ratings Average:
26.211/7= 3.7444 out of 5

 

Once the “excellent” clinical instructors were identified and meeting times arranged,

the researcher traveled to meet with each of the “excellent” clinical instructors. After

brief introductions, the “excellent” clinical instructor was asked to complete a

demographic survey. Once the demographic survey was completed, a face-to-face

46

 

interview was performed and digitally recorded. Procedures for the face-to-face
interviews paralleled those performed by Nahas (1998) in her phenomenological study of
nursing students. That is, semi—structured, open-ended interviews lasting up to one hour
were recorded and performed with the “excellent” clinical instructors. The respondents
were asked to describe the socialization processes they have experienced. A semi-
structured interview protocol was used to assist the researcher in focusing on
socialization (See Appendix E). The protocol addressed the following issues:
demographic information; undergraduate experience as an athletic training student,
perceptions of preparedness to work with athletic training students after undergraduate
education; perceptions of preparedness to work with athletic training students after
graduate education; characteristics and style of their best teacher in college; athletic
training experiences that have particularly affected respondent; the respondent’s feelings
pertaining to the role of the clinical instructor and athletic training education; experiences
that have helped to prepare the respondent to teach athletic training students; experiences
the respondent wished they had in their athletic training education; the respondent’s
feelings on providing multiple experiences when dealing with athletic training students.
Analysis

Nahas (1998) utilized seven steps described by Colaizzi to analyze her study. They
were adapted and applied to this study. The steps utilized included:
1) Reading and re-reading all of the informants’ transcribed interview data.
2) Extracting significant statements or phrases that relate to socialization from each of the
informant’s descriptions.

3) Formulating meanings from these significant statements or phrases.

47

 

4) Organizing these meanings into clusters of themes.
5) Integrating results into an exhaustive description of socialization.

The taped interviews were listened to a second time and key points were written
down. The researcher examined each transcript and documented the key points to identify
a general understanding of the respondent’s experiences. The transcripts were coded by
the researcher to identify significant statements and phrases. Through multiple readings,
themes stood out to the researcher and sub-themes emerged. The researcher organized
these themes into clusters, being careful to ensure major themes and points were not
omitted.

Demographic Results

Program directors from eight different CAATE Accredited Athletic Training
Education Programs were asked to provide names of the non—faculty/non-graduate
assistant Certified Athletic Trainers that function as ACI/CIs for their respective
institutions. Of the eight, five institutions replied. The program directors were then asked
to rate each of their ACI/Cls according to Dr. Weidner’s ratings form. Ratings were
received on 21 different ACIs and all were ranked within their own institution. The top
two from each institution were contacted via US. Postal Service and e-mail to participate

in a face-to-face interview. The ACI/CIs from one of the institutions did not return the

 

request to participate. One of the ACI/Cls from another institution responded, but noted
that they were not interested in participating in the study. Of the other three schools that
responded, one respondent stated that he was not interested in participating. Therefore
additional respondents were identified from the schools that did respond with the final

result being seven respondents who indicated that they were interested in participating in

48

this research project. Three came from one institution and four came from the other two
institutions.

The range of the ratings scores for the seven selected for face-to-face interviews was
2.63. to 4.69 out of 5.0. The average score was 3.7444 (26.211/7). The demographic
makeup of these individuals is described in Table 4a and 4b in Appendix F. A profile of
each respondent is located in Appendix G.

Of the seven participants, five were male and two were female. To help with
confidentiality issues, the respondents’ gender was not displayed and male pronouns were
used to represent all respondents. In addition, the institutions where the respondents
currently work were not identified. The average years of certification were 17.8 with 16
average years of teaching clinical courses. Five of the respondents attended an internship
undergraduate program; one attended an NATA accredited undergraduate program; the
final respondent graduated from a CAAHEP accredited undergraduate athletic training
education program. An interesting note on this last individual was the fact that he started
in an internship program that was converted to a CAAHEP accredited program prior to
his graduation. All seven individuals have a master’s degree, and two of the seven hold
PhDs. Two individuals earned teaching certificates. Four have had formal training in the
field of education, and three teach classroom courses for credit. On average, each
individual worked at 1.5 institutions prior to their current employment.

In the presentation of the data, quotations have been modified to remove extraneous

words so that the prose reads more smoothly.

49

 

CHAPTER 4
FINDINGS

As the data were gathered, a redundancy was found in the research questions as
originally stated. Thus in an effort to be parsimonious, I have refined and restated the
research questions as follows:

1) What are the characteristics of ATCs acting as clinical instructors in the
Commission on Accreditation of Athletic Training Education Programs
(CAATE) accredited institutions?

2) What were the educational goals and beliefs towards athletic training
education associated with excellent clinical instructors in the CAATE
accredited athletic training education pro grams?

3) What were the characteristics of the socialization processes they experienced
to become excellent clinical instructors?

In the presentation of data, the educational backgrounds as it relates to research
questions 1 and 3 will be discussed. It was redundant to discuss this in relationship to
research question 2.

This section answered these questions by identifying themes that emerged from the
face-to-face interviews and supporting these themes with the appropriate data.

Research Question 1

After reviewing the transcripts as they related to the first research question of what are
the characteristics of ATCs acting as clinical instructors in the Commission On
Accreditation of Athletic Training Education Programs (CAATE) accredited institutions,

I found, five main characteristics, each with sub themes. These characteristics included:

50

attending an internship institution for their undergraduate work; obtaining an advanced
degree which allowed for the accumulation of more experiences; obtaining job
experience prior to their present positions; being a good clinician; believing that their first
responsibility is to the athletic department. Each of these characteristics were further
divided into components.
Attending an Internship Undergraduate Program

Attending an internship program as the route to become eligible to sit for Board of
Certification Examination emerged as a strength of “excellent” clinical instructors. As a
result of attending an internship program, three sub-themes emerged. Many of the
institutions that the respondents attended for their undergraduate education had employed
athletic training staffs of two. By having small athletic training staff sizes, the athletic
training students had the opportunity to immediately be exposed to immediate and
intensive “hands-on” opportunities and the accumulation of many clinical hours of
athletic training experiences. This section explores these trends and supports them with
findings from the research.
Small Stafl' Sizes

Six of the seven respondents attended an internship program for their undergraduate
education. Respondent 5 started in an internship program, but the pro gram received
Commission on Accreditation of Allied Health Education Programs (CAAHEP)
accreditation prior to his completion of the program, and he therefore graduated from a
CAAHEP accredited program. Respondent 7 graduated from a NATA accredited
program. All were exposed to the internship program as Respondent 7 attended graduate

school at an institution that sponsored an undergraduate internship program.

51

The reason that the respondents were thrust into immediate hands-on experiences may
be due to the fact that many of their undergraduate institutions sponsored certified
athletic training staffs of two. This was cited by respondents 3, 4, and 6 while respondent
7, who graduated from the NATA accredited program, reported four certified staff
members. The following statements from Respondents 1 and 6 exemplify how they
would step in to assist the certified athletic training staff member:
Essentially we were responsible for just about everything. Pre-practice, pre-game
preparation, treatments of student athletes, rehab, injury evaluation, and we would
consult with one of the certified’s on board to determine whether or not someone
needed to go to the hospital or to see one of the physicians. Essentially we were
working within the role of what a certified athletic trainer would work
(Respondent 1).
Students were assigned to a sport. . . Athletic training students made a lot of their
own decisions. There were times when the staff ATC was on the road, that we as
students ran the facility. . . The level of sophistication was much lower. It was a
lot of emergency care. If we had somebody for rehab, we knew what they were
supposed to do. I mean it was ice and heat and stretching and taping. The level of
sophistication was still evolving at that point (Respondent 6).

Hands-on Experiences

All respondents reported numerous clinical experiences, hours and opportunities to
become actively involved in their athletic training education. The term used by most was

“hands on.”

52

These “hands-on” opportunities allowed the athletic training students to become
responsible for all aspects of the teams’ healthcare from pre-practice treatments to game
coverage to traveling as athletic training students without the supervision of an ATC.
Many of the respondents reported being assigned to teams early in their undergraduate
career. Respondent 3 recalled that athletic training students at his school were not
assigned to work with a team but remained in the athletic training room, and the athletes
signed up on a board for treatments. When athletic training students were done working
with an individual, they called the next name on the board for treatment. It didn’t matter
what sport the athletes played. The athletic training students just took the next athlete

listed on the board.

Respondent 6 recalled his experience as an undergraduate athletic training student
with these words:
It was a lot less formal than it is now. Everything we learned we kinda learned
hands-on. You learned everything in the athletic training room. I took the Cramer
course as a high school student. You knew how to tape. That’s what you did in
those days. We were essentially taping machines for football (Respondent 6).
Accumulation of Clinical Hours
The undergraduate athletic training education of the respondents also focused on the
immense number of clinical hours they acquired while in the athletic training room. The
requirement for an individual attending an internship program was the accumulation of
1,800 clinical observation hours in a 4-year period. This number was lowered to 1,500
hours in the early 19905. NATA accredited programs required students to accumulate a

minimum of 800 hours. Respondent 7, who attended a NATA accredited undergraduate

53

institution, still acquired many more clinical hours than were mandated. Respondent 7
reported that fellow undergraduate students competed to see who could acquire the most
hours. He stated that he and his classmates accrued “mega hours” in the neighborhood of
2,500 to 3,000, and each individual athletic training student “tried to get as many as you

could and write them on the wall.”
Summary
Attending an internship program gave the respondents the opportunity to immediately
work in the athletic training room. The respondents reported that their undergraduate
institutions had small athletic training staffs, with some reporting staff sizes of two.
These small staff sizes enabled the athletic training students to immediately start work in
the athletic training room, learn “hands-on,” and accrue many athletic training room
hours.
Upon graduation, all the respondents interviewed sought an advanced degree.
The Acquisition of an Advanced Degree
The acquisition of an advanced degree is the second common characteristic that
emerged after talking with the respondents. All of the respondents interviewed hold a
minimum of a master’s degree, although the minimum requirement to enter the field of
athletic training is a bachelor’s degree. The National Athletic Trainers Association cites
that 70 percent of Certified Athletic Trainers have a master’s or doctorate degree (The
Facts About Certified Athletic Trainers brochure from the NATA). Earning an advanced
degree provided these individuals the opportunity to function as graduate assistants and to
gather additional clinical experiences. By continuing their education and earning a

master’s degree, the clinical instructors had gained four things: these individuals were

54

responsible for clinical decision making; some taught undergraduate students; they were
permitted to see the transition to an accredited program as institutions scurried to meet

the January 1, 2006 mandate; a difference between athletic training and sports medicine
became distinguishable during their preparation.

On Their Own
Respondents 2 and 4 both were placed in high school settings during their graduate

assistantships. Generally, in the high school setting, graduate assistants are certified, and
make their own decisions. There are no athletic training staff members to whom graduate
assistants treating high school athletes can turn to when they have questions. Also, there
is limited access to physicians. Whereas, graduate assistants providing athletic training
services for their institution can refer to certified staff athletic trainers, team physicians or
other graduate assistants for support. In response to being placed in the high school by
himself, Respondent 2 had this to say:
I think graduate school prepared me to become independent, working
independently, making decisions on my own. I was out at a school by myself, and
I was responsible, and there is no one else there. As an undergrad, you always
have someone to turn to. . . . It forced me to be independent and make decisions
and it forced me to be in that supervisory role (Respondent 2).
Respondent 4 recognized the fact that being in the high school setting for his graduate

assistantship forced him to mature as an athletic trainer because he was the one making

the decisions. “If I screwed up, it was my fault and the kid could maybe get hurt because

of me” (Respondent 4).

55

Gaining Teaching Experience
A second subctheme that developed from the respondents having advanced degrees

was that they gained teaching experiences during graduate school. Respondent 6 received
a teaching certificate in secondary physical education, psychology and sociology, and
Respondent 7 received a teaching certificate in special education K-12. The other
respondents did not have teaching certification, but four of the seven reported some
formal training in the education field. The training that the respondents received during
graduate school played a significant role in developing their attitude towards the

education of athletic training students. Respondent 6 recalled his efforts to learn the

teaching profession during graduate school as:
I was so hungry for knowledge on my own. I was reading everything I could get

my hands on. Everything that was written in the field, I think I read. Amheim and
O’Donaghue you read cover to cover to prepare for certification. About 1976 is
when Hoppenfeld came out and they never made another edition of it. They made
it right the first time. That’s my feeling on that one. You don’t need to do it again

(Respondent 6).
Respondent 6 had some training in education as an undergraduate and compared

himself to others in his education classes:
Having (teaching certification and) a degree in psychology, I thought a lot of the

education classes were common sense. But when I got out and was around people

teaching other classes, I realized that I do have a pretty good education-here

(Respondent 6).
He continued by commenting on the skill of his college professors:

56

Ihad some great instructors. All were male who went to school on the GI. Bill
after World War II or Korea Then they went out and taught, and got an advanced
degree when they were teaching at the high school or elementary level and
eventually worked their way into a college teaching job. They didn’t come out
(graduate) as collegiate instructors. They didn’t just go to school. They really had
the practical experience. Today people are getting a lot of theory from a lot of
theorists but they haven’t sat in there and done the job (Respondent 6).

Respondent 5 didn’t teach academic courses as part of his graduate assistantship
position, but functioned as a teaching assistant for rehabilitation and assessment courses.
This helped him learn the priorities of rehabilitation and allowed him to identify when an
athletic training student was struggling with rehabilitation progressions. Although
Respondent 5 does not currently teach academic courses for credit and reports no desire
to formally teach, he commented that his ambition was to stay within the college setting
Therefore, he “needed to know how to teach.”

Graduate school provided graduate athletic training students opportunities to supervise
undergraduate athletic training students. Teaching undergraduate courses gave the
graduate students a chance to review and provide practical application to the material that
was covered in the classroom. Respondent 3 found this helpful as first-year athletic
training students’ knowledge and skills paralleled what he was teaching in beginning and
advanced athletic training courses. Knowing that you have to teach the academic portion
of athletic training education forced Respondent 3 to feel prepared in his lessOn plans,

because if you’re going to teaching something, “you feel like you have to know it well”

(Respondent 3 interview).

57

Becoming Familiar with Accreditation Standards

Three of the respondents went to graduate school in the I980s or earlier. While they

currently work in Commission on Accreditation of Athletic Training Education (CAATE)
accredited programs, they did not gain experience working in an accredited program
while attending graduate school. The other four respondents worked in graduate
programs that sponsored undergraduate accredited programs. Since a majority of these
individuals attended an internship program throughout their undergraduate experience,
they were unfamiliar with the accredited curriculum. By working in a program that was
working towards accreditation or one that was accredited while they were in graduate
school, they began understanding the expectations of a curriculum-based program.
Respondent I referred to this as a “state of flux.” While their graduate assistantship
responsibilities focused on athletic training services in the athletic department, the
respondents could see the changes made during the transition to an accredited institution,

helping streamline their work with athletic training students. This is supported by the

following statement from Respondent 1:
I think my last year in grad school was easier to deal with students because you

knew the direction that we were going and you knew some of the things you
could do and couldn’t do anymore (Respondent 1).

Athletic Training Versus Sports Medicine
The final sub-theme resulting from interviewing ATCs with advanced degrees was the

emergence of the dividing line between “athletic training” and “sports medicine.” Many

people ask what the difference is, and the usual definition of sports medicine is

something like this: an umbrella term that encompasses all disciplines that deal with the

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care and performance of athletes. This could include things such as weight training, sport
psychology, sport nutrition, varying medical specialities (orthopedics, oncology, internal
medicine, optharnology, etc).
Athletic training is providing the day-to-day care and preparation that athletes need in
order to compete. Respondent 7 described the distinction between the two as:
Undergraduate (focused on) athletic training. While in graduate school I learned
about sports medicine. Athletic training includes basic evaluation, taping,
wrapping and bracing. But I didn’t see the interaction with physicians, didn’t see
an x-ray, did everything by myself. Sports medicine introduced me to
pharmaceuticals, various diagnostic techniques, different types of orthopedic
evaluations and I worked with physicians one-on-one daily (Respondent 7).
Summary
All the respondents attended graduate school and earned a master’s degree. Graduate
school attendance allowed the respondents a chance to secure graduate assistantship
positions resulting in opportunities to gain and enhance their experiences. Respondents
took responsibility for their decisions, were on their own, gained teaching experiences,
were exposed to accreditation standards, and learned the distinction between athletic
training and sports medicine.
Respondents also shared their prior job experiences, as described in the next section.
Prior Job Experience
Six of the seven respondents reported at least one full-tirne position prior to their
current employment. Of the six that were previously employed, three were previously

employed at one institution, and two were previously employed at two institutions. The

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sixth was employed at three institutions prior to his current employment. The former
employers consisted of six different universities, two clinics, one high school and an
Olympic Training Center. Varied work experience enhanced the respondents’

relationship with and ability to mentor athletic training students.
Respondent 7 recalled his first job at a high school. It gave him the opportunity to

learn and make decisions, both good and bad. He started an athletic training program, and
taught athletic training skills to high school students. Respondent 7 then recalled his
experience at an NCAA Division I institution and stated that it “shaped me more than I
realize. That was six years of really good people.” Respondent 7 was a head ATC at the
age of 24 and was probably one of the youngest NCAA Division I head ATCs at that
time. He reported that was, “scary because the athletes were the same age as I was.”

Respondent 6 laid the foundation for a small college’s athletic training program-

literally and figuratively,
I went to work at a small college as their first athletic trainer my first job out of

graduate school. Great athletic directors, super supportive, letting me do a lot of
things. It was a learning experience, an enriching experience and a rewarding
experience. My first summer there, I literally made an athletic training room, that
is I laid block and mixed mortar. I got light fixtures and electrical work from

some guys in the physical plant for a couple cases of beer. That was really

rewarding... The thing that influenced me more than anything was having my own
students where I was in charge. I had the responsibility to help these people learn
my profession and try to transmit my enthusiasm to them. That was both a

challenge and rewarding at the same time (Respondent 6).

6O

Respondent 2 recalled his experiences in two different employment settings, one at a
college and one with the United States Olympic Training Centers.

My experiences with the Olympics and the Para-Olympics were life-changing
experiences. Where you see the human drive and all that we’re capable of
regardless of our abilities or our disabilities. I think those are opportunities I
wouldn’t have had anywhere else. . . I’ve been part of national championship
basketball teams, which is an incredible experience. You go through all the pre-
season, all the season, all the daily practices and the injuries. There are ups and
downs in this field, and some days it’s just overwhelming and there seems like
there’s more downs than ups. To be a part of the success, not that winning is the
whole reason we do this, to be a part of a national championship and see the
success and see that this is what they’ve been striving for and you are a part of it.
I think it’s exciting, and it’s rewarding, and it’s fun to be a part of that
(Respondent 2).

When asked to think about all of his experiences and remark on which experiences in
his background prepared him for educating today’s athletic training student, Respondent
2 continued with:

Well I think all of them for a variety of reasons. You work in different settings.
I’ve worked the high school level, Division III, Division II, and the USOEC. I
think you do have a variety of sports, a variety of coaches, a variety of
administrators and a variety of athletic training students. You deal with so many
different people, the more different sites you’re in and different approaches, the

more you’re able to bring to the table (Respondent 2).

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Experience in a variety of settings is important for athletic training educators. By
participating in a variety of experiences, ACI/CIs can bring that knowledge to the clinical
environment and act as a resource for the athletic training student. These experiences also
shaped the ACI/CI into a good clinician within the field of athletic training. The
following section will explore this trait.

Being a Good Clinician

A forum theme central to the characteristics of ATCs acting as clinical instructors in
CAATE accredited athletic training education programs is that they all have skills
necessary to be a good clinician. This characteristic has been identified by Weidner and
Henning (2004) as one of the four domains of clinical teaching knowledge: “ACIs must
be knowledgeable of the subject matter within their field” (p. 341 ). Clinical instructors
must be willing to share their knowledge with athletic training students and also
acknowledge their own personal and professional weaknesses (Weidner & Henning,
2004)

Respondent 3’s learning experiences included a lot of manual therapy techniques such
as joint mobilizations and proprioceptive neuromuscular facilitation (PNF). Such training
was unique at the undergraduate level. Respondent 3 commented on his undergraduate
experience with manual therapies and the role they played in his development into a good
clinician:

I didn’t know that a lot of the skills I was being taught as an undergrad were not
being taught at other athletic training programs. . . I feel very fortunate to have
come out of my undergraduate program with a lot of knowledge and skills that a

lot of people didn’t have, such as manual therapy skills. . . The thing that affected

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me the most was that I had different skill sets than others from other programs. . .
Manual therapy has been most influential, that’s why I like athletic training, it’s
hands on, you do it (Respondent 3).

This hands-on approach was called upon when Respondent 3 went overseas with a
delegation of US. athletes. Respondent 3 recalled traveling with the US. Olympic Teams
and how he adapted to the limited modalities and rehabilitation equipment available:

In Yugoslavia, we had one bucket of ice for the whole US. delegation, and I
don’t know if we had any modalities to be honest about it. So I was glad that I
was able to do hands-on skills. What are you going to do? You gotta do
something. I could do joint mobs and PNF (proprioceptive neuromuscular
facilitation), muscle energy or whatever, and I could do some of that stuff. That
influenced my career a lot, being able to do those skills (Respondent 3).

When the respondents were asked if they felt appropriately prepared to teach today’s
athletic training student, six of the seven respondents responded with a yes due to their
clinical skills and their previous experiences. It was generally felt that the more
experiences an individual acquired, the more knowledge they passed onto future athletic
training students. They had more to look back on. They could and can help athletic
training students understand techniques that work and those that might not work, so that
athletic training students wouldn’t repeat a mistake. Respondent 3 summarized the need

for experiences by stating, “experiences increase your knowledge base so that you have

more to pass on.”
Respondent 5 was identified as an “excellent” clinical instructor with high ratings. He

believes he has good clinical skills, but does not feel appropriately prepared to provide

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learning experiences for athletic trainingstudents. With high ratings from his program
director and a bit of teaching experience, why does Respondent 5 feel inappropriately
prepared to provide learning experiences for today’s athletic training students?
Because all my knowledge goes to the elite athlete. I don’t need to know how to
teach, but I went to graduate school because I wanted to work in the college
setting, there you need to know how to teach. Right now (at his current position in
the collegiate setting) I don’t need to know how to teach. My main focus is
towards the student athlete (Respondent 5).

This makes a bit of sense due to the fact that as an undergraduate athletic training
student, all the information that one receives relates to providing healthcare services. In
the collegiate setting, the focus is the healthcare of the student athlete. Athletic training
students aren’t taught to relate information to anyone other than their patients. But when
Respondent 5 was asked if he felt like he does a good job as an ACI, he had this to say:

If there is a circle for the ACI maybe, maybe not; if there is a circle for athletic
training maybe I’m good because I want to be a master of athletic training. I don’t
want to be a teacher of athletic training. A teacher knows the textbook in the ACI
model described previously. Do I do a good job on that? Yeah sort of, but I don’t
really care about it. I want to be a master of every single aspect of athletic
training. But if I see the AT circle, I think I’m good because if a student asks, I
will teach them whatever they want. But I don’t need five or six of them. Athletic
training is so much information, I can’t give what I’ve got to that many people.

Like the movie Karate Kid, Mr. Miyagi is a master of karate. I don’t want to use

the word teach, because it is related to teacher. But Mr. Miyagi gives whatever he

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has to just one kid. But the teacher model for the NATA is one teacher for six to
eight people. If I want to be at the level of master, I don’t need five or six people,
I want to have just one or two (Respondent 5).

Being a good clinician was identified as a strong attribute of these “excellent” clinical
instructors. The following section will detail to whom these individuals primary
responsibilities lie.

Athletics First, Academics Second

Where are the loyalties of these “excellent” clinical instructors? The individuals
interviewed were neither full-time faculty members nor graduate assistants. All were paid
primarily by their departments of athletics to provide athletic training services to the
universities’ athletic teams. The respondents recognize that they have primary
responsibility to the department of athletics and “the healthcare of our student athletes” as
described by Respondent l, but are committed to using their setting to educate athletic
training students. Respondent 3 agreed by stating, “My number one job is to take care of

the players and keep them healthy and keep them out there. If I don’t do my job here, I

won’t have a job educating students.”

Another dilemma that these ACIs experience is the liability that may be involved in
having athletic training students practicing clinical skills on patients. If an athlete re-
injures themselves dtuing rehabilitation or is burned by the inappropriate use of a hot

pack, who is responsible? The athletic training student? No, it is the staff member

assigned to work that sport.
At the end of the day, I’m responsible for anything that happens. I’m going to

give you (the student) independence. But you need to understand that while you

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are here, we’re doing things my way because I’m responsible. I’ll give you input.
I’ll let you make changes. But you have to understand that when you leave, you
can go out and do it however you want. But when you’re here, you’re going to do
it the way that we do it (Respondent 2).

While the ACI/Cl’s main responsibilities are to the athletics department and to the
student-athlete, many feel that a portion of their responsibilities are to help educate
athletic training students and that the duties to athletics and to the ATEP are combined.
Respondent 6 felt that until about 10 years ago, the service to the athletics department and
the education of athletic training students was never a duel role, but one multifaceted
position. He continued by stating:

I never saw it as a second role because I remember reading an article in the
Physician and Sportsmedicine saying that athletic trainers were one of the best
health educators there were, that we as a profession were natural teachers

(Respondent 6).

Respondent 6 gave an example of how he currently combines the teaching and clinical
supervision aspects of his job by stating,

It’s all part of the same job. If I got a student that’s helping me get the baseball
team ready, if there is something they don’t know how to do and I’m doing it, I’m
going to show them how to do it. I may say I want stretches done this way or that
way, and I’m standing at the table next to them while I’m doing somebody else,
keeping an eye on them and watching what they’re doing. I don’t think it’s really
that big of a challenge. I think it’s a bigger challenge in football where you’ve got

a lot of students. But when they’re with the sports I’m with, I’ve got two or three

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students with me at a time. So it’s not really that big of a challenge. I think it
integrates itself pretty well. It’s just a matter of talking while you’re doing it many
times (Respondent 6).

Respondent 7 preferred to combine athletic training services and athletic training
education in the clinical setting, but noted that it may be hard to do both at a high level at
institutions where athletic teams are expected to win and bring money into the institution.

The coaches don’t understand what you have to do with it. My goal is to get
athletes back to competition as quickly and safely as you can and that will take
away from the education of the students. Sometimes you don’t have the
opportunity to share the knowledge with the student due to coaches’

demands. . .Would love to do both, but the real world of athletics won’t provide
for this. We still have to understand who our provider is. . .Major sports are a little
different than minor sports. It’s not that the coach is less stringent or less
motivated, but there are different levels and we have to understand that. . .You
need to be aware of the situation. You need to be aware that they are here. I can’t
just be in my own little world and look at somebody and not bring the athletic
training student into the play. I think it’s hard for the clinician to switch to
teaching mode, instead of just getting it all done. We get caught up with what we
do and then we have to put it in terminology that they (the athletic training
students) understand. Students have different levels. I think the athletic training
educators understand that. The NATA, the BOC, the CAATE understand that. I
don’t think it has been conveyed to the coaches, and I think that’s where we let

down a little bit. We tell the coaches how we’re going to do it. I don’t think they

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have a full grasp of what it is to educate the students. If I’m gone for an hour and
a player needs to find me, I’m doing something other than what they demand.
Some are great, others not, so it really varies on each coaching style. The
administrator, athletic directors the whole of athletics are left out sometimes, and I
think we missed the boat on that. I think it’s everywhere. Members of staff can
only supervise so many students, and students can’t do their own thing anymore.
The coaches don’t care. The administrators don’t care. We need to be very open
as to what their (the coaches) demands are. Sometimes we take our way of
thinking and force it upon people and forget that it needs to be a collaborative
effort. Coaches don’t understand why a kid can’t cover an 8 pm. practice. A lot
of that is communication. A lot of that education, now where that comes from in

each university setting, I don’t know (Respondent 7).

Research Question 1 Summary

The first research question, “What are the characteristics of ATCs acting as clinical

instructors in Commission on Accreditation of Athletic Training Education Programs

(CAATE) accredited institutions?” has been addressed in this section. Five main

attributes emerged. While each characteristic was indeed important, these attributes in

combination with one another were what set the “excellent” clinical instructor apart from

the “average” clinical instructor. The five attributes were each illustrated with text

derived from face-to-face interviews. These attributes were: attending an internship

institution for their undergraduate work; obtaining an advanced degree which allowed for

the accumulation of more experiences; obtaining job experience prior to obtaining their

present position; being a good clinician; seeing their first responsibility to be to the

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athletic department while simultaneously finding ways to educate athletic training
students. The next section explored research question number 2 and the educational goals
and beliefs these “excellent” clinical instructors displayed as they educated athletic
training students.
Research Question 2
The second research question was modified to read, “What are the educational goals
and beliefs towards athletic training education of excellent clinical instructors”? This
section begins with a discussion of how the respondents came to understand and be
committed to the teaching techniques they employ. Then I discuss the educational goals
that the respondents have for athletic training students, followed by a consideration of the
perspectives that the respondents have regarding athletic training education.
The Development of Educational Philosophies

How did these “excellent” clinical instructors develop and implement the educational
strategies they currently employ when educating athletic training students? The
respondents were asked, “What does learning mean to you?” The answers to these
questions laid the foundation for explaining the educational goals and beliefs that these
“excellent” clinical instructors have when educating athletic training students.
What Does Learning Mean T 0 You

How do the interviewees perceive student learning? Most commented on the different
learning styles that athletic training students may have as related to their Approved
Clinical Instructor (AC1) training. Respondent 7 tries to relate to each individual athletic

training student’s learning style but admits that, “I can’t always do that.” In regard to

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educating future professionals, the respondents were asked, “What does learning mean to
you?” The responses to this question could be placed into four themes.

1) Acquiring knowledge so that it could be put into practice. Respondents 1, 2, 3, 4 and 6
commented on the acquisition of knowledge and the application of that knowledge.

0 “Learning to me means acquiring knowledge both through formal education and
through practicing things on your own. . . . I think learning is the acquisition of
knowledge and putting that knowledge into practice, be it a skills set or whatever
it may be” (Respondent 1).

o “I think it (learning) is getting a concept, understanding it and being able to
practically apply it” (Respondent 2).

0 “Acquiring knowledge is most important. You’ve gotta have the knowledge and
skills in order to perform at a high level in your job” (Respondent 3).

o “If they (the ATS) can take it (knowledge) and use it on the field or in a rehab
setting. . . effectively and the right way” (Respondent 4).

0 “They integrate and apply that knowledge in a real situation” (Respondent 6).

2) Providing amble opportunities for athletic training students to practice their skills.

0 “Learning is taking a concept, understanding it and being able to apply it. It’s not
just being able to regurgitate it or to memorize it long enough to spit it back, or
speed through a check-off and not being able to do it again” (Respondent 2).

3) Learning is continuous, is a theme that Respondents 3, 5, and 7 all appeared to agree

upon.

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0 “Learning is continuous. I don’t thing we ever stop learning. . . . We need to
challenge ourselves and our practices and the only way we can do this is by
learning” (Respondent 3).
“Learning is never ending. . . . Learning is fun and is always changing. . . . As an
older ATC, I enjoy learning. But as a student it is hard to understand all the
different views” (Respondent 5).
0 “Learning is not stagnant, not absolute, but continuous” (Respondent 7).
4) Respondent 7 established the fourth theme that learning is a planned, collaborative
effort.
0 “Learning is a collaborative effort. . . . Learning is scary. The more you learn, the
more you realize you don’t know. . . . Learning is planned. Each setting provides
a unique learning experience, be it in the classroom, clinical, on the field or

during travel. . . . You have to want to learn. Some people shut it off”

(Respondent 7).

Experiences Increase Competency

How else was “excellence” achieved by these clinical instructors? The overriding
themes that emerged were competency, vast experiences, and perfected or practiced
skills. These factors ultimately lead to excellence as both a teacher and clinician. Six of
the seven interviewees felt well-prepared to provide learning experiences for today’s

athletic training student due to confidence built from past experiences and clinical

competency. Respondent 3 supported this notion by stating:

I think there is something to be said about experience. When you’re talking about

something, you can bring experiences into it (Respondent 3).

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The idea that competency of athletic training knowledge, experience in athletic
training situations and skills in evaluation, treatment and rehabilitation lead to teaching
excellence was summed up when Respondent 6 described good teaching by stating:

Competence in the field. Knowing what you’re talking about and being able to
communicate that. . . I want people to know what they are doing and why they are
doing it. Don’t get locked into one type of thinking. A lot of people are doing
something just because it’s there. They push buttons, and a light comes on, and
they walk away, and they’ve done their job. I think it hurts the profession and it
certainly is not providing the best clinical care (Respondent 6).
Summary of the Development of Educational Philosophies
Teaching techniques utilized by the respondents as they educate athletic training
students were described. Respondents also described their best teachers in college and the
meaning of learning. The field experiences the respondents had that related to increased
teaching competency were also explored.
Understanding what experiences shaped these individuals as educators and
professionals led to an outline of the respondents’ educational goals and beliefs as they
relate to athletic training education.
Educational Goals of the Excellent Clinical Instructors
The clinical instructor continues to play a huge role in the development of athletic
training students. Athletic training students typically spend six to eight hours per week
with an athletic training faculty member in various classes, learning the didactic
information required of an athletic trainer. On the other hand, the athletic training student

could easily spend fifteen to twenty hours (or even more) in their clinical assignments

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with their clinical instructor. It is with the clinical instructor that athletic training students
will have the greatest opportunity to practice and refine their athletic training skills. This
point was illustrated by Respondent 1:

If you’re the instructor of a modalities course, you’ve got those kids three or four
hours a week. Then I’ve got them for another 20 hours per week when we’re
actually going to integrate those skills that they’ve learned with patients, with
student-athletes, whomever it may be (Respondent 1).

The educational goals that the “excellent” clinical instructors interviewed had for the
athletic training students under their supervision fell into one of the following four
themes: to prepare the athletic training student to pass the Board of Certification (BOC)
examination; to provide an environment where the athletic training student could acquire
a variety of athletic training experiences; to prepare the athletic training student to enter
the athletic training profession; to have the athletic training student value learning. This

section explored these four areas.

Goal 1 : Prepare Athletic Training Students to Pass The Board OfCertification
Examination
The most obvious goal that the respondents reported was to prepare athletic training
students to take the Board of Certification (BOC) examination (Respondent 2).
Respondent 7 believed that basic information exists regarding athletic training that all
athletic training students must possess. A basic understanding of anatomy, medical
terminology, evaluation techniques, biomechanical principles, treatment protocols and

interpersonal skills are paramount. Athletic training students should know what is

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expected of them when answering a question or solving a problem given to them by their
clinical instructor.
This is not teaching for the test. There is information they need to know. Then
they can become a little more abstract in their thinking and thinking deeper on
how this relates to what they do in the real world (Respondent 7).
Goal 2: Help Athletic Training Students Acquire Relevant Experiences
Field experiences are crucial to the athletic training students’ development.

Respondent 2 described how he creates learning experiences for athletic training

students:

I try to give them as much experience as possible. I’m not going to put them in a
situation they are not prepared for or not able to do based on their classroom
knowledge. But I want them to try and start evals and at the beginning, take a
history and observe, and at least get that. . . An athlete comes in with an injury,
what should we do now? What should we do in two weeks? What should we do in
a month? Get them to think critically and to make plans as much as possible. Then
I’ll look at it and I’ll tell them what I think, and I’ll ask what do you think we
should do with this person? What should we do for treatment? What should we do
for rehab? Try to make them make decisions, and if I disagree with it, I’ll explain
what I think we should do because of the findings that we found. . . Make them
aware of what’s real. I think it’s very easy to get concepts in your mind based on
the book. Little things, like they come out thinking every injury you Icok at is

going to have an obvious answer, an obvious assessment, and that’s not the case.

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Sometimes it’s very cut and dry. Sometimes you never know what it is. And,
sometimes you just treat the symptoms (Respondent 2).
Respondent 5 revealed how he might handle an injury situation with an athletic
training student during practice:

Normally during an injury situation, “Come with me. Put your gloves on.” If they

are comfortable, I always provide an experience for them. If an athlete is puking,

sometimes we have to deal with nausea, a huge gash. Are you (the athletic

training student) ready for it? I go over the rules for practice. IfI don’t go onto

the floor, you don’t go either. We don’t need to run out on the floor every time

someone falls down. Then we talk about the injury, then the rehab (Respondent

5).

When asked if athletic training students are involved in his clinical setting,
Respondent 7 stated:

Students are involved with the athletes. They have to be involved. Learning is
hands-on depending on the situation. A player is down in a game in front of
15,000 people, I need to do what I have to do to combat the situation. Practice is a
bit less stringent. It’s stringent to the coach, but not to me. So there is a time and
place, but the students are definitely involved (Respondent 7).

While these “real life” experiences are great for athletic training students, they are
unfortunate for athletes. But athletic training students need to be present to take
advantage of learning situations even if they have not had a formal class regarding the

situation. It is important for athletic training students to see and many times feel what is

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going on, as that may be their only chance to experience such an injury or situation.
Respondent 3 commented on the importance of being in the right place at the right time:
Anytime we get something good in here, I try to get the students to feel it, which
is a problem because you can’t do a test until you’ve had the class. I’m sorry but
maybe they’re working football and there’s an ACL (injury). This may be their
only chance (to be involved in that situation). I may have to help them, but they
feel it because they need to feel it. It’s something you’ll never forget. . . We do try
to get the kids involved, and that’s the hard part with this whole educational thing.
They cut back their hours and try and have them not do these things. You can
only work so many hours and you can’t touch the people. I feel really bad for
them, because the Opportunities in the clinical setting are there when they’re there.
I mean you can’t make them up. You can’t create injuries. I feel real bad if it’s
four o’clock and they have to go home because they got their three hours, and
from four to six you get a good injury. They just missed an opportunity, and they
never get to see that broken arm again or what ever it might be. The only way you
see things is if you’re there when it happens, and unfortunately you have to wait a
lot for it to happen (Respondent 3).
Respondent 1 described how he has dealt with senior athletic training students:
When it gets to be January and February and you’re talking about taking your
certification exam in April, you just about got everything wrapped up. I mean,
you should be able to handle just about any situation that comes your Way. And I
think that’s one thing that I’ve really tried to do the last couple of years is say,

“It’ 3 your show. 1’ ll be here if you need help, but you’re going to be the one that

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does it.” And I think some have gotten a lot out of it, and for some, it’s been a real
eye opener (Respondent 1).
How exactly were athletic training students involved during their clinical rotation with
the respondents? Were they actively participating in the healthcare of the athletes or were

they just performing menial tasks like taking laundry down, filling water bottles or
coolers, or wiping down counters?
Students aren’t just used for menial tasks. They’re going to do what I’m going to
do. Whatever they’re going to do, I’m going to do. If they’re going to clean, I’m
going to clean. If I’m going to tape, they’re going to tape. If I’m doing rehab,
they’re going to help with rehab (Respondent 7).

While a portion of their clinical time is spent unengaged, athletic training students can
practice athletic training skills or perform daily chores. This is illustrated by Respondent
1:

I had a prime example a couple of years ago. I had a kid that came down every

day at one o’clock and what’s the first thing he did? He filled up water bottles

and coolers. I said, “is this a problem?” He said, “No.” “If I’m not here, you’re
going to do it and one day I want to do what you do, so it’s not that big of a deal”.
. . My feeling is it’s all part of what we do as an athletic trainer. No different than
if you’ve got a student-athlete that sprains an ankle and they come in and you
look at them, that’s all part of it. Yes, it does get tedious, and, yes, it gets boring.
And there are times when I will go and set up the football field by myself and do
it in half the time it takes three students, just to prove a point that you’re going to

have to do this if you want to work in this field (Respondent 1).

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While the current climate of athletic training education requires that athletic training
students be within auditory and visual supervision of their supervising ATC, it must be
understood that athletic training students provide a service to the athletic department and
to student-athletes while they are participating in their respective clinical rotation. This
was supported by Respondent 1:

I think the biggest thing is making sure our athletic training students understand
although they’re not part of the workforce, they are there to provide a service. Part

of their clinical education is to provide a service to the student-athletes

(Respondent 1).

Goal 3: Prepare Students to Enter the Workforce

Another goal that “excellent” clinical instructors had for athletic training students they
supervised was to instill the knowledge and skills necessary for athletic training students
to become productive athletic trainers in the workforce, where they can work
independently, make decisions and know how to function as Certified Athletic Trainers.
Athletic training students must realize that once they are out in the workforce, especially
if they are working with a professional, collegiate or high school athletic team, they are
not going to have a 20 or 30 hour work week. There is not “always going to be someone
there to make decisions for you. You need to start to make some of those on your own”
(Respondent 1).

Athletic training students are in the ideal environment to build in the experiences of
other professionals. They meet with other allied healthcare providers during clinical

rotations and have access to various Certified Athletic Trainers, exposing the athletic

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training student to a number of different philosophies and strategies in the management
of athletic injuries.
I try to get across to the students here, that you have so many different clinical
instructors that you cross paths with. You don’t have to agree with all of them, but
get exposure to all of them and say, I like this that they do, I don’t like this that
they do. This is how I would want to do it and this is howl wouldn’t. . . You’re
never going to have this opportunity again where you’ve got so many other
people to go to for advice and someone else is responsible (Respondent 2).
Respondent 1 reinforced that undergraduates always have someone to turn to:
This is the last time you’re ever going to deal with six certifieds on a daily basis
within two buildings. Take advantage of the time you have here and make sure

that when you leave in May, you can go out and you can function on your own

(Respondent 1).

Goal 4: Encourage Students to Value Learning

A final goal that many “excellent” clinical instructors had for athletic training students
was a growing “thirst for knowledge” and valuing learning for learning’s sake.
Developing a thirst for learning may be incredibly hard to do for students who are so
grade driven, but they must develop a mindset of “I want to know this because it’s going
to make me better at what I do” (Respondent 6). Respondent 7 stated, “Learning is scary.
The more you learn, the more you realize what you don’t know.” It is interesting to note
that the comments regarding the importance of encouraging athletic training Students to

develop a value for learning came from the two clinical instructors who have a teaching

certificate and have been trained as educators.

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In this section, lhave summarized the goals that these “excellent” clinical instructors
have for their athletic training students. Next we turn to the excellent clinical instructors,
perceptions about athletic training education.

“Excellent ” Clinical Instructors ’ Thoughts Regarding Athletic Training Education

This section examines the role that the respondents feel they play in athletic training
education in conjunction with the thoughts that they have towards athletic training
students and athletic training education. Four themes emerged regarding the perceptions
of the respondents towards athletic training education. They believe: 1) A primary role of
the clinical instructor is to provide an environment where the athletic training student can

take the information learned in the classroom and integrate that information in the clinical
setting; 2) Athletic training students who are pro-active receive a better education; 3)

Today’s athletic training students need more clinical exposure; 4) Athletic training

students need clinical exposure in a variety of settings.

Belief]: Bridging the Gap Between the Academic and "Real ” World

When asked, “What is the role of the clinical instructor in the education of today’s
athletic training student?” Excellent clinical instructors focused on providing an
environment where athletic training students could practice and expand the knowledge
that they received in the classroom. The role the clinical instructor plays is critical as the
athletic training student will be spending approximately 20 hours per week with their
clinical instructors in the clinical setting versus 3 to 6 hours with the athletic training
faculty member. Due to the clinical expertise required of athletic trainers, ReSpondent 4

feels that the role of the clinical instructor in athletic training education is huge. With the

changes in athletic training education, the role of the clinical instructor may not be

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exactly defined, as Respondent 6 pointed out. “I think it’s still evolving. We are still
trying to figure out just what are we supposed to do in some cases.” For the most part,
the clinical instructors interviewed felt that they should be “bridging the gap”
(Respondent 2). The “gap” that needs to be “bridged” is the gap formed between the
academic coursework required of athletic training students and the clinical experience
required of athletic trainng students. Scenarios presented in the classroom are often
presented in ideal situations. Clinical rotations give athletic training students the
opportunity to see the discrepancies that exist between information presented in the
classroom and the “real” world applications that need to be done on a daily basis. This
concept is described by Respondent 7:
(The clinical instructors role is to) bring the academic educational world to the
clinical setting through integration, instruction, supervision, teaching through
taking the knowledge they learned in the academic setting to make sure the
athletic training student is evolving into a good clinician. You have to watch and
critique them. Don’t be afraid to tell them what they do well and don’t do well
(Respondent 7).

Clinical instructors are responsible for integrating what athletic training students have
learned in the classroom with “a real world setting” (Respondent 1). Respondent 1
continued:

I think that we have to identify through the use of our educators and through our
students the strength of our students- - what they can do, what they can’t do.

Make sure we push them as far as they can within their clinical rotations

(Respondent l).

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Respondent 2 supported Respondent l by commenting on the difference between

describing a situation and actually experiencing the situation:
I can lecture these guys if they come into spring ball or two-a-days. I can give

them a 45 minute lecture on what it’s going to be like out there. But until they see
the chaos, they can’t understand it. I think that we’re able to be there to help with
their education or make it practical so they grasp the concepts better, where they
can see it in action. (They) see that sometimes this works and sometimes this
doesn’t and (I) kinda help them put all the pieces together and complete the

picture (Respondent 2).

Respondent 3 agreed that clinical instructors need to support classroom education with

clinical education:

Perfect the skills that they have learned in the classroom. Anytime we get
something good in here, I try to get the students to feel it (to experience what that
injured body part feels like through palpation or special testing). . .maybe they’re
working football and there’s an ACL, this may be their only chance (to experience
an injury to this extent). I may have to help them, but they feel it because they
need to feel it. It’s something you’ll never forget (Respondent 3).

Respondent 6 wanted athletic training students to view athletic training from medical
and competitive athletics perspectives. Athletic training students need to be aware of
medical issues, bio-mechanics involved in athletics and that ofien times the competitive
athletics perspective is quite a bit different from a purely medical perspective. The
medical perspective would focus on the injury and the healing process, often times with a

delayed return to activity. The competitive athletics perspective often times focuses on

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wins and losses, financial gains to both the athlete and the institution, and the fact that
many times athletes are returned to play prior to being totally healed.
Respondent 7 is interested in acting as a mentor for athletic training students to help

them define the profession of athletic training. “It’s not all about winning. It’s not all

about losing.”
I’m going to show them the real world of athletic training, from the side they

don’t see. Interaction with the physician. Interaction with coaches and athletes.
Seeing what works on the side that maybe they don’t get instructed in class on.
Balance, time management and commrmication (Respondent 7).

Respondent 5 wanted athletic training students to see that not everything is a textbook
scenario. “Rehabilitation is not I, 2, 3, 4, 5, 6. Sometimes it’s 1, 3, 4, 2” (Respondent 5).
Respondent 5 continued:

I have a bit of an old-school mentality, so the athletic training student needs to
watch me carefully when I’m doing something like taping. . . My rule is I’ll show
and explain a skill step by step. I feel that I’ve done enough for them at that time.
It is the student’s responsibility for follow-up. If the student has questions, asks to
see it again or asks why a certain procedure was done, my responsibility is to
respond to them. When I show something to them with an explanation, that’s my
role. It is the student’s responsibility to ask questions. Same goes with rehab, I
explain to them why (things are done) psychologically, physiologically and
functionally. It is the student’s responsibility to ask questions. One time is not

enough. Students must ask questions. Let them practice, and if they have an

opportunity to use the skill, use it. The athletic training student should come to me

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and ask to repeat a demonstration if they have questions. I shouldn’t have to come

up with the information by myself (Respondent 5).

their education.
Belief 2: Pro-Active Students Get a Better Education
Students who are aggressive get a lot better education than those who are passive.
. The aggressive ones will come watch and ask questions and I can help them while

I’m doing the activity or whatever (Respondent 3).

of athletic training students. That is, athletic training students need to be pro-active as
they pursue their athletic training education. Those who actively participate, seek
opportunities to get involved and are truly passionate about their athletic training
education will receive a much better athletic training experience than a student who is
passive towards his or her educational experience.
Once a clinical instructor is comfortable with an athletic training student’s skills, most
hand the reins over to the student. This was illustrated by Respondent 1, who stated:
I always tell them I will let you do as much as you want to do. I don’t have a
problem with that. But at the same time, if you’re sitting in the corner and you
Show no interest to get invOlved, I’m not going to come up to you everyday and

say, go take a look at this person or can you go out and do this (Respondent I).

This idea was further supported by Respondent 2:

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want to be there and I only force them so much (Respondent 2).
Respondent 3 added, “I’ll teach you anything you want, but you have to ask me.”
Athletic training students become more aggressive towards their education and “stand
on their own” (Respondent 2) when they become comfortable and confident in their
knowledge.
If the student is comfortable, they’re going to be willing to do more, and try more
and get more involved. If they don’t feel comfortable for whatever reason, I think

(that) deters from the experience (Respondent 2).

You have to communicate to the students, and I think they understand that
sometimes it’s a teachable moment and sometimes it isn’t. Certain things I don’t
expose them to. I’ve tried telling them everything, and I’ve tried telling them
nothing. I’m somewhere in the middle. It’s hard. You have to keep that balance.
They’re still students. They’re still l7, l8, l9, and some things they don’t need to

know. I want to tell them everything, so they don’t fail in the future, but that’s not

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realistic and you’ve got to find that balance of when they’re ready. Eventually you

have to push them out of the nest and let them go. . . I’ve tried letting them know

Belief 3: Athletic Training Students Need More Clinical Experiences
The lack of clinical experiences in medical education has been described by Dr.
Herbert Fred (2005) as “Hyposkillia.” Athletic training education is no different, and
athletic training students need clinical exposure to develop and thrive. Some respondents
felt that the current athletic training educational model is somewhat to blame for the
decrease in clinical experiences that athletic training students acquire. This is supported
by Respondent 6:
The fi'ustration that I think a lot of athletic trainers feel with the current
educational model is there is not enough hands-on (opportunities for athletic
training students). They’re certainly not getting the experience I had. They just

don’t get enough opportunity to practice the profession (Respondent 6).

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Respondent 3 commented that in the current educational model, athletic training
students could theoretically become certified without entering the clinical setting.
It looks like today you can almost get certified without going to the clinical
setting, and I think that is wrong because one thing about knowledge is being able
to impart that knowledge. I think you have to have the combination of both or
you’re not going to be well-rounded. You might get certified, but you’re not
going to be very good at it. Experiences are crucial (Respondent 3).

The clinical instructors interviewed all commented on their undergraduate experiences
and how they were thrust into performing activities in the athletic training room early in
their education. Many traveled without ATC supervision. Respondent 7 recalled that he
tried to get as many hours in the athletic training room as possible and would have a
competition among the undergraduates by posting their hours on the wall for all to see.
Sometimes these “Mega Hours” would total up to 2,500 to 3,000 and that was for an

individual who went to a NATA accredited program when the minimum hour
requirement was 800.
While these “excellent” clinical instructors acquired many hours in the athletic
training room, their academic preparation consisted of somewhere between two to six
courses, in stark contrast to the multitude of courses required for athletic training students
today. It appears that the educational pendulum has shifted from that of fewer academic
courses and many clinical hours to that of more academic preparation at the expense of
clinical hours. Examples of the effects on today’ s athletic training students of not gaining

the exposure of meaningful experiences follow.

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Respondent I commented on the variables associated with athletic training students’
clinical time. Items like not scheduling athletic training students for extensive hours per
week, allotting appropriate days off, scheduling around work and personal schedules all
needed to be considered.

I think one of the biggest things was dealing with time issues. Like I said, when
we went through and you were assigned to men’s basketball, you were there for
everything men’s basketball did, unless you had class. And for us (presently) I
know that was a big hold up when all of a sudden they are supposed to be here 15
to 20 hours per week, and we need to work around this and we need to work
around their work schedules. It was tough, I think, for a while trying to adjust to
that. My thoughts were this should be a priority in your life, and a lot of times this
didn’t seem like it necessarily was (Respondent 1).

Injuries can’t be created. Athletic training students need to be present when these
incidents occur. If they are not, athletic training students lose valuable ofien
irreproducible clinical experiences.

We do try to get the kids involved, and that’s the hard part with this whole
educational thing. They cut back their hours and try and have them not do these
things. You can only work so many hours and you can’t touch people. I feel really
bad for them because the opportunities in the clinical setting are there when
they’re there. I mean, you can’t make them up. You can’t create injuries. I feel
real bad if it’ s four o’clock and they have to go home because they get their three
hours, and then from four to six you get a good injury. They just missed an

opportunity, and they never get to see that broken arm again or whatever it might

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be. The only way you see things is if you’re there when it happens, and
unfortunately you have to wait a lot for it to happen (Respondent 3).
Inexperienced undergraduates carry deficiencies on to graduate school.
I can see differences in graduate students and where they come from. They come
in with very different knowledges even though they are all certified. I think they
are a lot less experienced when they come in as graduate students, because they
haven’t been on their own. When you go on your own the first time, hOpefully
you start to sweat a little bit and your heart rate goes up because you’re thinking,
“Oh my goodness, I’m about to take care of a patient and if anyone drops the ball,
it’s me.” I think they miss out on some of that (as undergrads) because there’s
always a Certified (Athletic Trainer) with them. They don’t really have that fear
that goes to your heart that I really think helps you in a lot of ways. . . They come
in here, and they’re certified. We throw them to the wolves. They haven’t had the
experience at their school previously, and they haven’t been on their own yet. It’s
all sort of magical that all of a sudden, you take one test and a day later, you’re
certified. But what really changes between this day and that day? Nothing, except
you passed an exam. (It’s) not because you suddenly had more knowledge on that
day, yet we expect (you) to be knowledgeable just because you have some letters
behind your name (Respondent 3).
Getting today’ s athletic training student to gather more experiences appears to be
crucial in the minds of these “excellent” clinical instructors. A lack of experiences and

personal skills is a noticeable trend in the medical education community. One solution is

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to have the athletic training student view and participate in different experiences in varied
settings determined by the program’s clinical coordinator and the clinical instructors.
Belief 4: Athletic Training Students Must See Dijfirent Aspects of Athletic Training
Where do athletic training students gain learning experiences, and do these
experiences really matter? These two questions were asked of all of the respondents.
While some commented on the value of learning within the classroom and other non-
traditional athletic training clinical sites, most emphasized the importance of dealing with
different sports and different levels of athletic competition. Before this point is explored
further, it is important to illustrate Respondent 6’s point that many athletic training
students don’t understand sports and the mechanics involved in a particular sport.
One of the things that is happening is that some kids really don’t understand
sports well. So I’ve got to teach them about sports, trying to get them to integrate
with the sports and really use what they learn in their classes. Kinesiology, I think
in particular, is huge for an athletic trainer. Take what they learned in the classes
and start making it practical, then add to that a knowledge of the sport we’re
working with at a particular time (Respondent 6).
Respondent 6 continued by contrasting the exposure athletic training students may get
at football, swimming, track and baseball.
There is a lot of variability there (between sports). The sport itself affects
learning. Football is a very high intensity environment. You have a lot of coaches.
You have a lot of athletes. Swimming is sorta cerebral. You’re in there with a lot
of analysis looking at strokes, looking at mechanics. Their personalities and the

approaches you take are going to be different. They’re both competitive, but your

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approaches will be different: how you speak to them, what you tell them, how you
break things down for them. Football players don’t talk about mechanics a lot.
Swimmers are all mechanics. Track people are mechanics. It really depends on
where you’re at. Baseball is a little in between. I don’t think anything has been
analyzed more than baseball. Who has more statistics than baseball? That affects
the clinical approach you gotta have with these people. Part of what you have to
do to relate to these people to get them to do what you want them to do because
an awful lot of what we do deals with rehab of orthopedic injuries. From the
educational standpoint, the student has to gear into that too, and understand that
it’s a little bit different between sports. Swimming and track you can probably ask
me questions and get pretty good explanations. At football, I may tell you to wait
until later because I can’t deal with this now because it’s too intense of an
environment. So that’s going to delay things a little bit and make it a little bit less
efficient, because they’re not going to get the feedback right at that moment
(Respondent 6).
Respondent 2 commented on the value of experiencing different clinical settings
stating:
Different settings are going to offer different opportunities. If they’re at a clinic
rotation, then they may get exposed primarily by doing. They’re shown how to set
up ultrasound and they’re following through. If they’re in the ER (emergency
room), they’re primarily observing. . . Each rotation presents different things.
You’ re going to have specific injuries that are more common in certain sports.

Certain things happen in hockey that doesn’t ever happen at football, and vice-

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versa. Football for example, the sheer number and the contact/collision nature of
the sport exposes the student to so much more. I think it offers more learning
opportunities because there’s so much going on all the time (Respondent 2).

Not only is it important for athletic training students to gain clinical experiences with
different athletic teams, it is also important for them to gain clinical experiences with
athletics at different levels of competition.

I think it (the experiences) varies. Unfortunately I think it varies probably a lot. . .
With our athletic training facilities here, I think that’s why it’s important to have
upper body or lower body or collision sports. I think you get a lot different
perspective when you see a gymnast. They do a trick and they fall, and they get
right back up, versus a tennis player who gets hurt in a minor way and is out. I
think you need to see a variety of things and the personality of the athletes in the
sports. . . The level of the school is different as well between Division I, II, III or
NATA. A different level school, the urgency is different and the healthcare and the
doctor’s actions are different in the healthcare (delivery). The experiences are that
much more different. Maybe better, maybe worse. Maybe they get more attention
at a smaller school. Maybe worse in that you don’t get to work as closely with the

doctor or see 10 MRl’s in two weeks (Respondent 3).

Respondent 7 also commented on the importance of having athletic training students

experience different divisions and schools of different sizes.

Respondent 5 compared experiences at football versus the sport he covers, basketball,

where he tries to be pro-active to limit the number of injuries he sees by incorporating

prehabilitation with his players.

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Football injuries occur almost everyday, and basketball, no. So it’s really difficult
to talk about injury assessment or rehab because the athletic training student
doesn’t see it at basketball. But for football, they can see step one through step
five. Even little things, removing shoulder pads, removing shoes and socks,
everytirne they get taped. . . The athletic training students say basketball is really
boring because the athletes don’t get hurt. I explain to the athletic training student,
once the athlete gets hurt, there is nothing we can do. We can do rehab, but the
best thing is they don’t get hurt. I spend more time before injury rehab in prehab
or prevention with balance exercises and mental mind set. . . When the athletic
training student goes to different sports, the athletic training student needs to be
prepared for different views (Respondent 5).

In the clinical setting, fast, quick, correct decisions need to be made, and athletic
training students aren’t getting this “critical decision making time.” ACI/CIs can work
with athletic training students in a controlled environment, but the “real world” of athletic

training is in an uncontrolled environment.
Summary of Research Question 2

Research question 2 examined the educational goals and feelings that “excellent”
clinical instructors had towards athletic training education. Before these goals and
thoughts could be examined, the activities that shaped the respondents’ educational

philosophies were briefly outlined. Comments were discussed pertaining to the
respondents’ best teachers in college and their thoughts on learning.
The educational goals of the excellent clinical instructors were based on one of four

different themes. The respondents wanted athletic training students to be able to pass the

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BOC examination, acquire a variety of experiences, develop and become proficient with
the skills that are needed to become a productive professional, and to value learning.

The beliefs that the respondents had about athletic training education also fell into four
different themes: what is taught in the classroom must be reinforced by bridging the gap
between theory and practice; proactive students who take an active role in their education
have a more meaningful learning experience; athletic training students currently are not
getting enough clinical experiences; and athletic training students must experience a
variety of clinical settings.

The next section addresses the third and final research question regarding the
characteristics of the socialization processes that the “excellent” clinical instructors
experienced.

Research Question 3

The third research question addressed the characteristics of the socialization processes
that these “excellent” clinical instructors were exposed to on their way to becoming
“excellent”. This section re-introduces the concept of professional socialization and
explores the socialization processes that these “excellent” clinical instructors underwent
in their undergraduate and graduate experiences and once they entered the profession as a
professional. I discuss the anticipatory socialization that molded and shaped the
respondents and specific examples of anticipatory socialization events. The academic
coursework these individuals were exposed to is outlined, followed by a description of
the professors the respondents encountered as the profession evolved from amale-

dominated field to one where females also are in the classroom and athletic training

room. Positive organizational socialization experiences are described, followed by

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negative organizational socialization experiences the respondents encountered in the job
setting.

Research question 3 also explores the experiences the respondents wish they had as
they developed into athletic training professionals. The experiences desired of the
respondents included more formal academic coursework, more training and exposure to
educational methodologies, and a better understanding of the new competencies that
today’s athletic training students need to demonstrate.

Professional Socialization

Sabari (1985) divided the preparation of becoming a professional into two segments:
the formal academic preparation and a period of clinical training. The culmination of the

academic and clinical training, in which the individual learns the professional skills,
values, attitudes and behavior norms is termed professional socialization (Pitney, Iisley &
Rintala, 2002, p. 63). Professional socialization includes both anticipatory and
organizational socialization. “Anticipatory socialization includes aspects of socialization
before entering a work setting or organization, whereas organizational socialization
entails processes that occur after entering the work setting or organization” (Pitney, Iisley
& Rintala, 2002, p. 63).

Socialization processes are key components in an individual’s transition from student
to a contributing professional. The rest of this section explores the anticipatory and
organization socialization processes that have shaped and molded the respondents.
Anticipatory Socialization

Anticipatory socialization includes experiences and knowledge acquisitions that occur

during a student’s preparation to become a professional. Pitney, Iisley & Rintala (2002)

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described anticipatory socialization as those aspects of socialization that one encounters
prior to entering the work setting. An individual learns to become a member of a
particular group of which he/she does not yet belong. It is during this preparation phase
that athletic training students are taught how to be athletic trainers, not only with
technical skills, but in their demeanor, communication, and thoughts. While many of the
psychomotor skills required of an athletic trainer are related to the CAATE Standards,
other skills are not addressed by the accrediting agency at all. Omitted lessons from the
curriculum include how to set up for games and practices, what to do on road trips, and
how to relieve stress.

My discussion of the anticipatory socialization processes of the respondents is divided
into the following categories: a description of the overall undergraduate socialization
experience; specific examples that the respondents believe have shaped them in one way
or another; a description of the formal coursework the respondents undertook; and finally
a description of the teachers that taught the respondents and the introduction of females
into athletic training education.

Undergraduate Anticipatory Socialization. As stated several times in this dissertation,
six of the seven participants initially attended an educational institution that sponsored an
internship program. One of the programs was an internship program until receiving
Commission on Accreditation of Allied Health Education Programs (CAAHEP)
accreditation while the participant was in his second year. The seventh participant
attended a NATA accredited institution for his undergraduate degree then, attended a

graduate program that sponsored an undergraduate internship program. While this

program was NATA accredited, Respondent 7 reported that athletic training students

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performed athletic training duties without direct supervision. The undergraduate
internship programs had limited formal academic work, but the clinical component
required many hours, up to 1,800 observation hours at one time. Respondent 7 did not
attend an internship program, but accrued “mega hours” in the range of 2,5 00 to 3,000
hours.
Many institutions simply did not have the appropriate athletic training staff to meet their
medical responsibilities. Respondents 3, 4 and 6 reported that when they were
undergraduate students, their undergraduate institution employed two certified athletic
trainers. This forced their athletic departments and athletic training staff to rely on
athletic training students to cover athletic practices or travel to athletic events
unsupervised. When these “excellent” clinical instructors were undergraduate students,
they were assigned to an athletic team and were responsible for all aspects of that team’s
medical coverage. They reported early in the fall, often before the start of school for pre-
season football, volleyball, cross country and tennis practices. They stayed with their
assigned team over breaks and were required to stay past the end of school if their
assigned team continued playing after graduation.
The respondents had amble opportunities as undergraduate students to get their hands
“dirty” in the field of athletic training and gain “hands-on” experiences.
Essentially we were responsible for just about everything, pre-practice, pre-game
preparation, treatments of student athletes, rehab, injury evaluation. Then we
would consult with one of the Certifieds (Athletic Trainers) on board to determine

whether or not someone needed to go to the hospital or to see one of the

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physicians. . . Essentially we were working within the role of what a certified

athletic trainer would work in (Respondent 1).

Respondent 6 continued by stating:

students ran the facility (Respondent 6).

The athletic training students in these internship programs essentially functioned as
substitute staff, in an environment that was less formal than it is today.

The level of sophistication was much lower. It was a lot of emergency care. If we
had somebody doing something for rehab, we knew what they were supposed to
do. I mean it was ice and heat and stretching and taping. . . We were essentially
taping machines for football (Respondent 6).

The availability of vast experiences for these “excellent” clinical instructors when they
were students played an important role in their development as health care professionals
and clinical instructors. They practiced and perfected their craft, and often made
decisions on their own without supervision. Medical students and allied health students,
in current educational programs lack experience and critical thinking skills, a situation
defined as “hyposkillia” or a “deficiency of clinical skills” (Fred, 2005, p. 255).

By definition, those afflicted are ill-equipped to render good patient care. Yet,

residency programs across the country are graduating a growing number of these
“hyposkilliacs,” physicians who cannot take an adequate medical history, cannot
perform a reliable physical examination, cannot critically assess the information

they gather, cannot create a sound management plan, have little reasoning power,

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knowledge and skills when dealing with actual patients (Knight, 2008, p. 79).

The roots for “hyposkillia” haven’t been identified yet, but Dr. Fred believes that

One of the ATCs was also a physical therapist. Both were very knowledgeable
and big on professionalism. Athletic trainers at that time wore white pants. It was
drilled into us that this was a profession and we were going to be professionals.
We took a lot of pride in ourselves. There was a lot of pride in being here,

because if you didn’t tow the line, you’d be shown the door pretty quick

(Respondent 6).

 

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Respondent 2 recalled the first time he felt his first positive valgus test for a medial
collateral ligament tear.
I know who it was on. I know what training room I was in. I know everything that
happened. When you can see what’s wrong, make that assessment, get someone
back to activity, I think those are great positive experiences (Respondent 2).
Respondent 3 realized that not every athletic training student learned the skills he
acquired when he was an undergraduate student. Respondent 3 was exposed to and
became fairly proficient with manual therapy skills (joint mobilizations, proprioceptive
neuromuscular facilitation, muscle energy and manual resistance exercises) during his

undergraduate education. Athletic training students from other institutions were not
trained in these skills.
I didn’t know that a lot of the skills I was being taught as an undergrad were not
being taught in other athletic training programs. . . I feel very fortrmate to have
come out of my undergraduate program with a lot of knowledge and skills that a

lot of people didn’t have (manual therapy skills). . . The thing that affected me the

most was that I had different skill sets than others from other programs
(Respondent 3).

Respondents 4 and 5 talked about the mistakes they made during their anticipatory
socialization process. Respondent 4 was in the high school setting for his graduate work.
This setting helped him to mature as an athletic trainer because he was the only person
making decisions. “If I screwed up, it was my fault and the kid could maybe get hurt

because of me” (Respondent 4). While Respondent 4’ s scenario was a “what it” scenario,

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Respondent 5 remembered one instance in particular in which he made a mistake when

he gave an athlete medication.
One instance was with over-the-counter medications where an athlete had a
concussion and asked if they could have some ibuprofen. I didn’t know they had a
concussion. I didn’t check with anybody and gave the kid some ibuprofen. I got
yelled at big time for that. I learned to communicate with others and the athlete,
and to get a previous history. I also know when to use and not use medications. . .
I had an internship at (name withheld) University. I knew how I wanted to do
things and then would check with my supervisor to double check and to make
sure. As a student or intern always ask, because my mistake will be their mistake.
So always ask (Respondent 5).

Respondent 7 remembered the first road trip he took as an undergraduate. In graduate
school he recalled the sport of gymnastics really scaring him because of the potential for
danger and major injury, and with cyclists in the velodrome. Cycling really shaped how
Respondent 7 reacts to injury because, in the velodrome, if one athlete goes down, all 15
will go down. He learned to prepare for disaster and triage.

Some anticipatory socialization processes that the respondents experienced were
described in this section. These socialization processes included attending an internship
program, acquiring many hours and clinical experiences. In addition, specific experiences
were mentioned that played a significant role in the development of these individuals as

professionals.

Formal Coursework. What about the academic preparation of these individuals?

Were they thrown into the athletic setting and asked to perform, or were they given the

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academic tools they needed to function as medical professionals? While the individuals
interviewed had very positive comments on the experiences they acquired, most
expressed a desire for better academic preparation heading into the profession. They
sensed a lack of academic preparation may be influencing their actions as clinical
instructors. Respondent 2 recalled taking core classes such as anatomy and physiology,
chemistry and kinesiology, and basic and advanced athletic training classes. He received
no formal training in modalities, therapeutic exercise or administration. Respondent 3
also recalled taking just two athletic training courses. Respondent 1 outlined his athletic
training curriculum.
We had a few formal classes that we actually went through. I think we had to
pickup eight or nine additional credits. It was just a small blurb in the bulletin if
you wanted to do an athletic training internship. A lot of your courses were
already covered through Health and Fitness Management or PE or Health
Education. Your physiology, chemistry, anatomy and a core of athletic training
courses which was a rehab course, a modalities course, administration course,
prevention and care. I’m hard-pressed to come up with another one (Respondent
1).

Most all the respondents expressed a desire to have more formal coursework in the
field of athletic training and a course or two in educational methodologies. This point will
be expanded later in this paper. Who provided the instruction, limited though it was, for
our interviewees as undergraduate students? The next section will explore this topic.

Best Teacher In College. “Who was your best teacher in college?” There were a

variety of responses as to the topics that these individuals taught. Most subjects covered

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the sciences, and few were actually in the athletic training discipline. The courses
included: kinesiology, biomechanics, nutrition, human anatomy and physiology, and
rehabilitation. When asked what made these teachers so good, the responses included the
ability to be open with the students and the expectation that students who put forth efi‘ort
would get something out of the course. These teachers made things practical and had the
experience, expertise and competence to relate their personal experiences to the materials
being covered in class. This helped “humanize” the material, as stated by Respondent 2.
Other respondents stated that great teachers had a “passion” for teaching, and were

very logical and detail-oriented in their teachings. Respondent 3 recalled his best teacher
in college in this way:

Bob was quiet, but he went into a lot of detail. He would be one of those that if

you asked him what time it was, he’d tell you how to build a watch. He’d go into

a lot of detail (Respondent 3).

Respondents noted that their best teachers clearly communicated expectations as to
what needed to be done in order to succeed in the course. Respondent 6 felt that
expectations are not as clearly communicated today and a better job needs to be done,
especially because more of today’ s athletic training students have to work in order to pay
for their schooling and have less time to focus on school.

Let’s have performance objectives, learning objectives written down, then general
expectations; participation, grading, examination structure in an organized fashion
so students know what their getting into. Seventy-five percent of students have

jobs at this institution. You can’t be changing things at the last minute on them

(Respondent 6).

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Another characteristic of great teachers was the successful integration of skills from
the classroom to athletic training room. These instructors demanded perfection and
required students to envision the entire picture of the lesson and how it would impact
their role as athletic trainers. Respondent 7 recalled his best teacher opened the
respondent’s mind to treating an ankle injury. “It’s more than just treating an ankle, and
throwing an ice bag on it, and treating with modalities.”

Respondent 6 used the teaching techniques of his best teacher in college. In his

 

dealings with athletic training students, Respondent 6’s current philosophy is that a

logical progression in elementary concepts needs to be presented, built upon, deve10ped

into more advanced concepts, and integrated in practical use. He described a lesson:
In my modalities class, you present some basic physiological principles, then
basic scientific principles and then you’re going to start bringing in more
advanced principles of both and advancing those on how they interact with each
other and what they do. So after the end of the course they’ve got that element in
there and then you integrate that with clinical practice and clinical decision
making (Respondent 6).

Respondent 4 incorporated problem-based learning into his teachings with athletic
training students, who were given a scenario or case study. The athletic training students
are given limited information of the situation and have to identify what things they need
to know in order to define the problem, what strategies they can employ to correct the
problem and what they may need to do in the future to prevent the problem. This is done

in a group setting first, so ideas can be discussed and evaluated. Then the process is done

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individually. Athletic training students piece together the full picture, taking an abstract
problem with many possible solutions and coming to an educated justifiable resolution.
Male Teachers and the Advent of Female Teachers: A Time Of Transition. While the
focus of this paper is not the type of instructor a student had, it must be noted that the
elder interviewees were socialized into the athletic training profession when the field was
male-dominated, and the addition of female ATCs and female athletes interacting within

the athletic training room changed the way things were done. Respondent 6 described the

 

era prior to Title IX:
I had some great instructors. All were male who went to school on the GI. Bill
after World War II or Korea, and then went out and taught and got an advanced
degree. When they were teaching at the high school or elementary level, [they]
eventually worked their way into a college teaching job. They didn’t come out as
collegiate instructors. They didn’t just go to school. They really had the practical
experience. Today people are getting a lot of theory from a lot of theorists, but
they haven’t sat in there and done the job (Respondent 6).

The three elder respondents were undergraduates in the 19703 and ‘805. All had male
teachers predominantly in the classroom, and their clinical instructors were 100 percent
male. These individuals experienced small athletic training staffs usually with two ATCs.
The athletic training room when Respondent 7 was an undergraduate became co-
educational his junior year. Respondent 6 described the influx of women into the field
and the addition of the first female ATC at his undergraduate institution:

There were two staff ATCs when I was an undergraduate, both were male. The

women’s athletics were out of the physical education department. In January of

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merged with athletics. We were the first school to hire a female ATC in the

conference in 1975. Sports were growing, females were coming into the

professional socialization is termed organizational socialization. Organizational
socialization includes the processes that occur after the individual enters the work setting

(Pitney, Iisley & Rintala, 2002). This section describes the organizational socialization

experiences as reported by the respondents.

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Organizational Socialization Experiences.
I had a student—athlete with some significant mental illness and had to react to that
on a road trip, and those are things I don’t think we necessarily are educated in
that well. And at the time you have to make a decision and you hope you make
the right one. You realize this decision that I make may affect this kid for the rest
of his life, by whatever we are going to do today and then having to call the
parents and tell them what happened. That was a rough 36 hour period. That
really isn’t related to anything on-the-field. But again, those are all things that
happen with the job (Respondent 1).

The above experience described by Respondent I would not typically involve the
athletic training student, as athletic training students aren’t mature enough to deal with
some situations (Respondent 2).

Respondent 2 recalled experiences drawn from his experiences with The United States
Olympic and Para-Olympic athletes and their extraordinary human drive and desire to

succeed. Respondent 3 also commented on his international experiences while traveling
with U. S. national teams.

In Yugoslavia we had one bucket of ice for the whole US. delegation, and I don’t

know if we had any modalities to be honest about it. So I was glad that I was able
to do hands-on skills. What are you going to do? You gotta do something. I could
do joint mobs and PNF (proprioceptive neuromuscular facilitation), muscle
energy or whatever, and I could do some of that stuff. That influenCed my career a

lot, being able to do those skills (Respondent 3).

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In the above example, it was the skills and knowledge that Respondent 3 acquired
during the anticipatory process that were then used in the development of organizational
socialization.

Respondents 2 and 7 revealed that the athletic trainer’s primary purpose was to
provide medical care, but to see the athletes and teams practice day in and day out and
succeed also provides them with satisfaction. “It’s never been about the game, but
working in the athletic training field. The victories and championships don’t really
matter” (Respondent 7).

I’ve been part of national championship basketball teams, which is an incredible
experience. You go through all the pre-season, all the season, all the daily
practices and the injuries. There are ups and downs in this field and some days it’s
just overwhelming and there seems like there’s more downs than ups. To be a part
of the success, not that winning is the whole reason we do this obviously, to be a
part of a National Championship and see the success and see that this is what
they’ve been striving for and you’re a part of it. I think it’s exciting and it’s
rewarding and it’s fun to be a part of that (Respondent 2).

A tragic event that requires the implementation of an emergency action plan can allow
an individual to come away with positive thoughts and feelings. This was the case for
Respondent 4 when the emergency action plan was set to action at his institution during a
summer youth camp.

One camper caught a forearm to the head and almost died. We had the right steps
in place and did the right things. It all fell together right because we did it right in

the past and knew the emergency action plan. I had a flood of emotions

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afterwards. You do what you need to do at the time and 20 minutes later the
camper was in surgery. Afterward you really think about it (Respondent 4).
Every athletic trainer hopes that they never have to initiate the steps of their
emergency action plan. But if they do, it is nice to know that everything ran smoothly.
Respondents 6 and 7 developed their own athletic training programs at their first jobs
after graduation. Respondent 6 was employed by a small college and Respondent 7 had a
job at a high school. Both established programs using their own athletic training students
and educated these budding healthcare professionals.
I literally made an athletic training room. That is, I laid block and mixed mortar. I
got light fixtures and electrical work from some guys in the physical plant for a
couple cases of beer. That was really rewarding. . . The thing that influenced me
more than anything was having my own students where I was in charge. I had the
responsibility to help these people learn my profession and try to transmit my
enthusiasm to them. That was both a challenge and rewarding at the same time
(Respondent 6).
Respondents described some of the socialization experiences they encountered once
they secured a position as an athletic trainer. Since they were employed, these
experiences can be described as organizational. These situations provided the
respondents with additional experiences in which to practice their craft. These situations
placed the respondents in unique situations where they had to make decisions and to
utilize the skills they have acquired.
Negative Organizational Experiences. With the joys and tribulations that athletic

training professionals may encounter, negative experiences also shaped these individuals.

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The amount of time athletic trainers spend at work and the variety of individuals the
athletic trainer must answer to, lead to burnout.
Negative experiences are the stressors in this field, and the fact that often times
you feel like you’re in a no-win situation because you’re trying to please coaches,
athletes and often times parents. And you’ve got students and you’ve got the
athletes themselves, you’ve got athletic training students. You’ve got all these
populations that want something from you. Not all of these people have realistic
goals or expectations, and you’re trying to please them and have to deal with the
repercussions when you can’t. . . It’s frustrating. It’s all the same old stuff. I mean
the hours, all this stuff, it’s tiring. It’s a job that takes a lot out of you. There’s a
lot of emotion, highs and lows everyday. I try to get up every morning and be
ready for anything. Just so you don’t let it drive you crazy (Respondent 2).
Another negative topic that affected the organizational socialization of these
individuals involves program administration. Respondent l fears writing reference letters
for athletic training students who may perform poorly. What are the repercussions for the
individual who wrote the reference letter, especially if the certified athletic trainer is
interested in a future position at that institution?
I’m very hesitant to write a letter of recommendation and put my name with a
student unless I know they’re not going to embarrass me and they’re going to do a
good job wherever they’re going, be it for a job, a GA position. We had a student,
a GA position, starting fall of ’08 and again, you know, write the letters, make
phone calls, not really go out on a limb, but you know, paint a good picture for

this guy, cause he did a good job in the two years that he worked with me. And

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get a phone call two weeks ago, he decided not to take the GA position. I’m real
hesitant to put my name with these kids right now. Because I don’t know,
somewhere down the road, let’s say I want to go to that institution for a job and
all of a sudden, well you signed for Joe Smith and then he ended up bailing on us,
so you know what, we don’t want you either. And that’s a concern of mine. And
that’s got me thinking bad things (Respondent 1).

Another concern is when individuals responsible for the accreditation of the ATEP do
not see the process through to completion, leaving others the responsibility to pick up the
slack, also contributes to burnout and a negative experience.

Finally, for these “excellent” clinical instructors who accrued so many hours and
experiences as undergraduate students, there is frustration with the current educational
model limiting athletic training students’ exposure to clinical experiences. The
respondents were trained one way, and today’s athletic training students are educated a
different way as described by Respondent 6.

The frustration that I think a lot of athletic trainers feel with the current
educational model is there is not enough hands-on. It doesn’t seem like the
students are getting, they’re certainly not getting the experience I had. They just
don’t get enough opportunity to practice the profession (Respondent 6).
Summary
This section described professional socialization experiences of the “excellent”
clinical instructors. Professional socialization was divided into two components:
anticipatory and organizational. Anticipatory socialization consists of skills, knowledges

and attributes that one acquires prior to entering the workforce. Organizational

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socialization includes attributes that one develops after entering the workforce. Examples
of the anticipatory and organizational socialization experiences that shaped how the
respondents think and act were provided. The next section examines the experiences that
the respondents wish they had had.
Desired Experiences

The individuals interviewed for this research project mentioned the importance of
gaining and having experiences related to educational methodologies and formal
coursework. This section details the experiences they wished they had during their
preparation as athletic training professionals. The areas of deficiency fall into one of two
broad categories: a desire to have more formal training and the sense that many of the
individuals interviewed do not have a thorough grasp of the current competencies
required of CAATE institutions. The formal training involves additional coursework in
courses such as modalities, rehabilitation, administration, nutrition and psychology and
the inclusion of educational methodologies in their coursework. Many of the CAATE
competencies are new to the individuals interviewed, and they may be unsure of how to
perform these tasks properly, or evaluate athletic training students as they perform them.

This section focuses on these implied deficiencies, starting with a desire to have more

formal training.

A Desire for More Formal Academic Training

Five of the seven interviewees attended an undergraduate institution that sponsored
internships that prepared them to sit for the NATA Board of Certification examination.
One respondent started his career in an internship program, but the institution became

Commission on Accreditation of Allied Health Education Programs (CAAHEP)

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accredited during his undergraduate tenure. The seventh respondent attended an NATA
accredited program.

While all seven individuals reported a hands-on, experiential learning environment
where they acquired “mega hours” (Respondent 7), the academic course offerings in
athletic training education were limited in scope and breadth. Respondent 3 took only two
athletic training courses as an undergraduate: a basic and advanced athletic training
course.

We took the core classes, anatomy, chemistry, kinesiology and then we had basic

and advanced athletic training. At that point, we didn’t have any modalities or

rehab, or administrative classes (Respondent 2).

This was reinforced by Respondent 1, who stated:

The educational component was not much at that time. We had few formal classes
that we actually went through. I think we had to pick up eight or nine additional
credits. It’s just a small blurb in the bulletin if you wanted to do an athletic
training internship. A lot of your courses were already covered through Health
and Fitness Management or PE or Health Ed. Your physiology, chemistry,
anatomy and a core of athletic training courses which was a rehab course, a
modalities course, administration course, prevention and care. I’m hard-pressed to
come up with another one (Respondent 1).
The lack of academic courses could be due to the fact that the preparation of athletic
training students, according to Respondent 6, was a lot less formal than it is now.
Everything then was learned in the athletic training room, hands-on. Athletic training

students learned how to tape. They were “taping machines” (Respondent 6).

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The level of sophistication was much lower. It was a lot of emergency care. If we
had somebody doing something for rehab, we knew what they were supposed to
do. I mean it was ice and heat and stretching and taping. The level of
sophistication was still evolving at that point (Respondent 6).

Respondent 2 summed up his preparatory deficiencies by stating:

I would say more actual classroom learning. I think if I had a class in modalities,
that would have been beneficial. Modalities for sure. An administrative class
would have been beneficial. More in-depth rehab classes would have been
beneficial. . . I would have liked it if we would have had more emphasis in
nutrition and more emphasis on psychology, because those are two areas that are a
huge part of what we do on a daily basis (Respondent 2).

The topic of more training in educational methodologies is discussed next.

A Desire jbr Educational Methodologies
I’ve always had a role in education. There’s never been a time when I have not.
There has never been a semester when I haven’t been an instructor at some level. .
. I was prepared as a teacher. . . I understood when I came into the profession I
was going to be teaching the profession. That was part of the expectation when
you entered the profession (eldest and most senior of the respondents, Respondent
6).

The above statement introduces this section because of the message it portrays.
Respondents 6 and 7, through their academic careers, have become certified as teachers

and have been trained as teachers. Respondent 6 was certified to teach secondary physical

education, psychology and sociology. Respondent 7 was certified as a K-12 special

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education teacher and has since gone on to receive his Ph.D in kinesiology and still
practices as a clinician. He is not a full-time faculty member. They have been joined by
Respondent 3 who also earned his Ph.D. in kinesiology and still practices as a full-time
clinician, teaching one academic course a year. Respondent 3 did not acquire teaching
certification through his master’s degree, but received some pedagogy training while
doing Ph.D. work.

The other respondents expressed a desire to have more training in educational
methodologies and strategies, and felt that the additional skills would help them guide
athletic training students under their supervision (Respondents l, 3 & 4).

When we talked about the education, formal training in education, I’ve got none.
My bachelor’s degree is basically a combination of Health Ed and PE. There’s
very little as far as the theory of education and how to go out and teach. I think
that’s one thing that if I would have had that, I could do a better job with our
students (Respondent 1).

Maybe more experience with lesson plans early on or how to time so how do you
know it’s going to go an hour or whatever, this topic, how to get it in the
timeframe I need to get it in to, the content. I think that’s something you learn
over time, is how you’ve got twenty minutes, you know you’ve got a lesson plan
that’s going to continue on in the next class or not or do you really want an hour
and twenty minutes. And some stuff you can continue that’s fine. But some stuff
you want done that day. You really don’t want to run over that day, it’s not

continuous, it make it disconnected more I think (Respondent 3).

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While many of the respondents admit wanting more training in educational theories
and methodologies, Respondent 5 had no desire to be an educator and wants only to

provide healthcare services to the elite athlete. His sentiments are summed in the

following statement:
I don’t want to be the educator. But I work at a college and people look at me as

an educator. I am here because I want to take care of the student-athlete. I don’t
have any wish for the teaching aspect at all (Respondent 5).
Respondent 5 ironically had the highest rating from his program director for his

institution and the third highest rating of the seven interviewees from the program

directors overall.
This section examined the experiences that these “excellent” clinical instructors wish

they had had in their academic preparation. These deficiencies focused on a desire to
have more formal academic training pertaining to the field of athletic training with
additional courses in modalities, rehabilitation and administration, with a second focus on
some type of training in educational methodologies and theories. The next section

focuses on the new competencies and skills that are continually being introduced to

ATEPs that are unfamiliar to the clinical instructors evaluating them.

New Competencies Abound

Strohschein, Hagler, & May (2002) expressed a concern that students and new

practitioners often perceive an inconsistency between theory and practice. Strohschein,
Hagler & May (2002) cited an example of a realistic dilemma: “As education programs in

the United States and Canada move toward graduate degree entry level, there may be

some apprehension on the part of clinical educators with an undergraduate degree who

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are expected to provide supervision for graduate students” (p. 4). This phenomena is

currently presenting itself in the area of athletic training education where new graduates
are functioning as clinical instructors who are deficient in clinical skills and well-
established clinicians are expected to determine proficiency of skills and competencies
that may be unfamiliar to them. The interviewees felt that they did not grasp the new
competencies that have been added to athletic training education since they graduated.
An example being the concept of joint mobilizations and the use of the convex-concave
rule as related to the use of manual therapy and mobilizations (Athletic Training
Educational Competencies 4th Edition, 2006, p. 30). And since these individuals work in
the clinical setting and not the academic, they receive very little feedback on what the
new competencies are and how to properly perform them. This section deals with the
clinical instructors’ frustration with evaluating clinical proficiencies about which they
may know nothing.

Some of this fi'ustration stems fi'om the fact that the respondents do not know when
new skills and theories are introduced in the athletic training education curriculum. “Kids
have a better knowledge base and I have to stay current,” stated Respondent 7. Students
are assigned to clinical instructors and it’s “here you go, here is a student, teach them.” It

is left up to the clinical instructor to find out, can this kid tape, can this kid do an

evaluation or can’t they. This is illustrated by Respondent 3:

I don’t know for sure what they’ve been taught or not taught, or what they don’t
know. I don’t know where to begin. Because sometimes you just don’t know

where to begin, because you have so much knowledge that they don’t have yet

(Respondent 3).

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Respondent 3 ’5 statement is further supported by Respondent 2:

There are classes that they take that I haven’t taken, and it’s hard to necessarily do
it because you don’t know what they (the faculty) are teaching. Ideally, if we
could sit in on every class the students take and know what they’re being taught,
that would be beneficial. But at the same time, that’s not necessarily realistic for
us to sit in on all those classes at the same time as well. . . I think sometimes
having a better understanding of what exactly they’re being taught in the
classroom setting would probably benefit us (Respondent 2).

Not only are the clinical instructors frustrated that they are not aware of what is being
taught in the classroom, they are frustrated with the clinical competencies they are asked
to evaluate. Some of these competencies the clinical instructor has never seen or heard of.
Nevertheless, they must determine if an athletic training student is proficient. Instructors
also question the practicality of some of the special tests and skills that the athletic
training students are required to perform. A proficiency may state an athletic training
student has to perform a knee evaluation and check all boney landmarks, all soft tissue
palpations, all manual muscle tests, all neurological checks and all special tests. In
reality, many of those procedures will not be done on 90 percent of knee evaluations. The
student has to learn the process. The clinical instructors want them to learn “real world”
applications. If an athlete gets hurt in a game, a complete evaluation will not be given to
that athlete on the field. The injury site will be evaluated and an on—the-field diagnosis

will be made with five to six special tests, not the 40 or so the educators are saying are

necessary. This point is illustrated by Respondent l:

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My knowledge in what I actually learned as far as athletic training goes was based
on five or six courses through an internship program. We’ve got students that
come to us with proficiencies, especially when we start getting into some of these
special tests, I’ve got no idea. I’ve never seen them before. And that gets
frustrating. Then we’re supposed to check these kids off on things, and I have no
idea what they are. Or if I have to sit down and look at their book before I can go
through it with them to determine what are we actually looking at here? It goes
back to, you may learn 40 different special tests for the knee compared to the
seven that I do on a regular basis. And if you do these seven, you’re probably
going to be okay. So I think that is the integration between what they’re taught in
the classroom and then the real world. It’s half-time at a football game, I don’t
have time to do a whole assessment here of the knee. I need to figure out whether
or not this kid’s still got an MCL, ACL and their meniscus intact. That is all I
need to do. I don’t need to do all these other things (Respondent l).

A majority of these “excellent” clinical instructors received on-the-job training
through internship programs and athletic training education is continually evolving,
leaving many clinical instructors feeling frustrated due to the addition of new athletic
training competencies. Either these clinical instructors were not taught the material when
they were athletic training students or they weren’t informed of new competencies when
they were implemented. The combination of these issues with their perception of what
should happen in the “real world” when an athlete gets injured, as Opposed to the

“academic world,” has left many clinical instructors disheartened with athletic training

education.

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Research Question 3 Summary

The third research question focused on the socialization processes that these
“excellent” clinical instructors experienced to become “excellent”. The aspects of
professional socialization were described, and the components of anticipatory and
organizational socialization detailed. Anticipatory socialization experiences, those
experiences prior to entering the workforce, that were common to all the interviewees
included many hands-on activities and numerous clinical time in the athletic training
room. While most interviewees attended an internship program during their
undergraduate preparation, they worked with small athletic training staffs that were
mostly male and had little academic coursework as it pertained to the athletic training
profession.

Organizational socialization experiences, or those socialization experiences one
encounters after entering the workforce, were also described, followed by an outline of
experiences these individuals wish they had had. The interviewees regret not having more
coursework in the field of athletic training and educational methodologies, and they
expressed a sense of frustration in not being up-tovdate on current competencies required

of today’s athletic training students.
Chapter 4 Summary

Three questions framed the structure of this research:

1) What are the characteristics of ATCs acting as clinical instructors in the

Commission on Accreditation of Athletic Training Education Programs

(CAATE) accredited institutions?

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2) What were the educational goals and beliefs towards athletic training
education associated with excellent clinical instructors in the CAATE

accredited athletic training education pro grams?

3) What were the characteristics of the socialization processes they experienced
to become excellent clinical instructors?

Regarding research question 1, five themes emerged. First, the excellent clinical
instructors interviewed overwhelmingly attended an internship program for their
undergraduate education. Attending internship programs for their undergraduate
education thrust the interviewees into practicing athletic training skills since certified
athletic training staffs were small, the interviewees were able to accumulate many clinical
experiences and practice hands-on skills. Second, the respondents each earned advanced
degrees which assisted them in clinical decision making. They also taught
undergraduates, which helped them become familiar with accreditation standards and to
distinguish between sports medicine and athletic training. Third, the respondents had job

experience prior to their present position. Fourth, the respondents classified themselves as

having good clinical skills, and fifth, respondents reported that their primary
responsibility was to the department of athletics.

Research question 2 pertained to respondents’ feelings toward athletic training
education. Respondents were asked to reflect on their best teacher in college and the
meaning of learning. The educational goals that respondents had for athletic training
students included: passing the certification examination, acquiring clinical experiences,
preparing for the workforce and learning to value learning. The respondents’ beliefs and

assumptions towards athletic training education included: training should bridge the

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“gap” between classroom and clinical; pro-active athletic training students receive a
better education and experience; athletic training students need more clinical experiences;
and athletic training students must see different aspects of the athletic training profession.
Research question 3 examined the anticipatory and organizational socialization
experiences of the respondents and concluded with a discussion of the experiences they
wished they had had. Their anticipatory socialization experiences included their
undergraduate education, their coursework, and the influence of their professors.
Organizational socialization experiences included admitting student-athletes for
psychological evaluation, working national events (Olympic and Para-Olympic) with
limited resources, activation of an emergency action plan, being part of championship
teams and development of an athletic training room from scratch. Negative experiences
focused on how athletic trainers cannot please everyone as coaches, players,
administrators and parents all want something different from the athletic trainer to
frustration with the current educational model. Respondents also indicated they would
have appreciated more formal coursework, training in educational methodologies, and the

opportunity to develop a better grasp of the educational competencies required by the

CAATE.

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CHAPTER 5
DISCUSSION

Three research questions formed the basis for this research project. These research
questions were:

1) What are the characteristics of ATCs acting as clinical instructors in
Commission on Accreditation of Athletic Training Education Programs
(CAATE) accredited institutions?

2) What were the educational goals and beliefs towards athletic training
education associated with excellent clinical instructors in the CAATE
accredited athletic training education pro grams?

3) What were the characteristics of the socialization processes they experienced
to become excellent clinical instructors?

Chapter 5 is divided into four sections. The Summary of Findings outlines the
research findings. This is followed by a Discussion of Key Points,
Implications/Recommendations for Practice, and Future Research Suggestions.

Summary of Findings
The basic findings that emerged from this research concerned the ideas and processes
that approved clinical instructors (ACTS) and clinical instructors had pertaining to athletic
training education. This summary is divided into three sections pertaining to the three
research questions.
Findings for Research Question I : Characteristics of ATCs Acting as Clinical Instructors
Five themes emerged in the response to Research Question 1: 1) the respondents

attended an internship undergraduate program where they acquired vast clinical and

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hands-on experiences; 2) the respondents acquired an advanced degree which allowed
them to gather additional experiences within the profession; 3) the respondents had job
experience prior to their current position; 4) the respondents all consider themselves good
clinicians; and 5) the respondents’ primary duties are to the athletic departments for
which they work and their secondary duties are to the academic departments to which
they act as clinical instructors.
Findings for Research Question 2: Goals and Beliefs Regarding Athletic Training
Education
Goals in Athletic Training Education
Four goals emerged when the clinical instructors were questioned about their role in
athletic training education. The clinical instructors want to: 1) prepare athletic training
students to take their Board of Certification Examination; 2) give athletic training
students as much practical experience as possible; 3) prepare athletic training students to
immediately enter the workforce; and 4) to have athletic training students value learning.
Perceptions Regarding Athletic Training Education

Research Question 2 then explored the perceptions the respondents had towards
athletic training education and four main ideas emerged.

The first was that the clinical instructor’s purpose is to bridge the gap between theory
and practice. The second idea was that athletic training students who are pro-active in
their educational pursuits receive a better education than those students who are passive.
A third idea was that athletic training students need more clinical experiences. Finally,
athletic training students should be exposed to a variety of clinical settings. Each clinical

setting, including lower body intensive (i.e., basketball and track), upper body intensive

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(i.e., volleyball and tennis), equipment intensive (i.e., football and hockey), and general
medical (i.e., physician’s offices, physical therapy clinics), offers unique experiences
with different clientele.
Findings for Research Question 3 .' Socialization Processes Experienced by Excellent
Clinical Instructors
The clinical instructor participants identified and described their anticipatory and
organizational socialization experiences. Additionally, they identified the experiences
they desired. These included: a desire for more formal academic training in athletic
training related classes; instruction in educational methodologies; and knowledge of new
competencies required of athletic training students.
Summary
This section briefly summarized the findings from the three research questions central
to this study. The findings highlighted key elements in the development of the “excellent”
clinical instructors.
Discussion of Key Points
Two key points emerged from this research project. First, although the participants in
this study obtained more hands-on clinical experiences as compared to current athletic
training students, neither group was exposed to pedagogical strategies or methods in the
didactic portion of their athletic training education. Therefore, clinical instructors of the
future may find themselves lacking not only sufficient clinical experiences but also
sufficient teaching preparation. They have less clinical practice time than in past years
and have little preparation concerning how to effectively implement and deliver athletic

. training content knowledge to athletic training students in their classrooms. Second,

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ACI/Cls feel ill prepared evaluating athletic training students’ clinical proficiencies.
Their education did not address evaluation techniques nor have they been exposed to
many of the current clinical competencies.

The field of athletic training (like other allied health fields, such as physical therapy,
occupational therapy and physician’s assistants) is feeling the tension between theory and
practice in the education of prospective professionals in their fields. How much theory
should be balanced with practice to prepare the student to enter the profession is the thin
line that needs to be navigated.

In athletic training education and this project in specific, it appears that the clinical
instructors think of effective teaching as effective clinical practice. When they reflected
upon their interactions with athletic training students, the respondents did not give much
thought to what Shulman (1986) calls pedagogical knowledge and pedagogical content
knowledge. Pedagogical knowledge pertains to knowledge of basic teaching skills, and
pedagogical content knowledge concerns deep knowledge of how to teach effectively
within one’s particular field. Recently graduated athletic training students who become
clinical instructors have had more exposure to subject matter in their courses than their
counterparts who graduated fifteen or more years ago, but less clinical experience than
their senior counterparts. Furthermore, athletic training education today does not address
basic pedagogical issues nor how to teach specific content knowledge. Thus, the

preparation of athletic training educators today results in professionals who not only have
limited clinical skills but also limited knowledge and skills as teachers.

In summary, athletic trainers used to have much opportunity for clinical practice, but

no training on how to teach those clinical skills. Current athletic training students and

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recently graduated athletic trainers have less clinical experience coupled with no training
in educational methods; however they have had more exposure to subject matter in their
courses. These individuals are then going into universities to educate athletic training
students, although they have limited preparation to do so. This trend is occurring not only
in athletic training education, but also in other allied health education. Lack of attention
to preparation in clinical practice has been termed “Hyposkillia.”
Hwoskillia
“Hyposkillia,” a term coined by Herbert Fred MD. (2005, p. 55), describes the lack of

skills that today’s medical students have in their dealings with patients. Dr. Fred believes
that physicians of today do not take the time to get to know their patients, and their
clinical skills wane due to their reliance on technology to diagnosis an illness. Dr. Fred
believes that physicians today do not take the time to perform a complete clinical
evaluation. While an illness or injury could possibly be diagnosed without specialized
testing, a diagnosis is not made until all the technological tests have been completed.
Many of the respondents who participated in this research commented on the lack of
practical experience possessed by today’s athletic training graduates.

This is not a trend isolated to the field of athletic training, but a trend throughout the
medical education community. Dr. Fred (2005) described the increasing number of
“hyposkilliacs” who are graduating from medical schools:

Physicians who cannot take an adequate medical history, cannot perform a
reliable physical examination, cannot critically assess the information they gather,

cannot create a sound management plan, have little reasoning power, and

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communicate poorly. . . They learn to order all kinds of tests and procedures but
don’t always know when to order or how to interpret them (Fred, 2005).
Dr. Fred’s comments are supported by Kenneth Knight PhD, ATC, in his editorial
regarding the critical thinking skills of recently-graduated athletic trainers:
Comments from many athletic trainers over the past few years convince me that
newly graduated athletic trainers suffer from a similar malady. Recent graduates
possess great knowledge and skills, but suffer from an inability to apply their
knowledge and skills when dealing with actual patients (Knight, 2008, p. 79).

Respondents 1, 2, 3, and 6 also commented on the lack of clinical experiences and
decision making skills that today’s athletic training students receive. This lack of
experience reinforces Dr. Fred’s and Dr. Knight’s theory of “Hyposkillia”.

What led to this lack of problem? Why did athletic training students in the past acquire
more clinical hours than students of today? Could it be due to the upgrading of the
profession? Could the professionalization of medical education be to blame? A
bachelor’s degree was all that was required to enter the field of physical therapy; that
requirement was changed to a master’s degree and now the entry point for a clinician in
physical therapy is a doctorate of physical therapy. The Doctorate of Physical Therapy is
a clinical degree basically requiring a student to acquire a four-year bachelor’s degree,
and then he or she must apply to physical therapy school. Once in physical therapy
school, the student is trained clinically to become a physical therapist. Nursing now
requires a four-year degree. The entry point for athletic training could change from a
bachelor’s to a master’s degree (NATA News, April 2009). Specifying requirements and

demanding more academic preparation elevates the professionalism of these fields,

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protects students, and limits the number of clinical hours expected from students but does
not educate these individuals in pedagogical issues or how to teach the content
knowledge they have acquired.

One major dilemma that has emerged in the field of athletic training education is that
of limited clinical experiences. Respondents 1, 3, and 6 felt athletic training education has
lessened the clinical experiences required by athletic training students, leaving an
unrealistic picture of the profession. The clinical instructors interviewed felt that athletic
training students need more clinical exposure to gain experiences and to hone their
athletic training skills.

According to 1.5 of the CAATE Standards for the Accreditation of Entry Level
Athletic Training Education Programs (revised 9-11-07), all requirements of an athletic
training education program must be based in course credit. This means that the clinical
hours athletic training students acquire for a course have to be stated in the syllabus. It is
recommended that the syllabus has an upper and lower limit for hours.

Section I 3.5 of the CAATE Standards for the Accreditation of Entry Level Athletic
Training Education Programs (revised 9-11-07) states that athletic training students must
be treated as any other student working on campus. Two common examples are utilized.
Work study students and student-athletes are limited to working 20 hours per week;
therefore the general rule of thumb is that athletic training students should work no more
than 20 hours per week in clinical placements. Some athletic trainers feel that this is an
injustice to the athletic training student because the real world of traditional athletic

training is not based on a 40-hour work week. The limits misrepresent the demands of the

profession.

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Athletic training students must be permitted relief days from clinical experiences,
even though the athletic trainer of a sport might not have a day off. Athletic training
students do not have to report early for preseason camp or stay over Thanksgiving,
Christmas, semester or spring breaks even if their clinical assignment may be actively
participating at that time. In contrast to the usual situation today, Respondent 2 reflected
back to his undergraduate experiences:

I think you were assigned usually to teams. At that time you were assigned more
to sports than to clinical instructors, and you almost always came back for camp,
so you were there (in the athletic training room or with that sport) all the time
(Respondent 2).

Clinical instructors (Respondents l, 3 and 6) complained that athletic training students
do not spend enough time in the athletic training room securing clinical experiences. This
contrasts with the experiences reported by the respondents where they spent many hours
in the athletic training room, practiced critical decision making, and utilized opportunities
to practice their athletic training skills.

Respondents 3 and 6 felt that the current educational model is too restrictive in
allowing athletic training students to accumulate clinical experiences and opportunities to
practice clinical skills. These deficiencies are seen in graduate assistants as well.
Respondent 6 commented on his frustration with the current educational model:

The frustration that I think a lot of athletic trainers feel with the current
educational model is there is not enough hands-on. . . . they’re certainly not
getting the experience I had. . . . They just don’t get enough Opportunity to

practice the profession (Respondent 6).

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Why the decrease in clinical hours? Some athletic trainers may say it is due to the
increased supervision requirements placed on clinical instructors of athletic training
students. The CAATE Standards protect athletic training students so that they are not
over-worked or placed in a litigious situation. However, allowing athletic training
students to act as a regular college students and have time off from clinical duties paints
an unrealistic picture of the traditional athletic training setting.

Since athletic training is so “clinically based,” as described by Respondent 4, the
knowledge and skills acquired in the classroom need to be put to practice and refined.
Many times this occurs in the clinical setting. The current Commission on Accreditation
of Athletic Training Education (CAATE) Standards for Accreditation of Entry-Level
Athletic Training Education Programs requires 75 percent of an athletic training student’s
clinical time must be under the supervision of a certified athletic trainer. While it is
important for athletic training students to be exposed to other allied health settings and
professionals, a minimum of three—quarters of their clinical time has to be spent with a
certified athletic trainer. Why this requirement? One reason may be that athletic training
students have to be socialized into the field of athletic training. The processes of
anticipatory and organizational socialization are continual. Athletic training students see
how athletic training faculty act in their professional environment and how athletic
training clinicians interact with each other, athletic training students and student-athletes.
What an athletic trainer does and how an. athletic trainer is supposed to act is constantly

reinforced to athletic training students. Is this how athletic trainers learn how to teach?

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Inadequate Preparation

Another key finding focuses on the fact that ACI/Cls feel ill prepared in evaluating
athletic training students’ clinical competencies. The individuals interviewed reported
feeling ill prepared evaluating athletic training students’ clinical proficiencies. Three
areas emerged that can be addressed concerning this feeling of inadequacy: l) The
classes the respondents’ took during their undergraduate education regarding athletic
training were few in number; 2) The respondents would like to have had coursework in
educational methods and strategies; 3) Many of the proficiencies that are required of
athletic training students today were not learned by the ACI/CIs who are evaluating them.
Thus, the ACI/Cls need to be educated regarding these changes as well as changes in
accreditation and athletic training educational reform.
Lack of Formal Coursework

The formal coursework pertaining to athletic training was limited when the
respondents were pursuing their education. Coursework usually consisted of some
anatomy and physiology, chemistry and kinesiology with a basic and advanced athletic
training course (Respondents 2 and 3). The respondents reported very limited exposure to
courses such as orthopedic assessment, modalities, rehabilitation and administration.
However, athletic training education has evolved to address this matter. The Fourth
Edition of the Athletic Training Educational Competencies (2006) has addressed these
areas in the twelve content areas required of accredited athletic training education
programs. Athletic training students today receive instruction in these coUrses and

additional courses like pharmacology, pathophysiology and general health assessment.

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Coursework in Educational Methodologies

While two of the respondents received teaching certification through their
undergraduate education and one through his attainment of his Ph.D., there was no
coursework or emphasis on educational methodologies during their athletic training
education. Additional coursework in the area of education would have assisted these
ACI/CIs in developing and implementing a better educational atmosphere at their clinical
sites. Probably, the best way to address this deficiency is to incorporate educational
methods into the fifth edition of the Athletic Training Educational Competencies being
drafted at this time. By incorporating educational methods and strategies into the body of
athletic training education, athletic training students will learn the skills necessary to
become competent clinicians and educators, enhancing athletic training education for all.
Additional Educational Competencies

Due to the increased coursework required of athletic training students in today’s
athletic training education programs, athletic training students “have a better knowledge
base” (Respondent 7) than many of the ACl/Cls evaluating them. The clinical instructors
are not sure what athletic training students are taught in class and many times are
required to evaluate students on skills they themselves are not aware of or not been taught
themselves. This places the clinical instructor at a disadvantage and often requires them
to look things up prior to a meeting with the athletic training student. While this situation
in many cases may help the clinical instructor learn a new skill or test, how can they
appropriately evaluate as skill or proficiency they themselves may not be‘competent in or

may not have performed in many years? Athletic training education programs can help

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rectify this scenario by educating their respective clinical instructors concerning new
skills and proficiencies as well as accreditation and educational reform updates.

The issues addressed in this section suggest big implications for curriculum design in
athletic training education. Not only do athletic training educators need to possess the
requisite clinical skills and content knowledge, but they also need to possess some degree
of pedagogical skills and need to be able'to apply those pedagogical skills as they teach
the content knowledge to prospective athletic training students. This attention to
pedagogical skills and pedagogical content knowledge should be incorporated into the
athletic training curriculum. These issues are important not only in athletic training
education, but also in other allied health fields.

Implications/Recommendations for Practice

This is a study about a particular emerging profession and thus, it speaks to the
athletic training profession. But it has relevance to the preparation of other professionals
in the university today. This study helps us to see that in many professions there is a
tension between the audiences of potential learners. By opening a window on the athletic
training profession, a window is provided on the broader questions in a number of
professional fields that concern practical training and advancing knowledge. Athletic
training is a microcosm for the dilemmas confronting most applied professions.

A number of different audiences need to be addressed regarding the implications and
recommendations that stem from this research: the Commission on Accreditation of
Athletic Training Education (CAATE); athletic training educators; and athletic training

students.

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Recommendations for the Commission on Accreditation of Athletic Training Education
(CAA TE)
Recommendation I: Incorporate educational methods and strategies into athletic training
education and the Athletic Training Educational Competencies.
Discussion: The Fourth Edition of the Athletic Training Educational Competencies
(2006) do not contain competencies that emphasize teaching athletic training students.

The Athletic Training Educational Competencies describe skills that are necessary to

 

work as a clinician, not as an educator, resulting in instruction in subject matter content
knowledge, but no training or exposure to subject matter pedagogical knowledge or
curricular knowledge (Shulman, 1986). Competencies should be incorporated that
address these areas of deficiency.

Respondent 4 suggested that graduate students be required to help teach classes. When
Respondent 4 was a graduate student, teaching was not required but at the institution
where he currently works, graduate students are required to act as teaching assistants and
lecture. “I think that’s really good because it gives them some experience doing that”
(Respondent 4).

These “excellent” clinical instructors build upon basic athletic training concepts when
they deal with athletic training students. The progression is discussed in the Clinical
Instructor Educator Seminar Handbook (2001) where essential teaching elements are
presented. These essential teaching elements include requisite knowledge of athletic
training by the ACI. It is important to note that the possession of the requisite knowledge,
“does not guarantee effective teaching or learning” (Clinical Instructor Educator Seminar

Handbook, 2001, p. 20). The second essential teaching element involves

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“transformation,” which is “the process of the instructor transforming what is known into
material that can be taught to others” (Clinical Instructor Educator Seminar Handbook,
2001, p. 20). Third, the excellent clinical instructor must develop “instructional
performance.” Instructional performance is the art of teaching as it takes place in the
classroom, laboratory and clinic, and the teacher/student interactions that take place in
venues. Reflective evaluation of the teacher is the fourth element and entails review and
analysis of both the instructor’s and student’s performance of a given task and how a
particular situation was handled be it in the classroom or clinical setting. Finally,
comprehension is enhanced as the teacher, or in this case, the clinical instructor, learns
from the actual teaching experience based on what worked well and what didn’t. Not
only does the athletic training student learn from the experience, but so does the clinical
instructor.

Athletic training education programs should try to build a staff of clinical instructors
who have clinical experience and practice with educational methods and strategies,
(Respondents 3, 4, 6, and 7) to create an optimal learning environment for the athletic
training student. Conversely, it is recommended that athletic training faculty not only
have experience in educational methodology, but possess substantial clinical experience.
This may be hard to achieve because faculty ATCs are often required to do research and
publish and do not have time to provide healthcare services for the athletic department.
But it is the clinical instructor who has experience in both teaching and working in the
field that will make a bigger impact on athletic training students. Clinical instructors who
have experience in educational methodologies and strategies will be better prepared to

construct a more optimal learning environment, and athletic training faculty who have a

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wealth of clinical experience will be able to relate to the clinical demands that the
profession dictates.

Rationale: The respondents in this research desired more coursework pertaining to
educational methods and strategies. The current athletic training competencies do not
address educational methods or strategies. By including educational methods and
strategies in the current athletic training educational competencies, athletic training
students will at least be exposed to them and will therefore be able to utilize those skills
once they become ACI/CIs.

Recommendation 2: Better communication with all constituents who are involved in
athletic training education, the athletic departments and governing agencies of which
athletic departments are members, must be established and on-going.

Discussion: It may be time to include athletics departments and their respective
organizations (conference offices and governing bodies, such as the National Collegiate
Athletic Association (NCAA) and National Association of Intercollegiate Athletics
(NATA) etc.) in athletic training education and athletic training education reform as
supported by Respondent 7. Athletic department coaches and support staff must
understand the duel role the approved clinical instructor/clinical instructor (ACI/Cl) has
and its impact on athletic training education. A collaborative effort must be made by all
playing a part in the education of athletic training students for athletic training education
to prosper. Clinical instructors are placed in a difficult spot trying to provide appropriate
healthcare coverage to the athletes and their athletic departments (which ultimately pay
their salaries) and to the academic side of campus. It is hard to switch back and forth

between the two roles, as explained by Respondent 7. However, the coaches, athletic

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directors and governing bodies, do not understand the role the staff athletic trainer has to
athletic training education (Respondent 7).

In addition, the governing bodies of athletic training (the BOC) and athletic training
education (the CAATE) should consider meeting and educating the governing bodies of
athletics (NCAA, NAIA, league offices) to establish open lines of communication so that
the needs of the athletics department and the needs of athletic training education can both
be met. There are ample opportunities to gain meaningful clinical experiences through
intercollegiate athletics, but all involved parties need to understand the requirements,
needs and limitations of each agency.

Rationale: Involving all parties impacted by athletic training education reform will
produce a better environment for all involved.

Recommendation 3: Continue to research to explore whether the entry-level athletic
trainer should hold a bachelor’s degree or master’s degree.

Discussion: Currently the entry-level degree required to practice athletic training is a
bachelor’s degree. As the findings to research question 2 indicate, there is great concern
among the respondents regarding the lack of clinical experiences that athletic training
students are getting in their athletic training education. Having a master’s degree is not
important, but the experiences are. Where and how do athletic training students best get
these experiences? Athletic training students have to complete their athletic training
education in a minimum of two years and a maximum of four years. Upon graduation
with a four—year athletic training degree, many seek to further their education and to gain

further experiences at graduate school.

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Having the entry-level requirement for athletic trainers be a master’s degree may
further decrease the clinical experiences acquired because graduate students are exposed
to clinical experiences for only two years. The change would also negate graduate
assistantship opportunities. By increasing the academic preparation of athletic trainers,
athletic training is being professionalized like many other healthcare professions.
However the clinical experiences of those “better academically prepared” individuals will
be severely limited. This means that graduate experiences in conjunction with
undergraduate experiences are required to accrue the number of clinical hours that
professionals in the past accrued.

Increasing the qualifications to become an athletic trainer is part of the
professionalization process. Currently one can prepare to sit for the BOC examination
after completing a bachelor’s degree. Discussions continue about increasing the
minimum education requirements to a master’s degree, as alluded to in the April 2009
issue of the NATA News. Sara Brown MS, ATC, chair elect of the NATA Education
Council believes that the time has come to re-evaluate the minimum qualifications for
entry-level athletic trainers to be on pare with the health care providers who have at least
a master’s as an entry-level degree.

A finite number of hours exist in the professional preparation of the athletic training
student. These hours must be divided between the didactic preparation of the student and
the clinical preparation of the student. As athletic training education has evolved,
increased academic coursework has been added. As a result, clinical experiences have
been compromised. Upgrading the profession of athletic training by increasing the

didactic coursework and limiting the number of clinical hours protects the athletic

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previously and they haven’t been on their own (Respondent 3).

An effective balance must be established between a student’s didactic and clinical
experiences. Making the entry-level into the profession of athletic training a master’s
degree will further decrease the clinical experiences athletic training students will
acquire, as the graduate student will have a maximmn of two years to gain clinical
experiences, thereby increasing “hyposkillia” unless other concessions are made.

Clinical instructors act as conduits to promote the profession through the emphasis of
clinical skills, whereas athletic training educators promote the profession through
academics with the emphasis on research. The increase in academic preparation helps to
professionalize the athletic training profession, at the expense of clinical prowess.
Rationale: There are finite opportunities in athletic training education to include didactic
and clinical experiences. If more didactic coursework is mandated, less time is available
for clinical experience. If athletictraining education moves to a master’s degree as entry
level, less clinical experiences will be gathered prior to that individual being graduated.
Ultimately as the individual progresses in the profession, they will have fewer

experiences to draw from as they become ACI/CIs in the future.

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Recommendation I: Work to change the academic culture in athletic training education
so that clinical expertise is rewarded.

Discussion: Increasing academic qualifications are needed to meet the demands of the
academic requirements of the university in research and publication, but these increased
qualifications do so at a cost to clinical experiences.

Athletic training students’ clinical experiences have drastically decreased from the
time when the respondents to this research were students. Requiring a master’s degree to
enter the profession of athletic training is again being discussed. The requirements of
athletic training faculty to perform and publish their research may actually make the
problem worse. Athletic training students who aspire to become athletic training faculty
will go to graduate school to work on their master’s degree. What options do they have as
graduate assistants? 1) To accept a traditional athletic training position thereby gaining
additional clinical and professional experiences; or 2) To accept a position teaching
undergraduate athletic training students. If they accept the traditional athletic training
graduate assistantship position, they will enhance their expertise in the field, but will not
receive training in educational methods or strategies. If they accept a teaching position,
they will receive feedback from students and athletic training faculty regarding their
methods, but will be teaching with very limited clinical experience. In either situation,
since athletic training education currently only addresses subject matter content

knowledge, neither the clinician nor the academician is developing subject matter

14]

 

pedagogical knowledge or curricular knowledge, both integral components of effective
teaching (Weidner & Henning, 2004; Shulman, 1986).

The athletic training graduate student pursuing a Ph.D. will likely apply for a graduate
assistantship or fellowship working with athletic training faculty who can assist with
instruction 0r research. Once again, the potential to gain clinical experiences will suffer.
The next step for the doctoral student with the clinical experience of an undergraduate is
to apply for a faculty position. He or she has never been in an unsupervised environment
making return-to-play decisions or rehabilitation plans. Generally, athletic training
faculty members are required to generate research, write grants and publish papers. These
are all worthwhile endeavors necessary to the profession, but athletic training faculty who
have progressed from bachelor’s degree to master’s degree to doctorate have little clinical
experience and, due to the requirements of their position (research and publishing), have
little clinical skills. Athletic training students who intend to become clinicians see this as
a deficiency, and the students who aspire to become academicians follow in the footsteps
of faculty, perpetuating the decline in mentoring through practical experience.

Universities are engaged in developing new knowledge through research and need to
establish ways to link practical training with the important commitment of the university
to create knowledge. The dilemma of increased credentialing, while well intentioned,
may well undermine the practical abilities of the profession.

One idea may be to require faculty ATCs to acquire a certain number of clinical hours
in the athletic training room per year or to develop an Athletic Trainer Educator

Certification modeled after the Certification for Nurse Educators (CNE) through the

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National League for Nursing (NLN) www.nln.org/facultycertification/index.htm. 4/2/10.)
The goals of the CNE Certification include:
1. Distinguish academic nursing education as a specialty area of practice and an
advanced practice role within professional nursing
2. Recognize the academic nurse educator’s specialized knowledge, skills, and
abilities and excellence in practice
3. Strengthen the use of core competencies of nurse educator practice
4. contribute to nurse educator’s professional development
(www.mln.org/facultycertification/index.hth, 4/2/10).
Rationale: Changing the academic culture will require faculty athletic trainers to stay
proficient in their athletic training skills as well as provide the vital research and
publication link to further the profession.
Recommendation 2: Establish better communication with ACI/CIs regarding
accreditation and curricular issues.
Discussion: Athletic training education program (ATEP) program directors must do a
better job communicating with their ACI/CIs. They need to be informed of accreditation
updates, curricular changes, psychomotor competency updates and proper evaluation
techniques of psychomotor skills as depicted by Respondent 1.
More communication needs to be established between the ATEP and clinical
instructors to streamline the preparation of athletic training students, and to define what is
expected of each athletic training student and each clinical site in regard to the

development of the athletic training student. This involves informing ACI/CIs of what is

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being taught in the classroom and documenting the skills that each athletic training
student has mastered.

Rationale: Better communication from the ATEP was desired from the respondents. This
communication should focus on accreditation updates, skill proficiencies, and changes in
athletic training education. The incorporation of this suggestion will produce better
athletic training students and ultimately better clinical instructors.

Recommendation 3: Athletic training students need to understand the nature of the work
and what the athletic training profession is like.

Discussion: Athletic training educators and ACI/CIs need to work together to portray
correctly the athletic training profession. There appears to be a line of separation
between the academic and clinical sides of athletic training education as denoted by the
Theory Application Gap, identified by Carr & Drummond (2002), and discussed in
Chapter 2.

Rationale: By having decreased clinical hours, athletic training students are getting an
unrealistic view of the demands placed on athletic trainers in the work setting.
Recommendation 4: Require all graduate students to teach.

Discussion: Athletic training students either undergraduate or graduate, don’t receive
training in educational methodology. Graduate students are sometimes expected to teach
undergraduate classes, but often do so with no educational background or methods.
Athletic training students should be exposed to educational methodologies in their
undergraduate years and practice those skills on into graduate school. Requiring graduate
students to teach will instill in them the skills needed when they become clinical

instructors upon graduation.

144

Rationale: Athletic trainers are often natural born teachers (respondent 6) but need to
develop educational skills. Pitney, Iisley & Rintala (2002) state, “the more formal
anticipatory socialization process begins during an undergraduate professional education”
(p. 65). Incorporating educational methods in undergraduate athletic training education
programs exposes students to educational skills. Requiring graduate students to teach
undergraduate athletic training students reinforces the educational environment. Hence, a
need for educational competencies in athletic training education has been identified. The
result will be athletic trainers who not only have clinical experiences but experiences in
creating and implementing proper educational environments.

Recommendations for Athletic Training Students
Recommendation 1: Become proactive towards your athletic training education.
Discussion: The quality of a student’s athletic training education is directly related to the
involvement and experiences actively sought during undergraduate and graduate
education. The best-prepared athletic training students seek practical experiences, arrive
early to practices and assignments, and stay late and continually work on polishing their
athletic training skills. Repetition of athletic training skills is crucial. Skills that have
already been evaluated need to be reviewed, practiced and refined. Athletes continually
practice the fundamental skills of their sport. Basketball players practice dribbling and
shooting; baseball players practice throwing, catching and hitting. Even the most basic
fundamental athletic training skills such as taping, modality usage, manual therapy
techniques, and basic first aid and injury evaluation need to be practiced‘and reviewed.

Athletic training students who actively participate, seek opportunities to get involved, and

145

 

are truly passionate about his athletic training education will receive a better educational
experience than students who are passive towards their educational experiences.

The desire to mentor athletic training students who are proactive in their educational
pursuits is indicated by a comment made by Respondent 3 who stated, “Students who are
aggressive get a lot better education than those who are passive.”

The proactive athletic training student demonstrates that he is ready to take on
additional responsibilities by taking the initiative to perform skills in which he is
proficient. He seeks to ask questions. If he has questions regarding rehabilitation
protocols, he asks the clinical instructor if he can carry out a rehabilitation plan. Once the
athletic training student gains the confidence of the clinical instructor, the clinical
instructor is more likely to hand over the reins (Respondents 1, 2 and 3).

Athletic training students become more proactive towards their education and “stand
on their own” (Respondent 2) when they become comfortable and confident in their
knowledge.

The clinical instructor has a duty to the athletes to provide care. However,
circumstances may arise with student-athletes which are not appropriate for athletic
training students to experience. These circumstances may revolve around confidentiality,
athlete’s safety or game situations (Respondents 2 and 7).

Athletic training students must realize the skills taught in the classroom and evaluated
by their ACIs portray the process of the skill. The actual applied skill may be entirely
different. For example, a taping procedure can be modifiedto meet the needs of the
injury and the athlete. Spending a half-hour on the field doing a knee evaluation is

unacceptable. The athletic training student has to determine what needs to be done on the

146

 

field and to perform those skills in the most effective and efficient way possible. This
point is illustrated by Respondent 1:
It goes back to, you may learn 40 different special tests for the knee compared to
the seven that I do on a regular basis and if you do these seven, you’re probably
going to be ok. . . It’s half-time at a football game, I don’t have time to do a whole

assessment here of the knee. I need to figure out whether or not this kid’s still got

an MCL, ACL and his meniscus intact. That is all I need to do. I don’t need to do
all these other things (Respondent 1).
Rationale: Students need to take an active interest in their own education. Discrepancies
are being seen in graduate students as well. Athletic training students who are proactive
develop into athletic trainers who become proactive in the profession. These proactive
individuals then become the educators of tomorrow’ 5 athletic training students and the
change agents needed to promote the athletic training profession.
Recommendation 2: Athletic training students need to see different aspects of the athletic
training profession and to develop an understanding of and appreciation of sport skills.
Discussion: Athletic training students must participate in clinical experiences that involve
upper body intensive activities, lower body intensive activities, general medical exposure
and equipment intensive activities. Athletic training students must also spend time with
as many different sports as possible and understand the skills, positions and strategies.
Rationale: By understanding the biomechanics involved in various physical skills,
athletic training students will understand the movement patterns involved and will be

more adept at evaluating, treating, and rehabilitating a broader range of conditions more
effectively.

147

Recommendation 3: Remember that your actions not only reflect upon you, but you
ACI/Cl as well.

Discussion: Clinical instructors want athletic training students to excel. Clinical
instructors will assist athletic training students if they seek an active role in their
development. The hours spent with the clinical instructor eventually culminate with the
request for a letter of reference. The athletic training student must be competent and
possess the skills that are essential for an athletic training professional in order to earn a
supportive reference letter. Athletic training students must realize that a reference letter
reflects upon the student, the clinical instructor and the profession. Athletic training
students must realize that the clinical instructor places his professional reputation on the
line each and every time he makes a referral on the student’s behalf or writes a letter of

recommendation, therefore, athletic training students should represent their ACI/Cls with
the respect they deserve.

Rationale: Clinical instructors provide a vital role in athletic training education
supervising athletic training students. Clinical instructors also have professional goals
and desire to advance through the ranks just like the athletic training student greenhom.
Therefore clinical instructors must be careful how they support athletic training students
seeking jobs so that the clinical instructor’s name and reputation are not tarnished by an
athletic training student’ 5 decision to renege on a promise. An example exists when
Respondent I mentioned that he was hesitant to write letters of recommendation for
athletic training students. He had written a letter for a student who was applying for a

graduate assistantship, but turned it down when it was offered. Respondent l worries

148

about the ramifications that may develop if he in turn would apply for a position at that
institution.

This section examined the different audiences addressed regarding this research
project. The BOC and the CAATE were addressed and suggestions were made regarding
communication with all shareholders in athletic training education and the
professionalization of the field by making the entry point a master’s degree.
Recommendations were made concerning the incorporation of educational competencies
into athletic training education. The current academic system and requirements for
faculty promotion perpetuate the issue of “hyposkillia.” Finally, athletic training students
were called upon to be more proactive in their education and be respectful of their
clinical instructors as they pursue employment in the athletic training profession.

Future Research Suggestions

Many ideas for future research emerged as a result of this study, but a limitation must
be noted prior to expanding upon these ideas. The program directors selected for this
research project were asked to rate the ACI/CIs whom they supervised on the basis of
their ACI/Cls teaching abilities. However it must noted that the program directors’
evaluations appeared to be based on the clinical instructors’ clinical skills rather than
their teaching expertise. In short, the “excellent” clinical instructors were selected
because of the perceived “excellent” clinical skills the program directors believed they
had. The following ideas for future research related to athletic training education emerged

from this research project.

149

Athletic Training Education Paradigms

Further research should explore the “professionalization” of health care professions
and the need for increased academic preparation. As mentioned, many healthcare
professions require a master’s degree minimum for entry-level. Currently athletic training
has a bachelor’s degree requirement for entry-level. Does the increased academic
preparation take away from clinical skill development? The CAATE currently has no
hour requirement for clinical experiences. The respondents in this research project
reported that they accrued up to 3,000 hours of undergraduate experience over a four-year
period. These hours were acquired prior to the January 1, 2004 accreditation mandate.

More didactic information is required of athletic training education as a move away
from acquiring practical experience is sensed. The accreditation mandate has been in
place for five years and it may be too early to determine what the appropriate balance is
between clinical and didactic preparation. As the athletic training education pendulum
swings from more clinical and less didactic to more didactic and less clinical, an effective
balance between the two needs to be established.

Socialization of Athletic Training Education Faculty

Another area to explore further is the socialization process that must be undertaken by
athletic training faculty as they ascend the academic promotion ladder. Colleges and
universities are requiring faculty to publish research and secure grants to be promoted.
More of their training is classroom and research dominated, again deemphasizing the
clinical nature of the profession. If the curriculum is more academic in nature, there may
be a push to have more Ph.D.s who possibly have fewer clinical experiences than ATCs

in the field.

150

Currently, there are numerous opportunities for graduate assistants to act as teachers
and research assistants. It seems likely that those with teaching and research backgrounds
and thus limited clinical experience and expertise will go on to earn Ph.D.s and
eventually be hired as professors to teach within an ATEP, reinforcing the didactic aspect
of athletic training education. In essence, those individuals responsible for athletic
training classroom instruction have limited experience in the field and may in fact be
emphasizing the didactic aspect to their students, perpetuating the problem of decreased
clinical experiences.

Therefore, research may be needed to examine the subject matter content knowledge,
subject matter pedagogical knowledge and curricular knowledge that athletic training
educators currently possess. Research should also determine where improvements could
be made.

Replication of the Current Study of the Socialization Processes of A T EP Program
Directors

This research examined the socialization processes of excellent clinical instructors
identified by their respective program directors. The same protocol could be replicated
identifying excellent program directors and determining the processes and experiences
that they underwent to become excellent. It would interesting to see if they, too, had
clinical experiences above 1,500 hours, if they attended internship programs or, as is
being hypothesized, if they took a more direct academic route to their positions.

Teaching Styles
Students’ learning styles were referred to many times throughout the interviews with

the respondents and were described in ACI training workshops. No mention was made of

151

the respondents’ teaching styles. Daniel Pratt (2002) described five teaching perspectives:
transmission, apprenticeship, developmental, nurturing and social reform. Further
research could determine where athletic training educators and clinical instructors new to
athletic training education fall within the five perspectives and where more experienced
clinical instructors and athletic training faculty fall. Longitudinal studies could be done
on those clinical instructors just entering'the field and how their dominate perspectives
change over time. The same could be done with athletic training faculty.
Results Across the Country
This study could be replicated looking at clinical instructors and faculty members to
see if similar results occur across the country. How does the respondents’ experience
compare to those of clinical instructors in other areas of the country?
Entry-Level Master’s
Research needs to be established that determines the quality of the athletic trainer who
graduates from an entry-level masters program, a CAATE accredited bachelors program
and a graduate who obtains a masters degree after graduating fi'om a CAATE accredited
bachelors program. If “hyposkillia” is real, a comparison between these three programs
would indicate any discrepancies, especially since an entry-level masters program has
essentially the same requirements as a bachelor’s degree program.
Entry-Level of the Profession
Finally, it is important to determine whether the entry point into the athletic training
profession should remain a bachelor’s degree or be elevated to a master’s degree, and the
implications for doing so. Elevating the entry-level of the profession to a master’s degree

would, in essence, displace all the undergraduate programs since the only route to enter

152

 

the profession would be with a master’s degree. This would force colleges and
universities to assess the feasibility and desire to offer a master’s degree and determine
the impact the loss of the undergraduate degree may have on their athletics programs.
Age as a Factor
Age did not play a role in the results of this research, but may play a role in how
clinical instructors interact with athletic training students. Research could be done to look
at the role age plays in how clinical instructors interact with athletic training students.
Role Females Play and have Played in Athletic Training and Athletic Training Education
While this study did not focus specifically on issues pertaining to women as athletic
trainers, a few comments from respondents remind us that females have only been
involved in athletic training during recent years. One of the respondents recalled the first
female coming into the league he worked in during the mid 19705. Since then the role of
females in athletic training and athletic training education has expanded slowly at first
and now rapidly. Research should be done to identify the obstacles, challenges, and
changes that females have made in the athletic training profession.
Conclusion
This chapter was organized around four different sections: Summary of Findings,
Discussion of Key Points, Implications for Practice and Ideas for Future Research. Each
stated information that emerged fi'om interview with clinical instructors.
The Summary of Findings described excellent ACI/CIs demographic background,
educational backgrounds and experiences, thoughts on clinical education, desires of

Clinical Instructors and the ACI/Cls primary responsibilities and allegiance.

153

 

 

 

The Discussion of Key Points focused on the respondents’ socialization processes.
Then the need for more clinical experiences for athletic training students was addressed
along with current CAATE standards regarding clinical education. The theory of
“Hyposkillia” was described.

Implications for Practice addressed three different audiences. The first audience was
two organizational agencies, the Board of Certification and the Commission on
Accreditation of Athletic Training Education (CAATE). The Board of Certification
section included entry-level education needs. Regarding the CAATE, respondents
suggested that communication be established with those outside the clinical education
realm, such as athletic directors and NCAA administrators to inform them of athletic
training education requirements so that a more streamlined educational system might be
established. Incorporating educational methods into the athletic training educational
competencies was a common request madeby the respondents, who would like to see
athletic training educators provide better communication with the ACI/Cls who work in
their educational programs. The potential consequences of what respondents perceive as
decreased clinical experiences by faculty members were outlined. It was strongly
suggested that athletic training students become proactive in their educational pursuits,
master the physical psychomotor skill and thought processes of the profession, and be
prepared to call on those skills they may need in a given situation. The last suggestion
given to athletic training students was to represent their ACI/Cls with the respect that
they deserve. Respondents regretted not getting better representation from their former

students in the field.

154

 

 

Future research possibilities included determining an appropriate balance between
didactic and clinical education, and exploring the socialization processes of program
directors and the ramifications of making a masters degree as the entry point into the

athletic training profession.

155

APPENDICES

156

 

APPENDIX A

Invitation Letter to Program Directors

157

 

Dear Athletic Training Education Program Director:

I am writing to invite you to participate in a research project which will explore the socialization processes
undertaken by clinical instructors that have allowed them to develop into “excellent” clinical educators.
This study represents research being completed as a requirement to fulfill my Ph.D. in Higher Adult and
Lifelong Education (HALE) at Michigan State University. I am asking you to participate in this study
because of your position as Program Director of your Athletic Training Education Program and your ability
to evaluate the clinical instructors you utilize in your program. Participation is entirely voluntary. There
are no known risks associated with participation in this study.

I would like to send to you a short rating form for you to complete for each on-campus clinical instructor
that is not a full-time faculty member or graduate assistant that your program utilizes. The form that I will
send is based on a rating instrument called “Selection, Training, and Evaluation of Athletic Training
Approved Clinical Instructors” developed by Weidner and Henning (2004). I expect that you will need to
spend about 10 minutes completing the rating form per clinical instructor. I am sending this request to
Athletic Training Education Program Directors at public institutions throughout the state that sponsor
CAATE accredited ATEPs. I will use your responses to select clinical instructors to invite to participate in
my study. While you may not directly benefit from your participation in this study, your participation in
this study may contribute to identifying themes central to the education of athletic training students. All
responses will remain anonymous and confidential protected to the maximum extent allowable by law.

I hope you will assist me in conducting this research on the socialization processes of clinical instructors. I
would appreciate your returning the enclosed sheet providing me information about the clinical instructors
in your program in the self addressed stamped envelope.

If you have concerns or questions about this study, such as scientific issues, how to do any part of it, or to
report an injury, please contact the researcher at:

Joseph D. Susi 11 MS, ATC
2306 W. 4th Ave

Sault Ste. Marie, MI 49783
(906) 635-2161

isusi@lssu.edu

You are also welcome to contact my project adviser, Dr. Ann Austin at aaustin@msu.edu. Should you
have any questions or concerns about your role and rights as a research participant, or would like to register
a complaint about this study, you may contact, anonymously if you wish, the Director of MSU’s Human
Research Protection Program, Dr. Peter Vasilenko, at 517-355-2180, Fax 517-432-4503, or e-mail
irb@msu.edu or regular mail at 202 Olds Hall, MSU, East Lansing, MI 48824. Thank you very much for
your time and consideration in this matter.

Sincerely,

Joseph D. Susi 11 MS, ATC
Doctoral Student

HALE Program Michigan State University

158

 

 

 

 

Name of University

 

Program Director’s Name

 

Names of non full-time faculty/non—graduate assistant on-campus clinical instructors:

1.

 

2.

 

 

 

 

 

 

 

9.

 

10.

 

All names and identifying information will remain anonymous and confidential.

159

 

APPENDIX B

Ratings Letter and Ratings Instrument

160

 

Appendix B
Dear Athletic Training Education Program Director:

Thank you for your interest in clinical education research. Enclosed please find the
rating instrument that you will utilize to rate each of your on campus non-faculty / non-
graduate assistant clinical instructors. Please fill out a separate survey for each on
campus clinical instructor and return to me in the self addressed stamped envelope
provided.

The Program Director Ratings Forms will then be compiled and selection of clinical
instructors for face-to-face interviews will be performed. All responses will remain
anonymous and confidential protected to the maximum extent allowable by law.

Participation is voluntary, you may choose not to participate at all, or you may refuse to
participate in certain procedures or answer certain questions or discontinue your
participation at any time without consequence.

There are no known risks associated with participation in this study and while you may
not directly benefit from your participation in this study, your participation in this study
may contribute to identifying themes central to the education of athletic training students.

Thank you for your interest and participation

Sincerely

Joseph D. Susi 11 MS, ATC
Doctoral Student
HALE Program Michigan State University

161

 

Athletic Training Education Program Director’s
Rating Record of On-Campus Clinical Instructors

Questions for this record are from the “Selection, Training, And Evaluation of Athletic
Training Approved Clinical Instructors” (ACI) developed by Dr. Weidner. Accessed
from www.n_ataec.org[l_rtml/clinical evaluation tools.html. It is the survey instrument
that will be utilized by program directors of Athletic Training Education Programs within
the state of Michigan to rate their on-campus clinical instructors. The questions asked of
the program directors represent those items in Standard 4.0 of Dr. Weidner’s
questionnaire where the instructional skills of ACI are examined.

Use the following scale to respond to the criteria listed below for this standard:
1 = Never; 2 = Seldom; 3 = Occasionally; 4 = Usually; 5 = Always

Criterion 4.1
The ACI collaborates with the Program Director and/or Clinical Education Coordinator

to plan learning experiences.
1 2 3 4 5 Unknown

Criterion 4.2
The ACI implements, facilitates, and evaluates planned learning experiences with athletic

training students.
1 2 3 4 5 Unknown

Criterion 4.3 .
The ACI understands the athletic training students’ academic curriculum, level of .
didactic preparation, and current level of performance, relative to the goals of the climcal

education experience.
1 2 3 4 5 Unknown

Criterion 4.4 . .
The ACI takes advantage of teachable moments during planned and unplanned learning

experiences by instructing skills or content that is meaningful and immediately

applicable.
1 2 3 4 5 Unknown

Criterion 4.5 . . . . . .
The ACI employs a variety of teaching styles to meet indivrdual athletic tramrng

stude ts’ needs.
1 n 2 3 4 5 Unknown

Criterion 4.6 ' ' d
The ACI helps athletic training students’ progress towards meeting the goals an

objectives of the clinical experience as assigned by the Program Director and/or Clinical

lliducatron Coorzdmator. 3 4 5 Unknown

162

Criterion 4.7
The ACI modifies learning experiences based on the athletic training students’ strengths
and weaknesses.

I 2 3 4 5 Unknown

Criterion 4.8

The ACI creates learning opportunities that actively engage athletic training students in
the clinical setting and that promote problem-solving and critical thinking.

1 2 3 4 5 Unknown

Criterion 4.9
The ACI encourages self-directed learning activities for the athletic training students

when appropriate.
2 3 4 5 Unknown

Criterion 4.10
The ACI performs regular self-appraisal of his teaching methods and effectiveness.
1 2 3 4 5 Unknown

Criterion 4.11
The ACI is enthusiastic about teaching athletic training students.
1 2 3 4 5 Unknown

Criterion 4.12
The ACI communicates complicated/detailed concepts in terms that students can
understand based on their level of progression within the athletic training education

program.
1 2 3 4 5 Unknown

Criterion 4.13 . . .
The ACI encourages athletic training students to engage in self-directed learmng as a

means of establishing life-long learning practices of inquiry and clinical problem solving.
1 2 3 ' 4 5 Unknown

163

 

 

Dear Dr. Weidner,

My name is Joe Susi and I contacted you last year regarding the survey
you developed to evaluate ACI's. I have read the research article you
wrote where you introduced the assessment form.

The reason that I am writing to you is to ask your permission to use
your instrument to gather information for my dissertation. I am
interested in exploring the socialization processes that influence an
ACI/CI attitude towards education.

Specifically I am interested in using your Section 4.0 to have PD rate
their ACI/CI's instructional skills. I will then use this data to

identify ACI/CI's to interview to determine the socialization processes
they encountered.

Could you kindly respond via e-mail as to the possibility of using this
assessment. I can be reached at jsusi@lssu.edu. I have copied my
advisor Dr. Ann Austin on this note as well.

Thank you for your time and consideration

Looking forward to hearing from you

Joseph D. Susi 11 MS, ATC

Program Director
Athletic Training Education

Lake Superior State University

164

That will be fine. Just reference appropriately. The form is copyrighted and
registered. Thanks.

----- Original Message -----

From: "Joe Susi" <jsusi@lssu.edu>

To: <tweidner@bsu.edu>

Cc: <aaustin@msu.edu>; <jsusi@lssu.edu>

Sent: Wednesday, February 15, 2006 11:40 AM

Subject: Permission to use survey

Dear Dr. Weidner,

My name is Joe Susi and I contacted you last year regarding the survey
you developed to evaluate ACI‘s. I have read the research article you
wrote where you introduced the assessment form.

The reason that I am writing to you is to ask your permission to use
your instrument to gather information for my dissertation. I am
interested in exploring the socialization processes that influence an
ACI/CI attitude towards education.

Specifically I am interested in using your Section 4.0 to have PD rate
their ACI/CI's instructional skills. I will then use this data to

identify ACI/CI's to interview to determine the socialization processes

they encountered.

Could you kindly respond via e-mail as to the possibility of using this

165

 

 

assessment. I can be reached at jsusi@lssu.edu. I have copied my
advisor Dr. Ann Austin on this note as well.

Thank you for your time and consideration

Looking forward to hearing from you

Joseph D. Susi II MS, ATC

Program Director

Athletic Training Education

Lake Superior State University

166

 

 

APPENDIX C

Invitation to Participate in F ace-to-F ace Interviews

 

167

 

Appendix C

Dear Certified Athletic Trainer:

You have been identified as a clinical instructor for the Athletic Training Education Program at
your institution. The purpose of this letter is to invite you to participate in a research study that
will explore the socialization processes undertaken by clinical instructors. Participation is entirely
voluntary. This study represents research being completed to fulfill the dissertation requirements

of the Higher Adult and Lifelong Education program at Michigan State University. I am asking
you to participate in this study due to your position as a clinical instructor for your Athletic
Training Education Program. There are no known risks associated with participation in this study.

I would like to arrange a time to interview you to get your input on some questions that have been
developed to explore the processes that excellent clinical instructors have encountered that have
made them so proficient in what they do. The interview would take approximately 1 to 1 1/2
hours and would be conducted at your convenience. Your identity and responses will remain

anonymous and confidential protected to the maximum extent allowable by law.

I hope that you will assist me in conducting this research. While you may not directly benefit
from your participation in this study, your participation in this study may contribute to identifying
themes central to the education of athletic training students. If you would be willing to assist in
this research project, please return the lower portion of this letter with the appropriate information

in the self-addressed stamped envelope provided so that an interview time can be arranged.

If you have concerns or questions about this study, such as scientific issues, how to do any part of

it, or to report an injury, please contact the researcher at:

Joseph D. Susi II MS, ATC

2306 W. 4th Ave
Sault Ste. Marie, MI 49783

(906) 635-2161
jsusi@lssu.edu

You are also welcome to contact my project advisor, Dr. Ann Austin at aaustin@msu.edu. Should
you have any questions or concerns about your role and rights as a research participant, or would
like to register a complaint about this study, you may contact, anonymously if you wish, the
Director of MSU’s Human Research Protection Program, Dr. Peter Vasilenko, at 517—355-2180,
Fax 517-432-4503, or e-mail irb@rnsu.edu or regular mail at 202 Olds Hall, MSU, East Lansing,

MI 48824. Thank you for your time and consideration in this matter.
Sincerely,
Joseph D. Susi 11 MS, ATC

Doctoral Student

HALE Program
Michigan State University

168

 

 

 

I voluntarily agree to participate in the study

I understand that I cannot be a participant in this research project without
being audio-taped during the interview process and understand that I will
be audio-taped during the interview and that the information obtained by
the researcher will be protected to the maximum extent allowable by law.
Once all data has been gathered from the audio tape, the audio recording

will be destroyed

 

Initials

I do not wish to participate in the study

Name

 

 

Institution

 

Phone Number

 

E-Mail Address

169

 

 

APPENDIX D

Table 3: Responses from Program Directors and ACI/Cls

170

 

Appendix D

 

 

 

 

 

 

 

 

 

 

Table 3
Table 3: Responses fi'om Program Directors and ACI/Cls
Newly Accredited within the last 5 years Accredited Longer than 5
years
NCAA University 1 University 2 University 3 University 4 University 5
Division I
Schools
Response None Yes, will help No, would not Yes, will help Yes, will help
From Program with research help at this with research with research
Director time
Number of N/A 8 N/A 4 4
Clinical 3 selected 2 selected 0 selected
Instructors -

Response N/A Top 3 selected N/A Top No response
From Clinical respondent from any of
Instructors yes; the clinical

Second instructors
Highest no;
Third highest
yes;
2 interviewed
NCAA University University N/A University N/A
Division II 6 7 8
Schools
Response Yes, will help Yes, will help None
from Program with research with research
Director
Number of 2 3 N/A
Clinical 2 selected 0 selected
Instructors
Response Top 2 selected No response N/A
from Clinical from any of
Instructors the clinical
Instructors

 

 

 

 

 

 

 

171

APPENDIX E

Interview Protocol

172

Appendix E
Note: The protocol below identifies the primary interview questions for this study. However,
since this is a qualitative study, there may be minor adjustments made to the questions based
upon the flow of the interview.

Interview Protocol

Professional Socialization in Athletic Training Education
And it’s Impact on the Development of Excellent Clinical Instructors

Interviewer:

 

Place:

 

Time:

 

Date:

 

Participant Number:

 

Introduction:

Once again, thank you for volunteering to participate in this research study. The purpose of this
study is to identify the socialization processes that have shaped clinical instructors beliefs and
practices. This interview consists of questions about your educational background and
experiences, as well as your practice as a professional. There are no right or wrong answers.

Please be as honest and candid as you can in your responses. I promise to ensure you complete
confidentiality. Other than myself, no one will have access to your specific responses except my
academic advisor, Dr. Ann Austin. The pseudonym you selected will be used in place of your
name and the name of your institution and any other potentially identifying information will be
changed or not used in this study. When the study is complete, I will destroy the audio recording
of our conversation.

Participation is voluntary, you may choose not to participate at all, or you may refuse to
participate in certain procedures or answer certain questions or discontinue your
participation at any time without consequence. This interview will take approximately 60
minutes. You may ask any questions regarding the research, and they will be answered fully.
Results from this study may be presented at educational conferences or submitted for publication.
I appreciate your time and valuable input.

Do you have any questions before we begin?

I voluntarily agree to participate in the study

 

Participants Signature

173

Background lnforrnation
Clinical Instructor Demographic Survey

 

 

 

Name Institution

Title ‘ Are you a full time faculty member __
Number of years Certified_________ Number of years teaching clinical courses_______
Circle One: Male Female Age 20-25 26-30 31-35 36-40

Undergraduate Degrees 41-45 46-50 51-55 56- over

Graduate Degrees

Certifications

Undergraduate Pro gram at the time you graduated (Circle One)
Internship NATA Accredited CAAHEP Accredited CAATE Accredited

Graduate Program at the time you graduated (Circle One)
Internship NATA Accredited CAAHEP Accredited CAATE Accredited

Are you a F ull-time employee of this institution? Yes No

Do you currently or have you ever held a teaching certificate? Yes No
If yes, what area of specialization?

Do you provide athletic training services for your institution? Yes No
What sports do you provide services for?

If you don’t provide services for specific athletic teams, whom do you provide services
to?

Are you currently or within the past 5 years been assigned as an athletic trainer with
athletic training responsibilities with a team or sport? Yes No

If yes, which sports or teams?
Number of different sports you have worked with.

Do you teach any classroom courses for credit?
Have you had any formal training in the field of education?

Other institutions where you have worked?

174

1) Tell me a little bit about your undergraduate experiences as an Athletic Training
Student.

2) Do you feel that you were appropriately prepared after your undergraduate education
to work with Athletic Training Students? Why or why not?

3) Do you feel that you were appropriately prepared after your graduate education to
work with Athletic Training Students? Why or why not?

4) Who was your best teacher in college?

5) What made them so good?

6) If you saw “good teaching” what would it look like?

7) Do you use any of their teaching techniques in your dealings with educating athletic
training students?

8) What do you consider to be the aim of your teaching?

9) What athletic training experiences have really affected you? How have they affected
you?

10) What is the role of the clinical instructor in the education of today’s athletic training
student?

11) How do you balance the shared role you have between athletics and academics?

12) What does learning mean to you?

13) Do you feel appropriately prepared to provide learning experiences for today’s
athletic training student? How and why?

14) What experiences in your background have prepared you for educating today’s

athletic training student?

175

15) What experiences do you wish you had that may have better prepared you for
educating today’s athletic training student?

16) How do you think the learning experience varies depending on where the learning

occurs?

176

APPENDIX F

Table 4a: Demographic Makeup of Respondents

Table 4b: Demographic Makeup of Respondents (continued)

177

 

Appendix F
Table 4 a-b

Table 4a: Demographic Makeup of Respondents

 

 

 

 

 

 

 

 

 

 

 

 

Current Title Age Range Number of Years Teaching
Years Teaching Certification
Certified Clinical
Courses

Respondent l Coordinator of 31-35 10 7 No
Athletic
Trainin

Respondent 2 Assistant 36-40 16 10 No
Athletic
Trainer

Respondent 3 Associate 46-50 27 27 No

Head Athletic

Trainer

Respondent 4 Assistant 31-35 6 2 No
Athletic
Trainer

Respondent 5 Assistant 36-40 6 6 No
Athletic
Trainer

Respondent 6 Associate 56-over 32 32 Yes
Athletic
Trainer

Respondent 7 Assistant 51-55 28 28 Yes
Athletic
Trainer

 

 

 

 

 

178

 

Table 4b: Demographic Makeup of Respondents (continued)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Undagraduatqundergrad Graduate Formal Teaches Number 0
Program Type Degree Degree Training Classroom prior
in Courses institutions
Education where
employed
Respondent Internship Health and Exercise No No 2
1 Fitness Science
Management
Respondent Internship Health and Biomechanicsl No No 3
2 Fitness
Management
Respondent Internship Physical Physical Yes Yes 0
3 Education Education
PhD in
Kinesiolgy
Respondent Internship Biology Athletic Yes Yes 1
4 Training
* Working on
PhD
Respondent *Intemship Athletic Sports No No 1
5 when student Training Management
started.
Program
gained
CAAHEP
Accreditation
prior to their
graduation
Respondent Internship Psychology Physical Yes Yes 1
6 Education
and
Education
Respondent NATA Special Special Yes No 2
7 Accredited Education Education
and Sports
Medicine
PhD in
Kinesiolo

 

 

179

 

 

APPENDIX G

Respondent Profiles

180

Appendix G
Respondent Profiles

Seven respondents were interviewed for this study, five of which were male and two
female. To help preserve confidentiality of all these individuals, the respondents will be
referred to as “respondents.”
Respondent 1

Respondent 1 has been certified for 10 years as an athletic trainer and currently fills
the title of Coordinator of Athletic Training Services for his institution. He received his
undergraduate degree in Health and Fitness Management and his graduate degree in
Exercise Science both from the same institution. This individual is employed by the
institution that he received his degree from. The undergraduate program that he attended
was an internship program and has since become a CAATE accredited program. This
respondent is a full time employee of his institution and has been teaching clinical
courses for seven years. Prior to being employed at his current institution, this individual
worked at another university and a sports medicine clinic. While this individual acts as an
Approved Clinical Instructor for his institution, he has no formal training in the field of
education and has never held a teaching credential. This individual functioned as a
graduate assistant athletic trainer during his graduate schooling and had very little
interaction with athletic training students. The institution was in a “state of flux” as the
institution was transitioning from an internship program towards CAAHEP accreditation.

Respondent 1 has experience working a wide variety of athletic events and sports teams.

181

 

Respondent 2
Respondent has been certified for 16 years and holds the title of Assistant Athletic

Trainer for the institution of which he works. He received his undergraduate degree in
Health and Fitness Management fiom the institution that he is currently employed with
and his graduate degree in Biomechanics fiom a MAC school. The undergraduate
program was an internship program at the time of this individual’s enrollment and is
currently CAATE accredited. The graduate pro gram was NATA accredited at the time of
this individual’s attendance. This individual is an Approved Clinical Instructor for his
institution, but does not teach any classroom courses for credit nor has he had any formal
training in the field of education. Hence, he has never held a teaching certificate.
Respondent 2 cites experience with a variety of different sports, including college and
international competitions as well as working with a sport that won a national
championship. He was employed as a graduate assistant while he was in graduate school
and was placed at a local high school. Prior to his employment with his current employer,
this individual worked at two different universities and a national sports agency after
graduate school.

Respondent 3

Respondent 3 has been certified for 27 years and functions as the Associate Head

Athletic Trainer at his institution. He has been teaching clinical courses for 27 years as
well. He received his undergraduate degree in Physical Education from an internship
program and his graduate degree in Physical Education from the same institution. The
graduate program was an internship program as well and this individual acted as a

graduate assistant during his time there. This individual has also gone on to acquire his

182

PhD in Kinesiology from the institution of which he is employed. Upon graduation with
his graduate degree, this individual was hired by his current employer. While this
individual has gone through ACI training by his institution, he does not participate in
psychomotor evaluation of athletic training students. This clinical instructor has never
held a teaching certificate, but did take a class in pedagogy in his PhD training and
currently teaches two classroom courses for credit.
Respondent 4

Respondent 4 has been certified for 6 years and currently functions as an Assistant
Athletic Trainer and Clinical Coordinator for his institution. This individual was a non-
traditional student who started his schooling at the age of 22 after working for a few years
after high school graduation. This individual chose an internship program as it allowed
him to start within the discipline right away. His undergraduate degree was in Biology
and his graduate degree was in Athletic Training from the institution of which he is
currently employed. During his graduate education, this individual was a graduate
assistant and was placed at a local high school where he didn’t have too much interaction
with undergraduate athletic training students. He has been teaching clinical courses for 2
years. Prior to being hired by his current employer, this individual worked at a local
regional medical center. This individual functions as an AC1 for his institution and while
he has never held a teaching certificate, he does teach some courses for credit.
Respondent 4 has had three courses in the field of education and is currently working

towards his PhD.

183

Respondent 5

Respondent 5 has been certified for 6 years and functions as an Assistant Athletic
Trainer for his institution. This individual was a non-traditional student who graduated
with his bachelors degree at the age of 28 or 29. The undergraduate institution that he
attended was an internship program when he was admitted, but changed to a CAAHEP
accredited program before he graduated. Hence his undergraduate degree was in athletic
training. This individual then went to graduate school at a different institution and
received a graduate assistantship and worked with the institution’s athletic teams. His
graduate degree is in Sports Management. This individual functions as an AC1 for his
institution and has been teaching clinical courses for six years. He has never had a
teaching certificate and outside of ACI training, has no formal training in the field of
education. This individual does not teach any classroom courses for credit and was
employed at a different university prior to being hired by his current employer.
Respondent 6

Respondent 6 has been certified for 32 years and acts as an Associate Athletic Trainer
and Adjunct Lecturer for his current institution. The undergraduate program that he
attended was an internship program and is the same institution that he currently works
for. His undergraduate major was in psychology with minors in sociology and physical
education. Once accepted to graduate school, he received a graduate assistantship to work
with the collegiate athletic teams. This individual’s graduate degree is from the same
institution as his undergraduate degree with majors in Physical education and education.
This individual does state that at the time of his certification exam, an individual had to

be certified as a teacher in order to sit for the examination. He has been teaching clinical

184

courses for 32 years and currently teaches modalities for his institution. This individual
does have a secondary teaching certificate in physical education and sociology and does
cite formal training in the field of education. This individual did work at a different
university for 10 years before returning to his alma mater. While at this different
institution, this clinical instructor started an athletic training education program and
literally built an athletic training facility by laying block and mortar. He currently
functions as an ACI for his institution.
Respondent 7

Respondent 7 has been certified for 28 years and currently acts as an Assistant
Athletic Trainer and ACI for his institution. He has been teaching clinical courses
supervising athletic training students for 28 years. This individual attended a NATA
Accredited undergraduate program and majored in Special Education with a minor in
athletic training. Upon graduation this individual went to graduate school at the
institution that currently employs him. There, he had a graduate assistantship and majored
in Special Education and Sports Medicine. This individual also completed a PhD from his
employing institution in Higher Education Administration. This individual possesses a
teaching certificate in special education K-12 and has had many courses in the field of
education, although he does not cmrently teach any classroom courses for credit. This
individual has worked at one other university and a high school prior to being employed

by his current institution.

185

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186

 

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