THE DEVELOPMENT AND INTEGRATION OF COGNITIVE AND CLINICAL SKILLS IN
UNDERGRADUATE ATHLETIC TRAINING EDUCATION PROGRAMS: A SURVEY OF
RECENTLY CERTIFIED ATHLETIC TRAINERS
By
Brian Anthony Bratta

A DISSERTATION
Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of
Kinesiology- Doctor of Philosophy
2014

ABSTRACT

THE DEVELOPMENT AND INTEGRATION OF COGNITIVE AND CLINICAL SKILLS IN
UNDERGRADUATE ATHLETIC TRAINING EDUCATION PROGRAMS: A SURVEY OF
RECENTLY CERTIFIED ATHLETIC
By
Brian Anthony Bratta
Athletic training education began as an apprenticeship program in which students took a
base level of classes while gaining a large portion of their training in the clinical setting. Current
education standards have evolved into a full academic curriculum governed by an accrediting
body. The increase in curriculum initiated recognition of athletic training as an allied health
profession as well as creating a base level of knowledge for all athletic training students prior to
sitting for the national certification exam. With this progression, an increase in textbook
knowledge is expected, as a result skills are being overlooked that were developed during the
field experiences of the apprenticeship, skills such as interpersonal relations and professional
development.
The purpose of this study was to examine the perceptions of newly certified athletic
trainers (ATs) regarding the development and integration of skills in their athletic training
education program. Specifically, the instruction of clinical skills, interpersonal skills and
professional personal development based on the Commission on Accreditation of Athletic
Training Education (CAATE) standards. Along with determining the level of development and
integration, determination of the level of importance of the classroom, laboratory and field
settings was also identified.

Individuals that were members of the National Athletic Trainers’ Association (NATA)
and had successfully completed their national certification exam within the previous 18 months
received an e-mail invitation to complete an online survey. One hundred fifty-four respondents
(8.65% response rate) completed the survey with an average certification time of 11.68 months.
The primary employment setting with the highest frequency rate (36.4%) was collegiate- NCAA
division, while the second highest frequency (22.1%) was the High School setting.
“In the classroom” had the highest frequency of responses for general CAATE skills
(52.9%), interpersonal skills (49.3%) and professional personal development (44.8%) for area of
development and integration of skills. Respondents identified the field as the highest level of
importance followed by the classroom and the laboratory setting for all of the three categories.
Utilizing a Pearson correlation test, there was no statistically significant difference between class
size of athletic training education program and level of development and integration in each of
the three categories. There was also no association between collegiate division of competition
and perceived level of development and integration of skills among respondents.
According to the data compiled in this research, the majority of the respondents for each
of the three categories identified “In the classroom” as the main area for development and
integration of skills in their athletic training education. When differentiating between the
classroom, laboratory and field settings, respondents placed a high level of importance on the
field setting above the classroom and laboratory settings.

ACKNOWLEDGEMENTS

There are many people that if not for their support and guidance, I would not have been
able to accomplish the task of completing this dissertation. To my dissertation committee, you
have taught me many things about education, research and life. Dr. John Powell, ATC, you have
helped me understand not only statistics and research, but you have taught me to take my time
and make sure it is done right so that when the public sees it, my best effort is noted. Dr. John
Dirkx, you have taught me to not only understand and appreciate research, but to also listen to
what is being addressed and how to utilize it in the “real world.” Dr. Sally Nogle, ATC, your
insight and guidance has allowed me to mature as an educator, researcher and clinician. Dr.
Tracey Covassin, ATC, we have worked together on many projects and you have helped me
understand working with the large machine to produce quality work. To my co-workers in
athletic training, you have shown me patience in the clinic, a sounding board to talk through as
well as quality advice to continue and persist. Many thanks are given to you for there is no way I
would be in this position without you.
To my life mentors, Dr. Robert Tallitsch and Dr. Paul Olsen, you saw something in me
that I didn’t and made sure I was successful. Every time that I have the opportunity to chat with
you, there is a sense of reassurance and guidance that I cannot get from anyone else. To my
extended family and friends, your love and support has given me a sense of confidence and
security that was needed to complete this dissertation. My mother-in-law, Kathy Hunsinger, and
father-in-law, Chris Hunsinger, you have given me the strength and love of your family and there
is nothing I can’t do without your love.
iv

My immediate family, my strength and my guiding light, thank you for everything. To
my mom, Kay, and dad, Phil, thank you for being my first teachers in life. Your love, care and
understanding through my winding road of education challenged me to be the best that I can be
while helping others. To my sisters, Amy and Julie, and their families, Alex, Logan, Danielle
Kobb and Jon, Lauren and Jackson Kern, you set the bar high for family standards and showed
love and support along the way. I am honored to be your brother. To my rock and main
support, my wife, Anna, you have been the best thing in my life for many years. I love you for
everything that you are and everything that I am when I am with you. And most of all, I thank
God for the opportunity to live in this world and hopefully make a difference in the lives of
others.
To my daughters, Teagan and Tenley, my life has never been crazier with you in it and I
wouldn’t trade it for the world. Always know that dad loves you and will support you in
whatever dreams you wish to achieve. I love you.

v

TABLE OF CONTENTS

LIST OF TABLES ....................................................................................................................... viii
LIST OF FIGURES ....................................................................................................................... xi
Chapter 1 ......................................................................................................................................... 1
Introduction ..................................................................................................................................... 1
1.1 Overview of the problem ...................................................................................................... 1
1.2 Significance of the problem .................................................................................................. 3
1.3 Purpose of the Study ............................................................................................................. 5
1.4 Research Questions ............................................................................................................... 5
1.5 Operational definitions of terms ........................................................................................... 6
Chapter 2 ......................................................................................................................................... 9
Literature review ............................................................................................................................. 9
2.1 History of Athletic Training.................................................................................................. 9
2.2 Current curriculum requirements (As of 11/1/12) .............................................................. 20
2.2.1 Category 1: Evidence Based Practice (EBP) ............................................... 25
2.2.2 Category 2: Prevention and Health Promotion (PHP) ................................. 25
2.2.3 Category 3: Clinical Examination and Diagnosis (CE) ............................... 27
2.2.4 Category 4: Acute Care of Injuries and Illnesses (AC) ............................... 27
2.2.5 Category 5: Therapeutic Interventions (TI) ................................................. 28
2.2.6 Category 6: Psychosocial Strategies (PS) .................................................... 29
2.2.7 Category 7: Healthcare Administration (HA) .............................................. 29
2.2.8 Category 8: Professional Development and Responsibility (PD) ................ 30
2.2.9 Category 9: Clinical Integration Proficiencies (CIP) ................................... 30
2.3 Socialization to the field of athletic training ....................................................................... 31
2.3.1 Anticipatory Socialization ........................................................................... 31
2.3.2 Professional Socialization ............................................................................ 32
2.3.3 Organizational Socialization ........................................................................ 33
2.4 Challenges that occur in the field of athletic training ......................................................... 34
2.5 Learning styles in Athletic Training Education .................................................................. 37
2.6 Educational standards in other medical professions ........................................................... 44
2.6.1 Nursing......................................................................................................... 44
2.6.2 Physician (MD or DO) ................................................................................. 45
2.6.3 Physical Therapy.......................................................................................... 51
Chapter 3 ....................................................................................................................................... 53
Methodology ................................................................................................................................. 53
3.1 Purpose................................................................................................................................. 53
3.2 Research Design................................................................................................................... 53
3.3 Participants ........................................................................................................................... 53
3.4 Instrumentation .................................................................................................................... 54
3.4.1. Demographic Survey ................................................................................... 54
vi

3.4.2. Survey of Level of Development and Implementation of Skills ................. 54
3.5 Data Collection and Management ....................................................................................... 56
3.6 Data Analysis ...................................................................................................................... 56
Chapter 4 ....................................................................................................................................... 59
Results ........................................................................................................................................... 59
4.1 Overview ............................................................................................................................. 59
4.2 Demographic Data ..................................................................................................................
4.3 Perceptions regarding development and integration of specified skills evaluated: ............ 62
4.3.1 General CAATE athletic training skills ....................................................... 62
4.3.2 Interpersonal Skills ...................................................................................... 63
4.3.3 Professional Personal Development Skills .................................................. 65
4.4 Does graduating class size affect the development and integration of skills required for
athletic
training by CAATE? ................................................................................................................. 66
4.5 Does level (e.g. NCAA division I-III or NAIA) of athletic training education program
affect
development and integration of skills required for athletic training by CAATE ..................... 67
4.6 Do field experiences within the athletic training education of participants play an
important role in
the instruction of general CAATE athletic training competencies? ......................................... 69
4.7 Do field experiences within the athletic training education of participants play an
important role in
the instruction of interpersonal skills within the field of athletic training? .............................. 70
4.8 Do field experiences within the athletic training education of newly certified ATs play an
important
role in the instruction of how to cope with the demands of the profession? ............................ 71
4.9 Summary ............................................................................................................................. 72
Chapter 5 ....................................................................................................................................... 73
Discussion ..................................................................................................................................... 73
5.1 Summary of Research Questions ........................................................................................ 73
5.2 Limitations to the study ...................................................................................................... 80
5.3 Future Research .................................................................................................................. 81
5.4 Summary ............................................................................................................................. 82
APPENDICES .............................................................................................................................. 83
Appendix A: Survey of Development and Implementation of Skills of Recently Certified
Athletic Trainers….……………………………………………………………………….….84
Appendix B: Responses of Individual Questions ................................................................... 124
Appendix C: Letter to Cohort to Participate in Survey........................................................... 138
WORKS CITED ......................................................................................................................... 139

vii

LIST OF TABLES

Table 4.1 Frequency Distribution of Participants by Ethnicity .......................................................... 60
Table 4.2 Frequency Distribution of Participants by Division of Competition of Undergraduate
Education Institution........................................................................................................................... 60
Table 4.3 NATA Districts Represented by Participants ...................................................................... 61
Table 4.4 Current Employment Settings of Participants .................................................................... 62
Table 4.5 Aggregate Count of Responses for Perceived Development and Integration of the General
CAATE Skills....................................................................................................................................... 63
Table 4.6 Aggregate Count of Responses for Perceived Development and Integration of
Interpersonal Skills by Participants .................................................................................................... 64
Table 4.7 Aggregate Count of Responses for Perceived Development and Integration of Professional
Personal Development Skills .............................................................................................................. 66
Table 4.8 Count and Mean Level of Importance of Classroom Setting by Division ........................... 68
Table 4.9 Count and Mean Level of Importance of Laboratory Setting by NCAA Division ............... 68
Table 4.10 Count and Mean Level of Importance of Field Setting by NCAA Division....................... 69
Table 4.11 The Average CAATE Skills Development and Integration (SDI) score for each of the
Educational Settings ........................................................................................................................... 69
Table 4.12 The Average Interpersonal Skills Development and Integration (ISDI) score for each of
the Educational Settings...................................................................................................................... 70
Table 4.13 The Average Professional Personal Development Skills Development and Integration
(PPDI) score for each of the Educational Settings ............................................................................. 71
Table B1.1 CAATE CE-20: "Use standard techniques and procedures for the clinical examination of
common injuries, conditions, illnesses and diseases." ...................................................................... 125
Table B1.2 CAATE CE-15: "Demonstrate the ability to modify the diagnostic examination process
according to the demands of the situation and patient responses." .................................................. 125
Table B1.3 CAATE TI-11: "Design therapeutic interventions to meet specific treatment goals." ... 125
Table B1.4 CAATE TI-11a: "Assess the patient to identify indications, contraindications, and
precautions applicable to the intended intervention." ...................................................................... 126
Table B1.5 CAATE TI-13: "Describe the relationship between the application of therapeutic
modalities and the incorporation of active and passive exercise and/or manual therapies, including
therapeutic massage, myofascial techniques, and muscle energy techniques." ................................ 126

viii

Table B1.6 CAATE CE-16: "Recognize the signs and symptoms of catastrophic and emergent
conditions and demonstrate appropriate referral decisions." .......................................................... 126
Table B1.7 CAATE PHP-23: "Apply preventative taping and wrapping procedures, splints, braces
and other special protective devices." .............................................................................................. 127
Table B1.8 CAATE CE-4: "Describe the principles and concepts of body movement, including
normal osteokinematics and arthrokinematics."............................................................................... 127
Table B1.9 CAATE TI-17: "Analyze gait and select appropriate instruction and correction strategies
to facilitate safe progression to functional gait pattern." ................................................................. 127
Table B1.10 CAATE PD-9: "Specify when referral of a client/patient to another healthcare provider
is warranted and formulate and implement strategies to facilitate that referral." ........................... 128
Table B1.11 CAATE PHP-32: "Describe the role of nutrition in enhancing performance, preventing
injury or illness, and maintain a healthy lifestyle to patients."......................................................... 128
Table B1.12 CAATE CE-21o: "Assess and interpret findings from a physical examination that is
based on the patient's clinical presentation for dermatological concerns." ..................................... 128
Table B1.13 CAATE PS-13: "Identify and describe the basic signs and symptoms of mental health
disorders (e.g. psychosis, neurosis); sub-clinical mood disturbances (e.g. depression, anxiety); and
personal/social conflict (e.g. adjustment to injury, family problems, academic or emotional stress,
personal assault or abuse, sexual assault or harassment) that may indicate the need for referral to a
mental healthcare professional." ...................................................................................................... 129
Table B1.14 CAATE PHP-12: "Assess current practice guidelines related to physical activity during
extreme weather conditions (e.g. heat, cold, lightning, wind)."........................................................ 129
Table B1.15 CAATE CE-6: "Describe the basic principles of diagnostic imaging and testing and
their role in the diagnostic process." ................................................................................................ 129
Table B1.16 CAATE TI-29: "Describe how common pharmacological agents influence pain and
healing and their influence on various therapeutic interventions." .................................................. 130
Table B1.17 CAATE TI-22: "Identify and use appropriate pharmacological terminology for
management of medications, inventory control, and reporting of pharmacological agents commonly
used in an athletic training facility."................................................................................................. 130
Table B1.18 CAATE PS-6: "Explain the importance of educating patients, parents/guardians, and
others regarding the condition in order to enhance the psychological and emotional well-being of
the patient.......................................................................................................................................... 131
Table B1.19 CAATE AC-43: "Instruct the patient in home care and self-treatment plans for acute
conditions." ....................................................................................................................................... 131
Table B1.20 CAATE PD-11: "Identify strategies to educate colleagues, students, patients, the public,
and other healthcare professionals about the roles, responsibilities, academic preparation, and
scope of practice of athletic trainers." .............................................................................................. 131
Table B1.21 Report irresolvable issues when appropriate to senior staff or supervisors ................ 132

ix

Table B1.22 CAATE CE-13: "Obtain a thorough medical history that includes the pertinent past
medical history, underlying systemic disease, use of medications, the patient's perceived pain, and
the history and course of the present condition.".............................................................................. 132
Table B1.23 CAATE HA-11: "Use contemporary documentation strategies to effectively
communicate with patients, physicians, insurers, colleagues, administrators, and parents or family
members." ......................................................................................................................................... 132
Table B1.24 CAATE HA-1: "Describe the role of the athletic trainer and the delivery of athletic
training services within the context of the broader healthcare system." .......................................... 133
Table B1.25 The ability to adapt to the demands of the profession of athletic training (e.g. hour
demand, non-traditional work schedule, burnout, work-family conflict). ........................................ 134
Table B1.26 CAATE PD-7: "Perform a self-assessment of professional competence and create a
professional development plan to maintain necessary credentials and promote life-long learning
strategies." ........................................................................................................................................ 134
Table B1.27 Develop the ability to maintain a balance between career and personal life .............. 134
Table B1.28 CAATE TI-7: "Identify patient- and clinician-oriented outcomes measures commonly
used to recommend activity level, make return to play decisions, and maximize patient outcomes and
progress in the treatment plan."........................................................................................................ 135
Table B1.29 CAATE PD-8: "Differentiate among the preparation, scopes of practice, and roles and
responsibilities of healthcare providers and other professionals with whom athletic trainers
interact." ........................................................................................................................................... 135
Table B1.30 Maintaining a sense of spiritual self, consistent with personal beliefs ........................ 135
Table B1.31 CAATE EBP-4: "Describe a systemic approach (e.g. five step approach) to create and
answer a clinical question through review and application of existing research." .......................... 136
Table B1.32 Effectively coping with the pressures of return to play from the coaching staff .......... 136
Table B1.33 CAATE EBP-7: "Conduct a literature search using a clinical question relevant to
athletic training practice using search techniques and resources appropriate for a specific clinical
question." .......................................................................................................................................... 136
Table B1.34 Knowing the scope of practice and being able to determine when to ask for help in
situations when needed ..................................................................................................................... 137
Table B1.35 Remaining calm during situations that require advanced medical assistance within the
realm of athletic training .................................................................................................................. 137

x

LIST OF FIGURES

Figure A1.1 Welcome Page of Survey ................................................................................................ 85
Figure A1.2 Demographics Questions ................................................................................................ 86
Figure A1.3 Athletic Training Demographics Questions ................................................................... 87
Figure A1.4 Instructions of Survey ..................................................................................................... 88
Figure A1.5 CAATE Competency CE-20 ............................................................................................ 89
Figure A1.6 CAATE Competency CE-15 ............................................................................................ 90
Figure A1.7 CAATE Competency TI-11 ............................................................................................. 91
Figure A1.8 CAATE Competency TI-11a ........................................................................................... 92
Figure A1.9 CAATE Competency TI-13 ............................................................................................. 93
Figure A1.10 CAATE Competency CE-16 .......................................................................................... 94
Figure A1.11 CAATE Competency PHP-23 ....................................................................................... 95
Figure A1.12 CAATE Competency CE-4 ............................................................................................ 96
Figure A1.13 CAATE Competency TI-17 ........................................................................................... 97
Figure A1.14 CAATE Competency PD-9 ............................................................................................ 98
Figure A1.15 CAATE Competency PHP-32 ....................................................................................... 99
Figure A1.16 CAATE Competency CE-21o ...................................................................................... 100
Figure A1.17 CAATE Competency PS-13......................................................................................... 101
Figure A1.18 CAATE Competency PHP-12 ..................................................................................... 102
Figure A1.19 CAATE Competency CE-6 .......................................................................................... 103
Figure A1.20 CAATE Competency TI-29 ......................................................................................... 104
Figure A1.21 CAATE Competency TI-22 ......................................................................................... 105
Figure A1.22 CAATE Competency PS-6........................................................................................... 106
Figure A1.23 CAATE Competency AC-43 ........................................................................................ 107
Figure A1.24 CAATE Competency PD-11 ........................................................................................ 108
Figure A1.25 Irresolvable Issues ...................................................................................................... 109
Figure A1.26 CAATE Competency CE-13 ........................................................................................ 110
xi

Figure A1.27 CAATE Competency HA-11 ........................................................................................ 111
Figure A1.28 CAATE Competency HA-1 .......................................................................................... 112
Figure A1.29 Adapting to the Demands of the Profession................................................................ 113
Figure A1.30 CAATE Competency PD-7 .......................................................................................... 114
Figure A1.31Maintaining a Balance ................................................................................................ 115
Figure A1.32 CAATE Competency TI-7 ........................................................................................... 116
Figure A1.33 CAATE Competency PD-8 .......................................................................................... 117
Figure A1.34 Sense of Self ................................................................................................................ 118
Figure A1.35 CAATE Competency EBP-4 ........................................................................................ 119
Figure A1.36 Coping with Return to Play ........................................................................................ 120
Figure A1.37 CAATE Competency EBP-7 ........................................................................................ 121
Figure A1.38 Knowing Scope of Practice ......................................................................................... 122
Figure A1.39 Remaining Calm ......................................................................................................... 123

xii

Chapter 1

Introduction
1.1 Overview of the problem
According to the United States Bureau of Labor Statistics (www.bls.gov), the field of athletic
training has evolved over the past 60 years into an allied health field that is not only recognized
by the American Medical Association (AMA), but is also considered to be a field that is growing
“faster than average.” The increase in the number of accredited athletic training education
programs through the Commission on Accrediting Athletic Training Education (CAATE)
nationwide has produced an increase in certified athletic trainers (ATs) in a variety of different
work settings. These programs are teaching students in-depth information about the foundations
of medicine to aid in the prevention, evaluation, treatment and rehabilitation of patients. In the
early phases of athletic training education, the curriculum included a hybrid of pre-requisites
from the life sciences, pre-physical therapy program and classes that prepared students for a
secondary teaching job, most commonly physical education (NATA.org, 2012). Current trends
in athletic training education introduce a stronger medical training through clinical-based
curricula that promotes learning over time and through evidence based laboratory training
(Turocy, 2000). Evidence based clinical education gives the student an opportunity to learn
skills by physically performing the task at hand while having appropriate supervision by a
preceptor. When the athletic training student is faced with an emergency for which the skills
have been practiced, a higher level of confidence is seen when performing the necessary tasks to
help the patient (Heinrichs, 2002).

1

In order to become an AT, a student must complete an athletic training education
curriculum approved by CAATE and successfully complete an exam that is regulated by the
Board of Certification (BOC) for athletic training. In the early phases of the certification
process, this exam consisted of two sections: the written scientific foundations and the practical
application. The written scientific foundations tested the base knowledge a candidate had in the
different disciplines of athletic training including human physiology, anatomy and exercise
physiology as well as medical competency. The practical application section involved a physical
manipulation of a human model by the person completing the exam in order to perform
orthopedic assessments, muscle testing as well as identifying pertinent landmarks on the body.
Over time, the certification process introduced a written simulation section. This included a
step-by-step evaluation and treatment of a situation in which an injured athlete required attention
(www.nata.org). The exam format has recently changed combining the scientific foundations,
the practical applications and the written simulation section into a single, computer-based exam.
The format of the current exam is similar to that of other medical certifications including some
board examinations for physician licensing as well as physical therapy licensing (AMA.org;
APTA.org).
The current CAATE curriculum standards and the testing procedures established by the
BOC have led to an increase in the demand for direct supervision and mentorship of the athletic
training student during their undergraduate education. Preceptors are required to remain in
audible and visual contact with all athletic training students during any evaluation, treatment or
rehabilitation of an athlete (CAATE.net). This gives the athletic training student the guidance
required as well as reducing the liability of malpractice, and assists the athletic training student in
reassurance of proper technique and care of the athlete.
2

1.2 Significance of the problem
The current standards for an athletic training education programs have been determined
by the NATA Executive Council on Education (ECE) and governed by CAATE. They require
specific clinical competencies to be completed in a learning over time environment. The student
is taught the material in the lecture/classroom setting and is allowed to practice in the laboratory
setting. The students then apply their knowledge in the appropriate time and manner when
necessary in the real life setting. These activities are conducted under the direct supervision of a
practicing AT known as a preceptor. Learning in this fashion allows the athletic training student
an opportunity to gain confidence in performing the skills required in a laboratory scenario.
While gaining experience with the preceptor, the athletic training student then can apply the
techniques practiced from the laboratory scenario to real world situations.
With the incorporation of direct supervision of athletic training students, the preceptor
maintains a supervisory position over the student and completes many of the administrative
duties of athletic training that the student may not be allowed to complete. These activities
include AT and coach interaction during return-to-play decision-making, as well as injury reports
and activity rosters. The preceptor maintains leadership with explanation of injuries to the
athlete as well as others associated with the athlete, i.e. parents, significant others, media. While
the athletic training student witnesses these occurrences, he or she is not placed directly into the
situation. This allows observation of the experience and possible challenges without direct
consequences. Understandably, this is an experience that is facilitated more thoroughly when the
student becomes certified and is practicing independently.
A question that arises with the newest CAATE standards centers on whether the athletic
training students receive the appropriate amount of guidance and preparation in their education
3

to be prepared for real world experiences as an independent AT. CAATE standards do not allow
the athletic training student to spend time in their athletic training experiences beyond what the
federal work-study guidelines allow (CAATE.net). Is this a true sense of the responsibilities a
practicing AT incurs when working directly with a collegiate or professional team? Along with
this idea, does the direct supervision by a preceptor allow an athletic training student enough
experience to be able to respond appropriately in emergencies? This also can include being able
to discuss injuries and return to play with parents, athletes and coaches.
Research within the athletic training profession shows more ATs are experiencing
burnout (Hendrix, 2000; Reed, 2004) as well as an increase in work and family conflict when
practicing in the field (Mazerolle, 2008a, Mazerolle, 2008b). This can place pressures on the AT
that they are unfamiliar with and cause responses that may place athletes’ welfare in jeopardy.
Do the current standards within the athletic training educations across the nation prepare AT
students with the appropriate training to be able to cope with the demands of the profession?

4

1.3 Purpose of the Study
The purpose of this study is to examine the perceptions of newly certified athletic trainers
(ATs) regarding the development and integration of their athletic training skills during their
athletic training education program; specifically, the instruction of clinical, interpersonal and
professional personal development skills as identified in the Commission on Accreditation of
Athletic Training Education (CAATE) standards. Along with determining the level of
development and integration of their skills, participants are asked to identify a level of
importance of the classroom, laboratory and field settings in their educational growth.
1.4 Research Questions
In order for this study to examine the development and integration of specific athletic
training skills during education, a set of research questions was compiled. These research
questions take a look at the individual skills sets (General CAATE athletic training skills,
interpersonal skills, and professional development skills), location and size of athletic training
education programs and how they interact in the different environments. The complete list of
research questions is listed below.
1. What are the perceptions of recently certified ATs regarding the development and
integration of their preparation in:
a. General CAATE athletic training skills
b. Interpersonal Skills
c. Professional Personal Development Skills
2. Does graduating class size affect the perceived instruction in general CAATE skills?

5

3. Does level (e.g. NCAA division I-III or NAIA) of athletic program affect perceived
instruction in general CAATE skills?
4. Do field experiences within the athletic training education of newly certified ATs
play an important role in the instruction of general CAATE athletic training
competencies?
5. Do field experiences within the athletic training education of newly certified ATs
play an important role in the instruction of interpersonal skills within the field of
athletic training?
6. Do field experiences within the athletic training education of newly certified ATs
play an important role in the instruction of how to cope with the demands of the
profession?
1.5 Operational definitions of terms
In order to fully understand this study, there are some common terms and definitions
pertinent to the field of athletic training. These terms include common titles for different
individuals that play a role in athletic training education as well as agencies that have oversight
over the educational process of an athletic trainer.
Certified athletic trainer (AT) - Allied healthcare professional who specializes in the
prevention, diagnosis, treatment and rehabilitation of medical conditions involving
impairment, functional limitations, and disabilities in physically active populations
(NATA, 2012).
Board of Certification (BOC) - A committee that establishes and reviews the standards of
practice of athletic training for an AT (bocatc.org, 2013).
6

National Athletic Trainers’ Association (NATA) – An association in which professional
athletic trainers belong in order to interact and progress the profession (NATA, 2013).
Commission on Accrediting Athletic Training Education (CAATE) - An organization
charged with the development, maintenance and promotion of the appropriate minimum
education standards of athletic training education programs (CAATE, 2013).
Program Director - A person who is a full time employee of the institution holding full
faculty status and having programmatic administrative rights and responsibilities. This
person must be credentialed and in good standing with the Board of Certification (BOC)
and hold a degree commensurate with similar faculty within the institution (CAATE,
2013).
Clinical Education Coordinator - A faculty member of the institution responsible for
student clinical progression, clinical site evaluation, student evaluation, preceptor
training, and preceptor evaluation. This person must be credentialed and in good
standing with the BOC and must be allowed release time commensurate with the
responsibilities given (CAATE, 2013).
Athletic Training Faculty - Faculty associated with the institution that instruct athletic
training students in the acquisition and application of athletic training skills in the
classroom or clinical experience (CAATE, 2013).
Medical Director - A licensed MD or DO who coordinates medical resources and content
with the Program Director for the athletic training students within the athletic training
education program (CAATE, 2013).

7

Preceptor - A clinical instructor who helps facilitate experiences with the athletic training
students in the athletic training setting. Qualifications include being credentialed within
the state and health care profession and practicing in a health care setting where an
athletic training student can interact and gain experience (CAATE, 2013).

8

Chapter 2

Literature review
2.1 History of Athletic Training
The Greeks and Romans sponsored athletic events to honor their Gods. During these
times, individuals were given the task of training and caring for the athletes to ensure adequate
competition. These include the aleiptes, professionals known as "anointers" who massaged oils
onto the body of the athlete to ensure optimal muscle health. The paidotribes were people that
specialized in physical training; including strengthening and maximizing the agility of the
athlete, and the gymnastes, highly sought after individuals for their specialized sport training
(Ablemedia.com). The idea of performing interventions on their athletes to achieve optimal
performance can be seen as the earliest form of sports medicine in history. Since that time, with
the help of science and technology, the field of athletic training has evolved into a recognized
allied health field. Prior to the specialization of athletic trainers, a member of the coaching staff
or a local volunteer physician provided many of the athlete’s medical needs.
The modern athletic trainer, initiated in the 1930s by the United States Olympic
Committee (USOC), developed skills initially through on the job training and from techniques
shared from other professionals with medical experience. The USOC began sending trained
medical professionals, later known as athletic trainers, with their teams to care for the athletes.
These professionals shared techniques and knowledge through workshops and seminars hosted
by the USOC. In 1938, during the Drake Relays track event at the University of Iowa, the first
National Athletic Trainers’ Association (NATA) was formed by individuals recognizing
9

themselves as practicing athletic trainers in the realm of athletics. At this time, the NATA
agreed to convene twice a year at the Drake Relays in Iowa City, IA and the Penn Relays held at
the University of Pennsylvania in Philadelphia, PA. This continued until the beginning of World
War II when a large portion of the athletic trainers enlisted and utilized their skills to aid men in
battle. Unfortunately, shortly after in 1944, the NATA became bankrupt and was no longer in
existence (Ebel, 1999).
Although many regional groups of athletic trainers maintained contact with one another
and held small conventions, the NATA did not re-established itself until 1950. During this time,
many athletic trainers practiced in different environments, and had no recognized formal
education or certification process in place nationwide. William E. Newell, the first man
appointed as the National Secretary of the NATA in 1955 and later the Executive Director, along
with the appointment of a Committee on Gaining Recognition convened to develop the basic
skills and educational needs of individuals wishing to become athletic trainers (Delforge, 1999).
Over time, this committee became the Professional Education Committee and the first to oversee
the initial athletic training curricula in universities. In 1956, the Committee on Gaining
Recognition was charged with its first order of business, the professionalization of athletic
training through a national certification process, later approved by the NATA board of directors
in 1959 (Schwank, 1971). This included the basic standards required for becoming an athletic
trainer including educational standards in the classroom as well as in the field prior to sitting for
the exam.
The curriculum model proposed in 1959 had two basic tenets to support an individual
becoming an athletic trainer. First, the required classes would be aligned with the prerequisites
for physical therapy school. Other than a few specific classes, most universities already offered
10

these classes and therefore the model did not require a significant change within the participating
institutions. This was an easy step for adding athletic training into the curriculum, but did not
differentiate the profession from physical therapy. The second emphasis was to fulfill the
requirements for secondary school teaching certification. Prior to becoming an athletic trainer,
the student needed to complete the specific university requirements for a teaching certificate. As
a valued asset in the secondary school system, the athletic trainer could care for the athletes in
addition to teaching classes (e.g., physical and health education). The initial curriculum for those
seeking employment in athletic training consisted of (Delforge, 1999):
All physical therapy school pre-requisites:
Biology/Zoology (8 Semester hours)
Physics and/or Chemistry (6 Semester hours)
Social Sciences (10 Semester hours)
Other electives as required by the school
Specific course requirements during undergraduate studies:
Anatomy
Physiology
Physiology of Exercise
Applied anatomy and kinesiology
Laboratory physical science
Psychology
Coaching Techniques
First aid and Safety
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Nutrition and Foods
Remedial Exercise
Organization and Administration of health and physical education
Personal and community hygiene
Techniques in athletic training
Advanced techniques in athletic training
Laboratory practices in athletic training
Recommended courses
General physics
Pharmacology
Histology
Pathology
The first athletic training education programs were recognized by the NATA in 1969
after colleges and universities were given time to adjust the curriculum to fit the committee’s
outline. Committee members included ATs from Mankato State University, Indiana State
University, Lamar University and the University of New Mexico (Delforge, 1999). The NATA
then named the Committee on Gaining Recognition, with its new moniker being the Professional
Advancement Committee, into two subcommittees known as the Subcommittee on Professional
Education and the Subcommittee on Certification (Newell, 1984). Aptly titled, the
Subcommittee on Professional Education developed and maintained the academic curricula of
the recognized athletic training education programs, while promoting the development of other
programs in a variety of collegiate settings. The Subcommittee on Certification, charged with
developing the first certification process, introduced the first certification examination in 1970
12

and anyone wishing to take the examination completed studies through one of four different
preparation paths. Completing a degree from an NATA-approved university with the
appropriate coursework completed at a satisfactory level constituted the first route. The second
route outlined preparation for the certification examination through an “apprenticeship” program
that had similar coursework, but focused on clinical education more than an academic
curriculum. Completion of a physical therapy degree illustrated the third route. The NATA felt
that being competent as a physical therapist showed adequate preparation for the national
certification exam for athletic training. The fourth route allowed athletic trainers that were
“actively engaged” in the profession prior to 1970 to be to be “grandfathered in” as a certified
athletic trainer (Westphalen, 1978). Administered in Waco, Texas, in August of 1970, 28
candidates completed the first national certification exam (Lindquist, 2007). The initial exam
consisted of two sections. “Basic and Clinical Sciences” contained 75 questions focused on
anatomy, physiology, mechanics and pathology of athletic injury as well as the principles of
injury prevention. The second section, known as “Theory and Practical Application of Athletic
Training,” included 75 written questions and 5 oral/practical questions assessing a candidates
understanding of first aid, injury conditions, therapeutic modalities, rehabilitation, and taping and
bracing techniques (Grace, 1999).
During the 1970s, athletic training education grew within the collegiate curricula. Along
with this growth came the need for a separation from the field of physical therapy for the
developing athletic training profession. There were enough students interested in athletic
training that new courses could be filled. The NATA presented a revised athletic training
education curriculum developed for colleges wishing to provide coursework specifically for
athletic training (NATA, 1980). This curriculum included:
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Anatomy (1 course)
Physiology (1 course)
Physiology of Exercise (1 course)
Applied anatomy and kinesiology (1 course)
Psychology (2 courses)
First aid and safety (1 course)
Nutrition (1 course)
Remedial Exercise (1 course)
Personal, community and school health (1 course)
Basic athletic training (1 course)
Advanced athletic training (1 course)
Laboratory or practical experience in athletic training including a minimum of
600 hours under the direct supervision of an NATA certified athletic trainer
Compared to the previous curriculum, there was less focus on the pre-professional
courses such as chemistry and physics and a stronger focus on the clinical application of skills
while under the direct supervision of a certified athletic trainer. During the time spent under
direct supervision, the students completed a set of behavioral objectives outlined by the
Professional Education Committee. These objectives were in place to ensure that learning skills
in the field encompassed a consistent amount of information acquired in the classroom.
Different athletic environments incur a myriad of situations and the NATA wanted to help
develop a well rounded AT in case the clinical experiences did not utilize certain skills. That
was why the behavioral objectives needed to be completed. Along with the modification of
coursework and the addition of the clinical experience, the NATA moved away from the
14

requirement of completing a secondary teaching credential (NATA, 1980). This created more of
a focus on the specialization of athletic training, rather than as a secondary position that
employed athletic trainer in the high school setting.
The athletic training education field was achieving major milestones in the 1980s. By
1982, the NATA recognized 33 undergraduate athletic training education programs and 9
graduate level athletic training education programs nationwide, a large increase from the initial 4
programs in 1969 (Delforge, 1982). The increased interest from colleges and universities to gain
recognition from the NATA for an athletic training education program led to the implementation
of a requirement for an athletic training major in recognized institutions prior to the certification
exam. The NATA board of directors approved the major in 1980 and allowed the schools 6
years to implement the major. The change was to be completed no later than July 1, 1986, but
was delayed and rescheduled for July 1, 1990 (Delforge, 1982). The NATA also developed the
Guidelines for Development and Implementation of NATA Approved Undergraduate Athletic
Training Education Programs in 1983 so that institutions could have a strategy for creating this
new major (NATA, 1983). This document Identified specific competencies required of an
athletic training student during their education preparation. These competencies were an
adaptation from the original behavioral objectives and needed to be adequately demonstrated by
the student prior to graduation and sitting for the national certification exam. In order for a
student to fully understand and demonstrate these skills, they had to learn specific subject matter
required by the NATA (NATA, 1983). This included:
Prevention of athletic injuries/illnesses
Evaluation of athletic injuries/illnesses
First aid and emergency care
15

Therapeutic modalities
Therapeutic exercise
Administration of athletic training programs
Human anatomy
Human physiology
Exercise physiology
Kinesiology/biomechanics
Nutrition
Psychology
Personal/community health Instructional methods
The NATA implemented a specific formalized instruction plan for the athletic training
major to create a separation from physical therapy and secondary education majors. The
American Medical Association (AMA) had previously been aware of the field of athletic
training, but in 1990, they formally recognized the education curriculum. This news came after
the NATA reached out to the Committee on Allied Health Education and Accreditation
(CAHEA) to conduct formalized assessment and accreditation of recognized athletic training
education programs (NATA, 1990). The NATA felt that utilizing an outside committee to
regulate the education process led to a higher recognition through the AMA and was a major step
forward for the recognition of athletic trainers as proven allied medical professionals. Meetings
were held between CAHEA and the NATA Professional Education Committee (PEC) to develop
an assembly of medical professionals as an established board to maintain regulations for athletic
training education. This committee, named the Joint Review Committee of Athletic Training
(JRC-AT), consisted of members of the American Academy of Family Physicians (AAFP), the
16

American Academy of Pediatrics (AAP), the AMA, the NATA and a little later in the appointing
process, the American Orthopedic Society for Sports Medicine (AOSSM) (NATA, 1995). The
main task charged to JRC-AT became development of guidelines and regulations not only for the
implementation of athletic training education, but also to develop required standards for each
student prior to sitting for the national certification exam. These standards were similar to the
competencies in athletic training that NATA-PEC had developed previously, but also were to
increase the recognition of athletic training as an allied health profession.
In 1994, CAHEA disbanded due to the proposal that the AMA, instead of being the
primary sponsor for the regulation of allied health education, would team up with the United
States Department of Education and create a new committee, the Committee on Accreditation of
Allied Health Education Programs (CAAHEP). JRC-AT then reported to CAAHEP instead of
CAHEA. Under the new joint sponsorship of AMA and the U.S. Department of education,
CAAHEP accredited 28 allied health professions in the United States (Rosenthal, 1991). This
transfer to a different committee also saw an increase in the number of accredited entry level
athletic training education programs as well as graduate level athletic training education
programs. There were 82 entry-level athletic training education programs as of June 1998, up
from 68 previously recognized programs by NATA (JRC-AT, 1998). Under CAAHEP,
programs seeking accreditation must follow a sequence in order to complete the process. The
first step included submission of an application to JRC-AT that was then signed by the Chief
Executive Officer (CEO) of the institution. This application must include a plan of matriculation
through approved coursework and successful completion of a degree or specialization in athletic
training. Once the application had been submitted, the program seeking accreditation underwent
a 2-year candidacy period in which the JRC-AT evaluated the different aspects of the application

17

to ensure appropriate standards of practice according to the application. Yearly, the program
also had to submit three hardbound copies of a self-study to the JRC-AT detailing the successes
or failures of the program. This self-study continued to be submitted after the 2-year candidacy
period was completed as well (JRC-AT and CAAHEP, 2001). These self-studies became a form
of checks and balances to identify any discrepancies or violations and assure that the standards
for accreditation were upheld.
Standardizing the athletic training education process through CAAHEP was a positive
step for the field of athletic training as it regulated the material instructed to students, but it was a
short-lived endeavor. In the fall of 2003, JRC-AT announced separation from CAAHEP and
creation a self-regulated committee known as the Committee on Accrediting Athletic Training
Education (CAATE). According to JRC-AT, this committee benefited the field, as it would
provide efficiency, flexibility, promotion of the professionalism, and development of collegial
relationships (CAATE, 2012). The process for programs seeking accreditation was similar in the
fact that an application required approval from the institution’s CEO, depending on the
institution it could be the president, chief academic officer or whomever they deemed had the
authority, however they disbanded the 2-year candidacy period. In addition, CAATE
reformatted the site visit policy and materials required. CAAHEP required 21 items to be part of
the self-study, whereas CAATE only required 17 (CAATE.net, 2012). The latter CAATE
requirements included:
The current academic catalog with AT class times and descriptions
The current application from and criteria for becoming an AT student
A copy of current cards of all NATABOC ATs involved with the program

18

A listing of all students in the program and their respective clinical supervisors
Job titles and descriptions of all support staff assisting in the athletic training
education program
The institutional professional growth policy
A list of all electronic resources available to anyone associated with the AT program
A list of all periodicals available to anyone associated with the AT program
A list of all periodicals owned by the entire institution
Syllabi for all courses associated with the AT program
The current AT Student Handbook
A copy of the AT program policy and procedure manual
A list of all texts utilized in the program
Description and floor plan of all facilities utilized
A list of all instructional uses on-campus therapeutic modalities, rehabilitation and
health assessment equipment for instruction and use at all clinical sites.
A list of all instructional use first aid and emergency care equipment and supplies for
instruction and use at all clinical sites
A list of equipment inspection dates for all modalities and equipment utilized for
instructional use

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CAATE enacted a landmark decision on January 1, 2004 when it ceased recognizing
students from internship athletic training education programs as viable candidates to sit for the
national certification exam. Up to this point, two routes for completing the requirements to sit
for the national certification examination had been recognized and utilized. This meant that all
programs had to become more curriculum based instead of the internship option, changing the
educational process for many institutions. Due to this change, many athletic training education
programs were discontinued instead of transitioning into the academic program. By 2005, all
athletic training education programs had to be in accordance with the new standards placed by
CAATE, or the students enrolled in their curriculum could not sit for the board certification
exam. Since this time, CAATE has created updated editions to their standards, but have been the
accrediting body that has been in place since separation from CAAHEP.
2.2 Current curriculum requirements (As of 11/1/12)
The bases for an athletic training education program to be recognized and accredited
through CAATE are outlined in the Standards for the Accreditation of Professional Athletic
Training Programs, which can be viewed at any time on their website, www.CAATE.net. The
standards are a culmination of eight different content areas that are pertinent to the field of
athletic training. CAATE recognizes those fields as:
Evidence-Based Practice
Prevention and Health Promotion
Clinical Examination and Diagnosis
Acute Care of Injury and Illness

20

Therapeutic Interventions
Psychosocial Strategies and Referral
Healthcare Administration
Professional Development and Responsibility (CAATE Standards)
This information is taught to athletic training students through didactic, laboratory and
clinical courses offered by the institution. The acquisition of this information must also be
taught through a continuum of learning over time under the direct supervision of a preceptor
deemed competent by the institution. A preceptor can include ATs, physicians, physical
therapists and anyone practicing in the medical field. This allows the student to utilize the
information from the classroom in a variety of different applicable settings. For instance, a
student learns a specific orthopedic examination in a classroom and is allowed to practice it in
the laboratory setting. During the clinical experience, the chance arises that the examination is
required to determine an injury the athlete has sustained. The student, under direct supervision
of a preceptor, is allowed to perform the examination. The student’s skills are then discussed
with the preceptor following the examination and evaluated on performance.
Initially, if an institution wishes to receive CAATE accreditation for their athletic training
education program, the institution must be accredited through the United States Department of
Education or a Council for Higher Education Accreditation recognized agency. Along with this
recognition, an $1800 yearly fee for accreditation must be paid. The institution must offer a
minimum of a baccalaureate degree in athletic training. Within this athletic training education
program, there must be an educational mission with goals and objectives for the quality of
student learning, instruction and overall effectiveness of the program (CAATE Standards, 2012).
21

The institution must employ an athletic training education program director, a clinical education
coordinator, athletic training faculty and preceptors to complete a staffing team. All of these
individuals play a role in the completion of the education process for students wishing to
complete the program.
The educational content of the institutions athletic training education program is not
specifically outlined in the CAATE Standards for the Accreditation of Professional Athletic
Training Programs, but the manner in which the information is disseminated and regulation of
the athletic training student’s learning process is outlined. The requirements in place by CAATE
on the athletic training programs is as follows (CAATE Standards, 2012):
A current version of all athletic training knowledge, skills and abilities must be
utilized
Structured classroom, clinical and laboratory environments must be involved in the
formal instruction of the athletic training material.
Athletic training students must have the opportunity to interact with other medical
and health care personnel on a continual basis throughout their learning process.
Course syllabi detailing specific measureable objectives must be utilized and clearly
written in all athletic training courses.
A logical progression must be followed during clinical education in which the student
gains clinically supervised responsibility through an increasing amount of autonomy

22

leading up to graduation or culmination of education.
Opportunities for real time experiences must be afforded to the athletic training
student to hone skills and clinical abilities that a practicing AT would experience.
Athletic training students will have opportunities to interact and associate with
different patient populations and different allied health providers.
Discrimination based on sex, ethnicity, religious affiliation, or sexual orientation for
clinical education assignments will not occur.
Opportunities for the athletic training student will include, but are not limited to:

Team and individual sports
Sports requiring protective equipment
Teams of different sexes
Patients that are of a non-sport population
Different disciplines within the realm of medicine
Sites that are utilized for clinical education will be evaluated on regular basis to
ensure quality of education at each site.
The majority of an athletic training student’s clinical experience will be under the
direct supervision of a BOC AT.
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In order for an athletic training student to perform skills on athletes, he or she must be
officially enrolled in the athletic training education program.
Clinical experiences must be educational in nature. Athletic training students must
have a minimum of one day off per 7-day period and the athletic training education
program must outline a minimum and maximum hours required for the clinical
experience.
Preceptors must undergo a provision for clinical education opportunities. This
includes regular communication with the athletic training education administration.
The preceptor must be physically present when athletic training students are
performing skills in order to intervene if the athlete or patient is in imminent harm.
The National Athletic Trainers’ Association Executive Committee for Education (NATAECE) has developed the specific learning content for the athletic training education programs
accredited by CAATE. Over time, this information has evolved along with the profession of
athletic training. The NATA-ECE, Board of Certification and CAATE recognize nine categories
in the 5th Edition Competency Matrix as specific learning elements (CAATE.net). Each of these
categories is recognized as individual entities and must be taught through the learning over time
concept that has been established for athletic training education programs.

24

2.2.1 Category 1: Evidence Based Practice (EBP)
Evidence Based Practice (EBP) is comprised of 14 specific items that must be taught in
and evaluated within the athletic training education program. Students must be able to
recognize and analyze current research published within the allied health field. The
student must be able to critically evaluate this material, as well as incorporate it into their
athletic training practices. This section, a new section added for the fifth edition of the
competencies, is important for students as they recognize the potential impact of
technology and advances in research, implementing those that are applicable to improve
patient care.
2.2.2 Category 2: Prevention and Health Promotion (PHP)
The Competency Matrix is known as Prevention and Health Promotion (PHP). This
category has 49 specific items divided into 8 subcategories. These subcategories are:
General Prevention Principles, Prevention Strategies and Procedures, Protective
Equipment and Prophylactic Procedures, Fitness/Wellness, General Nutrition Concepts,
Weight Management and Body Composition, Disordered Eating and Eating Disorders,
and Performance Enhancing and Recreational Supplements and Drugs. In the General
Prevention Principles, the student must recognize epidemiological ideals that take place
within the field of athletic training as well as medicine. This can include injury rates,
prevalence, monitoring systems and risk factors in athletic participation. Prevention
Strategies and Procedures includes ideals such as pre-participation physical exams, as
well as environmental concerns that are the responsibility of the athletic trainer for
monitoring the athlete’s safety and well being. Protective Equipment and Prophylactic
Procedures provide an understanding of the type of equipment utilized for constructing
25

and properly fitting bracing and other special devices the athlete may require for
participation. The main concepts covered in the Fitness/Wellness category include the
general ideals of proper hygiene and exercise for the basic athlete, as well as methods for
designing and implementing fitness programs to enhance the abilities of athletes.
General Nutrition Concepts include proper dietary intake and instruction on the basics of
nutrition (e.g., protein, carbohydrate, vitamin and mineral consumption), as well as
hydration and proper re-hydration techniques for optimum performance. Weight
Management and Body Composition work in concert with the General Nutrition
Concepts to help the athletic training student understand proper body composition for
optimum performance in athletics, whether the athlete is in need of gaining or losing
weight for optimum participation in their sport. This also includes techniques for
evaluation of body composition and eating habits. Disordered Eating and Eating
Disorders is an important sub-category as it focuses on the dangers of problematic eating
that athletes face, and how to recognize and refer these athletes to proper care when the
signs and symptoms of disordered eating appear. Most recently, there has been a surge of
interest in the supplement and drug industry to help athletes gain an edge over their
opponents. The Performance Enhancing and Recreational Supplements and Drugs
portion of PHP helps athletic training students gain valuable knowledge for optimizing
performance while limiting bodily harm. This can include athlete education about
supplement and drug use as well as physiological responses of the body to the use of
supplements and drugs.

26

2.2.3 Category 3: Clinical Examination and Diagnosis (CE)
Clinical Examination and Diagnosis (CE) examines orthopedic assessment of the skeletal
body of athletes, as well as evaluates function and biomechanical analyses of motion.
Along with the clinical orthopedic assessment, the athletic training student must also be
able to perform an assessment of general medical conditions that an athlete may incur,
such as illness, dermatological concerns and infections. This must be accomplished
through thorough evaluation skills and a general knowledge of assessment tools from the
medical field, including muscle, neurological, and general medical testing. This category
is comprised of 21 different items of assessment with the final two items outlining the
testing process through a total of 26 specific points.
2.2.4 Category 4: Acute Care of Injuries and Illnesses (AC)
Acute Care of Injuries and Illnesses (AC) focuses the athletic training student’s education
on managing problematic situations with athletes in a timely and efficient manner. This
category is comprised of six subcategories as follows: Planning, Examination, Immediate
Emergent Management, Immediate Musculoskeletal Management, Transportation, and
Education. The Planning subcategory introduces the legal, moral and ethical aspects of
injury management, and outlines responsibilities and roles that a person accepts when he
or she becomes an athletic trainer. The Examination section utilizes the assessment of
the scene, as well as the athlete, to properly develop a plan of care. Immediate and
Emergent Management helps the athletic training student enact their developed plan for
optimal acute care of an injured athlete. This also includes CPR, First Aid techniques
and Emergent Care such as airway obstruction and exercise-induced asthma. Immediate
Musculoskeletal Management is similar to Immediate and Emergent Management as it
27

continues to focus on acute care of injured athletes, but focuses more on the
immobilization of injured appendages and musculoskeletal injuries. The Transportation
subcategory focuses not only on the transportation of the athlete to the appropriate
medical facility, but also the appropriate mode of movement for the injured athlete from
the field of play. This can include spine boarding as well as emergent transportation,
(i.e., two-person carries) and transportation via ambulance. Being able to instruct not
only the athlete in proper home care of an injury, but caregivers associated with the
athlete (i.e. parents, roommate, or significant other) is the main focus of the Education
subcategory. This is important as it allows the athlete and others to aid in the treatment
and recovery from injury.
2.2.5 Category 5: Therapeutic Interventions (TI)
The Therapeutic Interventions (TI) category encompasses physical rehabilitation skills as
well as therapeutic modalities and therapeutic medications. Each of these subcategories
deals with the recovery of an athlete in their journey to return-to-play or overcome an
injury, and encompasses 31 total items of learning. Physical rehabilitation includes
therapeutic exercise prescription, as well as overcoming the pain cycle through such
techniques as immobilization and manual mobilization. A student will need to
understand the physiology and use of therapeutic modalities such as electric stimulation
and ultrasound, as well as their contraindications. This will assist in the healing process
without causing further harm or damage to the tissue or body part that has been injured.
Medications can also optimize the healing process for an athlete and athletic training
students will need to be aware of the benefits and potential side effects. This includes
prescription medications administered by a physician to over-the-counter medications
28

that an athletic trainer may suggest. Holistic medications such as herbals and vitamins
fall under this scope of practice as well.
2.2.6 Category 6: Psychosocial Strategies (PS)
Athletes show varying personality traits that have the potential to improve and enhance,
as well as exacerbate or hinder their performance. An athletic trainer needs to be able to
recognize these traits and either help the athlete utilize these characteristics to enhance
performance or cope with them. The Psychosocial Strategies (PS) section, new with the
fifth edition of the competencies, addresses this issue. It is divided into three different
sub-categories: Theoretical Background, Psychosocial Strategies, and Mental Health and
Referral, and consists of 18 specific items that need to be learned by the athletic training
student. Theoretical Background outlines ideals within a personality including emotional
response to injury, decision-making, and interpersonal skills. The Psychosocial
Strategies help an athletic training student assist the athlete in overcoming adversity by
utilizing techniques such as imagery, self-talk and goal setting. Mental Health and
Referral gives the athletic training student a better understanding of personality traits and
behaviors that require assistance beyond the scope of sports medicine and can aid an
athlete by obtain the guidance needed to perform better and deal with issues outside of
sport that are affecting them.
2.2.7 Category 7: Healthcare Administration (HA)
Healthcare Administration (HA) encompasses the legal and organizational concerns of
athletic training. The NATA has outlined many ideals in the successful implementation
of athletic training in the clinical, educational and professional settings. These ideals
include strategic planning for a successful athletic training room or clinic, as along with
29

managing inventory, budgeting and expenditures. In order for an athletic training student
to fully understand the competencies put into place, they also need to understand legal
guidelines and principles of practice that are included in the 30 items of this section. This
section outlines the required federal and local guidelines, as well as scope of practice of
an athletic trainer in a specific setting.
2.2.8 Category 8: Professional Development and Responsibility (PD)
The field of athletic training has evolved into a recognized allied health field and in order
to continue their success as an organization, future athletic trainers must continue to
prove successful. The Professional Development and Responsibility (PD) section of the
competencies ensures that athletic training students have a solid history of the field of
athletic training as well as the legal and community obligations that are placed on them.
Within the 12 items outlined in this section, the athletic training student must have a
strong knowledge of the NATA, its Code of Ethics, Role Delineation and scope of
practice as well as influences that may be placed on healthcare by athletic training. This
will enable the field of athletic training to continue providing a positive influence on
sports medicine.
2.2.9 Category 9: Clinical Integration Proficiencies (CIP)
The Clinical Integration Proficiencies (CIP) is the final section of the 5th Edition
Competencies Matrix. This section integrates each of the preceding 8 categories into a
comprehensive clinical education for the athletic training student. The CIPs allow the
AT student the opportunity to utilize skills that are learned in the classroom in a real time
scenario under the supervision of a preceptor. Each student must complete all CIPs prior
to graduation and sitting for the national certification exam.
30

Each of the sections of the Competencies Matrix addresses a different aspect of the field
of athletic training and will continue to evolve as technology and medicine advances. The CIP
section of the Matrix assists student learning over time, a concept addressed by the NATA and
the CAATE, and allows the athletic training student to coordinate skills in theoretical models as
well as real time situations with the reassuring supervision of a preceptor.
2.3 Socialization to the field of athletic training
A driving influence in the success of an athletic trainer in the field is socialization.
Professional socialization can enhance athletic training success and appreciation in the field or
have a negative impact on experiences leading to burnout and job dissatisfaction (Pitney, 2002).
An athletic trainer, as with many in the allied health and physical education fields, undergoes a
theoretical framework of socialization into the profession through three basic phases (Lawson,
1983a; Lawson, 1983b, Lortie, 1975, Hayden, 1995; Harvill, 1981):
Anticipatory Socialization
Professional Socialization
Organizational Socialization
2.3.1 Anticipatory Socialization
Anticipatory socialization occurs when a student, early in the educational process, is
exposed to the field of athletic training. This can occur through personal experience, such as
being injured while participating in athletics, or through exposure at such events as a career fair
or field trip. The importance of athletic trainers practicing in the high school setting is not only
valuable for the prevention, treatment and rehabilitation of injured athletes, but also as an

31

important promoter of the field of athletic training. Many times, this can be the first interaction a
student has with the profession. After being made aware of the field, the student searches out
more information about the field and pathways for becoming a certified athletic trainer. During
this phase, the student has minimal understanding of what truly occurs in the field of athletic
training, but has a piqued interest and ventures further to find out more about the profession.
2.3.2 Professional Socialization
The interest that begins during the anticipatory socialization stage is furthered through the
professional socialization stage in which the student seeks out formal education in the field.
Collegiate courses such as science, psychology, biomechanics and athletic training application
courses enlighten the student to the needs of the profession of athletic training. It is at this stage
of the socialization that the student gains a stronger understanding of the field from not only an
educational perspective, but also through clinical application. Within the literature for nursing
and physical therapy organizational socialization, this is the stage in which the student begins to
assimilate true experiences in the field through the use of clinical laboratories as well as
shadowing experiences (Teschendorf, 2001). This is also the phase in the socialization process
in which values, attitudes and norms of behavior are introduced and develop within the student
(Hayden, 1995). These values can enhance a student’s desire to be in the profession or hinder
their growth, causing a stronger likelihood of job dissatisfaction or burnout when they have
arrived in the professional setting (Winterstein, 1998). The professional socialization phase
extends for some athletic training students through a graduate assistantship (GA). A GA is a
certified athletic trainer gaining not only experience through advanced education, but also
practicing within the clinical aspect of athletic training with the assistance of other, more
experienced certified athletic trainers on staff at the institution granting the advanced degree.
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The GA can develop and mature their skills as well as having a clearer understanding of
limitations within their current experience level. This type of advanced education enlightens the
student to nuances of athletic training not taught during their initial education, such as intrainstitution politics and organization they may not have encountered completing their
baccalaureate degree.
2.3.3 Organizational Socialization
The final phase in the socialization of professionals in athletic training is organizational
socialization in which the certified athletic trainer, following completion all of the necessary
schooling, attains a position where they are the medical authority (under the tutelage of a
physician) for an institution. This can include the industrial setting, the clinical setting within a
medical facility, high school position, collegiate position or professional position in other
settings. Within this realm, the practicing AT depends on their educational background along
with organizational preparation or mentoring provided by the employer. In a study done by
Pitney et al (2002) of ATs at the Division 1 level of the National Collegiate Athletic Association
(NCAA), many of the responses displayed a sense of being overwhelmed by a new setting, the
intense volume of work required and the added responsibilities not necessarily related
specifically to patient care (Pitney, 2002). Additionally, many of the subject’s responses
identified a lack of “formal induction processes” into the field to fully understand the role that
they were holding at the institution, seemingly a sense of “learning on the run.” A successful
institution or organization can improve this situation by introducing a mentoring program in
which a more senior athletic trainer within the institution assists a new employee with situations
that are not within normal educational protocols, similar to suggestions made by Parkay et al

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(Parkay, 1992). This may aid in the reduction of burnout, work-family conflict and job
dissatisfaction.
2.4 Challenges that occur in the field of athletic training
The field of athletic training continues to be recognized as a growing allied health field,
however there are certain parameters in the profession that require a strong set of coping skills to
achieve success. If these skills are not utilized, burnout, work-family conflict or a departure
from the profession can occur. It has been documented that athletes achieve burnout in their
sport due to overtraining and a lack of variety (Feigley, 1984, Morgan, 1987), this can occur in
athletic trainers as well (Hendrix, 2000). The characteristics of burnout are depicted as
negatively-perceived events that are uncontrollable by the person that lead to 1)
depersonalization, 2) emotional exhaustion and 3) a feeling of a lack of personal
accomplishment. Depersonalization can be described as having unfeeling or uncaring responses
to patients. Feelings of fatigue and emotional overextension due to patient and colleague
interaction are the main characteristics of emotional exhaustion and decreased feelings of
personal accomplishment include a feeling of worthlessness and/or failure (Maslach, 1996).
These characteristics may be due to chronic stress, overexposure to high-pressure situations in
the work place and general job dissatisfaction. The Maslach Burnout Inventory (MBI) was
developed by Maslach and Jackson to help diagnose the problem, and has become one of the key
tests to identify burnout in many professions (Maslach and Jackson, 1981).
The Cognitive-Affective Model of burnout developed by Smith describes burnout as a
long-term concern that evolves through perceived demands that includes possible physiological
changes in the person that can lead to medical concerns (Smith, 1986). Stressors that can lead to
the increase in burnout include continued high work volume, required long hours at the
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workplace, unclear roles and responsibilities within the workplace, conflicting responsibilities as
well as interpersonal conflicts among co-workers (Capel, 1990)
Netermeyer defines work-family conflict as “a discord that arises when the time devoted
to or time spent fulfilling professional responsibilities interferes with or limits the amount of time
available to perform family-related responsibilities” (Netermeyer, 1996). Mazerolle et al
describe factors that lead to work-family conflict as long work hours and included travel, job
satisfaction, job burnout and intention to leave a position (Mazerolle, 2008b). The profession of
athletic training requires great time commitment when working with sports. Many times, the
athletic trainer arrives hours prior to an event (i.e., practice or competition) and is required to
stay after to complete post-workout treatments. This can cause a strain on the athletic trainer and
this person’s out-of-work lifestyle, such as time spent with family, friends or even personal time
needed for activities to balance a person’s life (i.e. exercising, religious preferences or personal
time). Pitney describes that obligations to family, friends and work will weigh differently on the
individual. This can cause internal conflict within that person as a feeling of competition of
“selves” within that person can lead to animosity and unhappiness (Pitney, 2006).
Although these challenges occur in the field of athletic training, researchers are
determining which factors are the leading causes of burnout and work-family conflict
(Mazerolle, 2008a, Netermeyer, 1996, Hendrix 2000). There is also research determining which
factors can minimize these effects. Reed (2004) outlined 10 major factors that ATs utilize to
reduce the negative effects of the profession (Reed, 2004). They are:
Planning
Instrumental social support
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Adjusting to job responsibilities
Positive evaluations
Emotional social support
Humor
Wishful thinking
Religion
Mental or behavioral disengagement
Activities outside the profession
Other suggestions to decrease work-family conflict and burnout include creating flexible hours
for work during off-season times, increasing staff numbers so that athletic trainers do not have to
cover multiple sports during different seasons and utilizing compensatory time off for extra
hours worked (Mazerolle, 2008b). Currently, the CAATE has no required education for athletic
training students in any of these fields (Mazerolle, 2008c), but incorporation of coping skills into
athletic training education programs can help strengthen athletic training students in preparing
for future endeavors in the field. A strong setting of coping skills help the athletic training
student work through issues that may occur while practicing in the field. In addition, ATs that
are currently practicing can pass along coping strategies they find successful when practicing in
the profession.

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2.5 Learning styles in Athletic Training Education
The current trend in athletic training education is problem-based learning in which
students learn material and are able to put the knowledge they gain to use in scenario or
laboratory settings. Heinrichs outlines that “[t]he greatest challenge facing any professionaleducation program (e.g., medicine, health professions, law, business, aviation) is to produce
professionals who are capable of independent and critical thinking, who can sequentially analyze
and solve dynamic problems, who possess a commitment to lifelong learning, who can rapidly
understand problems in order to make critical decisions on the field and in the clinic, and who
can work as part of a team” (Heinrichs, 2002). These goals are met by the athletic training
student through proper instruction and adequate access to learning scenarios within their
education.
Initially, an athletic training student needs a solid foundation of knowledge to continue
through the active learning process. This includes a working knowledge of basic science as well
as an established understanding of kinesiology and modern medicine. These didactic skills,
along with a level of maturity allow engagement in the learning process from an internal fixation
in order to become a stronger athletic trainer. This level of maturity comes through societal
experience, as well as a desire to learn out of necessity for clinical application. This is
concurrent with Knowles’ work with andragogy in adult learning (Knowles, 1980). Knowles’
theory outlines four original and two later known assumptions of the adult learner. They are 1) a
person evolves from a dependent personality to a self-directed learner as the person matures, 2) a
major resource that an adult learner relies on is the experience that they have accumulated, 3) the
social role of an individual can determine inclination for need and want to learn as an adult, 4)
knowledge that is learned for an adult learner is utilized immediately rather than in the future, 5)
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internal motivation is key versus external drive, and 6) There is a need to know why they need to
learn material (Merriam, 2007).
Once a student reaches a level of maturity to be considered an adult learner and plays an
active role in the education process, Biddle identified that the integrative framework they are
working with is dependent on one of two theories, either the self-efficacy motivation theory or
the self-determination theory (Biddle, 1999). The major hypothesis in the self-efficacy
motivation theory relies on the instructor making the learner feel wanted and competent in the
learning environment. This provides the learner a sense of confidence and ease to allow a sense
of worth in the learning process as well as a sense of ownership in the material learned (Bandura,
1986). Personal ownership of their education needs to be present in the athletic training student
in order to take control of the learning process. Utilizing instructors that create a positive
learning environment shows the learner that more is accomplished in the learning progression
when the student has a sense of worth and feels needed within the process. The second theory
that Biddle identifies with, the self-determination theory, encompasses two general classes of
motivation: the self-determined and the controlled learner. The self-determined learner is an
active learner choosing to be a part of the learning process and has an internal drive to succeed
due to either choice or previous experience (Biddle, 1999). The controlled learner is regulated
through compliance and experience, meaning the learning process is completed because it is part
of a plan or a necessity for progression (Deci, 1999). This plan can include career goals,
achievement in the field of athletic training or simply a desire to help others.
The field of athletic training education requires its students to achieve a level of learning
that places them in the category of adult learners for two main reasons. The first is that the level
of expertise required to assist others in emergency medicine, treatment and rehabilitation of
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injuries as well as psychological issues also requires a level of maturity associated with
professionals that aim for success in academics. The second is that in adult learning, students
utilize experience in the learning process, as well as the information taught in the present rather
than the future (Johnstone, 1965). The information taught in the athletic training education
program is learned, practiced and employed in the sports medicine setting by students on a daily
basis while interacting with the athletes. This immediacy of use also reinforces to the learner to
become self-directed in the learning process as a result of needed information to help athletes.
The concept of self-directed learning (Merriam, 2007) can be outlined as follows:
To enhance the ability of the adult learners to be self-directed in their learning,
To foster transformational learning as central to self-directed learning,
To promote emancipatory learning and social action as an integral part of selfdirected learning
Self-directed learning teaches the athletic training student to seek out information they
feel is critical to their education and future endeavors in athletic training. This means that selfdirected learners should never stop learning and in order to flourish, they always seek out new
information to utilize in the field. In order for an instructor to facilitate self-directed learning in
the athletic training education program, they create positive learning environments for the
students. Mensch (2002) found that educational environments led by instructors that promoted
self-directed learning in the athletic training education programs surveyed led to increased
motivation to learn, persistence and adaptive behaviors (Mensch, 2002). This also led to a
stronger learner/instructor and peer-to-peer relationships.

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The second concept of self-directed learning encourages the learner to challenge prior
ideals. In order for this to occur, a previous level of learning must be achieved and is many
times developed through didactic learning. Philosophies developed from these didactic
experiences are then challenged by new information and the student actively determines his or
her stance on the information previously driven by their belief system. Once this information is
discussed and re-evaluated, the learner then is able to understand material from different
perspectives and then, as Brookfield explains, able to “become critically aware of what has been
taken for granted about one’s own learning” (Brookfield, 1985).
As a student learning in the field of athletic training, many different techniques and
concepts within the field can accomplish the same goal of returning an injured athlete to play or
preventing the occurrence of injury to the athlete. What a self-directed learner achieves, in order
to be successful, is a sense of which concepts to employ within given scenarios. Many times, in
the athletic training programs, a concrete technique is taught and the student learns the theory
and concepts behind it, but when they attend a conference or workshop they learn a new idea that
challenges past teachings. The self-directed learner then recognizes each of the concepts,
decides which one works best for their situation, or create a new ideal from a comprehensive
look at what has been learned to develop yet another way to form ideals for preventing an injury
or returning an athlete to play. This promotes what is known as emancipatory learning by
athletic training students, as well as the production of new ideals to enhance the field of athletic
training and assist athletes.
CAATE employs a concept known as learning over time as a key component of all
accredited athletic training education curricula (CAATE.net). This means that a student initially
becomes exposed to the information or concepts didactically in the classroom and then is
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allowed to practice the skills in a clinical laboratory setting. This allows the athletic training
student to perform tasks with the direct supervision of an instructor to help them when unsure of
a concept or assistance is required to perform a skill. Once the skill is understood, practiced and
a clear understanding of when to utilize the skill is understood, the students are allowed to gain
experience under the direct supervision of a practicing AT. The AT allows students to perform
skills on athletes in need of assistance for the reason that the skill is required, but is in direct
supervision to intervene if the student is performing incorrectly or placing the athlete into a
harmful situation. This is similar to operant conditioning outlined by Skinner (1974) and allows
the athletic training student repetitions of practice prior to being an AT without supervision
(Skinner, 1974).
Problem-based learning (PBL) is another concept often employed by athletic training
education programs to aid in the acquisition of knowledge and skills of the students. PBL is
rooted in cognitive psychology in which the learner plays an active role in understanding theories
and concepts. The idea is that groups of learners are given a task in order to accomplish a goal,
which is solving a problem. This problem is based on real world scenarios and requires either a
previous knowledge about specific concepts or the self-learning of these concepts by the
collective group. PBL also employs leadership qualities, group cooperation, communication
skills and team building (Heinrichs, 2002). According to Barrows (Barrows, 2000), four
processes must occur when a problem is introduced to the group:
Development of possible hypotheses as to the cause, physical diagnosis and/or
management of problem,
Pertinent information is obtained,

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Issues in the case that are unclear to the group are divided up and overcome by
information individual group members obtain, learn and share with the group,
The hypothesis, data and learning issues are reassessed in order to solve the
problem given to the group
Medical schools have been documented as utilizing PBL as early as 1969 at McMaster
University, the College of Human Medicine at Michigan State University, Maastrich University
in the Netherlands and Newcastle University in Australia (Barrows, 1996). The implementation
of PBL within the medical field training allows students the opportunity to take an active role in
their education, as well as allow them to develop problem-solving skills utilized in the clinical
application of their profession. Barrows also describes educational objectives that are possible
through the utilization of PBL within the field of medicine. They are as follows:
The acquisition of an integrated knowledge base,
The acquisition of a knowledge base structured around the cues presented by
patient problems,
The acquisition of a knowledge base enmeshed with problem-solving, processes
used in clinical medicine,
The development of an effective and efficient clinical problem-solving process,
The development of effective self-directed learning skill,
The development of team skills (Barrows, 1996).

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Within each of these educational objectives, the learner, in this case the medical student, plays an
active role not only in the learning process, but also with gaining experience in problem solving
when issues arise. Not all patients act like a textbook case and have every problem be well
defined. That is why the medical student needs to develop the appropriate questions and
responses to unorthodox symptoms with patients. The same can be assimilated for athletic
training students in a small window of time to determine the appropriate diagnosis of an athlete
to determine if the athlete is fit to return-to-play or should be held from participation. Along
with the emergency side of athletic training, if an athlete is performing rehabilitation and not
responding to the exercises as desired, the athletic trainer adjusts and allows for variations so that
the outcome for the athlete can be positive. Many of these cases are optimized with the use of
problem-based learning within the athletic training education program.
Similar to PBL is a concept known as the Sociocultural Learning Theory (SLT), in which
social interaction of the learner needs to take place in order for learning and maintenance of
interest in the learning process (Vygotsky, 1978). Vygotsky (1978) emphasized three major
themes that provided the guidelines for SLT. Social interaction playing a large role in the
cognitive development of skills is the first major theme. Secondly, he contends that the tools for
learning are not created through isolation of ideals, but through communal evolution of a society
working together toward a common goal. The third and final theme is that learning is a
developmental or genetic process in which cultural development focuses on the process by which
higher learning is achieved, not only by the material (Vygotsky, 1978). Within these ideals,
Vygotsky introduces the concept of scaffolding of concepts built upon one another to create
higher learning. The breaks in knowledge are completed through past experience of instructors
with material or concepts, similar to a support structure for education.
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2.6 Educational standards in other medical professions
2.6.1 Nursing
Nursing, a medical field in the allied health discipline, requires an initial broad spectrum
of medical education becoming more focused as a person targets a specific niche within the field.
A foundation of scientific material such as chemistry, physics and anatomy is required as well as
interpersonal and evaluation skills. These skills cannot be taught strictly from a book in order
for a person to be a successful nurse. According to Ebbert, “[c]ompetencies of nurse
practitioners are dependent upon development and application of a strong fund of knowledge in
the specialty area and demonstration of technical, interpersonal, and critical thinking skills,
attitudes and ethics” (Ebbert, 2004). This means that a person practicing in the nursing field not
only understands medicine, but also utilizes the correct techniques at the appropriate time, and
accommodates the needs of the patient. In order for this to occur, educational facilities utilize
Standardized Patient Experiences (SPEs) in which actors and actresses create “real-life”
laboratory situations for the nursing students. During these SPEs, the clinician, a nursing
student, thoroughly evaluates the patient’s history from an actor or actress who has studied the
signs and symptoms of the disease or illness portrayed to determine the appropriate course of
action for the patient. The patient reacts and responds to the delivery of diagnosis and treatment
as a true response and the practitioner deals with the situation accordingly. Educationally, this
allows the instructors to evaluate the students from a formative and summative evaluation. The
formative evaluation allows the instructors to identify the strengths and weaknesses of the
student as the experience is taking place. The summative evaluation occurs after the experience
has taken place and the student and instructor evaluate the scenario together (Gagne, 1974).

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When assessing the SPEs, a criterion-referenced evaluation is utilized with a
predetermined level of expertise expected for each level of student. This mandates that the
student must be at a specific level of education prior to advancing to the next course or sequence
of criterion. The majority of the times, SPEs are utilized at the conclusion of the semester so that
a student is allowed to learn the material and become familiar with the techniques through
learning laboratory settings. Students in the nursing programs report a strong agreement with the
sense of realism, usefulness of feedback by SPEs and challenge of SPEs when surveyed after
completion of a program within a larger Midwestern university, 4.8 out of 5 on a Likert Scale
(Ebbert, 2004).
The use of SPEs provides a quality opportunity for nursing students to utilize models that
have been coached in the signs and symptoms of an illness or disease, but it is also costly. The
institution providing the education for the nursing students absorbs the cost of hiring the actors
or actresses for the scenarios, as well as the preparatory work required for learning the role they
are playing. Typically, the actors and actresses are hired at an hourly rate during specific times
of year and the cost of hiring them can be included in the tuition for the students, but is a cost
that is incurred when utilizing the SPE.
2.6.2 Physician (MD or DO)
The role of the physician is similar to that of an athletic trainer in that patient care is
required to assist someone with an injury or illness. The level of schooling and expected
understanding of medicine is higher in a physician versus an athletic trainer, but the learning
process of medicine is similar. The Accreditation Council for Graduate Medical Education
(ACGME) is similar to the CAATE in the recognizing of 6 general competencies for the
completion of an advanced medical degree. Those competencies are 1) patient care, 2) medical
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knowledge, 3) practice-based learning and improvement, 4) professionalism, 5) interpersonal and
communication skills and 6) systems-based practice (ACGME.org, 2012). Each of these
competencies is introduced in the classroom or laboratory setting during medical school, then
practiced and utilized throughout a medical students residency period. Upon the completion of
the residency program, students are required to master these skills according to the standards in
place through the ACGME.
In order to be considered fully proficient in the patient care competency, a resident “must
provide patient care that is compassionate, appropriate, and effective for the treatment of health
problems and the promotion of health” (ACGME.org, 2012). This competency and description
also include a checklist of information that must be established in order to be complete.
Communicate effectively and demonstrate caring and respectful behaviors when
interacting with patients and their families
Gather essential and accurate information about their patients
Make informed decisions about diagnostic and therapeutic interventions based on
patient information and preferences, up-to-date scientific evidence based, and
clinical judgment
Develop and carry out patient management plans
Counsel and educate patients and their families
Use information technology to support patient care decisions and patient
education

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Perform competently all medical and invasive procedures considered essential for
the area of practice
Provide health care services aimed at preventing health problems or maintaining
health
Work with health care professionals, including those from other disciplines, to
provide patient-focused care
The description of medical knowledge according to the ACGME is that a medical student
“must demonstrate knowledge about established and evolving biomedical, clinical and cognate
sciences and the application of this knowledge to patient care” (ACGME.org, 2012). The
checklist that is associated with this includes:
Demonstrate an investigatory and analytic thinking approach to clinical
situations,
Know and apply the basic clinically supportive sciences that are appropriate to
their discipline.
Practice-based learning and improvement includes a solid understanding of new
techniques that have been introduced and utilized in the profession. Competency in this category
requires that a student “must investigate and evaluate their patient practices, appraise and
assimilate scientific evidence, and improve their patient care practices” (ACGME.org, 2012).
This includes:
Analyze and practice experience and perform practice-based improvement
activities using a systemic methodology,
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Locate, appraise, and assimilate evidence from scientific studies related to their
patients’ health problems,
Obtain and use information about their own population of patients and the larger
population from which their patients are drawn,
Apply knowledge of study designs and statistical methods to the appraisal of
clinical studies and other information on diagnostic and therapeutic effectiveness,
Use information technology to manage information, access on-line medical
information, and support their own education,
Facilitate the learning of students and other health care professionals.
Communication is crucial in the medical field not only with patients, but also within the
health profession in order to complete the proper diagnosis and treatment. The ACGME has
established that a medical student “must demonstrate interpersonal and communication skills that
result in effective information exchange and teaming with patients, their patients families, and
professional associates” (ACGME.org, 2012). These expectations include:
Create and sustain a therapeutic and ethically sound relationship with patients,
Use effective listening skills and elicit and provide information using effective
nonverbal, explanatory, questioning, and writing skills,
Work effectively with others as a member or leader of a health care team or other
professional group.

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To gain trust and credibility in the medical field, a strong level of professionalism is
required. The definition of professionalism through the ACGME standards is that a medical
student “must demonstrate a commitment to performing professional responsibilities, adherence
to ethical principles, and sensitivity to a diverse patient population” (ACGME.org, 2012). To
establish this a student must show:
Respect, compassion, and integrity; a responsiveness to the needs of patients and
society that supersedes self-interest; accountability to patients, society, and the
profession; and a commitment to excellence and ongoing professional
development,
Commitment to ethical principles pertaining to provision or withholding of
clinical care, confidentiality of patient information, informed consent, and
business practices,
Sensitivity and responsiveness to patients’ cultures, age, gender, and disabilities.
The final competency outlined by the ACGME, systems-based practices, alludes to a
larger scale awareness of the medical field. A medical student “must demonstrate an awareness
of and responsiveness to the larger context and system of health care and the ability to effectively
call on system resources to provide care that is of optimal value” (ACGME.org, 2012; Marple,
2007). This includes:
An understanding of how their patient care and other professional practices affect
other health care professionals, the health care organization, and the larger society
and how these elements of the system affect their own practice,

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Know how types of medical practice and delivery systems differ from one
another, including methods of controlling health care costs and allocating
resources,
Practice cost-effective health care and resource allocation that does not
compromise quality of care,
Advocate for quality patient care and assist patients in dealing with system
complexities,
Know how to partner with health care managers and health care providers to
assess, coordinate, and improve health care and know how these activities can
affect system performance,
These standards set forth by the ACGME are assessed within the previous competencies,
however different avenues of testing are utilized in different medical programs. Structured Oral
Examination (SOE), in which a student verbally describes the scenario and the methods to
accomplish treatment, is one of the avenues utilized in medical competency (Hottinger, 2006).
This is a common technique in the Swiss medical licensing process and is becoming more
common in the United States. The other technique in assessing clinical competence in medical
students and residents is through Standardized Patient-based Clinical Examination (SCE).
Similar to the SPE of a nursing student, an actor or actress is given the signs and symptoms of an
illness or disease and the medical student works through the scenario to determine the pertinent
diagnosis (Vu, 1994). The second approach, the SCE, is utilized in the United States Medical
License Examination (USMLE) during step two of the board licensing procedures of a medical
student (USMLE.org, 2012). During this examination, medical students work directly with a
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“patient” to determine the pertinent diagnosis, as well as the course of action required to begin
treatment for the disease or illness.
2.6.3 Physical Therapy
The field of physical therapy utilizes many different techniques of education, however to become
a licensed physical therapist, a person successfully completes a national exam similar to that of a
medical boards examination. In the last 10 years, the field of physical therapy education has
undergone a change in schooling requirements from a master’s level degree to a doctorate level
degree prior to being able to sit for this exam. This change in post baccalaureate education
allows students to accumulate a stronger understanding of the field of physical therapy in
academic and professional settings. The change to a terminal degree from an outsider’s
perspective is one that allows more time to study the field for a stronger understanding of the
material. From an internal perspective, the extension of the program allows the physical therapy
student a better opportunity to work with the material from a laboratory setting, as well as gain
experience through extended internships with practicing physical therapists.
The profession of physical therapy has a previous history of utilizing PBL as previously
discussed in this research. The concept of a PBL focuses the learning objectives to diagnose and
treat patients within the health care scenarios. They also allow the students to access their
previous knowledge of the basic sciences and experience over time. Three common approaches
utilized when focusing the curriculum on PBL are 1) sole use of PBL in a curriculum for
learning, 2) a transitional curricula and 3) a single course approach (Solomon, 1996). The
curriculum that focuses solely on the utilization of PBL has been shown to have an initial
difficulty level for beginning students, but as the student becomes familiar with the process, a
clearer understanding of the material is seen. A transitional curriculum allows the students to
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utilize previous successful learning techniques, while learning the ideals of PBL. This has
shown to be the most successful of the techniques. The third technique, in which each section of
subject matter is taught and tested utilizing PBL, allows the student full understanding of a
concept or theory prior to moving on to the next subject. A drawback of this technique is a
disconnect in the continuity of the material and does not allow the student to blend ideas into a
unique philosophy. Teaching subjects individually does not allow for a holistic approach to the
healing process for the student.
As a physical therapy student gains experience through completed internships or
affiliations in different settings of the profession, an understanding of material as it relates at a
practical level becomes apparent. Practical learning occurs through experiences of repetitive
usage with professionals in the field. The student is allowed to see how a professional employs
similar techniques to those taught during academic times and makes changes to allow for
personal philosophies or through the trial and error process. Corrections that have been made by
the professional shed light on what has worked and what not to do in different situations through
experience.

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Chapter 3

Methodology
3.1 Purpose
The purpose of this study was to examine the perceptions of newly certified athletic
trainers (ATs) regarding the development and integration of their athletic training skills in their
athletic training education program; specifically, the instruction of clinical skills, interpersonal
skills and professional personal development as identified in the Commission on Accreditation of
Athletic Training Education (CAATE) standards. Along with determining the level of
development and integration of their skills, a determination of the level of importance of the
classroom, laboratory and field settings in their educational growth was assessed.
3.2 Research Design
This study was a one-time non-experimental survey. The independent variables are the
sex, age, race/ethnicity, institution of education, highest level of education, and current
employment setting. The dependent variables are level of perceived competence in CAATE
skills, interpersonal skills and professional development skills.
3.3 Participants
The participants in this study are ATs that have completed their athletic training
education requirements in a CAATE approved athletic training education program. These
participants have successfully completed the national certification exam set forth by the BOC
within the previous 18 months of completing the survey. Participants were allowed to leave the
survey at anytime and/or skip questions without penalty to them or their previously answered
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questions. Participants were recruited through an invitation electronic mailing list provided by
the National Athletic Trainers’ Association (NATA). This list was generated with the specific
parameters that the person be a member of the NATA and had completed the BOC exam within
18 months prior to the survey being administered.
3.4 Instrumentation
3.4.1. Demographic Survey
The information collected for this study was anonymous in nature as the subject did not
have to input name, place of employment or specific program of completion for their
undergraduate studies. Demographic information included questions pertaining to sex, age, race,
NATA district, level of education, i.e. Bachelors or entry-level Masters Degree, months certified,
and current employment setting (i.e. corporate, industrial, clinical, high school, collegiate).
3.4.2. Survey of Level of Development and Implementation of Skills
A self-administered 35-item survey was utilized on a 5-point Likert Scale to determine
the level of development and integration of the education that a subject has encountered with the
topic at hand. The questions posed in the survey did not utilize the complete list of competencies
put forth by CAATE, but were specifically identified by the researcher as skills necessary for
success in the profession. The questions were categorized into either 1) the general CAATE
competencies, 2) interpersonal development, or 3) professional personal development. The
general CAATE competencies were taken directly from the current standards (5th Edition
Competencies) in place for athletic training students’ requirements for graduation from an
accredited CAATE athletic training education program (CAATE.net). The interpersonal skills
were CAATE competencies developed from situations in which the practicing AT had interacted
with others in the medical field, coaching and administrative staffs, injured athletes and persons
54

significant to the injured athlete. The majority of the professional personal development
questions were CAATE competencies that relate to the AT as a person and not care giving.
However, a few questions had been derived from research that has studied obstacles within the
profession of athletic training that relate directly to the AT, including burnout, work/family
conflict and life balance (Winterstein, 1998; Hendrix, 2000; Mazerolle 2008a; Mazerolle, 2008b;
Mazerolle, 2008c; Reed, 2004).
The 5-point Likert Scale ranges from 0, not introduced in AT education, to 5, learned in
the classroom, practiced in the laboratory setting and allowed to utilize in a real life setting with
an actual patient. These responses were determined on a continuum basis in accordance with the
CAATE standards in which learning over time is to be utilized. The material was to be presented
the skills in the classroom, allowed to practice said skills in the laboratory setting and then
applied in field experiences where applicable. The subjects’ responses allowed for analysis of
how in-depth the level of development and implementation of a skill was achieved in the athletic
training education program.
Following the completion of the mastery development and implementation portion, the
subject was then to rate the different educational environments on their level of importance
during the education process for that specific competency. The subject was allowed to respond
individually to the importance of the classroom, theoretical scenarios in the laboratory setting
and the field experience with a response of no importance (1), low importance (2), moderate
importance (3), high importance (4) and most important (5).
Following the completion of these questions, association of the results occurred by
combining the two responses to understand a sense of the subjects’ development and

55

implementation of a skill and what educational setting had the highest level of importance for
that skill.
3.5 Data Collection and Management
Responses to the survey were tabulated utilizing the survey engine website,
Surveymonkey.com, and were transferred for analyzing through Microsoft Excel spreadsheets
and SPSS software (Version 17.0, IBM Inc.). The link to the survey was distributed by the
NATA via electronic mail (e-mail) to 1780 participants in the “certified” category that meet the
study inclusion criteria. The e-mail correspondence sent to participants included an explanation
of the study (Appendix C). Those completing the survey gave implied consent to participate.
Subjects were able to discontinue the survey or skip questions at any point they deem necessary
without penalty. Because of the nature of SurveyMonkey.com, the instrument was available 24hours per day for the 6 -week testing period. A 6-week period was determined as ample time for
each individual to complete the study. A reminder was emailed to them for two 2-week cycles
following the initial invitation email. The results of the survey were kept within the website and
downloaded and analyzed by the researcher at anytime for review.
Data recorded on the Surveymonkey.com website were anonymous and password
protected so that there were no participant identifiers. Any data that was downloaded and
analyzed outside of the website was kept on a password protected computer or on hard copies
that placed in a locked file cabinet in the researcher’s office.
3.6 Data Analysis
Demographic data was summarized using descriptive data. The completed results of the
survey were analyzed on an individual question basis within each of the three categories (1.
56

General CAATE competency, 2. Interpersonal Skill, 3. Professional development). This
allowed for specific analysis of the competency and it’s understanding and level of educational
importance by the participant. The totals for each answer to the specific question were
represented as a percentage of the total answers for that question. The statistical significance
level were set at p< .05. Data analyzed using the Statistical Package for the Social Sciences
(SPSS) 21.0 software.
The following research questions were analyzed for significance:
1. What are the perceptions of recently certified ATs regarding development and
integration of the:
a. General CAATE athletic training skills
b. Interpersonal Skills
c. Professional Personal Development Skills
2. Does graduating class size affect the perceived instruction in general CAATE skills?
3. Does level (NCAA division I-III or NAIA) of athletic program affect perceived
instruction in general CAATE skills
4. Do field experiences within the athletic training education of newly certified ATs
play a significant role in the instruction of general CAATE athletic training
competencies?
5. Do field experiences within the athletic training education of newly certified ATs
play a significant role in the instruction of interpersonal skills within the field of
athletic training?

57

6. Do field experiences within the athletic training education of newly certified ATs
play a significant role in the instruction of how to cope with the demands of the
profession?

Each of the research questions were analyzed independently of one another utilizing
different statistical methods. Research question 1 utilized descriptive statistics to determine
perceived level of competency in each category. Research question 2 utilized a Pearson
correlation analysis procedure in order to determine level of perceived competency in
comparison to class size. Research question 3 utilized a univariate ANOVA to determine the
relationship between level of perceived competency in general CAATE skills and NCAA
division.

58

Chapter 4

Results
4.1 Overview
The purpose of this study was to examine the perceptions of newly certified athletic
trainers (ATs) regarding the development and integration of their athletic training skills in their
athletic training education program; specifically, the instruction of clinical skills, interpersonal
skills and professional personal development as identified in the Commission on Accreditation of
Athletic Training Education (CAATE) standards. Along with determining the level of
development and integration of their skills, participants were asked to identify the level of
importance of the classroom, laboratory and field settings in their educational growth.
4.2 Demographic Data
An electronically mailed invitation to participate in the study was sent to 1,780 ATs who
were certified during the previous 18 months. One hundred and fifty-four respondents
completed the entire survey, for a response rate of 8.65%. Females comprised 66.9% of the
responses, for a total of 103 people. Males comprised 33.1% of the cohort with a total number of
51 respondents. One person did not respond to the gender question. The average age of the
participants was 23.62 years of age (± 2.04 years). The youngest respondent was 22 and the
oldest was 36 years of age. Participants ranged in months of certification from 1 month to 18
months, with an average of 11.68 months of being certified. The majority of subjects responding
to the study characterize themselves as Caucasian (91.6%). Table 4.1 summarizes the responses
of ethnicity to the study.

59

Table 4.1 Frequency Distribution of Participants by Ethnicity
Ethnicity
Respondents Percent
Caucasian
141
91.6%
Latinos
7
4.5
African American/Black
2
1.3
Asian
1
0.6
American Indian/Alaskan Native
0
0.0
Other
3
1.9

Over half of the participants completed their undergraduate education at an NCAA
Division I institution (56.4%). The representation from undergraduate institutions attended
based on collegiate divisions (e.g. NCAA division I-III, NAIA), is represented in Table 4.2.
Table 4.2 Frequency Distribution of Participants by Division of Competition of Undergraduate
Education Institution
NCAA Division

N

Percent

I

91

59.1

II

24

15.6

III

32

20.8

NAIA

7

4.5

Total

154

100

The NATA divides North America into ten different districts based upon their regional
location. This was developed so that each region could not only interact with its membership,
but also provide adequate representation at the national level. The division of the district
representation showed that District 4 had the most participants (30.5%), while District 6 and
District 10 had the least responses (3.2%). Table 4.3 indicates the NATA districts represented.
60

Table 4.3 NATA Districts Represented by Participants
District

N

Percent

District One (CT, ME, MA, NH, RI, VT, Quebec,
New Brunswick, Nova Scotia)

12

7.8%

District Two (DE, NJ, NY, PA)

18

11.7

District Three (DC, MD, NC, SC, VA, WV)

16

10.4

District Four (IL, IN, MI, MN, OH, WI,
Manitoba, Ontario)

47

30.5

District Five (IA, KS, MO, NE, ND, OK, SD)

19

12.3

District Six (TX, AR)

5

3.2

District Seven (AZ, CO, NM, UT, WY)

9

5.8

District Eight (CA, NV, HI, Guam)

13

8.4

District Nine (AL, FL, GA, KY, LA, MS, TN,
Puerto Rico, Virgin Islands)

10

6.5

District Ten (AK, ID, MT, OR, WA, Alberta,
British Columbia, Saskatchewan)

5

3.2

154

100

Total

The majority of the participants completed their athletic training education through an
undergraduate curriculum (98.1%, N=151), while two participants (1.3%) completed their
athletic training education through an entry-level masters program and one respondent (0.7%)
did not answer.
The current employment setting showed most participants worked in the College NCAADivision I (36.4%) and the High School setting (22.1%). The remaining settings are summarized
in Table 4.4.
61

Table 4.4 Current Employment Settings of Participants
Current Setting
High School
Hospital/clinic
Dual Role
Industrial/corporate wellness
Collegiate NCAA- Division I
Collegiate NCAA-Division II
Collegiate NCAA-Division III
Collegiate NAIA
Junior/Community College (NJCAA)
Other
Total

N
34
13
7
3
56
9
7
0
4
21
154

Percent
22.1%
8.4
4.5
1.9
36.4
5.8
4.5
0
2.6
13.6
100

4.3 Perceptions regarding development and integration of specified skills evaluated
The skills evaluated in this survey were divided into three specific categories; general
athletic training skills, interpersonal skills and professional personal development skills as
mandated by CAATE. The results below identify the cumulative participant responses for all of
the questions in each the specific category. In the following tables, the participant responses in
each of the groups are aggregated in order to create a general understanding of the frequency of
responses for the questions in each of the three categories (general skills, interpersonal skills, and
professional personal development skills). These frequencies indicate the perceptions of newly
certified ATs development and integration of skills assessed.
4.3.1 General CAATE athletic training skills
The general CAATE standards identified for the development of athletic training skills
are represented in questions 1-17 of the survey (Q10-Q43 via surveymonkey.com, Appendix A).
A few examples of these skills include orthopedic evaluation of injuries, designing therapeutic

62

interventions, and application of appropriate protective devices. Table 4.5 shows the total
responses of the cohort regarding participants’ perceptions of where their skills were developed
and integrated into their current ability level. In order to gain a general understanding of the
cohort’s level of development and integration, the total response scores were calculated, however
a complete list of individual responses can be found in Appendix B. The results show that the
majority of participants (52.9%) reported the level of development and integration of their
general CAATE skills was “In the classroom setting.” The second most common response
(20.1%) for the general CAATE skills was “With actual patients in the athletic training room,”
followed closely behind with 17.2% choosing “With theoretical patients in the laboratory
setting.” When further examining the questions in this category individually, multiple questions
were seen to have an overwhelming response to “In the classroom setting.” For example,
CAATE Standard HA-1: “describe the role of the athletic trainer and the delivery of athletic
training services within the context of the broader healthcare system,” had a response rate of
80.5% (124 out of 154 responses) as “In the classroom setting.”
Table 4.5 Aggregate Count of Responses for Perceived Development and Integration of the
General CAATE Skills
Response
Not introduced in athletic training education
In the classroom setting
With theoretical patients in the laboratory setting
With actual patients in the athletic training room/clinic
With actual patients in field experiences
Total

N
61
1882
612
717
288
3560

Percent
1.7%
52.9
17.2
20.1
8.1
100

4.3.2 Interpersonal Skills
The development and integration of Interpersonal skills represent questions 18-24 of the
survey (Q44-57 via surveymonkey.com, Appendix A). This category includes development of
63

skills necessary to instruct patients in home care of injuries as well as the dangers and the need
for prevention of sport related injuries to athletes. Table 4.6 shows the response pattern for the 7
questions and where the participants felt these skills were developed and integrated in the
education process. Response to each of the individual questions are found in Appendix B.
Similar to the responses for the general CAATE skills, the most common response for the
development and integration of Interpersonal skills (49.3%) was “In the classroom setting.” The
second most common response (25.6%) was “With actual patients in the athletic training
room/clinic. Upon individual analysis of questions in this category, many of the responses
showed a high rate of response of “In the classroom setting.” For example, CAATE Standard
PD-11, “Identify strategies to educate colleagues, students, patients, the public, and other
healthcare professionals about the roles, responsibilities, academic preparation, and scope of
practice of athletic trainers” had a response rate of 68.2% (105 out of 154 responses) “In the
classroom setting,” while the next most frequent response was “With actual patients in the field”
having a response rate of 12.3%.
Table 4.6 Aggregate Count of Responses for Perceived Development and Integration of
Interpersonal Skills by Participants
Response
Not introduced in athletic training education
In the classroom setting
With theoretical patients in the laboratory
setting
With actual patients in the athletic training
room/clinic
With actual patients in field experiences
Total

64

N
59
639

Percent
4.6
49.3

120

9.3

332

25.6

145
1295

11.2
100

4.3.3 Professional Personal Development Skills
The development and integration of the participants’ professional personal development
skills include questions 25 through 35 of the survey (Q58-70 via surveymonkey.com, Appendix
A). These skills include developing a long-term plan for success in the field of athletic training
as well as being able to utilize current research to develop a plan of treatment for an athlete.
Table 4.7 shows the response pattern indicating where the participants felt these skills were
developed and integrated in the education process. A complete list of individual responses to
questions in this category is found in Appendix B. Similar to the previous categories, the
majority of participants (44.8%) reported the level of development and integration of
professional personal development skills was “In the classroom setting.” In contrast to the
previous two categories, the second most popular response (19.3%) was “With actual patients in
the field experiences.” This reflects the idea that outside of the classroom, participants that took
this survey believe that the development and integration of their professional personal
development skills came from field experiences in which they were able to interact with ATs
practicing in the profession. When looking at the questions individually, “In the classroom
setting” was a prevalent response, but the next most frequent response varied among the
individual question. For example, CAATE Standard PD-7: “Perform a self-assessment of
professional competence and create a professional development plan to maintain necessary
credentials and promote life-long learning strategies” showed a response rate of 63% for “In the
classroom setting,” while the next most common response was “Not introduced in AT education”
(16.9%). This shows that a large portion of participants had little or no discussion regarding the
self-reflection of their career.

65

Table 4.7 Aggregate Count of Responses for Perceived Development and Integration of
Professional Personal Development Skills
Response
Not introduced in athletic training
education
In the classroom setting
With theoretical patients in the
laboratory setting
With actual patients in the athletic
training room/clinic
With actual patients in field experiences
Total

N
233

Percent
11.8

885
123

44.8
6.2

354

17.9

380
1975

19.3
100

4.4 Does graduating class size affect the development and integration of skills required for
athletic training by CAATE?
This research question addressed the inquiry to determine if there is a correlation between
development and integration of skills required for athletic training by CAATE and the relative
size of the graduation class. The association between class size and development and integration
of each of the required skills (general CAATE skills, Interpersonal skills, and Professional
personal development) was determined utilizing an individual Pearson correlation test for each
category. The results of the test for general CAATE skills showed that there was no statistical
significance between class size and development and integration of skills in general CAATE
skills (r = -.107, p = .177). This means that across the different class sizes reported by those in
the completed survey cohort, there was no relationship between the number of students in the
athletic training education graduating class and level of development and integration of the
General CAATE Skills assessed in this survey. The results of the Pearson correlation test for the
Interpersonal skills category showed that there was no statistically significant difference between
class size and development and integration of Interpersonal skills (r = -.142, p = .064).
Therefore, although closer to statistical significance than the General CAATE Skills, across the
different class sizes reported by those in the completed survey cohort, there was no relationship
66

between the number of students in the athletic training education graduating class and level of
development and integration of the Interpersonal skills assessed in this survey. The results of the
test for Professional personal development showed that there was no statistically significant
difference between class size and development and integration of Professional Personal
Development (r = .022, p = .774). Similar to the data in the previous categories, regardless of
class size, ATs perceive comprehension of the Professional Personal Development skills
similarly.
4.5 Does level (e.g. NCAA division I-III or NAIA) of athletic training education program affect
development and integration of skills required for athletic training by CAATE
This research question addressed the development and integration of general CAATE
athletic training skills and NCAA division of competition of undergraduate education institution.
In order to determine if there was any statistical significance between the two factors, a
univariate ANOVA was run on the mean level of importance for the educational settings. This
revealed no statistically significant difference between the classroom setting and NCAA division
of competition of undergraduate education institution (F= .023, p= .995), between the laboratory
setting and NCAA division of competition of undergraduate education institution (F= .838, p=
.475), or between the field setting and NCAA division of competition of undergraduate
education institution (F= .797, p= .498). Each educational setting was individualized to
determine mean level of importance for each division of educational setting. Table 4.8 identifies
the mean level of importance of the classroom setting by NCAA Division.

67

Table 4.8 Count and Mean Level of Importance of Classroom Setting by Division
Division
NCAA Division I
NCAA Division II
NCAA Division III

N
91
23
30

Mean Level of Importance
3.85
3.83
3.83

Std. Deviation
.48
.54
.53

NAIA

7

3.87

.39

The majority of responses for division are from NCAA Division I (n=91) with the least
amount of responses from the NAIA (N=7). Table 4.9 identifies the mean level of importance of
laboratory setting by NCAA division.
Table 4.9 Count and Mean Level of Importance of Laboratory Setting by NCAA Division
Division
NCAA Division I
NCAA Division II
NCAA Division III

N
89
22
30

Mean Level of importance
3.63
3.59
3.71

Std. Deviation
.61
.64
.57

NAIA

7

3.32

.60

Similar to the classroom setting responses, the majority of responses (N=89) came from
the NCAA Division I setting. Table 4.10 identifies the mean level of importance of the
field setting by NCAA division. As can be seen below, the mean level of importance for
each division is higher for the field setting than the classroom or laboratory setting.

68

Table 4.10 Count and Mean Level of Importance of Field Setting by NCAA Division
Division
NCAA Division I
NCAA Division II
NCAA Division III

N
89
23
30

Mean Level of Importance
4.15
4.05
3.95

Std. Deviation
.62
.67
.63

NAIA

7

4.10

.48

4.6 Do field experiences within the athletic training education of participants play an important
role in the instruction of general CAATE athletic training competencies?
In order to determine a response to this research question, the sum of all scores for the
level of importance of each of the educational settings was compiled. The Skills Development
and Integration (SDI) is a mean of the subjects’ responses to level of importance for each of the
educational settings for athletic training education and can be seen in Table 4.11. The score is
based off a total of 5 points; 1 point equates to no importance while 5 points equates to most
important educational setting.
Table 4.11 The Average CAATE Skills Development and Integration (SDI) score for each of the
Educational Settings
Educational Setting
Classroom Setting
Laboratory Setting
Field Setting

Aggregate Score
3.84
3.64
4.09

Std. Deviation
.49
.61
.62

Within the SDI, the Field Setting (4.09) displayed the strongest mean level of importance
as reported by the subjects that completed the survey. The Classroom Setting (3.84) displayed a
mean level of importance higher than the Laboratory Setting (3.64), but less than the Field
Setting. This indicates that ATs perceive that the field setting, and therefore field experiences,
plays an important role in the development and integration of general CAATE skills during their
69

athletic training education. In order to further evaluate the data, each individual question was
analyzed for mean level of importance according to the specific response made and can be found
in Appendix B.
4.7 Do field experiences within the athletic training education of participants play an important
role in the instruction of interpersonal skills within the field of athletic training?
In order to determine a response to this research question, the sum of all scores for the
level of importance of each of the educational settings was compiled. The Interpersonal Skills
Development and Integration (ISDI) is an average mean of the subjects’ responses to level of
importance for each of the educational settings for athletic training education and can be seen in
Table 4.12. The score is based off a total of 5 points; 1 point equates to no importance while 5
points equates to most important educational setting.
Table 4.12 The Average Interpersonal Skills Development and Integration (ISDI) score for each
of the Educational Settings
Educational Setting
Classroom Setting
Laboratory Setting
Field Setting

Aggregate Score
3.65
3.38
4.08

Std. Deviation
.60
.75
.60

Within the ISDI, the Field Setting (4.08) displayed the strongest mean level of importance as
reported by the subjects that completed the survey. The Classroom Setting (3.65) displayed a
mean level of importance higher than the Laboratory Setting (3.38), but less than the Field
Setting. The ISDI score is similar in response to the SDI score for mean level of importance.
The Laboratory Setting in the Interpersonal Skills section is lower (3.38) than in the General
CAATE Skills section (3.64). This means that participants perceive that the field setting, and
therefore field experiences, plays an important role in the development and integration of
70

Interpersonal skills during their athletic training education. In order to further evaluate the data,
each individual question was analyzed for mean level of importance according to the specific
response made and can be found in Appendix B.
4.8 Do field experiences within the athletic training education of newly certified ATs play an
important role in the instruction of how to cope with the demands of the profession?
In order to determine research question eight, the sum of all scores for the level of
importance of each of the educational settings was compiled. The Professional Personal
Development skills (PPDI) is an average mean of the subjects’ responses to level of importance
for each of the educational settings for athletic training education and can be seen in Table 4.13.
The score is based on a total of 5 points; 1 point equates to no importance while 5 points equates
to most important educational setting.
Table 4.13 The Average Professional Personal Development Skills Development and Integration
(PPDI) score for each of the Educational Settings
Educational Setting
Classroom Setting
Laboratory Setting
Field Setting

Aggregate Score
3.42
2.94
3.86

Std. Deviation
.69
.83
.74

Within the PPDI, the Field Setting (3.86) displayed the strongest mean level of importance as
reported by the subjects that completed the survey. The Classroom Setting (3.42) displayed a
mean level of importance higher than the Laboratory Setting (2.94), but less than the Field
Setting. This means that participants perceive that the field setting, and therefore field
experiences, plays an important role in the development and integration of Professional Personal
Development skills during their athletic training education. In order to further evaluate the data,

71

each individual question was analyzed for mean level of importance according to the specific
response made. The results of each individual question are found in Appendix B.
4.9 Summary
To summarize the responses of the research questions, the majority of subjects feel that
they are developing and implementing their general CAATE skills, Interpersonal skills, and
Professional Personal Development skills in the classroom setting. Subjects perceive their
instruction of the three different skills categories similarly regardless of class size and there is no
association between collegiate division of competition of undergraduate education and perceived
level of instruction for the general CAATE skills. Subjects do feel that their field experiences
have a higher level of importance in their education than the classroom setting and the laboratory
setting.

72

Chapter 5

Discussion
5.1 Summary of Research Questions
This study focused on the assessment of the perceived educational preparation of recently
certified athletic trainers (ATs) certified in their athletic training education programs. The study
examined the level of development and integration of general CAATE skills, interpersonal skills,
and professional personal skills as directed by Commission on Accrediting Athletic Training
Education (CAATE). Participants were asked to identify the specific educational settings
associated with the learning over time continuum during their undergraduate education and to
rate the relative importance of the classroom, laboratory and field experiences in their
preparation for athletic training.
The importance of each of the categories investigated (General CAATE skills,
interpersonal skills, professional personal development skills) is that they are essential to the
success of an AT. The general CAATE skills include orthopedic skills such as evaluation of
musculoskeletal injuries, treatments of a myriad of injuries as well as performing rehabilitation
for those injuries so the patient can return to normal function. Skills that are an absolute for
aiding patients as well as successful completion of the national certification exam administered
by the Board of Certification (BOC).
Athletic training is a service-based profession in which the AT deals with people as
patients, colleagues, parents, coaches and administrators. They have to be able to interact with
patients to determine the appropriate needs, converse with other healthcare professionals in order

73

to help facilitate the appropriate care of patients and finally, ATs need to be able to express
themselves to coaching staff members as well as significant others associated with the patient,
such as parents, spouses and other family members. In order to do this, a base set of
interpersonal skills must be established. Most recently, CAATE has incorporated new
competencies that address some of the interpersonal skill development needs (CAATE.net).
Finally, in order for an AT to be successful, they need to be able to cope with the
demands of the profession adequately. This includes being able to balance work life and
personal life, minimize burnout in the profession and appropriately promote the profession.
Mazerolle (2008a, b, and c) has documented a high incidence of burnout in the field of athletic
training due to different factors that need to be addressed during an ATs education in order to be
minimized. If awareness is raised, then solutions can be found to minimize the likelihood of
occurrence.
The first research question identifies participants’ perceptions of the process by which
they were able to develop and integrate professional skills in the three categories (i.e., general
CAATE skills, interpersonal skills and professional personal development skills). According to
CAATE standards (CAATE.net), the student is to have an opportunity to learn their skills
didactically in the classroom, practice them in the laboratory setting and finally be able to put
them to use in the field setting.
The findings from the current study for each of the three categories (i.e., general CAATE
skills, interpersonal skills, professional development) indicate that the majority of the
respondents felt that they best developed and integrated their skills in what CAATE identifies as
the first step in learning over time or “in the classroom setting.” This does not mean that the skill

74

was not addressed in the other educational settings; it simply means that ATs perceived they
gained the best grasp of the material in the classroom. The second most common response for
the general CAATE skills and the interpersonal skills was “With actual patients in the athletic
training room/clinic.” This seems to indicate that participants felt they had the opportunity to
further develop the base knowledge learned in the classroom with actual patients under the direct
supervision of a preceptor without the high pressure of being in the field. In this type of setting,
the pressure for return to play is not as prevalent, as the majority of the time the evaluations and
treatments/rehabilitations are not in the public eye and have less stress associated with them
when compared to competition situations. In contrast, the professional personal skills
development and integration identified “With actual patients in field experiences” as a strong
aspect of their program. This indicates that outside of the classroom setting, athletic training
students are learning the skills necessary to cope with the demands of the profession in the actual
field settings of athletic training. Bandura’s theory of sociocultural learning, in which a student’s
education is based on the process of observational learning in the environment, lends insight into
these results (Bandura, 1986). ATs are utilizing a base knowledge they have acquired in the
classroom and/or laboratory setting and have the opportunity to develop and integrate the
specific skill more completely through experiences and observations in the field. This may
include dealing with return to play issues addressed during competitions, as well as interacting
with coaches, athletes and healthcare professionals in a situation when timing is essential.
The association of class size and perceived competency was the focus of research
question four. The question addressed the anecdotal concept that smaller class sizes would
increase instructor and student interaction and therefore more opportunity to comprehend the
material presented. This rationale was based off the self-efficacy motivation theory that allows
75

the learner to feel more confident in comprehending the skills taught when the instructor makes
the learner feel indispensable in the learning process (Biddle, 1999). A large, highly populated
classroom does not allow for equal interaction of the instructor with the individual students.
Consequently, the student does not feel a sense of worth in the class and is therefore less engaged
as an active learner. Within the self-efficacy motivation theory is the concept of the
sociocultural learning theory in which learners need to interact with their peers in order to better
understand the material and maintain a sense of interest in the learning process (Vygotsky,
1978). A large class size allows for less complete interaction of the students and their
instructors, and therefore less interest in the learning process. The results of this research
question were inconclusive for various reasons. The first reason was that there was an error in
comprehension of the question. Multiple subjects in the study reported class sizes larger than
designated on any athletic training education website. CAATE requires that all athletic training
education programs designate how many students are enrolled in each level of the program on
their website and none of the programs researched showed numbers greater than 30 students.
Sixteen of the respondents reported a number higher than 30 and were consequently not included
in data analysis. Even with these respondents removed from the data, there was no statistically
significant difference found between class size and perceived competency in the skills. This
means that regardless of class size, athletic training students perceive they are getting a similar
education of the base standards required to pass the certification exam and be a successful
athletic trainer. CAATE is striving to create an equal opportunity of education for all athletic
training students regardless of institution attended, and according to the findings of this study, is
successfully achieving this goal.

76

Research question five refers to the level of athletic competition of undergraduate
institutions attended by newly certified athletic trainers and their level of perception of the
general CAATE skills. The reason that level of athletic competition was utilized as an identifier
was because there is a direct association between institution size and level of competition.
Typically, a large institution participates in the NCAA Division I and possibly Division II, while
the smaller institutions participate in the NCAA division III or NAIA. When comparing the
different educational settings across individual divisions of competition, there were no statistical
significance between Divisions I, II, III and NAIA. Thus, the relative level of importance for
each of the educational settings for the general CAATE skills for each of the collegiate divisions
of competition was similar across all levels. According to the results, regardless of division of
competition, ATs perceive a similar level of development and integration of skills in the
classroom, laboratory and field portions of their education required to become a certified athletic
trainer in the classroom, the laboratory and the field. Along with the different levels of
competition, many times there are different opportunities for care for the athletes participating in
collegiate athletics. Different levels of care include medical staff present to help in an
emergency situation, diagnostic equipment available during these emergency situations and
medical equipment available to aid in the emergency situation. Therefore, an athletic training
student may have the opportunity to utilize the equipment and become more comfortable with
different treatments as they are more readily available. Conversely, an athletic training student
may become more comfortable with their athletic training skills if there are no other resources
available to them. For example, a school with fewer resources may not have bracing equipment
readily available and the athletic training student is required to depend on taping skills to
appropriately support an injured athlete. The findings of this study support the notion that ATs

77

perceived they are getting equal opportunities for development and integration of their skills in
all educational settings regardless of level of competition.
The final three research questions examined the importance of the field experiences on
the development of skills in each of the three categories (i.e., general CAATE skills,
interpersonal skills, and professional personal development skills) in the current athletic training
curriculum. In each of the three categories, the field experience had a higher relative level of
importance than the classroom and the laboratory settings. This means that respondents are
recognizing the field setting as an important educational setting for the development of skills in
athletic training. In the past, during the apprenticeship phase of athletic training education, the
field setting was important to students as they were able to learn in real life situations and gain
experience through trial and error (Delforge, 1999). Hundersmarck (2005) noted a similar
response in the law enforcement profession by cadets who had recently graduated from the
police academy. Similarly, medical students were given an opportunity to experience emergency
medical services during their residency and felt they learned more about emergency techniques
on the scene than in the classroom (Stewart, 1987). This study’s findings suggest that even
though educators speculate that athletic training is becoming a more academic field in which
students aren’t receiving hands on training required for success, the respondents perceive their
field experiences as an important educational setting in their training. According to Lawson
(1983b), the field experience is a part of the professional socialization phase of a student’s
athletic training career. This is the time in which the values, attitudes and norms of behavior are
introduced and developed within the student (Hayden, 1995). Winterstein (1998) also believes
this is the place and time in an athletic training student’s career in which the development of

78

these characteristics can either enhance or hinder a student’s perspective of athletic training
career and be catalyst for job dissatisfaction and burnout in the profession.
In summary, newly certified ATs perceive the development and integration of the
different skills assessed comes mainly “in the classroom setting” with the athletic training
room/clinic secondary for the general skills and interpersonal skills. On the other hand, the
professional development skills and coping with the demands of the profession, the primary
setting is in the classroom, while the secondary setting is in the field with practicing preceptors.
The experiences of the preceptors have lead to the opportunity to establish themselves in the
athletic training profession and lend that experience and understanding to the athletic training
student as they are faced with the demands of the profession.
Regardless of the class and institution size of the undergraduate athletic training
education program, ATs report a similar base level of education. A goal of CAATE is to allow
all athletic training students the same opportunity for learning skills necessary to successfully
pass the certification exam and practice in the field regardless of the college setting, geographical
location or curricular design in which develop their professional skills. According to the results
of this study, these goals are being met.
Prior to the termination of the apprenticeship program, field experiences played an
important role in the development of skills of an athletic training student. The results of this
study indicate that ATs still place a high level of importance on the experiences in the field over
the classroom and laboratory setting. As the profession of athletic training continues to evolve,
administrators will need to understand the importance of the field setting and maintain its
presence in the athletic training education process. This may mean that students are gaining

79

exposure to concepts in the classroom that are unfamiliar to them, however, they are placing a
high level of importance on the field experience to gain a stronger grasp on the concepts
introduced in the classroom.
5.2 Limitations to the study
There are several limitations to this study that need to be addressed. First, this study
utilized selected competencies from the CAATE standards represented within the most recent
guidelines (CAATE, 2012). The competencies chosen were derived from a theory by the
researchers of this study that spanned from the global tasks that all athletic trainers must be able
to implement and were specific tasks selected for each research category. Further research may
include a different sampling if not the entire list of competencies to determine alternate details.
The next limitation of this study was the fact that there was a small sample size as well as
incomplete data from participants. The survey consisted of 79 questions, which included the
demographics section and 35 specific competencies. A number of respondents of the survey did
not complete every question. This may be because the survey was too lengthy or that the
participant did not want to honestly answer the question, possibly skewing the data. Future
research may want to shorten the questionnaire and examine specific factors instead of
generalizing and conducting research on these three factors.
An additional limitation of this study is that the participants self reported how they felt
about specific topics and their own perception of development of skills. Even though the survey
included only ATs that received certification within the previous 18 months, there could be
discrepancies in their memory of education while answering the questions. Participants may

80

have perceived their skills are high when their preceptors perceive a different a standard. Future
research may include a follow up survey to their respective supervisor and or program director.
5.3 Future Research
This study examined the level of development and integration of different skill
competencies identified as essential for members of the athletic training profession. Now that a
base knowledge of development and integration of CAATE skills, interpersonal skills and
professional development has been cited, there are a few concepts that could be further
investigated to continue to ensure appropriate and adequate knowledge within the profession.
Future research could include more qualitative data that would include information coming from
the recently certified AT’s supervisors. Many times, a person may feel that they are adequate in
their knowledge, but there could be a discrepancy as to exactly what is being done. If a
practicing AT is unaware of newer or advanced techniques that provide better results in their
evaluation or rehabilitation, they may not know they aren’t reaching their highest level of
potential. This would give the recently certified AT a false sense of confidence and therefore
skew their perspective.
Further research could focus more on the educational side of AT. One of the first
avenues that could be researched is the level of satisfaction that a recently certified AT has on
their education and its efficacy. Now that they are practicing in the field, do they feel that their
education prepared them adequately for the demands? This question was not asked in the current
research, but may have impacted the reasoning behind responses that showed inconsistencies
through the survey responses.

81

Finally, future research could include a follow up study with respondents who have been
certified for a longer period. For example, do their perspectives on their education change as
they are in the profession longer? Do they specialize into different facets of AT that may
diminish their general knowledge but enhance specific aspects of healthcare? These are
questions that should be asked in future research to enhance our understanding of athletic
training education.
5.4 Summary
The main goal of the Commission on the Accreditation of Athletic Training Education
(CAATE) is to create competent professionals regardless of institution attended. Individuals
wishing to become athletic trainers in the profession can attend an accredited program and know
that they will receive a quality education. The difficulty in creating a baseline education that any
person can be successful in is that everyone has different styles of learning and comprehending
the material. Some individuals are verbal learners, while others may be hands on learners, and
finally some may learn just by listening to the information presented. According to the data in
this study, participants place a high amount of value in the development and integration of their
skills in the classroom. Those that felt the classroom wasn’t as important placed value in the
development and integration of their skills in the field experiences whether in the laboratory
setting or in the field under direct supervision of the preceptors. This means that no matter what
type of learner a person is, the CAATE has created a model of athletic training education that
encompasses the different learning styles while allowing the athletic training student many
opportunities to understand the information through learning over time.

82

APPENDICES

83

Appendix A

Survey of Development and Implementation of Skills of Recently Certified Athletic Trainers
Appendix A represents the questions that were included in the online version of the
survey. The demographics portion of the survey was completed utilizing a screen that scrolled
downward in order to complete every question contained in that section. When respondents
continued on to the competency portion of the survey, they were unaware of the different
sections (General CAATE Skills, Interpersonal Skills, and Professional Personal Development
Skills). Each specific competency was described at the top if its own individual page with the
corresponding questions (Educational Setting and Level of Importance) below. When the
respondent finished that competency, they were instructed at the bottom of the screen to proceed
to the next page, which contained another competency and questions until they completed the
final question.

84

Figure A1.1 Welcome Page of Survey

85

Figure A1.2 Demographics Questions

86

Figure A1.3 Athletic Training Demographics Questions

87

Figure A1.4 Instructions of Survey

88

Figure A1.5 CAATE Competency CE-20

89

Figure A1.6 CAATE Competency CE-15

90

Figure A1.7 CAATE Competency TI-11

91

Figure A1.8 CAATE Competency TI-11a

92

Figure A1.9 CAATE Competency TI-13

93

Figure A1.10 CAATE Competency CE-16

94

Figure A1.11 CAATE Competency PHP-23

95

Figure A1.12 CAATE Competency CE-4

96

Figure A1.13 CAATE Competency TI-17

97

Figure A1.14 CAATE Competency PD-9

98

Figure A1.15 CAATE Competency PHP-32

99

Figure A1.16 CAATE Competency CE-21o

100

Figure A1.17 CAATE Competency PS-13

101

Figure A1.18 CAATE Competency PHP-12

102

Figure A1.19 CAATE Competency CE-6

103

Figure A1.20 CAATE Competency TI-29

104

Figure A1.21 CAATE Competency TI-22

105

Figure A1.22 CAATE Competency PS-6

106

Figure A1.23 CAATE Competency AC-43

107

Figure A1.24 CAATE Competency PD-11

108

Figure A1.25 Irresolvable Issues

109

Figure A1.26 CAATE Competency CE-13

110

Figure A1.27 CAATE Competency HA-11

111

Figure A1.28 CAATE Competency HA-1

112

Figure A1.29 Adapting to the Demands of the Profession

113

Figure A1.30 CAATE Competency PD-7

114

Figure A1.31Maintaining a Balance

115

Figure A1.32 CAATE Competency TI-7

116

Figure A1.33 CAATE Competency PD-8

117

Figure A1.34 Sense of Self

118

Figure A1.35 CAATE Competency EBP-4

119

Figure A1.36 Coping with Return to Play

120

Figure A1.37 CAATE Competency EBP-7

121

Figure A1.38 Knowing Scope of Practice

122

Figure A1.39 Remaining Calm

123

Appendix B

Responses of Individual Questions
Appendix B displays the aggregate results to the individual competency in question
within the survey. Subjects were asked to complete two sections for each competency. The first
question asked the subject in which educational setting the material was presented and integrated
in their learning process. The answers to this inquiry are based on the concept of learning over
time in which each phase builds upon one another.
•
•
•

Not presented in Athletic Training Education
In the Classroom Setting
With Theoretical Patients in the Laboratory Setting: including in the
classroom setting
• With Actual Patients in the Athletic Training Room: After being taught in the
classroom and allowed to practice in the laboratory setting
• With Actual Patients in the Field Setting: After being taught in the classroom,
practiced in the laboratory setting, with actual patients in the athletic training
room
The follow up question to where the information was presented and integrated in the
subject’s education was to determine level of importance of each of the educational settings
within their education. The three educational settings were the classroom, the laboratory and the
field. Subjects were required to rate each of the settings based on a 5 point Likert scale with
integers at (1) no importance, (2) low importance, (3) moderate importance, (4) high
importance, and (5) most important. The charts below correlate the aggregate responses for each
educational setting in which the information was presented and integrated with their reported
level of importance for each of the same settings.

124

General CAATE Proficiencies
Table B1.1 CAATE CE-20: "Use standard techniques and procedures for the clinical
examination of common injuries, conditions, illnesses and diseases."
Educational Setting
Not introduced in AT education
In classroom setting
With theoretical lab patients
With actual patients in AT room
With actual patients in field

Count
0
45
30
62
17

N%
.0%
29.2%
19.5%
40.3%
11.0%

Mean Level of Importance
Classroom Laboratory Field
0
0
0
3.78
4.02
4.53
3.67
4.31
4.40
3.63
3.92
4.84
3.76
3.94
4.94

Table B1.2 CAATE CE-15: "Demonstrate the ability to modify the diagnostic examination
process according to the demands of the situation and patient responses."
Educational Setting
Not introduced in AT education
In classroom setting
With theoretical lab patients
With actual patients in AT room
With actual patients in field

Count
0
24
28
62
40

N%
.0%
15.6%
18.2%
40.3%
26.0%

Mean Level of Importance
Classroom Laboratory
Field
0
0
0
3.75
3.75
4.42
3.32
4.18
4.54
3.34
3.74
4.65
3.32
3.70
4.95

Table B1.3 CAATE TI-11: "Design therapeutic interventions to meet specific treatment
goals."
Educational Setting
Not introduced in AT education
In classroom setting
With theoretical lab patients
With actual patients in AT room
With actual patients in field

Count
0
62
26
53
13

N%
.0%
40.3%
16.9%
34.4%
8.4%

125

Mean Level of Importance
Classroom Laboratory
Field
0
0
0
4.02
3.89
4.32
3.81
4.35
4.04
3.66
3.77
4.60
3.92
3.77
4.92

Table B1.4 CAATE TI-11a: "Assess the patient to identify indications, contraindications, and
precautions applicable to the intended intervention."
Educational Setting
Not introduced in AT education
In classroom setting
With theoretical lab patients
With actual patients in AT room
With actual patients in field

Count
0
86
33
26
9

N%
.0%
55.8%
21.4%
16.9%
5.8%

Mean Level of Importance
Classroom Laboratory
Field
0
0
0
4.19
3.92
4.17
3.82
4.15
4.00
3.62
3.85
4.54
3.56
3.89
4.89

Table B1.5 CAATE TI-13: "Describe the relationship between the application of therapeutic
modalities and the incorporation of active and passive exercise and/or manual therapies,
including therapeutic massage, myofascial techniques, and muscle energy techniques."
Educational Setting
Not introduced in AT education
In classroom setting
With theoretical lab patients
With actual patients in AT room
With actual patients in field

Count
0
45
44
56
9

N%
.0%
29.2%
28.6%
36.4%
5.8%

Mean Level of Importance
Classroom Laboratory
Field
0
0
0
4.18
3.82
4.29
3.45
4.36
4.27
3.34
3.61
4.61
3.67
3.78
5.00

Table B1.6 CAATE CE-16: "Recognize the signs and symptoms of catastrophic and emergent
conditions and demonstrate appropriate referral decisions."
Educational Setting
Not introduced in AT education
In classroom setting
With theoretical lab patients
With actual patients in AT room
With actual patients in field

Count
0
80
55
6
13

N%
.0%
51.9%
35.7%
3.9%
8.4%

126

Mean Level of Importance
Classroom Laboratory
Field
0
0
0
4.21
3.87
3.95
3.89
4.56
4.35
3.33
3.83
4.83
3.77
3.85
4.92

Table B1.7 CAATE PHP-23: "Apply preventative taping and wrapping procedures, splints,
braces and other special protective devices."
Educational Setting
Not introduced in AT education
In classroom setting
With theoretical lab patients
With actual patients in AT room
With actual patients in field

Count
0
26
65
43
20

N%
.0%
16.9%
42.2%
27.9%
13.0%

Mean Level of Importance
Classroom Laboratory
Field
0
0
0
3.62
3.92
4.23
2.89
4.60
4.37
3.14
4.23
4.74
2.80
4.05
4.65

Table B1.8 CAATE CE-4: "Describe the principles and concepts of body movement, including
normal osteokinematics and arthrokinematics."
Educational Setting
Not introduced in AT education
In classroom setting
With theoretical lab patients
With actual patients in AT room
With actual patients in field

Count
4
128
14
8
0

N%
2.6%
83.1%
9.1%
5.2%
.0%

Mean Level of Importance
Classroom Laboratory
Field
3.50
4.25
4.25
4.34
3.50
3.45
4.00
4.00
4.14
4.00
3.75
4.75
0
0
0

Table B1.9 CAATE TI-17: "Analyze gait and select appropriate instruction and correction
strategies to facilitate safe progression to functional gait pattern."
Educational Setting
Not introduced in AT education
In classroom setting
With theoretical lab patients
With actual patients in AT room
With actual patients in field

Count
2
68
58
19
7

N%
1.3%
44.2%
37.7%
12.3%
4.5%

127

Mean Level of Importance
Classroom Laboratory
Field
4.00
4.50
5.00
3.84
3.87
4.01
3.52
4.17
3.71
3.58
3.84
4.53
3.43
3.71
5.00

Table B1.10 CAATE PD-9: "Specify when referral of a client/patient to another healthcare
provider is warranted and formulate and implement strategies to facilitate that referral."
Educational Setting
Not introduced in AT education
In classroom setting
With theoretical lab patients
With actual patients in AT room
With actual patients in field

Count
4
64
23
51
12

N%
2.6%
41.6%
14.9%
33.1%
7.8%

Mean Level of Importance
Classroom Laboratory Field
3.25
2.67
3.75
4.03
3.42
4.06
3.74
4.17
4.13
3.24
3.16
4.61
3.50
3.33
4.83

Table B1.11 CAATE PHP-32: "Describe the role of nutrition in enhancing performance,
preventing injury or illness, and maintain a healthy lifestyle to patients."
Educational Setting
Not introduced in AT education
In classroom setting
With theoretical lab patients
With actual patients in AT room
With actual patients in field

Count
4
135
3
9
3

N%
2.6%
87.7%
1.9%
5.8%
1.9%

Mean Level of Importance
Classroom Laboratory Field
3.25
3.25
4.25
4.25
3.22
3.49
4.33
4.33
4.33
3.78
3.56
3.89
4.33
3.00
4.00

Table B1.12 CAATE CE-21o: "Assess and interpret findings from a physical examination
that is based on the patient's clinical presentation for dermatological concerns."
Educational Setting
Not introduced in AT education
In classroom setting
With theoretical lab patients
With actual patients in AT room
With actual patients in field

Count
4
87
18
34
11

N%
2.6%
56.5%
11.7%
22.1%
7.1%

128

Mean Level of Importance
Classroom Laboratory Field
3.67
3.00
4.00
3.86
3.11
3.89
3.94
4.39
4.44
3.65
3.38
4.44
3.55
3.82
4.55

Table B1.13 CAATE PS-13: "Identify and describe the basic signs and symptoms of mental
health disorders (e.g. psychosis, neurosis); sub-clinical mood disturbances (e.g. depression,
anxiety); and personal/social conflict (e.g. adjustment to injury, family problems, academic or
emotional stress, personal assault or abuse, sexual assault or harassment) that may indicate
the need for referral to a mental healthcare professional."
Educational Setting
Not introduced in AT education
In classroom setting
With theoretical lab patients
With actual patients in AT room
With actual patients in field

Count
7
120
19
6
2

N%
4.5%
77.9%
12.3%
3.9%
1.3%

Mean Level of Importance
Classroom Laboratory Field
2.71
2.57
3.14
4.07
3.24
3.54
4.16
4.37
3.84
3.67
2.50
4.83
3.50
2.50
5.00

Table B1.14 CAATE PHP-12: "Assess current practice guidelines related to physical activity
during extreme weather conditions (e.g. heat, cold, lightning, wind)."
Educational Setting
Not introduced in AT education
In classroom setting
With theoretical lab patients
With actual patients in AT room
With actual patients in field

Count
0
105
10
8
31

N%
.0%
68.2%
6.5%
5.2%
20.1%

Mean Level of Importance
Classroom Laboratory Field
0
0
0
4.21
3.30
3.98
3.50
3.90
3.60
4.00
3.63
4.75
3.74
3.58
4.77

Table B1.15 CAATE CE-6: "Describe the basic principles of diagnostic imaging and testing
and their role in the diagnostic process."
Educational Setting
Not introduced in AT education
In classroom setting
With theoretical lab patients
With actual patients in AT room
With actual patients in field

Count
10
116
5
12
11

N%
6.5%
75.3%
3.2%
7.8%
7.1%

129

Mean Level of Importance
Classroom Laboratory Field
3.63
3.38
4.25
3.97
3.07
3.72
4.00
3.40
3.40
3.83
3.25
4.58
3.55
3.27
4.73

Table B1.16 CAATE TI-29: "Describe how common pharmacological agents influence pain
and healing and their influence on various therapeutic interventions."
Educational Setting
Not introduced in AT education
In classroom setting
With theoretical lab patients
With actual patients in AT room
With actual patients in field

Count
0
139
7
5
3

N%
.0%
90.3%
4.5%
3.2%
1.9%

Mean Level of Importance
Classroom Laboratory Field
0
0
0
4.31
3.14
3.50
4.43
4.29
4.00
3.60
3.40
3.60
4.67
3.33
4.33

Table B1.17 CAATE TI-22: "Identify and use appropriate pharmacological terminology for
management of medications, inventory control, and reporting of pharmacological agents
commonly used in an athletic training facility."
Educational Setting
Not introduced in AT education
In classroom setting
With theoretical lab patients
With actual patients in AT room
With actual patients in field

Count
11
114
4
22
3

N%
7.1%
74.0%
2.6%
14.3%
1.9%

130

Mean Level of Importance
Classroom Laboratory Field
1.78
1.67
2.11
4.18
3.08
3.55
4.25
3.75
4.00
3.41
3.09
4.32
4.33
3.33
4.00

Interpersonal Skills Development
Table B1.18 CAATE PS-6: "Explain the importance of educating patients, parents/guardians,
and others regarding the condition in order to enhance the psychological and emotional wellbeing of the patient
Educational Setting
Not introduced in AT education
In classroom setting
With theoretical lab patients
With actual patients in AT room
With actual patients in field

Count
8
73
12
41
20

N%
5.2%
47.4%
7.8%
26.6%
13.0%

Mean Level of Importance
Classroom Laboratory Field
3.13
2.88
3.25
3.89
3.14
3.99
3.00
3.92
4.08
3.29
3.54
4.66
3.15
2.85
4.65

Table B1.19 CAATE AC-43: "Instruct the patient in home care and self-treatment plans for
acute conditions."
Educational Setting
Not introduced in AT education
In classroom setting
With theoretical lab patients
With actual patients in AT room
With actual patients in field

Count
3
30
19
74
28

N%
1.9%
19.5%
12.3%
48.1%
18.2%

Mean Level of Importance
Classroom Laboratory Field
3.33
4.00
4.00
3.57
3.60
4.47
3.26
4.05
4.37
3.43
3.55
4.60
3.36
3.32
4.71

Table B1.20 CAATE PD-11: "Identify strategies to educate colleagues, students, patients, the
public, and other healthcare professionals about the roles, responsibilities, academic
preparation, and scope of practice of athletic trainers."
Educational Setting
Not introduced in AT education
In classroom setting
With theoretical lab patients
With actual patients in AT room
With actual patients in field

Count
11
105
1
18
19

N%
7.1%
68.2%
.6%
11.7%
12.3%

131

Mean Level of Importance
Classroom Laboratory Field
2.09
1.82
3.09
4.11
2.90
3.49
5.00
3.00
3.00
3.50
3.56
4.56
3.21
2.79
4.68

Table B1.21 Report irresolvable issues when appropriate to senior staff or supervisors
Educational Setting
Not introduced in AT education
In classroom setting
With theoretical lab patients
With actual patients in AT room
With actual patients in field

Count
19
71
10
40
14

N%
12.3%
46.1%
6.5%
26.0%
9.1%

Mean Level of Importance
Classroom Laboratory Field
2.61
2.50
3.11
3.66
3.01
3.51
3.50
4.20
3.70
3.03
3.33
4.45
2.71
2.71
4.57

Table B1.22 CAATE CE-13: "Obtain a thorough medical history that includes the pertinent
past medical history, underlying systemic disease, use of medications, the patient's perceived
pain, and the history and course of the present condition."
Educational Setting
Not introduced in AT education
In classroom setting
With theoretical lab patients
With actual patients in AT room
With actual patients in field

Count
0
45
46
47
16

N%
.0%
29.2%
29.9%
30.5%
10.4%

Mean Level if Importance
Classroom Laboratory Field
0
0
0
4.04
3.93
4.42
3.61
4.54
4.41
3.81
4.04
4.79
3.81
4.06
4.81

Table B1.23 CAATE HA-11: "Use contemporary documentation strategies to effectively
communicate with patients, physicians, insurers, colleagues, administrators, and parents or
family members."
Educational Setting
Not introduced in AT education
In classroom setting
With theoretical lab patients
With actual patients in AT room
With actual patients in field

Count
3
72
10
56
13

N%
1.9%
46.8%
6.5%
36.4%
8.4%

132

Mean Level of Importance
Classroom Laboratory Field
4.50
4.00
4.00
3.80
3.42
4.07
4.20
4.40
4.40
3.41
3.61
4.55
3.38
3.77
4.85

Table B1.24 CAATE HA-1: "Describe the role of the athletic trainer and the delivery of
athletic training services within the context of the broader healthcare system."
Educational Setting
Not introduced in AT education
In classroom setting
With theoretical lab patients
With actual patients in AT room
With actual patients in field

Count
3
124
4
10
13

N%
1.9%
80.5%
2.6%
6.5%
8.4%

133

Mean Level of Importance
Classroom Laboratory Field
3.00
4.00
3.50
4.03
2.88
3.48
3.00
3.25
3.50
3.80
4.00
4.20
3.69
3.31
4.77

Professional Personal Development Skills
Table B1.25 The ability to adapt to the demands of the profession of athletic training (e.g.
hour demand, non-traditional work schedule, burnout, work-family conflict).
Educational Setting
Not introduced in AT education
In classroom setting
With theoretical lab patients
With actual patients in AT room
With actual patients in field

Count
13
48
1
47
45

N%
8.4%
31.2%
.6%
30.5%
29.2%

Mean Level of Importance
Classroom Laboratory Field
2.15
2.08
3.62
3.65
2.73
3.52
4.00
3.00
3.00
2.81
2.72
4.79
2.80
2.60
4.89

Table B1.26 CAATE PD-7: "Perform a self-assessment of professional competence and create
a professional development plan to maintain necessary credentials and promote life-long
learning strategies."
Educational Setting
Not introduced in AT education
In classroom setting
With theoretical lab patients
With actual patients in AT room
With actual patients in field

Count
26
97
4
11

N%
16.9%
63.0%
2.6%
7.1%

16

10.4%

Mean Level of Importance
Classroom Laboratory Field
2.85
2.27
2.88
4.01
2.63
3.16
3.50
4.00
4.25
2.91
3.18
4.64
3.25

3.69

4.75

Table B1.27 Develop the ability to maintain a balance between career and personal life
Educational Setting
Not introduced in AT education
In classroom setting
With theoretical lab patients
With actual patients in AT room
With actual patients in field

Count
27
54
2
32
39

N%
17.5%
35.1%
1.3%
20.8%
25.3%

134

Mean Level of Importance
Classroom Laboratory Field
1.93
1.70
2.67
3.48
2.60
3.69
3.00
3.50
3.00
2.81
2.34
4.53
2.62
2.41
4.69

Table B1.28 CAATE TI-7: "Identify patient- and clinician-oriented outcomes measures
commonly used to recommend activity level, make return to play decisions, and maximize
patient outcomes and progress in the treatment plan."
Educational Setting
Not introduced in AT education
In classroom setting
With theoretical lab patients
With actual patients in AT room
With actual patients in field

Count
7
40
24
56
27

N%
4.5%
26.0%
15.6%
36.4%
17.5%

Mean Level of Importance
Classroom Laboratory Field
2.71
2.71
3.57
3.80
3.45
4.45
3.42
4.08
4.29
3.55
3.64
4.55
3.74
3.93
4.81

Table B1.29 CAATE PD-8: "Differentiate among the preparation, scopes of practice, and
roles and responsibilities of healthcare providers and other professionals with whom athletic
trainers interact."
Educational Setting
Not introduced in AT education
In classroom setting
With theoretical lab patients
With actual patients in AT room
With actual patients in field

Count
6
106
5
19
18

N%
3.9%
68.8%
3.2%
12.3%
11.7%

Mean Level of Importance
Classroom Laboratory Field
3.00
2.17
2.83
4.07
2.90
3.67
3.60
4.20
3.80
3.63
3.47
4.68
3.50
3.11
4.50

Table B1.30 Maintaining a sense of spiritual self, consistent with personal beliefs
Educational Setting
Not introduced in AT education
In classroom setting
With theoretical lab patients
With actual patients in AT room
With actual patients in field

Count
77
41
4
19
13

N%
50.0%
26.6%
2.6%
12.3%
8.4%

135

Mean Level of Importance
Classroom Laboratory Field
1.74
1.48
2.38
3.90
2.63
3.20
4.25
4.00
4.25
2.79
2.79
4.53
2.31
2.69
4.62

Table B1.31 CAATE EBP-4: "Describe a systemic approach (e.g. five step approach) to create
and answer a clinical question through review and application of existing research."
Educational Setting
Not introduced in AT education
In classroom setting
With theoretical lab patients
With actual patients in AT room
With actual patients in field

Count
20
107
12
9
6

N%
13.0%
69.5%
7.8%
5.8%
3.9%

Mean Level of Importance
Classroom Laboratory Field
2.40
1.90
2.05
4.11
3.03
3.13
3.75
3.92
3.75
3.89
4.00
4.44
3.50
4.17
5.00

Table B1.32 Effectively coping with the pressures of return to play from the coaching staff
Educational Setting
Not introduced in AT education
In classroom setting
With theoretical lab patients
With actual patients in AT room
With actual patients in field

Count
16
33
11
43
51

N%
10.4%
21.4%
7.1%
27.9%
33.1%

Mean Level of Importance
Classroom Laboratory Field
2.00
2.19
3.75
3.30
3.00
4.30
3.36
3.45
4.18
3.28
3.40
4.63
2.98
2.96
4.84

Table B1.33 CAATE EBP-7: "Conduct a literature search using a clinical question relevant
to athletic training practice using search techniques and resources appropriate for a specific
clinical question."
Educational Setting
Not introduced in AT education
In classroom setting
With theoretical lab patients
With actual patients in AT room
With actual patients in field

Count
3
135
5
3
8

N%
1.9%
87.7%
3.2%
1.9%
5.2%

136

Mean Level of Importance
Classroom Laboratory Field
3.33
2.00
2.33
4.34
2.67
2.73
3.40
4.00
4.00
4.00
4.00
4.00
3.87
3.50
4.63

Table B1.34 Knowing the scope of practice and being able to determine when to ask for help
in situations when needed
Educational Setting
Not introduced in AT education
In classroom setting
With theoretical lab patients
With actual patients in AT room
With actual patients in field

Count
4
63
8
44
35

N%
2.6%
40.9%
5.2%
28.6%
22.7%

Mean Level of Importance
Classroom Laboratory Field
2.50
2.25
3.25
4.05
3.22
3.81
3.38
3.63
3.63
3.59
3.41
4.59
3.57
3.34
4.74

Table B1.35 Remaining calm during situations that require advanced medical assistance
within the realm of athletic training
Educational Setting
Not introduced in AT education
In classroom setting
With theoretical lab patients
With actual patients in AT room
With actual patients in field

Count
3
23
27
29
72

N%
1.9%
14.9%
17.5%
18.8%
46.8%

137

Mean Level of Importance
Classroom Laboratory Field
2.67
3.33
4.00
3.45
3.50
4.64
3.41
4.07
4.19
3.31
3.72
4.90
3.04
3.55
4.89

Appendix C

Letter to Cohort to Participate in Survey

Dear Participant,
My name is Brian Bratta and I am completing a doctoral degree at Michigan State
University. I am writing to ask for your participation in research for my research practicum
project.
This survey is being conducted to identify the different clinical instruction strategies that
were employed by the athletic training faculty during your undergraduate athletic training
education program. We are asking for your participation as a certified athletic trainer that has
completed the certification exam during the last 18 months. The survey is available from the
Survey Monkey link at the bottom of this page. The entire survey will take about 20 minutes to
complete. Participation is voluntary and you must be 18 years or older to participate. The
survey does not require any personal information and only the responses to the questions will be
included in the database. The analysis of the information collected from the survey uses the data
as an aggregate. You may decline participation at any time and you may also skip questions.
Your response to this survey is voluntary and you can terminate your participation by closing
you web browser. The results of this research will add insight into the clinical education teaching
techniques used by clinical instructors. Anonymity will be maintained to the maximum extent of
the law.
If you have any questions or concerns about this survey and/or your role as a participant,
please do not hesitate to contact me at 105 IM Sports Circle, East Lansing, MI 48824 or at
brattabr@ath.msu.edu. If you have any questions 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, MSU’s Human Research Protection Programs at 517-355-2180, FAX 517-432-4503,
or email irb@msu.edu, or regular mail at 207 Olds Hall, MSU, East Lansing, MI 48824. This
student survey is not approved or endorsed by NATA. It is being sent to you because of NATA’s
commitment to athletic training education and research.
I thank you in advance for your contribution to this research and for your willingness to
share your experiences. Please click on the link below to proceed to the survey. Doing so will
indicate your voluntary agreement to participate in this research.
Internet site inserted here
Sincerely,
Brian Bratta, MS, ATC, CSCS
John Powell, PhD, ATC
Secondary Investigator
Responsible Primary Investigator
Doctoral Candidate
Graduate ATEP Director
Michigan State University
Michigan State University
105 IM Sports Circle
105 IM Sports Circle
East Lansing, MI 48824
East Lansing, MI 48824
517-432-5018
517-432-5018
brattabr@ath.msu.edu
powellj4@ath.msu.edu

138

WORKS CITED

139

WORKS CITED

Ablemedia.com/ctcweb/consortium/ancientolympics5.html, Retrieved on 10/14/12
Accreditation Council for Graduate Medical Education. Policies and Procedures. ACGME.org,
2012.
American Medical Association. www.AMA.org
American Physical Therapy Association. www.APTA.org
Bandura A. Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood
Cliffs, NJ: Prentice-Hall. 1986.
Barrows H. Problem-Based Learning Applied to Medical Education. Springfield, IL: Southern
Illinois University Medical School; 2000: 1-11.
Barrows H. Problem-Based Learning in Medicine and Beyond: A Brief Overview. New
Directions for Teaching and Learning. Winter 1996; 68: 3-12.
Brookfield S. Self-directed learning: a critical paradigm. Adult Educ Quart. 1985; 35(2).
Bureau of Labor Statistics. www.bls.gov.
Capel S. Attrition of athletic trainers. J Athl Train. 1990; 25: 34-49.
Commission on Accrediting Athletic Training Education. www.CAATE.net
Commission on Accrediting Athletic Training Education. 5th Edition Competencies Matrix.
www.CAATE.net; 2012.
Commission on Accrediting Athletic Training Education. Standards for the Accreditation of
Professional Athletic Training Programs. www.CAATE.net; 2012.
Deci E et al. Motivation and Education: the Self-Determination Perspective. Educ Psychol.
1991; 26: 325-346.
Delforge G and Behnke R. The History and Evolution of Athletic Training Education in the
United States. J Ath Train. 1999; 34(1): 3-61.
Delforge G. The athletic training major: a report from the Professional Education Committee.
Athl Train, JNATA. 1982; 17:288-290.
Ebbert D, Connors H. Standardized Patient Experiences: Evaluation of Clinical Performance
and Nurse Practitioner Student Satisfaction. Nurse Educ Persp. January/February 2004; 12-15.
Ebel RG. Far Beyond the Shoe Box: 50 years of the NATA. New York: Forbes; 1999.

140

Feigley D. Psychological burnout in high-level athletes. Phys SportsMed. 1984; 12(10): 109119.
Gagne R, Briggs L. Principles of Instructional Design. New York: Holt, Rinehart and Winston;
1974.
Grace P. Milestones in Athletic Trainer Certification. J Athl Train. 1999; 34(3): 285-291.
Green JL. Multiple perspectives: Issues and direction. In Beach et al, Multidisciplinary
perspectives on literacy research (19-33). National Council of Teachers of English: Urbana, IL,
1992.
Harvill L. Anticipatory socialization of medical students. J Med Educ. 1981; 56: 431-433.
Hayden J. Professional socialization and health education preparation. J Health Educ. 1995;
26: 271-276.
Heinrichs K. Problem-Based Learning in Entry-Level Athletic Training Professional-Education
Programs: A Model for Developing Critical Thinking and Decision- Making Skills. J Athl Train.
2002; 37(4): S-189-S-198.
Hendrix A et al. An examination of stress and burnout in certified athletic trainers at division 1A universities. J Athl Train. 2000; 35(2): 139-144.
Hottinger U et al. Structured oral examination of the Swiss medical licensing examination:
Development and testing in a pilot project. Submitted for publication, 2006.
Hundersmarck SF. “Between the Classroom and the Streets: The Transition from Police
Academy Recruit to Police Officer.” Professional Studies Review 2, no. 1.2005: 85-98.
Johnstone J, Rivera R. Volunteers of Learning: A Study of the Educational Pursuits of Adults.
Hawthorne, NY. 1965.
Joint Review Committee on Educational Programs in Athletic Training and Commission on
Accreditation of Athletic Training Education. 2001 CAAHEP accreditation and guidelines.
Centennial, CO: JRC-AT. 2001.
Joint Review Committee on Educational Programs in Athletic Training. JRC-AT News. Spring
1998.
Knowles M. The Modern Practice of Adult Education: From Pedagogy to Andragogy (2nd ed.)
New York: Cambridge Books.
Lawson H. Toward a model of teacher socialization in physical education, part 1: the subjective
warrant, recruitment, and teacher education. J Teach Phys Educ. 1983; 2:3-16.
Lawson H. Toward a model of teacher socialization in physical education, part 2: entry into
schools, teachers’ role orientations, and longevity in teaching. J Teach Phys Educ. 1983; 3:315.

141

Lindquist M, Arrington S and Schoepner K. The BOC Exam: The first 40 years. Jacob North
Printing Co.
Lortie D. Schoolteacher: A Sociological Study. Chicago, IL: University of Chicago Press; 1975.
Marple, B. Competency-Based Resident Education. Otolaryngol Clin N Am. 2007; 40: 12151225.
Maslach C, Jackson S. Maslach Burnout Inventory: Manual. 2nd ed. Palo Alto, CA: Consulting
Psychologists Press; 1996.
Maslach C, Jackson S. The measurement of experienced burnout. J Occupat Behav. 1981; 2:
99-113.
Mazerolle S et al. Work-family conflict, part 1: Antecedents of work-family conflict in national
collegiate athletic association division 1-A certified athletic trainers. J Athl Train. 2008a ;43(5):
505-512.
Mazerolle S et al. Work-family conflict, part II: job and life satisfaction in national collegiate
athletic association division 1-A certified athletic trainers. J Athl Train. 2008b; 43(5): 513-522.
Mazerolle S et al. Addressing WFC in the athletic training profession through high-quality
discussion. Athl Ther Today. 2008c; 13(4): 5-10.
Mensch J, Ennis C. Pedagogic Strategies Perceived to Enhance Student Learning in Athletic
Training Education. J Ath Train. 2002; 37(4): S199-S207.
Merriam S et al. Learning in Adulthood: A Comprehensive Guide (3rd ed.) San Francisco, CA:
Wiley and Sons. 2007.
Morgan W et al. Psychological monitoring of overtraining and staleness. Br J Sports Med.
1987; 21: 107-114.
National Athletic Trainers’ Association. www.NATA.org
National Athletic Trainers’ Association. AMA endorses athletic training as an allied health
profession. NATA News. September 1990: 4.
National Athletic Trainers’ Association. Guidelines for Development and Implementation of
NATA Approved Undergraduate Athletic Training Education Programs. Greenville, NC.
National Athletic Trainers’ Association; 1983
National Athletic Trainers’ Association. Guidelines for Development and Implementation of
NATA Approved Undergraduate Athletic Training Education Programs. Greenville, NC.
National Athletic Trainers’ Association; 1980.
National Athletic Trainers’ Association. JRC-AT update. NATA News. March, 1995: 13.
National Board of Medical Examiners. USMLE Step 2 Clinical Skills. USMLE.org, 2012.

142

Netermeyer R et al. Development and validation of work-family conflict and family-work
conflict scales. J App Psychol. 1996; 81(4): 400-410.
Newell WE. Reflections on athletic training. Athl Train, JNATA. 1984; 19: 256-259, 311.
Parkay F et al. Professional socialization: a longitudinal study of first-time high school
principals. Educ Admin Q. 1992; 28: 43-75.
Pitney W. Organizational influences and quality-of-life issues during the professional
socialization of certified athletic trainers working in the National Collegiate Athletic Association
Division I setting. J Athl Train. 2006; 41(2): 189-195.
Pitney W et al. The professional Socialization of Certified Athletic Trainers in the National
Collegiate Athletic Association Division I Context. J Athl Train. 2002; 37 (1): 63-70.
Reed S, Giacobbi P. The stress and coping responses of certified graduate athletic training
students. J Athl Train. 2004; 39(2): 193-200.
Rosenthal J, ed. Accreditation Manual. Chicago, IL: American Medical Association; 1991.
Schwank WC, Miller SJ. New dimensions for the athletic training profession. J Health Phys
Educ Recreation. September 1971: 41-43.
Skinner B. About Behaviorism. New York: Knopf. 1974.
Smith R. Toward a cognitive-affective model of athletic burnout. J Sport Psych. 1985; 8: 36-50
Solomon P et al. A comparative study of learning processes and outcomes in two problem-based
curriculum designs. J Phys Ther Educ. 1996; 10:72-76.
Stewart RD, Paris PM, Heller MB. Design of a resident in-field experience for an emergency
medicine residency curriculum. Annals of Emergency Medicine.1987; 16(2): 175-179.
Teschendorf B, Nemshick M. Faculty roles in professional socialization. J Phys Ther. 2001;
15: 4-10.
Turocy P et al. Clinical Experiences are not predictive of outcomes on the NATABOC
examination. J Athl Train. 2000; 35 (1): 70-75
Vu N, Barrows H. Use of Standardized Patients in Clinical Assessments: Recent Developments
and Measurement Findings. Educ Res. 1994; 23:23.
Vygotsky L. Mind in Society: The Development of Higher Psychological Processes.
Cambridge, MA: Harvard University Press; 1978.
Westphalen SW, McLean L. Seven years of certification by the NATA. Athl Train, JNATA.
1978; 13: 86-88, 91.
Winterstein A. Organizational commitment among intercollegiate athletic trainers: examining
our work environment. J Athl Train. 1998; 33: 54-61.

143