Influence of Gender in Preceptor-Student Dyads on Student Performance in Clinical Education: A Report from the AATE Research Network.

CONTEXT: Health professions education programs incorporate clinical education to prepare students for autonomous clinical practice. Although preceptor-student gender dyads impact student evaluations, specific influences of gender dyad pairings on student autonomy and behavior implementation have not been identified. OBJECTIVE: To examine the influence of preceptor-student gender dyads on athletic training student opportunities to engage in clinical practice during clinical experiences and to determine whether constitution of preceptor-student gender dyads influenced student ability to enact professional behaviors during patient encounters (PEs). METHODS: Multisite panel design involving 12 professional athletic training programs (ATPs, 5 undergraduate, 7 graduate). Participants included 338 athletic training students enrolled in ATPs that used E*Value to document PEs during clinical experiences. Student gender, student role in the PE (observe, assist, or perform), preceptor gender, and student implementation of behaviors associated with core competencies during the PE were measured outcomes. RESULTS: The 30,446 PEs were categorized into 4 preceptor-student dyad categories. Female students with male preceptors were less likely to perform PEs than they were to observe them (OR 0.76; 95%CI 0.69, 0.83; p<0.001). Female students with female preceptors reported fewer opportunities for behaviors associated with interprofessional education and collaborative practice (IPECP) (X2(3)=16.6, p=0.001). CONCLUSIONS: Female athletic training students under male preceptorship had fewer opportunities to perform during PEs, and female students under female preceptorship had limited opportunities to participate in IPECP. Health professions education program administrators should encourage students to advocate for opportunities in autonomous practice and implementation of professional behaviors.

Implementation of Patient-Centered Care by Athletic Training Students during Clinical Experiences: A Report from the Association of Athletic Training Education Research Network.

Patient-centered care (PCC) is a core competency that should be required by all healthcare education programs, but little is known about its implementation in athletic training clinical experiences. Therefore, we examined characteristics of patient encounters documented by athletic training students implementing PCC behaviors. A multisite panel design was used to recruit 363 students from twelve professional athletic training programs (five undergraduate, seven graduate). Over 1.5 years, clinical experience patient encounter data were logged in E*Value Case Logs, including student role during the encounter, length of encounter, and clinical site. Generalized estimating equations models characterized the likelihood students included PCC behaviors in 30,522 encounters. Discussing patient goals was associated with student role (χ2(2) = 40.6, p < 0.001) and length of encounter (χ2(4) = 67.6, p < 0.001). Using patient-reported outcome measures was associated with student role (χ2(2) = 21.6, p < 0.001), length of encounter (χ2(4) = 34.5, p < 0.001), and clinical site (χ2(3) = 17.3, p = 0.001). Implementing clinician-rated outcome measures was affected by length of encounter (χ2(4) = 27.9, p < 0.001) and clinical site (χ2(3) = 8.6, p = 0.04). PCC behaviors were largely associated with student role and length of encounters; clinical site had less impact. Athletic training educators should emphasize progressive autonomous supervision with preceptors and encourage students to facilitate slightly longer patient visits, when possible, to incorporate more PCC behaviors.

Interprofessional Team Collaboration for Routine and Emergent Mental Health Concerns Among Collegiate Student-Athletes: A Case Series from the Association for Athletic Training Education Research Network.

Collegiate student-athletes experience an increasing number of mental health concerns. To help address these concerns and provide high-quality health care for student-athletes, institutions of higher education are being encouraged to create interprofessional health care teams that are specifically dedicated to managing mental health. We interviewed 3 interprofessional health care teams who collaborate to manage routine and emergency mental health conditions in collegiate student-athletes. Teams represented all 3 National Collegiate Athletics Association (NCAA) divisions and included athletic trainers, clinical psychologists, psychiatrists, dietitians and nutritionists, social workers, nurses, and physician assistants (associates). The interprofessional teams indicated that the existing NCAA recommendations helped to solidify members and roles of the mental health care team; however, they all believed their teams would benefit from more counselors and psychiatrists. Teams had different mechanisms for referral and accessing mental health resources on their campuses, which may make on-the-job training for new members of the team an organizational necessity.

Characteristics of Patient Encounters for Athletic Training Students During Clinical Education: A Report From the Association for Athletic Training Education Research Network.

CONTEXT: To enhance the quality of patient care, athletic training students (ATSs) should experience a wide variety of clinical practice settings, interact with diverse patient populations, and engage with patients who have a wide variety of conditions. It is unclear in what ways, if any, ATSs have diverse opportunities during clinical experiences. OBJECTIVE: To describe the characteristics of patient encounters (PEs) ATSs engaged in during clinical experiences. DESIGN: Multisite panel design. SETTING: Twelve professional athletic training programs (5 bachelor's, 7 master's). PATIENTS OR OTHER PARTICIPANTS: A total of 363 ATSs from the athletic training programs that used E*Value software to document PEs during clinical experiences. MAIN OUTCOME MEASURE(S): During each PE, ATSs were asked to log the clinical site at which the PE occurred (college or university, secondary school, clinic, or other), the procedures performed during the PE (eg, knee evaluation, lower leg flexibility or range of motion, cryotherapy), and the patient's diagnosis, with the International Classification of Diseases, Tenth Revision code (eg, S83.512A knee sprain, anterior cruciate ligament). RESULTS: A total of 30 630 PEs were entered by 338 ATSs across 278 unique clinical settings. More than 80% of PEs occurred in college or university and secondary school settings. More than half of the diagnoses were categorized as affecting the lower body region. Examination and evaluation procedures and application of therapeutic modality procedures each contributed approximately 27% of procedures. CONCLUSIONS: It was surprising that ATSs were not gaining experience in all clinical practice settings in which athletic trainers commonly practice. Our data suggest that students may be consigned to working with patients who have more frequently occurring injuries, which may not prepare them for the realities of autonomous clinical practice. These findings indicate that directed efforts are needed to ensure that ATSs are provided opportunities to engage with diverse patient populations who have a variety of conditions in an array of clinical site types during their clinical experiences.

Core Competency-Related Professional Behaviors During Patient Encounters: A Report From the Association for Athletic Training Education Research Network.

CONTEXT: To enhance the quality of patient care, it is important that athletic trainers integrate the components of the core competencies (CCs; evidence-based practice [EBP], patient-centered care [PCC], health information technology [HIT], interprofessional education and collaborative practice [IPECP], quality improvement [QI], professionalism) as a part of routine clinical practice. In what ways, if any, athletic training students (ATSs) are currently integrating CCs into patient encounters (PEs) during clinical experiences is unclear. OBJECTIVE: To describe which professional behaviors associated with the CCs were implemented by ATSs during PEs that occurred during clinical experiences. DESIGN: Multisite panel design. SETTING: A total of 12 professional athletic training programs (5 bachelor's, 7 master's level). PATIENTS OR OTHER PARTICIPANTS: A total of 363 ATSs from the athletic training programs that used E*Value software to document PEs during clinical experiences participated. MAIN OUTCOME MEASURE(S): During each PE, ATSs were asked to report whether professional behaviors reflecting 5 of the CCs occurred (the professionalism CC was excluded). Summary statistics, including means ± SDs, counts, and percentages were tabulated for the professional behaviors of each CC. RESULTS: Data from 30 630 PEs were collected during the study period. Professional behaviors related to EBP were the most frequently incorporated during PEs (74.3%, n = 22 773), followed by QI (72.3%, n = 22 147), PCC (56.6%, n = 17 326), HIT (35.4%, n = 10 857), and IPECP (18.4%, n = 5627). CONCLUSIONS: It is unsurprising that EBP and PCC behaviors were 2 of the most frequently incorporated CCs during PEs due to the emphasis on these competencies during the past several years. However, it is surprising that ATSs did not incorporate behaviors related to either HIT (in 65% of PEs) or IPECP (in 82% of PEs). These findings suggest that directed efforts are needed to ensure that ATSs are provided opportunities to incorporate professional behaviors related to the CCs during clinical experiences.

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

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

Energy Balance, Eating Disorder Risk, and Pathogenic Behaviors Among Athletic Trainers.

CONTEXT: Research exists on energy balances (EBs) and eating disorder (ED) risks in physically active populations and occupations by settings, but the EB and ED risk in athletic trainers (ATs) have not been investigated. OBJECTIVE: To assess ATs' energy needs, including the macronutrient profile, and examine ED risk and pathogenic behavioral differences between sexes (men, women) and job statuses (part time or full time) and among settings (college or university, high school, nontraditional). DESIGN: Cross-sectional study. SETTING: Free-living in job settings. PATIENTS OR OTHER PARTICIPANTS: Athletic trainers (n = 46; male part-time graduate assistant ATs = 12, male full-time ATs = 11, female part-time graduate assistant ATs = 11, female full-time ATs = 12) in the southeastern United States. MAIN OUTCOME MEASURE(S): Anthropometric measures (sex, age, height, weight, body composition), demographic characteristics (job status [full- or part-time AT], job setting [college/university, high school, nontraditional], years of AT experience, exercise background, alcohol use), resting metabolic rate, energy intake (EI), total daily energy expenditure (TDEE), exercise energy expenditure, EB, macronutrients (carbohydrates, protein, fats), the Eating Disorder Inventory-3, and the Eating Disorder Inventory-3 Symptom Checklist. RESULTS: The majority of participants (84.8%, n = 39) had an ED risk, with 26.1% (n = 12) engaging in at least 1 pathogenic behavior, 50% (n = 23) in 2 pathogenic behaviors, and 10.8% (n = 5) in >2 pathogenic behaviors. Also, 82.6% of ATs (n = 38) presented in negative EB (EI < TDEE). Differences were found in resting metabolic rate for sex and job status (F1,45 = 16.48, P = .001), EI (F1,45 = 12.01, P = .001), TDEE (F1,45 = 40.36, P < .001), and exercise energy expenditure (F1,38 = 5.353, P = .026). No differences were present in EB for sex and job status (F1,45 = 1.751, P = .193); χ2 analysis revealed no significant relationship between ATs' sex and EB ({\rm{\chi }}_{1,46}^2= 0.0, P = 1.00) and job status and EB ({\rm{\chi }}_{1,46}^2 = 2.42, P = .120). No significant relationship existed between Daily Reference Intakes recommendations for all macronutrients and sex or job status. CONCLUSIONS: These athletic trainers experienced negative EB, similar to other professionals in high-demand occupations. Regardless of sex or job status, ATs had a high ED risk and participated in unhealthy pathogenic behaviors. The physical and mental concerns associated with these findings indicate a need for interventions targeted at ATs' health behaviors.

Athletic training students' engagement in interprofessional education in the classroom and during clinical education.

Interprofessional education is an area of emphasis within healthcare. Little is known regarding what other healthcare professions athletic training students engage with during interprofessional education. Therefore, our purpose was to identify the healthcare students that athletic training students engage with in the classroom/laboratory and during clinical education. We used a cross-sectional survey design with open-ended questions to survey 90 athletic training program directors. Data were analyzed using descriptive statistics and an analysis of variance to determine differences between demographic characteristics and engagement with other healthcare students in the classroom/laboratory and during clinical education. The alpha level was set at .05. Overall, athletic training students regularly engaged with students from other healthcare professions in the classroom/laboratory and during clinical education, with physical therapy and nursing being most common. Unfortunately, more than 30% of respondents indicated no engagement with other healthcare professions during clinical education or in the classroom. It was concluded that athletic training faculty need to capitalize on opportunities to expose athletic training students to other healthcare students, as well as utilizing teaching and evaluation strategies that foster interprofessional education and practice. Similarly, students need to capitalized on opportunities to engage in interprofessional practice.

Providing Transgender Patient Care: Athletic Trainers' Compassion and Lack of Preparedness.

CONTEXT: Previous researchers have indicated that athletic trainers (ATs) had a favorable view of treating transgender patients, yet the ATs did not perceive themselves as competent in their patient care knowledge or abilities. OBJECTIVE: To gain more in-depth information about ATs' knowledge and experiences regarding the health care needs of transgender student-athletes. DESIGN: Mixed-methods study. SETTING: Individual, semistructured follow-up interviews. PATIENTS OR OTHER PARTICIPANTS: Fifteen ATs (4 men, 10 women, 1 transgender female; age = 34 ± 9 years, experience = 11 ± 8 years) who took part in a cross-sectional survey in April 2018. MAIN OUTCOME MEASURE(S): The interviews were audio recorded and transcribed verbatim. Member checking was completed to ensure trustworthiness of the data. Next, the data were analyzed via a multiphase process and 3-member coding team who followed the consensual qualitative research tradition. The coding team analyzed the transcripts for domains and categories. The final consensus codebook and coded transcripts were audited by a member of the research team for credibility. RESULTS: Four main domains were identified: (1) perceived deficiencies, (2) misconceptions, (3) concerns, and (4) creating safety. Participants described knowledge deficiencies in themselves, health care providers within their units, and providers able to provide safe transition care. The ATs demonstrated misconceptions when defining transgender and transitioning and when describing how the body responds to hormone replacement therapy. They expressed concern for the mental health and wellness, self-image, and potential cost of transgender health care for transgender student-athletes. However, participants also described efforts to create safety within their units by validating transgender patients, instilling trust, adjusting the physical environment, and engaging in professional development to improve their knowledge. CONCLUSIONS: Athletic trainers wanted to create a safe space for transgender student-athletes but lacked the necessary knowledge to treat transgender patients. Professional resources to improve their knowledge, skills, and abilities in caring for transgender patients are a continuing need.

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

CONTEXT: Mentoring has been identified as an important method to support newly credentialed athletic trainers during their transition to practice. Gaining a better understanding of this relationship could provide valuable insights that may assist employers and professional programs to develop a plan, which could better facilitate the transition. OBJECTIVE: To examine what aspects of the mentoring relationship provided the most benefit during transition to practice. DESIGN: Grounded theory. SETTING: Individual phone interviews. PATIENTS OR OTHER PARTICIPANTS: 13 athletic trainers who graduated from a professional master's program, were certified between February and July of 2016, and obtained employment between July to August 11 of 2016 participated in this study (6 female, 7 male, 26±3 years; work settings included professional sports, college, secondary and middle school, and clinic). Data saturation guided the number of participants. DATA COLLECTION AND ANALYSIS: Phone interviews using a semi-structured interview guide were conducted at 3, 8 and twelve months of work experience. Data were analyzed using a constant comparative approach. Credibility was established through investigator triangulation, peer debriefing, and member checks. RESULTS: Participants recognized the mentoring relationship as a foundational aspect of the transition to practice. Mentors should be available by phone, email, and/or text and to answer questions, provide feedback and/or discuss ideas. Participants want honest feedback, even when that feedback is constructively critical. Feedback was sought regarding topics such as patient care, communication, and networking. Participants needed reassurance and support from their mentor which helped to validate and improve confidence. CONCLUSIONS: Newly credentialed athletic trainers should seek a mentor who will be available to communicate in various ways and provide regular and constructive feedback. Future research should investigate how mentoring relationships influence other aspects of the transition such as patient care, overall job performance, turnover, and satisfaction.

Preparedness, Confidence, and Best Practices in Preventing, Recognizing, Managing Mental Health Cases in NCAA Institutions.

CONTEXT: Currently, the National Collegiate Athletic Association (NCAA) recommends written policies and procedures that outline steps to support student athletes facing a mental health challenge and the referral processes for emergency and non-emergency mental health situations. OBJECTIVE: To assess the mental health policies and procedures implemented and athletic trainers' perceived confidence in preventing, recognizing and managing routine and crisis mental health cases across all three divisions of NCAA athletics. DESIGN: Cross-sectional survey design and chart review. SETTING: Online survey Participants: Athletic trainers with clinical responsibility at NCAA member institutions (n=1091, 21.5% response rate). MAIN OUTCOME MEASURE(S): Confidence in screening, preventative patient education, recognizing and referring routine and emergency mental health conditions (5-point Likert scale: 1= not at all confident, 2= hardly confident, 3= somewhat confident, 4= fairly confident, 5=very confident) using a content-validated survey (Cronbach's α=0.904) and mental health policy and procedure chart review. RESULTS: Respondents indicated they felt "fairly confident" with screening (40.21%, n=76/189) for risk of any mental health condition and "fairly confident" in implementing preventative patient education (42.11%, n=80/190). Respondents were "fairly confident" they could recognize (48.95%, n=93/190) and refer (45.79%, n=87/190) routine mental health conditions. Respondents were "fairly confident" they could recognize (46.84%, n=89/190), but "very confident" (46.32%, n=88/190) they could refer mental health emergencies. Policies lacked separate procedures for specific emergency mental health situations such as suicidal/homicidal ideation (36.1%), sexual assault (33.3%), substance abuse (19.4%), and confusional state (13.9%). Policies lacked prevention measures such as student athlete involvement (16.7%) in annual mental health education (16.7%). CONCLUSIONS: While athletic trainers were generally confident in their ability to address emergency and routine mental health conditions, opportunities exist to improve policies for prevention, screening, and referral. Best practice guidelines should be used as a guide to develop policies that foster an environment of mental health wellness.

Athletic Trainers' Competence, Education, and Perceptions Regarding Transgender Student-Athlete Patient Care.

CONTEXT: Transgender student-athletes are increasingly participating in sport, requiring athletic trainer (AT) preparedness to care for their needs. OBJECTIVE: To measure ATs' (1) perceived definition of transgender, (2) comfort and competence working with transgender student-athletes, (3) sources of education, (4) perceived legal concerns, and (5) perception of competitive advantage. DESIGN: Cross-sectional study. SETTING: Mixed-methods survey. PATIENTS OR OTHER PARTICIPANTS: Collegiate or university ATs (n = 5537) received an email invitation to participate; the data of 667 ATs were included in the analysis. MAIN OUTCOME MEASURE(S): A multipart 43-item questionnaire addressing the primary objectives of the study, with other factors that were explored in relation to these objectives to uncover potential influences on their responses. We calculated descriptive statistics, and for open-ended responses, we used the consensual qualitative research tradition. RESULTS: About half (48.1%, n = 321) of the participants agreed they were competent in treating transgender patients, but only 36.0% (n = 240) believed they were competent in practicing collaboratively with an endocrinologist in the drug-screening processes. Fewer than half (45.6%, n = 304) of participants felt they were competent in using appropriate terminology relating to transgender patients. The ATs disagreed when asked if they were competent regarding counseling transgender patients about the effects of hormone replacement therapy on sport participation (48.1%, n = 321) or on mental health concerns (40.3%, n = 269). Participants learned most frequently from media outlets (35.2%, n = 235) or personal experiences with family, friends, or themselves (33.7%, n = 225), yet 35.1% (n = 243) received no education in caring for transgender patients. Many ATs (41.2%, n = 278) believed that transgender female student-athletes had a competitive advantage. In contrast, 6.6% (n = 44) of participants indicated that transgender male student-athletes had a competitive advantage. CONCLUSIONS: Although collegiate ATs generally felt competent in treating transgender patients, they did not feel capable of addressing specific aspects of transgender patients' health care needs. Regardless of the resulting perceived unfair advantage, ATs must be aware of the regulations and therapeutic effects associated with hormone-related therapy for transgender student-athletes.

Newly Credentialed Athletic Trainers' Perceptions of Their Transition to Practice.

CONTEXT: Newly credentialed athletic trainers (ATs) have reported stress and role ambiguity during the transition to practice. Previous researchers focused on their qualitative experiences, yet no investigators have explored how characteristics such as the setting or type of educational program affect the transition to practice. OBJECTIVE: To determine how newly credentialed ATs perceived their transition to practice. DESIGN: Cross-sectional study. SETTING: Online survey. PATIENTS OR OTHER PARTICIPANTS: Of 1835 newly credentialed ATs (18%) certified and employed between January and September, 332 completed the survey within 3 months of employment (129 men, 203 women; age = 23.58 ± 2.54 years). MAIN OUTCOME MEASURE(S): The survey consisted of demographic information (eg, employment setting, job title) and 3 sections: (1) comfort level during the transition (CL), (2) feelings of mentorship and support (MS), and (3) feelings of organizational transition. Participants identified their feelings of nervousness, support, and understanding organizational values using a Likert scale (1 = strongly disagree, 4 = strongly agree). Descriptive statistics were calculated for each survey item. Mann-Whitney U and Kruskal-Wallis (H) tests were used to determine associations between different demographic characteristics and responses regarding orientation and CL, MS, and feelings of organizational transition. RESULTS: Most participants agreed or strongly agreed that they felt nervous (n = 264, 79.2%) and that the transition was stressful (n = 227, 68.1%) but they felt prepared for their job (n = 262, 78.7%). No differences in CL were present among settings (H = 5.64, P = .228), job titles (H = 4.88, P = .087), or types of professional program (U = 6488, P = .279). Respondents who were assigned a mentor reported better perceptions of MS (U = 6250, P < .001). Most participants felt that supervisors adequately explained administrative procedures during orientation (n = 169, 54.3%) and felt they were adequately oriented to organizational values (n = 252, 75.7%). CONCLUSIONS: New ATs felt nervous when entering their new role, but having a mentor and receiving a detailed orientation helped alleviate stress during the transition to practice.

Challenges for Newly Credentialed Athletic Trainers During Their Transition to Practice.

CONTEXT: Understanding the challenges faced by newly credentialed athletic trainers (ATs) as they transition into clinical practice could assist employers and professional programs in developing initiatives to enhance this transition. OBJECTIVE: To explore the challenges faced by newly credentialed ATs during their transition from student to autonomous practitioner. DESIGN: Qualitative study. SETTING: Individual phone interviews. PATIENTS OR OTHER PARTICIPANTS: A total of 34 ATs certified between January and September 2013 participated in this study (18 women, 16 men; age = 24 ± 2 years; work settings = college, secondary school, clinic, and other). Data saturation guided the number of participants. DATA COLLECTION AND ANALYSIS: An interview guide was used. All interviews were recorded and transcribed verbatim. Data were analyzed via phenomenologic reduction, with data coded for common themes and subthemes. Trustworthiness was established via intercoder reliability, member checks, and peer review. RESULTS: Initially, participants had difficulty making decisions independently. However, making decisions and receiving positive feedback helped them develop confidence. Communication with coaches and parents was challenging, especially for those in the secondary school setting. Participants also experienced role ambiguity, as they were unsure of basic organizational and administrative structures and expectations. Mentor inaccessibility was the final challenge described by respondents. In particular, those in the secondary school setting and with part-time employment felt they did not have a supervisor or mentor whom they could contact for support and guidance. CONCLUSIONS: Professional programs should educate students on potential challenges to help them understand what they might encounter during the transition to clinical practice. Employers should provide clear expectations and job descriptions to alleviate some of the stress and role ambiguity. If a mentor is not provided by the employer, the newly credentialed AT should seek one to assist during the transition.

The Prioritized Research Agenda for the Athletic Training Profession: A Report From the Strategic Alliance Research Agenda Task Force.

CONTEXT: Athletic trainers (ATs) must be equipped with evidence to inform their clinical practice. A systematic, inclusive, and continuous process for exploring research priorities is vital to the success of ATs and, more importantly, their patients' positive outcomes. OBJECTIVE: To identify research priorities and unify research with clinical practice to improve patient care and advance the profession. DESIGN: Mixed-methods study. SETTING: Focus groups and a Web-based survey. PATIENTS OR OTHER PARTICIPANTS: A total of 87 ATs (43 men [49.4%], 44 women [50.6%]; age = 40 ± 11 years; experience = 18 ± 11 years) participated in focus groups. Of the 49 332 e-mails sent, 580 were undeliverable, 5131 ATs started the survey (access rate = 10.5%), and 4514 agreed to participate (response rate = 9.3%). MAIN OUTCOME MEASURE(S): Our study consisted of 6 focus-group sessions, a content-expert review, and a Web-based survey. Themes from the focus groups were used to develop the research priorities and survey instrument. We used the 25-item validated survey to determine whether the research priorities and findings of the focus groups were generalizable. Endorsement of research priorities and recommendations was achieved when respondents indicated they agreed or strongly agreed. RESULTS: Respondents endorsed 5 research priorities: health care competency (n = 4438/4493, 98.8%), vitality of the profession (n = 4319/4455, 96.9%), health professions education (n = 3966/4419, 89.8%), health care economics (n = 4246/4425, 96.0%), and health information technology (n = 3893/4438, 87.7%). We also made the following recommendations: (1) develop funding initiatives that align with the agenda, (2) develop postdoctoral fellowships focused on clinical research, (3) facilitate collaborative relationships between clinicians and researchers, and (4) make research evidence more readily available and more applicable. CONCLUSIONS: Using a systematic and inclusive process, we developed a prioritized research agenda for the athletic training profession. The agenda was endorsed by the leaders of each Strategic Alliance organization and adopted as the Athletic Training Research Agenda.

Transition to Practice for Graduate Assistant Athletic Trainers Providing Medical Care in the Secondary School Setting.

CONTEXT: Transition to clinical practice can be challenging for newly credentialed athletic trainers (ATs), who are expected to immediately step into their roles as autonomous clinicians. For those providing care in the secondary school setting, this transition may be complicated by the fact that many practice in isolation from other health care providers. OBJECTIVE: To explore the transition to practice of newly credentialed graduate assistant ATs providing medical care in the secondary school. DESIGN: Phenomenologic qualitative study. SETTING: Secondary school. PATIENTS OR OTHER PARTICIPANTS: The 14 participants (2 men, 12 women; age = 23.3 ± 2.0 years) were employed in the secondary school setting through graduate assistantships, had been credentialed for less than 1 year, and had completed professional bachelor's degree programs. DATA COLLECTION AND ANALYSIS: We completed 14 semistructured phone interviews. Interviews were recorded and transcribed verbatim. A general inductive approach was used for data analysis. Trustworthiness was established through multiple-analyst triangulation, peer review, and member checks. RESULTS: A period of uncertainty referred to a time during which participants were anxious as they began practicing independently. Legitimation through role engagement signified that as the period of uncertainty passed, participants developed more confidence in themselves and legitimation by engaging in their role. Acclimation through physician communication and professional relationships highlighted the importance of developing a relationship with the team physician, which provided a source of feedback and support for continued growth and confidence. CONCLUSIONS: To prepare for this period of uncertainty, educators and preceptors should encourage students to interact with members of the health care team and communicate with parents and coaches. Employers should implement initiatives to orient newly credentialed ATs to their roles, provide clear job expectations, and assign or assist with identifying mentors. Newly credentialed ATs should seek support from many different individuals, including the team physician, who can provide support, feedback, and encouragement.

A Narrative Analysis: Examining the Transition to Practice for the Full-Time Secondary School Athletic Trainer.

CONTEXT: The transition to clinical practice is an important topic in athletic training because it is viewed as a stressful time that is accompanied by self-doubt. Mentorship and previous experience support the transition to practice, but little information is available on the organizational entry of the athletic trainer (AT) who is employed full time in the secondary school setting. OBJECTIVE: To understand the experiences of newly credentialed ATs in full-time positions in the secondary school setting. DESIGN: Qualitative study. SETTING: Secondary schools. PATIENTS OR OTHER PARTICIPANTS: Seventeen ATs (4 men, 13 women; age = 25 ± 4 years) were employed full time in the secondary school setting. On average, the full-time ATs worked 40 ± 10 hours per week. DATA COLLECTION AND ANALYSIS: All participants completed a semistructured telephone interview with 1 researcher. Data were analyzed using a narrative analysis, and credibility was established by peer review and researcher triangulation. The narrative research paradigm guided our protocol and supported the rigor of the study. RESULTS: Our analyses revealed that transition to practice was organic, such that the newly credentialed AT gained awareness by engaging in the role daily. Additionally, the transition process was facilitated by previous experience in the setting, mostly from educational training. Ongoing communication with various stakeholders (athletic directors, team physicians, and peer ATs) in the setting also assisted in the process of transitioning. Finally, mentorship from previous preceptors provided support during the transition process. CONCLUSIONS: Transitioning into full-time clinical practice in the secondary school setting was informal and supported by professional relationships and past experiences. Past experiences allowed for awareness but also the development of mentoring relationships that continued beyond the clinical education experience. Communication also assisted the newly credentialed AT, as it provided feedback for legitimation by multiple stakeholders.

Maintaining Professional Commitment as a Newly Credentialed Athletic Trainer in the Secondary School Setting.

CONTEXT: Professional commitment, or one's affinity and loyalty to a career, has become a topic of interest in athletic training. The expanding research on the topic, however, has omitted newly credentialed athletic trainers (ATs). For an impressionable group of practitioners, transitioning to clinical practice can be stressful. OBJECTIVE: To explore the professional commitment of newly credentialed ATs in the secondary school setting. SETTING: Secondary school. DESIGN: Qualitative study. PATIENTS OR OTHER PARTICIPANTS: A total of 31 newly credentialed ATs (6 men, 25 women; mean age = 24 ± 3 years) participated. Of these, 17 ATs (4 men, 13 women; mean age = 25 ± 4 years) were employed full time in the secondary school setting, and 14 ATs (2 men, 12 women; mean age = 23.0 ± 2.0 years) were graduate assistant students in the secondary school setting. DATA COLLECTION AND ANALYSIS: All participants completed semistructured interviews, which focused on their experiences in the secondary school setting and transitioning into the role and setting. Transcripts were analyzed using the phenomenologic approach. Creditability was established by peer review, member checks, and researcher triangulation. RESULTS: Four main findings related to the professional commitment of newly credentialed ATs in the secondary school setting were identified. Work-life balance, professional relationships formed with the student-athletes, enjoyment gained from working in the secondary school setting, and professional responsibility emerged as factors facilitating commitment. CONCLUSIONS: Affective commitment is a primary facilitator of professional commitment. Newly credentialed ATs who enjoy their jobs and have time to engage in nonwork roles are able to maintain a positive professional commitment. Our findings align with the previous literature and help strengthen our understanding that rejuvenation and passion are important to professional commitment.

Orientation Process for Newly Credentialed Athletic Trainers in the Transition to Practice.

CONTEXT: Orientation is an important part of socialization and transition to practice, yet the orientation process for newly credentialed athletic trainers (ATs) is unknown. OBJECTIVE: To determine how newly credentialed ATs are oriented to their roles. DESIGN: Cross-sectional study. SETTING: Online survey. PATIENTS OR OTHER PARTICIPANTS: Three hundred thirty-two of 1835 newly credentialed ATs (18%) certified and employed between January and September of 2013 completed the survey (129 men, 203 women; age = 23.58 ± 2.54 years). DATA COLLECTION AND ANALYSIS: The survey consisted of demographic information (eg, employment setting, job title) and 2 sections: (1) orientation tactics and (2) usefulness of orientation tactics. For the first section, participants identified if various orientation tactics were included in their orientations (eg, policies and procedures review). For the second section, participants identified how useful each orientation tactic was on a Likert scale (1 = not useful, 4 = very useful). Descriptive statistics were calculated for each survey item. Mann-Whitney U and Kruskal-Wallis tests were used to determine differences between demographic characteristics and orientation tactics. A Bonferroni correction accounted for multiple comparisons. A panel of experts established the content validity of the survey. The Cronbach α was used to establish internal consistency (α = 0.802) Results: The most common orientation tactics were meeting with supervisors (n = 276, 82.9%) and staff members (eg, coaches; n = 266, 79.9%) and learning responsibilities (n = 254, 76.2%). The least common orientation tactics were simulation of the emergency action plan (n = 66, 19.8%) and preceptor development (n = 71, 21.3%); however, preceptor development was not applicable to many participants. The most useful orientation tactics were simulating the emergency action plan (3.45/4.0) and meeting with staff members (3.44/4.0). Participants who felt their orientation prepared them for their roles were exposed to more tactics during orientation (Mann-Whitney U = 17 212, P < .001). CONCLUSIONS: Many tactics were used to orient newly credentialed ATs to their roles, but orientations varied based on the practice setting.