Reviewing Reform

With NATA educational reforms now firmly in place, their day-to-day effects are raising some questions. For example, are today’s students being overly supervised?

By David Hill

David Hill is an Assistant Editor at Training & Conditioning. He can be reached at dhill@MomentumMedia.com

Training & Conditioning, 15.4, May/June 2005, http://www.momentummedia.com/articles/tc/tc1504/reform.htm

When a series of reforms in athletic training education took full effect in January 2004, some questions were left unanswered. Were the new criteria the best way to educate and certify aspiring athletic trainers? What effects would the changes have on the day-to-day care of athletes? Eighteen months later, many athletic trainers are still struggling with these questions.

As Supervisor of Athletic Training, Program Director, and Clinical Coordinator at Ithaca College, Kent Scriber, EdD, ATC, PT, sees plenty of positive outcomes from the educational reforms. For example, athletic training students are no longer seen simply as a cheap pool of labor. There is also more consistency in the knowledge and experience gained by students before they are allowed to sit for the certification test.

On the other hand, Scriber has seen sports teams that would have had an athletic training student with them in the past sent on road trips without any athletic training support at all. He’s also seen some of his athletic training students apply for jobs without ever having had to make an independent decision.

While some people initially viewed the educational reforms as a revolution in athletic training, today they’re seen as more of an evolution. In this article, we’ll take a look at where the evolution is heading.

What’s Changed
Although the educational reforms consisted of 18 specific measures, there were two big ones for athletic training education programs. No longer could an internship program alone qualify an applicant to take the national Board of Certification (BOC) exam. A bachelor’s degree from an accredited educational program had to accompany clinical experience. In addition, work with sports teams could not count as clinical-experience hours unless the students were directly supervised by a certified athletic trainer acting as a clinical instructor.

As a result, supervision of students has become more formal and intense. “We’re doing a much better job with supervision of students, meaning they report to a clinical instructor,” says Herb Amato, DA, ATC, Director of Athletic Training at James Madison University. “We have one or two students with a certified athletic trainer, and those students are constantly being educated. They’re not working 50 hours a week, with 40 of them unsupervised. They’re working 23 or 24 hours a week, all supervised.”

That, in turn, has improved both the substance of and respect given to athletic training education. “What we have done as a profession means that certification credentials are a little more valuable for everyone,” Amato says. “The reforms have also made universities treat athletic training similar to the other allied health programs. Now we have pretty much the same number of full-time faculty as the school’s physician assistant program because we have about the same number of students.”

The supervision requirement helped ensure that the emphasis was on education instead of meeting the manpower needs of intercollegiate athletic programs. “It’s not education’s job to make sure athletics are covered,” Amato says. “If an athletic department can’t cover teams adequately with their medical staff, then it needs to either reduce the number of sports or find some other way to do it.”

Most schools have been able to adapt. For example, at the University of New Hampshire, the athletic department had already planned to add sports medicine staff.

“Previously, we had a certified athletic trainer on campus whenever a practice was going on, but it wasn’t unusual for that practice to be covered by a student,” says Dan Sedory, MS, LAT, ATC, Program Director and Associate Clinical Professor in Athletic Training at UNH and Chair of the NATA Entry-level Education Committee. “The certified athletic trainer would be in the athletic training room in case he or she was needed. When the new requirements came out, it meant that the certified athletic trainer had to be at the practice or in very close proximity, so that they could be there to supervise and intervene, if necessary.

“As these changes worked their way through the pipeline, I talked to the head athletic trainer, who communicated these things with his boss, the athletic director, so that we all knew ahead of time that these changes were taking place,” continues Sedory. “We knew it was going to require the athletic training staff and education program to change how they do business.”

Communicating with both academics and athletics was a key strategy for Mark Bohling, MS, LAT, ATC, Director of Athletic Training and Assistant Professor of Kinesiology at Texas A&M University-Corpus Christi. Bohling was starting athletic training from scratch, both as an academic program and a service for TAMU-CC’s newly launched intercollegiate athletics department as it went from a two-year to a four-year school. By creating an academic program at TAMU-CC, Bohling was able to tap into a synergy between athletics and academics.

“With the individual workouts and activities that the NCAA allows, we were having teams practice or work out without someone supervising the student-athletes,” Bohling says. “So we approached the athletic department to get more staff to cover that. At the same time, we told the academic side that we needed more clinical instructors to supervise the students because without supervision they weren’t really receiving clinical instruction time—they were just acting as first responders, and in that case were really not getting any educational benefit.” Bohling now has three full-time assistants and a graduate assistant.

Reduced Coverage
In the past, the Ithaca College athletic training program typically assigned students to particular sports teams. In some cases, the students traveled with the team and served as its de facto day-to-day athletic trainer. But since the educational changes went into effect, Scriber has had to revamp that system. As an NCAA Division III institution, the athletic department couldn’t simply hire more staff, and the academic program wasn’t willing to hire more professors.

“Now some of our teams don’t have anyone covering them,” Scriber says, “because we don’t have enough certified athletic trainers to travel with every team, plus teach and do everything else.”

Scriber wonders if more colleges should consider hiring students to travel with teams as first responders. “I don’t think students should replace an athletic trainer, yet there are certain aspects of athletic training that someone with some minimal skills can carry out fairly successfully without much risk,” Scriber continues. “I’m talking about pre-event taping and stretching and those kinds of things. And then if there is an injury, they can at least assess it at least from a first-aid standpoint and then initiate an emergency action plan.”

It’s crucial, however, to write a thorough job description specifying what such people can and can’t do, and that everyone involved, including the coaches, understands the limits and agree to them, says Scriber. That also goes for athletic training students who are under direct supervision as part of their education.

“I’ve met numerous times over the last few years with our athletic staff, explaining what’s going on with education reform, what a student can and can’t do, and what we expect them to do,” he says. “Return-to-play decisions, rehabilitations, and treatments are some of the things they absolutely are not allowed to do.”

Sometimes, athletic training students are sent on road trips with teams if the host institution can provide a certified athletic trainer to supervise. “But then you get into the whole issue of why somebody else from a different institution is supervising my student,” says Scriber. “Is that a responsibility I have a right to throw onto them?”

Scriber wonders if today’s athletic training students are getting the same clinical experience as their predecessors, who sometimes went unsupervised. He points to an example involving a recent Ithaca graduate who, during a job interview, was asked how much time he had spent working independently while he was in school. That was hard to answer, because any clinical experience the student received credit for was required to be under the direct supervision of an instructor. If he was helping an Ithaca team informally, his decision making didn’t carry much real, practical weight—even though the student had been studying in an accredited athletic training education program.

“These people are going to graduate never having made a health care decision on their own, never having to think about it, because there’s always a certified athletic trainer looking over their shoulder,” says Scriber. “How are they going to be able to make difficult decisions at their first job? I think it’s an interesting dilemma we’ve gotten ourselves in from an educational standpoint.”

A Matter of Degrees
Now, candidates to become certified athletic trainers need a college degree, which has sparked a new question: Should that be a bachelor’s or master’s degree? This is one of the questions being explored by the NATA Educational Degree Task Force. The panel plans to discuss its work at the NATA convention in June and give a full report in time for the NATA Board of Directors’ consideration in December.

But in March, the task force gave a preliminary report on its findings so far. Among them: The bachelor’s degree should remain the entry point into the profession and accredited programs should offer degrees specifically with the term “athletic training” in them by the 2014-15 academic year. As for the issue of bachelor’s versus master’s, curriculum directors who’ve worked through the first reform have views on it, pro and con.

Bohling says the push toward requiring a master’s degree is partly fueled by similar requirements in other allied health fields, such as physical therapy. “But I think we need to worry about our own profession instead of trying to mirror what other professions have done,” Bohling says. “History shows the Board of Certification exam is a good tool to make athletic training students prove what they know and that they’re competent. I think the bachelor’s degree requirement has done that just fine.”

The name change would suffice for some people. “If someone was in an athletic training program, their degree should reflect that,” Sedory says. “As long as the words ‘athletic training’ are in the degree somewhere, I think that presents to the public that this person is graduating with a degree in athletic training. I don’t think it has to be very precise—it could be a ‘bachelor’s degree in athletic training,’ or maybe a ‘bachelor of science in kinesiology/athletic training’—but I think those words should be in there somewhere.”

As for requiring a master’s, Sedory isn’t convinced. “To me, if you’re going to use the master’s as a minimum degree for certification, you’re really saying that the undergraduate program isn’t preparing people for the workplace—there are extra skills and knowledge that you need to succeed in the workplace, and you can only achieve that through two extra years of school. That would be the reason to go with the master’s as the minimum.”

Logistically, requiring a master’s could wreak havoc for many curriculum programs. For one thing, many universities require graduate level courses be taught only by instructors with graduate degrees. This could end the certified graduate assistant instructor as a viable position, since few graduate assistants have a graduate degree.

“Even though there are more athletic trainers getting their doctorate, I don’t think there are enough of them out there to meet what the programs require,” says Bohling. “I know our institution would have a tough time.”

It would also be hard for many institutions to start a new graduate program, particularly schools like James Madison that focus on undergraduate education, says Amato, whose program offers only a bachelor’s degree in athletic training. “We’re doing a good job as an undergraduate program,” he says. “Our students work hard. It’s a lot of information to give them in a two-and-a-half or three-year program, because they still have to meet their general education requirements. But at James Madison, our strength is in undergraduate education, so we’re not going to change just to change.”

A New Master’s
An emerging educational form in athletic training is the entry-level master’s degree. Donald Fuller, PhD, ATC, Athletic Training Program Director at the University of Findlay, says there are 14 such programs in the nation, compared to about 350 undergraduate athletic training programs. One of the most recent of these master’s programs began two years ago at Findlay. With 26 athletic training education programs in Ohio, more than any state, Findlay saw the entry-level master’s degree as a way of setting its athletic training academic offerings apart, Fuller says.

The program is aimed primarily at people who decide to pursue an athletic training career late in their undergraduate years or after earning a bachelor’s degree in something else. Another popular option is a three-plus-two plan, in which students pursue a bachelor’s degree at Findlay—most in the program opt for strength and conditioning, Fuller says—then begin taking athletic training courses during their senior year. They emerge after five years with a bachelor’s in their chosen discipline and a master’s in athletic training.

One attraction for many young people is that by delaying the heavy athletic training-specific course load and clinical experience demands, the program can be less hectic than many schools’ undergraduate athletic training tracks. “They can do what they want in their first three years,” says Fuller. “They can actually be college students. Imagine that: Being able to participate in sports, study, hang out, get a part-time job, be active in student activities—things you can’t do as an undergraduate athletic training student because of the course load and clinical experience requirements.”

Unlike an advanced master’s with a specialization or research or teaching focus, the entry-level master’s program is designed to impart the skills necessary to sit for the BOC exam. That may take some getting used to within the profession and for employers, Fuller admits, because the name of the degree won’t indicate there’s a difference between it and an advanced master’s degree.

But the broader approach has some unique advantages, including a path to dual credentials, such as teaching and athletic training. “Teachers in Ohio will soon need a master’s degree,” Fuller says. “It’s very difficult for undergraduate athletic training programs to have a combined teaching and athletic training major because there are just so many requirements now for athletic training. With the entry-level master’s, you can have someone with an undergraduate degree in teaching do our master’s program in two years and have two credentials.”

Whatever new models for athletic training education emerge, whether credentials become harder to acquire, whether graduate degrees become required, one thing is certain: The evolution will continue along with the field itself. Scriber notes that as athletic training moves toward more standardized training, many medical schools are revamping their approaches to training the next generation of doctors, moving away from an emphasis on rigid protocols in favor of teaching more critical thinking and decision-making.

“It’s an ongoing professional growth issue for athletic training,” Scriber says. “It’s not going to be solved in a year or two. It’s going to be a long-term process.”


Sidebar:
Another Model
What are athletic departments without accredited curriculum programs doing to provide coverage for athletic teams? Northwestern University is one school that fits the category, and it has implemented two programs to ease the athletic training department’s load.

First, it has started an athletic training internship program for certified postgraduates. The internship allows recent certified graduates to gain valuable additional clinical experience while helping extend the full-time sports medicine staff.

Northwestern picks four interns for the 10- or 12-month posts, assigning each to a sport team they travel with. Because they are certified, they can be given much more independence than they had while earning their undergraduate clinical experience. “While they are supervised generally by a certified athletic trainer who is a full-time staff member, they act autonomously without that direct supervision,” says Tory Lindley, MA, LAT, ATC, Head Athletic Trainer at Northwestern.

The majority then go on to become graduate assistants in athletic training at another university, although some start the program with a master’s degree in hand and are seeking more or different kinds of experience before going on the job market. “Some want to get more experience at either the Division I level or network in the Midwest,” Lindley says. “We also have students who come out of their graduate assistantship and would like to spend a year in Chicago and to be around this environment. It bridges the gap between their GA experience and becoming a full-time staff member.”

Lindley says he’d want to continue the internships even if the athletic department suddenly were able to greatly expand the full-time, permanent staff, because it’s a way to contribute to the profession. “As we’ve moved through the appropriate educational reform, this type of program provides exactly the kind of athletic trainers that employers are looking for,” he says. “It nicely fits a need for the entry-level students coming out of their CAAHEP-approved programs to get additional experience with providing health care, working through decisions about participation and constant communicating with supervisors.”

Northwestern also operates a sports medicine aides program. Not unlike aides programs at high schools, undergraduates do a lot of the legwork of athletic training in return for a chance to observe sports medicine as a potential career and learn some basic skills. They set up practice-site supplies and equipment, help keep athletes hydrated, help with pre-practice taping sessions, and provide first-aid response, then observe during injury evaluations. Most are in undergraduate pre-medical or physician assistant curriculums, but some also go on to pursue an entry-level master’s degree in athletic training at another university.