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Who Moved My Cheese?1 is a pop culture book that examines the process of change and how change (or the lack of change) affects people's lives and their goals. Each of us has inherent mechanisms that help us cope with change and overcome the fear associated with it. Change often represents moving out of a comfort zone into new territory. Change is good. Change is needed. Change can also be scary. Change is certainly the operative word in the preparation and certification of entry-level athletic trainers.
Just over 10 years ago, the National Athletic Trainers' Association, Inc (NATA) was essentially a closed shop. Our national organization set the standards, approved entry-level and graduate programs, established the requirements to sit for the certification examination, created the examination, and administered the examination.
From a practical standpoint, that method was easy to comprehend: NATA regulated everything. When it came to asking questions, getting answers, or pointing fingers, you knew where to go. Procedurally, however, this was not an appropriate method.
Under the old system, the NATA Board of Directors ultimately acted as the law, judge, and jury. Because of this, “NATA approval” of education programs and “NATA certification” were only recognized by one agency: NATA.
To their credit, the Board of Directors realized the need to divest these functions. For certification of athletic trainers and accreditation of entry-level education programs to be recognized and accepted, organizational changes were needed. The membership agency, the certifying agency, and the accrediting agency must be separate entities. This system forms a healthy, functional system of checks and balances.
Although these agencies have been separate from NATA for more than a decade, it appears that some people are now beginning to recognize that change has occurred. (How many times have you heard someone refer to an NATA-certified athletic trainer? The NATA has not granted certification since 1991.) For many, “Education Reform” has placed our educational process under the microscope and caused us to reevaluate a number of longstanding procedures. However, most of the changes and issues facing us are unrelated to the actual reform process.
We are now noticing the totality of the changes that have been occurring over the last decade and balancing them with the changes recommended by the NATA Education Task Force and approved by the Board of Directors in 1997. Our cheese is being moved.
The change from our hours-based approach to clinical education to an objective, practice-oriented approach is significant. Some programs have responded to this emphasis by creating massive checklists for student evaluation. While this approach is easy to conceptualize and construct, it is not easy to implement. This method creates undue demands on clinical instructors and faculty, suppresses the need for clinical decision making, and oversimplifies the concepts of learning, teaching, and reasoning.
Along with putting the “education” into clinical education, some members perceive that education reform has taken away from the students' ability to practice and work unsupervised. Nothing can be further from the truth. Since 1991, the NATA Board of Certification has required students to be supervised while functioning as athletic training students (ie, while garnering clinical hours).
The presence of a supervisor does not imply a lack of student autonomy and decision making. The two are not contradictory terms. Proper supervision can allow for independent decision making on the part of the student. Supervisor intervention is only required if the student is about to cause harm.
Concern has also been expressed about the “expanded scope” of the general medical competencies. In fact, all but 20 of the 91 specific general medical conditions listed were included in the 1992 edition of Athletic Training Educational Competencies2 (most are found on pages 23 and 24), including those that have become symbolic of the new standard. Other content was added that reflects our expanding places of employment and the increasing diversity in our patient population. Fear of expanding our base of knowledge and perhaps our scope beyond “just” orthopaedic conditions can be self-limiting. A review of the epidemiologic articles published in the Journal of Athletic Training indicates that 25% to 30% of the conditions seen by certified athletic trainers are nonorthopaedic.
No programs have yet been evaluated under the new standards and guidelines. Reports that programs have not received accreditation because they failed to meet the new competencies or clinical education guidelines or abide by any other change attributed to education reform are not true. The first site visitations using the new Joint Review Committee on Educational Programs in Athletic Training standards3 will be conducted shortly after this editorial is published. After that, we can begin to analyze what is—and what is not—working.
Accreditation is not an automatic process. No one can say in good conscience that every program should receive accreditation. Part of education reform is raising the bar. When the bar is raised, there is no guarantee that every program will make it over.
The education-reform process has been the most open in the history of this profession. Starting with the Education Task Force in 1994, the NATA, the NATA Board of Certification, and the Joint Review Committee on Educational Programs in Athletic Training have sought member input. Three drafts of the revised competencies and clinical proficiencies were opened for member feedback, as were the clinical education guidelines. More than 30 informational articles have appeared in our professional publications. Yes, our cheese has been moved, but we were told that it was moving and where it was going.
Fear of change can cause unforeseen reactions and can bring out the best—or worst—in people. I am proud of the manner in which most of our members have responded to the call to improve our educational process. I can only hope that the sound of many whispers of support can drown out the few screams of dissent.
Change can be scary. But the cheese is still there.
Chad Starkey, PhD, ATC, is an Associate Professor of Athletic Training at Northeastern University, Boston, MA, and the Chair of the NATA Education Council Executive Committee.