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Objective: To provide an overview of the limited amount of peer-reviewed literature on athletic training education that has been published in athletic training journals. Publications that related specifically to the development of evaluation tools or specific addenda to the required athletic training curriculum were not included.
Background: As education reform continues to unfold in athletic training, it is important for all certified athletic trainers to understand the research that undergirds the educational practices in athletic training. Many of the profession's educational practices have been taken from standards and methods developed by the discipline of education, with very little validation for applicability to the discipline of athletic training. A very limited number of comprehensive scientific investigations of the educational standards and practices in athletic training education have been carried out; however, for more research to be conducted, it is essential that the currently available research be reviewed.
Description: The summaries of athletic training educational research in this article include the topics of learning styles, facilitation of learning and professional development, instructional methods, clinical instruction and supervision, predictors of success on the National Athletic Trainers' Association Board of Certification certification examination, program administration, and continuing education. The amount of research in athletic training education is limited when compared with the amount and quality of educational research available in other professions, such as medicine, nursing, dentistry, physical therapy, and occupational therapy. In this article, I attempt to describe the existing literature and identify what is needed to expand the breadth and depth of research in athletic training education.
Clinical Advantages: This article is intended to help educators identify areas within athletic training education that require further validation and to provide both educators and clinicians with insight into the current validated educational practices that may be appropriate to incorporate into educational settings or practice.
Many of today's professional-education practices have been adapted from standards and practices investigated generally in education, with very little investigation into or validation for applicability to the discipline of athletic training. Although research in athletic training education has evolved and proliferated during the past 15 years, the breadth and depth of that research still is very limited. Several of the studies found in this body of literature have used very limited samples from just a few institutions interested in collecting data on specific topics. The topics of the research range from learning styles and teaching methods to passing the National Athletic Trainers' Association Board of Certification (NATABOC) certification examination and continuing education.
As education reform in athletic training continues to unfold, it is important for all certified athletic trainers to understand the research that undergirds the educational practices in athletic training and to continue the investigation of educational theory as it relates to athletic training education. My intent is to provide an overview of the peer-reviewed literature in athletic training education that has been published in athletic training journals. Publications that related specifically to the development of evaluation tools or specific addenda to the required athletic training curriculum were not included but may be located in 2 national databases: Health and Psychosocial Instruments (HaPI)1 and the Mental Measurements Yearbook2 electronic databases.
Learning is the goal of all educational programs, and understanding how athletic training students learn is essential. Athletic training students have been identified in one study as independent learners who learn best from experience and self-involvement.3 Appropriate supervision allows students to have a sense of autonomy, as students become more accomplished when they have a sense of working or learning alone. Although these students valued others' opinions, their own opinions were most important to them. They also required a variety of stimuli to learn and were able to learn best kinesthetically when they touched and manipulated the learning materials.3 These students preferred written examinations to oral examinations, with most of their study time devoted to reading. Draper3 recommended that, based upon these findings, athletic training instruction should incorporate more “hands-on” activities that promote active participation. He also proposed assigning reports, take-home assignments, and research projects to maximize the students' ability to learn independently. Lastly, to enhance the students' overall successes, he recommended that the students improve their overall reading comprehension, because most of their study time was spent reading.3
Athletic training students' learning styles have been identified using the Kolb Learning Style Inventory4 as primarily assimilators and convergers.5–7 Assimilators grasp the larger concept and are able to assimilate diverse data into an integrated whole. They are less likely to focus on the practical application of ideas and are more interested in the soundness of the ideas or theories themselves.4 Convergers are good at problem solving and learn best through active experimentation. When these learners are presented with new learning opportunities, they move quickly to find the one correct answer.4 All of the works in this area support the concept that some athletic training students also portrayed accommodating learning styles,5–7 but the extent to which that attribute was portrayed varied among studies. Accommodators enjoy hands-on and new or challenging experiences. These learners tend to act on “gut” feeling rather than logical analysis; they like to concentrate on doing tasks and having new experiences.4
Coker5 observed that learning styles shifted based on the learning setting. The assimilator learning style was most commonly displayed when students were in the classroom setting, with only 15% of their learning coming from their use of the convergent style. In the clinical setting, the convergent (42%) and accommodating (31%) styles were demonstrated in similar amounts.5 Brower et al6 noted that learning styles should be assessed when students enter an athletic training educational program (ATEP) to not only make students and faculty more aware of how students learn but also to sensitize students to potential weaknesses they may have for learning in a particular genre.6
Other researchers have identified both internal and external factors that may influence student learning. Harrelson et al8 observed that undergraduate athletic training students learned best in well-lit learning environments. These students also demonstrated a preference for learning in the afternoon, and the authors expressed concern that this preference may affect clinical education, which occurs primarily in the afternoons.8 Stilger et al9 identified both academic and financial concerns as producing the greatest amount of stress in athletic training students, and those stresses affected learning. Stress levels fluctuated throughout the year, with midterm and final examinations marking the most stressful times.9
Researchers in this area of athletic training education identified learning styles and some of the general needs of athletic training students based only on one learning style inventory. They also suggested further investigation into the development and assessment of instructional methods that could enhance student learning. Future research in this area also could include more investigations of this learning style or learning styles based on other paradigms. For those interested in pursuing this investigative tract, several scientific investigations of learning styles in nursing have been published and may serve as models for future studies of learning styles in athletic training.
Learning and professional development in athletic training students can be facilitated in many ways. Students making the transition to entry-level professional must develop more advanced learning skills that incorporate critical thinking. Critical thinking integrates a hierarchy of learning behaviors into more abstract and complex learning.10 When using critical thinking, students are required to recall and comprehend knowledge, then apply that knowledge to specific and concrete situations. Once students understand those applications, they are asked to analyze how situations can be compared and contrasted with other situations, recognizing relationships and organizational principles. The last step in developing critical thinking is to synthesize the learning to other learning. This method of learning requires students to skillfully apply the knowledge and experiences they have acquired in making discriminating judgments and evaluations.10
By increasing the expectations for critical thinking, students were able to analyze and synthesize situations and to evaluate criteria to improve the quality of skills.10 Fuller10 found that athletic training educators attempted to foster more critical thinking, as demonstrated through the development of learning objectives that stressed critical thinking; however, only 14% of all examination questions required students to use critical thinking. Educators also attempted to promote critical-thinking skills through written course assignments, such as research papers and case studies, with the expectations for critical-thinking skills increasing as students progress through their education.10
Portfolio development is one example of the promotion of critical thinking through written works. Portfolios include a collection of materials representing documented evidence of the scope and progress of the students' learning.11 As part of portfolio development, students are asked to convert documents into evidence of their learning, articulating the precise thinking about how the documents assisted in learning. They are encouraged to compare recent and earlier documented evidence placed in the portfolio, bridging the gap between theory and practice.11
Because critical-thinking skills are the essence of professional practice, this area of educational research is critical to the continued development of athletic training professionals. Future research could include analysis of the effectiveness of current practices and the development and assessment of new methods to improve critical thinking in athletic training students. Many of the other health care professions already have performed these types of investigations, including nursing and occupational therapy. These studies may provide a foundation for similar validation processes in athletic training education.
During the 1990s, a number of investigations focused on the use of technology to develop learning.12–18 Many athletic training educators were found to be interested in incorporating computer-based instruction into their academic programs,12 and many programs already used computer-based instruction at the undergraduate level as an adjunct to other forms of instruction.12,13 Two unique types of computer-based instruction were examined: computer-assisted instruction, which generally consisted of only text materials, and an interactive athletic training educational curriculum (IATEC) computer program, which incorporated multimedia technology.14 The IATEC yielded learning effects14–18; however, these effects were not sufficient to validate using the IATEC alone without other instructional methods.14 The application of learning on an oral practical examination was similar between traditional and IATEC methods.14,17 The application of learning to written examinations was less for the IATEC method as compared with the traditional lecture method of instruction, but IATEC did demonstrate a learning effect on the written examination.14
Investigators in this area noted the great need for further research in this area, including the identification of factors that influence the effectiveness of computer-based instruction and the identification of content areas in which computer-based instruction could be most effective. Fincher and Wright12 noted that it may be important to identify the type of students who could benefit most by the use of computer instruction. Other research recommendations included further validating the previous studies by incorporating a broader sample of students, incorporating full teaching units as opposed to single lessons, and determining the ability of students to retain learning gained through IATEC.14 Similar peer-reviewed works in the professions of dentistry,19 medicine,20 and nursing21 may assist athletic training educators in identifying other areas within computer-based instruction for investigation.
Clinical instruction is one of the foundations of athletic training education, and the role of the clinical instructor (CI) in that education is vital. One study22 found that CIs spent approximately 21 hours per week participating in clinical education, and that amount of time was expected to increase with the evolution of educational reform. The CIs solicited enjoyed teaching and valued the opportunity to be involved with the process. They cited a sense of responsibility as their motivation for clinical teaching.22 Clinical instructors with more than 6 years of experience found more time for clinical teaching than did those with less experience, and those with teaching certifications felt more confident in their academic preparation for the role than did nonteachers. Experienced teachers also developed more diverse clinical-instruction activities than did those with no teacher preparation; however, the most common clinical-instruction methods used by all CIs included athletic trainer-dominated methods such as lecture, telling, and presenting styles.22
Effective clinical instruction was also linked to the qualities of the CI. Good CIs modeled the positive characteristics they expected from their students. They were involved with their students, demonstrated good communication skills and a positive attitude, and served as mentors. They were clear and organized when working with students, provided good feedback, and emphasized problem solving in their demonstration of clinical skills. Good CIs consistently worked to improve their own knowledge and skills.23 The antithesis of a good CI was one who demonstrated negative characteristics. Negative CI characteristics included treating students with disrespect, providing negative feedback, and being unavailable to students.24
Regardless of the quality of clinical instruction, students are supervised by CIs during clinical-education experiences. Andersen et al25 found that students believed they were adequately supervised during clinical education, and they were satisfied with the quality of the supervision they received.25 The students and their CIs held the same perceptions of the quality of clinical supervision based upon 6 categories of supervisory skills: providing information and technical support, fulfilling supervisory responsibilities, facilitating interpersonal communication, fostering student autonomy, promoting competence in athletic training domains, and providing a professional role model.25 An important product of this work was the development and validation of the Athletic Training Supervisory Skills Inventory (ATTSI),25 which could be used by educational programs to evaluate the quality of supervision provided by CIs.
The quality of clinical education and supervision often is influenced by the quality of the clinical-education setting. Weidner and Laurent26 identified 12 characteristics of an acceptable clinical-education setting, which include criteria for the environment and the attributes of the CI (Table (Table1).1). Future research suggestions in this area of CI effectiveness and supervision include comparing CI criteria with student success (competence),23 identifying helpful teaching behaviors and methods for the teaching and evaluation of clinical skills, and identifying how students learn clinical skills. It was suggested that research include analysis of the effects of the environment, administration, and other personal factors on clinical instruction and student learning.26 Examples of peer-reviewed publications on clinical instruction and CI effectiveness in the professions of nursing,27 physical therapy,28 and allied health education29 may provide other models for future research in athletic training.
Determining the students' success rate on the NATABOC certification examination is one method to assess the overall learning achieved in an academic program. Students graduating from ATEP programs had a higher first-time passing rate on the examination than did non-ATEP program graduates.30,31 These students also outscored internship students on each performance domain of the written examination30,32 and oral practical section of the examination.32 Harrelson et al33 observed that no single criterion was predictive of overall success on the examination. They, like others, found that overall grade point average (GPA) was most predictive of passing all 3 sections of the examination,32,33 and students with higher GPAs scored better on the written section of the examination.3,30 A combination of overall GPA, athletic training GPA, academic minor GPA, American College Testing (ACT) composite scores, and the number of semesters enrolled in the university predicted success on the NATABOC certification examination.33
Other researchers found that certain criteria, once perceived as affecting the quality of learning and, thus, the passing rate on the examination, did not affect the outcomes. Little relationship was found between learning styles3 or the acquisition of clinical-experience hours in excess of 2000 and passing the national examination.3,31 Other perceptions that students who participated in more high-risk sport clinical assignments or had specific sport experiences (such as football) were more likely to pass the NATABOC certification examination were unfounded, as was the effect of past athletic training experiences.31 However, those individuals with past allied health experience were more likely to pass the written portion of the examination than those without past experience. Older students were more likely to pass the practical portion of the examination than younger students.31 Findings from these studies were used to validate the recent revision in the NATABOC requirements from an hour-based model to a competency-based model.
Current research on the ability to predict outcomes on the NATABOC certification examination has been comprehensive, but future research into the effect of the new academic requirements on student examination success will be necessary for the continued growth of the profession. Other outcomes, such as employer satisfaction and correlation of learning to future job requirements, also could be important.
The task of administering an ATEP is complicated and varies greatly from program to program; however, some commonalities have been identified in the athletic training literature. One common consideration is the selection of students into academic programs in athletic training. Generally, this process involves either a direct admission to the program upon entering as a freshman or a competitive second admissions process. Both processes are designed to predict a student's potential success based upon specified criteria. Admission criteria must be objective and verifiable as required by the current Commission on Accreditation of Allied Health Education Programs (CAAHEP) standards (section IC1).34 Most criteria involve an evaluation of GPA or some other type of standardized tests.
For those students admitted directly into the athletic training program as freshmen, Platt et al35 found that high school GPA was most predictive of college or program GPA. Scores on the Scholastic Aptitude Test (SAT) did not predict student academic success in athletic training programs.35 Keskula et al36 reported similar findings in graduate athletic training admissions. Undergraduate GPA was predictive of graduate GPA, accounting for 34% of the variance in scores. Standardized tests (eg, Graduate Record Examinations) were not predictive.36 Future research in this area could include an analysis of program admissions requirements and the ability of those criteria to predict student academic and clinical success.
The selection of students into an academic program often falls to the program director. This administrative portion of the program director's responsibilities has become much more important in the last 13 years.37,38 In 1987, research/publishing and teaching were found to be the most important responsibilities of undergraduate program directors, with graduate program directors ranking research/publication as the most important responsibility.38 However, in 2001, teaching and administration were recognized as the most important responsibilities of undergraduate program directors, and scholarship was ranked least important.37 It must be noted, however, that the level of importance of responsibilities delineated in these 2 studies continued to be the antithesis of the promotion and tenure guidelines37,38 that require most faculty to excel in both teaching and scholarship. Starkey and Ingersoll39 identified the amount of scholarly productivity as consistent with academic rank and not necessarily affected by educational degree. Program directors included more doctoral-trained faculty with more years of experience as certified athletic trainers and more years working as a program director.37 They had fewer clinical and clinical-instruction responsibilities than in past years and carried more academic responsibilities.37 These new responsibilities made program directors more eligible for elevation in academic rank and, subsequently, more accountable to academic tenure and promotion standards. The future research in this area could include an analysis of the success of program directors in achieving promotion and tenure and the effect of these standards on the evolving group of the certified athletic trainers who are assuming more full-time academic appointments other than as program directors.
Continuing education is one way for those professionals involved in athletic training education to stay current and continually improve their clinical skills. Several factors were identified as contributing to this need for continuing education. These factors, identified by Cuppett40 (Table (Table2),2), address the needs of every certified athletic trainer involved in an ATEP. The continuing-education topics most identified and of interest to certified athletic trainers included organization and administration, rehabilitation, and counseling and guidance.41,42 Other, less traditional topics included time management, legal issues, promotion and marketing, and the provision of care and management of the business associated with the “nontraditional” athlete. Surveys of certified athletic trainers revealed that most desired more breadth and depth in continuing-education presentations.41 These findings have been the basis for several changes in the structure and composition of the national symposia program.
It was suggested that more alternative avenues for continuing education be considered to address the certified athletic trainer's adult learning needs. These alternatives included such topics as workplace self-directed learning.43 Other adult learning needs included identifying the learning needs, then involving the learners in the setting of learning goals and objectives. It was also suggested that the developed programs implement particular learning strategies that were specifically based upon the goals and objectives established by the group.43 These activities also included more small-group discussions and hands-on opportunities.41 Cuppett40 recently identified 5 areas, one for each domain of practice, that certified athletic trainers most wanted covered in a continuing education program (Table (Table33).
The purpose of this article is to provide certified athletic trainers with an overview of the research in athletic training education that has been published in athletic training journals. It is not intended to be a critical review of all literature in these topic areas. As education reform continues to unfold in athletic training, it is important for all certified athletic trainers to be knowledgeable about the available research, to understand the need to conduct more comprehensive research on these educational standards and practices with broader samples of subjects, and to publish the results in refereed journals. Young investigators should be encouraged to publish the results of master's theses and doctoral dissertations to further strengthen the science that undergirds the practices of athletic training education. Experienced investigators should be encouraged to begin to examine the new educational standards and criteria to determine the validity of using those standards to educate future athletic training professionals. The future of athletic training education depends upon the future of research in athletic training education.