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In the process of evaluating the current status of clinical supervision in athletic training education programs (ATEPs), I have been most impressed by the extraordinary progress in the expanded scope of the profession and the recognition of athletic training as an allied health profession. Although great strides have been made in ATEPs during the past 30 years, a significant challenge to achieve a true clinical-education model for our discipline exists. Because our profession was developed through the apprenticeship/internship structure, the primary focus has been on attaining practical skills to provide service for athletes. Although the contributions of mentoring and professional socialization cannot be negated, the information imparted to the students was unsystematic.
As ATEPs continue to mature, a greater emphasis on didactic preparation along with a clinical-education model will be required to ensure consistency in the academic preparation of entry-level National Athletic Trainers' Association Board of Certification (NATABOC)-certified athletic trainers. The competencies and proficiencies adopted by the National Athletic Trainers' Association (NATA) Education Committee have standardized the structure across the profession. Athletic training education is now faced with the challenge of adopting a strong clinical-education model that will focus on the learning experiences of athletic training students. The following are issues that need to be addressed to successfully integrate the clinical-education component with the curricular standards and students' needs.
Experience has demonstrated that not everyone who is an NATABOC-certified athletic trainer (ATC) should be a clinical supervisor, yet this knowledge is seldom applied when students are assigned for their clinical experiences. Students are frequently assigned to particular clinical supervisors based on the sport or clinical activity for which they have responsibility. Under such a system, ATCs who are uninterested in working with athletic training students or have little understanding of individual learning styles, evaluation techniques, or enhancing critical thinking may consistently be assigned numerous students. Unfortunately, in these situations, the clinical experience of the student frequently comprises predominantly low-level repetitive tasks and limited interaction with the clinical educator.
Because more athletic trainers are graduating from college without degrees in education, it cannot be assumed that they have benefited from courses in learning principles, educational methods, or evaluation. This void needs to be addressed because it is the responsibility of the clinical supervisors to serve as instructors and mentors. Instead of assigning more students to a clinical-education site, we should assign fewer students and then only to competent and educationally committed ATCs or other qualified allied health personnel.
Graduate assistants (GAs) serving as clinical supervisors need to be carefully selected and monitored for their commitment to athletic training education and maturity to work with undergraduate athletic training students. Most GAs are trying to earn the respect of the staff for future recommendations that will launch their careers while they complete their graduate-degree requirements. Because the turnover rate for GAs is intentionally high, attempts to enhance clinical-education instructional skills become fragmented. Although some graduate students are ready to commit themselves to athletic training education, the clinical-education needs of the athletic training students are not near the top of most GAs' crowded lists of priorities. Unfortunately, administrators continue to assign less expensive graduate assistantships instead of exploring options for hiring more qualified clinical-education faculty.
Athletic training education badly needs quality integration across the didactic and clinical components of the curriculum. The academic unit often fails to appreciate that understaffing problems on campus or at affiliated settings will not be solved by the assignment of undergraduate students to clinical experiences at the understaffed site. When appropriately implemented, clinical education demands more time than it saves the clinical supervisor.
Whenever possible, the ATEP should be located in the college with other allied health professions having similar accreditation requirements and clinical-education components. In addition, it is important that academic majors in athletic training receive programmatic status equivalent to other academic majors, including comparable compensation and released time for clinical education. Although organizational factors may appear to be only peripherally related to the topic of clinical education, having administrators who are familiar with clinical education and responsible for units with similar needs and funding formulas facilitates obtaining much-needed resources and positions for the clinical-instruction component. For the ATEPs not currently located in units with other allied health professions, the need to educate administrators will be crucial to obtaining funding for personnel to offer quality clinical-education experiences.
To enhance clinical education, strategies need to be implemented to establish clinical faculty positions. Clinical hours that are tied to academic credit should be comparable with the formulas used to determine student credit and clinical faculty workloads for other allied health programs. Clinical supervisors who meet ATEP standards should be compensated with a stipend or released time and provided with clinical faculty status. These awards should be on a limited-term, renewable contractual basis to assure accountability to the academic unit.
The primary concern in clinical education is the professional development of the athletic training student. If institutions are to meet the challenge of understanding and implementing competency-based and proficiency-based education, the emphasis must be on the quality of the learning experience and individual instruction. The strength of the current structure is that the Role Delineation Study of the NATABOC,1 the NATA Educational Competencies,2 and the NATABOC certification examination have resulted in clearly defined expectations for entry-level athletic training professionals. The students know what is expected of them and must take ownership for their learning experiences.
Another issue that needs to be addressed is direct supervision. Upper-class athletic training students have frequently been placed in unsupervised environments that allow for little communication with their clinical supervisors at a time when they can benefit most from meaningful interaction for integrating theory and practice. The content requirements of the NATA Educational Competencies are extensive, and every opportunity to reinforce learning and application will assist the student in gaining greater mastery of the material. Being relegated to the role of first responder because the upper-class athletic training student is unsupervised is a sad commentary on clinical education.
A concern that encompasses athletic training in general and clinical education specifically is the attrition rate of prospective athletic training students. Considerable effort is exerted to recruit highly qualified individuals through a competitive admission process. Unfortunately, we often lose the students we thought had the potential to be most successful in the profession because they frequently become disillusioned by repeating mundane duties that fail to challenge them intellectually and require a significant time expenditure.
The athletic training student must apply the knowledge and skills learned in the didactic and laboratory sessions in a clinical environment. Learning experiences need to be assigned according to each student's academic and clinical progress. Students require experiences beyond the intercollegiate settings; exposure to various professional work settings should be mandatory and not merely recommended because athletic team coverage is no longer a major source of employment for ATCs.
Program directors should take the time to listen to the students and have them evaluate their learning experiences. The students can provide valuable feedback on the effectiveness of their clinical supervisors and the quality of the instruction being received. Communication with the students relative to taking ownership of their professional preparation is more easily defined with the recent educational reforms. Students need an advocate when caught in uncomfortable situations with their clinical supervisors. It is important to obtain all perspectives but pay attention to the valuable insights the students can provide.
Successful, high-quality athletic training clinical education rests squarely on the shoulders of professional personnel working with the students in a clinical environment. The clinical supervisor must be aware of the content being taught each week to which the clinical-education component is linked. Strong clinical education requires careful planning for each individual and time for interaction to develop and integrate skills for optimal professional development. Rather than more students, fewer students assigned to clinical supervisors would enhance the learning process and provide a more enjoyable experience for all parties.
The clinical-education plan is in place. The challenge before us is to embrace clinical education as a crucial element to support the didactic portion of the athletic training students' professional development. Change can be difficult. We are being asked to adapt to a system that is quite different from the way we were prepared for our careers in athletic training. Students have always been valued by athletic training as critical links to the future of the profession. By implementing quality clinical-education programs to meet the current demands of the discipline, the future of athletic training will be assured.
Editor's Note: Karen R. Toburen, EdD, ATC, served as a department head and program director and member of the Joint Review Committee on Athletic Training and the NATA Professional Education Committee. She chairs the NATA Convention Committee and currently works as an athletic training education consultant.