In the last few months, as a member of GLATA and now a member of the NATA, I have been approached or asked to participate in surveys used to evaluate my perceptions about a transition to an entry-level masters professional degree in athletic training.  Although I believe in discourse and discussion on the issue, I do neither endorse nor encourage surveys that are intended to provide “evidence” when they are steeped in poor methodology.  I am a quantitative, survey researcher and frankly I am offended that people think they can slap some questions into surveymonkey or qualtrics and call it research… in any journal, this kind of research would be rejected for failed/invalid instrumentation.  The same would be true if I measured temperature using an oral thermometer in a heat illness study!

You can find the link to the survey here:

So let’s begin… how does this particular survey fail in methodology…

1.  Bias is a systematic error that can prejudice the findings in some way 
     a. In the introduction letter the authors suggest that “The questions included in this survey have been put together to address some issues that the white paper either ignored or did not address.”
          i.       How does this influence the reader? Does this suggest that the NATA and those that served on this committee did not appropriately represent you?  How would that make you feel? Angry? Disoriented? Unappreciated? Might this impact the findings?

2.  Sampling bias occurs when a sample does not accurately reflect true representation within the target population
     a. Also in the introduction, the authors tell us how they hope to distribute this survey… “We are distributing this survey to some members via email. But we are going to rely mainly on the power of the social media- Facebook, Twitter, professional blogs, etc., so please send the site of this survey or to as many of your athletic training colleagues or professional friends as possible including educators, clinical staff, and even undergraduate, graduate and doctoral students over e-mail and social media outlets.”
           i.      Does this seem systematic to you? What kind of respondents will you get if you focus solely on social media? Will you access some of the older, more seasoned athletic trainers in the profession? Will you only entice the youth… those of whom are 50% likely to leave the profession in the next 5 years? And how will that impact the findings?

3.  Forced responses within a survey violate your rights as a respondent… you should have the right to choose which items you respond to or not. This falls under the protection for persons under federal guidelines and the Belmont Report of 1979.

4.  The orientation of responses in this survey lists strongly agree from left to right suggesting that upon downloading the data a strongly agree response will be indicative of a “1” and a strongly disagree will be indicative of a “5”.  Did the authors mean to provide the results backwards? That will certainly make data analysis difficult!

5.  The orientation of the responses are also listed horizontally; however, methodologists in survey research, particularly Dillman and colleagues have identified that vertical responses are likely to yield the most accurate results.  Apparently how we read things MATTERS!

6.  Double barreling items occurs when a respondent is asked to evaluate two concepts within the same item.
     a. “Advancing the entry-level degree for professional practice from the current Bachelors degree to a Masters degree will be more likely to improve patient outcomes and ensure longevity of the profession of athletic training.”
          i.      Here the authors ask that you rate your level of agreement (well actually, they don’t give you any directions at all, but they assume you will rate your level of agreement) with two concepts: 1) that an entry-level masters will improve patient care and 2) that it will ensure longevity in the profession.  Are those two things the same? Or different? Can you have opposing views on each? Should you be able to?

7.  Items that ask about factual things like the presence of evidence cannot be perceived… they are factual.
     a. “There is clear evidence in the athletic training research journals that suggests improved patient outcomes are likely to result from transitioning to a Masters degree as our entry-level professional degree.”
          i.      Is this true or is this untrue? Furthermore… the use of the word “clear” to describe the evidence also incites confusion in the reader… is it clear to me? Or is it clear to you?

Need I go on? I understand people want their voices to be heard!  But don’t do it by using my responses to a poor survey to manipulate my perceptions.  This is a poorly constructed method of quantitative survey research… if you want to ask the question… ask the question… do you agree or disagree with the NATA Whitepaper finding… I AGREE and I will continue to support the progress of the profession and my national organization because I have faith in their due diligence.  I believe in the NATA, the BOC, and the CAATE in that they have the best interest of the profession as the driving force…

Lindsey E. Eberman PhD, LAT, ATC

All the Athletic Trainers for the Boston Marathon and similar venues are volunteers.  What have you done recently to volunteer?  Your medical knowledge is a great way to give back to the community.  There are numerous opportunities available for you.  During the summer, each state hosts their own Special Olympics Summer Games.  These athletes need athletic trainers too.

Below is the link to the main Special Olympics page.  Within you can find your state contact them about the needed medical help. http://www.specialolympics.org/

As we know, many youth sports leagues are not yet covered by athletic trainers.  Coordinating care for an event may be the start to these events always being covered by a staff position.  Local YMCA youth leagues also could always use coverage!  In addition, the NATA can use help with the upcoming convention in Indianapolis! See the link below for more information. http://convention.nata.org/get-involved/​

With the summer coming up find a 5k, marathon or triathlon to volunteer for!  Let's get athletic trainers out into the community these next few months.

Elizabeth Neil, LAT, ATC

In light of the recent 1 year anniversary of the bombings during the Boston Marathon, ESPN released a well written article featuring athletic trainers.  So often we as Athletic Trainers are quick to criticize media for not using the correct terminology or “guessing” on what injury may occur.  “Athletic Trainers Just Did Their Job” was published the past Monday and has been shared across numerous social media sources.  Please use the link below to read the article. 

http://espn.go.com/boston/story/_/id/10818360/2014-boston-marathon-athletic-trainers-just-did-their-jobs?src=mobile

Behind the scenes of almost all sporting events is a team of medical personnel including athletic trainers.  When tragedy struck, these once barely noticed people became heroes for the nation but I believe that ESPN stated it well; they were all just “doing their job”.

Outside The Lines, a featured presentation broadcasted on ESPN first aired the following video in October 2013. The following is the story of Devin Wang, a Boston University athletic training student and her experience in the 2013 marathon. 

http://espn.go.com/espn/feature/story/_/id/9868852/portrait-rescue


Beth Neil, LAT, ATC

So today is the last day where you could write letters to support for #AB1890, which would bring Athletic Training licensure to California. For more information on the Assembly Bill, click here. 

Every year, the California Physical Therapy Association would lobby against this bill, as portrayed in their official twitter account. Their main arguments presented in the tweets recently are that "it create a scope of practice that is too broad for ATs" and that "it would allow ATs to practice beyond their education and training. Not safe for consumers."
Whether you are parents, administrators, coaches, athletic trainers, athletic training students, other healthcare providers, or everyday healthcare consumer, I ask for a favor... Please write a letter to your state official to support this AB 1890. The letter is pre-written and would take you 5 minutes or less of your time. http://cqrcengage.com/cata/home . So let us show our support to our brothers and sisters in California. The success of this AB1890 passing through would bring about not only victory to athletic trainers, but also coaches, parents and most importantly, the health and safety of our athletes and kids.


Denny Wongosari, LAT, ATC

Recent college graduates that pass the board of certification (BOC) exam are determined to have met the requirements necessary to practice as entry-level athletic trainers. Despite demonstrating competency to practice independently as credentialed professionals, many young professionals and recent college graduates have the desire to gain advanced knowledge within the field of athletic training and to develop their clinical skills before heading out into the world with full autonomy. As a result many young professionals will seek further education in athletic training within the first 2-3 years after becoming certified.

Currently there are 16 active post-professional athletic training education programs that are accredited by the commission on accreditation of athletic training education (CAATE). CAATE accredited post-professional programs are designed to prepare athletic trainers for advanced clinical practice, research and scholarship, in order to enhance the quality of patient care, optimize patient outcomes, and improve patients’ health-related quality of life. The CAATE states that: “The mission of a Post-Professional Athletic Training Graduate Degree Program is to expand the depth and breadth of the applied, experiential, and propositional knowledge and skills of athletic trainers, expand the athletic training body of knowledge, and to disseminate new knowledge in the discipline. Post-professional graduate education in athletic training is characterized by advanced systematic study and experience—advanced in knowledge, understanding, scholarly competence, inquiry, and discovery.”

Post-professional programs in athletic training are now a popular choice for further education amongst newly certified athletic trainers. However, with the potential move to professional masters degrees in athletic training in the pipeline post-professional masters degrees may no longer continue to exist. Instead the transition to athletic training residency programs and athletic training doctoral degrees is being considered. Post-professional residency programs in athletic training provide advanced preparation of athletic training practitioners through a planned program of clinical and didactic education in specialized content areas using an evidence-based approach to enhance the quality of patient care, optimize patient outcomes, and improve patients’ health-related quality of life.

As a student currently enrolled in a CAATE accredited post-professional program, I believe that my program is meeting the purpose defined by the CAATE and is allowing me to achieve my goals of gaining further clinical and experiential knowledge whilst also being exposed to research opportunities, adding to the current body of knowledge and advancing my scholarly competence.

What is your position regarding post-professional programs?

Are they more beneficial to entry level athletic trainers than degrees in other specializations? such as…exercise physiology, kinesiology, sport psychology, sport administration, etc.?

If our profession is to make the move to professional masters degrees, would you consider additional schooling and consider an athletic training residency or doctoral program? 


Stephen Edwards LAT, ATC

There is much debate regarding the future of Athletic Training education. We have already discussed the way Athletic Training is currently housed in educational institutions and the way Undergraduate ATs can be negatively perceived by other health care programs. Under the current system, ATs are not being perceived as highly educated individuals by other students preparing to enter the healthcare workforce. We have also identified a maturity issue, in which students graduating from baccalaureate programs have not adequately developed emotional intelligence needed to provide high quality patient care.

Two main resolutions are possible if an entry-level masters system is adopted. 1) Increased respect from health care providers, insurance companies, and patients. 2) More prepared and qualified Athletic Trainers.

A professional degree at the masters level has the potential to develop stronger curriculum with more time to focus on core classes. Instead of cutting classes or attempting to combine two classes into one, programs can adapt to an integrated model to help students better blend all the domains of the profession.

In some of the arguments for/against a professional degree at the masters level, individuals have cited that 70% of Athletic Trainers get a Masters degree, yet there are currently only 16 accredited Post-Professional ATEP programs… so let’s ask ourselves… what are they studying? Clinical experience only? If individuals are earning Master degrees in fields not directly focused on Athletic Training, clinicians are not further enhancing AT knowledge, critical thinking, or evidence-based medicine.

I understand the argument that there is no current evidence stating that this new system will work; however, I believe it is a step forward. We are already falling behind other healthcare professions. Our goal is not to simply change our requirements from Bachelors to a Masters; we are working to reform the entire educational system! Furthermore, I believe most individuals with still strive to further their education, particularly as more opportunities for clinically-based, Doctorate of Athletic Training (DAT) programs emerge (stay tuned for that discussion tomorrow).

In many of the arguments against the development of professional degrees at the masters level, individuals cite the need for more clinical experience and development as students are “working” as graduate assistants.  In my opinion this is a double-edged sword of sorts.  Is the real issue, a loss of workforce, or is it that students develop and enhance skills while pursuing a masters degree… couldn’t one argue this means we aren’t adequately preparing our students at the baccalaureate level and therefore we NEED the advanced clinical practice?  Couldn’t one argue that this is because our baccalaureate level students have competing demands and different goals… which could be solved by more focused experiences in a more controlled environment at the masters level?

Michael Neal, LAT, ATC

In continuation with our education series, one of the biggest concerns that many educators face today is asking whether or not their students are ready. With the current expansion of work settings and a diversification of our patient population, we are giving more all-around standards for athletic trainers. From the Professional Education in Athletic Training White Paper, finding #2 states, “Transition to graduate professional education facilitates continued evolution in the professional competency requirements to better reflect the clinical practice requirements of current and future ATs in a changing healthcare environment.”

Presently, topics such as special populations, pharmacology, mental health, third-party reimbursements and professional growth are gaining wide exposure all over the country and yet we do not cover them adequately; most of these emerging expected skills and issues are touched briefly in class sessions, but not explored comprehensively. This is a barrier to the evolving healthcare policies that embrace interprofessional standards for healthcare disciplines. Practicing evidence based medicine, interprofessional education, and information technology are just some of these prime examples of expected core standards, not well done in all of our programs. These standards are important part of our current Athletic Training Education Competencies. This brings me into thinking that, what if we are not adequately preparing our undergraduates?

With my current master thesis in relation to transition-to-practice, I have discovered that the literature equates and references Emotional intelligence (EI) as an important factor in medicine and other healthcare disciplines.  It is suggested that professional mental health is as important as effective practice.  According to a study on EI, good EI includes the ability to understand and control emotions, to be empathetic, to be socially competent. In this study, 33.6% of first year medical students were poor in all six domains of EI. Besides EI, there is evidence that non-technical skills of young emerging adults from age 18-23 are underdeveloped.  For example, a consortium reports conducted by four government organizations interviewed over 400 employers across the United States, and in their findings, employers rank professionalism (93.8%), teamwork (94.4%) and oral communication skills (95.5%) as the top three most important workforce skills for collegiate graduates, and yet around 43% believe that 4-year college graduates qualify as “satisfactory” in these three categories.

As an athletic trainer who graduated from a traditional 4-year undergraduate program, I understand how rewarding it was to go through school in 4 years. However, I do feel that there are certain aspects of non-technical skills I needed to brush upon once I was at my first job. I was blessed to be able to work as a Resident Assistant in my undergraduate study and would perceive myself as adequately prepared for the workforce. But I will admit that when I was working at a small div II institution in Colorado, I never thought I would be so challenged with mental health and social issues of athletes… all on top of managing my new administrative duties. My point is this: There are times when entry-level undergraduate athletic trainers will be put in situations that they have never been challenged before and consequently, it may affect the quality of care. I am not saying all baccalaureate prepared athletic trainers an inadequate, but I am saying that perhaps we are starting to expect much more from our profession and that a graduate level program may be a better route for preparing our students for the workforce.


Denny Wongosari, LAT, ATC

With the current clamoring of ATs regarding the “Professional Education in Athletic Training” whitepaper, we thought it best to engage you all in a healthy discussion.  While some will choose to stand by their position, we simply encourage everyone to become informed. Today’s topic, within the scope of transiting our degree to a masters level, we will be discussing the impact on curriculum.

Finding #5 of the whitepaper states that the “Transition to professional education at the graduate level would increase the likelihood that education programs are better aligned with other health care professional programs.”  In 1996, 17 years ago the NATA Board of Directors called upon us in education to align our programs with schools of health professions.  To date, that has not occurred given that only 21% of programs are housed within colleges/schools with other peer health professions programs.  As a member of a department with athletic training, physical therapy, physician assistant studies, and occupational therapy, I can tell you… my job as a Program Director is eased by the commonalities between programs. I do not face the same administrative misunderstanding that my colleagues often experience. Our programs are financially and administratively supported because of the similarities we share with other health professions.

Finding #6 of the whitepapers states that “Professional education at the graduate level should facilitate interprofessional education.”  For the 33% of programs housed in separate units and the 16% that are the only Athletic Training programs at their respective institutions, interprofessional education (IPE) is not only difficult, it can sometimes be impossible.  Moreover, programs, like ours at Indiana State, face different, less tangible challenges with IPE. We face circumstances where IPE with undergraduate students is scoffed at… because obviously it is “beneath” graduate students (from other disciplines) to spend time learning from with and about Athletic Training students learning at an undergraduate level.  Other disciplines sometimes fail to see the difference between professional and post-professional degrees… and while my graduate students are practicing clinicians and have already shaped their professional identity… the other disciplines would prefer work with them, simply because they are earning the “same” degree.

Finding #8 of the whitepaper states that “Professional education should not complete with general education, liberal arts, and foundational science requirements because it detracts from the effectiveness of the professional educational experience.” This, in my opinion, is the greatest challenge faced by our current educational model.  While a general education curricula is crucial to establishing contributing citizens, the competing demands of shaping a young person to contribute in the world and the development of a fine-tuned clinician is often at odds.  Add to this the competing demands of the millennial student and their needs to have life-work balance (NOT A CRITICISM from me!) and often jobs to support the growing cost of higher education.  Our undergraduate students are expected to do more, to be more than their classmates in other majors.  And the consequences are found in the quality of their clinical experience and the expectations, we as educators, can hold within our classrooms.

From this singular, only curricular perspective, a transition to a professional degree at the masters level has the potential to improve the quality of education and ability to interact with other disciplines with ease.  Furthermore, it will allow undergraduate to focus on the things that will make them strong contributors and effective graduate students.  And who knows… with a little creative curricular artistry, programs could be delivered in a 3+2=5 model to quicken the time to degree and potentially decrease cost, all without compromising the quality of the clinician.

Lindsey E. Eberman PhD, ATC  

This week, our blog has raised awareness about tolerance and open-mindedness. Collectively, we agree that equal opportunity is important, both as practitioners and colleagues. 

The evidence tells us hiring bias still exists.  When we know that regardless of gender, managers are twice as likely to hire a man (read more)… When we know that unqualified individuals are measuring our worth as health care providers based on wins and losses (read more)… we are losing!  As long as the individual is qualified for the position; their gender, ethnicity, sexual orientation, and/or religious affiliation should not matter.

What’s worse is when we handicap ourselves even more to bias based on things we can’t see… Commonly in Athletic Training, hiring committees select individuals based on previous sport experience… not education, qualifications or dedication to the profession. Why are we making things even harder to succeed?

As Athletic Trainers we specialize in musculoskeletal injuries. Our education at the professional level focuses on gaining a variety of experiences with multiple sports, including acute and chronic conditions for the lower and upper extremity, equipment intensive experiences, and general medical conditions.  We are well-versed in the prevention, recognition, and treatment of musculoskeletal injuries regardless of sport.

I understand that each of us comes to the profession with our own set of values and perspective, but when we insert those values onto other people, particularly in the hiring process, what are we actually doing? What are the long term implications? Are we creating an environment that never changes, where people hire others that are only like themselves? Do we achieve the diversity in our profession that is reflective of the diversity in our patients?

Michael Neal LAT, ATC

As we continue to encourage open mindedness and advocacy for minorities throughout this week’s blog, I have the privilege to talk about a very sensitive topic: the Lesbian Gay Bisexual and Transgender community (LGBT). With the movement for same-sex marriage and related social awareness, the United States has become more socially accepting and supportive for the LGBT community compared to a decade ago. For more info, check out this survey on social acceptance.

However, there is still ongoing discrimination towards the LGBT community especially in healthcare, both as providers and patients. As patients, the LGBT community is known to have a higher prevalence of HIV, mental illness, substance use, smoking, and other health conditions. They face a number of challenges when trying to access health services, including barriers in obtaining insurance coverage, gaps in coverage, cost-related hurdles, and poor treatment by health care providers.  For example, a recent survey from Center for American Progress found that one in three LGBT individuals with incomes under 400% FPL are uninsured, a group that could qualify for assistance under the Affordable Care Act. Some have been left out of the system due to denial (pre-existing condition) of coverage or provider inexperience with their health needs.  Even a majority of members of the LGBT community with insurance have been reportedly dissatisfied with their service.  As healthcare providers, the LGBT community is facing similar discrimination as well.  The intolerance may be in the form of judgment from colleagues or even denial of employment.  For these reasons, the Gay and Lesbian Medical Association (GLMA) was founded to advocate and support for medical providers and students who are LGBT. Check out their GLMA site. 

Consider that some of us may not discuss patient and practitioner interactions like these during our undergraduate preparation. This is a failure in our education… we have a responsibility toward cultural awareness and competency.  The go-to should always be toward a culture of openness, a culture of inclusion.  We should treat others how we wish to be treated ourselves. I fervently believe that to be an athletic trainer, one must have a heart for service.  Continue to love other people and be mindful/sensitive for their needs.  At the end of the day, we are all humans and we should see each other as such, instead of judging and isolating others.

Denny Wongosari LAT, ATC