Mini-Editorial Compilation for Special Section

Abstract

In the oft-used parable, the Blind Men and an Elephant, 6 blind monks are asked to touch an elephant in order to provide their interpretations of the object being experienced, in this case through tactile sensation only.1 Each monk is allowed to touch only one segment of the elephant before giving their version of the truth, the truth equating to the essential “what” of each monk's solitary tactile experience. As one might expect, each account provides a uniquely different and fractal version of an independently experienced subjectivity—the monk who grasped the tail describes it simply as a “rope,” the monk who panned the torso describes it rather mundanely as a “wall,” the monk who handled the thick and gently swaying trunk identified it as a “tree branch,” and so forth. Given the fragmentary experiences and reports, the blind monks fail to agree on what it is that they all experienced, bickering and even coming to blows over the epistemological and ontological quagmire. At the same time, they provided a perverse delight to the observing king, who queried them about their fractional sensory experiences and subsequent attempts to interpret what they perceive as “reality.” In the Buddhist version of this commonly used parable, the Buddha compares the blind men to able-sighted scholars and preachers who, because of their insular and myopic views, are deemed to be blind also in how they view and interpret reality: “Just so are these preachers and scholars holding various views blind and unseeing … in their ignorance they are by nature quarrelsome, wrangling, and disputatious, each maintain reality is thus and thus.”1This special section of the Athletic Training Education Journal (ATEJ) is an attempt to do just that—to create a platform to hear more voices, to see more perspectives, and to weigh more evidence. In other words, it is an attempt to create conversations generating more questions, and at times, maybe even a few answers. Within the 400-plus accredited athletic training education programs in the United States are hundreds of bright, energetic, and deeply committed educator-practitioners with an array of diverse experiences and insights, but who individually are just as blind and solitary as the monks, with their individual experiences. Collectively, however, these educator-scholar-practitioners are capable of seeing more, knowing more, and experiencing more. Together they are fully capable of painting a bigger and more inclusive picture of educational reform by combining their individual insights, experiences, and interpretations. This cooperation can chart a richer and more lucid projection of the future, of a different path, or better yet, of multiple pathways. Together, the evidentiary experiences of a body of committed and talented athletic training educators and practitioners can represent more, and by extension, can be viewed with less scrutiny, greater objectivity, and farther-reaching application. Together, a greater body of blind monks can more aptly discover, deliver, and assess the evidence needed to inform our next steps, our immediate and far-flung future. Perhaps more so now than at any time in the profession's history, the exposition and arrangement of athletic training education and practice should not be left to a handful of blind monks to interpret, argue, and articulate. At this juncture in the profession's history, it is critical that a larger, more inclusive and experienced group of monks be brought into the fold, consulted, and relied upon to help chart the course we all seek.Transitions often foster anxiety, fear, and isolation as each person or program focuses on change from a limited scope and perspective. At times like these, it is important to consider the works of Walter Benjamin.2 Benjamin, a renowned scholar, discussed growth through the illustration of the cameraman and the painter. From the perspective of the cameraman, focus is on the fine details by using lenses that capture every detail; however, the painter paints for a while and steps back to see the bigger picture. We are at a point in education reform in which the fine details are being crafted; yet how this all fits together in a broad, effective educational program presents an opportunity for creativity and innovation. These are complex and challenging times for athletic training on at least 3 interrelated planes. First, and most obvious, is our impending educational transformation to the entry-level master's degree. Not only are there the obvious challenges associated with the degree transition for existing undergraduate athletic training programs, but we must also address the myriad questions and issues surrounding the future and role of postprofessional residencies and clinical doctorates in athletic training. Second, numerous state athletic training associations are still working to secure, strengthen, or clarify their state practice acts, and in so doing, they are battling other professional health care associations for their rightful place at the regulation table, including securing the federal recognition that athletic training deserves as a legitimate, “nontechnician” health care profession. Relatedly, we must consider how the master's degree will affect existing regulatory language and statutes in the 48 states that currently have regulation. Third, it can be argued that athletic trainers are still working feverishly to gain true professional legitimacy, to carve out their authentic and core domain of practice, including their role in various emerging settings and technologies, to definitively articulate their rightful knowledge base and to generate and distribute evidence supporting their effectiveness and viability as a health care option for patients and providers. In short, the profession has many serious “balls in the air” now, and how we design and operationalize the master's degree transition will certainly affect both the physics and the optics affecting the many interconnected balls we are juggling.Given these interconnected challenges, athletic training education and practice are not immune from the Buddha's warning to the blind monks concerning the pitfalls of insularity and subjectiveness—all who are committed to the profession have the responsibility to be not only cynical of the interpretation of a few blind monks but also to be proactive and constructive. For clarity, the blind monks and elephant story shows us that individually we are all “blind,” and, thus, there are multiple partial interpretations of the reality we seek—in this case, the details, events, and objectives surrounding the transition process, standards, and intended outcomes of our transition to the master's degree. The parable also reminds us of the power and usefulness of multiplicity and wholeness—the idea that all scholars and practitioners need to engage in the ongoing dialogue about our future. We must guide our leadership through substantive, rigorous input so when we step back years after implementation, we can honestly say we all played a part in and own the direction of this profession because we all contributed our expertise to the organization seeking our input. Focusing exclusively on how this transition will affect our individual programs is myopic and dangerous for the profession. Sharing our insights, experiences, expertise, and failures as well as participating in the larger, critical conversations provide a broader canvas for us to paint the future.In this issue of the ATEJ, we are excited to bring you several concise mini-editorials from well-established and respected athletic training scholar-educator-practitioners such as Craig Denegar, Paula Turocy, Malissa Martin, Jay Hertel, Chad Starkey, Stacy Walker, and Tina Claiborne. Collectively, this team represents considerable breadth and depth in teaching, doing, and thinking athletic training; all have spent considerable time toiling in the trenches with students, colleagues, and other academicians, and each is duly recognized for his or her considerable contributions to the profession. Most importantly, each of these contributors have long been dedicated to the advancement and proliferation of the athletic training profession. They have given considerable portions of their lives to the production and dissemination of knowledge and practice, likely at the expense of other elements of their personal lives. Their mini-editorials, which we have called “chip shots,” address key issues in athletic training for all to ponder. These issues include:As we transition into the era of the professional master's degree, we hope the many poignant and well-reasoned points presented in these chip shots will inspire you to ask more questions, seek multiple perspectives, and perhaps generate answers, solutions, or insights to enhance our profession at this critical juncture.We have also solicited and present a series of critical and timely articles on some rather substantial and relevant issues related to athletic training education in the master's degree era: a combination of theoretical, critical review, position, and experimental scholarship conducted by an equally established and reputed group of authors. First up, Editor-in-Chief of this journal and esteemed educator-scholar Dr Kimberly Peer kicks things off by outlining what she believes we need in athletic training education using the Perspective Transformation Model. Dr Peer takes up the baton handed to her by Drs Turocy and Martin in their chip shots and proceeds to directly challenge the readership and larger professional body of athletic training educator-scholars-practitioners to “do something,” to become more active, be open-minded, and challenge each other to become more inclusive and transformative in our perspectives about the future of athletic training education. In short, Dr Peer asks us to close the gap on our colleagues in medicine and other health care fields by conducting more poignant and direct inquiry in athletic training educational reform.In that vein, Drs Jennifer and Patrick McKeon and Dr Paul R. Geisler take Dr Peer's appeal a step further by taking advantage of the current evidence-based medicine movement in athletic training and proposing a multicomponent model for evidence-based athletic training that calls for more of our professional practices to be based on relevant and productive evidence, including our interrelated regulatory and educational apparatuses. In part, the challenges levied by Drs Starkey, Martin, Walker, Claiborne, and Turocy in their chip shots harmonize with many of the primary threads presented in this ambitious and far-reaching article, as it calls for athletic training educators and policymakers to be more proactive, responsible, and critical with their personal work as educator-scholar-practitioners in the profession.In support of these first 2 articles, Dr Geisler and colleagues follow with a largely theoretical-philosophical discourse that addresses a myriad of epistemological challenges for the profession, posing many rhetorical questions about professional knowledge and legitimacy intended to disposition the ontological status and place of athletic training as we move into this new professional epoch. As it deals with the production, ownership, dissemination, and validation of knowledge in athletic training, the primary theoretical thread of this bold philosophical narrative mirrors the “knowledge production” challenge put forth in Dr Hertel's chip shot, albeit on a slightly different plane.The 2016 Emerging Athletic Training Educator award winner, Dr Stephanie Mazerolle, and frequent writing partner Dr Thomas Dodge, tackle the oft-contentious issue of student supervision, its effectiveness, and evidence relevant to various supervisory policies in health care education. In this short but critical review and proactive article, Drs Mazerolle and Hodge effectually expand upon Dr Starkey's chip shot by directly challenging the profession to better address the available and incorporated evidence, policies, and practices that guide current and future supervisory models for professional education. Inherently, the Mazerolle and Hodge article also interconnects with the evidence-based education article penned by Geisler, McKeon, and McKeon in that it challenges a critical and longstanding policy of clinical education.Across any domain, it is well accepted or at least expected that policymakers and regulators have a duty to weigh all fractal evidence with suspicion and to seek out alternative answers and versions of reality that offer other interpretations and avenues forward. If a collective good were to be envisioned, implemented, and subsequently achieved, athletic training would do well to create an earnest mechanism and a medium for more monks to share their experiences and interpretations toward the collective and pressing needs of the profession, from the ground up. Given the challenges drawn for athletic training at this moment, now is just such an occasion for our profession to heed the Buddha's warning—the moment calls for the perspectives of many, for as many blind monks as are willing to put their thoughts, insights, and interpretations toward the common good, to listen, to look, to speak, and mostly, to think. In this light, athletic training policymakers, practitioners, administrators, and educators would do well to come together in order to gather a more complete picture of things as they are and, most importantly, as they may be in the near and far futures if we hope to avoid the bickering and counterproductive fate of the blind monks. Both the American Medical Association (AMA) and the Canadian Athletic Therapists Association (CATA) have recently shown us different ways of doing just this, and perhaps we can as a profession find inspiration from either of these developments.In response to various perceived shortcomings over their educational processes and outcomes and a few interconnected revolutions in the socioeconomic and cultural aspects of medical practice, the AMA has been actively trying to reconceptualize medical education from the ground up by awarding $12.5 million to a cooperative consortium of over 20 American medical schools to reexamine what they do and how they do it—everything from improvements in the humanistic demands and aspects of clinical practice and patient centeredness, to the effective use of technologies, to enhancements of student-centered accelerated competency-based education, to expedited programs and curricular models that integrate science, clinical experiences, and clinical reasoning.3 This aggressive and obligated program intends to reimagine medical education in the 21st century, or more directly, “to create the medical school of the future” by funding and finding evidence demonstrating what will work and then making that evidence available to other programs.Although certainly not equivalent in scope, funding, or timing, the National Athletic Trainers' Association (NATA) Foundation's recently announced education-centric grants for best practice research in athletic training education are a welcome and long-overdue opportunity for progressive and creative educators in our field to seek funding for their projects. Furthermore, the NATA has created the Education Advancement Committee spearheaded by Dr Michael Miller to promote and advance educational research and practice in the profession. With the support of the NATA Board of Directors, the ATEJ has also expanded to double its size for the 2016 publication year. This generous action reflects confidence in our scholars to grow educational research in the profession and provide an avenue for prompt, professional dissemination of new knowledge. These and other initiatives provide opportunities for the advancement of educational research; however, it is up to each of us to jump into the fold and use our knowledge, skills, talents, and expertise to promote athletic training education. If we look exclusively at educational reform as a transition to the master's degree without consideration from the experts in regulation, clinical practice, postprofessional education, and even continuing education, we are practicing as cameramen with a narrow focus and close-up perspective. Now is the time to step back and practice like a painter, to add a stroke or two and then look at how it has or might impact the overall picture. Our future is a work in progress. It relies on each of us to use our expertise to create a masterpiece that will withstand the test of time.Inspired by 2 published commentaries concerning the state of their educational practices and profession, the CATA recently completed a comprehensive, ground-up assessment of their educational operations in order to chart a more constructive course for their profession and educational practices.4 Conducted over the course of a full year, a multiperspective task force consisting of all accredited program directors (n = 7) and 4 administrators from their accrediting, certifying, and governing associations developed 10 consensus statements and associated caveats for athletic therapy education, which were presented to the CATA Board of Directors for analysis and potential implementation. Recently published in the ATEJ, this cooperative work was intended to “share the results of an evidence-based, consensus-driven planning process addressing key educational issues in the profession of athletic therapy in Canada”4(p6) and to highlight the importance of gaining input from stakeholders to identify critical issues in education practice before the future was chartered. Interestingly, the key words for this article included clinical competence (after all, the end game for our educational practice), clinical education, curriculum, and evaluation—all important constructs of the educational apparatus and all linked to a plethora of evidence in the various health care pedagogy fields. The relevance of such a systematic, ground-up, and evidence-based process for educational reform and policy to athletic training in the United States is clearly evident and inspiring; it is also displayed in myriad places within this special section of the ATEJ.The opportunity to engineer better results for our profession is there for the taking—we just need to pursue an active and productive role with this engineering and put our money where our mouths are in terms of getting the work done. The CATA and the AMA have done just this by patiently putting into action collaborative and evidence-driven mechanisms intended to generate the results they want for their systems. Athletic training has too much to lose, and far too much to gain, as it transitions into the master's degree era. We hope in this special section of the ATEJ that you find inspiration, arguments, and an opening for something new, something better.Athletic training, and the educational requirements to enter the profession, have evolved. Less than 40 years ago, students interested in athletic training could achieve certification through completion of an internship. Instruction was typically provided by practicing athletic trainers steeped in the art of caring for athletes. Athletic training educators with a terminal academic degree were counted on one hand.Students pursuing athletic training were a significant source of free labor, and the growth of athletic training education was supported. Athletic training became an academic major with hundreds of institutions transitioning programming to meet new accreditation standards while maintaining tuition-paying, free labor. With recognition as a health care profession and the development of an academic major, there came substantially greater expectations for athletic training research to advance learning and practice. The pendulum has swung, and rather than education being led by athletic trainers well-versed in the art of clinical practice, it is now led by athletic trainers who are well prepared to pursue research versus providing health care.Concurrently, the scope of athletic training has expanded. The practice of athletic training is no longer limited to collegiate and professional settings, and high school athletics has advanced beyond that of an emerging practice setting. The athletic trainer's scope of responsibilities has also expanded. For example, recognition of the complexity of mild traumatic brain injuries and the long-term consequences of traumatic joint injuries continues to force change in educational standards and practice.As athletic training education continues into the master's degree era, expectations of greater depth—from practice of the art to generation of new knowledge—will grow. Expectations will also persist for greater breadth in knowledge to address the growing complexities in patient care and the unique needs of athletes and physically active people across the life span.The challenges of greater depth and breadth in teaching and learning are not unique to athletic training. Nursing, pharmacy, and physical therapy offer 3 comparisons in which transition in degree and academic standards has occurred. Educators in these professions are similarly faced with balancing the art and science of practice, the translation of knowledge to practice, and the preparation of graduates for greater scopes of practice in their careers.There is, however, a critical difference between entry-level education programs in these professions and those in athletic training. The smallest academic programs in these professions exceed the largest entry-level programs in athletic training in terms of the number of students and faculty. The faculty of top programs consist of experts in practice and highly talented researchers who collectively assure breadth and depth across the curriculum.The success of advancing the practice of athletic training through elevation of academic standards will depend on the ability to develop deeper and broader programs with faculty whose research and clinical expertise blend to optimize learning. This is a challenge that can be met only through larger entry-level athletic training education programs more similar to those found across the spectrum of health professions. This reality will force change, a change that is necessary in the evolution of athletic training education and the advancement of the practice of athletic training.Many changes have occurred in athletic training (AT) education over the years, with some of the most significant changes occurring in just the last 10 years. Change is not only inevitable, but also necessary as a profession evolves and diversifies. Today, it appears we again are on the precipice of a new wave of AT practice and, therefore, possibly a new wave of AT education to support that practice. In my humble opinion, before we begin contemplating what content we might need to add to support that practice, I firmly believe we must first determine what constitutes entry-level practice and what constitutes advanced practice. If we can determine these boundaries first, then the decisions as to how to build the educational infrastructure to support that practice will become apparent.Curricular decisions generally are made after a needs analysis, and any changes to professional education should come from thoughtful and purposeful analysis based upon patient care and practice-setting needs. If we consider the needs of entry-level practice with advanced AT practice, we can better determine the basic skills, content, and underlying knowledge required of entry-level AT professionals. In addition, we can better determine the advanced skills, content, and educational preparation advanced AT practitioners need when caring for more frail, vulnerable, and/or complex patients—a typical hallmark of advanced professional practice. Practice setting alone should not dictate additions to entry-level practice or advanced practice requirements, nor should the need to advance skills and content dictate the need for specialty certifications. Advancing skill and content to take care of the same types of patients who may present with more complex problems is by definition “advanced practice,” which is different from creating a specialty certification to develop new or different skills and content to address a different population of patients or patient needs. We need to plan for our next practice evolution when making adjustments in current practice needs. Since what is considered advanced practice today may in the future become entry-level practice, it is essential to analyze on a more regular basis and identify when advanced practice becomes an expectation of entry-level practice. To add new advanced educational content to what is now considered entry-level practice without doing our due diligence to determine the need is self-serving and may result in less support as we move forward to change laws and regulations that govern AT practice.Another important consideration essential to our educational and practice evolution, as well as to the support we need to implement these changes into law and health care regulation, will be the involvement and support of our long-time advocates and supervisors, our physician partners. National certification and most state AT practice legislation are built upon collaborative practice with, and oversight by, physicians. Making any changes in AT education and practice should be done in partnership with our supporting physician groups. Physician direction, oversight, and endorsement has not only helped lift our AT practice standards and expectations to where they are today but has also proven to be successful in our legislative and lobbying efforts. In addition, this supportive relationship has prevented our profession from experiencing the same negative lobbying efforts and costly appeals other professions have experienced when attempting to move to autonomous practice.Finally, when the time comes for us to progress both entry-level and advanced educational requirements, it will be important for the changes made to educational content to be supported by appropriate basic and applied science coursework, as well as by the previous learning needed to set a sound foundation for understanding the new requirements. Unlike technicians, professionals need to be more than accurate or safe with a skill; they must understand and consider individual differences among patients, analyze and diagnose conditions, and interpret information to make complex decisions based on a broad base of knowledge and experience. As we move ahead, we must continue to assure all changes in professional practice expectations are accompanied with the same thoughtful changes in the foundational knowledge, skills, and expectations that have been the hallmark of AT education. It will be this same attention to detail that will ensure future athletic trainers are as prepared as possible for entry-level and advanced practice.Often being a content expert becomes synonymous with being a good teacher. A deep understanding of content does not make one a good teacher but is needed to advance frontiers of knowledge. In his renowned book What the Best College Teachers Do,1 Ken Bain notes that the first characteristic of a quality instructor is to know the content. However, knowing content and being able to transfer the content in a meaningful way to meet a variety of learning styles so students can understand and apply the content, as well as transfer their understanding to new situations, involve very different skills sets. These skill sets can be quite challenging, especially without the appropriate education and training.Designing learning experiences based upon current evidence that engages the learner, creating instructional delivery requiring interaction embedded in authenticity, and assessing student learning through a variety of means are not skills one develops by being a content expert, certified athletic trainer, or through an internship-like process. Rather, this knowledge and the accompanying skill sets are developed and nurtured over time through purposeful and significant learning experiences.Just as we must nurture and support the development of athletic training educators, we must also support the educators' development into “teaching scholars.” The Scholarship of Teaching and Learning is related to 3 basic activities: (1) engagement with existing knowledge on teaching, (2) self-refection on teaching, and (3) learning in one's discipline.2 According to Boyer3 the scholarship of teaching remains elusive within many professions and institutions of higher education.Scholarship in education focusing on teaching and learning activities can be quite beneficial to the body of knowledge, but it is often unsupported by institutional award systems, in particular when it comes to the rigors of promotion and tenure. Much time is spent on conceptualizing and designing courses/curriculum, learning experiences, instructional technologies, and assessment activities and measures followed by the reflection and evaluation of these tasks to determine efficacy in student learning and achievement. This is scholarship. I refer to this as hidden scholarship. This hidden scholarship is performed on a daily basis with few, if any, individuals knowing its worth. Creative teaching that is effective needs to be shared with or without regard to an institution's reward system. These activities need to extend beyond the privacy of the classroom and into the professional and public domain.We have over 300 athletic training program directors in this county, with a similar number of clinical education coordinators along with athletic training education faculty. I would consider most of these individuals to be “teaching scholars.” Yet what percentage of these individuals are actually publishing, presenting platform or poster presentations, or merely speaking about e