Graduate Assistant Athletic Trainers Research Articles

Energy Balance, Eating Disorder Risk, and Pathogenic Behaviors Among Athletic Trainers.

Research exists on energy balances (EBs) and eating disorder (ED) risks in physically active populations and occupations by settings, but the EB and ED risk in athletic trainers (ATs) have not been investigated. To assess ATs' energy needs, including the macronutrient profile, and examine ED risk and pathogenic behavioral differences between sexes (men, women) and job statuses (part time or full time) and among settings (college or university, high school, nontraditional). Cross-sectional study. Free-living in job settings. Athletic trainers (n = 46; male part-time graduate assistant ATs = 12, male full-time ATs = 11, female part-time graduate assistant ATs = 11, female full-time ATs = 12) in the southeastern United States. Anthropometric measures (sex, age, height, weight, body composition), demographic characteristics (job status [full- or part-time AT], job setting [college/university, high school, nontraditional], years of AT experience, exercise background, alcohol use), resting metabolic rate, energy intake (EI), total daily energy expenditure (TDEE), exercise energy expenditure, EB, macronutrients (carbohydrates, protein, fats), the Eating Disorder Inventory-3, and the Eating Disorder Inventory-3 Symptom Checklist. The majority of participants (84.8%, n = 39) had an ED risk, with 26.1% (n = 12) engaging in at least 1 pathogenic behavior, 50% (n = 23) in 2 pathogenic behaviors, and 10.8% (n = 5) in >2 pathogenic behaviors. Also, 82.6% of ATs (n = 38) presented in negative EB (EI < TDEE). Differences were found in resting metabolic rate for sex and job status (F1,45 = 16.48, P = .001), EI (F1,45 = 12.01, P = .001), TDEE (F1,45 = 40.36, P < .001), and exercise energy expenditure (F1,38 = 5.353, P = .026). No differences were present in EB for sex and job status (F1,45 = 1.751, P = .193); χ2 analysis revealed no significant relationship between ATs' sex and EB ({\rm{\chi }}_{1,46}^2= 0.0, P = 1.00) and job status and EB ({\rm{\chi }}_{1,46}^2 = 2.42, P = .120). No significant relationship existed between Daily Reference Intakes recommendations for all macronutrients and sex or job status. These athletic trainers experienced negative EB, similar to other professionals in high-demand occupations. Regardless of sex or job status, ATs had a high ED risk and participated in unhealthy pathogenic behaviors. The physical and mental concerns associated with these findings indicate a need for interventions targeted at ATs' health behaviors.

Supervisor Perceptions of Newly Credentialed Athletic Trainers' Transition to Practice

Context Transition to practice for newly credentialed athletic trainers (ATs) has been described through the perspective of educators, supervisors of graduate assistant ATs, students, and recent graduates; however, the opinion of supervisors of full-time ATs has not been thoroughly investigated. Objective (1) Describe supervisor perceptions of the transition to full-time practice for newly credentialed ATs and (2) describe current onboarding processes used by employers. Design Phenomenological qualitative study. Setting Semistructured interviews. Patients or Other Participants Purposive sample of 10 (4 men, 6 women) supervisors of newly credentialed ATs. Supervisors reported an average of 13.5 years of supervisory experience (range, 5–26 years). Data Collection and Analysis Questions addressed supervisor expectations, strengths and weaknesses of newly credentialed ATs, and the organization's onboarding process. The primary researcher transcribed audio recordings and each participant reviewed transcripts. Two researchers coded themes using an inductive process; a peer auditor completed an independent review. Disagreements were negotiated until consensus was reached. Results Two categories emerged: (1) characteristics of newly credentialed ATs and (2) onboarding strategies. The first category was organized into 2 subcategories: (1) knowledge, skills, and abilities (KSAs) and (2) unrealistic job expectations. The majority of supervisors felt that newly credentialed ATs were knowledgeable; however, the translation of knowledge into practice was viewed as an area requiring mentorship. Participants also reported that newly credentialed ATs often were poorly informed of the work schedule and time demands. In regard to onboarding processes, the researchers identified 7 different strategies reported by supervisors. Conclusions Newly credentialed ATs were perceived as knowledgeable but struggling to transition knowledge to clinical practice and often did not understand the work demands. Seven onboarding strategies were reported by participants; each of these can be used to develop KSAs of newly credentialed ATs. The KSAs should be addressed through a yearlong process consisting of orientations, shadowing, mentorship, seminars, and skill assessments.

Newly Credentialed Athletic Trainers' Perceptions of Professional Preparation for Their Role as Collegiate Graduate Assistants

Context: The professional preparation of newly credentialed athletic trainers (ATs) has been passionately debated. Understanding how newly credentialed ATs feel they are prepared will help enhance professional preparation. Objective: Explore newly credentialed ATs' perceptions of their professional preparation for their role. Design: Phenomenological qualitative. Setting: Phone interviews with graduate assistant ATs in the collegiate setting. Patients or Other Participants: Nineteen collegiate graduate assistants (15 female, 4 male; average age = 23 ± 0.15 years; National Collegiate Athletic Association Division I: 13, II: 3, III: 2, National Association of Intercollegiate Athletics: 2; postprofessional athletic training program: 6). Main Outcome Measure(s): Participants were recruited via an e-mail from the National Athletic Trainers' Association database sent to all certified students. Data were collected via phone interviews, which were recorded and transcribed verbatim. Interviews were conducted until data saturation occurred. Data were analyzed through phenomenological reduction, with data coded for common themes and subthemes. Credibility was established via member checks and peer debriefing. Results: Two themes emerged: facilitators and barriers. Overall, participants felt academically prepared for their role, but preparedness was often dependent on the facilitators of academic rigor, hands-on opportunities in clinical education, and their preceptor. Barriers included a lack of rigor in the academic setting, lack of active opportunities in clinical education, the culture of clinical experiences, and incongruence. Incongruence existed when students were exposed to all the competencies during didactic education, but never gained experience with some skills (eg, rehabilitation, documentation, communication) if situations never arose or they were not actively involved clinically. Conclusions: Athletic training students are being exposed to a variety of learning experiences academically, but often do not gain clinical experience if situations do not arise or preceptors do not allow active participation. To ensure new ATs are prepared, academic programs need to ensure rigor and place students with preceptors who provide active learning opportunities.

Transition to Practice for Graduate Assistant Athletic Trainers Providing Medical Care in the Secondary School Setting.

Transition to clinical practice can be challenging for newly credentialed athletic trainers (ATs), who are expected to immediately step into their roles as autonomous clinicians. For those providing care in the secondary school setting, this transition may be complicated by the fact that many practice in isolation from other health care providers. To explore the transition to practice of newly credentialed graduate assistant ATs providing medical care in the secondary school. Phenomenologic qualitative study. Secondary school. The 14 participants (2 men, 12 women; age = 23.3 ± 2.0 years) were employed in the secondary school setting through graduate assistantships, had been credentialed for less than 1 year, and had completed professional bachelor's degree programs. We completed 14 semistructured phone interviews. Interviews were recorded and transcribed verbatim. A general inductive approach was used for data analysis. Trustworthiness was established through multiple-analyst triangulation, peer review, and member checks. A period of uncertainty referred to a time during which participants were anxious as they began practicing independently. Legitimation through role engagement signified that as the period of uncertainty passed, participants developed more confidence in themselves and legitimation by engaging in their role. Acclimation through physician communication and professional relationships highlighted the importance of developing a relationship with the team physician, which provided a source of feedback and support for continued growth and confidence. To prepare for this period of uncertainty, educators and preceptors should encourage students to interact with members of the health care team and communicate with parents and coaches. Employers should implement initiatives to orient newly credentialed ATs to their roles, provide clear job expectations, and assign or assist with identifying mentors. Newly credentialed ATs should seek support from many different individuals, including the team physician, who can provide support, feedback, and encouragement.

Graduate-Assistant Athletic Trainers' Perceptions of Professional Socialization in the Collegiate Setting: Part I.

Many newly credentialed athletic trainers (ATs) pursue graduate assistantships, which allow them to gain experience while being supervised by an experienced AT. The graduate-assistant (GA) ATs' perception of their socialization process into the collegiate setting is unknown. To explore the professional socialization of GAs in the collegiate setting. Qualitative study. Phone interviews. A total of 19 collegiate GAs (15 women, 4 men; average age = 23 ± 0.15 years; National Collegiate Athletic Association Division I = 13, II = 3, III = 2; National Association of Intercollegiate Athletics = 2; postprofessional athletic training program = 6) participated. Data were collected via phone interviews and transcribed verbatim. Interviews were conducted until data saturation occurred. Data were analyzed through phenomenologic reduction. Trustworthiness was established via member checks and peer review. Four themes emerged: (1) role identity, (2) initial entry into role, (3) maturation, and (4) success. Before beginning their role, participants envisioned the assistantship as a way to gain independent experience while being mentored. They perceived themselves as the primary care providers for their athletic teams. Those who were immediately immersed into clinical practice adapted to their role quickly despite experiencing stress initially. Participants felt that a formal orientation process and a policies and procedures manual would have alleviated some of the initial stress. The GAs matured as they practiced clinically and developed confidence as they gained experience. Personal attributes, experience, and peer and supervisor support contributed to perceived success as GAs. Factors that hindered perceived success were lack of confidence, an unsupportive environment, and long hours. When looking for graduate assistantships, ATs should seek a position that allows them to practice independently and provides didactic educational opportunities while aligning with their athletic training philosophies.

Graduate-Assistant Athletic Trainers' Perceptions of the Supervisor's Role in Professional Socialization: Part II.

Many new athletic trainers (ATs) obtain graduate-assistant (GA) positions to gain more experience and professional development while being mentored by a veteran AT; however, GA ATs' perceptions of the supervisor's role in professional development are unknown. To explore the supervisor's role in the professional development of GAs in the collegiate setting. Qualitative study. Phone interviews. A total of 19 collegiate GAs (15 women, 4 men; average age = 23 ± 0.15 years; National Collegiate Athletic Association Division I = 13, II = 3, III = 2; National Association of Intercollegiate Athletics = 2; postprofessional athletic training program = 5). Data were collected via phone interviews and transcribed verbatim. Interviews were conducted until data saturation occurred. Data were analyzed through phenomenologic reduction. Trustworthiness was established via member checks and peer review. Three themes emerged: (1) GAs' expectations of supervisors, (2) professional development, and (3) mentoring and support. Participants expected their supervisors to provide mentorship, support, and feedback to help them improve their athletic training skills, but they also realized supervisors were busy with patient care responsibilities. Most participants felt their supervisors were available, but others believed their supervisors were too busy to provide support and feedback. Participants felt their supervisors provided professional development by teaching them new skills and socializing them into the profession. Furthermore, they thought their supervisors provided mentorship professionally, personally, and clinically. Supervisors supported the participants by standing behind them in clinical decisions and having open-door policies. The graduate assistantship allows new ATs to gain experience while pursuing professional development, mentorship, and support from a supervisor. The extent of development is highly dependent on the supervisor, but most supervisors mentor GAs. When looking for graduate assistantships, future GAs should seek positions in which supervisors actively provide mentoring and professional development.

Influences on Graduate Assistant Athletic Trainers’ Career Intentions and Career Goals

The graduate assistant (GA) athletic trainer position often symbolizes an important transitory role from student to autonomous practitioner. The position also is used to help gain valuable experience for future employment. Our purpose was to understand the socialization process of the GA athletic trainer as well as investigate the career intentions as they begin to seek employment following their experiences in that transitory role. Twenty-five (5 males, 20 females) GA athletic trainers were recruited and participated in this study. Findings indicate the experiences of novice athletic trainers serving as GAs have the potential to both positively or negatively influence perceptions of the athletic training profession and, ultimately, career intentions.

Supervising Athletic Trainers' Perceptions of Graduate Assistant Athletic Trainers' Professional Preparation

Context Recent debate has ensued regarding the readiness of newly credentialed athletic trainers (ATs) to function as independent clinicians. Some ATs believe the professional preparation of athletic training students is not adequate. Objective To describe supervisors' perceptions regarding the preparation of college graduate assistants (GAs) to practice as independent practitioners. Design Consensual qualitative research. Setting Individual phone interviews. Patients or Other Participants Twenty-one collegiate ATs who had supervised GAs in the collegiate setting for a minimum of 8 years (16 men, 5 women; years of supervision experience, 14.6 ± 6.6 years). Participants who met the inclusion criteria were recruited via e-mail from the Board of Certification database and through snowball sampling. Interviews were conducted until data saturation occurred. Main Outcome Measure(s) Data were collected via phone interviews, which were recorded and transcribed verbatim. Data were analyzed by a 4-person consensus team, who independently coded the data and compared ideas until consensus was reached and a codebook was created. Trustworthiness was established through member checks and multi-analyst triangulation. Results Three themes emerged: (1) previous preparation, (2) shortcomings in GAs, and (3) suggestions for athletic training program improvement. Supervisors felt GAs were prepared academically, but there were some gaps in preparation, such as their ability to independently practice and their rehabilitation skills. Shortcomings were professional communication, role execution, and personality. Supervisors felt preparation could be improved by increasing time in clinical education, developing communication skills, and having increased experience with psychosocial intervention, rehabilitation, and nonorthopedic conditions. Conclusions Didactic preparation of GAs is the best it has ever been, yet new ATs still need more experience while being mentored by experienced ATs. Professional programs could implement standardized patient experiences to provide opportunities for new ATs to practice in communication or in other areas of weakness.

Variations in High School Sport Injury and Treatment Rates by Athletic Trainer Work Status

Many sport-related injury surveillance systems utilize athletic trainers (AT) to report athlete injuries. Yet, little research has examined how AT characteristics may affect injury reporting and management. PURPOSE: To determine whether injury and treatment rates in high school football vary by AT work status. METHODS: : ATs (n=44) supervising high school football and reporting injury data to the National Athletic Treatment, Injury and Outcomes Network (NATION) program during 2011-2013 provided work status and high school football AT/medical staff information. Overall injury rates [# injuries / # athlete-exposures (AE) * 1000], time loss injury rates (i.e., only injuries resulting in over 24 hours of time loss), and treatment rates (# treatments / # injuries) were calculated. Rate ratios (RR) and 95% confidence intervals (CI) compared rates by AT work status (high school employee vs. outside setting, including graduate student assistants). RESULTS: Fourteen ATs were high school employees; 30 ATs, 20 of whom were graduate assistants, were not high school employees. All ATs received assistance from other AT/medical staff. However, 76.7% of outside setting ATs did not work with paid AT/medical staff, whereas 71.4% of employed ATs did. The overall and time loss injury rates were 17.9 and 4.9/1000AEs, respectively. The treatment rate was 8.8 per injury. Compared to high schools with outside setting ATs, schools who employed ATs had higher rates of overall injury (27.4 vs. 7.3/1000AEs; RR=3.8; 95%CI: 3.5, 4.0; P<0.001) and treatment (9.9 vs. 3.2 per injury; RR=3.1; 95%CI: 3.0, 3.2; P<0.001). However, high schools with outside graduate assistant ATs had a higher time loss injury rate than those with other ATs (6.5 vs. 4.2/1000AEs; RR=1.5; 95%CI: 1.4, 1.7; P<0.001). CONCLUSIONS: Injury and treatment rates varied by the work status of the AT supervising high school football. Being employed by an outside setting may limit the time that ATs can attend to, manage, and report student-athlete injuries, leading to lower reported rates. Higher time loss injury rates reported among high schools with graduate assistant ATs may suggest that there is also a difference in the manner that graduate student ATs classify injuries. Continued examinations of the association of AT characteristics and rates of injury and treatment are warranted.

Supervising athletic trainers' perceptions of professional socialization of graduate assistant athletic trainers in the collegiate setting.

Many newly credentialed athletic trainers gain initial employment as graduate assistants (GAs) in the collegiate setting, yet their socialization into their role is unknown. Exploring the socialization process of GAs in the collegiate setting could provide insight into how that process occurs. To explore the professional socialization of GAs in the collegiate setting to determine how GAs are socialized and developed as athletic trainers. Qualitative study. Individual phone interviews. Athletic trainers (N = 21) who had supervised GAs in the collegiate setting for a minimum of 8 years (16 men [76%], 5 women [24%]; years of supervision experience = 14.6 ± 6.6). Data were collected via phone interviews, which were recorded and transcribed verbatim. Data were analyzed by a 4-person consensus team with a consensual qualitative-research design. The team independently coded the data and compared ideas until a consensus was reached, and a codebook was created. Trustworthiness was established through member checks and multianalyst triangulation. Four themes emerged: (1) role orientation, (2) professional development and support, (3) role expectations, and (4) success. Role orientation occurred both formally (eg, review of policies and procedures) and informally (eg, immediate role immersion). Professional development and support consisted of the supervisor mentoring and intervening when appropriate. Role expectations included decision-making ability, independent practice, and professionalism; however, supervisors often expected GAs to function as experienced, full-time staff. Success of the GAs depended on their adaptability and on the proper selection of GAs by supervisors. Supervisors socialize GAs into the collegiate setting by providing orientation, professional development, mentoring, and intervention when necessary. Supervisors are encouraged to use these socialization tactics to enhance the professional development of GAs in the collegiate setting.

Perceptions of Support Networks During the Graduate-Assistant Athletic Trainer Experience.

The graduate-assistant position can be a highly influential experience because it is often the first time novice athletic trainers (ATs) are practicing autonomously. To gain an understanding of how graduate-assistant ATs (GAATs) perceive professional socialization and mentorship during their assistantships. Semistructured phone interviews. Graduate-assistant ATs in various clinical settings. Twenty-five GAATs (20 women, 5 men) studying in 1 of 3 academic tracks (postprofessional athletic training = 8, athletic training-based curriculum = 11, non-athletic training-based curriculum = 6). Median age was 24 years. Phone interviews were digitally recorded and transcribed verbatim. Data analysis used principles of the general inductive approach. Credibility was maintained using peer review, field notes, and intercoder reliability. Participants identified peer support throughout their experiences, in both academic and clinical settings. The GAATs frequently relied on other GAATs for support due to shared experiences and understanding of workloads. Participants described difficulty receiving supervisor support from full-time staff ATs due to the supervisors' workload and time constraints, limiting their availability for mentoring. Guidance from academic support personnel occurred only in athletic training-centered academic programs. Communication emerged as helpful for incoming GAATs; the previous GAATs provided formal mentorship via job descriptions highlighting role responsibilities and expectations. Differences between assistantship types were noted only in terms of receiving balanced mentorship between the academic and clinical staffs, such that students studying in postprofessional athletic training programs perceived more balanced support. Our results confirm the literature regarding the GAAT's pursuit of continued formal mentoring. The GAATs perceived less support from full-time AT staff members due to limited availability. Therefore, GAATs leaned on their peers for support during the graduate experience.

An Assessment of Burnout in Graduate Assistant Certified Athletic Trainers

Graduate assistant athletic trainers (GAATs) must balance the demands of clinical care and the academic load of graduate-level students. To examine burnout among GAATs with clinical assistantships at National Collegiate Athletic Association (NCAA) Division I institutions and to identify the personal and situational variables that are related to burnout. Cross-sectional study. Division I universities offering graduate assistantship programs. Two hundred one GAATs enrolled at NCAA Division I universities with graduate assistantship positions. The Athletic Training Burnout Inventory, which assesses stress and burnout among ATs through 4 constructs: emotional exhaustion and depersonalization, administrative responsibility, time commitment, and organizational support. The 6-point Likert scale is anchored by 1 (never true) and 6 (always true). The GAATs who traveled with athletic teams (4.051 ± 0.895) and those who provided classroom instruction (4.333 ± 1.16) reported higher levels of stress due to time commitment than those who did not travel (3.713 ± 1.22) or teach (3.923 ± 0.929). We also found a difference in administrative responsibility across clinical settings (F(6,194) = 3.507, P = .003). The results showed that GAATs in NCAA Division I clinical settings (44.55 ± 13.17 hours) worked more hours than those in NCAA Division III clinical settings (33.69 ± 12.07 hours) and those in high school settings (30.51 ± 9.934 hours). Graduate assistant ATs are at risk for burnout because of the time necessary to complete their clinical and academic responsibilities and their additional administrative responsibilities. Graduate assistants who work in the Division I clinical setting are at greater risk for burnout than those in the secondary school setting because of the large number of hours required.

Work-Family Conflict, Part I: Antecedents of Work-Family Conflict in National Collegiate Athletic Association Division I-A Certified Athletic Trainers

Work-family conflict (WFC) involves discord that arises when the demands of work interfere with the demands of family or home life. Long work hours, minimal control over work schedules, and time spent away from home are antecedents to WFC. To date, few authors have examined work-family conflict within the athletic training profession. To investigate the occurrence of WFC in certified athletic trainers (ATs) and to identify roots and factors leading to quality-of-life issues for ATs working in the National Collegiate Athletic Association Division I-A setting. Survey questionnaire and follow-up, in-depth, in-person interviews. Division I-A universities sponsoring football. A total of 587 ATs (324 men, 263 women) responded to the questionnaire. Twelve ATs (6 men, 6 women) participated in the qualitative portion: 2 head ATs, 4 assistant ATs, 4 graduate assistant ATs, and 2 AT program directors. Multiple regression analysis was performed to determine whether workload and travel predicted levels of WFC. Analyses of variance were calculated to investigate differences among the factors of sex, marital status, and family status. Interviews were transcribed verbatim and then analyzed using computer software as well as member checks and peer debriefing. The triangulation of the data collection and multiple sources of qualitative analysis were utilized to limit potential researcher prejudices. Regression analyses revealed that long work hours and travel directly contributed to WFC. In addition to long hours and travel, inflexible work schedules and staffing patterns were discussed by the interview participants as antecedents to WFC. Regardless of sex (P = .142), marital status (P = .687), family status (P = .055), or age of children (P = .633), WFC affected Division I-A ATs. No matter their marital or family status, ATs employed at the Division I-A level experienced difficulties balancing their work and home lives. Sources of conflict primarily stemmed from the consuming nature of the profession, travel, inflexible work schedules, and lack of full-time staff members.

Role Strain in Collegiate Athletic Training Approved Clinical Instructors

Certified athletic trainers who serve as Approved Clinical Instructors (ACIs) in the collegiate setting are balancing various roles (eg, patient care and related administrative tasks, clinical education). Whether this balancing act is associated with role strain in athletic trainers has not been examined. To examine the degree of, and contributing factors (eg, socialization experiences, professional and employment demographics, job congruency) to, role strain in collegiate ACIs. Cross-sectional survey design. Geographically stratified random sample of ACIs affiliated with accredited athletic training education programs at National Collegiate Athletic Association (NCAA) Division I, II, and III institutions. 118 collegiate ACIs (47 head athletic trainers, 45 assistant athletic trainers, 26 graduate assistant athletic trainers). The Athletic Training ACI Role Strain Inventory, which measures total degree of role strain, 7 subscales of role strain, socialization experiences, professional and employment characteristics, and congruency in job responsibilities. A total of 49% (n = 58) of the participants experienced a moderate to high degree of role strain. Role Overload was the highest contributing subscale to total role strain. No differences were noted between total role strain and role occupant groups, NCAA division, or sex. Graduate assistant athletic trainers experienced a greater degree of role incompetence than head athletic trainers did (P = .001). Division II ACIs reported a greater degree of inter-role conflict than those in Division I (P = .02). Female ACIs reported a greater degree of role incompetence than male ACIs (P = .01). Those ACIs who stated that the ACI training provided by their institution did not adequately prepare them for the role as an ACI experienced greater role strain (P < .001). The ACIs in the collegiate setting are experiencing role strain in balancing their roles as health care providers, clinical educators, and administrators. Methods to reduce role strain need to be considered.