Exploring the Transition to Practice for the Newly Credentialed Athletic Trainer: A Programmatic View

Challenges Faced During Professional Preparation and Transition to Practice Among Diverse Early Professional Athletic Trainers

CONTEXT

Early professional (EP) athletic trainers (ATs) may encounter adjustments and develop individual identities to master a new role, which can be difficult while transitioning from student to autonomous professional. Previous literature lacks content about the transition to practice of credentialed ATs who identify as Black, Indigenous, or people of color (BIPOC).

OBJECTIVE

To identify challenges during the professional education and transition to practice of EP ATs identifying as BIPOC.

DESIGN

Qualitative study.

SETTING

Virtual interviews.

PATIENTS OR OTHER PARTICIPANTS

Fifteen recently credentialed ATs (13 women, 2 men; age = 26.73 ± 1.41 years, experience = 13.80 ± 4.03 months) who self-identified as BIPOC.

DATA COLLECTION AND ANALYSIS

We used an interview guide, validated by peer (n = 1) and expert (n = 3) review, to structure the data collection sessions. Data saturation guided recruitment, and we achieved theoretical redundancy after the final interview. We analyzed the data with a phenomenological approach and used multianalyst triangulation (n = 2) and peer review (n = 2) as credibility strategies.

RESULTS

All participants mentioned being victims of microaggressions because of their race during either their professional preparation, work environment, or both. Those who chose to report the incidents felt a lack of support from work supervisors, faculty, peers, and preceptors. Participants noted a preference for racially concordant mentoring to facilitate talking to a person who could better understand BIPOC EPs' experiences. Respondents also relied on outside support from friends and family as coping mechanisms. Finally, participants experienced perceived incompetency from supervisors due to their limited work experience as EPs and felt their professional preparation was stunted by the COVID-19 pandemic.

CONCLUSIONS

Participants perceived that their transition to practice was stressful due to the microaggressions encountered, a lack of support, and a lack of racially concordant mentoring. Diversity, equity, and inclusion training should be incorporated into athletic training education and workspaces to assist in providing more welcoming environments for BIPOC EP ATs and students.

Multistakeholder Perceptions of Young Professionals' Integration During Role Transition

CONTEXT

The transition to autonomous clinical practice for early professionals (EPs) has been found to be a stressful time, but no studies with multiple stakeholder groups have been completed.

OBJECTIVE

To examine the perceptions of EPs' integration during role transition from multiple stakeholder groups.

DESIGN

Qualitative study.

SETTING

Online interviews.

PATIENTS OR OTHER PARTICIPANTS

Seventeen EPs in the first 2 years of their first job postcertification (9 women, 8 men, age = 26 ± 5 years, experience = 9.5 ± 5 months), 16 supervisors and mentors of EPs (6 women, 10 men, age = 52 ± 11 years), and 10 faculty members and 8 preceptors (11 women, 7 men, age = 43 ± 10 years).

DATA COLLECTION AND ANALYSIS

Semistructured interviews using a validated interview guide based on the current literature were conducted. We analyzed data using consensual qualitative research principles. Multiple-analyst triangulation (n = 3), member checking, and peer review served as trustworthiness strategies.

RESULTS

We identified 4 themes that defined the integration of EPs during role transition. The integration of EPs was facilitated through role inductance and mentoring. Early professionals struggle finding balance to avoid burnout as they are new to the profession and feel obligated to exceed expectations from a coverage standpoint rather than focusing on the quality of care delivered. Finally, stakeholders suggested a timeline by which EPs become fully integrated into autonomous professional practice and understand all aspects of their role that typically takes anywhere from 1 to 3 years.

CONCLUSIONS

Early professionals benefited from appropriate graded autonomy during clinical education to develop their clinical reasoning skills, confidence, and mentoring network with past preceptors. Ongoing personal and professional support are needed during the initial few years to ease EPs' role inductance while they gain more experience and establish their clinician identity. Expectations for EPs should be reasonable to allow for the provision of quality care, adequate work-life balance, and integration into the profession without guilt.

A Theoretical Model of Transition to Practice for Athletic Trainers

CONTEXT

The transition to practice of newly credentialed athletic trainers (ATs) has become an area of focus in the athletic training literature. However, no theoretical model has been developed to describe the phenomenon and drive investigation.

OBJECTIVE

To better understand the lived experience of the transition to practice and develop a theoretical model of transition to practice for ATs.

DESIGN

Qualitative study.

SETTING

Telephone interviews.

PATIENTS OR OTHER PARTICIPANTS

Fourteen professional master's athletic training students (7 men, 7 women, age = 25.6 ± 3.7 years, from 9 higher education institutions) in the first year of clinical practice as newly credentialed ATs.

DATA COLLECTION AND ANALYSIS

Participants completed semistructured phone interviews at 3 timepoints over 12 to 15 months. The first interview was conducted just before graduation, the second 4 to 6 months later, and the third at 10 to 12 months. The interviews were transcribed and analyzed using a grounded theory approach.

RESULTS

We developed a theoretical model to explain the causal conditions that triggered transition, how the causal conditions were experienced, the coping strategies used to persist through the first year of practice, and the consequences of those strategies.

CONCLUSIONS

The model provides a framework for new athletic training clinicians, educators, and employers to better understand the transition process in order to help new clinicians respond by accepting or adapting to their environment or their behaviors.

The Role Mentoring Plays in the Transition to Practice of Newly Credentialed Athletic Trainers

CONTEXT

Mentoring has been identified as an important method of supporting newly credentialed athletic trainers (ATs) during their transition to practice. Gaining a better understanding of this relationship could provide valuable insights that may assist employers and professional programs in developing a plan to better facilitate the transition.

OBJECTIVE

To examine which aspects of the mentoring relationship provided the most benefit during transition to practice of newly certified ATs.

DESIGN

Qualitative study.

SETTING

Individual phone interviews.

PATIENTS OR OTHER PARTICIPANTS

A total of 13 ATs who graduated from a professional master's program, were certified from February through July 2016, and obtained employment from July through August of 2016 participated in this study (6 women, 7 men; age = 26 ± 3 years; work settings included professional sports, college, secondary and middle school, and clinic). Data saturation guided the number of participants.

DATA COLLECTION AND ANALYSIS

Phone interviews using a semistructured interview guide were conducted at 3, 8, and 12 months of work experience. Data were analyzed using a constant comparative approach. Credibility was established via investigator triangulation, peer debriefing, and member checks.

RESULTS

Participants recognized the mentoring relationship as a foundational aspect of the transition to practice. Mentors should be available by phone, email, or text to answer questions, provide feedback, or discuss ideas. Respondents wanted honest feedback, even when that feedback was constructively critical. Feedback was sought regarding topics such as patient care, communication, and networking. Participants needed reassurance and support from their mentors to help validate and improve their self-confidence.

CONCLUSIONS

Newly credentialed ATs should seek a mentor who will be available to communicate in various ways and will provide regular and constructive feedback. Future researchers should investigate how mentoring relationships influence other aspects of the transition to practice, such as patient care, overall job performance, turnover, and satisfaction.

Newly Credentialed Athletic Trainers' Perceptions of Their Transition to Practice

CONTEXT

Newly credentialed athletic trainers (ATs) have reported stress and role ambiguity during the transition to practice. Previous researchers focused on their qualitative experiences, yet no investigators have explored how characteristics such as the setting or type of educational program affect the transition to practice.

OBJECTIVE

To determine how newly credentialed ATs perceived their transition to practice.

DESIGN

Cross-sectional study.

SETTING

Online survey.

PATIENTS OR OTHER PARTICIPANTS

Of 1835 newly credentialed ATs (18%) certified and employed between January and September, 332 completed the survey within 3 months of employment (129 men, 203 women; age = 23.58 ± 2.54 years).

MAIN OUTCOME MEASURE(S)

The survey consisted of demographic information (eg, employment setting, job title) and 3 sections: (1) comfort level during the transition (CL), (2) feelings of mentorship and support (MS), and (3) feelings of organizational transition. Participants identified their feelings of nervousness, support, and understanding organizational values using a Likert scale (1 = strongly disagree, 4 = strongly agree). Descriptive statistics were calculated for each survey item. Mann-Whitney U and Kruskal-Wallis (H) tests were used to determine associations between different demographic characteristics and responses regarding orientation and CL, MS, and feelings of organizational transition.

RESULTS

Most participants agreed or strongly agreed that they felt nervous (n = 264, 79.2%) and that the transition was stressful (n = 227, 68.1%) but they felt prepared for their job (n = 262, 78.7%). No differences in CL were present among settings (H = 5.64, P = .228), job titles (H = 4.88, P = .087), or types of professional program (U = 6488, P = .279). Respondents who were assigned a mentor reported better perceptions of MS (U = 6250, P < .001). Most participants felt that supervisors adequately explained administrative procedures during orientation (n = 169, 54.3%) and felt they were adequately oriented to organizational values (n = 252, 75.7%).

CONCLUSIONS

New ATs felt nervous when entering their new role, but having a mentor and receiving a detailed orientation helped alleviate stress during the transition to practice.

Challenges for Newly Credentialed Athletic Trainers During Their Transition to Practice

CONTEXT

Understanding the challenges faced by newly credentialed athletic trainers (ATs) as they transition into clinical practice could assist employers and professional programs in developing initiatives to enhance this transition.

OBJECTIVE

To explore the challenges faced by newly credentialed ATs during their transition from student to autonomous practitioner.

DESIGN

Qualitative study.

SETTING

Individual phone interviews.

PATIENTS OR OTHER PARTICIPANTS

A total of 34 ATs certified between January and September 2013 participated in this study (18 women, 16 men; age = 24 ± 2 years; work settings = college, secondary school, clinic, and other). Data saturation guided the number of participants.

DATA COLLECTION AND ANALYSIS

An interview guide was used. All interviews were recorded and transcribed verbatim. Data were analyzed via phenomenologic reduction, with data coded for common themes and subthemes. Trustworthiness was established via intercoder reliability, member checks, and peer review.

RESULTS

Initially, participants had difficulty making decisions independently. However, making decisions and receiving positive feedback helped them develop confidence. Communication with coaches and parents was challenging, especially for those in the secondary school setting. Participants also experienced role ambiguity, as they were unsure of basic organizational and administrative structures and expectations. Mentor inaccessibility was the final challenge described by respondents. In particular, those in the secondary school setting and with part-time employment felt they did not have a supervisor or mentor whom they could contact for support and guidance.

CONCLUSIONS

Professional programs should educate students on potential challenges to help them understand what they might encounter during the transition to clinical practice. Employers should provide clear expectations and job descriptions to alleviate some of the stress and role ambiguity. If a mentor is not provided by the employer, the newly credentialed AT should seek one to assist during the transition.

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

CONTEXT

  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.

OBJECTIVE

  To explore the transition to practice of newly credentialed graduate assistant ATs providing medical care in the secondary school.

DESIGN

  Phenomenologic qualitative study.

SETTING

  Secondary school.

PATIENTS OR OTHER PARTICIPANTS

  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.

DATA COLLECTION AND ANALYSIS

  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.

RESULTS

  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.

CONCLUSIONS

  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.

Orientation Process for Newly Credentialed Athletic Trainers in the Transition to Practice

CONTEXT

  Orientation is an important part of socialization and transition to practice, yet the orientation process for newly credentialed athletic trainers (ATs) is unknown.

OBJECTIVE

  To determine how newly credentialed ATs are oriented to their roles.

DESIGN

  Cross-sectional study.

SETTING

  Online survey.

PATIENTS OR OTHER PARTICIPANTS

  Three hundred thirty-two of 1835 newly credentialed ATs (18%) certified and employed between January and September of 2013 completed the survey (129 men, 203 women; age = 23.58 ± 2.54 years).

DATA COLLECTION AND ANALYSIS

  The survey consisted of demographic information (eg, employment setting, job title) and 2 sections: (1) orientation tactics and (2) usefulness of orientation tactics. For the first section, participants identified if various orientation tactics were included in their orientations (eg, policies and procedures review). For the second section, participants identified how useful each orientation tactic was on a Likert scale (1 = not useful, 4 = very useful). Descriptive statistics were calculated for each survey item. Mann-Whitney U and Kruskal-Wallis tests were used to determine differences between demographic characteristics and orientation tactics. A Bonferroni correction accounted for multiple comparisons. A panel of experts established the content validity of the survey. The Cronbach α was used to establish internal consistency (α = 0.802) Results:  The most common orientation tactics were meeting with supervisors (n = 276, 82.9%) and staff members (eg, coaches; n = 266, 79.9%) and learning responsibilities (n = 254, 76.2%). The least common orientation tactics were simulation of the emergency action plan (n = 66, 19.8%) and preceptor development (n = 71, 21.3%); however, preceptor development was not applicable to many participants. The most useful orientation tactics were simulating the emergency action plan (3.45/4.0) and meeting with staff members (3.44/4.0). Participants who felt their orientation prepared them for their roles were exposed to more tactics during orientation (Mann-Whitney U = 17 212, P < .001).

CONCLUSIONS

  Many tactics were used to orient newly credentialed ATs to their roles, but orientations varied based on the practice setting.

A Narrative Analysis: Examining the Transition to Practice for the Full-Time Secondary School Athletic Trainer

CONTEXT

  The transition to clinical practice is an important topic in athletic training because it is viewed as a stressful time that is accompanied by self-doubt. Mentorship and previous experience support the transition to practice, but little information is available on the organizational entry of the athletic trainer (AT) who is employed full time in the secondary school setting.

OBJECTIVE

  To understand the experiences of newly credentialed ATs in full-time positions in the secondary school setting.

DESIGN

  Qualitative study.

SETTING

  Secondary schools.

PATIENTS OR OTHER PARTICIPANTS

  Seventeen ATs (4 men, 13 women; age = 25 ± 4 years) were employed full time in the secondary school setting. On average, the full-time ATs worked 40 ± 10 hours per week.

DATA COLLECTION AND ANALYSIS

  All participants completed a semistructured telephone interview with 1 researcher. Data were analyzed using a narrative analysis, and credibility was established by peer review and researcher triangulation. The narrative research paradigm guided our protocol and supported the rigor of the study.

RESULTS

  Our analyses revealed that transition to practice was organic, such that the newly credentialed AT gained awareness by engaging in the role daily. Additionally, the transition process was facilitated by previous experience in the setting, mostly from educational training. Ongoing communication with various stakeholders (athletic directors, team physicians, and peer ATs) in the setting also assisted in the process of transitioning. Finally, mentorship from previous preceptors provided support during the transition process.

CONCLUSIONS

  Transitioning into full-time clinical practice in the secondary school setting was informal and supported by professional relationships and past experiences. Past experiences allowed for awareness but also the development of mentoring relationships that continued beyond the clinical education experience. Communication also assisted the newly credentialed AT, as it provided feedback for legitimation by multiple stakeholders.

Support Received During the Transition to Practice for the Secondary School Graduate-Assistant Athletic Trainer

CONTEXT

Transitioning into clinical practice can be stressful for the newly credentialed athletic trainer (AT). The support provided by mentors, peers, and athletic training faculty can increase confidence and enhance the transition. To create specific initiatives for a smoother transition, the perspectives of those in the secondary school setting are needed.

OBJECTIVE

To examine the transition to practice and mentorship of newly credentialed ATs providing medical care in the secondary school setting.

DESIGN

Qualitative study.

SETTING

Secondary school setting.

PATIENTS OR OTHER PARTICIPANTS

A total of 14 ATs (2 men, 12 women; age = 23.0 ± 2.0 years) participated in our study. They 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.

DATA COLLECTION AND ANALYSIS

We completed 14 semistructured phone interviews. Interviews were recorded and transcribed verbatim. Two researchers independently following the stepwise progression of a general inductive approach completed the data analysis. Trustworthiness was established through multiple-analyst triangulation, peer review, and member checks.

RESULTS

Two major themes emerged regarding the support received by our participants: past mentors and current networks of professionals. Past mentors provided autonomous learning opportunities during clinical education and then served as resources for guidance and advice. Current networks of professionals were defined by 2 subthemes: professional medical care providers and non-medical care providers within the secondary school setting (ie, athletic directors, coaches, parents).

CONCLUSIONS

Former preceptors and faculty provided resources and support to help develop the newly credentialed AT's confidence and facilitate the transition. Preceptors should allow increased independence to help their students develop as clinicians. The creation of networks within the community, that is, the secondary school itself, is also critical in the transition as it provides the AT with role legitimation.

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

CONTEXT

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.

OBJECTIVE

To explore the professional socialization of GAs in the collegiate setting.

DESIGN

Qualitative study.

SETTING

Phone interviews.

PATIENTS OR OTHER PARTICIPANTS

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 COLLECTION AND ANALYSIS

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.

RESULTS

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.

CONCLUSIONS

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.

Exploring the Perceptions of Newly Credentialed Athletic Trainers as They Transition to Practice

CONTEXT

Research is limited on the transition to practice of newly credentialed athletic trainers (ATs). Understanding this transition could provide insight to assist employers and professional programs in developing initiatives to enhance the transition.

OBJECTIVE

To explore newly credentialed ATs' experiences and feelings during their transition from student to autonomous practitioner.

DESIGN

Qualitative study.

SETTING

Individual phone interviews.

PATIENTS OR OTHER PARTICIPANTS

Thirty-four ATs certified between January and September 2013 participated in this study (18 women, 16 men; age = 23.8 ± 2.1 years; work settings were collegiate, secondary school, clinic, and other). Data saturation guided the number of participants.

DATA COLLECTION AND ANALYSIS

Participants were interviewed via phone using a semistructured interview guide. All interviews were recorded and transcribed verbatim. Data were analyzed through phenomenologic reduction, with data coded for common themes and subthemes. Credibility was established via member checks, peer review, and intercoder reliability.

RESULTS

The 3 themes that emerged from the data were (1) transition to practice preparation, (2) orientation, and (3) mentoring. Transition to practice was rarely discussed during professional preparation, but information on the organization and administration or capstone course (eg, insurance, documentation) assisted participants in their transition. Participants felt that preceptors influenced their transition by providing or hindering the number and quality of patient encounters. Participants from larger collegiate settings reported more formal orientation methods (eg, review policies, procedures manual), whereas those in secondary school, clinic/hospital, and smaller collegiate settings reported informal orientation methods (eg, independent review of policies and procedures, tours). Some participants were assigned a formal mentor, and others engaged in peer mentoring.

CONCLUSIONS

Employers could enhance the transition to practice by providing formal orientation and mentorship. Professional programs could prepare students for the transition by discussing how to find support and mentoring and by involving preceptors who provide students with opportunities to give patient care.

Orientation Tactics Utilized in Postprofessional Athletic Training Programs

Context: Some newly credentialed athletic trainers pursue a postprofessional degree with a curriculum that specifically advances their athletic training practice. Orientation sessions are a tactic used to assist these students' transition into these new roles of graduate student and independent clinician, yet the structure of these sessions is unknown.

Objective: Understand how postprofessional athletic training programs' orientation session structure integrates new students.

Design: Qualitative.

Setting: Semistructured phone interviews.

Patients or Other Participants: Nineteen program directors (10 men, 9 women) from 13 Commission on Accreditation of Athletic Training Education–accredited and 6 unaccredited postprofessional athletic training programs.

Main Outcome Measure(s): Phone interviews were digitally recorded and transcribed verbatim. Data analysis used the principles of conventional content analysis. Credibility was maintained using peer review, member checks, and researcher triangulation.

Results: Orientation sessions were used to familiarize students with policies, procedures, and expectations regarding their roles as student and clinician. These sessions occurred before role engagement, and were described by the themes type and time. Type referred to whether the orientation session was blended or individual. Blended sessions discussed information pertaining both to the academic program, such as course registration and research expectations, and to the clinical information affecting the graduate assistantship. Individual orientation sessions, on the other hand, discussed only academic program information or clinical information, not both. Time referred to the frequency of the orientation sessions. One-time orientation sessions occurred over the course of 1 day or 1 week, after which no additional orientation activities occurred. Conversely, ongoing orientation occurred throughout the semester.

Conclusions: Postprofessional athletic training programs used different orientation methods to help newly credentialed athletic trainers transition into graduate students and practicing clinicians.

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

CONTEXT

The graduate-assistant position can be a highly influential experience because it is often the first time novice athletic trainers (ATs) are practicing autonomously.

OBJECTIVE

To gain an understanding of how graduate-assistant ATs (GAATs) perceive professional socialization and mentorship during their assistantships.

DESIGN

Semistructured phone interviews.

SETTING

Graduate-assistant ATs in various clinical settings.

PATIENTS OR OTHER PARTICIPANTS

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.

DATA COLLECTION AND ANALYSIS

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.

RESULTS

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.

CONCLUSIONS

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.