Search

Context Athletic training is a multifaceted profession characterized by interpersonal relationships and a team approach to care. Collaborative relationships, by nature, open the door to conflict, which has been reported frequently in the collegiate athletic setting. However, secondary school athletic trainers' (ATs') experiences with conflict and pressure in their role are not readily understood. Objective To measure the extent and sources of stress, pressure, and conflict within the secondary school athletic training setting and determine if differences exist across employment characteristics. Design Cross-sectional study. Setting Secondary school athletics. Patients or Other Participants Secondary school ATs (n = 725, age = 39.8 ± 10.5 years, years certified = 16.7 ± 9.7, years in current role = 10.6 ± 7.8). Main Outcome Measures Participants were asked to reply to an online questionnaire with quantitative measures pertaining to organizational conflict and workplace dynamic. Employment type (school district employee, school district teacher, medical or university facility, independent contractor) and status (full time, part time) served as independent variables. Likert-scale scores (1 = strongly agree to 5 = strongly disagree; 1 = always to 5 = never) and perceived sources of stress, pressure, and conflict were the dependent variables. Analyses consisted of Kruskal-Wallis tests with Mann-Whitney U post hoc tests and odds ratios to assess associations between variables of interest. Results We obtained a 15.3% response rate (725/4745). Although the ATs reported experiencing conflict and pressure, these experiences were relatively infrequent and not universal. Compared with part-time ATs, full-time ATs described higher ratings of strong relationships with coaches (P = .003) and principals (P = .002). The most frequently identified sources of conflict were parents (59%) and coaches (53.9%), followed by athletes (32.6%). Full-time ATs were 1.6 times more likely to report experiencing conflict with a coach than part-time ATs (odds ratio = 1.550, 95% CI = 1.037, 2.317; P = .040). Conclusions Secondary school ATs' experiences regarding organizational conflict were relatively positive. Instances of pressure and conflict were noted, though relatively infrequently, and these experiences were largely uninfluenced by employment type.

Context Perceived stress and burnout are significant concerns among athletic trainers (ATs) due to growing professional demands. The global COVID-19 pandemic brought additional stressors, especially for health care providers, including the need to learn and integrate new skill sets in order to continue providing safe and effective patient care. Objective To explore the influence of COVID-19 stressors on ATs engaged in patient care. Design Cross-sectional study. Setting Internet survey. Patients or Other Participants A total of 429 ATs (age = 33 ± 9 years; experience = 11 ± 9 years; 74 men, 355 women) currently providing patient care. Main Outcome Measure(s) We recruited participants from social media sites to complete a questionnaire with the Coronavirus Anxiety Scale (CAS), Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS MP), and qualitative questions related to the effects of COVID-19. We calculated correlations between CAS and MBI-HSS MP composite scores (emotional exhaustion, personal accomplishment, and depersonalization) and used regression analysis to explore if CAS scores could be predicted by vaccination status (vaccinated or unvaccinated), sex, and MBI-HSS MP composite scores. We analyzed the qualitative data using a phenomenological, inductive approach with multianalyst triangulation and peer review as trustworthiness strategies. Results Significant correlations existed between CAS and MBI-HSS MP composite scores (P < .001). Emotional exhaustion (P < .001) and depersonalization (P = .008) explained 28% of the variance in CAS scores (F2,405 = 81.29, P < .001). Three major areas of focus emerged: effects on wellness, emphasis on the value of athletic training, and the lessons learned and future innovation to inform potential long-term changes in the athletic training profession. Conclusions Key factors of emotional exhaustion and depersonalization during the pandemic may have exacerbated the potential for burnout among ATs. The pandemic affected ATs' wellness, changed perceptions of ATs, and altered operating procedures. Healthy coping strategies and organizational support are suggested for those who are struggling.

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 study objective was to determine the magnitude and frequency of head impacts in NCAA Division III soccer athletes based on player position and type of play (offense, defense, transition). Across player position, male and female soccer defenders sustained the most head impacts (males IR = 18.89, 95% CI = 16.89–20.89; females IR = 8.45, 95% CI = 7.25–9.64; IRR = 2.23, 95% CI = 1.87–2.67). The study revealed a nonstatistically significant interaction between sex, player position, and type of play for both linear (p = .42) and rotational accelerations (p = .16). Defenders sustained the majority of the head impacts in the study sample, suggesting preventative initiatives should be focused on back row players.

Context Conflict is prevalent between sports medicine professionals and coaching staffs regarding return-to-play decisions for athletes after injury in the National Collegiate Athletic Association (NCAA) Division I setting. The firsthand experiences of athletic trainers (ATs) regarding such conflict have not been fully investigated. Objective To better understand the outside pressures ATs face when making medical decisions regarding patient care and return to play after injury in the NCAA Division I Football Bowl Subdivision (FBS) setting. Design Qualitative study. Setting Semistructured one-on-one telephone interviews. Patients or Other Participants Nine ATs (4 men, 5 women; age = 31 ± 8 years [range = 24–48 years]; years certified = 9 ± 8). Data Collection and Analysis Interviews were audio recorded and later transcribed. Thematic analysis was completed phenomenologically. Researcher triangulation, peer review, and member checks were used to establish trustworthiness. Results Two major themes emerged from the qualitative analysis: (1) pressure is an expected component of the Division I FBS AT role, and (2) strategies can be implemented to mitigate the negative effects of pressure. Three subthemes supported the second major theme: (1) ensuring ongoing and frequent communication with stakeholders about an injured athlete's status and anticipated timeline for return to play, (2) providing a rationale to coaches or administrations to foster an understanding of why specific medical decisions are being made, and (3) establishing positive relationships with coaches, athletes, and administrations. Conclusions External pressure regarding medical decisions was an anticipated occurrence for our sample. Such pressure was described as a natural part of the position, not negative but rather a product of the culture and environment of the Division I FBS setting. Athletic trainers who frequently face pressure from coaches and administration should use the aforementioned strategies to improve the workplace dynamic and foster an environment that focuses on patient-centered care.

Significant evidence has emerged that a high volume of sprinting during training is associated with an increased risk of non-contact injuries in professional soccer players. Training load has been reported as a modifiable risk factor for successive injury in soccer. Sprint workload measures and non-contact injuries were recorded weekly in twenty-one professional soccer players over a one season period. Odds ratio (OR) and relative risk (RR) were calculated based on the weeks of high and low load of total distance (TD), high-speed distance (HSD), sprint distance (SPD). and repeated sprints (RS). The Poisson distribution estimated the interval time between the last injury and the new injury. The weeks with high-load levels increased the risk of non-contact injury associated with TD (OR: 4.1, RR: 2.4), HSD (OR: 4.6, RR: 2.6), SPD (OR: 6.9, RR: 3.7), and RS (OR: 4.3, RR: 2.7). The time between injuries was significantly longer in weeks of low-load in TD (rate ratio time (RRT) 1.5 vs. 4.2), HSD (RRT: 1.6 vs. 4.6), and SPD (RRT: 1.7 vs. 7.7) compared to weeks of high-load. The findings highlight an increased risk of non-contact injuries during high weekly sprint workloads. Possibly, TD, HSD, and SPD measured via a wearable inertial measurement unit could be modeled to track training and to reduce non-contact injuries. Finally, the interval time between the last injury and the new injury at the high-load is shorter than the low-load.

Context Conflict between athletic trainers (ATs) and other stakeholders can occur because of competing interests over medical decisions regarding concussion. However, we are unaware of any studies specifically exploring these situations across various collegiate athletic affiliations. Objective To investigate the challenges faced by ATs when treating concussed student-athletes. Design Qualitative study. Setting Online questionnaire. Patients or Other Participants A total of 434 ATs (267 women, 166 men, 1 missing data; age = 27.73 ± 3.24 years, experience = 5.17 ± 2.67 years) completed the questionnaire (response rate = 14.47%). Our participants represented multiple employment settings within intercollegiate athletics. Data Collection and Analysis We sent an online questionnaire to 3000 ATs working in the collegiate and university setting across the United States. A survey expert verified face, content, and construct validity of the questionnaire in 2 rounds of review, and 3 ATs completed a content-validity tool before we finalized the survey. We analyzed the qualitative data using a general inductive approach and ensured trustworthiness through multiple-analyst triangulation and peer review. Results When we examined the responses from our participants regarding their work with student-athletes who had sustained concussions, we found 2 major themes, each with subthemes. First, educational efforts appeared to be only modestly effective because of a lack of honesty, noncompliant actions, and coach interference. Second, return to learn was challenging because of a lack of communication among stakeholders, athletes being anxious about needing accommodations, and difficulty convincing faculty to provide reasonable accommodations. Conclusions Based on our findings, we recommend continued efforts to improve the culture surrounding concussion in collegiate athletes. Athletic trainers should include key stakeholders such as coaches, student-athletes, parents, faculty, and other educational administrators in their educational efforts to improve the policies and culture surrounding concussion treatment.

In 2015, new practice recommendations to remove equipment prior to transport when cervical spine injury is suspected were released. The purpose of this study was to determine current emergency management practices and perceptions of the new practice recommendation. We received completed mixed-method surveys from 143 athletic trainers practicing in the Mid-Atlantic region (response rate = 10.11%). The majority of respondents stated that the number of personnel required, along with the training and time to practice equipment removal, were barriers to implementation. Requiring assistance from emergency medical services (EMS) was common, but many failed to practice with local EMS. Emergency management procedures should be appropriate given the resources (personnel and training) available. Collaboration between athletic trainers and EMS is needed.

Context Professional master's athletic training students are at high risk for changes in mood state and an increase in burnout levels during an academic semester due to stressors including academic workload, clinical expectations, and/or research projects, among other factors. Objective To determine mood states and burnout levels among professional master's students during the middle and end of an academic semester. Design Cross-sectional study. Setting Online survey. Patients or Other Participants The sample consisted of first and second year professional master's students (males = 11, females = 30, age = 23.39 ± 1.44 years) who attended Commission on Accreditation of Athletic Training Education accredited athletic training programs. Interventions The independent variable was time (midsemester and end of semester). We sent the link to the online survey via e-mail to program directors and asked them to forward it to all students in the professional master's programs they led. Main Outcome Measure(s) The dependent variables were the subsets of burnout (depersonalization [DP], personal accomplishment, and emotional exhaustion [EE]) along with the overall mood state score. We used the modified 22 item Maslach Burnout Inventory and the modified 40 item Profile of Mood States. Results Burnout scores from the personal accomplishment subscale of the Maslach Burnout Inventory were statistically different between the 2 time points ({\rm{\chi }}_1^2 = 5.765, P = .016) in comparison to DP ({\rm{\chi }}_1^2 = 0.027, P = .869) and EE ({\rm{\chi }}_1^2 = 1.256, P = .262). For Profile of Mood States scores, the composite total mood disturbance score was not statistically different between the 2 time points ({\rm{\chi }}_1^2 = 0.200, P = .655). Conclusions Our findings indicated that, as a whole, high level stressors were reported from lack of personal accomplishment. Clinically, mood states were reported to not change from midsemester to end of the semester.

Context Newly credentialed athletic trainers are expected to be independent practitioners capable of making their own clinical decisions. Transition to practice can be stressful and present challenges for graduates who are not accustomed to practicing independently. Objective Explore the perceptions of professional master's students as they prepare to experience role transition from students to autonomous clinical practitioners. Design Qualitative study. Setting Nine higher education institutions. Patients or Other Participants Fourteen athletic training students (7 male, 7 female, age = 25.6 ± 3.7 years) participated. Main Outcome Measure(s) Participants completed a semistructured interview over the phone which focused on the perception of preparedness to enter clinical practice. All transcribed interviews were analyzed using a general inductive approach. Multiple-analyst triangulation and peer review were used to ensure trustworthiness. Results We found themes for facilitators and challenges to transition to autonomous clinical practice. Students felt prepared for independent practice due to (1) mentoring networks they had developed, (2) exposure to the breadth of clinical practice, and (3) autonomy allotted during clinical education. Potential challenges included (1) apprehension with decision making and (2) a lack of confidence. Conclusions Our findings suggest graduates from professional master's programs, although ready for clinical practice, may require more time and exposure to autonomous practice to build confidence. Professional master's program administrators should work to provide clinical education experiences that expose students to a wide variety of clinical situations (patients, settings, preceptors) with appropriate professional role models while providing decision making autonomy within accreditation standards.

Strength training using high and lower load such as contrast training (CST) seems to be beneficial as it addresses larger adaptive reserves in youth athletes. Therefore, the aim of this study was to investigate the effects of CST on dynamic balance (composite score during dynamic balance test (CS-YBT)), one repetition maximum lower-limb back squat (1RM), jumping performance (single-leg hop (SLH) or countermovement jump height (CMJ)), lower-limb asymmetry (predicted from the single-leg jump performance between two legs [ILA]) in elite youth male volleyball players. Thirty-one male youth volleyball players aged 14 years were randomly assigned to a CST group (n = 16) or a control group (n = 15). The tests were performed before and after 8 weeks of training. Significant group × time interactions was observed for CS-YBT [p < 0.001, ηp2 = 0.70], 1RM [p < 0.001, ηp2 = 0.95], SLH with right and left leg [p < 0.001, ηp2 = 0.69 and 0.51], CMJ [p < 0.001, ηp2 = 0.47]), whilst it was not notable in ILA [p < 0.294]. Post hoc tests showed that CST group demonstrated greater improvement in all of the dependent variables from medium to large effect size (for all p < 0.001). As a result, 8 weeks of CST twice a week can be an effective and efficient training along with volleyball training to improve skill-related fitness measures, except for lower-limb asymmetry in young volleyball players.

Context: Teaching, scholarship, and service are required of all faculty in order to earn tenure. Faculty members hired directly from doctoral programs may not be adequately prepared to face the responsibilities of a full-time position in the professoriate. Objective: To explore what mechanisms as part of doctoral education influenced the perceptions of junior faculty development while transitioning postgraduation. Design: Qualitative phenomenological study. Setting: Fourteen higher education institutions. Patients or Other Participants: Sixteen junior faculty (7 male, 9 female, age = 32 ± 3.5 years) representing 7 National Athletic Trainers' Association districts participated. At the time of the interview, participants were within their first 3 years of a full-time faculty position. All participants earned doctorates from residential programs and had an assistantship position. Main Outcome Measure(s): All participants completed a semistructured telephone interview. The interview guide was focused on the experiences of junior faculty within their first 3 years in a tenure-track position. Questions were grounded within the literature and purpose of the study. We analyzed the interviews through a psychosocial developmental lens using a general inductive approach. Results: Two themes of doctoral preparation emerged that influenced the perceptions of junior faculty transitioning into a faculty role: breadth and depth of the doctoral assistantship and doctoral coursework related to academia. Doctoral assistantships with breadth and depth helped participants develop competence, while doctoral coursework related to academia provided content expertise. Conclusions: Doctoral education is the platform for transition into academia. Our findings suggest that doctoral program assistantships that provided both breadth and depth of experience facilitated transition. Coursework related to academia influenced perceptions of transition into the faculty role by exposing participants to pedagogy and higher education infrastructure.

Context:The responsibilities of new faculty members can be stressful because of the expectations of research, teaching, service, and for some, administration. The strain from transition and role complexity can impact faculty members' perceptions of the experience and therefore professional development.Objective:To understand how individual characteristics and behaviors influenced development of new faculty during their transition from doctoral students to faculty members.Design:Qualitative phenomenology study.Setting:Higher education institutions with Commission on Accreditation of Athletic Training Education-accredited athletic training programs.Patients or Other Participants:Sixteen junior faculty (7 males, 9 females, age = 32 ± 3.5 years) representing 7 National Athletic Trainers' Association districts and 14 different higher education institutions participated.Main Outcome Measure(s):A semistructured telephone interview protocol was used to examine the experiences of junior faculty within their first 3 years of a faculty role. Interviews were coded inductively using a psychosocial developmental interpretive lens. Credibility was established with saturation of the findings and researcher triangulation.Results:The data revealed 3 individual behavioral characteristics positively influenced the development of junior faculty through transition: (1) adaptive perfectionism, (2) competence gained through experience, and (3) the use of a mentor network. Our participants adapted personal expectations in light of outcomes that differed from personal standards; gained competence by seeking experience before, during, and after their doctoral studies; and used a mentor network to ease transition.Conclusions:Our findings suggest that individuals who are able to reflect on their performance and self-adjust personal standards and/or behaviors have a positive perception related to their ability to be successful during transition. Competence gained through experience apart from doctoral assistantships appears to facilitate the transition into higher education. Also, the creation and maintenance of a mentor network that provides a variety of support from multiple sources appears to improve transition by providing comradery, security, and help.

Quantifying head impacts is a vital component to understanding and preventing head trauma in sport. Our objective was to establish the frequency and magnitude of head impact mechanisms in men’s lacrosse athletes. Eleven male lacrosse athletes wore xPatch sensors during activity. Video footage of practices and games was analyzed to verify impacts and code them with impact mechanisms. The authors calculated incidence rates (IRs) per 1000 exposures with corresponding 95% confidence intervals (CIs) and used multivariate analysis of variances to compare the linear (g) and rotational (rad/s2) accelerations between mechanisms. A total of 167 head impacts were successfully verified and coded with a mechanism using video footage during 542 total exposures. The highest IR was head to body (IR = 118.08; 95% CI, 89.15–147.01), and the lowest was head to ball (IR = 3.69; 95% CI, 0–8.80) (incidence rate ratio = 32.00; 95% CI, 67.83–130.73). Analysis indicated that impact mechanism failed to significantly alter the combined dependent variables (multivariate F10,306 = 1.79, P = .06, η2 = .06, 1−β = 0.83). While head to head, body to head, and stick to head mechanisms are penalty-inducing offenses in men’s lacrosse, head to ground, head to ball, and combination impacts have similar head accelerations. If penalties and rules are created to protect players from traumatic head injury, the authors recommend stricter enforcement.

Background A reliable measure of dynamic postural control is needed for inclusion in the sports-related concussion assessment battery. Currently, there is not a clinical gold standard. The Limits of Stability (LOS) test has potential to be a useful tool to collect objective data on important dynamic postural stability variables. Psychometric properties of the LOS test with healthy young adults are yet to be established. Hypothesis/purpose The purpose of this study was to examine the intra-session and test-retest reliability for the LOS on the NeuroCom® VSR Sport when performed by young adults. Study design Reliability study. Methods Twenty-seven healthy university students completed four trials of the LOS in each of two testing sessions one week apart. Relative reliability was measured within each session with an intraclass correlation coefficient (ICC[3,k]) for Session 1 and Session 2, respectively, on each of the five dependent variables (movement velocity [MVL], directional control [DCL], maximum excursion [MXE], endpoint excursion [EPE], and reaction time [RT]) provided by the Neurocom. Test-retest reliability was assessed using a repeated-measures analysis of variance along with an ICC (3,k) for relative reliability. An ICC value of 0.90 or higher was defined as having a high reliability, moderate reliability for ICC values between 0.80-0.89, and below 0.80 as questionable. Results The reliability within each session for LOS composite scores for MVL, DCL, and MXE was moderate to high (ICC[3,k]=0.89-0.95). These same three variables also had high levels of test-retest reliability (ICC[3,k]=0.95-0.96). EPE and RT had moderate reliability over time (ICC[3,k]=0.88) but differences for within session reliability. Conclusions LOS provides a reliable measure of dynamic postural control for young adults. Two trials are recommended at baseline with the first being an adaptation trial to ensure accuracy of findings. Care needs to be taken when interpreting EPE and DCL scores on post-injury tests due to a learning effect for those variables. Level of evidence 2c.

Context: Evidence suggests that doctoral education is incongruent with faculty positions, but this has yet to be specifically examined in athletic training. Objective: To gain understanding of the alignment of doctoral education and faculty workload, including institutional characteristics, from the perspectives of junior faculty members. Design: Qualitative, phenomenological research. Setting: Higher education institutions with Commission on Accreditation of Athletic Training Education–accredited programs. Patients or Other Participants: Twenty athletic training faculty members (14 women and 6 men) who were 32 ± 3 years of age and averaged 10 ± 4 years of experience as athletic trainers and 2 ± 2 years as a full-time faculty member. Main Outcome Measure(s): We developed, peer-reviewed, and piloted 2 semistructured interview guides to obtain participants' perspectives on their doctoral preparation, entrance into higher education, and faculty workload. We completed telephone interviews with each participant over the course of 4 months. Transcribed interviews were analyzed by 2 investigators using a phenomenological approach, then reviewed by 2 additional qualitative researchers. Mechanisms of trustworthiness included member-checking, multianalyst triangulation, and peer review. Results: Two themes emerged from this study: (1) workload and (2) congruency. Faculty workload was dominated by teaching, but faculty had several demands on their time, including administration, service, and research. Most faculty positions focused on teaching, whereas their doctoral education was more focused on research, possibly because of a lack of congruency between doctoral education and faculty position institution types. Although mismatches occurred between doctoral education and faculty workload, participants were often aware of these differences and selected faculty positions aligned with their career goals. Conclusions: Faculty workload is generally teaching-focused and contains additional demands that are often not included in doctoral education programs. Doctoral advisors should promote adequate socialization to these characteristics of faculty positions, and doctoral students should consider their interests and faculty workload when searching for faculty positions.

Context: Patient ventilation volume and rate have been found to be compromised due to the inability to seal a pocket mask over the chinstrap of football helmets. The effects of supraglottic airway devices such as the King LT and of lacrosse helmets on these measures have not been studied. Objective: To assess the effects of different airway management devices and helmet conditions on producing quality ventilations while performing cardiopulmonary resuscitation on simulation manikins. Design: Crossover study. Setting: Simulation laboratory. Patients or Other Participants: Thirty-six athletic trainers (12 men, 24 women) completed this study. Intervention(s): Airway-management device (pocket mask, oral pharyngeal airway, King LT airway [KA]) and helmet condition (no helmet, Cascade helmet, Schutt helmet, Warrior helmet) served as the independent variables. Participant pairs performed 2 minutes of 2-rescuer cardiopulmonary resuscitation under 12 trial conditions. Main Outcome Measure(s): Ventilation volume (mL), ventilation rate (ventilations/min), rating of perceived difficulty (RPD), and percentage of quality ventilations were the dependent variables. Results: A significant interaction was found between type of airway-management device and helmet condition on ventilation volume and rate (F12,408 = 2.902, P < .0001). In addition, a significant interaction was noted between airway-management device and helmet condition on RPD scores (F6,204 = 3.366, P = .003). The no-helmet condition produced a higher percentage of quality ventilations compared with the helmet conditions (P ≤ .003). Also, the percentage of quality ventilations differed, and the KA outperformed each of the other devices (P ≤ .029). Conclusions: The helmet chinstrap inhibited quality ventilation (rate and volume) in airway procedures that required the mask to be sealed on the face. However, the KA allowed quality ventilation in patients wearing a helmet with the chinstrap fastened. If a KA is not available, the helmet may need to be removed to provide quality ventilations.

Context:Work-life balance has become a growing concern in athletic training, but little is known about the experiences of faculty and finding it. Challenges in finding work-life balance have been reported among faculty in higher education, and those who are new to a role are often susceptible to increased stress and overload.Objective:Examine junior athletic training faculty members' experiences with work-life balance during their role inductance.Design:Qualitative inquiry.Setting:Higher education institutions.Patients or Other Participants:Sixteen junior faculty (7 male, 9 female) representing 7 National Athletic Trainers' Association districts participated. The average age of the junior faculty members was 32 ± 3.5 years. Twelve were in tenure track and 4 had non–tenure track positions.Main Outcome Measure(s):All participants completed phone interviews with one researcher following a semistructured interview protocol. Recorded interviews were transcribed and analyzed following a phenomenological approach. We intentionally selected 3 primary measures of trustworthiness to establish the rigor of the study: (1) peer review, (2) multiple-analyst triangulation, and (3) researcher triangulation.Results:Three factors were identified as inhibitors of work-life balance for junior faculty: (1) role inductance, (2) research and teaching, and (3) upcoming deadlines. Two organizational strategies (flexibility and mentorship) and 2 individual strategies (time management and personal outlets) emerged as facilitators for work-life balance.Conclusions:Junior faculty in athletic training can experience conflict in balancing their roles as faculty members as well as their outside and own personal interests. The data support previous literature, and illustrates that organizational factors precipitate imbalance and a combination of organizational and individual strategies promote balance.

Context: New faculty are expected to teach, be productive scholars, and provide service in order to earn tenure, but few experience the full spectrum of faculty responsibility during doctoral preparation. Recent evidence suggests mentorship and orientation are important during role transition. However, how employers facilitate role transition for new faculty remains unclear. Objective: Examine the perspectives of junior faculty members' organizational socialization into higher education, specifically focusing on mentorship and orientation sessions. Design: Qualitative study. Setting: Fourteen higher education institutions. Patients or Other Participants: Sixteen junior faculty (7 male, 9 female; age = 32 ± 3.5 years) representing 7 National Athletic Trainers' Association districts participated. At the time of the interview, all participants were within their first 3 years of a full-time faculty position. Main Outcome Measure(s): All participants completed a semistructured telephone interview. The interview guide was focused on the experiences of junior faculty and was developed based upon the literature and purpose of the study. We analyzed the transcribed interviews using a general inductive approach. Results: Mentors provided support to assist in the transition to faculty positions on a variety of topics, although formal mentoring programs are identified as helpful only if a relationship develops. Regarding the second theme, participants noted orientation sessions organized by the institution or department that provided a clear overview of the position. However, despite their use, many described the orientation sessions as not providing essential information that would have been helpful. Additionally, tenure and promotion processes often had purposefully vague criteria regardless of how thorough the explanation, leading to stress. Conclusions: Our findings suggest that higher education administrators help new athletic training faculty transition by providing mentors and orientation sessions. Findings also suggest that these experiences, at times, are not comprehensive and caused the transition to academe to be stressful.

Context: It is important to understand the process whereby athletic trainers learn about their future roles, particularly when the roles can be complex and demanding. Little is known about the experiences of athletic training doctoral students, including facilitators and barriers to socialization as aspiring faculty members. Objective: To investigate factors influencing the anticipatory socialization of athletic training doctoral students into future faculty roles. Design: Qualitative study. Setting: Universities with athletic training doctoral students. Patients or Other Participants: We recruited 28 students (19 women, 9 men, age = 28 ± 3 years) with a minimum of 1 year of doctoral coursework completed and participating in an assistantship at the time of the study to reach data saturation. Participants were certified for 6 ± 3 years and represented 5 National Athletic Trainers' Association districts and 9 institutions. Data Collection and Analysis: We completed semistructured, 1-on-1 telephone interviews with participants. We transcribed each interview verbatim and analyzed the data using an inductive approach. Peer review, multiple-analyst triangulation, and member checks ensured trustworthiness. Results: We uncovered 4 themes from our analysis related to facilitators and barriers to professional socialization. Participants described comprehensive autonomous experiences in research that allowed them to feel confident they could sustain a scholarly agenda. Independent experiences and lack of pedagogy training yielded mixed preparedness relative to teaching responsibilities. Limited formal experience led to incomplete role understanding related to the service component of the professoriate. Finally, with regard to the administrative duties associated with athletic training faculty positions, participants noted a lack of direct exposure to common responsibilities. Conclusions: Role occupation in various aspects of the professoriate helped doctoral students prepare as future faculty members, although full role understanding was limited. Intentional exposure to research, teaching, service, and administrative expectations during doctoral experiences may facilitate the socialization of future athletic training faculty into academic roles.

Context:Educational reform is occurring again in athletic training. The profession, at this time, should reflect on the structure of clinical education, particularly with direct supervision. Clinical education plays a critical role in the development of future practitioners and should provide students with a chance to gain autonomous experience, with appropriate feedback and discourse.Objective:In this commentary, we discuss direct supervision and present an alternative model for supervision (graduated supervision) in athletic training.Background:Currently, there are concerns regarding the readiness of students to transition to independent practice. These trepidations are centered on the policies related to direct supervision and chances for students to gain autonomous experiences needed to prepare them to make clinical decisions.Synthesis:Graduated supervision may provide an alternative lens for athletic training to regulate clinical education, while facilitating experiences that can assist in student development and preparedness to transition into independent, credentialed patient care.Results:Athletic training supervision policies do not align with other health care professions, yet a major impetus for educational reform was founded on the premise that we should model our degree level more comparably.Recommendation(s):Programs should allow for supervision that encompasses a trusting relationship between preceptors and students. Supervision can be modified (more versus less constant interactions) based upon the students' performance, knowledge, and skills. Shifting the way supervision is implemented can still allow for ensuring patient and student safety, but also allow for students to become critical thinkers.Conclusion(s):Direct supervision policies should be updated to allow students to develop confidence, competence, and critical thinking abilities as well as to better align the athletic training profession with other health care programs.

Context:Athletic training students' ability to transition into professional practice is a critical component for the future of the profession. However, research on professional master's students' transition to practice and readiness to provide autonomous care is lacking.Objective:To determine professional master's athletic training students' perceptions regarding how they were prepared to transition to practice as clinicians.Design:Qualitative study.Setting:Professional master's athletic training programs.Patients or Other Participants:Sixteen students, 8 program directors, and 5 faculty members from professional master's athletic training programs.Main Outcome Measure(s):An online questionnaire was distributed via Qualtrics and analyzed using an inductive technique. Participants responded to a series of open-ended questions related to the structure and curricular offerings of their respective programs. We secured trustworthiness through multiple analyst triangulation and peer review.Results:We found that both students and faculty identified clinical education as the major facilitator in the socialization process used to prepare students for the transition into clinical practice. Three further subthemes emerged: (1) Both stakeholder groups felt that students gained experience through diverse and immersive clinical education experiences; (2) Preceptors provided mentorship; and (3) Students developed confidence to enter clinical practice as a result of these supported experiences.Conclusions:Professional master's programs provide clinical education experiences designed to help athletic training students gain the skills and confidence necessary to become autonomous practitioners. The diversity and mentorship contained within these experiences facilitates confidence and preparedness.

Context Organizational conflict, particularly between coaches and medical professionals, has been reported in collegiate athletics. Different values create room for conflict between coaches and athletic trainers (ATs); however, ATs' experiences when making medical decisions are not fully understood. Objective To investigate the presence of organizational conflict regarding medical decision making and determine if differences exist across athletic affiliations. Design Cross-sectional study. Setting Collegiate athletics (National Collegiate Athletic Association [NCAA], National Association of Intercollegiate Athletics [NAIA], National Junior College Athletic Association [NJCAA]). Patients or Other Participants A total of 434 ATs responded (age = 27.7 ± 3.2 years, years certified = 5.2 ± 2.7), representing the NCAA Division I (DI; n = 199), Division II (DII; n = 67), Division III (DIII; n = 108); NAIA (n = 37); and NJCAA (n = 23) settings. Main Outcome Measure(s) The survey instrument contained quantitative measures and open-ended questions, with affiliation as our primary independent variable. Responses to Likert-scale questions (1 = strongly agree, 5 = strongly disagree) regarding organizational pressures within athletics served as the dependent variables. Kruskal-Wallis analysis-of-variance and Mann-Whitney U post hoc tests assessed differences in organizational conflict across affiliations. Open-ended questions were analyzed inductively. Results We obtained a 14.47% (434 of 3000) response rate. National Collegiate Athletic Association DI ATs disagreed less than NCAA DII and DIII and NJCAA ATs that they would worry about job security if turnover in the head coaching position occurred (P < .05). Regarding the influence of coaches on job performance, differences were found between NCAA DI and DIII and between DI and NJCAA ATs (P < .01). Visibility of the injury and situational factors influenced the level of perceived pressure. Conclusions Athletic trainers perceived pressure from coaches regarding medical decision making. Division I ATs placed greater emphasis on the role that coaches played in their job performance and job security. Athletic departments should consider transitioning to patient-centered models of care to better align values and reduce the external pressures placed on ATs.

The commissioners of the Commission on Accreditation of Athletic Training Education (CAATE) and the Board of Directors of the National Athletic Trainers’ Association (NATA) have acted to move the professional degree in athletic training from a bachelor’s degree to a graduate degree. The decision was largely based upon growth of the profession and aligning with the face of healthcare education. Therefore, we wanted to understand the perceived benefits of the graduate model. Using a qualitative paradigm, we electronically interviewed 29 students and faculty members (13 athletic training faculty and program directors, 16 students) currently in Professional Masters Athletic Training Programs (PM ATP). These represented 13 of the 29 (45%) CAATE-accredited PM ATPs. Five themes emerged from the data: (1) engagement and time spent in clinical education allows students to prepare for their roles as athletic trainers, (2) faculty stress the importance of interprofessional education, (3) expecting prior foundational knowledge allows focused education training at the graduate level, (4) increased professional commitment to stay in athletic training rather than use the training/education as a stepping-stone to other career paths, and (5) higher student maturity facilitates deeper learning. Based on these results, the perceived benefits of the PM ATP model are multifactorial.

Background Head impacts have been studied extensively in football, but little similar research has been conducted in men's lacrosse. It is important to understand the location and magnitude of head impacts during men's lacrosse to recognize the risk of head injury. Methods Descriptive epidemiology study set on collegiate lacrosse fields. Eleven men's lacrosse players (age=20.9±1.13years, mass=83.91±9.04kg, height=179.88±5.99cm) volunteered to participate. We applied X2 sensors behind the right ear of participants for games and practices. Sensors recorded data on linear and rotational accelerations and the location of head impacts. We calculated incidence rates per 1000 exposures with 95% confidence intervals for impact locations and compared the effect of impact location on linear and rotational accelerations with Kruskal-Wallis tests. Findings We verified 167 head impacts (games=112; practices=55). During games, the incidence rate was 651.16 (95% confidence interval=530.57–771.76). The high and low incidence rates for head impact locations during games were: side=410.7 (95% confidence interval=292.02–529.41) and top=26.79 (95% confidence interval=3.53–57.10). For games and practices combined, the impact locations did not significantly affect linear ( χ 2 3 =6.69, P =0.08) or rotational acceleration ( χ 2 3 =6.34, P =0.10). Interpretation We suggest further research into the location of head impacts during games and practices. We also suggest player and coach education on head impacts as well as behavior modification in men's lacrosse athletes to reduce the incidence of impacts to the side of the head in an effort to reduce potential injury.

Clinical education provides the backbone for the socialization process for athletic trainers. It is the chance for students to engage in the role, within a real-time learning environment that allows for not only the adoption of knowledge, skills, and critical decision making, but also the profession’s foundational behaviors of professional practice. Recent criticisms of the current education model, in which the degree is conferred, center on the lack of critical thinking and confidence in clinical practice for newly-credentialed athletic trainers, as many suggest there is concern for the abilities of students to transition to practice smoothly. We offer three areas of focus for clinical education experiences for students (autonomy, mentorship, and feedback), believing this could support the development of independent thinking and confidence in skills. Our discussions are focused on the evidence available, as well as personal experiences as educators and program administrators.

A reliable measure of dynamic postural control is needed for inclusion in the sports-related concussion assessment battery. Currently, there is not a clinical gold standard. The Limits of Stability (LOS) test has potential to be a useful tool to collect objective data on important dynamic postural stability variables. Psychometric properties of the LOS test with healthy young adults are yet to be established.The purpose of this study was to examine the intra-session and test-retest reliability for the LOS on the NeuroCom® VSR Sport when performed by young adults.Reliability study.Twenty-seven healthy university students completed four trials of the LOS in each of two testing sessions one week apart. Relative reliability was measured within each session with an intraclass correlation coefficient (ICC[3,The reliability within each session for LOS composite scores for MVL, DCL, and MXE was moderate to high (ICC[3,LOS provides a reliable measure of dynamic postural control for young adults. Two trials are recommended at baseline with the first being an adaptation trial to ensure accuracy of findings. Care needs to be taken when interpreting EPE and DCL scores on post-injury tests due to a learning effect for those variables.2c.

Context: Recent literature has focused on reasons for athletic training student persistence and departure. However, accredited professional bachelor's athletic training program (ATP) directors' opinions regarding student retention have yet to be studied, to our knowledge.Objective: To determine reasons for athletic training student persistence and departure from professional bachelor's ATPs across the United States from the program directors' (PDs') perspective.Design: Two-part qualitative study.Setting: Commission on Accreditation of Athletic Training Education professional bachelor's ATPs.Patients or Other Participants: For Part 1 of this study, we asked PDs of all 343 ATPs to complete an online survey, gathering responses from 177 (51.6%). Using data saturation as a guide, Part 2 included performing follow-up telephone interviews to gain further understanding, clarity, and triangulation with 16 randomly selected PDs.Main Outcome Measure(s): During Part 1, participants chronicled responses to open-ended questions as part of the online survey. For the second part of the study, the telephone interviews followed a semistructured format and were recorded to facilitate transcription. We analyzed data using grounded theory and secured trustworthiness by using multiple-analyst triangulation, member checks, and a peer review.Results: Program directors reported athletic training students persist due to their career goals, the personal relationships they create, and because they enjoy and are dedicated to athletic training. The respondents stated that athletic training students leave ATPs because of the academic rigor, the program not meeting expectations, a loss of interest, career considerations, and financial reasons.Conclusions: Program directors should educate prospective athletic training students about athletic training by providing a realistic explanation of the roles and responsibilities of the profession. Selecting clinical education sites with preceptors who enjoy their career choice and good working conditions may help solidify athletic training student commitment to the ATP and the athletic training profession.

Context: Some athletic training program (ATP) directors use direct admit, where students are admitted into the ATP directly out of high school. Other ATP directors admit students into the program after a set time period on campus through a secondary admissions process. It remains unknown why ATP directors use various admissions practices. Objective: To determine why ATP directors use a secondary admissions process. Design: Qualitative study. Setting: Professional bachelor's ATPs. Patients or Other Participants: We asked ATP directors from all 343 professional bachelor's ATPs to participate in an online survey. We received responses from 177 (51.6%). Main Outcome Measure(s): The survey asked participants both when students are first eligible for admission into their ATP and to explain the rationale behind their specific admissions process. We used grounded theory to analyze the data and maintained the trustworthiness of the analysis via multiple-analyst triangulation, member checks, and a peer review. Results: The majority (92.1%) of respondents used a secondary admissions process to formally select students into their ATP. The ATP directors stated that opportunities for socialization, the ability to maintain quality control, and the chance to complete general education requirements were important reasons to admit students into the ATP after they have been on campus for at least 1 semester. Conclusions: The use of a secondary admissions process appears to help ATPs provide a glimpse of the profession through observation and introductory coursework. The secondary admissions process also allows faculty and staff to evaluate student potential, while students are given time to focus on their transition to college life. We believe the timing of formal admittance to the ATP is an important decision that warrants thought and discussion between the program faculty and staff to provide curricular sequencing that works for both prospective students and the ATP faculty and staff.

Research has identified that learning in the clinical education setting can be reciprocal between preceptors and athletic training students. However, the frequency of and the potential benefits to reciprocal learning are not fully understood. The purpose of the current study was to explore the frequency and perceived value of reciprocal learning in clinical education from both the athletic training student and preceptor perspective. Reciprocal learning was identified by preceptors and athletic training students as occurring frequently during clinical education. Preceptors and athletic training students valued the opportunity to learn from one another.

Context: Retaining athletic training students has been identified as problematic by approximately half of athletic training program (ATP) directors. It is unknown what ATP directors do to improve athletic training student retention.Objective: To identify initiatives that ATP directors use to improve the retention rates of athletic training students in their programs.Design: Qualitative study.Setting: Undergraduate ATPs.Patients or Other Participants: We asked directors of ATPs across the nation to complete an Internet questionnaire. We obtained responses from 171 out of 343 ATP directors (51.6%). In addition, we completed follow-up interviews with 16 randomly selected ATP directors.Main Outcome Measure(s): During the online questionnaire, we asked ATP directors to describe any specific initiatives they or their ATP used that were aimed at retaining athletic training students and ideally what they would like to do to improve athletic training student retention at their institution. During the follow-up telephone interviews, we asked participants to further describe their retention strategies and other techniques not already mentioned in their questionnaire responses to gain further insight. We used a general inductive approach to analyze the data and performed multiple-analyst triangulation, member checks, and a peer review to ensure the trustworthiness of the analysis and results.Results: During data analysis, we identified 3 themes that highlight the ATP directors' initiatives to retain athletic training students. Directors discussed fostering a family atmosphere, strategic planning, and having resources available to support students as ways to improve retention.Conclusions: Athletic training program directors are encouraged to integrate students into their programs early through informal and formal participation opportunities, evaluate student potential prior to formal admissions, plausibly through an interview process, and educate students on scholarship opportunities to help offset tuition and fees associated with program completion.

The National Operating Committee on Standards for Athletic Equipment (NOCSAE) has developed impact attenuation thresholds that protective helmets worn in sport must meet to be commercially available in an attempt to prevent injury. It remains unknown how normal helmet use in athletic activity alters the force attenuation ability of lacrosse helmets. We tested 3 new and 3 randomly selected used helmets from 2 popular lacrosse models (Cascade Pro7, Cascade CPXR). All used helmets had been worn for 3 collegiate seasons prior to testing and had never been refurbished. Helmets were drop-tested using 3 prescribed impact velocities at 6 locations according to the NOCSAE lacrosse helmet standard, and we compared the Gadd Severity Index (GSI) scores between new and used helmets using a repeated measure ANOVA with location as the repeated variable and data separated by impact velocity. All 12 helmets passed the NOCSAE GSI threshold for all testing conditions; however 1 used helmet shell cracked resulting in a failed test. We found a significant main effect for helmet age at the low (F5,50=2.98, P=.02), medium (F5,50=3.71, P=.006), and high (F5,50=2.70, P=.03) velocities. We suspect that helmet use can degrade materials under some conditions, but improve performance in others due to changes in helmet composition from use. The clinical implications of the differences in GSI scores noted remain unclear. Because one helmet shell cracked resulting in a failed test, used helmets should be regularly inspected for cracks or other signs of mechanical fatigue that may weaken helmet integrity.

Context Many professional master's athletic training program directors believe retention is a problem facing athletic training education. However, it remains unknown what steps, if any, are taken to improve retention. Objective To inquire with program directors about their respective methods and interventions aimed at increasing retention rates. Design Qualitative study. Setting Professional master's athletic training programs. Patients or Other Participants Fifteen program directors out of 25 responded to an online survey invitation for a response rate of 60%. We also completed follow-up telephone interviews with 8 randomly selected program directors to gather greater insight into the ways they improve retention. Main Outcome Measure(s) We asked directors of all 25 professional master's athletic training programs in the United States to complete an online survey. We also asked 8 program directors from those who responded to complete telephone interviews. Grounded theory guided data analysis and we secured credibility through the use of multiple-analyst triangulation, member checks, and peer review. Results We identified 3 themes of ways program directors help improve student retention rates. Our participants described adequately screening admissions packets, providing financial support to defray the cost of pursuing a degree in athletic training at the professional master's level, and various student initiatives. Conclusions Based on our findings, we recommend a thorough application process that screens prospective students and identifies those who can complete the program. Program directors should also find ways to help defray the costs of earning a master's degree to allow students to become integrated into the program intellectually, socially, and clinically without increasing stress levels. Finally, providing students with opportunities for early socialization and mentoring should be aimed at explaining program expectations while preparing the students for professional practice.