Master's Level Professional Athletic Training Programs: Program Characteristics, Graduation Requirements, and Outcome Measures

Survey Design

The survey instrument was developed based on the research questions and a review of the literature and was based on similar themes to those included in our survey of MLP athletic training students.⁸ Before data collection, we tested the usability and technical operation of the survey with 3 BLP athletic training program directors who would not be invited to take the final survey. We made adjustments to the readability of the survey questions based on this feedback (feedback included clarification of wording, reducing redundancy of questions). The survey included 31 questions divided into the following categories: program director demographics (3 questions), program history (9 questions), cohort characteristics (5 questions), program requirements (7 questions), outcome measures (3 questions), and program director opinion (4 questions). Nineteen questions were multiple choice (primarily yes/no), 10 questions required respondents to enter an integer or percentage, and 2 questions were open-ended (see the Table for a list of questions and question type).

Table.  Survey Questions

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Statistical Analysis

Open-ended questions were categorized based on the common themes that emerged; categories were created to allow for the use of statistical analysis. We used deductive and inductive content analyses to interpret the emerging themes from the raw data. Data were organized by coding each individual raw data response with a 1-word or 2-word description, forming a meaning unit. Meaning units were then categorized according to their similarities and organized within the research areas under investigation. All responses were independently coded, and there was 100% agreement between the authors on the categories.

All quantitative data analyses were conducted using SPSS (Version 20, SPSS Inc, Chicago, IL). Statistical analyses included standard correlations (for numerical data) and point biserial correlations (measures of association for dichotomous and continuous variables). Mean, range, and standard deviation statistics were calculated for quantitative data, and cross tabs were used to determine percentages of each category within the nominal data (multiple choice questions, coded open-ended questions). See the Table for a description of how each question was analyzed.

Program Director Demographics

Of the 25 MLP program directors who received our survey, 11 responded (44% response rate). Respondents reported having been a program director for just over 8 years (8.3 ± 3.6 years; range, 3–12 years). The majority (63.6%) pursued the internship route to certification (no respondents graduated from an MLP program). Just over half (54.5%) had previously been a program director or faculty member in a BLP program (BLP faculty members, 6.3 ± 3.5 years; range, 0–11 years).

Program History

Responding MLP programs had all been accredited as of 2003 or more recently (2003–2011; mean = 6.2). No MLP programs transitioned from a BLP program. One responding MLP program currently has both MLP and BLP programs at its institution. Just over half of the responding MLP programs previously offered an internship route to certification (54.5%; n = 6), and 50% of those that had internship routes moved to an MLP program after the elimination of the internship route to certification (3/6). Three MLP programs also offer post-professional programs in which they employ graduate assistant athletic trainers: 2 offer post-professional athletic training (PPAT) master's programs, 1 offers a terminal degree in a related field (field not specified). Fifty-five percent (n = 6) of respondent MLP programs pursued accreditation as the result of their college/university looking to develop additional graduate programs, while 36% (n = 4) did so because of a lack of MLP programs in the geographical area. The remaining program director indicated that the MLP program was preferred over the BLP route as a result of the related ability to recruit more “focused, mature” students.

Cohort Characteristics

Respondent programs had a 3-year average program size of 21.9 (SD = 7.6; range, 14–36), accepting an average of 13.5 students per cohort (SD = 5.7; range, 9–25). Average first-to-second year retention rate was 91.4% (SD = 6.7%; range, 80%–100%). Primary reasons reported for students not being retained into the second year were academic difficulties (n = 7) and personal/life change (n = 4) (1 program reported 100% retention rate; 1 program selected both). The reported 3-year average graduation rate was 91.2% (SD = 6.5%; range, 81%–100%).

Program Requirements

The minimum GPA required to remain in good standing was 3.0 on a 4.0 scale in 10 of the 11 programs (2.8 was required in the remaining program). Two MLP programs require students to complete a thesis in order to graduate (18%); 8 of the 9 remaining MLP programs require a nonthesis structured research project (89% of nonthesis programs). One MLP program requires students to present at a conference; no MLP programs require students to publish a scholarly research article. Forty-five percent require a comprehensive examination (n = 5). Two MLP programs also have professionalism requirements, such as attendance at state/national Conferences and/or state/national Capital Hill Day.

Outcome Measures

The average 3-year aggregate first-time BOC pass rate was 91.7% (SD = 9.5%; range, 70%–100%). Program directors reported that 93% of graduates practice as athletic trainers after graduation (SD = 9.96%; range, 68%–100%), while an additional 1% go on to pursue a terminal degree (SD = 2.96%; range, 1%–10%).

Program Director Opinion

Ninety-one percent of responding program directors believed that the MLP route to certification better prepares athletic training students to pass the BOC examination and better prepares athletic training students to practice as athletic trainers (n = 10 for each). Ten program directors also believed that the BLP route to certification should be eliminated (not the same 10 as reported previously). Program directors were asked about their perception of the purpose of the MLP route to certification. Five themes emerged during coding of responses provided by 9 program directors: serves a more focused student (5 responses); serves a more mature student (4 responses); alternate to the bachelor's route to certification (3 responses); improved professional preparation of students (3 responses); and serves students who are more committed to a career in athletic training (2 responses). Some respondent comments were coded as multiple themes.

Correlations

Standard correlations and point biserial correlations were calculated to evaluate potential associations between variable sets. Specifically, we were interested in potential associations between retention and graduation rates, between cohort sizes and various program characteristics, and between BOC pass rates and various program requirements. We found a significant relationship between retention and graduation rates (r(9) = 0.696, P = .025, 95% confidence interval [CI] = 0.112–1.298). No significant correlations were found between cohort size and existence of other athletic training programs at the institution (BLP, PPAT, terminal degree) (r(9) = 0.006, P = .985, 95% CI = −0.748–0.760) or between cohort size and years of accreditation (r(9) = 0.519, P = .101, 95% CI = −0.125–1.164). A significant relationship was found between structured research requirement and first-time BOC pass rates (r(9) = 0.762, P = .006, 95% CI = 0.273–1.250); specifically, the program without a structured research requirement had the lowest BOC pass rate. No significant correlation was found between programs that required a comprehensive examination and first-time BOC pass rates (r(9) = 0.031, P = .929, 95% CI = −0.723–0.784).

Program History

Of the 11 responding programs, 3 developed their MLP program when they closed their internship program, while no MLP programs developed from BLP programs. According to the CAATE, only 3 institutions have ever closed their BLP programs to develop MLP programs ( oral communication, March 4, 2013). With the CAATE having released its substantive change document for programs transitioning from bachelor's to post-bachelor's programs in March 2013, it is expected that many undergraduate programs will transition to the master's level. As part of this process, it may be helpful to consult with programs that have moved to MLP from either internship or BLP programs to develop strategies to aid in this transition. Additionally, two MLP programs also have a PPAT master's program, and 1 MLP program offers a terminal degree in a related field. Institutions with both MLP and PPAT programs could be consulted to gain insight into how the 2 programs complement each other but maintain separation within the same institution.

Should athletic training move to a post-bachelor's entry to the profession, it would effectively eliminate PPAT master's programs.¹ This is an important consideration in the debate surrounding the future of athletic training education. Concerns have been raised about the potential elimination of the graduate assistant model¹; however, the increase in residency programs (now accredited by the CAATE) and the emergence of the first DAT program (clinical doctorate in athletic training) may aid in filling the gap between entry-level education and a terminal degree. Fifty-five percent of MLP programs surveyed reported that they pursued the development of an MLP program as the result of their college/university looking to develop additional graduate programming; this may well be the motivation for PPAT master's programs to consider developing clinical DAT programs.

Cohort Characteristics

There was a wide range of cohort sizes reported in our study (13.5 ± 5.7; range, 9–25). There were no significant correlations between cohort size and existence of other athletic training programs at the institution (BLP, PPAT, terminal degree) or between cohort size and years of accreditation. We therefore conclude that cohort sizes are largely institution-dependent. Despite many program differences across the MLPs surveyed, our data indicate that students who are retained past the first year will likely graduate, despite the demanding nature of the second year, with its increased clinical responsibility and structured research requirements in the majority of MLP programs.

Program Requirements

Ten MLP programs reported that the minimum GPA to remain in good standing was 3.0 on a 4.0 scale (2.8 was required in the 11th program). This is consistent with previous anecdotal reports, in that GPAs in the range of 2.5 to 3.0 were the common minimums, and is based on the common minimum graduate school GPA requirements of 3.0.¹ Ninety-one percent of MLP programs reported requiring a thesis or structured research project. This has been cited as an advantage of MLP programs.¹ Data from this study suggest that the requirements of a thesis or structured research requirement were correlated with higher first-time BOC pass rates. However, the limited number of responses (10 programs required structured research, 1 program did not require structured research) may limit the generalizability of this correlation. Additional research should continue to explore this relationship.

Outcome Measures

The 3-year aggregate first-time BOC pass rate reported by program directors (mean = 91.7%; pooled estimate) is significantly higher than the national averages in each of the past 3 exam cycles (2009–2010: 43.3%; 2010–2011: 60.7%; and 2011–2012: 82.3%).¹³ No previous studies have compared first-time pass rates between BLP and MLP candidates; however, if the data obtained in this study are accurate and generalizable to all MLP programs, the first-time pass rate of MLP candidates is significantly higher than that of BLP candidates. A comparison of BLP and MLP pass rates would contribute significantly to the conversation about the future of athletic training education.

The 93% graduate placement rate reported here is consistent with self-reported pursuit of employment using the ATC credential in research with current MLP students.⁸ Additionally, the percent of MLP graduates reportedly pursuing employment using their ATC credential is higher than the 82.4% that been reported in previous research¹⁴ that pooled both BLP and MLP graduates. Unfortunately, the limited number of programs that participated in this study may make it difficult to generalize this percentage to all MLP graduates.

Program Director Opinions

The themes of “focused” and “mature” student recruitment emerged in several ways as a purpose of MLP programs, both as write-in responses for the “other” option for Question 12 and as open-ended responses for Question 28. Seven of 9 responses to Question 28 mentioned “more focused student” or “more mature student.” This is somewhat intuitive, as graduate-level education innately has a more focused nature, while undergraduate education encompasses general education requirements in addition to major-specific coursework.² Anecdotally, students who enter MLP programs may be more committed to becoming an athletic trainer, as the master's degree is the advanced degree for the majority of athletic trainers. Conversely, recent expert commentary¹ suggests that students entering BLP programs may be using the curriculum as a stepping stone toward other health care professions. Previous research⁸ has indicated that MLP students typically wait only 1.2 years after completion of their undergraduate degree to enroll in an MLP program and that nearly 95% of students who enter MLP programs do so because they want to become an athletic trainer (while less than 5% enter MLP programs only after not being accepted into their graduate program of choice). The results of this current study and our previous research⁸ seem to imply that MLP programs are, in fact, recruiting students who are more likely to pursue employment using their ATC credential (93.5% reported by MLP students, 93.6% reported by program directors). The percent of MLP students who pursue employment using their ATC credential is at least equivalent to graduates of PPAT programs (based on qualitative interviews with PPAT students and anecdotal expert commentary).^15–17 Several program directors in this study highlighted this as an important purpose of the MLP route to certification: educating students who truly want to be athletic trainers.

The most common rationales proposed for moving athletic training education to the post-bachelor's level (MLP) include improving the professional preparation of students and aligning our professional programs with our peer health care professions.^1,2 These are very similar to rationales cited for the elimination of the internship program: enhancing the credibility of the field and better preparation of athletic trainers.⁹ Other recent arguments for moving to the MLP level include the perception that there is a greater emphasis placed on research at the graduate level.² In our study, 10 of 11 programs represented required a thesis or structured research project. If we are able to generalize these findings, 91% of MLP programs have a structured research requirement. Our correlation found that programs with this requirement had higher first-time BOC pass rates. However, as stated previously, the limited number of program directors who participated in this study indicates that caution should be taken when attempting to generalize our results to all MLP programs. While additional research in this area is needed, as the CAATE and the NATA Board of Directors consider a possible transition to mandatory post- bachelor's education, they should consider a structured research requirement as part of MLP program accreditation standards. This opinion has been expressed previously.¹

Limitations and Future Research

Limitations of our study include the fact that the data reported by MLP program directors were self-reported, which may impact the validity of the data. Additionally, while our response rate was slightly higher than is typically gained through survey data (44%), 14 of the 25 MLP programs were not represented in this study. This may diminish the generalizability of our results, about which we attempted to caution throughout the discussion. We also recognize that our survey was limited in its scope, potentially omitting some additional lines of questioning that could contribute to the ongoing educational debate.

This study is an important first step, as it provides some preliminary evidence that MLP programs are graduating students who succeed on the BOC examination and pursue employment using their ATC credential at higher rates than students in BLP athletic training programs. However, direct comparisons between BLP and MLP programs are lacking. These comparisons were major discussion points between 1994 and 1997 as the Education Task Force researched a potential shift and presented their recommendation to eliminate the internship route to the NATA Board of Directors. Additional studies making direct comparisons of BLP and MLP program outcomes will contribute greatly to the discussion of the future of athletic training education. Future research efforts should focus on the feasibility of transitioning BLP programs to MLP programs. Without this research, mandates from the CAATE and/or the NATA Board of Directors on transitioning to the MLP degree may result in many BLP programs looking to transition without a template or best-practice standards. These research efforts could be enhanced by retrospective analysis of other allied health professions' successful transitions to master's entry-level degrees. Further research is being conducted by the authors to correlate additional MLP program and graduation requirements with BOC pass rate and employment rates to attempt to determine the characteristics of the most successful MLP programs.

Finally, additional research efforts should examine the effects on patient satisfaction and outcomes of moving exclusively to MLP programs, as this is the quintessential real-world outcome that both athletic training educators and practitioners can agree on.