Retention Initiatives Used by Professional Bachelor's Athletic Training Program Directors

Participants

The present data was collected using 2 separate strategies: an Internet survey sent to all participants and follow-up telephone interviews conducted with a smaller, random group of participants generated from the initial pool of respondents. We initially sent an Internet survey request to all 343 undergraduate ATP directors in the United States in the spring 2012 semester. A total of 171 ATP directors (51.6%) completed the Internet survey. A total of 83 ATP directors, upon completion of the Internet survey, stated they would agree to a follow-up telephone interview. From this subset, we randomly selected 16 ATP directors to complete the telephone interviews using a random number table. Data analysis was ongoing throughout the 1-on-1 interviews, and it was at 16 respondents that we achieved data saturation with no new themes emerging from the data. Demographic information for the directors who completed the online survey and for those who completed the telephone interviews is in the Table.

Table. Frequencies for Institutional Information of Athletic Training Program Survey Respondents and Interview Participants

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Data Collection Procedures

Before we initiated data collection, the Institutional Review Board of the host institution approved our study. As stated previously, we collected data using 2 separate processes. We administered our online survey similar to methods suggested previously.²³ First, we sent a personalized e-mail to directors of all undergraduate ATPs in the United States informing them of the purpose of the study and asking for their participation. One week later, we sent another personalized e-mail with a link to the online survey. We delivered the survey electronically using QuestionPro Survey Software (QuestionPro Inc, Seattle, WA). The first page of the survey was an Institutional Review Board approved consent form. Two weeks later, we sent a reminder e-mail to those who had not completed the survey, followed by another reminder e-mail an additional week later. Seven days after the last reminder e-mail, we personally called the remaining ATP directors to ask for their participation. After receiving no new responses for 2 days, we terminated data collection.

We contacted those randomly chosen for telephone interviews by e-mail to schedule a date and time for the conversation. We finalized the scheduled call after we received a signed consent form. The interviews followed a semistructured format, allowing for additional questions to be asked to ensure rich data, and lasted approximately 30–45 minutes. We tape recorded the conversations and transcribed them to facilitate data analysis.

Data Analysis

We used a general inductive approach²⁴ to analyze the responses to the open-ended Internet survey questions and the telephone interview transcripts. Similar to grounded theory,²⁵ the main goal of the general inductive approach is to make sense out of large amounts of data by creating links between the data and the research objectives. The objective of the current study was to identify the initiatives ATP directors use to improve athletic training student retention. Therefore, we focused on the responses to 2 survey questions and 1 telephone interview question. The survey questions used asked the participants to describe any specific initiatives they or their ATP used that were aimed at retaining students and ideally what they would like to do to improve athletic training student retention at their institution. During the telephone interviews, we asked participants to describe retention strategies used by their ATP and used follow-up questions and prompts to achieve an appropriate level of detail in the answers. Analysis started by reading the transcripts several times. After getting a sense of the data, the researchers started applying codes to the data. Following several additional reads, we combined the codes into categories by grouping similar topics. We finished by condensing the categories into final themes by reducing overlap.

We used several techniques to ensure the trustworthiness of the data and results. First, the 2 primary authors participated in multiple-analyst triangulation. Through this procedure, the researchers analyzed the data independently and negotiated over the coding scheme and final themes. The 2 primary authors discussed the systematic steps of the analysis process prior to engaging in data analysis, thus ensuring consistency with the procedure but still maintaining the rigor of independent evaluation. In the current study, no content or nomenclature changes were necessary based on the conversations between the 2 authors upon completion of the analysis. Second, we performed member checks with 4 randomly selected ATP directors by providing them their transcript and the final themes of the data analysis. We asked them to verify the accuracy of their transcripts prior to beginning data analysis and the final themes generated from the multiple-analyst analysis. Finally, we had a peer review our coding structure and the presentation of the final results. The review was completed by an individual who is an athletic training educator and scholar who has extensive graduate level training in qualitative methods and data analysis.

Family Atmosphere

Many participants stated that they try to foster a family atmosphere by cultivating personal relationships between the various stakeholders within the ATP. For example, mentoring and positive interactions between ATP faculty and staff have been found to facilitate persistence to graduation.^1,26 Analysis revealed that our ATP directors value the creation of a family atmosphere as a means to retain their students. One ATP director summed this theme up by stating that 1 initiative used in her program to bolster retention is to have “significant interpersonal contact with students to know them as individuals and promote a ‘family' atmosphere in the ATP.” A similar response came from a participant who stated, “We have a tradition of family style gatherings and enjoyment of each other as staff, and students with staff, and this seems to maintain a positive setting [for our students].”

The development of a family atmosphere in the workplace has been identified by work-life balance scholars as an important retention factor for male and female athletic trainers at the National Collegiate Athletic Association Division I setting, as it helps stimulate professional/organizational commitment and improve work-life balance.^27,28 Despite this literature being rooted in the Division I setting, applications can be drawn to our population primarily because differences are rarely found between the collegiate divisions regarding levels of satisfaction and intentions to stay.²⁹ Moreover, previous literature has suggested that athletic training students steer away from the profession because of a concern regarding time for parenting and nonwork obligations and interests.⁴ However, if athletic training students are able to witness a family-friendly work environment and interact with preceptors who display organizational commitment because of adequate work-life balance, persistence is more likely.^30–32 Organizational commitment is necessary and foundational for both workplace/employee and ATP/student retention. In addition to achieving and displaying a balanced lifestyle, preceptors have the responsibility to orient their students properly and make them feel welcome. We presume that, when ATPs invest in their students' professional development and demonstrate support, the students feel valued, which in turn increases their commitment to their academic programs and translates into persistence. This supposition is supported by some of the accessible literature on student professional development and socialization.^7,8,12

Students must be committed to their degree program in order to persist until graduation. Commitment can be stimulated by integration and realization of professional and personal goals.^1,11,15 Academic and social integration that is fostered through personal relationships with ATP personnel were discussed by a participant who stated that, in his program, he tries to “promote new students' academic integration into the program by providing them with early experiences that allow them to interact with our students, faculty, and preceptors.” The importance of personal relationships, which includes positive interactions amongst ATP personnel and students, was identified by previous authors¹ as necessary for persistence to graduation. The findings of that particular study were from the student perspective, which is now supported by our ATP directors, as illustrated by this statement on how nurturing the relationships between faculty and students can help retention. The ATP director stated:

We want to make sure we know each of our students, and they know each of us. So we think that also helps with retention once they're formally in the program, so they feel comfortable coming and talking with us if they've got a question or a problem or think maybe their career goal has changed, and we're not delaying that conversation.

Fostering relationships among students, faculty, and preceptors appears to help students feel comfortable by getting to know each other on a personal level. The relationships established between ATP stakeholders help sustain a family atmosphere, particularly as a means to mentor students during their professional development and socialization into their future roles as athletic trainers. Our participants suggested that building relationships with faculty, staff, and peers helps improve athletic training student retention. Previous work also found that the small class sizes that typically occur in ATPs facilitate a close-knit community.¹ Similarly, previous work² has found that providing athletic training students with individual attention can potentially improve their retention rates by improving social integration into their institutions.^10,15,16

Historically, mentorship has been the keystone for professionally socializing students into their future roles, as indicated by the number of empirical investigations citing mentorship as fundamental to integrating, socializing, and retaining students in their athletic training degree programs.^{1,4,9,26,33,34} Our participants indicated that mentorship programs were another initiative used to inspire a family atmosphere. Several participants also discussed the need to promote positive encounters between students, something accomplished by forming a peer mentoring program. Our participants seemed to prefer more informal mentoring arrangements, as found previously, as a socializing agent for both undergraduate⁹ and professional master's³⁴ ATPs. A typical informal mentoring program is outlined by the following quote:

We've tried very hard to get our upper-class students to be good mentors and peers, so that when students do observation hours, the first-year students, that our upper-class students are engaging them, talking about, “What did you learn in class today,” helping them learn various tape jobs that they've learned or universal precaution techniques or whatever it is.

Student facilitated mentoring has been found to help socialize novice athletic training students into the professional responsibilities and program expectations, as it provides opportunities for informal learning and the development of role understanding.^13,14 Once students understand and accept their role through the informal mentoring program, they often feel integrated and vested, a necessary aspect for retention.^1,4

Recent evidence³⁵ suggests that program pride and tradition can support retention of athletic training students, as it fosters commitment to the ATP mostly due to the success and involvement of alumni. Some ATP directors mentioned the importance of alumni in creating a family environment and using them as an influence on current students. One participant stated:

One of the things that we do is we have alumni and current students hold different events throughout the year. Essentially, they're trying to get the students into the fold and comfortable with other students in the program, alumni, and get them the opportunity to ask questions in a nonofficial way, where they don't feel like they're being evaluated.

While strategic to several ATP directors' retention plans' mentoring programs, alumni involvement was more formalized than peer mentoring programs discussed by our participants.

Our participants found value in cultivating a family style atmosphere within the ATPs they direct. Many did so by holding various social activities and through informal peer mentoring. Faculty and peer support provided to students in ATPs stimulates retention, as it promotes professional enthusiasm and drive.^12,36 Based on our data, fostering relationships between ATP stakeholders also creates a collegial, family-centered environment associated with retention in athletic training.²⁷

Strategic Planning

Evidence suggests that college and university administrators who use a more selective, competitive admissions process are more likely to retain their students,³⁷ an initiative discussed by our participants. Directors of ATPs often spoke of proactive measures, such as admission standards or the use of a secondary admissions process, they had taken in order to improve student retention in their programs. The most common response under this theme referred to the ATP admissions standards and the use of a secondary admissions process to help socialize recruits before being formally admitted to the ATP. The finding was not surprising, as only 7.3% of the survey respondents and 18.8% of the telephone interview participants directly admit prospective students from high school before completing any college coursework. Thus, the majority of our participants used a secondary admissions process to select students for ATP admission. One ATP director explained how sticking to their admissions standards has helped reduce attrition within the ATP she directs. She said:

At this point, having statistics on the first-time passing rate of students who come in on probation, meaning that they are below the minimum criteria on several items that we require for application to the program, we have shifted our focus back to only accept the students who meet the minimum criteria.

Additional participants noted similar practices. One stated:

Student retention is not a problem. Through our competitive admissions process we are able to select those who have a desire to succeed and not select those who academically would not [succeed].

Other participants would like to increase their admissions standards to help reduce attrition in their programs. One ATP director stated, “We are currently working on strengthening our admissions requirements. The students with the lowest [grade point averages] are the most likely to drop out of the program.” Another agreed by saying, “We are in the process to make retention more challenging by increasing the [grade point average] for incoming freshman.” Multiple additional ATP directors agreed that their capability to retain students would be enhanced by improving the admissions criteria of their ATPs. Perhaps some early attrition is necessary to reduce numbers to those who can handle the rigor of the program,³⁸ allowing athletic training faculty and preceptors to focus on students with the highest chances of success.

Other participants noted the use of a secondary admissions process to help socialize students to the profession and allow them time to make a decision on whether studying athletic training was right for them. One ATP director explained how pushing the secondary admissions process back a year to make it later helped improve retention. She explained by saying:

One of the biggest things we've done to increase retention in our program is we've put off the athletic training application process so our students don't begin their professional phase until their junior year. They've had 2 years to not only figure out if athletic training is for them, and to understand everything that goes along with the major, but they've also had time to adjust to college life. So I think that was 1 of the biggest things we did to increase retention. Before, in the past, what we did is we had students complete observation hours in their freshman year and start the whole retention process in their sophomore year. What we found is we had a big dropout rate because I think students—it wasn't that they didn't love athletic training or didn't like the major. It was just that it was a little too much too soon trying to make a freshman a health care provider before they even found out where their college dorm was located or where their rooms were located. I think that's 1 of the biggest things we did.

The above participant believed that moving the secondary admission process back a year allowed prospective students to become socialized, not only into the athletic training profession and the ATP, but also into the institution and life as college students.

Another participant explained that the ATP he directs used to admit students directly out of high school. He changed the process and found that including a socialization period while in college helped improve persistence. He said:

We used to be a program that admitted freshman the day they walked in the door. What we discovered was, halfway through their freshman year, halfway through their sophomore year, the kid was in over his head and thought athletic training was personal training and things like that. Like I said, now we are very meticulous in how we do things with freshman in terms of their orientation and their applications, exposing them to athletic training. We have an introduction to athletic training class, which is kind of a general class for all students, but we highly encourage applicants to take that class, again, just so that they know what they're getting into; they've been exposed to it. The first day they walk into the athletic training clinic isn't the first day they're in the academic program and they go, “Oh, wow, I thought athletic training was strength and conditioning,” or, “I thought athletic training was personal training. This isn't what I thought.” We're very, like I said, kind of meticulous in how we orientate kids to our program, which I think then carries over once they're in [the ATP]. They're comfortable with what they're doing.

The use of a secondary admissions process was popular among ATP directors, as approximately 93% select students into ATPs after some college coursework has been completed.² It has also been found that the timing of the secondary admissions process is a key factor when considering athletic training student persistence. Retention rates for athletic training students are higher when the secondary admissions process occurs later in a student's college career, potentially because it allows students more time to explore whether entering an ATP is the right choice for them.² Prospective students may also require time to develop a subjective warrant, which includes perceptions of the necessary knowledge, skills, and attitudes to perform work in a specific occupation³⁹ and is influenced by role models and other individuals, educational experiences, and social influences among others factors.⁴⁰

Social integration, intellectual integration, commitment, and the clinical education experience are factors that have been found to alter the decision to apply to an ATP.³⁸ Perhaps focusing on the variables influencing application during the period preceding formal admission can help facilitate student socialization and result in students entering an ATP with an accurate depiction of the curriculum and the profession. Furthermore, a secondary admissions process may allow for more interactions between ATP faculty and instructors if introductory coursework or an observation period is included without overwhelming students. In comparison to a direct admission process, research suggests increasing the amount of mentoring received as well as improving academic integration to encourage the student to persist.^4,15,41

We spoke with 1 ATP director who admits high school students directly into his ATP as first semester freshman. He thought the way his staff handles the selection process improved retention. He explained the process:

We interview every student before they are accepted into the program. So I think we're the only place in the country that does that. So we require high school students, as part of the selection process, to come on campus and interview, and that's a key part of our selection process. So we think that in itself cuts down on some attrition. So if a student were to come and interview here, and they had great [Scholastic Aptitude Test] scores and excellent grades, and then at the interview, they have no idea what athletic training is, and they have no interest in being an athletic training major, we won't accept them into the athletic training major.

When a secondary admissions process is not used, ATP directors should work to ensure socialization has occurred before the student enters the ATP, as it is common for prospective students to have an incomplete understanding of the athletic training profession.⁵ In the example above, the faculty and staff interview each high school applicant to ensure they have an accurate understanding of the curriculum and the profession. We speculate that many ATP directors do not directly admit students into their program because such an interview process may be cumbersome logistically. Scheduling prospective students who live far from campus could be a challenge; however, requiring an interview may help reduce the applicants to those who are serious and passionate about entering the athletic training profession. Enjoyment and passion for athletic training, as well as dedication to the profession, have been found previously as reasons athletic training students persist to graduation.⁴² Moreover, as high school recruits may have incomplete perceptions and understanding of the role of the athletic trainer,⁵ taking the extra time to interview potential candidates can help educate them on the rigors of the program and demands of the profession.

A final subtheme revolved around curricular modifications ATP directors made or wanted to make to improve student retention. Many of the revisions pertained to clinical education. One participant wanted to “create more and better opportunities for students to engage in meaningful clinical education to keep their interest level high.” Another ATP director agreed, stating they wanted to “improve clinical experiences to demonstrate quality over quantity.” Some ATP directors did mention changes to the didactic portion of the curriculum. One participant mentioned that “we [the faculty and staff] are changing to a 5-semester program so the information is spread out more.” Interestingly, the opposite was being completed by another participant. In her program, the faculty and staff were “dropping the ATP program length by 1 semester.” Unfortunately, these responses came from the online questionnaire portion of the data; therefore, additional information about the reasons for these changes remain unknown. However, program length was not identified as a predictor of athletic training student retention, although it is probably inversely related to the timing of the secondary admissions process² discussed above.

Providing students with engaging clinical education experiences can help improve retention rates¹ and help reduce athletic training student frustration.¹³ In fact, previous research⁷ found that clinical integration through meaningful learning experiences improved professional self-efficacy, which in turn facilitated retention, as the student was able to visualize their professional identity. We believe ATP directors should work to provide athletic training students with authentic experiences where they are able to practice their skills while being supervised by a preceptor who is an appropriate professional mentor. Providing such experiences, particularly early on for athletic training students, will help students find their niche and feel integrated into the operations of the athletic training clinic, leading to improved persistence rates.^1,4 Clinical education sites should be continuously monitored and discontinued if athletic training students are not provided with opportunities to practice their skills with appropriate supervision.¹³

Finally, we had several participants state that they wanted to transition to a professional master's program to improve their retention rates. A typical answer to the question of, “What would you like to do to improve athletic training student retention at your institution,” was, “Transition to a professional master's program.” Similar to the subtheme regarding curricular revisions, additional data explaining this answer is unavailable because these responses came from the online questionnaire. However, the response is interesting as the discussion regarding transitioning the entry-level degree to the master's level continues to strengthen.^43 a Previous research has found that the retention rate of professional bachelor's athletic training students is 81%,² while professional master's athletic training students retain at a rate of 89%.⁴⁴ However, at the time of data collection, these results were unknown, and ATP directors probably relied on anecdotal evidence to make the assertion that moving to a professional master's ATP would improve the retention rates of athletic training students.

Resources

Student departure from a degree program or a college/university is caused predominantly by financial aid, cost, or affordability.⁴⁵ Our final theme, resources, explores the concept of financial compensation. The most popular response in this theme pertained to offering students scholarships. Recipients of merit scholarships are more likely to persist in their academic studies compared to those who receive other forms of financial aid,⁴⁶ which aligns with several of our participants' initiatives regarding retention. For example, 1 participant explained improving her program's athletic training student retention rate by providing scholarship opportunities. She said, “We have some scholarship monies for all students which increase as the student progresses within the program.” One ATP director explained how scholarship funding can help improve athletic training student dedication to the profession. He stated:

We are starting a scholarship for freshmen that will allow us to get them more involved from the beginning and give them a sense for the profession. It also allows us to give them competitive scholarship money to keep them out of other extracurricular activities that would interfere with their ability to commit all of their time to the program and not feel so overwhelmed.

Additionally, multiple ATP directors stated that they would like to offer scholarship opportunities to improve athletic training student retention. Some of these respondents went into more detail; 1 in particular wished she could help students afford college. She explained:

I wish tuition would be lower so the students could follow their dreams and stay in college. I wish the students did not have to work to pay tuition. Holding down a full-time job and completing the major is extremely difficult.

Financial considerations heavily influence student retention, especially as current economic conditions continue to remain bleak. Athletic training students are not exempt from the financial strain of higher education, as ATP directors have identified financial difficulty as a common reason for athletic training student departure.⁴² Often college students must hold part-time or work-study jobs to help offset the costs of tuition. Specific to athletic training students, the costs of clothing, insurance, and travel associated with clinical education are additional expenses to be considered. Several of the ATP directors discussed providing scholarships to cover specific expenses such as insurance, memberships, or certification examination fees. One stated that the faculty and staff “pay for the first-time attempt of the [board of certification] exam.” Similarly, another stated that “scholarships reduce the costs to the student by providing memberships, uniforms, and liability insurance.”

Unlike most college students, the rigor of the didactic education and the time associated with clinical education responsibilities makes it difficult for athletic training students to have time for a part-time job.⁴⁷ Previous research has found anxiety related to the costs associated with completing an ATP as a facilitator of student stress,¹⁴ which can possibly influence the decision to persist, particularly due to concerns of financial compensation and time commitments related to the role of the athletic trainer.⁴ Athletic training faculty need to be particularly aware of the demands placed on athletic training students related to the necessity of part-time employment to support their clinical education experiences.

Having access to appropriate resources facilitates strong learning experiences and is essential to degree program persistence,^48,49 and many of the ATP directors mentioned the need for financial support for adequate staffing and facilities as keys in their ATPs for retention. One participant summed this theme up by stating he wanted to “be given adequate and appropriate financial and personnel resources in which the ATP director has responsibility for and authority over.” More specifically, ATP directors would like to “hire additional athletics staff,” “hire additional faculty,” and make “athletic training lab improvements with additional teaching tools” to improve persistence of students in their ATPs. Since role strain has been found to occur among athletic training preceptors,^50,51 hiring additional athletics staff might help reduce patient loads for preceptors and lower student to preceptor ratios. Additional faculty may also provide students with additional individual attention that may help improve retention rates.² Our participants noted that they tried to provide funding for the costs related to insurance, memberships, appropriate staffing, and learning facilities in order to retain athletic training students.