Program Directors' Perceptions of Professional Bachelor's Athletic Training Student Decisions to Persist and Depart
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.
INTRODUCTION
Student attrition may be harmful to athletic training programs (ATPs) in terms of competitiveness, prestige, and financial stability while students are hindered psychologically and opportunistically in the workforce.1 Athletic training students may leave an institution if no similar alternative program is available for them to choose or because of the program environment, which is shaped by factors such as faculty supportiveness and classmate interactions.2 Other considerations influencing the decision to persist within an ATP are societal perceptions of the major and potential future wages the student may earn after graduation.3
Previous work has begun to examine whether athletic training student retention is problematic with varying results.4,5 Recently, it was found that approximately half of professional bachelor's ATP program directors (PDs) perceived that athletic training student retention was currently a problem facing athletic training education, while half do not.6 Athletic training students have been found to persist in an ATP due to high levels of motivation,5 the development of personal relationships with others, a positive learning environment, and professional socialization.4 Several possibilities exist for why students may leave an ATP, including unengaged clinical education experiences,7–9 stress,7,10 the time commitment associated with completing the program,7 and fear of an inability to find work-life balance with a career in athletic training.7 To this point, researchers have described persistence and departure reasons from the athletic training students' perspective,4,5,11 an important and necessary perspective as they are the primary stakeholders in an ATP. However, only seeking the athletic training students' perspective does limit the understanding of retention within ATPs.
Program directors of ATPs may have a keen perspective on persistence and departure decisions of students as they have likely dealt with multiple athletic training students who have persisted to graduate from an ATP and athletic training students who have questioned or decided not to finish a degree in athletic training. The experiences of PDs while interacting with a wide variety of athletic training students may yield different results than those studies, which have investigated reasons for persistence and departure from individual athletic training students. Therefore, our purpose was to determine reasons for athletic training student persistence and departure from professional bachelor's ATPs across the United States from the PD's perspective.
METHODS
We chose to use qualitative methods because we were interested in studying behaviors of athletic training students.12 Specifically, we were interested in retention decisions of athletic training students who had been formally admitted into a Commission on Accreditation of Athletic Training Education (CAATE) accredited professional bachelor's ATP and what motivated these decisions from the PD's perspective. We also wanted to keep the data collection adaptable, allowing for greater depth in the understanding of the phenomenon. We obtained qualitative data from participants through 2 separate processes. First (Part 1), the final section of an Internet-based survey contained several open-ended questions for participants to respond to, allowing us to capture the thoughts of a wide range of PDs. The survey, the Athletic Training Student Retention Survey for PDs, was developed as part of a larger study6 to investigate PD perceptions of persistence and departure of athletic training students. Specific to the current study, we were interested in the responses to the questions asking the PDs to list the top 3 reasons students typically persist and depart from the ATP they direct. We also completed audio recorded semistructured follow-up telephone interviews with 16 participants to clarify perceptions of athletic training student persistence and departure decisions among PDs of professional bachelor's ATPs in Part 2 of the study. Specific to the telephone interviews, we asked participants to give some examples of what aspects of their ATP influence athletic training student persistence and departure the most.
Participants
We obtained completed online survey responses from 177 out of the 343 (51.6%) PDs of all CAATE accredited professional bachelor's ATPs. From the group who completed the online survey and responded that they would consider participating in Part 2 of the study (n = 83), we randomly selected 16 PDs to participate in follow-up telephone interviews to provide greater detail, help clarify the open-ended response in the survey, and triangulate the overall findings of the study. Data saturation determined recruitment, and we settled on 16 participants for interviews, as we found redundancy in themes. Demographic information for the institutions represented by the participating PDs for parts 1 and 2 can be seen in the Table. The participants for Part 1 of the study represented ATPs that use direct admission (7.3%) and ATPs that use a secondary admissions process (92.7%) when selecting prospective students. The majority of the PDs who participated in the telephone interview employed a secondary admissions process (81.2%) with the remaining using direct admissions into the ATP (18.8%).
Data Collection Procedures
Following Institutional Review Board approval, we administered the Internet-based survey for Part 1 of the study similar to the methods of Dillman.13 First, we sent a personalized e-mail to all participants notifying them of the purpose of the study and asking them for their participation. One week later, we sent out the link to the survey using QuestionPro Survey Software (QuestionPro Inc, Seattle, WA) followed by 2 reminder e-mails to those who had not completed the survey after 2 weeks and 1 week, respectively. We called all participants who had not completed the survey 7 days after the third e-mail request to personally ask for their participation. We ceased data collection 1 week after the telephone calls. Detailed information on the development of the survey has been presented previously.6
For Part 2, we randomly selected 16 PDs to participate in telephone interviews. We contacted the PDs by e-mail to gauge their interest and availability for completing the telephone interview. After we received a signed informed consent form, we scheduled a date and time for the interview. The lead author conducted all of the audio recorded interviews, and we had them transcribed prior to data analysis. The semistructured telephone interviews lasted approximately 30–45 minutes and allowed for the gathering of rich description and detail while allowing us to ask and prompt for clarification. We felt it was important to include both data collection procedures to allow for the gathering of opinions of a large audience (survey), the flexibility for asking follow-up questions to garner rich detail (interviews), and as a means for data triangulation. For this particular study, we focused on the responses to the questions asking what aspects of the ATPs alter athletic training student persistence and departure the most. We developed the interview guide based on the current literature on athletic training student retention4,5,11 and pilot tested the interview guide on 3 separate occasions. We performed think-aloud interviews with 3 athletic training educators to ensure participants would interpret the questions similarly,14 and we completed another piloting with 4 additional athletic training educators over e-mail to improve content and clarity.15 Finally, we had a panel of experts, who we identified as authors of peer-reviewed publications on athletic training student retention and/or socialization, review the guide for face, content, and construct validity.16
Data Analysis
We combined the data from parts 1 and 2 and analyzed both with a grounded theory approach.17 Our goal in the present study was to explain the phenomenon of athletic training student retention as perceived by PDs, making grounded theory appropriate for this study.12 The 3-step process included open coding first, followed by axial and selective coding. The process moved from analyzing the data line by line during open coding to creating themes by combining categories based on the connections between the data during axial coding. Finally, we eliminated redundancy during selective coding, allowing for the generation of final themes from the data.
We maintained trustworthiness of the data18 with 3 separate procedures. First, we used multiple-analyst triangulation by having 2 researchers with extensive qualitative research training and experience independently analyze the data. The 2 researchers coded the data using identical techniques and compared the coding scheme and the final themes. We agreed on the content of the final themes, but negotiated over the terminology of the themes until we came to 100% agreement. Second, we selected 3 participants to complete interpretative member checks simultaneously. During this process, we provided the selected participants with their transcripts and the final themes. The participants then confirmed the accuracy of the transcripts and the results. Finally, we asked a third athletic training researcher educated in qualitative methods to complete a peer debrief by analyzing the coding scheme and validating the final themes.
RESULTS
We were able to identify 3 major themes that emerged from the data explaining why PDs thought athletic training students persist in ATPs:
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Students persist due to their career goals;
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The personal relationships students build with faculty, preceptors, and peers encourage persistence; and
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Students complete a degree in athletic training due to their enjoyment, passion, and dedication to athletic training.
We developed 4 themes describing why PDs believe students leave ATPs:
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Students have difficulty managing the rigor of ATPs, which includes both the didactic coursework and the clinical practicum experiences;
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Athletic training is not what students expected, or their interests have changed, leading to departure;
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The perceptions of working as an athletic trainer cause students to question finishing a degree in athletic training; and
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Students leave ATPs because of financial hardship.
The themes from the analysis are defined and supported with participant quotes in the following sections.
Reasons for Athletic Training Student Persistence
Career Goals
Program directors believe athletic training students persist because they want to be athletic trainers or because completing a degree in athletic training gives them the skills to be successful in other health care professions. One participant wrote he believes students persist because they “love the field of athletic training and can see themselves in a particular job setting doing this [athletic training] for a career.” Similarly, an additional participant stated that students finish a degree in athletic training because they are “dedicated to pursuing a degree/career in athletic training.” Finally, 1 wrote that students who finish “have a strong desire to be an athletic trainer,” while another responded that students “enjoy the community atmosphere and can see themselves being part of the profession in the future.”
Interestingly, multiple participants stated a degree in athletic training could be helpful in preparing students for graduate programs and a career in other health care professions. One PD asserted that “they [students] want to use the athletic training degree as a stepping stone to another professional medical degree ([physician assistant], [physical therapy], etc.).” This sentiment was echoed as a participant said, “They [students] want to go into another career field where the foundational education as an [athletic trainer] is very helpful.” Another responded, “The fact that they [students] want to use athletic training as a spring board for [physical therapy] or [physician assistant] school as opposed to the traditional biology route” caused students to persist in her program. Students also “see the benefits of [a degree in athletic training] helping them in graduate school (ie, [physical therapy], [physician assistant], chiropractor, etc).” Finally, 1 PD thought using athletic training to get to other professions was a relatively common practice. He said:
I think it's common because I do know a lot of other programs have students who are kind of using athletic training as a route towards either [physical therapy] or [physician assistant] school. And I know some in those programs discourage that and might not actually accept somebody into the professional phase because of that. But if they still plan on becoming certified and credentialed and practicing [athletic training] in that way in combination with another profession, I mean I have no problem with it.
A professional bachelor's degree in athletic training can be used to prepare for other health care professions, especially those that have set the entry-level degree at the postbaccalaureate level.
Personal Relationships
Participants frequently referred to the connections students were able to foster with other individuals, such as faculty, preceptors, peers, and patients, as being a key component to persistence. One PD at a small, residential, research university summed up this theme when she said:
I think, honestly, 1 reason [students persist] is just the community, the family atmosphere that our program has. We're relatively small; our program's only about 30 to 34 students. And they are pretty close knit as far as our students and the classes that they're in, both in athletic training and other classes as far as kinesiology. And our preceptors are all pretty close, so they hang out a lot of times. You know, we're friends with our off-campus preceptors. So you just kind of see that everyone in our program, whether it's didactic or clinical education, all kind of have like this really working relationship to where we're always in contact with each other. And I think it makes the students feel like they're in a safe place, you know, and this is kind of a family, and they don't want to let their family members down. And so I really think that it's that atmosphere that's created by our students, and by our staff, and by our faculty that makes such a great difference.
Similarly, 1 PD said:
But I think that faculty involvement is 1 of the biggest issues. It's so helpful that we have clinical and academic faculty who are willing to sit down with students and give them the time that is needed to help answer their questions.
Another stated, “Meaningful relationships fostered with faculty, preceptors, and patients support their integration into the academic and athletic communities, which promotes persistence.” The importance of these relationships was stressed by 1 participant who responded, “The sociocultural aspect of the relationships/friendships/support network that they [students] form within their cohort and with athletic training faculty/athletic training staff/advisors” helps to retain students within the ATP. Additional participants also agreed that relationships with patients could help secure a student's place in an ATP. One PD wrote, “They [students] appreciate the feeling of accomplishment when athletes commend them on their skill.”
Enjoyment, Passion, and Dedication
The final theme came from the PDs' perception of student involvement in the ATP. One common response for why students persist in an ATP is because they “enjoy what they are doing.” A participant stated that students enjoy what they are doing and develop a passion for athletic training when they start “feeling competent and successful in their clinical experiences.” Similarly, students also enjoy athletic training when they form an “interest and engagement clinically,” according to another PD.
Interestingly, 1 participant stated he thinks student enjoyment and passion for the profession is helped by “good professional modeling by ATP faculty/staff (reasonable hours, good pay, report to academic affairs, not the athletic director, positive about the profession, reasonably happy in their jobs),” leading to improved retention. Students also enjoy the “wide variety of clinical experiences” according to 1 PD. Another stated that students develop a passion for athletic training when “they understand that they are getting quality clinical education experiences, so even though there is a great deal of time put into the major, they feel as though it will be worth it in the long run.” According to 1 participant, students also become dedicated to the program because, “As faculty and clinical staff, we work hard to provide students with the best academic experience possible.” One PD responded that dedication to the ATP occurs when students become “committed and see a commitment from faculty and staff as well as see the value of their education.” Another participant stated that clinical education can help develop student dedication to the ATP despite the time involved, particularly if they are enjoying the learning experience. He replied, “They [students] truly enjoy the subject matter that they are learning, despite the long hours required for clinical education.” Dedication to the program and excitement for athletic training were also fostered through didactic education as explained by 1 PD. “The faculty who teach the classes engage the students in the learning process which causes the students to want to learn more and more,” causing students to persist.
Reasons for Athletic Training Student Departure
Program Rigor
Program directors often mentioned the fact that completing a degree in athletic training is difficult, and this often leads to attrition. A participant explained why students depart by stating, “I think it's because our program's hard. You know, we demand a lot. I think for some students, whether they don't want to rise to that challenge or can't, I think it's probably both.” One PD mentioned the “path of least resistance mentality,” where students do not “look toward what the degree will get them; they just want to have an easy program with minimal time constraints.” Specifically, the challenging nature of the coursework makes it difficult for students to maintain acceptable academic standing within the ATP. Programs are often “too difficult for students who are not academically strong.” One participant stated the “academic component is challenging, and they [students] either fail or withdraw before they think they will fail.” Intriguingly, 1 PD noted there are easier ways to gain entrance to other graduate programs. He explained stating, “Some students just want to go to [physical therapy] school after they graduate, and the ATP requires too much work to earn the [Bachelor of Science] degree.”
Program directors also often mentioned the time-consuming nature of clinical education. A common response for why students often depart from an ATP was, “They [students] are overwhelmed by the time demand of clinical education.” Another participant explained the rigors of the academic and clinical education components of an ATP by stating,
I do think the emphasis on understanding and implementing clinical—or evidence-based medicine, both clinically and in the didactic components of our program, can be challenging to students who don't get it, or they can't get it. So I think that it's a challenge for them. Again, I think that some of the clinical expectations or—simply seeing the experiences of the typical college student, our students envy that—that their classmates outside of athletic training can have a job and hang out in the afternoons, and they don't have a lot of the other stressors that our students have. I think that contributes to departure.
One additional participant agreed that the program rigor often leads to attrition. He stated, “They [students] feel they need higher grades to get into graduate school, and their clinical assignments take too much study time, whether it is true or not.” Program directors also expressed the difficulty of participating in intercollegiate athletics and completing clinical education requirements. Students struggle when “they are an athlete and feel they cannot commit to the hours required for athletic training clinical as well as their athletic commitments.” Another participant agreed writing, “Student-athletes express interest in the program but don't pursue it because they believe they can't balance their time, or their coach will not accommodate the ATP field experience requirements.”
Expectations and Change in Interest
Student expectations for what athletic training is and what it will be like to study athletic training are often different from reality. Frequently, students do not have an accurate understanding of the profession. They often do not “understand the profession prior to applying” to the ATP or do not “really understand what an athletic trainer is and does.” “They [students] find out they do not like the field as much as they thought,” leading to attrition, according to 1 participant. Similarly, students:
. . . realize that athletic training is just not what they want to do (even though they thought that initially). They realize this through clinical education experiences and/or lack of achievement in the academic coursework.
Misconceptions about athletic training often lead students to switch to different majors. One PD stated the lack of a secondary admissions process could be part of the problem. He stated, “I would think that direct acceptance in [to an ATP] during freshman year” can cause attrition “because it does not allow them [students] an opportunity to explore other career options until they have already started in a program.”
Program directors reported student interests also often change leading to changes in the selected academic program. One participant wrote, students “realize that the athletic training profession is not what they want for a future.” During 1 of the interviews, another PD spoke to this point. She said:
Honestly, most of the students that have left, they're just not wanting to do athletic training anymore. I've never had anyone leave our program that said, “I hate your clinical education. I dislike the classes.” They just get here and realize this is not what they want to do for the rest of their life.
Often, this change in major is due to a change in career goals. One participant noted students often “really want to go into another field (eg, physical therapy).” It is important to note 1 PD did not see attrition as a problem. She wrote:
Asking 17- and 18-year olds to make career decisions will always lead to some attrition. This is not a bad thing. College is where you have discovery and learn about who you are and what you want to do with your life.
Career Perceptions
Program directors noted the fact that students are able to identify negative aspects to a career in athletic training, and in turn those factors stimulate questions about longevity in the major or profession. A participant wrote students question finishing her ATP when they come to “the realization of just how demanding the day-to-day life is for an athletic trainer (and not wanting to do that).” The salaries associated with careers in athletic training appear to be a barrier to finishing a degree in athletic training. One PD wrote the “amount of money they [students] believe they would make in the profession for salary versus the amount of time they would be expected to work each day” is a reason many students depart the program. Likewise, the “job outlook for making money is lacking.” Another participant wrote students often “perceive athletic training work conditions (hours and pay) as poor.” In addition, students are also often “concerned about future time commitment required of the profession as well as the pay scale.”
Having professional role models also plays a role in student departure decisions according to PDs. Students might question finishing an ATP when they “see dissatisfied preceptors in their positions, and they don't want that for themselves.” Similarly, another participant explained why attrition occurs in her ATP. She wrote:
I do believe that the morale in our athletic training clinic plays a role and that turnover in our staff and clinical sites makes it seem like [athletic training] is not a “viable” long-term profession (students can't see themselves doing it for 30–40 years).
Other students may depart from an ATP because “they don't see athletic training as their long-term career. [They] choose professions with better starting pay scales.”
Financial Hardship
The final theme related to student departure dealt with the ability of students to afford continued enrollment. When asked why students typically leave her ATP, 1 participant responded, “Money. Most of my students have left because the small private education is expensive.” A PD at a different small, private institution agreed stating:
The biggest, most common, frequent departure, not only from our program, but also even with our pre-athletic training majors, is financial. You know, a student comes in, “Yeah, I like the school; I just can't afford it.” By this being a small, private university, tuition, books, room and board, and all that add a significant cost to it. And sometimes people come not realizing what that ultimately is going to be in terms of full cost or with the economic downturn that obviously threw a lot of people into a difficult situation.
A third PD who is employed at an institution of a similar type stated:
Finances; the school's expensive. . . I think that's the number 1 battle that we're fighting right now in terms of attrition . . . students take out loans for college, and their debt is gonna be $90,000. You're gonna go out into a job that you're gonna start at maybe $30,000. It doesn't make sense.
Another PD agreed, stating the “cost of the school is a major issue” when trying to retain students in his ATP. It is not surprising that these quotes came from small private institutions that are tuition driven. It remains unknown if a similar problem exists at larger publically funded institutions.
This theme also emerged from the fact that students often do not have time for a part-time job due to clinical education requirements. A PD wrote, “The economy also has hit some students who cannot afford to go to school and do clinical experiences and still have a full-time job.” Another participant stated, “The ability to work a job while attending school is certainly a factor for many students” when deciding whether they should stay in their ATP.
DISCUSSION
Persistence Factors
We found that PDs believed students persist due to their career goals, the relationships they build, and because they enjoy what they are doing. The finding that students persist because they want to become athletic trainers supports previous research conducted with recent athletic training graduates4 and athletic training students5 as well as the self-efficacy theory application to career choice.19,20 This theory endorses the idea that dedication is determined by the ability of a person to successfully perform behaviors to provide a specific result.21 Based on this theory, students confident in their abilities as athletic trainers will persist and enter the profession. Students confident that athletic training is the right profession for them and who are dedicated to finishing an ATP do so because they want to enter the profession. The connection between a degree in athletic training and a career in athletic training is lucid and easy for students to make and for faculty to explain. In order to sit for the Board of Certification exam, which certifies one as an entry-level athletic trainer, he or she must graduate from an ATP accredited by the CAATE. The requirement of completing an accredited ATP in order to sit for the Board of Certification exam and gain certification allows students to see a clear career path after graduation, as the completed curriculum should provide a strong understanding of the roles and responsibilities of an athletic trainer. Although there are numerous settings where athletic trainers find employment, the roles and responsibilities of the position remain reasonably consistent, especially at traditional practice settings (secondary school, college athletics, and professional sports). These results are similar to those found previously when students were asked why they wanted to complete a degree in athletic training. Many students reported they enjoy sports and want to help physically active individuals,4,22 thus making a career in athletic training desirable.
The finding that students remain enrolled in ATPs because they see the skills they are learning as useful for their future aspirations is noteworthy. An investigation of the barriers to becoming an athletic trainer found that an interest in another career was a major reason students did not pursue the profession.22 Also, previous work has found that students use a professional bachelor's degree in athletic training as a way to prepare for other professions.23 Only 71.3% of athletic training students obtain careers in athletic training according to PDs.6 Similarly, 17.6% of a sample of senior athletic training students were not planning to pursue a career in athletic training.24 Of those not pursuing a career in athletic training, 28.5% wanted to enter physical therapy school, and 15.8% wanted to become physician assistants. Students see the hands-on skills they are learning and the clinical education as beneficial to pursuing a postbaccalaureate degree necessary to enter several other health care professions such as physical therapy, physician assistant, and occupational therapy among others. Although using athletic training to prepare for another professional health care career can improve athletic training student retention rates, we believe it is detrimental to professional (career) retention as these students often do not work as athletic trainers or only do so for a short period of time. However, we do believe dual-credentialed health care professionals are important and can help improve understanding of the athletic training profession among other health care professionals.
The 2 themes related to career goals stress the importance of early socialization of athletic training students. Students must be given a clear depiction of the knowledge and skills of athletic trainers as well as a description of the job market. They may choose a different career path if they believe misconceptions or do not have a robust understanding of the roles and responsibilities of an athletic trainer.22 If prospective students become interested in the profession early on, especially during the preprofessional phase of an ATP, they will be more likely to persist.4,5
The relationships students form with peers, faculty, and preceptors give students the feeling of a close-knit family where mentors and support can easily be found.4,25,26 This support system is relied on by athletic training students to help them deal with the stress of completing a degree in athletic training4,5,24,27 as well as forming legitimation,28 reducing burnout,29 finding work-life balance, and improving retention in the athletic training workforce.30,31 Students find peers as someone they can relate to, as they are often dealing with similar struggles. The participants of the current study listed the fact that the faculty were dedicated to student success and available to students as a reason athletic training students persisted to graduation. Also, students identify preceptors as mentors32 because of the level of trust they have in the personal relationships fostered during clinical education. Also, preceptors must have adequate communication skills to be effective in their professional role.33
The finding that students finish a degree in athletic training because they enjoy what they are doing and are dedicated to the program appears to be connected to the previous 2 themes. Students enjoy what they are doing and become dedicated to the program because they have positive relations with the various individuals they interact with on a daily basis. They also become dedicated to the ATP because they want a career in athletic training, and the only way to achieve that goal is by finishing a degree in athletic training. Our findings corroborate other research asking freshman students why they applied to gain entrance to an ATP11 and research inviting students to identify reasons why they persisted in an ATP.4,5 Athletic training faculty and preceptors should provide experiences that are interesting, challenging, exciting, and engaging by offering opportunities for real-time patient care to keep students eager to enter the profession. Perhaps students who spend large amounts of time completing the ATP requirements feel dedicated and committed to the program and profession, increasing the likelihood of persistence.
Departure Factors
Program directors stated that athletic training students sometimes leave ATPs due to the rigor of the coursework. Because ATPs are rigorous, completing the coursework and clinical education requirements often cause student stress and frustration,7,10 leading to feelings of being overwhelmed. If these student feelings continue or heighten, students may consider leaving an ATP for another program that appears more manageable. We believe that appropriately socializing students prior to formal admittance to the ATP will help students understand the demands of athletic training education. The observation period prior to formal ATP admittance has been identified by PDs as a socialization tactic.34 Previous research has shown that student retention rates are higher the later they are formally enrolled into the ATP (ie, enrollment after 4 semesters of coursework demonstrates higher retention rates than after only 2 semesters of coursework or no college coursework).6 Advisors and mentors of athletic training students should provide students with an accurate and honest depiction of what it takes to complete the curriculum. Although doing so may cause some prospective students to find other academic programs, it may facilitate dedication while allowing timely graduation for those who depart.
Another reason for student departure identified by PDs is because the expectations of the students are not being met or their interests change. Many students are initially attracted to studying athletic training because of a background of sport participation or the desire to work as part of a team.22 Prior research has found students who shift their interest away from athletic training do so because of a lack of proper socialization.23 Appropriate socialization of students is vital to their legitimation28 and development of an accurate understanding of the profession.22 The understanding of the athletic training profession by prospective students is limited,22 leading to a disconnect between expectations of students and the ATP. Students should enter an ATP for reasons that align with the mission of the program and the athletic training profession.22 Further, clinical education experiences that are not engaging and do not provide opportunities for active learning8,9 can cause student frustration7 leading to a lack of integration and leaving student expectations unmet. Interestingly, similar results have been found previously in nursing education as students often depart due to an inaccurate perception of the educational program.35,36
Our participants also explained that students contemplate leaving an ATP because of career considerations. It remains unclear if this process occurs internally as a personal evaluation of the profession or externally from advice they receive from mentors. Another possibility for the concern over entering the profession may stem from professional socialization. As students learn the roles and responsibilities of the profession, they may decide athletic training is not what they are interested in doing for the remainder of their professional life. One possibility for the change in student career goals may be due to the perceived lack of compensation for a career in athletic training paired with the time commitment associated with a career in athletic training.23,37 Also, students may change their desire to obtain a career in athletic training because they observe preceptors who struggle to find work-life balance, leading to the belief that the experiences of their clinical instructor is widespread and a reality of the profession.24 Further, role strain is common among preceptors due to the competing roles of health care professional and educator, stressing the importance of explaining the benefits of serving as a preceptor and support for those athletic trainers serving as preceptors.38 Selecting clinical education sites with preceptors who are experiencing burnout or have poor working conditions, including long hours and/or poor pay, may not exude excitement about the athletic training profession, thus leading to diminished athletic training student commitment. Conversely, selecting clinical education sites that have preceptors who can serve as appropriate professional role models by promoting the profession to athletic training students may help improve persistence rates of students by giving them an appropriate understanding of the roles and responsibilities of athletic trainers.23 However, it is also important to provide students with a realistic impression of the profession during clinical education opportunities.
Finally, the PDs identified financial hardship as a reason for student departure from the ATP. 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.39 Anxiety related to the costs associated with completing an ATP has previously been found to increase student stress.10 Athletic training faculty need to be aware of the demands placed on athletic training students and provide a supportive environment which allows students to engage in activities outside of athletic training.7
LIMITATIONS
It is important to note some limitations of the current study. Most notably, we asked for the opinions of PDs, not athletic training students or other program faculty and staff. However, we believe the perceptions of the PDs are important because of the large number of athletic training students they have likely admitted, mentored, instructed, and evaluated along the path to becoming credentialed as athletic trainers. Although we received responses from over half of the directors of ATPs nationally, generalizing our results to all ATPs may not be applicable. Some ATPs may have unique circumstances leading to additional reasons for athletic training student persistence and departure decisions. Because of this, it is difficult to make blanket recommendations for all ATPs. We recommend additional research to identify specific factors associated with athletic training student persistence or departure as decisions may be made based on institutional and/or programmatic factors.
CONCLUSIONS
We were able to extend the current literature by seeking reasons for professional bachelor's athletic training student persistence and departure decisions from PDs. We believe the data in the current study are particularly unique as PDs have direct knowledge of the students who depart the program and the specific reasons given by those students. Program directors believe students remain enrolled in ATPs because of their career goals, the personal relationships they create, and because they enjoy and are dedicated to what they are doing. According to PDs, students leave ATPs because of the academic rigor associated with completing a degree in athletic training, the program not meeting the student's expectations, the student changing their interest, career considerations, and financial reasons. Selecting clinical education sites that can include preceptors who are enthusiastic about the profession may help improve athletic training student commitment leading to retention. Finally, faculty and preceptors should promote the benefits of completing an ATP while disclosing potential drawbacks to help students make appropriate decisions regarding enrollment in an ATP and entrance into the profession.
Contributor Notes
Dr Bowman is currently an Associate Professor in the Department of Athletic Training at Lynchburg College. Please address all correspondence to Thomas G. Bowman, PhD, ATC, Department of Athletic Training, Lynchburg College, 1501 Lakeside Drive, Lynchburg, VA 24501. bowman.t@lynchburg.edu.