Athletic Training Students' Perceptions of Mentorship in Clinical Education

Design

We used a concurrent mixed-methods design to evaluate mentorship received within clinical education. Specifically, we used Web-based in-depth interviewing in parallel with a validated survey measure of perceptions of effective mentoring. We selected the use of a concurrent design as a means to gain a more comprehensive account of the mentoring that can occur in athletic training, specifically as it pertains to quality of experiences.^13,14 We planned to use the qualitative data as the primary source of data, and then use the response to the validated survey instrument as a means to provide context to the emergent data. Thus, we analyzed the qualitative data first, and then used the descriptive quantitative data as a supplement.¹⁴

Participants

We recruited 17 (14 females, 3 males) athletic training students to participate in our study. We purposefully recruited students of varying levels to gain a more comprehensive understanding of the mentoring process in athletic training clinical education. Purposeful access to our participants was gained by contacting athletic training faculty members who had a professional relationship (n = 7) with us. We used this purposeful sampling strategy¹⁵ to engage a variety of athletic training programs in a broad geographic area. We used their relationships with students currently enrolled in their programs as a means to gain access to them. The program faculty were asked to forward our e-mail to any student meeting our inclusion criteria. The e-mail included the link to our questionnaire for participation. This process was successful in gaining data redundancy. We also wanted to make sure each student had a minimum of 1 year of clinical education experience, in which they could draw upon those interactions to respond to our questions. Individual data is presented in Table 1. On average, our participants were 21 ± 1 years old and represented varying levels of academic standing (1 sophomore, 9 juniors, 7 seniors). All participants indicated they currently had a mentor when asked directly.

Table 1.  Individual Demographic Data

Abbreviation: F, female; M, male.

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Data Collection Procedures

Recruitment of participants was done after institutional review board approval was gained by the host institution and followed a purposeful sampling procedure.¹⁵ We specifically looked for students who had completed a minimum of 1 clinical practicum experience and 1 full semester as an athletic training student in a Commission on Accreditation of Athletic Training Education accredited program. Once the students agreed to participate, they were asked to complete the data collection process during the fall of 2014. This included completion of the Likert-scale mentoring survey and Web-based interview. An initial invitation was sent to each participant from the host site (Qualtrics, Provo, UT), and 2 follow-up e-mails were sent at 1 week and 3 weeks post the original e-mail.

Instruments

Upon completion of the background questionnaire, participants completed the Athletic Training Perceptions of Effective Mentoring Survey (ATSPME), first developed and validated by Pitney et al⁶ with a Cronbach α of 0.85 among athletic training students. The ATSPME includes 4 parts. The first part asks participants to identify whether they currently had a mentor and who that mentor was, after reviewing the definition of mentor. The second part of the ATSPME asks students to identify, using a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree), mentoring roles they felt were important. Examples of these questions can be found in Table 2. Section 3 asked the students to answer more generalized questions related to mentoring including their perceptions of the importance of mentor gender, experience, race, and age. Questions related to mentoring can be broken down into 6 constructs: (1) educational, (2) motivational, (3) relational/interpersonal, (4) counseling, (4) facilitative, and (5) career/employment. The fourth part of the original scale solicited demographic data, which we chose to ask first. We asked all participants to complete a series of questions related to their basic background as a student. Questions included sex, age, semester standing, and National Athletic Trainers' Association district. Questions from the survey instrument as drafted by Pitney and Ehlers² were designed to reflect the literature on mentoring, specifically focusing on characteristics and mentor roles.^9,16,17

Table 2.  Participant Responses

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Then we had our participants respond to an online written interview related to their experiences with mentoring (Appendix). We developed the open-ended questions based upon the existing literature in athletic training on clinical education,^18,19 mentoring,^8,20 and the ATSPME.⁶ Prior to data collection, we had 3 content experts review the interview guide for content, clarity, and accuracy. Those selected were done so based upon experience as qualitative researchers and knowledge related to clinical education and/or mentoring in athletic training. Each expert was provided the interview guide along with the purpose and research questions. Their feedback was digested, and updates to the guide were made accordingly. Edits included grammatical changes for clarity, restructuring for flow, and the addition of questions related to their mentoring experiences. A small pilot study of 2 athletic training students was also completed after the expert review to establish consistency with interviewing and to identify any potential issues during the online interviewing process. Data from the pilot was included in the analysis as presented next.

Data Analysis

Data were analyzed following a general inductive process of analysis.²¹ All transcripts were initially read holistically as a means to orient the researcher to the data. Then during second and third reads of the data, emerging segments of data were located and tagged. Meaningful chunks of data were labeled through inductive codes assigned by the researchers to describe the meaning of the data. Data was continually evaluated and re-organized as commonalities were identified. Categories were organized into overarching themes to ensure clear connections between participants' comments, specific codes, and general thematic findings.

Quantitative data was analyzed following the completion Qualitative data analysis. The scores for each item of the ATSPME were examined using Microsoft Excel (Redmond, WA). Means and standard deviations of each individual Likert question were evaluated.

Data Credibility Strategies

We employed several strategies to ensure credibility of the findings including a peer review, methodological triangulation, and multiple-analyst triangulation. Inherently, a concurrent method allows for methodological triangulation by embedding both forms of inquiry within the same study and allowing for a more comprehensive exploration of the topic.¹⁴ Multiple-analyst triangulation occurred between the first 2 authors independently following the procedures above. Prior to the analysis, both authors reviewed and agreed upon the steps of analysis and discussed the findings after completing the review. Then once the multiple-analyst triangulation was complete, the peer reviewed the presentation of findings including the code sheets, interview transcripts, and the selected data used to define our themes. Agreement was reached during this process.

Mentoring is a Relationship that Facilitates Student Advancement in Clinical Practice

Mentors help athletic training students develop as future clinical practitioners by not only allowing them to engage in the role, but also by providing them with chances to brainstorm, solve problems, and gain feedback on performance. Our participants indicate that they value mentors who demonstrate these previously mentioned attributes related to advancement of clinical practice. We asked our participants several Likert-scale questions pertaining to mentoring relationships, 6 of which directly relate to student development. Table 2 illustrates our participants' responses to these questions, which speak directly to advancing clinical practice. For example, Ben shared:

They [my mentors] allow me to take what I learn that day and apply it in the athletic training room. My mentors will even allow me to do things that I have not learned fully, with them supervising me. This helps me learn a lot!

Ben appreciates being able to apply his skills each day and to continually learn through his own trial and error under the supportive watch of his mentor.

Advancement of clinical practice was facilitated through teaching, as pointed out by Sarah, a junior athletic training student, “All of my preceptors up to this point have been excellent teachers, and I feel like they went out of their way to spend time teaching and helping me learn.” She continued that learning occurred because of the efforts her mentors made in fostering scholarship within the clinical education setting. Maggie wrote:

My preceptors created learning opportunities and allowed me to be actively involved in most if not all aspects of the athletic training profession. I have felt progressively more and more confident in myself and my knowledge.

Mentoring allowed for clinical advancement for the athletic training students because preceptors, who were identified by all of our participants as mentors, guided learning through application of knowledge and skills as well as through higher order thinking. A junior female athletic training student's comments regarding her mentor illustrate this concept of advancing clinical practice through critical thinking. Sally wrote:

It has impacted my learning by taking everything that I have learned in the classroom and apply it to real life. My preceptors have showed me a higher way of thinking and how to take everything the athlete says and synthesize it and come out with a differential diagnosis.

Further supporting the comments above, Abby discussed the advantages of having a mentor as the means to gain the real-life experience needed to advance as an athletic trainer. She journaled:

Having a preceptor/mentor allows me to critically appraise topics or theories taught in class and how I can incorporate them into clinical practice in an effective manner. Having a preceptor/mentor gives me an opportunity to discuss these topics and appraise them in a clinical aspect.

The mentoring relationship, according to our participants was one that allowed for the chance to become integrated into the athletic training clinical environment and a chance to understand how things work as a means to become ready for clinical practice.

A Mentoring Relationship Allows for the Development of Career Goals and Lets the Student Plan His/Her Future

Mentoring relationships have been perceived to be strong facilitators of career development for young professionals, particularly in the initial years of socialization and training.^22,23 Our participants viewed their mentors as people who could give helpful advice (4.8 ± 0.42) and help network with other professionals (4.3 ± 0.57). These particular characteristics are articulated by the career employment subset of questions with the ATSPME survey, which suggests that a mentor is able to help a mentee develop career goals and a plan to achieve those goals. Specifically, our participants felt mentors helped them figure out the next steps in their career development and allowed them to talk it out as they visualized their future careers. Ashley shared, “Having a mentor has helped me talk through my possible career goals and lead me in a direction that will bring me the most personal and professional success.” She continued about her current mentor:

I consider an assistant athletic trainer at my [current] college as my mentor. She is easy to talk to about anything that is going in my life, and she has some valuable insights into what my options are for the future.

Our other participants had similar comments about the importance of having a mentor, like Sarah who said, “It just helps me to sort through what I am thinking about with my career goals.” Mike too had similar thoughts on having a mentor saying he/she “always kept me inspired and on track towards my goals. They reminded me and gave me the support I needed to give my education meaning.”

Mentoring relationships had positive impact on career development as illustrated by separate statements made by 2 junior female students (Lynn and Kate) in their reflections on mentoring relationships:

I think having a mentor has made me look forward to the future in the profession and the variety of things I can do with this career. Between my student mentor and my preceptor, there are very distinct differences in what they have done in the profession so it allows me to set goals for myself in the future. –Lynn

Having a mentor has made me want to work in this field more than ever. My mentor is always so passionate about her job and working with athletes to make them better, so that gets me excited to push myself to my full potential so that I will be successful in the field. –Kate

These 2 quotes highlight the importance of professional enthusiasm in the mentoring relationship and how that can translate into the development of career goals that align with the positive experience. Our participants also believed that an effective mentor is inspirational and a good role model, which can provide context to their development of career goals. Moreover, a mentor can directly influence the pursuit of future employment settings as showcased by Ashley, a senior reflecting on her mentoring relationship:

Having a mentor has. . . also shaped my career goals because I would like to end up working in a collaborative environment like the clinic at my college because of the relationship I have built with my mentor.

Experience Drives Instruction While Youth Initiates Compassion During Mentoring Relationships

Athletic training students do not perceive age/experience to be predictive of a successful mentoring experience, but rather the type of mentoring that occurs between the student and mentor. Responses to questions directly pertaining to experience and effectiveness of the mentoring experience provide support to the qualitative responses. Scores for 2 questions in particular highlight this: “Mentoring is more effective when a mentor is significantly more experienced than the protégé” (2.4 ± 1.1), and, “Mentoring is more effective when the mentor and the protégé are of similar ages” (2.05 ± 0.8).

Our students viewed those preceptors with more experience as those who provided better instruction, while novice preceptors were perceived to provide more support and compassion during clinical education experiences. For example, Emma shared, “The more years of experience as a preceptor/athletic trainer usually means that they have seen more and experienced more, so they are usually better at teaching,” a direct acknowledgement that teaching is a skill that a more experienced preceptor possesses in comparison to a novice one. Another student Robin shares, “The longer you are doing something, the more experience you have in it, the more knowledge you have on the topic, the more you can share and teach on the subject,” comments that reflect, again, the idea that experience equals teaching skills and the ability to do so in the clinical setting. Our participants spoke of the educational component to mentoring, which for them developed over time through experience as a preceptor/mentor and athletic trainer.

Our participants perceived the novice preceptor as a mentor who was more understanding of the demands of the athletic training student and was able to provide more tolerance to their requests and demands related to completion of their responsibilities and expectations. For example, 1 athletic training student, Maggie, shared:

My first preceptor was a PhD student, and my second was a master's student. I felt like these 2 preceptors understood better what it was like to be an undergraduate student. They understood I had other homework and respected my time.

Her comments reflect that age, in this case, allowed for more compassion for the student as they balance workloads. Similarly, another student, Abby, shared her satisfaction with working with young preceptors as they could provide empathy during the clinical education experiences. She shared:

In my experience, I found graduate students to be more willing to mentor effectively because they are in a position to better relate to the demands that an undergraduate student might experience. I found to have enjoyed working with graduate students as preceptors and feel they are extremely positive mentors to work with.

Molly supports this by discussing how a more novice preceptor and mentor allows a student to integrate their classroom learning more at the clinical level because the preceptor just recently learned the skills themselves:

. . . I do think that having a preceptor who newer in the field can be beneficial because it is likely they learned similar things that you are currently learning, which gives you the opportunity to practice what you're doing in the classroom.

Abby also felt as though their best mentoring experiences came from their younger preceptors who were more willing to guide them:

From my experience as a student, years of clinical experience does not have an impact on my clinical educational experience. I feel that the experiences where I feel I have gained the most were with preceptors who were not experienced for the longest. I think that willingness to teach and engage, as well as ability to be flexible and communicate matter more than the number of years of experience they have.

Novice preceptors appear to provide more counseling in their mentoring behaviors as perceived by our participants. That is, they provided empathy and support because they had just lived those experiences and could relate to the demands and needs of the athletic training student.

When discussing experiences with a more seasoned preceptor and her thoughts on the influence of experience, Emma stated, “Yes, [I have noticed a difference] because the more years of experience a preceptor has usually means that they have seen more and experienced more. Also, they are usually better at teaching.” Emma's comments highlight the perception that experience of preceptors can impact teaching abilities; that is, experience can facilitate more teaching. Ben was able to summarize the influence of experience on mentorship with his comments:

The number of years of clinical experience does not have an impact on my clinical education experience. Athletic trainers who have been in the field for a long time are really great to work with because you know they are very knowledgeable about what they do and have plenty of experience with a variety of situations. Athletic trainers who are new in the field are also great to work with because they have new knowledge about new modalities and methods.

Mentoring as a Means to Provide Support and Understanding

Our participants, like that of Pitney and Ehlers,² found that athletic training students identify their preceptors as mentors. Thus, it is not surprising that they identified support and understanding as key aspects to their mentoring relationship, as both Weidner and Henning¹⁷ and Pitney and Ehlers² found that interpersonal skills were essential characteristics for both a preceptor and a mentor. Our participants articulated that support, understanding, empathy, and encouragement were all factors of their mentoring relationships, and thus giving credence to previous literature on the role of mentors in professional development.^2,6,23,24 Furthermore, these variables are helpful in mentoring the athletic training student, as at times they can become overwhelmed and stressed by the loads placed upon them as athletic training students.²⁶ Therefore, having a mentor may also be a means to reduce this burden and potential experiences of burnout. Empathy and support were perceived as necessary for mentoring to be successful and supportive of professional development.

In unpublished data,²⁷ it is suggested that women display more feminine traits (authentic, engaged, etc), and thus, these traits can better guide the development of the mentoring relationship. Our sample population was predominately female; thus, this could provide some context to our findings; that is, female athletic training students want their mentors and preceptors to exhibit what is commonly referred to as sex-specific traits.

Our participants also talked about shared experiences and having previous knowledge regarding the stresses associated with balancing academic, clinical, and life roles with their mentors, and this was regarded as necessary, particularly for a positive clinical experience. We know that positive clinical experiences are important in an athletic training student's professional development, as it allows for the growth of commitment and passion for one's intended profession.^28,29

Mentoring is a process that involves a more experienced person guiding and advising a less experienced individual; therefore, experience is often viewed as a platform for success in the relationship.⁶ However, maybe more important are the qualities possessed by the mentor that help facilitate success. Many have suggested, like our participants shared, that to perform the duties of a mentor effectively, one should display patience, support, approachability, understanding, compassion, and other interpersonal skills.^2,30,31 Simply put, the preceptor/mentor role is one that can provide counseling, support, and advice, skills founded by interpersonal attributes. These skillsets are often considered intangible, yet necessary for effective mentoring to occur. Expectations for these skillsets to be present during clinical education are likely, but could be developed through several mechanisms, including formal preceptor training and organic socialization into the role as the preceptor. Program directors and clinical education coordinators can encourage this development by including discussions of effective mentorship in preceptor training sessions as well as being informal mentors themselves through communication and role modeling. Furthermore, encouraging them to remember the demands they too faced as a student may help them demonstrate more support and understanding in the clinical education setting. Reflective journaling or self-reflections on the part of the mentor and mentee may serve as a means to stimulate this type of interaction.

Mentoring is a Relationship that Facilitates Student Socialization and Advancement in Clinical Practice

Our findings support mentoring promotes role learning,³² a critical piece in professional socialization. Having a mentor for an athletic training student provides the necessary role modeling needed to gain an appreciation for the roles and responsibilities associated with the athletic trainer's role in health care.³³ Today's student, described as the millennial, wants real-life experiences that promote interactive learning that is engaging and related to his/her future role.³⁴ To benefit from this, they need a facilitator, which in this case is their preceptor, who is viewed as a mentor, a relationship that likely develops organically, yet is founded on millennials' need to be social. Students look to develop meaningful relationships that promote collaborative learning, as it allows them to achieve their goals, and ultimately, it provides them with feedback they require to feel successful.^34,35

Mentoring relationships are founded on the premise that role learning will take place and that an effective mentor can demonstrate an interest in teaching, the development of the mentee, and the willingness to facilitate the growth of the mentee.^2,6 Our participants discussed the benefits of having their preceptors as mentors and felt that they directly advanced their clinical practice by engaging in discourse, critical thinking, and skill application. It was their mentors who allowed for them to gain an authentic experience, and this facilitated their skill competence. Clinical education is the foundation to which the athletic training student is able to practice the theory they have learned, and to support this, a mentor must be one who can counsel, advise, coach, teach, and support.³¹

A Mentoring Relationship Allows for the Development of Career Goals and Lets the Student Plan His/Her Future

Engagement in clinical education allows for athletic training students to visualize their futures as professionals,^26,33 as it provides exposure to the roles and responsibilities associated with the job as well as it helps them develop a professional role identity, a key factor to persistence in the workforce.³⁶ Professional role identities can be summarized as the realization and acceptance of the responsibilities of an athletic trainer, which can be formalized through professional socialization. A main function of a mentor is to help train a mentee toward a specific set of skills and knowledge related to his/her future scope of work, but a mentor also advises, counsels, and inspires a mentee during his/her pursuit of professional development and growth.³⁷ All of our participants, as in previous research,² recognized preceptors as mentors and valued their relationship with them as it allowed them to plan their futures. A direct link has been made with positive clinical education experiences, retention into the workforce, and successful professional socialization.^26,28 Fundamental to this positive clinical education experience is engagement in the mentoring relationship that facilitates professional socialization and legitimization into the role of the athletic trainer.^28,33,38

Our students not only shared the impact their mentors had on their ability to develop career goals and visualize them, but also how engaging in their experiences allowed them to develop passion and inspiration for a certain work environment. Findings that have been previously presented by Bowman and Dodge²⁶ and Mazerolle and Benes,³³ which suggested that diversity and direct exposure to the role of the athletic trainer can stimulate career planning as they can gain feedback from their authentic experience. Simply the act of functioning in the role, while being mentored by a strong role model allows for legitimization and actualization. Program directors and clinical education coordinators should be sure to provide diversity in experiences, but also seek out students' initial career plans as a means to provide direct interactions in that setting to allow for continued planning and confirmation of those career goals.

Experience Drives Instruction While Youth Initiates Compassion During Mentoring Relationships

A dichotomy exists regarding the age and experience (number of years) of the preceptor in regards to the level of instruction and supervision he/she can provide to an athletic training student. It is postulated that novice athletic trainers lack the clinical experience and knowledge to be effective as preceptors, as simply they cannot identify teachable versus nonteachable moments.³⁹ Despite this finding, many novice preceptors (<1 year in the role) feel adequately ready and prepared to engage in the preceptor role and only feel slightly hesitant to provide feedback regarding professional behaviors, not performance feedback.⁴⁰ Our findings illustrate that, in terms of mentoring, experience may not directly relate to effectiveness but rather the type of supervision and mentoring provided; that is, novice preceptors may offer a more supportive type of learning environment, whereas more experience facilitates a more formalized learning environment. Being a mentor can take on a variety of roles, but ultimately, is a complex combination of educational facets, interpersonal dimensions, and willingness to navigate the relationship associated with role modeling and mentoring.²

Our participants did not equate age or experience to be reflective of effectiveness and in fact valued the support and encouragement received from the younger (novice, intermediate) preceptors, suggesting that the interpersonal foundations² are fundamental for mentoring. In fact, Pitney et al⁶ identified encouragement as well as providing support and advice as key roles for effective mentoring, which may explain why our participants felt age/experience did not mitigate mentoring relationships. Moreover, this generation of learners is classified as millennial individuals who crave relationships, seek comfort in those relationships, and hunger to learn more.³¹ So, our findings imply that, when students are engaged in a mentoring relationship, they do not see age/experience as necessary, but rather see the need for learning and support. Program directors and clinical educator coordinators, when making practicum assignments, should consider the needs of the student; that is, some students may need support and nurturing at certain stages of their professional development, and thus, a novice preceptor may benefit them. In contrast, a student who is struggling with skill acquisition or application may need a more experienced preceptor to aid in this process as they can recognize the teachable moments. Effective mentoring may not be dependent upon experience, but rather willingness to engage in the process of mentoring.

Willingness to be a mentor has been suggested as an important characteristic for a good mentor.⁴¹ However, age and experience have not been linked to successful mentoring relationships, a finding that is unique from our study. This suggests that possibly those who have just navigated the socialization process to become athletic trainers demonstrate compassion and readiness to be involved with mentoring and professional development. The identity of serving as a preceptor may have resonated with those who are new to the profession due to a previously held desire to becoming a preceptor.

Limitations and Future Directions

Although we obtained saturation of data with our sample, we recognize that the relatively small sample may limit the applicability of findings to all athletic training students. Kram²³ outlines 4 phases (initiation, cultivation, separation, and redefinition) of effective mentoring, which suggests that the relationship develops over time. We only present data that speaks to a snapshot of the mentoring experience and relationship. That is, we used a retrospective approach to examining the mentoring experiences for the student and did not monitor the development of the mentoring relationship over time. Much like the existing literature, our study too shares the perceptions of and the opinions of students engaged in athletic training education as a reflection of the experience. Thus, future research should longitudinally examine the mentoring relationship. A final suggestion for further research could be to utilize the TEAM (take-on, engagement, achievement and maintenance) as a conceptual framework to evaluate the success and influence of mentoring on professional development and transition into the workplace.⁴²

Younger athletic training professionals appeared, as discussed by our participants, to be more empathetic and understanding. The focus of this study was to gain an understanding of experience related to serving in the role of the preceptor from the student's perspective. We did not collect information on the sex of the mentor. In the future, this information could provide better insights on sex influences on the mentoring relationship. Women are often viewed as those who exhibit more nurturing and compassion, which could spill over into their mentoring style.

Mentoring is a 2-way relationship; that is, the mentor and mentee willingly enter into the relationship. In our present study, we only present the perceptions of the student, and therefore, in future studies, we must conduct interviews with both the mentor and mentee to triangulate the findings. We used an online method to conduct our interviews; although a reliable method to do so, follow up is not immediately available. Despite our steps to ensure flow and accuracy with questioning, future studies using a different mode (focus groups or phone interviews) may provide additional insights on the development of a mentoring relationship.