Exploring Athletic Training Educators' Development as Teachers

Selection

Participants were purposefully selected based on the following inclusion criteria: (1) currently teaching at least 1 undergraduate athletic training class, (2) possessing a terminal degree (EdD or PhD) in athletic training, education, or a related field, and (3) possessing a minimum of 8 years of experience teaching athletic training courses. We chose 8 years of teaching experience as our benchmark to ensure participants had adequate role induction. Eight years of teaching experience should also allow for tenure and/or promotion, if applicable, to help ensure the participants were steadfast in their role as an educator. Our selection criteria were based upon our purpose, which was founded upon understanding the development as an athletic training educator; therefore, we wanted individuals who had been engaged in that role for a substantial period of time. Variations on length of time for role induction exist, yet we believe based upon the review of literature within athletic training that this time frame is appropriate.^20,21

Our Participants

Eleven individuals (4 men, 7 women; age range, 36–55 years [average = 45.5 ± 9.5 years]) participated in this study. Ten of the participants were white and 1 was Asian. Participants had been BOC certified for an average of 22.73 ± 5.71 years (range, 14–32 years) and had been in athletic training education for an average of 18.09 ± 6.01 years (range, 10–28 years). Each participant was assigned a pseudonym. Table 1 contains further information about each participant.

Table 1.  Participant Information

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Changes in Teaching over Time

Many of the participants discussed the changes in their teaching style and focus over the course of their careers in higher education. They discussed an evolution in their teaching philosophy that occurred over time. For example, Anthony, who has been teaching for 14 years, stated:

I use to be more concerned and more oriented to giving facts and pointing out facts to the students; the facts and things that I thought were important. Where now I think I still highlight specific information, but it's the concepts and theories that are more important. And to where I think currently my biggest challenge and objective is to take a student give them the facts, the information, but challenge them to apply it into the actual application, clinically. And so I use a lot of examples that are towards that, rather than just multiple-choice tests, for instance where you just test facts and knowledge and memorization. So I use more short answer, and essays if you will, even practical exams if it is something that fits into the class format.

During the videotaped teaching lesson, Anthony stressed concepts and theories, over memorizing terminology and other facts. He actually diverted from the PowerPoint (Microsoft, Redmond, WA) for most of the class to explain a concept differently than he had originally intended. When asked about this in the interview, Anthony said he just stopped advancing the slides and used the white board to address the topic. He stated he covered the same content addressed in the slides; he just did it in a different order. Although he stressed the importance of concepts, application of material, and the movement away from multiple-choice tests during the interview, Anthony's syllabus for this class painted a different picture. His syllabus for this course indicated that all examinations were Scantron format and that the grade in the course was largely from these examinations.

Pamela, another 14-year teaching veteran, also discussed a similar transition from focusing the minor details to now stressing the importance of larger concepts. For her, it was a move from memorization to practical application:

I think it's [her teaching] changed over the years, it's funny because I wish I had kept a journal from year to year of thoughts and everything but, I think over time it's changed to less worrying about having them know every little detail and focusing more on larger concepts that are applicable and transferrable to other content.

As addressed below, teaching became more about the application of information and less about individual facts and details for many of the participants. Over time, the participants felt that they grew into their roles and became inducted into the role of educator. Interestingly, Emily summarized the change in her teaching when she stated, “I feel like I am much more effective because I am comfortable, because I have been doing this role for such a long period of time.”

Participants also addressed the change in how they managed the classroom over the course of their careers. Matt, who has been teaching for 15 years, reflected and said,

I've really gone from somebody who tried to rule with an iron fist to being somebody who tries to be empathetic and sympathetic, while still making them [the students] accountable and responsible for their actions at the same time.

Along the same line, Kristen even called her early teaching style a “command style” at the beginning of her career.

Pamela also addressed the change in her classroom management and how she focused her time and energy in the classroom. She stated, “I gave myself permission to let it go, 'cause I can either focus on the one kid who seems not to care, or I can focus on the other 5 or 6 who are really wanting to be challenged and want to learn.” This evolution in teaching over the course of their careers was discussed by the majority of the participants, going from someone ridged in their teaching style and classroom management to someone more flexible and student focused. They started letting go of control on the material to allow students to have more ownership in discovering the information. For example, Lisa, with 22 years of teaching experience, stated:

I had to find ways to deliver content a little bit differently, let go of some of the control that I had with the content and let the students discover that content. Because with discovery, they're going to retain it much better than with me just up there talking about it. So I think that's what's changed, it's [her teaching] gone from lecture based to more engagement based—more activities, letting go, having my students discover content.

The variety in Lisa's teaching style was evident in her videotaped teaching lesson, in which she used both small- and large-group activities, PowerPoint with a lot of images, and questioning students to promote discussion and engagement.

The participants also discussed that changes in their teaching often were the result of feedback from students during the end-of-semester course evaluations. The participants indicated that they valued comments from the students and tried to address them in their future classes. Change also occurred during the course of the semester because of a lack in student engagement or understanding during a particular lesson. Jill, with 28 years teaching experience, may have said it best:

If they're [the students] not excited when they respond, if they're not excited like “oh I know that answer,” then I'm not hitting it where I need to hit it and I need to change that style, and it's often in the middle of a class. If I'm not hitting the mark where I have them engaged then I will suddenly, just spur of the moment, just pop up in another activity that forces them to integrate the knowledge and challenges them a little bit more.

Jill videotaped a lesson on biomechanics and used lecture with questioning, videos, and demonstrations to illustrate her points and maintain student engagement. Erin discussed her view on change in the classroom by simply stating, “You know, you try something new and it doesn't work, then you just move on and try something else.”

Clinical Experience

The majority of the participants discussed how their previous and current athletic training clinical experience had influenced their teaching. All the participants had different clinical experiences, ranging from graduate assistantships to those, such as Lisa and Kristen, who still practiced as part of their role at their university. Participants had a breadth of professional experience and with that experience combined, they collectively have been certified athletic trainers for approximately 250 years. Matt, who has practiced in both the secondary school and collegiate levels, stressed the importance of educators having clinical experience to draw from. He stated, “That's one thing that people who do a good job of teaching can, they can relate to what's happening, they can bring in stories that are meaningful to students.” Anthony, who has clinical experience primarily at the collegiate level, also reflected on this idea as an individual educator and stated,

I realized that my clinical background is what makes me, or what I think makes me, a better teacher, because I am able to understand or look at the materials from the student's perspective, the clinician's perspective, and relate that information that way.

Emily also addressed this when she said, “My personal experiences of either working clinically, or working as a professional in the field, I think have helped me craft my teaching.” Kristen, who still has a team assignment as part of her faculty role. said,

I think there's a huge thing to say about still practicing and still being involved in the profession, whether you have a team assignment still or you're volunteering. I think you have that connection when you're working with students.

Participants used their clinical experiences to discuss patient encounters, give concrete examples, and connect with students in the classroom.

Erin went on to discuss at length how having current clinical experiences help her feel “relevant” in the field. She sought out various clinical opportunities to volunteer as an athletic trainer. When reflecting on here time volunteering during football camp at the university she teaches at, Erin stated, “I'm basically showing the students that I'm remembering for myself how hard it is to work as an athletic trainer.” Erin continued to discuss how during this experience she did not see many injuries or have a very active role, which led her to seek out another volunteer opportunity with a local secondary school's football program. At the secondary school, she helped cover Friday night football games, which allowed her to do more than the college setting. Over and over again, Erin discussed how these experiences helped her stay relevant in the field and kept her stories fresh for the students. She also used her clinical experiences to “tell them [students] when I've screwed up in the past and let them laugh at poor decisions I've made.”

Encouraging Critical Thinking

Although all who participated in this study did not use the term critical thinking directly, they discussed the importance of having students learn and use critical-thinking skills. For example, Anthony stated:

I present a lot of scenarios or situation where there is no clear path, no simple answer, there is no right or wrong. I just want you [the student] to be able to identify and support the answer that you come up with. I try to utilize those a little bit more too, because I think there are many things, especially in athletic training, that aren't black and white.

Lisa discussed having students “discover” the content; through discovery there was increased engagement and retention of the information. She indicated that she used “thinking questions,” discussions, case studies, and scenarios throughout her classes in an effort to have students think about the material being presented. Meghan echoed a similar sentiment: “It's [teaching] more about critical thinking now, engaging the kids more, less content, more discovery, more building on what they knew in the past, tying things together.”

Kristen stated, “I needed to help them [the students] to develop a process for thinking and problem solving that started in the classroom if I wanted them to do that in the clinical component.” Kristen talked about using “strategic questioning” to bring students “through the different stages of cognitive processing.” For example, she indicated that she used worksheets that required identification first, which focus on lower cognitive skills. After that, her strategy involved questioning to use higher cognitive skills, which were more “thought provoking.”

During the interview, Meghan discussed that “instead of being so content driven…it's more about critical thinking… . More building on what they [the students] knew in the past, tying things together.” She continued to describe her teaching as “like a puzzle, where they [the students] have to put the pieces together.” She indicated that she designed tests that were short answer or case analysis to promote critical thinking in her students. Pamela discussed critical thinking with her students and stated, “I try to get students to think about things in more than one way. Because a lot of health care and athletic training is, well, it works in this situation but it might not work in the next situation.” In class, Pamela has tried to “not focus on things that are rote memorization.” She indicated that her teaching strategies involved frequent questioning of students in an effort to make them think about the material and problem solve. She demonstrated this in her teaching video by asking students a lot of questions during the lesson and providing real-life examples when possible.

Teaching for Application

Teaching for application refers to valuing the little details, yet also appreciating the complexity of each individual case or injury. Participants discussed making sure their teaching was relevant, practical, and applicable to what the students would be doing in the day-to-day responsibilities of their future positions. For example, Pamela repeatedly mentioned making her teaching and the content applicable for her students' future practice and their lives in general. She asked, “What's more important really for you [the student] to know as a professional leaving the program?” and continued on to say,

What do they need to know if they're going to be a practicing clinician? Versus, what do they need to memorize that would be great for them to know on an exam, that maybe 2 months from now if they never use again they may never remember? Because there's a lot of that.

The example Pamela used during her interview was cranial nerves. She discussed how the students needed to memorize the cranial nerves, not only because they are an important part of the anatomy, but also because students will probably have a question about cranial nerves on the BOC examination. However, according to Pamela, on the athletic field or court, it is not important if the student can list all the cranial nerves when an athlete has a potential head injury. What is important is if the student knows when to refer an athlete to a physician and what should be considered a medical emergency.

Similarly, Anthony stated:

I'm teaching to the application in the clinical world, I think they [the students] see that it's real. It's not that they're reading the concepts that they won't ever apply it again. It's not like trigonometry where they just have no clue how it may or may not apply. So whatever I'm teaching, I'm talking about this happens in the real world. I think they appreciate that. They kind of enjoy going back to their real environment and seeing whether that information actually happens or doesn't happen.

Steven may have summed it up best when he said, “I give a darn about the kids and that they're going to get the knowledge and information and that it is applicable to them with what they are going to be doing for the rest of their lives.”

Changes in Teaching over Time

The participants discussed not only the transition of their teaching styles, but also their classroom management philosophies over the course of their careers in higher education. As mentioned above, Matt discussed his shift in his style from “rule with an iron fist” to being more empathic. Other participants, like Pamela, discussed changes in focus and priorities. Through role engagement, or by “doing,” the participants' focus in the classroom changed over time from having total control over the content to allowing more self-discovery by the students. Participants indicated a change in priorities over time from teaching every detail and memorizing facts to a focus on theories and the larger concepts that are important for future athletic trainers to know. They did not seem to become more relaxed with their expectations or standards for student performance, just to have shifted their priorities since the beginning of their teaching career.

Some of this transition in their teaching style and classroom management can be explained by their successful socialization into the role of educator.²¹ Role socialization, or the process of incorporating the knowledge, skills, attitude, and affective behavior associated with a particular role,²⁸ and the transition from clinician to educator take time. A recent commentary²¹ in the Athletic Training Education Journal discussed the transition clinicians go through to become educators and how this period possibly impacts student learning. Turocy²¹ cites research showing it takes approximately 2 to 5 years for a teacher to transition from novice to expert. The participants of this study had been teaching for a minimum of 8 years, and many of them for much longer. They indicated a level of comfort in their roles and, because of their past experiences, a willingness to go beyond traditional “stand and deliver”–type instruction. To achieve this, and to encourage student engagement in the classroom, the participants were willing to try new things in the classroom, such as more student-centered activities and introducing new resources. As addressed by Turocy,²¹ expert teachers are more willing to do these things because they are less afraid of making mistakes. Our participants were not afraid to struggle during these attempts to try new methods, and if they failed, they indicated they would just try something else, as participants Jill and Erin mentioned. Part of this could be explained through the participants' role continuance and the learning that occurred over time as they taught. As confidence built and new teaching techniques were tried, even when techniques failed or did not go as planned participants retained enough confidence to keep moving forward and trying new techniques. Over time, they reflected on their teaching techniques and learning from these teaching moments and possible failures in the classroom.²⁹

The socialization process of athletic trainers in different roles, including the secondary school and collegiate settings,^30,31 graduate assistants,^20,32 and preceptors,³³ has been investigated. Although there is currently no research related to the socialization of athletic training educators, we can compare the results of this study with the socialization process that preceptors go through. Specifically, the socialization process of preceptors involves both formal and informal processes.³³ The formal processes include preceptor development, professional development sessions, and teacher certifications. Informal processes include observations of other preceptors, interactions with other preceptors and role models, and self-reflection and student evaluations. In comparison, the participants of this study also discussed both formal and informal processes that helped guide their teaching and socialize them into the role of educator. A few participants discussed attending the athletic training educators' conference and other professional development opportunities through the National Athletic Trainers' Association as events that helped shape their teaching practice. Surprisingly, all of the participants had some type of formal course work in teaching methods, curriculum design, or related areas as part of their undergraduate and/or graduate education. Although in this study, we found all participants had experience with different formal socialization processes, during the interviews the participants tended to focus on the informal processes that had influenced their teaching and helped them socialize into the role of educator. These included connecting with professional mentors, modeling expert teaching behaviors, and relying on student feedback, all of which were also recommended by Turocy²¹ as ways for novice teachers to transition to expert teachers. The quote from Jill in the “Results” section is just one example of the informal socialization processes the participants discussed. Although the purpose of this study was not to investigate the socialization process of athletic training educators, the results illustrate some of the processes that may occurred as these participants developed as educators.

Clinical Experience

The second subtheme refers to how the participants' current and/or previous clinical experience influenced their teaching practice. Although only 2 of the participants (Lisa and Kristen) had clinical responsibilities as a formal part of their faculty role, all of them discussed the influences clinical practice had on their teaching. Sharing previous experiences with the students was indicated as a way to help prepare students for future practice such as in the quotes in the results by Matt, Anthony, and Emily. Some participants felt this was a way to highlight concepts and engage students in the material presented; others wanted students to learn from their experiences, and mistakes, as athletic trainers. All the participants indicated real-life examples were a way to connect with students in the classroom. Storytelling has been used as a way to emotionally engage students and allow for reflection and visualization in nursing.³⁴ It has also been recommended that nurse educators reflect on their own clinical experiences and then use real-life experiences in the classroom to help students develop critical-thinking skills.³⁵

In 1995, when investigating the desired competencies of doctorally trained allied health care faculty, Elder and Nick³⁶ stated there was a need for faculty experienced with patient care who could integrate that with teaching and research. That need continues today. Specific to the need for experience with patient care, the topic of clinical competence among nurse educators has been the subject of ongoing discussion.^37–39 Clinical competence is important to allow educators to link theory to practice, and, as discussed by Benner and Shulman,³⁹ “dual clinical and classroom teaching assignments facilitate integration” of clinical examples into the classroom and vice versa. The authors go on to state, “Despite the hard work of teaching in the classroom and practicing in the clinical setting, the reward is being able to bring currency about practice to their students.”^39(p156) But with the possibly overwhelming requirements of tenure-track faculty positions, many educators simply do not have time for ongoing clinical practice. This is especially true when clinical practice is combined with all forms of service and potentially weighted less than teaching and/or research components required for promotion and tenure.⁴⁰

Some health care professions, such as nurse practitioners, require all providers, including educators, to maintain clinical practice for licensure.⁴⁰ With other professions, such as physical therapy, the requirement for active clinical practice varies by state. For example, Virginia requires 160 hours of active clinical practice during a renewal period, whereas Pennsylvania has no such stipulation for physical therapy license renewal.^41,42 The Commission on Accreditation in Physical Therapy Education Standards defer to individual state practice requirements for minimal, if any, active clinical practice for teaching faculty.⁴³ Beyond the possible state requirements, physical therapy accreditation standards do include that all core and associated faculty members must have “contemporary expertise” related to their teaching assignment (standards 4A and 4D). Although the standards do outline multiple ways this can be achieved (eg, additional certifications, residency, research and publications, and formal mentoring), just continuously teaching the same course(s) will not suffice for compliance with the standard.⁴³ Presently, we are unaware of any state that requires active clinical practice for athletic training license renewal or maintenance of the BOC credential. As long as athletic training educators maintain their continuing education units and renew their certification, they maintain their credential and are eligible to teach in professional athletic training programs.

From these results, it is recommended that athletic trainers considering a role in academia gain as much clinical experience as possible in a variety of settings before teaching full time. Whether that is through graduate assistantships or part-time or full-time employment, having diverse experiences and relevant personal examples to give students in the classroom is important. If possible, educators should consider per diem or volunteer athletic training experiences to maintain an aspect of clinical practice throughout their teaching careers. Educators could also begin to direct their professional development/continuing education activities to their areas of clinical expertise. This, in addition to clinical practice, is one way to keep current with their athletic training practice. Just as clinical experience is important for educators, and a way they can stay up to date on the evolving profession, so are the type of continuing education opportunities they elect to participate in. Continuing education is another way educators can stay fresh within the profession. We suggest educators engage in clinically relevant continuing education when possible to stay abreast of changes and learn new skills.