Part I: Doctoral Education in Athletic Training. The Post-Professional Education Committee Doctoral Education Workgroup Report

KEY POINTS

• The Post-Professional Education Committee appointed a workgroup to investigate doctoral education and recommend future directions for the profession. Most health professions have adopted postbaccalaureate clinical doctorate degree programs for entry to practice.

• Young professions often begin with apprenticeship models, which then mature and develop distinct bodies of knowledge that are taught in academic programs to prepare new clinicians.

• Educational progression and degree designations vary among health professions, but most adopted post-baccalaureate clinical doctorate degree programs for entry to practice.

• Perceived advantages of clinical doctorates include increased practice opportunities, professional standing, and increased curricular space. Perceived disadvantages include reduced research productivity, degree creep, increased student debt burden.

• Athletic training faculty, clinicians, employers, and academic administrators are 4 key stakeholders whose feedback can help shape doctoral education for athletic training.

INTRODUCTION

This is the first of 2 papers to address the National Athletic Trainers' Association's (NATA's) mandate to conduct a detailed analysis specifically focused on doctoral education (postprofessional education) in athletic training. The purpose of this paper is to provide a historical context to educate readers by presenting definitions and information on doctoral degree programs in other health professions. Definitions and foci of the advanced-practice clinical doctorate as defined in this paper are preliminary and may be modified once empirical data are obtained. Advantages and concerns of the clinical doctorate are discussed in the context of clinical practice and academic setting using other health professions' experiences.

CONTEXT

On June 25, 2012, the NATA Board of Directors (BOD) approved a document entitled “Future Directions in Athletic Training Education” presented to the BOD by the NATA Executive Committee for Education.¹ Whereas the initial document included 14 recommendations, a 15th recommendation specific to doctoral education was also approved by the BOD. This recommendation read:

The NATA, with the support of the Strategic Alliance, should conduct a detailed analysis specifically focused on doctoral education (post-professional education) in athletic training.

In the summer of 2014, the Post-Professional Education Committee (PPEC) appointed a workgroup of NATA members with experience in graduate education and curriculum to investigate doctoral education. The final workgroup consisted of 12 members (Table 1) charged with examining the current landscape of doctoral education in athletic training and making recommendations for future directions.

Table 1.  Post-Professional Education Committee (PPEC), Doctoral Education Workgroup

View Fullscreen

Discussions to address the issue began in September 2014. The workgroup quickly identified the need to define common terms related to doctoral education to facilitate an understanding of the differences among various degrees. The workgroup subsequently assisted the PPEC with developing a list of definitions with specific attention to postprofessional education terminology (Table 2).

Table 2.  Educational Definitions Developed by the National Athletic Trainers' Association (NATA) Post-Professional Education Committee (PPEC) and Doctoral Education Workgroup 2015

View Fullscreen

The Strategic Alliance's decision to adopt master's-level professional education is likely to yield an influx of athletic trainers seeking a new avenue for an advanced-practice degree, often referred to as a clinical doctorate. We felt it was especially pertinent to explore best practices and issues related to doctoral education as a foundation for our work. With this objective in mind, full-text articles published in English between the years 2006 and 2016 were extracted from a search of 38 databases in the University of Washington library with the search term health profession graduate education and yielded 456 results. Results were further narrowed by applicability to the identified questions of interest and discarding those that were editorial in nature. Two historical articles were used to provide context for educational progression among specific professions because contemporary sources were lacking. Data were also extracted from pertinent professional organizations, accrediting-body Web sites, professional texts, and the US Department of Labor database.

HISTORY OF DOCTORAL EDUCATION

Health professions have adopted a variety of degree pathways and designations to provide professional and postprofessional training. For most, such as audiology, dental surgery, osteopathy, podiatric medicine, physical therapy, medicine, optometry, and pharmacy, professional training is completed through postbaccalaureate doctoral degree programs designed to prepare students to enter professional practice. Occupational therapy offers both master's and doctoral degree options to enter professional practice. Athletic training and nursing continue to prepare professionals before the doctoral level (ie, associate's degree in nursing, bachelor's degree, master's degree).^2–6 Interestingly, some health professions, such as medicine and pharmacy, began as apprenticeship programs, which were then formalized as bachelor's degree programs before professional preparation was elevated to doctoral-level education. Optometrists are unique in that they started out as jewelers and craftsman making glasses with apprenticeship training, which then transitioned directly to a professional doctorate. Dentistry and podiatry likewise followed the apprenticeship to professional doctorate degree progression. Other professions, such as physical therapy, occupational therapy, and audiology, followed the pattern of certificate, bachelor's degree, master's degree, and professional doctorate, some progressing along that continuum more rapidly than others.^4–16

Health professions also demonstrate variations in graduate education models for postprofessional training. Postprofessional graduate education may include advanced theoretical and applied training (eg, doctor of science in physical therapy), focused theoretical research training (eg, doctor of philosophy [PhD]), or hybrid models providing advanced training in both clinical and research skills (doctor of athletic training [DAT]). Some doctoral degree programs, such as the doctor of nursing practice program, provide a new skill set tantamount to new professional training that advances the role and independent scope of practice within a profession. Trends indicate that health professions as a whole have shifted from the academic model of bachelor's and master's to a professional doctorate education model.^4–7

A recent investigation of health profession programs revealed that two-thirds (n = 10) of surveyed health professions follow the medical model, using postbaccalaureate entry-to-practice professional training provided at the doctoral level. A few professions (n = 4) reserved doctoral training for postprofessional training designed to advance knowledge in clinical or research practice. Of these professions, only occupational therapy provided a route for both entry-level and advanced-practice preparation at the doctoral level.⁸ The Accreditation Council for Occupational Therapy Education (ACOTE) recently mandated the entry-level degree in occupational therapy move to the doctoral level by July 1, 2027. The ACOTE will accredit only the professional occupational therapy doctorate after that date.⁹

Despite multiple professions undergoing educational transitions, few studies have assessed the impact of these changes. Perceived benefits of adopting entry-to-practice doctoral education include increased practice opportunities, professional standing, depth and breadth of learning, and curricular space.^17–19 A potential consequence of professional doctorates is reduced research productivity, because few professions transitioning their educational model require the completion of original research as part of the degree program.⁸

Physical therapy has already experienced a shortage of qualified research faculty and decreased scholarly production, which may have resulted from this educational change.^17,20,21 Other concerns related to entry-to-practice doctoral education include decreased motivation of students to pursue advanced-practice clinical or research training and decreased student preparation for effectively practicing in the rapidly changing health care market.^22,23 Nursing differs from the other health professions because doctoral education has been reserved for postprofessional training to provide practitioners with the opportunity to specialize, practice independently, improve patient outcomes, and conduct translational research.^19,23–25

Given the lessons learned from other professions, it's imperative that athletic training make informed decisions regarding the models used for professional and postprofessional education. It has been proposed that the profession reserve the master's degree for professional training and support doctoral education for advanced postprofessional training.⁸

The DAT degree has been described as a route to prepare athletic trainers with advanced clinical knowledge, patient care expertise, and the skill set for clinical innovation, while also preparing graduates with the skills necessary to contribute to world-class teams of research scientists conducting meaningful applied and translational research. The goal of these programs is to prepare graduates able to practice as master clinicians, educate the next generation of clinicians and scholars, and provide leadership in the profession to influence organizational administration and public policy.^{2,5,8,17,18,22,26–29}

The PhD and doctor of education (EdD) degree programs in athletic training have been described as routes to prepare research scientists and faculty focused on a specific area of expertise within the educational or biomedical research spectrum (basic, translational, and/or clinical research) or focus on professional issues using a robust mode of qualitative and/or quantitative inquiry. Historically, the intent of these programs has been for graduates to be immersed in research, work with master clinicians to design and conduct translational research and have the training to lead grant-funded and interdisciplinary research projects while also preparing for future faculty roles.^26–29

Athletic training must define and clarify the profession's educational progression or risk “degree ataxia,” with similar adverse consequences to those found in the physical therapy literature: reduced research training among doctoral students, increased shortage of qualified faculty, decreased specialized training for professionals, and diminished scholarly production and knowledge generation.^5,7,8

HISTORY OF DOCTORAL EDUCATION IN ATHLETIC TRAINING

For many years, athletic trainers interested in careers as scholars or curriculum directors pursued doctoral education in disciplines related to athletic training, rather than specifically within athletic training. Examples of such disciplines included, but were not limited to, rehabilitation sciences, kinesiology, exercise physiology, biomechanics, and education. Athletic trainers who completed these programs were often trained to conduct laboratory-based research related to the prevention and rehabilitation of injuries. Other programs, related to curriculum and instruction, were designed to prepare athletic trainers to conduct research examining academic program development and leadership, clinical education, assessment of learning outcomes, or similar topics.

While students continued to pursue tangential options for doctoral training, programs began to emerge that more specifically targeted athletic trainers with content and research foci congruent with the athletic training discipline. The development of these types of doctoral programs in athletic training was cited in the 2005 textbook Research Methods in Athletic Training, in which 12 examples of universities offering programs from which athletic trainers were obtaining doctoral degrees were listed.^30(p9) However, of these academic doctoral programs, very few directly articulated athletic training as the primary focus. Rather, the primary factor distinguishing doctoral programs as targeting athletic trainers was the presence of faculty mentors who were athletic trainers with terminal academic degrees. In 2016, the NATA listed 17 universities offering doctoral programs for athletic trainers on its Web site,³¹ but with the advent of the Commission on the Accreditation on Athletic Training Education as the accrediting body for educational programs, only 1 doctoral program was accredited and listed at the time of this writing (Table 3).³² Although only 1 accredited doctoral program in athletic training was listed in 2017, the 16 universities listed in 2016 continue to offer doctoral degrees, some with more than 1 type of doctoral program (eg, PhD, EdD, DAT, doctor of science in athletic training). Furthermore, some institutions offered similar programs but have not sought accreditation or formal recognition for their programs and have had no formal external review of their curriculum. It seemed likely, but was unclear, if the programs listed in 2016 that were not listed on the CAATE Web site still offer academic doctoral programs for athletic trainers. Furthermore, it is unknown if any institutions have transitioned to a clinical degree program (eg, DAT) or if they have plans to seek accreditation.

Table 3.  Universities Offering Doctoral Programs in Athletic Training in 2005, 2016, and 2017

View Fullscreen

Identifying a comprehensive list of academic doctoral programs for athletic trainers is not an easy undertaking, and the influence of accreditation on program success and enrollment is unknown. It is hoped that more will be learned from scholars in the field who have achieved a terminal degree through future stakeholder surveys. Doctoral education in athletic training may be an untapped area of emphasis for individuals seeking a career as an athletic training scholar or researcher. However, it is difficult to fully assess and make recommendations for doctoral education in the profession when so little is known about the current state of doctoral education for athletic trainers.

FUTURE DIRECTIONS: DOCTORAL EDUCATION IN ATHLETIC TRAINING RESEARCH

The Doctoral Education Workgroup was also tasked with gathering data from which recommendations on the future of doctoral education in athletic training could be made. Our analysis showed 4 key stakeholders who would provide necessary feedback to inform future educational recommendations: (1) athletic training faculty, (2) athletic training clinicians, (3) academic administrators, and (4) employers of athletic trainers. We determined that a survey could provide the necessary data, provided that it allowed for comparison among stakeholder groups and included questions regarding curriculum and instruction, characteristics or traits of graduates from a postprofessional clinical doctorate in athletic training program, influence on patient care, postgraduation employment opportunities, and benefits to the athletic training profession.

This preliminary literature analysis was used to develop stakeholder surveys to further explore this topic. Members of the PPEC Doctoral Education Workgroup will present a companion piece³³ with data collected from the 4 stakeholder groups to examine the perceived viability of the athletic training clinical doctorate in both the clinical and academic settings and will also provide recommendations for program development.

SUMMARY

Various educational pathways exist among health professions, with different goals, outcomes, and impacts. The majority of health professions have adopted the clinical doctorate as their professional degree, but others continue to reserve doctoral education for postprofessional training.

The formation of this workgroup and future products from the group represent a concerted effort from the NATA with the support of the Strategic Alliance to conduct a detailed analysis focused specifically on doctoral education (postprofessional education) in athletic training. It is the workgroup's goal to provide information necessary to inform the future directions of postprofessional education in athletic training.