The Evolution of the Mutual Recognition Agreement for the Athletic Training and Therapy Profession

Any mutual recognition agreement (MRA) serves as an international arrangement between 2 or more nongovernmental organizations as a means to recognize each organization's professional qualifications and standards for the purpose of satisfying the eligibility requirement(s) necessary for members of 1 to take the other's credentialing examination. The benefits of an MRA include:

• International recognition of the highest level of professional education and certification of athletic training and therapy (ATT).

• Partnership in an international network to promote the profession of ATT, including aspects such as exchange programs, research collaborations, and knowledge transfer.

• Collaboration in curriculum development, certification examination processes, and continuing education initiatives.

In the case of ATT, the MRA serves to determine the rights, roles, and responsibilities of the organizations providing credentials in ATT. It is not reciprocity; however, the MRA is a means to remove barriers for certified professionals to possibly obtain employment within these independent jurisdictions. All national immigration, federal, and state or provincial laws still apply to the credential holders; it is understood that the legal right to practice is ultimately determined by governmental agencies. The MRA simply allows access to each participating organization's credentialing examinations to make that portion of the process easier. Although this does not guarantee the individual would be granted the necessary immigration papers and permission to work, it has made possible the mechanism for individuals to become certified and, therefore, eligible to work in another national jurisdiction.

To qualify as a partner in the MRA, the applying institution's curriculum is evaluated, along with its accreditation standards, eligibility requirements, psychometrics on the exam, regulatory bodies governing those practices, professional conduct and ethics, discipline, and a continuing competence or continuing education structure.

Given that the purpose of an MRA is to satisfy the eligibility requirement(s) necessary to take another organization's credentialing exam, it is logical that a credentialing agency would initiate and lead the process of developing an MRA. Established in 1989 as a not-for-profit credentialing agency to provide a certification program for the entry-level athletic training profession, the Board of Certification (BOC)¹ was uniquely positioned to lead the charge in establishing an MRA. Within this purview, the BOC collaborated with other international organizations, as well as boards of the Strategic Alliance, in an effort to create an MRA that would enable ATT professionals to become certified and practice internationally.

In 2005, an MRA was developed between the Canadian Athletic Therapists Association (CATA) and the BOC, with Athletic Rehabilitation Therapy Ireland (ARTI)² joining the agreement in 2014. This agreement allowed CATA-certified athletic therapists, BOC-certified athletic trainers, and ARTI-certified athletic therapists whose certification status is in good standing with their respective credentialing organizations to become eligible to apply to take each organization's credentialing examination. The opportunity to take the partner organizations' certification exams, in effect, serves to remove barriers for already-certified ATT professionals by allowing them to seek employment or to practice within the corresponding countries.

This MRA was set to expire on December 31, 2020. Unfortunately, on October 1, 2019, the CATA notified the BOC and the ARTI that the CATA would cease its participation in the MRA as of November 29, 2019. The MRA between the BOC and ARTI, however, will remain in effect until December 31, 2020, unless it is extended or replaced by a new agreement. All parties had been negotiating a new MRA, and the hope is now to restart those negotiations. Despite this change in course, the BOC remains supportive of the efforts of the CATA and will continue to seek out opportunities to partner and collaborate with that organization in the future. However, in the more immediate term, the BOC and the CATA are actively working to address concerns from students affected by this change and to mitigate potential issues.

Before the MRA expires, the BOC and the ARTI have the opportunity to strategize and to more accurately define what their respective roles will be in the future as they continue to promote ATT globally. There are many opportunities for the future of global ATT, and the BOC continues to position itself and explore opportunities toward a recognizable international standard. The BOC has many goals to consider with these efforts, including the expansion of the ATT profession globally, while removing barriers to practice for ATT credential holders.

The BOC has recently approved the forming of an international committee (BOC-IC) to develop strategies for the development of ATT on a global scale. The BOC-IC is composed of member representatives from the BOC and the ARTI and will be chaired in 2020 by a former BOC director. The initial charge of the BOC-IC is to determine strategy for engaging international counterparts and to define its partnerships. The BOC-IC will report to the BOC board of directors as well as coordinate and promote the efforts of the BOC to global organizations that are interested in participating in the internationalization of ATT.

The efforts of the BOC-IC will help further the ATT profession internationally. However, the BOC and the ARTI remain committed to the remainder of the current MRA up to its 2020 end date. The BOC hopes to continue this partnership and develop others far into the future. The priority of the BOC is to advocate for the athletic training and therapy profession globally and to be recognized as the leader in the health care of athletic and physically active individuals.