Commentary on International Experience Opportunities for Athletic Training Students: A Perspective from the National Athletic Trainers' Association International Committee

KEY POINTS

• Opportunities exist for athletic training-specific international experiences, but at a lower rate than general university-sponsored international experiences.

• Participation in international experiences by athletic training students and faculty is low, which may be related to limited opportunities or other system barriers.

• The National Athletic Trainers' Association International Committee is developing publicly accessible resources to identify international experiences for athletic training students and faculty.

• With the globalization of the profession and emphasis on cultural competency, expanding international opportunities for athletic training students should be a priority.

INTRODUCTION

Imagine chatting with a prospective athletic training student. You ask, “What are your career goals?” She responds, “I want to be an athletic trainer in Spain.” Or you ask, “What are your educational goals?” He responds, “My dream is to study athletic training abroad.” What is your response? Do you encourage the student's interest? Do you warn the student that international recognition of the athletic training profession is limited? Or perhaps both? Although the athletic training profession is globalizing rapidly, opportunities for athletic training–related international experiences are often still a mystery to the average student and athletic trainer. Unfortunately, lack of clear direction can discourage participation in these valuable experiences.

There are many benefits to participation in international experiences, including enhancing one's cultural sensitivity, understanding global interdependence, and gathering functional knowledge of how to operate in a foreign environment.^1,2 Additionally, students who participate in study abroad experiences show improvements in interpersonal accommodation (understanding the need to be flexible and patient while communicating with other cultures).² In the context of athletic training education, these cultural and interpersonal skills gained during international experiences can be directly related to the 2020 Commission on Accreditation of Athletic Training Education (CAATE) standards for professional programs, which emphasize the incorporation of patient values (standard 62), communicating effectively and appropriately with various audiences (standard 59), and advocating for the health needs of communities (standard 56).³ Anecdotally, students often describe study abroad experiences as “a once-in-a-lifetime opportunity” or “transformative.” The importance of international experiences has also been highlighted by influential organizations in higher education. According to the Association of American Colleges and Universities,⁴ higher education in the 21st century faces globalization, which requires awareness of global interdependency and the need for enhanced international cooperation.

Literature specific to athletic training has identified potential barriers (eg, getting out of sequence in a cohort-model program), opportunities (eg, short-term faculty-led trips), and benefits (eg, enhanced cultural competency).^5,6 Jutte⁵ provides a helpful resource for athletic training faculty interested in creating their own short-term study abroad trip. However, few resources are available to help students or faculty mentors seeking existing international experience opportunities, and those resources that exist may not be widely known. This is despite recent advances in the athletic training profession internationally, including mutual recognition agreements with Canada and Ireland, the application for CAATE accreditation by the first university outside the United States, and hiring of 50 athletic trainers by the government of China to work with China's Olympic athletes. Therefore, the purpose of this commentary is to outline current and upcoming resources related to study abroad available through the work of the National Athletic Trainers' Association (NATA) International Committee (IC).

INTERNATIONAL EXPERIENCE INFORMATION FROM ACCREDITED PROGRAMS

The IC mission includes supporting and developing international experiences related to athletic training for both student and certified members. To that end, the IC collaborated with the CAATE to track the number of academic programs offering international experiences through its 2016–2017 annual reporting mechanism. One goal of data collection was to identify programs offering international experiences, in order to compile that information and provide it to NATA members seeking international opportunities. Academic programs identified in the 2016–2017 annual report received an e-mail in August 2018 inviting them to opt-in to a directory of international experience opportunities open to athletic training students or certified athletic trainers. This directory is an open resource posted on the IC webpage (https://www.nata.org/professional-interests/international). Program descriptions and contact information aim to aid members in identifying potential study abroad opportunities. Although it is not comprehensive, the IC hopes that this information will provide a starting resource for a member's individual search.

Although identification of individual programs offering international experiences is important, it is also helpful to look at the data as a whole. The 2016–2017 CAATE annual report was completed by 397 accredited professional programs and 13 accredited postprofessional programs. Program responses for the 4 questions (Table) about international experiences were required fields; thus, responses were for N = 410 programs. No postprofessional athletic training program offered an international experience, whereas 10.6% (n = 42) of professional athletic training programs offered an international experience. When asked if their institution offered an international experience (not specific to athletic training), 15.4% (n = 2) of postprofessional programs and 84.4% (n = 335) of professional programs responded in affirmation. Programs were also asked about athletic training program faculty and student participation in international experiences. In postprofessional programs, 15.4% (n = 2) of programs reported that at least 1 athletic training faculty member participated in an international experience, and 61.5% (n = 8) of programs reported that at least 1 athletic training student participated in an international experience. In professional programs, 23.4% (n = 93) of programs reported that at least 1 athletic training faculty member participated in an international experience, and 39.5% (n = 157) of programs reported that at least 1 athletic training student participated in an international experience.

Table International Experience Data from the 2016–2017 Annual Report

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These data have several limitations. In particular, the term international experience was not clearly defined (it was intended to include traditional study abroad courses and/or noncredit international service). Additionally, in retrospect the question “Have any of the athletic training program students participated in the international experience?” could be interpreted to refer to any international experience or to refer only to athletic training–specific international experiences. Thus, data may reflect individual program representatives' interpretation of the terms. Additionally, only accredited postprofessional programs were included in the data set. It is unknown if nonaccredited postprofessional programs offer international experiences. Despite these limitations, the IC believes this information is worth sharing in this commentary because it represents a first comprehensive pulse check on the presence or absence of athletic training international experience opportunities. Admittedly, future data collection needs to advance beyond an initial pulse check and better analyze the landscape of international experiences available to athletic training students and faculty. Yet a few observations and recommendations can be made from the current data.

OBSERVATIONS AND RECOMMENDATIONS

First, a minority of accredited programs (0% of postprofessional, 10.6% professional) offer an international experience directly through their athletic training program. Yet substantially more programs reported that at least 1 athletic training student participated in an international experience. This indicates that athletic training students are participating in other institutional offerings (eg, non–discipline-specific study abroad) or noninstitutional offerings (eg, an international medical service trip). Anecdotally, students have reported finding limited study abroad opportunities when searching for athletic training. However, when searches were broadened to include related disciplines such as sports science, health science, and sports medicine, more opportunities were available and have led to successful study abroad experiences related to the broader health/sports science discipline in South Africa, Ireland, Australia, and more. Future research should investigate exactly what types of discipline-related opportunities are available and being used, easing the path for future students.

Second, postprofessional programs reported offering fewer international experience opportunities and had lower faculty participation. This was not surprising given the focused nature of postprofessional programs. A higher percentage of postprofessional than professional programs reported at least 1 student participating in international experiences (61.5% versus 39.5%); however, the raw numbers for student participation were much higher in professional programs (157 versus 8). The reason for the higher percentage is unclear; it may be a factor of the small sample size for postprofessional programs. Alternatively, it may be that proportionally more opportunities exist for certified athletic trainers than for athletic training students, and that these opportunities occur outside of their academic program. Regardless of whether one views the percentages or raw numbers, it is clear there is room for vast growth in the quantity of international experiences available at both the professional and postprofessional levels.

Third, the current data do not distinguish between professional programs at the master's versus the undergraduate level. It is of interest to see how opportunities change, both for professional athletic training students and pre–athletic training students, as a result of the degree transition. One rationale for the transition of the professional degree to the master's level was so that professional programs would no longer compete with undergraduate general education requirements.⁷ Moving to the master's level would allow the student to engage more fully in coursework and extracurricular experiences during the undergraduate experience, then similarly to be immersed without distraction when enrolled in graduate professional courses and clinical experiences. In the (currently being phased out) undergraduate professional model, a semester-long study abroad experience may bump the student out of sequence in clinical rotations and/or coursework, thus strongly disincentivizing student participation in international experiences.^5,6 However, in the new preprofessional undergraduate model there may be more flexibility and opportunity for interested students to engage in international experiences! Athletic training educators could take advantage of this new flexibility by encouraging participation in undergraduate international experiences and helping students find discipline-specific opportunities. The enhanced cultural sensitivity, cultural competency, and functional knowledge resulting from study abroad benefit the student as an individual.^1,2 If the student progresses to a professional program, these experiences may bring helpful perspective to dialogue about patient values, communicating effectively cross-culturally, and other skills written into the 2020 CAATE standards. Additionally, because graduate-level accredited programs do not have to compete with general education requirements, these programs may have greater scheduling flexibility, which could facilitate the development of graduate international experiences. Used strategically, these experiences could enhance global recognition of the athletic training profession in addition to benefiting the individual student. In short, the degree transition creates an opportunity for increased engagement in international experiences, at the preprofessional, professional, and postprofessional levels. However, if that opportunity is not matched with clear options for athletic training and/or discipline-related international experiences, the opportunity to expand student engagement in international experiences may be lost. Considering rapid globalization of the profession and emphasis on culturally competent care, we believe that would be a sadly missed opportunity.

Fourth, there is a need for enhanced understanding of the current landscape of international experience opportunities. To address this need, the IC launched a detailed international experience survey in 2019 to all accredited professional programs nationwide. That research aims to further identify international experience opportunities to share with NATA members, as well as to identify strengths, challenges, and priorities for development related to international experiences for athletic training students.

CONCLUSIONS

Results indicated a minimal to moderate level of engagement in discipline-specific study abroad among athletic training students and faculty. Future research should identify opportunities and priorities for development to facilitate international experiences for athletic training students, especially experiences that align with the current educational standards. Resources provided by the NATA IC may help identify opportunities. With mutual recognition agreements in Canada and Ireland, recent developments in the athletic training profession in China, the application for CAATE accreditation by a university in Spain, and undergraduate space created by the degree transition, there has never been a time with more potential for international study and practice. The road is not yet smooth and straight, but current data indicate that an individual with initiative can find international experiences!