Signature Pedagogies in Athletic Therapy Education

Research Design

Complex phenomena, such as athletic therapy education, cannot be explored exclusively through a positivist research lens because it is not “out there” in an objective world, just waiting to be discovered, measured, or predicted. Rather, this phenomenon is culturally and historically mediated by the different educators, students, curricula, and academic institutions.¹⁶ Athletic therapy educators have unique teaching styles, teaching philosophies, differing levels of teaching experience, diverse educational backgrounds, and extensive clinical backgrounds, none of which can be controlled in a single research study. Therefore, the context of athletic therapy classrooms is far too complex to measure outcomes of an intervention study purely from a statistical perspective that relies on causal comparison of variables. On the basis of these assumptions, we used an interpretivist paradigm to explore the research questions.

A sequential explanatory mixed-methods approach¹⁷ was used to explore athletic therapy educators' preferred pedagogical strategies during athletic therapy courses. In this type of mixed-methods methodology, each source of data was considered to be “one piece of the puzzle,” contributing to our overall understanding of the phenomenon in question.¹⁸ Multiple data sets also helped to corroborate the results to ensure an account that was rich, comprehensive, and well developed.¹⁹

Setting

This study involved participants from 7 Canadian Athletic Therapists Association (CATA)–accredited institutions, 5 universities, and 2 colleges. Institutional ethics review board approval was obtained from each accredited institution before the study commenced.

Participants

We used a purposeful sampling procedure in this study.²⁰ All full-time educators with the Certified Athletic Therapists (CAT[C]) designation (26 educators in total) from 7 CATA-accredited institutions were invited to participate in our study. An introductory email was sent to the program director at each CATA-accredited institution, outlining the purpose of the research and expectations from study participants. These directors were then asked to forward the information to their full-time athletic therapy faculty. All directors were asked to send a follow-up email to eligible educators, 1 month after the original message. A total of 21 (16 women, 5 men) eligible educators voluntarily responded to the initial questionnaire (81% response rate), whereas 15 educators (11 women, 4 men) participated in the follow-up individual phone interviews (58% response rate). Descriptive demographic characteristics of each participant are provided in Table 1.

Table 1 Demographic Characteristics of Participants

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Data Collection Procedures

Questionnaire

We designed an online questionnaire to explore general pedagogical knowledge in athletic therapy educators, as well as the most frequently used teaching strategies (Table 2). The questionnaire was housed on the researchers' university online survey site, and a link to this site was provided to all eligible athletic therapy educators. To summarize, participants were asked a series of questions about general pedagogical knowledge, most frequently used teaching strategies, and using technology for educational purposes.

Table 2 Summary of Questionnaire Responses

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The first page of the questionnaire acted as the informed consent by outlining the purpose of the research, providing the researchers' contact information, and identifying the terms of participation (eg, reserving the right to withdraw participation, understanding the nature of participation). Each athletic therapy educator consented to participate in the study by following the webpage cues. All questionnaires were completed anonymously, but participants were asked to provide an email address if they were interested in being contacted for an individual interview. These email addresses were stored in a separate database so they could not be matched with specific questionnaire responses.

Participants responded to statements by using a 5-point Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree). The questions from this questionnaire were adapted from existing questionnaires by Archambault and Crippen²¹ and Schmidt et al²² to make them more applicable for an athletic therapy–specific context. Questions from the original questionnaires were created for a general education curriculum (eg, science, mathematics), so these were changed to reflect the specific topic areas from the athletic therapy curriculum (eg, orthopaedic assessment, rehabilitation). After modifying the questionnaire, it was reviewed by 2 athletic therapy educators who were experienced in questionnaire development and mixed-methods research. Both individuals had held academic appointments for at least 20 years and had numerous experiences using and designing questionnaires for research. To assess for face validity, these experts were asked to review the objectives of the study as well as each specific question on the questionnaire. On the basis of this expert review, no changes were made and the same instrument was used in the current study.

The data collected from these questionnaires were pooled together and analyzed in Microsoft Excel 2016 (Redmond, WA), by way of means and standard deviations, to establish trends in responses only. The quantitative results were not used to objectively measure the amount of pedagogical knowledge in athletic therapy educators; rather, the findings were used to identify trends that were further deconstructed during the qualitative interviews. All questionnaires were completed anonymously so individual responses could not be matched up to compare with interview transcriptions.

Individual Interviews

At the end of the questionnaire, all educators were invited to participate in a 60-minute individual phone interview, following a standardized, open-ended format. The semistructured interviews tended to be more conversational in an effort to clarify the intent of questions.²³ Per Patton,¹⁹ the interview schedule was developed on the basis of the research questions and the emergent trends from the questionnaire data (Table 3). For example, a trend emerged from the questionnaire responses that athletic therapy educators felt confident in the range of teaching strategies that they used in the classroom. Further probing questions were asked to explore what these specific strategies were and what factors affected such pedagogical decisions. All individual interviews were audio-recorded (with permission from participants), manually transcribed, and then sent to the participant to review for clarity or inaccurate transcription.

Table 3 Interview Question Schedule

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Data Analysis and Trustworthiness

Data analysis (Figure) followed an interpretivist approach as described by Thomas et al.²⁴ By following this approach, it was assumed that athletic therapy educators constructed their personal pedagogical approach by interpreting and interacting with their own unique educational environment. It was also assumed that this approach was shaped by various professional, (eg, expectations from the CATA), institutional, student, personal, and cultural interactions. Findings from both the questionnaires and interviews were combined to identify participants' pedagogical approaches to teaching in athletic therapy education and why they fashioned such an approach. As previously described, the questionnaire responses were initially analyzed to identify trends that were then further deconstructed during the individual phone interviews.²⁵ To develop a deeper understanding of these emergent themes, an inductive content analysis approach (as proposed by Hahn²⁶) was used to analyze the interviews. The first step was to manually transcribe all available interview data to gain an initial appreciation for what was said and how it was said.²⁴ The next step involved reviewing the transcriptions and developing general coding categories to organize the findings (eg, example of pedagogical strategy). The final step of the coding approach involved studying these generally coded categories and developing highly refined themes, also known as thematic coding.²⁷ The transcriptions were then read again to find significant quotations that supported the general research agenda and any emerging themes or subthemes.

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When analyzing the interview data, trustworthiness was established through member checks and peer review. After all the interviews were transcribed, coded, and analyzed, member checks were performed with 3 randomly selected interview participants to confirm the themes that emerged from the data.²⁵ During this member-checking process, all transcripts were emailed to the 3 selected participants, and interpretations of the themes were also shared. Follow-up 30-minute phone interviews were scheduled with each member-checking participant to have further discussion on the transcripts and emerging themes.²⁸ These participants were asked to respond with any incorrect or misleading information, but no major changes were made to the transcripts or themes. Peer review was also used with the second author to review the initial interview schedule and to discuss the initial thematic analysis as proposed by the lead author. Again, no major changes were made to any of the themes or subthemes.

Athletic Therapy Educators as Content Experts

When asked to describe themselves as educators, the sample of athletic therapy educators portrayed themselves as content experts. This presumption was corroborated in the questionnaire results when the participants agreed with the statements “I feel confident in my knowledge of key concepts in my area of specialization” (mean response of 4.71/5 = strongly agree) and “I feel confident that I use the latest resources to support the content of my teaching” (mean response of 3.99/5 = agree). When educators were further questioned during the interviews regarding why they considered themselves to be content experts, 3 main subthemes emerged: experience with the course content, professional continuing education requirements, and concurrently practicing as an AT.

Development of Pedagogical Knowledge in Athletic Therapy Educators

Pedagogical knowledge is defined as a deep understanding about the processes and practices of teaching and learning and how it encompasses overall educational purposes, aims, and values.³⁰ This unique form of knowledge includes knowing about effective techniques or methods to be used in the classroom, selecting different strategies based on the nature of the target audience.³⁰ The selection of different strategies is often influenced by various cognitive, social, and developmental theories of learning as well as how students construct knowledge, acquire skills, and develop habits of mind.³⁰

As demonstrated in the questionnaire results, the majority of athletic therapy educators perceived their level of pedagogical knowledge to be high. This was corroborated through respondents agreeing with the following statements in the questionnaire: (1) “I feel confident in my ability to assess student performance in the classroom” (4.57); (2) “I feel confident in my ability to adapt my teaching methodology based on student performance” (4.29); (3) “I feel confident in my ability to adapt my teaching to different learning styles” (4.29); and (4) “I am confident in my ability to assess student learning using multiple measures” (4.14). When the athletic therapy educators were further questioned about how they acquired or maintained this level of pedagogical knowledge, 3 central subthemes emerged: reflecting on experiences as an athletic therapy student, formalized pedagogy sessions, and informal professional development.

Pedagogical Differences Between Traditional and Innovative Athletic Therapy Educators

During the interviews, the educators were asked to discuss their personal teaching philosophies and to describe different teaching strategies most commonly applied in their classes. Again, a pedagogical distinction became apparent during these discussions. The same 5 educators described as having a greater level of pedagogical knowledge were able to openly discuss different teaching strategies and demonstrated a clear understanding of how and when to effectively implement a particular strategy. By comparison, the other 10 traditional educators were not as comfortable in these conversations. For example, when discussing case-based learning as a potential teaching strategy, the educators with a higher level of pedagogical knowledge were able to provide different contexts for how they would integrate these activities into their classes, whereas the other educators considered case-based learning to be simply using a case scenario as an example to add context to the content being taught.

The 5 educators who demonstrated a higher level of pedagogical knowledge identified many different pedagogical strategies that they commonly used in athletic therapy classrooms, including: case-based learning; flipped classrooms³¹; student critical-reflection activities; narratives and storytelling; self-directed learning; and cooperative learning. Another important component of effective teaching is knowing what teaching strategies fit the course content and understanding when to incorporate different teaching strategies.³² The athletic therapy educators with a greater level of pedagogical knowledge were able to have deeper conversations on selecting different pedagogical strategies while describing the factors that affected these pedagogical decisions. For example, one educator described the personal pedagogical growth of transitioning from using a content-driven approach to placing a greater emphasis on the teaching and learning:

Before, the discipline was the most important thing and I was very content driven. Now I just want to guide and encourage learning and use a more active-learning approach. I want to ensure that learning becomes real to my students. (ATEd-6)

This educator continued by describing the use of specific active-learning examples such as flipped classrooms, reflective activities that stimulated critical thinking, case-based learning, and problem-based learning. When deciding upon what teaching strategies to use, this educator said,

The content of the course drives my selection of teaching strategies. There are some courses (eg, therapeutic modalities) that from a safety perspective, I need to teach important pieces of content first so that the students know the basics, so they do not harm a patient. In these cases, I still use the traditional lecture to get the content across. But in other courses (eg, assessment courses), it is useful to implement more flipped classroom models, or learner-centered activities to really allow the students to build upon their prior experiences and to integrate what they may have seen at a placement or in other classes. (ATEd-6)

Two other athletic therapy educators who represented a higher level of pedagogical knowledge also made additional comments about Bloom's Taxonomy³³ and described how these principles guided their selection of different teaching strategies. These educators stated that different strategies were used when the objective was to develop higher levels of learning within Bloom's Taxonomy (analysis, synthesis, or evaluation) compared with stimulating the lower levels of knowledge (rote memorization) and comprehension. When the goal was to encourage higher levels of learning, more student-centered teaching strategies were implemented such as case-based learning, problem-based learning, and student reflection. When the course objective was focused on knowledge acquisition and factual recall, the traditional lecture-based approach was typically used.

Athletic Therapy Educators as Content Experts

The sample of athletic therapy educators in this study described themselves as content experts. Participants felt that much of their professional development focused on athletic therapy–specific content instead of how to improve as teachers. As one participant (ATEd-8) stated, “most educators are ATs first and educators second,” explaining why most of their ongoing development is related to increasing athletic therapy–specific content knowledge. Participants went on to describe how this content knowledge was continuously developed by teaching the same courses each year, through content-specific continuing education, and concurrently practicing as an AT.

Similar findings were discovered in the literature. Rich³⁴ found that some athletic therapy educators have a background in pedagogy and many others do not. This research also described how most graduate programs emphasize content knowledge rather than pedagogical knowledge, reinforcing the classification of medical professional educators as subject matter experts. Leone et al³⁵ also suggested that most athletic therapy professionals are trained in specific content areas during graduate preparation, but not always in teaching or pedagogy. Therefore, athletic therapy educators are often left to “learn on the job” while navigating the theory, skills, values, attitudes, and normative behaviors related to teaching. These issues are also apparent in other medical professions.^7,36

The vast majority of medical educators (including the profession of athletic therapy) appear to be professionals with limited formal pedagogical training, despite extensive experiences in education.³⁷ Unfortunately, having been in many classrooms does not necessarily make a person an expert in education. Our results demonstrate that there are athletic therapy educators with increased levels of pedagogical knowledge who are more innovative in their teaching approaches. There appears to be a lack, however, of collegial awareness of what these individuals know and how different pedagogical strategies can contribute to an athletic therapy program. Therefore, athletic therapy educators with limited levels of pedagogical knowledge could benefit from seeking more formalized pedagogical training opportunities to gain a better understanding of how different modes of teaching may enhance student learning and competency development.

Development of Pedagogical Knowledge in Athletic Therapy Educators

Our findings suggested a wide range of pedagogical knowledge in Canadian athletic therapy educators. Most educators appeared to fashion their teaching approaches through reflection of their personal experiences as athletic therapy students. Our results also identified conflicting results between perceived levels of pedagogical knowledge from questionnaire responses and actual levels of pedagogical knowledge as determined by the detailed conversations during individual interviews. It became clear that the sample of athletic therapy educators was divided into 2 groups: (1) the majority of educators who followed a traditional didactic teaching approach and (2) an innovative group who were more experimental in the classroom. This innovative group of athletic therapy educators incorporated different pedagogical strategies and appreciated how these modes of learning contributed to more effective instruction.

Few researchers have previously investigated the types of pedagogical strategies commonly used by athletic therapy education programs in Canada and the United States. Mensch and Ennis³⁸ examined the types of pedagogical strategies used in 5 athletic training education programs in Pennsylvania, Virginia, and Maryland. More specifically, these researchers focused on identifying the pedagogical strategies recognized by students as being essential components to their success in an accredited curriculum. The results of this study showed that the most beneficial teaching strategies were using case-based learning; creating authentic athletic training experiences through observational or hands-on activities; and using collaborative activities. Although these strategies were considered to be the most valuable by the sample of students, the majority of athletic training educators at these institutions still predominately used the passive, didactic lecture method as their preferred pedagogy.

Mazerolle and Yeargin³⁹ investigated how various pedagogical tools were used by American athletic training programs to promote a deeper understanding of anatomy and its relationship to athletic injuries. These researchers found that the most effective pedagogical strategies for teaching anatomy to athletic training students were: case-based learning, concept mapping, collaborative assignments, injury simulations, and univocal-dialogic discourse. These authors also suggested that effective educators should introduce learners to a variety of instructional methods to allow for differences in learning styles and preferences.

As demonstrated by the innovative group of athletic therapy educators in the current study, educations should continue to explore the use of different pedagogical strategies in their unique contexts. This recommendation to implement multiple pedagogical strategies is duly noted in the literature.^40–42 However, when choosing pedagogical approaches, an educator needs to consider a number of important factors including the impact that these different strategies have on student learning.^43,44

Pedagogical Differences Between Traditional and Innovative Athletic Therapy Educators

The final theme highlighted the pedagogical differences between the groups of traditional and innovative athletic therapy educators. The innovative educators appeared to be very passionate about improving themselves as teachers and described themselves as lifelong learners of pedagogy. The traditional group of educators used a more passive mode of learning and were less likely to experiment with using different pedagogical strategies.

Given that the majority of athletic therapy educators in this sample shared the same belief, the traditional passive lecture-based learning environment appeared to be the signature pedagogy of Canadian athletic therapy education. The majority of educators used a passive mode of learning that offered a body of knowledge to the students in a sequence of lectures and asked them to internalize that knowledge outside of class on their own time. Separate laboratory sessions were also used to teach hands-on practical skills. During the interviews, athletic therapy educators were asked why a “stand and deliver” mode of teaching was the most commonly used in the athletic therapy profession. Responses included (1) “Lecturing is an easy way to get a lot of information across to a lot of people. Because you can put a PowerPoint presentation together, stand up in front of the room and blast information at people.” (ATEd-13); (2) “Lecturing is how the students expect their education to be. They pay to have someone teach them the material as opposed to being mainly self-directed.” (ATEd-4); and (3) “People teach the way they were taught. It is scary for some people to go outside their comfort zone to look for innovative strategies, or the risk of trying something new.” (ATEd-10).

Historically, this mode of learning has commonly been seen in other medical professions, including medicine,⁴⁵ nursing,⁴⁶ and physiotherapy.⁴⁷ However, in recent years the trends in these medical professional programs have shifted from using a passive teacher-centered learning approach to more constructivist student-centered learning approaches.⁴⁷ Active, constructivist approaches facilitate learning by tasking students to think critically about the course content, focusing on deeper learning processes instead of rote memorization.⁴⁸ Given that the ultimate goal of athletic therapy programs is to develop competent individuals who are able to think critically when dealing with real-life situations, athletic therapy educators need to be cognizant of different pedagogical strategies and evaluate the impact that these strategies have on student learning.⁴⁹ On the basis of our findings, some athletic therapy educators appeared to be more progressive than others in implementing different strategies, but all educators should be more willing to experiment in the classroom to improve instruction.⁵⁰ According to current notions of constructivism,⁵¹ athletic therapy educators are encouraged to assume the stance of “reflective practitioner” and in doing so, evaluate their rationale for their current approach to teaching. Educators could also benefit from familiarizing themselves with what else is being done in other athletic therapy classrooms (and in other medical professions as well) and modify their pedagogical practices to enhance instruction, student learning, and competency development.^51,52

Recommendations for Athletic Therapy Educators

On the basis of this research, it is important for athletic therapy educators to examine how learning is fostered in their own institutions. Educational research that works in one context does not necessarily work in all contexts. However, athletic therapy educators should be aware of the pedagogical shift that is occurring in other medical professions such as medicine. Many medical schools have reacted to changes in medical knowledge, preferred learning styles of students, and effective teaching practices by decreasing the amount of factual knowledge that is passively lectured to students.⁵³ As an alternative, medical educators are implementing constructivist student-centered approaches that emphasize self-directed learning and problem-solving skills, leading to more effective instruction.⁵³ Similar pedagogical changes are also on the horizon for the athletic therapy profession. According to a consensus statement released by a CATA education task force, by the year 2020, all CATA-accredited programs will be expected to have a plan in place to move their individual program designs to a competency-based educational model.⁵⁴ In this type of learning model, students work on developing 1 core competency at a time and only move on to others when they have demonstrated mastery of the original competency.⁵⁵ Therefore, to be progressive in their approach, athletic therapy educators need to be aware of innovative pedagogical strategies and be able to evaluate how these new strategies fit into a competency-based model and their overall teaching philosophy.⁵⁵

Limitations and Future Directions

Several limitations were noted within this study. Although trustworthiness was addressed through member checking and peer-reviewing, additional methods could be used in the future. Multiple-analyst triangulation involves multiple researchers coding and reviewing themes, to develop a consensus and eliminate researcher bias, improving overall trustworthiness of the qualitative data.⁵⁶ In addition, the findings from this study involved athletic therapy educators' self-perceived level of pedagogical knowledge. There were no mechanisms in place to observe athletic therapy educators in their natural teaching environment to see how they teach and how they implement different teaching strategies in the classroom. Future research could directly observe classroom interactions and evaluate athletic therapy educators' pedagogical knowledge in actual practice. Furthermore, students could be included in a study to explore the effectiveness of these pedagogical strategies on student learning.

It is also important to note that athletic therapy education in Canada will be undergoing a pedagogical shift in the near future. By the year 2020, all CATA-accredited programs will be expected to have a detailed plan in place to move their program structure toward a competency-based educational model.⁵⁴ Therefore, pedagogical approaches may evolve due to this curricular shift. Future research should explore how student-centered pedagogies are compatible with a competency-based educational model and how this shift affects the level of pedagogical knowledge in athletic therapy educators.

Finally, the research described herein highlights the potential for innovative pedagogies to enhance athletic therapy education in Canada. Furthermore, current learning theory recommends complementary active modes of learning that promote a balance between foundational knowledge acquisition, practical skill application, and clinical skill development.⁵⁷ Future research should continue to explore the effectiveness of these innovative pedagogies while inquiring how to develop pedagogical knowledge in athletic therapy educators.