Factors Influencing a Student's Choice of a Graduate Professional Athletic Training Program

Participants

The targeted population for this study was graduate students currently enrolled in CAATE-accredited professional athletic training programs during the spring 2019 semester. We obtained e-mail addresses for 102 program directors of graduate-level CAATE-accredited professional athletic training programs using the program search function on the CAATE Web site. We asked program directors to forward our survey to their respective current graduate students. One hundred forty potential participants opened the survey. Of those, 52 students completed the survey for a completion rate of 37%. Data about participants' specific graduate athletic training programs were not collected (eg, name of institution). Inclusion criteria were graduate students over the age of 18, currently enrolled in a graduate-level CAATE-accredited professional athletic training program with the program status active – in good standing on the CAATE Web site (www.caate.net). Exclusion criteria were students enrolled in professional athletic training graduate programs with the status seeking accreditation, probation, voluntarily withdrawing accreditation, and degree change pending. We also excluded students enrolled in undergraduate athletic training programs. We received Institutional Review Board approval for exempt research; we obtained informed consent with the initial question on the survey, and only those who confirmed consent were able to complete the rest of the survey.

Instrumentation

We adapted the survey used for this study from a previous study conducted by Askew.⁷ The original survey was assessed for face, construct, and content validity.⁷ Askew described the validation process which included removing factors of influence that were ranked as not important by more than 50% of the respondents during pilot collection. The survey was then revised based on feedback from pilot study participants, and lastly the revised survey was reviewed by two content experts for face, construct, and content validity before finalizing the survey instrument. We received permission from the corresponding author to use the survey. The survey consisted of 11 demographic items, 6 Likert-scale items about factors that may have influenced school choice, and 2 open-ended questions about career goals and pursuing a doctoral degree. We uploaded the survey into Select Survey version 4.0.30 (ClassApps, Kansas City, MO) for distribution.

Data Collection Procedures

Data collection took place over 4 weeks between April and May 2019. E-mails were sent to 102 program directors of graduate-level CAATE-accredited professional athletic training programs, asking each program director to forward the e-mail and link to the survey to all graduate students enrolled in his or her professional athletic training program. Included in the initial e-mail were (1) inclusion criteria, (2) aim of the study, (3) estimated time to complete the survey, (4) link to the online survey, and (5) researcher contact information. A follow-up e-mail reminder was sent 2 weeks later, including appreciation for those who had already forwarded the initial e-mail and providing identical information from the initial recruitment e-mail for a second invitation to participate.

Data Analysis

Data analysis was conducted using SPSS version 25 (IBM SPSS, Chicago, IL). We calculated frequencies and percentages for participant age, dependents, gender, race, marital status, citizenship, state of permanent residence, enrolled in program in state or out of state, and National Athletic Trainers' Association (NATA) membership. We also calculated frequency distributions and percentages for the Likert-scale item data on factors that may have influenced the choice of graduate school. These Likert-scale items included types of people, nonacademic factors, diversity factors, college/university factors, athletic training program factors, and athletic training faculty factors. For the data obtained from the 2 open-ended questions, we used a general inductive approach and an open-coding process. Each author completed the coding independently. We discussed our initial findings and agreed on the final codes for each question. For the data obtained from the question about a career goal, the final coding categories included high school, college, professional, healthcare administration, military, occupational health, performing arts, physician practice, public safety, and undecided. These categories were then assigned a number from 1 to 10, respectively. The final coding categories for the open-ended question data for whether participants would pursue a doctoral degree included no, yes, possibly, in future, and unsure. These items were then assigned a numerical value from 1 to 5, respectively. Missing data for both open-ended questions were assigned 0. Finally, we calculated the frequencies and percentages for responses to these questions.

Factors Ranked as Very Important Influencing Students' Choice of Program

Notably, more than 80% (highest of the factors) of the participants identified the program's accreditation status as a very important factor to the selection of their graduate program, closely followed by the program's Board of Certification (BOC) pass rate (72.5% of participants) and the types of available clinical sites (62.7% of participants). The factors considered most important by our participants were most frequently related to the categories of athletic training program and athletic training program faculty. Table 3 displays the frequency and percentage for the top factors that were ranked as very important by participants.

Table 3 Top Factors That Influenced Student's Choice of Program^a

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Factors Ranked as Not Important Influencing Students' Choice of Program

The top 3 factors that were not important to influencing a student's choice of program all related to the diversity of ethnicity and gender. Participants felt that faculty of a similar ethnicity (78.8% of participants), other students of a similar ethnicity (76.9% of participants), and faculty of the same gender (75% of participants) were not important considerations to the selection of their graduate athletic training program. Generally, the participants considered the category of diversity as not important. No other not important categories were highly represented. Table 4 displays the frequency and percentage for the top factors that participants indicated to be not important when choosing a graduate athletic training program.

Table 4 Top Factors That Did Not Influence Student's Choice of Program^a

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Career Goals and Pursuing a Doctoral Degree

Results for the open-ended questions pertaining to participant career goals varied. Over half (67.3%) of the participants indicated the college or professional sports setting as their career goal. Figure 1 displays the frequency and percentage of intended career paths for participants. Lastly, we asked participants if they intended to pursue a doctoral degree upon finishing their master's degree. Thirty-one (59.6%) participants indicated that they were not planning to pursue a doctoral degree. Only 2 participants reported they were currently planning to obtain a doctoral degree. One stated,

I am currently considering pursuing a doctoral degree. I would love to pursue a DAT; however, my concern is about what that degree would mean to potential employers and how it will affect my marketability and salary postdoctoral degree (I still want to practice clinically).

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The other participant commented, “I am considering pursuing a doctoral degree (PhD) so that I can dive deeper into research and teach future ATs.” Figure 2 displays the frequency and percentages for the participants' intent to pursue a doctoral degree.

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Very Important Factors

Our participants rated items associated with the athletic training program as very important to their selection of graduate school. Relative to the program, our participants were most interested in accreditation status (80.8%), BOC pass rate (72.5%), clinical sites (62.7%), the length of the program (51.9%), program facilities (51.9%), prestige of the program (50%), and admission requirements (50%).

The accreditation status of programs was the most important factor for our participants. Graduates of athletic training programs must graduate from an accredited program to be eligible to sit for the BOC credentialing examination, so the importance of accreditation status is not a surprising finding.¹⁰ According to the CAATE Policies and Procedures Manual, the CAATE confers the following statuses of public recognition related to accreditation: Accreditation: Initial or Continuing, In good standing (no progress report due), Accredited-progress report due, Probation, Administrative Probation, Withhold Initial Accreditation, Withdraw Accreditation: Voluntary or Involuntary, and Degree change pending (for programs that have submitted materials to change level of degree).¹¹ We did not ask our participants which specific accreditation status was most important; however, initial or continuing status in good standing is likely the preferred status for prospective students. The factor of accreditation status has been a consistently important factor for graduate-level healthcare program students, especially for students selecting physical therapy and athletic training programs.^5,12,13 In fact, prospective physical therapy students indicated that not only did accreditation status influence their selection of which school to attend, but it further influenced whether they would even apply to such schools.¹³ Even before the transition to the graduate level, athletic training students at the undergraduate level consistently identified accreditation status as the most important consideration in their program selection.⁵ Another study determined that of prospective physical therapy students, women are more concerned than men about accreditation status, and this held true for our participants, with 88% of our female participants indicating it as very important. In comparison, only 44% of our limited sample of male participants felt that the program's accreditation status was very important.¹⁴

The factor of accreditation status likely poses a challenge for new athletic training programs, which will need to recruit a minimum of 2 cohorts of students before achieving initial accreditation. Marketing strategies for these programs may need to revolve around informing potential students about the process of accreditation, their status of accreditation, and the likelihood of obtaining it.

The BOC pass rate of a program was also a very important factor for our participants in selecting their future program. Graduates of accredited athletic training programs are eligible to sit for the BOC examination.¹⁰ In 2013, CAATE-accredited programs were required to meet a 3-year aggregate minimum of a 70% first-attempt BOC pass rate to maintain their accreditation status in good standing, and programs are further required to publicly post their BOC pass rate within one click of their program's home Web page.¹⁵ The fact that graduate-level professional programs have had consistently higher BOC pass rates contributed weight to the change of professional degree level in athletic training.¹⁶ Likely, the increased emphasis on the BOC pass rate and public availability of the BOC pass rate have resulted in increased awareness of its importance for prospective students. The finding of the importance of the BOC pass rate is again consistent with prospective physical therapy students, as they rated pass rate on licensing examination as hugely influential to their selection of which program to attend.^12,13 This again may pose a challenge for new programs, as it will take a minimum of 3 graduating cohorts of students to establish a 3-year aggregate BOC pass rate for the program, so administrators from new programs may need to focus marketing opportunities toward educating prospective students and parents about the planned preparation for the BOC examination.

The clinical sites that a program has available was also a very important factor for the majority of our participants. Students in athletic training programs are required to gain experience in a variety of clinical sites as a component of their clinical education.¹⁵ Past program graduates have indicated that monotonous clinical experiences throughout the program have left students feeling frustrated.¹⁷ Data collected from physical therapy students upon the completion of clinical rotation demonstrate that student satisfaction with the experience links to the interactions with patients, colleagues, and preceptors at the site, life satisfaction while assigned to the site, and the variety of patients seen at the site while assigned.¹⁸ This study did include variety as a component of student satisfaction; variety alone was not predictive of student satisfaction with a clinical rotation.¹⁸ Interestingly, over three-quarters of our participants (76.8%) indicated that their future career goals were to work in college, professional, or high school settings, which seems contradictory to a desire for a wide array of unique clinical experience sites from the school of their choice.

Previous research indicates that the diversity of clinical experiences is a factor that contributes to the growth of athletic training students as they progress through an athletic training program.¹⁹ It is also important to note that historical research, from a time when the BOC exam was delivered in a different format, had identified that the types of clinical experiences a student has do not influence performance on the BOC examination.^19,20 It is possible, since some of our participants (51.9%) also rated program facilities as very important, that the facilities associated with clinical sites contributed to this selection. This area may require additional study to understand better which aspects of clinical sites are essential to prospective students of graduate athletic training programs.

Participants also rated the interaction with faculty that they had during the selection process as very important to their final decision. Half of our participants felt that personal contact with faculty during the decision process was very important. However, even more (61.5%) indicated that positive interactions with faculty during the decision process were very important. Similar findings have been reported in medical education, in which the interactions of residents and faculty were rated as influential in residents selecting to match with a residency program.²¹ Trolian and Parker²² found that opportunities for interaction with faculty significantly contributed to student satisfaction within graduate programs. It is also worth noting that while about half of our participants felt that faculty clinical expertise and interactions with faculty were very important, faculty research expertise was not important to our participants. Many faculty in tenure track positions are obligated to conduct and promote research, sometimes to the detriment of maintaining clinical practice or improving on classroom instruction.²³ Programs may want to consider highlighting a diverse faculty with a breadth of expertise across both clinical and research foci to attract students to their programs. Additionally, in the absence of clinically active faculty, programs could consider more aggressive marketing of clinical experts who guest lecture or participate in program education to tap into prospective students' interests.

Overall, participants in our study identified several athletic training program characteristics that were very important to their selection of which program to attend. As we stated previously, new programs may be disadvantaged in recruiting students, as their ability to demonstrate their accreditation status or BOC pass rate is limited. Administrators of such programs might find that capitalizing on opportunities for personal interaction in the application and admissions process, and highlighting a variety of clinical sites as well as the program's facilities, entice more prospective students.

Not Important Factors

A dearth of diversity has long been identified as a detriment to the profession of athletic training.²⁴ However, our participants did not rate factors associated with diversity as having an important influence on their selection of graduate school. The majority of respondents ranked all of the factors related to diversity, including the diversity of the student body (63.5%), as well as faculty similar in ethnicity (78.8%), as not important to their decision in selecting a graduate athletic training program. These findings support existing data demonstrating that more than half of prospective physical therapy students consider ethnic, cultural, and gender characteristics of an entry-level physical therapy program not influential on their choice.²⁵

The findings of both our study and that of Wilcox et al²⁵ should be considered with caution, though, as it has been identified that diversity as a factor influencing graduate school selection is more important to a subset of the general population.^14,25,26 In fact, diversity has been established as an important factor to ethnic minority students other than African Americans in electing to enroll and matriculate in a given institution or program.^14,26 Considering that our participant sample contained 41 (78.8%) participants who identified themselves as Caucasian and only 8 (15.3%) participants identified as an ethnic minority other than African American, it is highly plausible that this influenced the results in this category. However, our findings do corroborate the existing data indicating that diversity is not a factor that influences the graduate program selection of Caucasian students.^25,26 When we examined the results from our non-white student participants (n = 11), more than half of them still identified the diversity of the faculty as not important, but more than a quarter of those same students identified the diversity of campus activities and the student body as moderately to very important. The sample of minority students was small, but it does appear that some aspects of diversity do have some importance to students who identify as a minority race or ethnicity, which is consistent with the existing literature demonstrating that persons of color consider diversity of faculty and student bodies to be a more important consideration in selecting a university than their Caucasian counterparts. Specifically, these studies identify that diverse students are more likely to consider graduate programs with diverse faculty or diverse student bodies.^14,25,26

Another interesting result of note was that public versus private school was identified as a factor that was not important to our participants. Retrospective studies on graduate school students have shown that demographic variables, motivation for attendance at professional graduate programs, and the motivation for university selection did not vary between the students who attended public or private undergraduate institutions.^27,28 The studies also indicate that the same students did not vary in their selection of public or private graduate institutions.^27,28 Our findings are consistent with these studies, in that our participants were not considering their choice of graduate school based on the type of institution. Despite ranking the type of institution as not important, cost/affordability and availability of financial assistance were both among the important factors. According to the CAATE 2017 to 2018 Analytic Report, tuition for an in-state student attending a private university is, on average, more than 3 times as expensive as in-state tuition at a public university.⁴ This information highlights a need for better education and understanding, potentially in the form of advising, for students to understand the influence of public versus private institutions on the cost and affordability of attending graduate school.

Overall, the category of diversity was highly prevalent among the factors that students felt were not important in selecting a graduate program. At face value, students may not have a preference between public and private institutions but do find importance in the cost of attending such an institution.

Limitations and Future Research

Our study included a small sample of athletic training students at graduate programs, and as such, this may limit the universal applicability of the findings. Concerning diversity, readers should interpret the inclusion of diversity in the factors that were not important to students cautiously, as our sample was primarily Caucasian, and that may have profoundly influenced the results. Additionally, we excluded programs with the status of seeking accreditation from this study. Therefore, the results showing accreditation status as very important to students may be biased. Future research should consider the opinions of students enrolled in all graduate-level programs regardless of accreditation status. Lastly, we asked students to rate factors as important or not important but did not have follow-up data to determine which aspects of those factors contributed to their rating.

Future research should aim to determine which aspects of clinical sites, program facilities, faculty clinical expertise, and program prestige are specifically important to prospective students in selecting a graduate program. We also need more research to determine the influence of diversity, in student body, faculty, and the general institutional community, in the selection of graduate programs from students of all racial, ethnic, and socioeconomic backgrounds.