The Socialization and Development of the Coordinator of Clinical Education in Athletic Training

Responsibilities

The CCEs felt their responsibilities involved any aspect related to clinical education. Examples of responsibilities included placing and mentoring students, preceptor communication and development, evaluation and assessment of clinical skills and placements, clinical site visits, and administrative duties related to maintaining clinical contracts and accreditation. Judy commented, “I am tasked with basically all things clinical education from making sure that we're adhering to all the standards that apply to clinical education.” In addition to coordinating clinical education experiences, participants discussed other roles based on institutional practices, contemporary expertise, and their specific rank and title such as research and managing simulation centers. Table 2 includes a list of roles and responsibilities specific to the CCE role.

Table 2 Common CCE Roles and Responsibilities

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Challenges

Participants described many challenges as they navigated their roles, such as maintaining appropriate documentation, navigating institutional policies, conflict management, and balancing the administrative responsibilities with other aspects of their faculty position. Maintaining documentation was a challenge for the CCEs. Brianna said,

When I came into my role, I started to understand what they did prior to me. There were things that were not getting done or like literally not even getting done in like 5 years, or paperwork that didn't have a signature on it, and now we're going to make sure we're going to sign forms when the kids turn them in. Something as basic as that, we just created our own process.

Moreover, participants noted challenges developing organizational systems and policies and procedures for clinical education if they were not in place already.

Another challenge CCEs faced were navigating their responsibilities and institutional policies. Whereas many responsibilities were similar among CCEs, there were some institutional practices and policies that made the role more nuanced. Often, participants commented they did not understand all aspects of their role. Saul stated, “I learned each year that there's something else, and something else, and still now there's not really a clear distinction of what falls under my roles and what falls under my program director's roles.” In addition to not completely understanding their roles, each institution was different, and although some participants had previous experience at another institution, they had to adjust to institutional policies when they assumed the role at a new institution. Jane shared, “Some of the administrative things that I didn't . . . I figured out how to navigate, but I stumbled quite a bit. It's very unique to your university or college or department.”

The CCEs also handled conflict management. Many reported not being prepared for the amount of relationship interactions they would have to manage. Julie stated,

What I was not prepared for was being a counselor and a mediator and I don't feel like I had the background in that. I feel like I spend a lot of time listening to a lot of problems that there really is no solution for and so I think that that's a huge time suck.

Another challenge discussed was the ability to navigate workload responsibilities and balancing all the duties of a faculty member, not just the administrative aspect of being CCE. Marla stated, “Balance. I think for me that was the hardest part. How do I just handle everything without feeling completely overwhelmed or dropping the ball on something else?” Participants felt the role of CCE was time-consuming and thought it challenging to fulfill all their job responsibilities, despite having some release time. Frankie commented,

Does it make sense to still have a large teaching load or not? I think we all know that the administrative responsibilities would be enough for a full-time position, but then most of us probably got into this for a love of teaching so what does that balance look like?

Some felt the teaching load limited their ability to fulfill CCE duties, whereas others felt their CCE duties pulled them away from the classroom and fulfilling teaching duties.

Collaboration

One aspect CCEs cited to be successful in their roles was collaboration, both internally and externally. The program director served as the primary internal collaborator, but others cited CCEs of other programs (ie, other health care professions) within their institution. Ruby said,

I'm in an entire health professions college. There's other PA [physician assistants], PT [physical therapists], health sciences, nursing, a whole bunch, but it was really nice because they actually had formed a clinical coordinators educators task force.

Collaborating internally provided CCEs with resources, such as examples of documents (eg, affiliation agreements, clinical site evaluations, policies and procedures, clinical tracking systems) and helping CCEs understand institutional policies (eg, legal). Jane commented, “Check with your administration, check with HR [human resources], check with your legal department. These are people you need to have contact with because they all might have a role in contracts.” Participants felt working with CCEs from other health care programs also helped with assessment, quality improvement, and brainstorming ways to handle complex clinical issues.

External collaborators included CCEs from other institutions and other athletic training colleagues. External collaborators allowed participants to bounce ideas off one another and provide support. Daphne commented, “As clinical directors it really helps us to dive into our network. I talked to a variety of different people that are in very similar roles to me on a regular basis and bounce ideas off each other.” In addition to reaching out to our CCEs for support, some CCEs share resources and coordinate simulations with other programs in the area.

Anticipatory Socialization

Anticipatory socialization includes all aspects of previous preparation for the role of CCE, including feelings or preparation, formal preparation, and informal preparation. Most CCEs felt prepared for some aspects of their role due to previous experience as an AT or experiences in graduate school, but most did not feel adequately prepared for all aspects of their roles. Elena commented,

Overall, I would say I didn't feel prepared at all, but I think I did feel prepared for some aspects of the job. Just from being an athletic trainer seeing things being in the field, seeing how things worked, like clinical placements of the student in the broad sense of it. Maybe not the details of how we did everything from there. I had a good understanding of trying to match students and pieces like that just from being an athletic trainer and a preceptor myself. But the ins and outs of the job and every detail that went into it, I don't really think I had any clue.

Participants felt adequately prepared for some aspects of their roles such as assigning students to clinical sites, but less prepared for other aspects such as developing and writing articulation agreements, managing conflict, knowing legal aspects of the role, or managing time overall among administrative responsibilities, teaching, research, and service (depending on their role).

Formal preparation for the role was limited, but some participants received preparation in graduate school. Frankie described her graduate school experience (master's level) as it prepared her for the role: “In my graduate program one of the focuses was preparation for the entry-level educator. We essentially did a site visit, we reviewed a self-study, and we had to go through all the standards and highlight what's in compliance.” Other participants received formal preparation through their doctoral education, whether that was through a role as a graduate assistant with the CCE or enrolled in a doctoral-level athletic training program. Melissa commented, “I had a little bit of help [with preparation] only because when I was going through my doctoral program and I did my internship with [the university's] athletic training program. I was working a lot with their CCE.”

Others felt informally prepared through their former roles as a clinician, preceptor, or faculty member. Daphne described her preparation by saying, “I came from working clinically for 11 years and being an adjunct and being a preceptor for those 11 years, so I knew what it was going to look like. I was excited to put all the pieces together.” Previous experience as a preceptor helped with various aspects of the role, such as developing relationships with preceptors and placing students with preceptors.

Organizational Socialization

The second subtheme that emerged was organizational socialization, which describes the process of learning and integrating into the roles as CCEs at their specific organization. As CCEs began their roles, they were integrated through organizational socialization. Similar to anticipatory socialization, organizational socialization included some formal aspects but was largely informal or absent for many CCEs. Formal aspects included meeting with the program director to learn role responsibilities. Chloe commented, “I had met with our program director. It was kind of, you're in charge of all the things clinical related and she's more the final signature on a lot of the didactic things.” Liz also commented, “We sat down and had a meeting and there was a verbal this is what your role is, this is what you do.” Whereas initial meetings with program directors were considered formal onboarding, meetings often continued informally as the CCEs integrated into their roles. Participants described informal meetings with the program director to help with socialization into the role. Barry stated, “The first time I served as coordinator clinical education, my program director [was] pretty involved and I learned a lot by just being able to ask questions and we kind of bounce things back and forth from each other.”

Organizational socialization was largely absent for most participants. Many participants noted learning about their roles from seeing what needed to be done or when duties were missed. Mallory commented, “Yeah, when I didn't do something, they said, ‘Why didn't you do this?' I didn't know.” Brianna shared similar experiences:

But after a year, I was like, oh man, there's things I should have been doing and I clearly was not. Like I should have been evaluating clinical sites and I was not. That's crazy. With my current employer, I've been clinical coordinator for 8+ years. So clearly, I just felt comfortable because I've been in that role, but zero socialization.

Participants commented they learned their role through trial and error or reading the CAATE Standards to determine what was missing. Many reported that they learned most about their role through a self-study or a site visit. Participants felt they were not adequately socialized into the role at their specific institution; although, CCEs who had assumed the role after being at the institution or a CCE at another institution adapted to their role more quickly.

Resources

The third subtheme that emerged was resources, which describes the institutional and professional resources used by the CCEs to learn more about their roles. Institutional resources included policies, procedures, forms, binders, or other items provided to help CCEs understand their role. Professional resources included the CAATE Standards,⁶ professional development conferences, research articles, or other items produced by the athletic training profession. Whereas this theme focuses on material resources, it also includes participants' descriptions of administration, colleagues, other CCEs, and alumni as resources for the role.

Institutional resources included items that were provided to participants to help them further understand their roles. Many participants were provided with either a binder or list of contact information. Frankie commented that she received a “giant binder and checklists and a step-by-step of how you go about securing a new affiliation agreement. Or here's how I've done site visits. Here's the chart that you can use.” Although having resources was helpful, some participants felt too much information was counterproductive, because they spent more time trying to find something than if they just started fresh. Participants felt the most useful institutional resources were contact lists for preceptors and relevant institutional officials (eg, individual in charge of facilitating articulation agreements), checklists and step-by-step guides for completing clinical expectations, examples of clinical paperwork (eg, preceptor evaluation of student, site-visit checklist), and policies related to onboarding students for clinicals.

In terms of the profession, many CCEs felt the CAATE Standards⁶ served as the primary resource to help them learn their role, but others cited current research related to clinical education as helpful. Vikki felt that CAATE defined the role of the CCE, stating, “Reading what CAATE kind of defines as the role of the coordinator of clinical education gives you at least a starting point to start to think about your role.” Daphne commented, “A lot of reading those new standards probably a gazillion times over and over again to interpret them, going to all the CAATE meetings, going to anything the CAATE put out. Reading anything that I could.” Elena concurred, “It's probably going through the standards and at least making sure we're hitting those at a minimum. Then from there, talking to others and learning from your failures and figuring it out as we go.” Shawn stated, “I've kept my eye out for different articles, especially the education journal articles that are coming out.” In addition, CCEs sought development opportunities through the CAATE accreditation conference and Athletic Training Educators' Conference to learn ways to be more successful in their roles.

Needs

During the socialization process, participants identified many needs, including resources, development, and mentoring and support. Some of the necessary resources included specific job descriptions with an outline of functions, a flowchart or timeline to describe when functions needed to be completed, and institutional policies, procedures, and contact lists of common staff at their respective universities. Whereas some participants received binders and/or lists of information, some participants who did not receive the resources strongly desired them. Emma commented, “I would take a binder any day. A checklist would be amazing right now.” Ariah concurred, “I would have appreciated just a list of expectations. If you could have spelled out a list. I could have knocked it out of the ballpark much earlier if I had known what was on the list of expectations.” Others desired a guide that could be universal among all athletic training programs. Paula stated, “I would love a CAATE for dummies handbook or something because some of the way that the accreditation standards are written, I was like what does that mean? I don't know what this means!” Participants outlined a few “chapters” in which they feel would be beneficial in the CCE survival guide, including clear expectations, deadlines (eg, annual report, procuring preceptor documentation), developing clinical assessments, clarity on CAATE Standards, legal aspects of clinical education (eg, affiliation agreements, Title IX violations), how to write policies, and general clinical onboarding.

In addition to resources, participants discussed professional development needs to be more successful in their roles as CCEs. Many CCEs specifically felt more development on the 2020 CAATE Standards⁶ would be beneficial. Aaron commented, “The CAATE can do more, as far as webinars or informational sessions. Like let's pull these 5 standards out and let's have a conversation or even a forum where people can share ideas.” A few participants recalled workshops through the National Athletic Trainers' Association (NATA) that were specific to the role of program director or CCE, and others wished this training existed. In response to what professional development would be ideal, Julie commented, “A training for new program directors and training for new clinical education coordinators.” Whereas many participants used the CAATE conference and Athletic Training Educators' Conference, others want more sessions related specifically to the role as a CCE.

Another socialization need of our participants was mentorship and support. Whereas some felt they had institutional mentorship and support, others felt they needed mentors who were also CCEs so they would understand some of the challenges and needs. Pam commented that she needed “Mentorship program or something like that.” Some participants reached out to colleagues who are in the role but not everyone had that resource. Barry stated, “I didn't have anybody to learn from.” Many participants agreed with the need for mentorship, but also expressed desire for a network of CCEs to collaborate and have a safe place to discuss challenges and learn from one another. Shawn stated, “I can see a benefit of having a network of people to bounce ideas off of a collective group. Get together on a zoom call you know once a month, just to have resources and to spark some ideas.” Overall, participants felt they needed more socialization into their roles as CCEs and most desired more formal training through onboarding, mentoring, and additional professional development.

Responsibilities

The role of CCE is very complex, and requires proficiency in administration, mentoring, evaluation and assessment, effective communication, and record keeping. Our participants described their responsibilities as including all aspects of clinical education. This is consistent with previous survey research exploring roles of the CCE.^7,50 The CAATE Standards include similar responsibilities such as oversight of student clinical progression, student assignment to clinical experiences, selection, professional development of, and communication with preceptors, and evaluation of preceptors, students, and clinical sites.⁶ Additional literature has found similar responsibilities in comparable roles in other health care professions, such as physical therapy,⁴³ occupational therapy,⁵¹ and nursing.⁵²

Challenges

Participants also described challenges in their role as CCE, including maintaining documentation, navigating institutional policies, conflict resolution, and managing workload responsibilities. CCEs have many responsibilities related to maintaining accreditation, which has been cited as the most common stressor for both CCEs and program directors.⁵⁰ To better support CCEs in their roles, specific guidelines with lists and timelines for documentation should be developed. For example, athletic training program faculty should determine which documents need to be collected for accreditation requirements (eg, evaluations of preceptors) and timelines for when they should be distributed and collected. This would help CCEs know which documentation is required and develop a plan for ensuring that appropriate documents are collected when needed.

Conflict management was also a challenge discussed by our participants and is a common part of the CCE role.⁷ Conflicts may arise in clinical education, whether they are conflicts between preceptors and students, conflicts at the clinical education site, or conflicts with maintaining clinical partnerships. Not only did participants feel underprepared to manage these difficult situations, but they also felt unprepared for time and stress associated with mediation. Similarly, center coordinators of clinical education in physical therapy indicated they needed more development with managing crises and conflict in situations in which students were not meeting expectations in clinical education.⁵³ Effective communication with preceptors and clinical sites can mitigate some of these conflicts. Policies for conflict resolution should be developed to alleviate some of the stress.^7,54 In addition, conflict resolution is an important aspect of good leadership.⁵⁵ Institutions should provide leadership training for CCEs to assist with challenges associated with managing conflicts in clinical education.

Challenges with managing workload responsibilities are well established in the literature. Previous literature highlights challenges in balancing responsibilities by junior athletic training faculty,^17,31 as well as role strain in athletic training educators who are expected to pursue and maintain program accreditation while also meeting the demands of institutional expectations.⁵⁶ Radtke⁷ found that approximately half of CCEs did not feel they were appropriately compensated for their CCE duties and suggested the size of the program and number of affiliated clinical sites should inform the reassigned workload time given to a CCE. Balancing work-life demands and having inadequate time to dedicate to all aspects of the CCE faculty role (eg, teaching, scholarship, and maintaining contemporary expertise) are some of the top stressors for CCEs⁵⁰ in athletic training and nursing.⁵⁷ Release time for our participants varied due to institutional policies, but most indicated the amount of release time was insufficient to meet the demands of the role. Participants who had more release time (ie, more than half of their load) felt they had adequate release. Future researchers should explore course release time and administrative requirements to ensure CCEs have adequate time to complete their duties.

Collaboration

The CCEs in our study described collaboration, resources, and development as integral in their success in their role. Like our participants, Sobralske and Naegele⁵² described seeking help from others in similar roles for clinical coordinators of family nurse practitioner programs. Program directors also attribute success to having supportive colleagues around them.⁵⁸ In addition, interactions with colleagues have been found to be integral to the socialization of new faculty in athletic training and physical therapy.¹⁹ A supportive collaborative environment allows for junior faculty to gain insights and advice from their colleagues. Institutions can support new CCEs by providing them with communities of practice. Communities of practice allow groups of people to work collaboratively and share and learn from one another¹⁹ and have been shown to decrease feelings of isolation in junior faculty members.⁵⁹ A community of practice containing CCEs from a variety of health care professions within an institution or one with athletic training CCEs from multiple institutions may help athletic training CCEs better understand their role and provide ongoing support as CCEs face challenges.

Anticipatory

Anticipatory socialization occurred through graduate school experiences or from former roles as clinicians, preceptors, or faculty members. The literature suggests some athletic training educators are prepared for their role through graduate work, whereas others describe little exposure to administration and accreditation standards during their doctoral work.⁴⁸ Klossner et al⁴⁷ found that future athletic training faculty were not often exposed to administrative roles during their doctoral education, which was similar to our findings. In addition, a recent survey found CCEs only received on average 1.3 hours of formal leadership preparation.⁵⁰ Similarly, athletic training and physical therapy junior faculty members experienced limited preparation for administrative roles during their doctoral preparation, which was a challenge.²⁷

Participants expressed that they felt prepared for some roles such as assigning students to clinical sites but were not prepared for other roles such as developing articulation agreements, managing conflict, or time management between administrative responsibilities. This was consistent with the literature, because Nottingham et al⁴⁸ and Mazerolle et al¹² found junior athletic training faculty members expressed being unprepared in administrative roles. Literature described mentorship as a means of socialization and understanding of the athletic training faculty role^12,13; In contrast to the literature, our participants did not describe mentoring as a means of preparing them for their role as CCE; however, they did suggest mentoring would have been helpful to them. Doctoral programs with the aim of preparing athletic training faculty members should include specific training and mentoring on administrative roles within athletic training programs. Mazerolle et al¹² found that mentoring and authentic experiences provide a foundation for understanding the role, so providing opportunities for doctoral students to be involved in accreditation tasks (eg, annual report, self-study, site visit) can also assist in preparing CCEs for their roles. Providing experience with administrative tasks can expose CCEs to typical responsibilities and can provide information about the appropriate questions to ask and types of individuals to contact when they begin a new role. Although institutional differences exist, gaining prior experience in administrative tasks can alleviate some of the stress during organizational integration.

Organizational

Organizational socialization provides individuals with the opportunity to gain on-the-job training specific to their role, which was informal for most of our participants. Although participants had formal orientations into their roles as faculty, they were not oriented into the role as a CCE. Most participants socialized themselves into their roles through trial and error; whereas, some learned their role through the reaccreditation process, like program directors as reported by Viesselman.¹⁴ New athletic training faculty members often supplement organizational methods for socialization with individual mechanisms, such as seeking out mentoring and engaging in activities to help them learn their role.³²

Onboarding and orientation are important aspects of organizational socialization; however, our results found that formal processes orienting CCEs to their administrative roles were largely absent. Previous research¹³ with new athletic training faculty members has found timely orientation sessions can provide a clear overview of the position to assist with role transition. However, extensive orientation sessions that are heavy with information at the beginning of employment can be overwhelming and instead should spread information out over time. As new CCEs transition into their roles, formal orientation with clear job description, overview of duties, and timing of duties would alleviate stress of learning the role. However, challenges exist in determining who is responsible for orienting the new CCE. When new faculty members transition into their role, Human Resources, Academic Affairs, and administrators are often responsible for new faculty orientation. There is not a clear distinction of individuals responsible for orienting CCEs into the role, and this responsibility might fall on the program director, who may not be fully aware of all aspects of the CCE's role. Future researchers should further explore best practices in orientation for CCEs and provide general resources to assist with CCE orientation.

Resources

For our participants, the CAATE Standards⁶ served as the primary resource to learning their role, as well as research related to clinical education and institutional policies and procedures, and an outline of the role. Institutional resources included binders of information or previously used forms and contracts, a flash drive or shared drive of documents, a stack of paper forms, or a list of contacts. Whereas this information can be helpful, it can be overwhelming and time-consuming to find relevant documents. Institution-specific resources can be very valuable during the socialization process, because they provide new employees with specific expectations, policies, and procedures necessary to be successful in their roles. For new ATs, being provided with a policy and procedure manual during orientation alleviates stress and allows them to feel comfortable in their role faster.²¹ In addition, new ATs in the college setting are often not provided with written resources beyond a job description, so managing administrative tasks are learned through trial and error.¹⁰ Whereas many CCEs are not often brand-new ATs, there is still a role transition which can be stressful. Providing resources can assist the CCEs in transitioning into their roles. In our study, participants who were provided with organized resources (eg, binder) and then an outline of tasks and specific due dates felt more prepared to take on their roles than those who received too little or too much unorganized information. As new CCEs are transitioning into their role, someone who knows the role (eg, program director, department chair, other CCEs) should provide current information, contact lists, and an outline of tasks that need to be completed with a timeline for completion.

Whereas some participants received institutional resources, others relied on external resources, such as the CAATE Standards⁶ and professional development opportunities, such as conferences. Seeking out professional development has been found to be a common practice among junior athletic training educators,³⁷ particularly professional development directly related to their faculty roles.³¹ Despite health care administration being the least preferred continuing education topic among ATs,⁶⁰ our participants found it valuable to help understand their roles. Participants recognized a need for continuing education related to being CCE, which is consistent with other ATs who select professional development opportunities on the basis of perceived needs and benefits.⁶¹ In addition to gaining valuable information from sessions, participants also found collaborating with other CCEs and faculty members at conferences was a good resource.

Needs

Participants identified needs to assist in their socialization and continued development in their role as CCEs, including resources (eg, policies and procedures), professional development, and mentoring and support. Similarly, as new ATs transition to practice, they desire specific policies and procedures, protocols, and a detailed outline of expectations so they can be successful in their roles.⁶² New graduate assistant ATs in the collegiate setting also appreciate having a manual to which they can refer when they have questions.²¹ Many new faculty are provided with tenure and promotion expectations and teaching resources as a part of their socialization¹²; however, this often does not extend to administrative positions. Our participants overwhelmingly expressed a need for CCE specific resources. This is similar to physical therapy, in which center coordinators of clinical education desire programs and training specific to their role.⁵³ Athletic training program faculty and institutional CCEs should develop resources for incoming CCEs to help them navigate and be successful in the role. Moreover, current CCEs could organize their tasks with timelines for completion to ensure they meet deadlines and pass on these resources to future CCEs.

Participants noted both the CAATE Accreditation Conference and Athletic Training Educators' Conference as opportunities for professional development; although, there are not often talks specific to the role as a CCE. The NATA has historically provided workshops for CCEs and program directors; however, these have been discontinued. The Strategic Alliance should explore ways to support program administration, such as reinvigorating these workshops to assist with socializing the CCEs into their roles. Beyond a specific workshop, webinars and sessions at conferences specific to the CCE role would be beneficial. Topics include role expectations of the CCE, legal aspects involved with coordinating clinical education experiences, navigating the 2020 CAATE Accreditation Standards,⁶ and writing the clinical aspect of the self-study, preceptor development, managing conflict, maintaining documentation, and tracking patient encounters. Future researchers should also explore these topics so that educational sessions could be developed to better prepare CCEs.

Having a mentor was also identified as a need by many participants, and participants would benefit from both internal and external mentors. Internal mentors can assist with understanding institutional policies, meeting various individuals, and learning organizational culture. Whereas some participants had formal mentors, many developed informal relationships with program directors or CCEs from other programs. This is consistent with new faculty members who value guidance from departmental faculty members on an as-needed basis.^13,32 Having a mentor can ease transition stress and help new faculty members understand their roles.^13,10,16 Mentors also provide support and guidance,¹⁶ which is vital to the socialization of CCEs. Our participants also noted the value of external mentors who were also CCEs, because some of their questions or needs were related to the role as CCE and were not institution specific. Because not all CCEs have mentors within their contacts, formal mentoring through professional avenues (eg, NATA Foundation mentoring program) can provide new faculty or new CCEs with support and guidance to help with their roles. The Strategic Alliance members could facilitate a mentoring network, whether through a committee or on GATher through the NATA (https://gather.nata.org). In addition, a network for CCEs on a forum such as GATher or peer-to-peer discussions can facilitate CCE socialization and help develop relationships.