Program Director Perspectives on Athletic Training Student Motivation to Complete Their Professional Athletic Training Degrees

Participants

A total of 8 PM PDs and 16 undergraduate PDs volunteered for our study. The PM PDs had 8 ± 6 years of experience in their roles and were 41 ± 4 years old. The undergraduate PDs had on average 6 ± 4 years of experience in the role of the PD and were 44 ± 8 years old. The Table provides additional information regarding the PDs and the institutions they represented.

Table.  Institution Demographic Information

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Data Collection

We purposefully recruited participants meeting our criteria: an athletic training professional serving as PD in either an PM program or undergraduate program accredited by the Commission on Accreditation of Athletic Training Education (CAATE). All participants were recruited via email after we secured Institutional Review Board approval. First, all PDs from CAATE accredited undergraduate and PM programs across the United States were asked to complete an internet-based questionnaire as part of a separate, larger study.⁷ At the end of the questionnaire, PDs were asked if they would be willing to participate in a follow-up telephone interview. We had a total of 83 undergraduate PDs and 10 PM PDs respond that they would be willing to participate. From this group, we randomly selected the participants for the current study (8 PM PDs and 16 undergraduate PDs) using data saturation as our recruitment guide.¹⁰ After continually reviewing the interview tapes during recruitment and data collection, the data from the 22 PDs resulted in data saturation allowing the cessation of data collection. The current study only examined the transcripts of the follow-up telephone interviews, not the data from the internet-based survey.

After we gained written consent from each participant, we scheduled tape-recorded semistructured telephone interviews. We chose to use telephone interviews for several reasons including the ability to access a broad geographic area and the flexibility afforded by one-on-one interviews to solicit additional information. During telephone interviews, the researchers were able to ask additional follow-up questions, which added to the robustness of the data. The secondary author completed all of the interviews, which lasted approximately 30 minutes. The interview sessions were guided by a set of questions developed by the secondary author initially, but reviewed and confirmed by the primary and tertiary authors. In addition, we pilot-tested the interview guide on 3 separate occasions including think-aloud interviews¹¹ and review by a panel of experts. Questions were open ended and designed to evaluate several facets of program administration, retention, and student development. At the conclusion of data collection, we had the interviews transcribed verbatim using aliases to facilitate data analysis while maintaining the confidentiality of our participants.

Data Analysis

Existing literature and the research questions helped guide the general inductive coding process that we followed during analysis. Specifically, the data analysis focused on questions such as, “How do you motivate your students to finish your program?” and, “Why are students motivated to finish your program?” We followed the very logical, stepwise general inductive approach as described by Thomas.¹² The general inductive approach to data analysis has been described as an efficient means to evaluate raw data particularly when concerned with determining the prevailing themes, which relate to the research objectives of the study. Gaining a holistic impression of the data through multiple readings is at the core of this process and helped us to determine the prevailing themes. During each reading of the data, we wrote notes (ie, memos) to categorize the data and stay organized with the most important findings. No labels were assigned during the first reading of the data; only with the subsequent readings did we assign labels to the data. The labels were evaluated on successive readings, and only those themes that were determined to be predominant and spoke to the research question were included in the final codes.

Credibility Strategies

To establish trustworthiness of the data, we selected 3 traditional credibility strategies including member checks, multiple analyst triangulation, and peer review.¹⁰ We completed member checks prior to analysis by having 4 randomly selected PDs review their transcribed interviews for accuracy and consistency. The strategy is simple but can enhance the credibility of the findings.¹³ The 2 lead authors completed multiple analyst triangulation, a credibility strategy that is becoming more popular and is effective as it provides rigor to the analysis and presentation of the findings. Prior to analysis, the authors discussed the steps for analysis and then completed the steps independently. The authors negotiated over the coding scheme until complete agreement on the final categories was achieved; in the end only terminology, not content, was discussed. We used a peer to confirm the findings that the first 2 authors agreed upon. The peer, our third author, was provided the coding sheets, transcripts, and the themes as determined by the analysis process. The peer was in agreement with the analysis and presentation of the results.

Internal Drive

The PDs were convinced that motivation to complete the ATP degree requirements was related to the intrinsic motivation of their students. A strong sense of professional responsibility is an important component of professional commitment for the athletic trainer,¹⁴ which is often internally driven. Take, for example, the comment 1 PM PD said regarding program completion, “In general, I think a lot of these students are intrinsically motivated just to finish what they start. After all they've put into it, I think they have intrinsic motivation for sure.”

The perception that internal motivation was a key factor for persistence was a common trend in the data from many of the PM PDs as the next 2 quotes indicate. One PM PD said,

A lot of them, this is what they want to do, and this is what they know that they want to do. So they're internally motivated because they want to get out and get that job. They have a lot of motivation.

Another PM PD noted a comparable perception on degree completion by stating, “The ones that we have that have graduated and the ones that we have currently have all had a strong intrinsic motivation, to be honest with you. They knew what they were getting into.”

As discussed by many PDs, regardless of program type, the drive for students to succeed and complete their degree requirements was the motivation to persist in their ATPs. An undergraduate PD illuminates this idea of internal drive sharing his students' success,

I'd have to say self-motivation is a key. Again, we have high-achieving students, and they—persistence is just part of their character, so I think that's one component. I think that, again, being part of a team or part of a family—we try to create this family atmosphere that we're all here together, we're all working towards the same thing—also motivates them to finish.

Internal drive and self-motivation were key factors discussed by a majority of the participants, regardless of program type; however, 1 stark difference was noted in the undergraduate population. A few of the undergraduate PDs discussed their students' drive to complete the degree as intrinsically motivated; however, at times, it was to move onto other areas of study or further medical training such as physical therapy, physician assistant, or medical school. This difference was not noted in the PM group, as 1 PD alluded to the fact that they had selected graduate school for athletic training purposefully. The participant shared,

Well, I think the prime motivation for the PM students is that they specifically decided to continue their education and pursue graduate studies because they wanted to do athletic training. This is not undergraduates coming in and picking a major because it sounds kind of cool.

Supporting the internal drive to complete the program in order to move forward in future medical or health care education is evident by this undergraduate PD's comments,

I mean, I think part of that comes from an inner motivation. Again, as an undergraduate program, I know that some of them are using it as a stepping stone for PT or med school or physician assistant.

Program Pride and Tradition

The motivation to complete the ATP degree requirements was also stimulated by competition among ATSs as well as a rich program tradition. The PDs spoke of the desire to support the success of previous classes in passing the Board of Certification (BOC) examination, attending prestigious graduate programs, and securing future employment settings as factors motivating students to finish. The successes of previous classes were mentioned by several PDs as motivating for students. Having knowledge of the career pursuits and current positions of program alumni allowed the current students a chance to envision their own careers and stimulated motivation to complete the program. One undergraduate PD shared the following while reflecting on student motivation,

We have a pretty wide variety of alumni across the country. They are employed [with] professional football, professional soccer, [as well as] we have people spread out in all sorts of colleges and high schools across the country. So I think the ability to make some connections somewhere else with a [university] alumni [sic] or knowing that, hey, I may be able to go on to this specific graduate school because you know somebody knows someone there. So I think those connections kind of help our students as well because they can see that our graduates are successful. They have interactions with them.

A similar comment was made by another undergraduate PD about the impact of alumni and their individual success on student motivation to complete the program. She said,

We do some alumni stuff back on campus so our students kind of get to see this is where they went [to graduate school] and this is what they do and look they were successful. I think that helps too, especially if they start seeing it first in the freshman and sophomore year.

Another PD was fortunate to have active alumni, which involved an on-campus visit to educate program students on their personal experiences. During the interview, the undergraduate PD described,

I would say alumni [help motivate our students]. We have two events—two preview day events. We have 5 alumni coming back from 5 different classes, so they get to hear—it's not just for the students we're recruiting, but it's also a retention effort for us. We want the students to see the other successes of folks that have graduated from this program and what they're doing and how they feel about their education and to honestly say what they would have done different, what they liked, maybe what they didn't like, what they think about changes that are happening. So they get kind of an unfiltered—I guess a voice from students that have, as some of them say, survived the process.

Motivation to complete the requirements of the ATP can be stimulated by the successes of program alumni because they serve as role models. Take, for example, this comment from 1 of the PM PDs regarding motivation to finish her program,

I think that, with the strong history of success on the BOC exam on the first attempt that the students who come now have—they feel a sense of responsibility to maintain the level of success that the program has had. . . And I think that our students are sought after in the workplace, and that makes them want to—our current students want to finish the program and be successful and continue to foster those relationships and build the reputation that our program has become known for.

Competition within the individual program was also discussed as a motivating factor for degree completion, as it bolsters the performance of the student. One PM PD shared,

Some of our students kind of try to compete with each other and try to do better than the other person. And so they're motivated to be better, or as good as, their colleagues or their fellow cohort members.

Our results suggested that program pride and tradition stimulated degree completion regardless of program type.

Accomplishment of Goals

Completion of the ATP requirements was also driven by the student's goal setting, which included becoming a certified athletic trainer. Internal drive, already presented, can facilitate the accomplishment of the student's goals, but many PDs felt that the ATS was motivated to complete the program due to personal goal setting. This is highlighted by 1 PM PD's comments,

But to finish the actual program. . . . Other than the fact that they'll have a goal of, whether it be grad school or whether it just be to become employed. And obviously becoming certified is going to be part of achieving that goal. And so I think it's a step-by-step process.

An undergraduate PD echoed goal completion by stating, “I think the way they're motivated, the most is a sense of accomplishment and trying to, ultimately, achieve what they came here for. And I think that is the case across the university.” Realization of the process of becoming an athletic trainer and the steps taken thereafter were also mentioned as helpful in motivating the ATS to complete the program. This is supported by another undergraduate PD's stating,

I think—that's hard to say. I think part of it is just once we get that group that this is—they know this is what they want—they want to do this; they want to excel; they want to head on into graduate school and do whatever's gonna be next in their career.

Program directors described their students as goal oriented, which facilitated their motivation to complete their degree programs in athletic training.

Disinterest and Dissatisfaction for Athletic Training

Student motivation for degree completion can be stimulated by a passion and interest in the roles and responsibilities of the athletic trainer.¹ Conversely, a student can become unmotivated to complete the degree requirements if they develop a disinterested or disheartened feeling while learning about the roles and responsibilities of the athletic trainer.⁵ Several of the PDs discussed situations where students decided to change majors because athletic training was not what they wanted to do professionally. Take, for example, the following comment from 1 undergraduate PD,

You know, a lot of the ones that end up changing, when they come in and they talk to me about that they might be changing majors, I ask, “Why? What's the reason?” And the reason [usually] is, “I really just don't think this is what I want to do.

A few other undergraduate PDs mentioned similar comments from their students saying, “I just now realized that this profession is just not for me.”

The decision to change majors before completing the degree requirements for athletic training was also precipitated by a limited understanding of the profession or the role of the athletic trainer in health care. This is supported by another undergraduate PD's discussion regarding students questioning their desire to remain in their ATP. Specifically, this PD said,

I would say that a lot of people come in, and they don't know what the difference between exercise science and athletic training is. And they come in, and they want to do athletic training, and probably like a lot of people, they think it's going to be Super Bowl Sunday every day or something like that. They realize that that's not what it is, or they think athletic training is not the medical side of things but the strength and conditioning side of things. And so that's 1 thing I think that people struggle with.

Another factor facilitating change is an interest in another health care field, such as physical therapy or physician assistant. The desire to pursue 1 of those fields motivated the student to change majors from athletic training. This is supported by a statement made by 1 undergraduate PD discussing advising students. This PD commented,

We tend to have students who find pretty quickly that they'd rather do physical therapy. We've only had a couple of students that stay in athletic training that really want the dual certification. They find that their interest is really, really in rehab and not the other pieces of athletic training.

A failure to make a connection with athletic training or visualize a career in athletic training was not just an undergraduate ATP issue. A few PM PDs discussed departure from their programs due to disinterest in athletic training or an interest in another career. For example, 1 PD discussed 1 PM student's decision to change graduate programs and stated,

We had 1 student. . . through his didactic work and through conversations that he had with the 2 faculty members, myself and our other faculty member, his passion and his strength really fell in the realm of strength and conditioning. He was getting conflicted with his field experience as to where he wanted to do more with his preceptor from a strength and conditioning standpoint than from a true athletic-training, injury-prevention, injury-management standpoint. So he was able to figure out that, although athletic training would help him do what he wanted to do, he needed more training in the strength and conditioning world.

Two other PM PDs mentioned similar issues regarding the realization that athletic training is not the career for them. Physical therapy, medical school, and physician assistant studies were all mentioned as alternative educational paths and reasons for students not completing their PM degrees. One PM PD highlighted attrition for alternative health care training by stating,

I did have a student who was not sure that athletic training was for him. They really wanted to go on to PA school or DO school. Based on his career goals, he felt—and I agreed with him—that going a different path would probably be the best route for him.

Students, as described by our PDs, often lose interest in athletic training because of a realization that the roles and responsibilities are not what they expected, which does not happen until they personally experience it for themselves through clinical education.

Internal Drive

Self-determination has been linked to student success, particularly achievement on their goals including degree completion and college graduation.¹⁵ Self-determination theory examines human motivation and behaviors, specifically what drives an individual to make choices. The theory suggests that humans possess an innate drive to develop and learn.^15,16 In fact, the literature suggests that internal motivation is more important for student success than extrinsic rewards such as grades earned, as it can negatively affect motivation and taking responsibility, personally.¹⁶ Internal drive was identified by our PDs as a major catalyst to the ATSs' completion of their athletic training degree requirements, which supports the self-determination theory previously mentioned^15,16 as well as the findings of Pitney¹⁷ regarding the professional commitment of the high school athletic trainer. Dodge et al² were the first to connect student motivation to degree completion, and our results continue to illustrate the importance of determination and self-motivation of the ATS as a means to facilitate persistence.

The development of decision making and goal setting skills, enhancing communication and relationship skills, and increasing self-awareness particularly in the area of strengths and weaknesses are facets of self-determination theory^15,16 and skills necessary for the professional athletic trainer. It appears as though our PDs recognize that the ATS who exhibits qualities as identified by the self-determination theory may be more likely to persist to graduation because they have the drive and commitment to their professional and personal pursuits, which supports another emergent theme—accomplishment of goals. During the educational experience, ATPs provide opportunities for student learning and legitimation into their future roles, all factors that can stimulate motivation and persistence in their degree programs.¹⁸ Engaging didactic and clinical education experiences can help stimulate learning while strong mentoring from faculty and staff has the potential to improve self-awareness and help an ATS realize their goals and support their motivation and drive for athletic training.

Previous literature has presented that students may use their athletic training education as a foundation for additional study in various medical fields.⁵ Our findings compliment previous research,⁵ as our PDs found the ATS to be internally motivated to complete the degree to move on to his or her next degree program. One notable difference in our findings as compared to Mazerolle et al⁵ focuses on program type. Degree completion as a means to transition to postprofessional or graduate medical/health care fields was found to be a stronger issue for undergraduate ATPs, compared to PM ATPs. As highlighted by 1 PM PD, students selected a graduate degree in athletic training because of their interest in athletic training, not as a means to a different health care career.

Accomplishment of Goals

Career goals drive an ATS's decisions to persist in his or her academic program, a finding that continues to permeate the retention literature.^2,5,6 From the perspective of the PD, ATSs are more likely to graduate with a degree in athletic training because they are motivated by reaching their goal of being college graduates as well as becoming athletic trainers. In isolation, this finding may only partially explain student motivation and persistence; however, when coupling the findings of Dodge et al² and Mazerolle et al,⁵ it is apparent that the ATS is professionally motivated and likely to persist when integrated into their roles.

Intrinsic motivation is a characteristic often associated with the athletic trainer and is particularly important as it appears to stimulate professional commitment for the athletic trainer.¹⁴ The ATS, as described by PDs, is motivated and determined, which is driven by the establishment of goals. Goal setting is a key element for improvement of self-determination, which ultimately relates to achievement of one's goals.^15,16 Although our study did not directly assess goal setting or gain the perspective of the ATS, it is likely that ATSs do develop the goal of becoming an athletic trainer and are able to achieve their goals through academic socialization. Previous literature¹ has identified that when an ATS is able to visualize themselves practicing as an athletic trainer, he or she becomes more motivated, and when he or she feels integrated through clinical education experiences, he or she is more satisfied and committed to accomplishing their goals.^1,19

Program Pride and Tradition

Program reputation is an important attractor for ATSs pursuing advanced studies in postprofessional athletic training programs²⁰; therefore, it is not surprising that our participants identified program pride and tradition as a factor for persistence. College selection by high school students is also highly impacted by academic reputation and athletic traditions,^21,22 and student-athletes often make their final selections based upon the head coach.²³ Together these findings highlight the importance of program success as a means to not only initially attract students, but also to retain them throughout their studies.

Networking has been previously identified as a facilitator of professional advancement and commitment,¹⁹ and as identified by Mazerolle and Dodge,²⁰ it can help facilitate the selection of graduate program and studies. In this study, making connections with program alumni was a means to motivate students to complete the athletic training degree at both undergraduate and PM programs because the ATS was able to learn about alumni success and prospects for future jobs. Direct mentorship is necessary for the ATS to become fully socialized into the role of an athletic trainer and often helps foster professional commitment and the development of professional goals; therefore, it is plausible that indirect mentorship through discourse with program alumni can too be positively influential. Furthermore, peer support, program personnel support, and preceptor support have been linked to retention and persistence for the ATS as they offer social integration² and legitimation¹⁸ but also an understanding of expectations related to athletic training and professional development.

Disinterest and Dissatisfaction for Athletic Training

A major mechanism for a student's failure to complete the degree requirements of their ATP is the realization that athletic training is not what they initially expected, or they have shifted their interest away from the roles and responsibilities of an athletic trainer.⁵ Although academic and clinical integration² is critical for persistence as it provides a realistic impression of the role of the athletic trainer, it can also have a contradictory effect whereby the ATS realizes he/she will not be happy working as an athletic trainer. Dodge et al² found that ATSs who changed majors did so because they were dissatisfied with the time commitment associated with an athletic training position, a finding that was corroborated by Mazerolle et al.⁵ Initial attractors to a career in athletic training include a love of sports, interest in medicine, and mentorship received by a high school athletic trainer.^24,25 Despite these preliminary attractors, the ATS often has an incomplete understanding of the breadth of the profession and the responsibilities associated with a position in athletic training.²⁴ It is likely that an ATS becomes unmotivated due to a lack of interest, engagement, or ability to visualize themselves in the role of an athletic trainer leading to attrition from the degree program. Comparatively, an ATS may become unmotivated or disenchanted due to interactions with a clinical preceptor who may be struggling with role strain or role overload as well as managing the often demanding nature of the profession.^26,27 The clinical education experience, which may be evaluated as less than positive, may influence attrition. Early exposure to athletic training, particularly clinical and academic integration through formal and informal socialization tactics,^28,29 may help the ATS develop a passion for athletic training or encourage departure before investing time into the program.

Recommendations

Reflecting on our data, we recommend that athletic training PDs and educators encourage students to set goals as a means to maintain motivation. Their goals should be specific and measurable, but also include short- and long-term outcomes. Although intrinsic motivation was discussed by many PDs as the reason for persistence, external rewards such as praise and recognition can also foster and support ATS motivation. The success of program alumni was also helpful in motivating ATSs to complete their degrees; therefore, we encourage PDs and educators to invite alumni back to campus to communicate with current ATSs about their experiences and current positions. Attending conferences and symposiums, such the National Athletic Trainers' Association Annual Meeting and Clinical Symposia, is another way to help students network with program alumni; thus, attendance should be encouraged by ATP faculty and staff. Inspiring and motivating students is an important role assumed by AT faculty and PDs. Although ATSs can be self-motivated, it is important to provide them with the support necessary to gain professional commitment.

Limitations

The findings of our study only reflect those of the PD, and although the reasons presented are reasonable and align with previous literature, they may not reflect the opinions of ATSs. A future investigation should look to include ATP faculty, clinical preceptors, and ATSs to gain full appreciation of motivation and persistence factors.

A second limitation centers on the comparisons made between program types as we did not gain access to all institutional types nor do we have equity between undergraduate and PM programs. Although we gained insight from PDs at a wide range of institutional types across the United States, it is possible that the findings of this study do not translate to all ATPs, particularly specific subsets.