Considerations for the Use of the Observation Experience to Aid in Early Socialization and Retention of Athletic Training Students

INTRODUCTION

Many factors can influence a student's decision to remain in an academic program or higher education institution. Although a simple definition for student retention remains elusive, it is universally understood to be a student's decision to persist within her selected academic program, university, or college until graduation.¹ The earliest theoretical model, developed by Tinto,² suggested that persistence to graduation was inevitable once the student was able to integrate academically and socially into her institution. Since then, other factors have emerged as influencing the student's decision to persist, including academic commitment and performance, academic engagement, motivation for one's intended career path, and faculty interactions and support.³

Although retention appears to be influenced by multiple factors, there is overwhelming evidence^4–6 that a sense of belonging to the academic and social communities, a sense of faculty interaction and support, and opportunities to be engaged or involved in campus activities can help retain the students within their universities. More recent data⁷ indicate that academic advising and student indecisions regarding career/major selection can impact student retention. Tinto^1,2 theorized that academic and social integration must occur for students to persist, which is heavily influenced by overall performance and interest in academics and receiving basic support from peer groups. The factors previously discussed are a reflection of those for institutional commitment rather than commitment at a programmatic level. Retention has also been regarded as an issue facing allied health care preparatory programs, with factors influencing retention among this student population including high stress levels,⁸ distorted early perceptions of the field of study,⁹ and low perceived self-efficacy.¹⁰

BACKGROUND

Application of retention strategies in athletic training programs (ATPs) as well as the retention of quality students has become a growing research interest among scholars.^11–16 Although data are lacking regarding actual turnover within ATPs, the increased empirical literature on the topic indicates interest and potential concern by AT educators. Dodge and colleagues¹⁴ corroborated Tinto's retention theory within the athletic training profession, but they also found that athletic training student (ATS) motivation for program completion and clinical integration was key to persistence. Clinical integration has been defined as the assimilation of students into the clinical portion of their athletic training education and is shaped by clinical learning and interactions with preceptors and peers.^14,15 Several other researchers^11,13,14 have further supported the importance of an engaging and fulfilling clinical education experience, especially early in the professional socialization of the ATS, as an important retention factor. Athletic training students who viewed their clinical education experiences as performing unrelated or meaningless tasks were less likely to be satisfied with their academic program and felt less clinically integrated.¹⁴ Unfortunately, many students engaged in the observation period, which is designed as a period of learning and early exposure to the role of the athletic trainer, spend time simply observing in an unstructured manner and are left with an unfulfilling experience. Moreover, the literature^15,16 suggests that professional commitment developed through positive clinical education experiences and strong mentorship can facilitate the ATS's persistence into the workforce.

APPLICATION OF RETENTION DATA

The aforementioned retention studies imply that for the ATS, the ability to identify with and gain experiences in the role of the athletic trainer can help with retention and degree completion. Unfortunately, not all ATSs have an appreciation for the profession, the complexity of the role of the athletic trainer, and the time commitment associated with the job before pursuing their degree programs.^14,16,17 Preprofessional ATSs who are less than satisfied with their clinical education experiences as a result of a lack of stimulation or clinical integration are less likely to persist.¹⁴ Literature regarding nursing student retention has indicated that students who struggle with the rigors of clinical education are predisposed to leaving the major. The facilitator for departure is oftentimes due to a flawed perception of the demands of the field.⁵ Conversely, students who enter their professional nursing preparation with an understanding of the health care field seem to be in the best position to succeed.¹⁸ Limited understanding of the professional diversity and varied employment settings associated with the athletic trainer appears to facilitate a disinterest in pursuing a career in athletic training as well.¹⁷ The purpose of this commentary is to discuss the often-mandatory observation period for the preparatory ATS to foster an interest in and a commitment to the profession to help retain high-quality, dedicated students. The observation period, as discussed here, can refer to either direct admittance out of high school or a secondary admission process, whereby students apply during their freshman or sophomore year after gaining acceptance to their respective institutions.

On the National Athletic Trainers' Association (NATA) career center Web site, there are 4 major categories listed for potential job settings. Athletic training employment sites include the following: professional sports, colleges and universities, secondary schools, and emerging settings (hospitals/clinics, military, law enforcement, physician extender, etc). Many preparatory ATSs are unaware of the employment setting diversity available for athletic trainers¹⁷ and appear to be initially attracted to the career as the result of a love of sports and medicine and the desire to be part of a team atmosphere. It also appears that those who have been exposed to athletic training at the secondary school level, through coursework or interactions with an athletic trainer, are positively influenced and more likely to persist in their studies.¹⁷ However, the secondary school setting is only one of many employment settings available for athletic trainers, and the role assumed in this setting can be starkly different compared to the role in hospital, industrial, collegiate, or professional settings. Moreover, students exposed only to the secondary school setting were generally unaware of the profession's diversity, underappreciated the demands of its hours and responsibilities,^14,16 and often failed to grasp how fulfilling and rewarding a career in athletic training can be.

Regardless of the mode of admission (direct acceptance or secondary application), ATSs are likely to require a period of observation hours during an introductory course for athletic training or over the course of the summer before admission. During this time, students are often exposed to the traditional clinical setting at the host academic institution, which confines exposure to treatment and rehabilitation hours, practice and competition setup and preparation, and injury evaluations. Moreover, the hours are often accrued in short intervals over a period of time, again restricting exposure to other tasks such as insurance claims, injury evaluation documentation, and other administrative tasks. Another consideration is the role of the supervising preceptors, who potentially are already overloaded¹⁹ as a result of balancing their multiple, demanding workplace roles. They are likely to be engaged in clinical supervision of matriculated students as well as in providing patient care, limiting the time they have to help the observation student acclimatize to the setting and profession. The observation experience is paramount for preprofessional ATSs, as it provides early socialization into the field; however, the experience should be maximized and highlight the profession's diversity.

Now that employment settings for athletic trainers are expanding, the expectations related to job performance and task completion vary greatly. Therefore, athletic trainers may be required to possess strengths in practice domains other than the traditional setting. For example, an industrial-occupational athletic trainer may need to have stronger knowledge and skills in ergonomics but will enjoy a more structured workday in terms of hours worked.²⁰ The traditional clinical setting, such as the collegiate setting, may offer opportunities for travel, unlimited resources, and interactions with high-caliber athletes but may require longer work hours and overcoming of bureaucratic challenges.²¹ As students become more familiar with different practice settings, their appreciation for different skill sets applicable to those settings increases. Learning about different practice settings may actually help preparatory students develop their own career goals and, in turn, increase their professional commitment. Mazerolle and Benes²² presented the idea that diversified clinical education experiences prepare ATSs for full-time employment by exposing them to all aspects of the profession and provided them with confidence and commitment to continue on in the field. Although their study involved graduating ATSs, it is possible to apply the underlying premise that exposure diversity may aid in retention.

Currently, the only anticipatory socializing agent for a preprofessional ATSs appears to be the secondary school athletic trainer, as many recruits, before admission into college and/or ATPs, find the profession through previous experiences with their high school athletic trainer.¹⁷ This initial exposure, although important, potentially limits their understanding of the full scope of athletic training practice. An incomplete understanding of the range of skill sets possessed by athletic trainers may deter students from persisting despite their potential for success or understanding of other settings. Moreover, most common retaining factors for the athletic trainer include fulfillment of work and life balance, professional autonomy, salary, and job satisfaction.^23,24 Without knowledge of the pros and cons of the various employment settings, attrition from the education program or eventual professional practice may be inevitable. Exposure to all facets of professional practice before program matriculation may help ATSs develop an accurate subjective warrant, where subjective warrant refers to individuals' beliefs or perceptions of professional requirements and how they perceive their ability to meet those demands.²⁵ Since flawed perceptions have been shown to contribute to health care–field departure decisions,^5,26 there appears to be a need for students to develop an accurate subjective warrant if they are to persist. Developing this accurate subjective warrant includes understanding both the typical year-round 40-hour work week enjoyed by industrial athletic trainers and the demanding, yet dynamic and fast-paced, life of the collegiate athletic trainer. Each clinical setting offers a different set of expectations and responsibilities; therefore, it is necessary to provide preparatory ATSs with the chance to match their professional goals, strengths, and personal interests to these settings.

RECOMMENDATIONS

An athletic trainer's role is complex²⁷ and can be mediated by educational preparation and professional socialization. Therefore, it is plausible that basic exposure to all the profession offers may provide students a chance to envision their professional career and help them make more informed decisions regarding a career in athletic training. Remembering that student retention can be strongly influenced by social, academic, and clinical integration,¹⁴ ATPs should necessitate a set number of hours within each of the practice domains, or even employment settings, instead of requiring a generic observation period anchored by a number of hours rather than by experiences. For example, students could spend each week of the typical 15-week semester shadowing different athletic trainers engaged in their different roles (ie, administrative work, treatment sessions), as well as those who work in both traditional (ie, college setting) and nontraditional (ie, industrial, law enforcement) employment settings. The ATP could create a checklist of experiences for the pre-ATS to engage in throughout the observation period as a means to ensure diversity and a holistic, realistic impression of the role of the athletic trainer. Each particular experience could have a question or objective to complete that helps the observational student develop a deeper understanding of the specific setting. For example, if observing in a performing arts setting, the student could inquire about the different types of injuries common to the setting. Upon completion of the experience/role/responsibility, the pre-ATS could move onto the next experience outlined in the checklist. The pre-ATS could also keep a reflective journal for each experience, which evaluates the overall experience and the positives and negatives associated with each clinical setting. The focus would then be more about the experience and exposure to the miscellany of the field rather than accruing a required number of hours.

Diversity in clinical integration also provides the confidence necessary for students to persist into the full-time work force.²⁵ Moreover, because failure of the clinical education experience to be engaging can lead to attrition from the field, especially in the earlier years of study,^11,12 it is important for students to feel clinically integrated and stimulated when engaged. Keeping a reflective journal while being engaged in the various settings can not only help them better evaluate their future role in the profession but also help avoid the monotony that can be associated with the observation period. Since pre-professional ATSs are unable to engage in actual patient care as a result of the Commission on Accreditation of Athletic Training Education standards, they should be included in discussions with preceptors, upperclass ATSs, and patients and reflect upon these experiences in their journals.

Examples of ways to structure the observation period (which includes observing the athletic trainer engaged in her different roles and working in various employment settings) includes development of a specific objective that must be completed by the observation student during that specific week or the use of preestablished questions that need to be answered during and upon completion of the experience. The objectives and questions can be part of the previously mentioned reflective journal kept by the ATS. For instance, the ATS can ask questions including “What do you find most rewarding about your role?”; “What challenges do you face in your role?”; and “What advice would you give a young professional regarding your role?” Additionally, you may have the ATS compare and contrast the clinical settings as a means to evaluate the complexity and uniqueness of each role/setting. Challenging the students to develop their own sets of questions to discuss with their preceptors can also foster critical thinking and ownership in terms of the learning experience. Moreover, these activities can facilitate communication among observation students, upper-level students, and preceptors. Younger students can also accompany upper-level students to their off-campus clinical education sites, especially nontraditional sites, if possible, for a day in order to interact with different preceptors and maximize exposure to different practice settings. Creating peer-learning opportunities may also be helpful with early socialization and education. This can be done by pairing preprofessional students with an upper-level ATS mentor with the intended purpose of discussing the profession.

CONCLUSIONS

Creating a more structured observation period, beyond the typical requirement of 50 to 100 nonspecific hours, can help better educate the student regarding the complexity of the roles of the athletic trainer. We are not suggesting including more hours but rather make the required observation period more purposeful and directive as a means to educate the pre-ATS on the diversity of the profession. It is important to highlight that although retention is a very important aspect for ATPs, the main goal behind an observation period is to expose students to professional practice through early socialization with the eventual goal of attracting and retaining quality athletic trainers. These observational experiences can also be useful in identifying those individuals who are not a good fit for the profession. It could be hypothesized that students who have difficulty assimilating into the clinical observation experience might have additional difficulty developing as ATSs in subsequent years. As the number of accredited programs remains steady at around 340, it is important for these programs to establish and enforce standards for retention, which include academic and clinical performance to ensure only those ATSs who are capable of meeting the educational standards and passing the Board of Certification examination are able to matriculate to graduation. Necessary attrition due to the inability to meet rigorous standards can only enhance the quality of the preprofessional student, who will eventually represent the future of athletic training. The observation period can benefit not only the student but also the ATP by fostering the recruitment and retention of high-caliber students who can continue to move the profession of athletic training forward within the health care and medical communities. Ultimately, a successful observation period may include a combination of hours shadowing athletic trainers engaged in roles outside of those of the host institution, including observation in hospitals/clinics, industrial settings, and others, as a means to evaluate the ATS's potential for success within the program. Again, the quality and diversity of the experience are more critical than the quantity of the hours.