The Impact of Clinical Experiences from Athletic Training Student and Preceptor Perspectives

Methodological Design

This study used a qualitative, descriptive research design and a general inductive¹⁵ approach for data analysis. The general inductive approach allowed the researchers to examine themes as they emerged from the data, providing a rich understanding of the participants' thoughts and opinions about clinical experiences. One of the researchers conducted individual, semistructured interviews with participants (which included both athletic training student and preceptors). The semistructured format allowed the researcher flexibility to probe more deeply into responses, to include follow-up questions where appropriate and to provide the participant the opportunity to guide the discussion, leading to more robust data. Having one researcher conduct the interviews enhanced the quality of the data by minimizing differences in the interview process. It also provided the opportunity for an independent review of the data during our analysis, which further enhanced their quality and minimized bias.

Participants

A total of 15 participants enrolled in the study (7 athletic training students and 8 preceptors). Data analysis was ongoing, and the researchers determined that data saturation had been reached with 15 participants; therefore, we recruited no additional participants. The average age of the athletic training students was 20 ± 1 years. All were from National Athletic Trainers' Association (NATA) District 1 university/colleges; 5 were women and 2 were men. The average number of years that the preceptors had been certified athletic trainers was 10 ± 7 years, and they had been preceptors for 6 ± 4 years. Two preceptors were men and 6 were women. Five preceptors were working at the university/collegiate level and 3 were working in a secondary school setting. The final sample included participants (athletic training students and preceptors) from 4 institutions in NATA District 1. The preceptors and athletic training student were not matched, and there was not necessarily a relationship between students and preceptors. Table 1 includes further information about the athletic training student participants, whereas preceptor information can be found in Table 2.

Table 1.  Athletic Training Students' Participant Information

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Table 2.  Preceptor Participant Data

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Data Collection Procedures

Prior to data collection, we obtained institutional review board approval from Boston University and an authorization agreement from the University of Connecticut institutional review board to accept the approval of the first board. Using purposeful convenience sampling, we contacted program directors and head athletic trainers and/or clinical education coordinators of college/universities with CAATE-accredited athletic training programs. We selected this initial sample based upon the professional networks of the lead authors, which we used to facilitate recruitment. We asked the aforementioned gatekeepers to forward an e-mail to all athletic training students who have completed at least one clinical experience as part of their athletic training education. Athletic training students who were interested in participating in the study contacted the researchers directly. One researcher, after receiving permission from the program director, recruited athletic training students in person at their institution by visiting a class to explain the study, answer questions, and distribute informed consent forms. This researcher does not currently work in the athletic training department at the school but does work in a different school/college at the university, so there was no influence over the recruited/enrolled participants. The head athletic trainer/clinical education coordinator forwarded an e-mail to all of the athletic trainers who served as preceptors for their respective athletic training programs. Preceptors who were interested in participating in the study e-mailed one of the researchers directly, provided informed consent, and enrolled in the study.

Once participants were enrolled in the study, one of the researchers conducted semistructured interviews that lasted approximately 30 to 45 minutes. Both athletic training students and preceptors answered a series of background questions before completing the open-ended questions regarding their thoughts, opinions, and experiences with clinical experiences and the impact that these experiences have on a student's professional development, retention, and perceptions of the field. The interviews were conducted in person when possible or over the phone. All interviews were digitally recorded to facilitate transcription.

Instrument: Interview Guide

We used 2 interview guides in this study; 1 for the athletic training students and 1 for the preceptors. We developed the interview guides based on the purpose of this study and findings from previous studies conducted by the researchers.^5,16 We also designed the interview guides to help triangulate the findings and capture a holistic understanding of the clinical experience and athletic training student experience. Prior to data collection, our interview guides were peer reviewed by two athletic training scholars and educators with experience in qualitative design. We included all suggested changes, which related to grammar and flow of questions, in the guides before implementation. Table 3 provides sample questions from the interview guides.

Table 3.  Sample Questions from Interview Guides

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Data Analysis

We analyzed the data using the general inductive process, as described by Thomas.¹⁵ We chose this method of analysis to help uncover the most dominant themes from our data as it related to the specific aims of our study. Initially, we read the transcripts in their entirety to gain a sense of the data. We felt this was an important step to help evaluate the data without bias. We continued this holistic evaluation of the data multiple times, and during the second and third “read-through,” we assigned categories (ie, labels) that we organized into more specific dominant themes to reduce redundancy. Upon completion of the independent reviews by the lead authors, we reviewed the themes and supporting data via phone. Our discussion centered on appropriate classifications of the data, not the overall content of the final themes. The negotiations revealed similar content of the themes but different classifications. Once we agreed upon the final labels for our themes, we shared the findings with our peer—the third author, who was not a researcher in this study but did review data collection procedures and interview guides prior to the study—who confirmed our findings.

Data Credibility

We completed several strategies to ensure credibility of the data as presented in the ensuing section. As reported by Creswell,¹⁷ a minimum of two credibility strategies should be used in a qualitative investigation. We selected 3 including a peer review, member checks, and multiple analyst triangulations. Our peer review was completed in two steps, first with our protocol and interview guide and second with our data analysis. As previously discussed in the instrument section, our peer reviewers were two athletic training educators and scholars with educational training in qualitative design. One of the two athletic training educators, the third author, confirmed the final presentation of the data in our manuscript by reviewing interview transcripts and the presentation of findings. We completed member checks with all participants by e-mailing them the final copy of their transcript for review. All participants were asked to verify the content of the interview transcript prior to data analysis. Two participants did not respond to the researchers' request for review; however, we included the data from their interviews in the analysis. Our final method, multiple analyst triangulation, was completed by the two primary authors autonomously following the aforementioned data analysis steps.

Realistic Experience

Clinical experiences provide meaningful and relevant opportunities for athletic training students to experience the realities of the athletic training profession while practicing and applying skills and content learned through their coursework. Having these realistic experiences can either solidify their commitment to the profession or help them realize they have different professional goals.

Awareness of the Profession.

Athletic training students and preceptors explain that clinical experiences provide an opportunity for students to be exposed to the realities of the profession to gain an understanding of the many aspects of the profession. Amanda, an athletic training student, stated: “My perceptions were already pretty clear . . . and if there is anything that has kind of changed, it's the realization about how much athletic trainers actually know. . . . It's not as easy as it looks.” Paul, another athletic training student, supports this when he explained that his clinical experiences exposed him to things he “wasn't expecting.” The preceptor perspectives can be summed up with Rachel's words: “I think that for the large part . . . the clinical experience is where they kind of learn what is athletic training [sic] supposed to look like in practice.” However, preceptors also identified that they believe clinical experiences expose students to the realities of the profession, which can impact their decision to remain in the field. Anna explained:

A clinical setting is a clinical setting—you see it when it's crazy, you see it when it's not. You see interactions between everyone, a coach, a coach and an athletic trainer and a patient and a coach. And you're very, very involved in that, and it's . . . a hard thing. You develop a lot of relationships . . . sometimes they find that athletic training is what they want to do and sometimes they don't.”

Dan supports this with his explanation:

I imagine when they do [many] rotations, they may say, and I know they do, I want physical therapy, I want physician's assistant, I want med school. I want out of here. Because of the hours, of the demand, how crazy we work . . . I know it impacts their decision.

The previous comments reflect our participants' perceptions that clinical education can shape the athletic training students' awareness of the profession, which can support persistence toward or departure from the profession.

Positive Experience

Overall, experiences as described by the preceptors and athletic training students are positive, especially when the athletic training student is engaged in learning and the preceptor is a strong facilitator of learning. Positive clinical experiences discussed by the participants helped the athletic training students learn about themselves as individuals and professionals, and it affirmed their career choice. Positive experiences are influenced by the match or fit between the athletic training student and the setting/preceptor and by the role the athletic training student takes in the experience. However, not all clinical experiences are positive. Both athletic training students and preceptors discussed that negative events in clinical experiences can be overcome through better events in different experiences or athletic training students “making the best of it,” which can lead to the students having an overall positive association with their clinical education. Participants also discussed how negative experiences can help athletic training students decide whether athletic training is truly the profession they want to enter, which can also be viewed as a positive outcome if the student better understands his or her professional goals.

Diversity in Experiences

Multiple experiences in various settings and sports are helpful to allow athletic training student to realize which setting best fits their personality and interests to help guide their career choices as well as providing them with an opportunity to experience different styles of practicing athletic training.

Realistic Experience

Clinical experiences provide opportunities for athletic training students to engage in meaningful, real-life experiences that should help them develop their skills as practitioners and apply the knowledge learned from coursework. The experiences can be essential to the socialization process and professional development of the athletic training student.^1,5,16,19 Participants in this study further explained that the realistic experiences athletic training students have during clinical education experiences increase their awareness of the profession as well as provide opportunities to practice and apply their knowledge and skills. Both athletic training students and preceptors identified that increasing awareness of the profession was positive for many athletic training students because it provided them further insight and understanding into the realities of the profession, and for other athletic training students, it helped them realize that they have different professional goals. Research has suggested that the athletic training student lacks a full understanding of the profession prior to educational training or integration,²⁰ and through clinical education, the athletic training students may shift their interest away from athletic training to another profession but only after gaining experiences in the role of the athletic trainer.⁶ Consequently, clinical education experiences are fundamental to the professional development of the athletic training student, regardless of their decision to persist or depart the profession.

The other aspect of the “realistic experience” theme was the importance of clinical experiences providing athletic training students with the opportunity to practice and apply skills. Both athletic training students and preceptors indicated that the hands-on aspect of clinical experiences is extremely valuable for the athletic training student's development as a future professional. This finding is not unique to the literature; however, it does continue to illustrate the need for hands-on learning that can be structured based upon academic standing or skill level. Frustrations can occur when the athletic training students feel disengaged, particularly when placed in a learning environment that does not match their current academic standing or level.^21,22 Reflective learning is also an important facilitator in the athletic training students' development but only when it occurs early in their educational training, when it occurs on a limited basis, or when it is coupled with discourse or application.²³

Positive Experience

Supporting previous research,^6,24 athletic training students in this study discussed how their clinical experiences solidified their career choices and affirmed their decision to be an athletic trainer. It is interesting that preceptors also described how clinical experiences can affirm career choice but from a professional commitment standpoint. They described how clinical experiences should foster a commitment to the profession and an excitement and motivation in students; a finding comparable to Mazerolle and Dodge⁴ and Dodge and Mazerolle.⁹ This is illustrated when clinical education experiences allow for the athletic training students to develop a professional commitment for their intended field, which helps them gain a holistic impression of the athletic trainer's role rather than just a one-sided version. For most athletic training students, clinical experiences increase their awareness of the profession in a positive way so that they become committed, passionate professionals. Preceptors play a critical role in fostering professional development, not only by modeling appropriate behaviors and attitudes, but also by encouraging clinical integration through honesty and direct communication.^9,14

It is important to note that some athletic training students described how their clinical experiences confirmed that they wanted to continue in a different career (eg, physical therapy); however, this was not necessarily a result of a negative experience. This finding suggests that there are many ways that a clinical experience might affirm career choice and that the events within students' clinical experiences are directly influencing decisions about their future professional paths. This finding is similar to Mazerolle et al⁶ in that clinical education can shape career decisions; however, for our cohort and unlike Mazerolle et al,⁶ the career-choice decision was not made based upon a negative experience but rather a matching of professional interests and personal goals.

Another important aspect of this theme was the importance of the fit or match of the experience regarding the setting and the preceptor. In the current study, the data suggest that athletic training students can have positive experiences when either the setting or preceptor is a good fit/match. Two examples are Paul, who, despite a negative relationship with his preceptor, loved his experience due to the site and Amanda, who, once she got comfortable as a result of her relationship with her preceptors, enjoyed her experience. Experience fit/match is especially important as athletic training students commonly identify their preceptors as their mentors and because authentic mentoring relationships are more likely to occur when the athletic training student and mentor have a personal relationship.⁷ Athletic training students have identified preceptor characteristics such as accessibility and approachability as important in positive mentoring experiences, and they feel that mentors facilitate knowledge and skill development and support professional development.^7,25 Athletic training programs should use this information to support their preceptors to increase the likelihood that the athletic training students will have a positive experience during any clinical experience and to facilitate mentoring relationships between the athletic training students and preceptors. However, it is important to note that for some students, being placed at a site that provides a quality learning experience despite their preceptor could also be valuable to consider when designing placements. Although the mentoring relationship might be most important in the athletic training students' professional development, the impact of a site they enjoy and learn from also appears to be important in the theme of a “good fit/match.”

Learning about themselves personally and professionally was an outcome of positive clinical experiences for the athletic training students in this study. Athletic training students must complete competencies to ensure that they have the professional skills necessary to be competent in the field. Perhaps it is just as important to require that athletic training students reflect on their experiences as they pertain to their growth on a personal and professional level. Adding a reflective component to clinical experiences might facilitate athletic training students' ability to examine themselves personally and professionally while adding value to their experiences. The use of journal writing has been suggested as a great learning tool to help the athletic training student develop critical thinking skills because it encourages reflection and ownership of learning.²⁶ In addition, journaling can act as a bridge between clinical experiences and classroom learning as well as provide an opportunity for critical thinking, expressing feelings, and helping make sense of experiences during clinicals.²⁷

Reflection does not and should not only include journaling. In a study comparing clinical decision making of novice and experienced clinicians, researchers found that each engaged in similar but different types of reflection during the clinical decision-making process.²⁸ Relevant findings from this research include the importance of novices having time to reflect on clinical decision making, having the opportunity to discuss reflections with a mentor, and gaining insight into how seasoned clinicians use reflection. The authors suggest that the development of reflection and metacognition skills are essential in assisting the students in the transition from classroom knowledge to real-world application and subsequent growth as a practitioner in the field. Reflection can have a role in clinical experiences, not only as a tool for self-evaluation and self-discovery, but also in learning clinical decision making and providing students with the opportunity to develop skills that will be necessary as a practitioner in the field. The findings of this study focus on the self-discovery aspect of reflection, but it brings up the larger concept using reflection in a purposeful way to help the athletic training student develop personally and professionally.

Data in this study also suggested that a positive clinical experience is influenced by the athletic training student; a finding that matches the information we know about today's college student (ie, the millennial who craves ownership in learning) and what we know about adult learners (ie, they can direct their own learning and are motivated by intrinsic rather than extrinsic factors).¹⁸ The athletic training students and preceptors in this study identified the role that the student has in creating a meaningful, engaging experience during their clinical experiences. Both discussed that if athletic training students are willing to learn and engage themselves in their experience, rather than just relying on their preceptors, they are going to have a more positive experience that will enhance their professional development. Motivated students are more likely to engage in, enjoy, and learn from their clinical experiences as well as persist to graduation, which is an important outcome for athletic training programs.¹³ However, the opposite can also be true. One preceptor discussed the challenge preceptors face when they are trying to provide a student with a quality experience but the student is not willing to engage and has a negative attitude about the experience. The fact that adult learners tend to be more intrinsically motivated and more ready for independent learning,²⁹ in conjunction with our findings, suggests that perhaps athletic training programs should explore ways to increase the intrinsic motivations of athletic training students in all of their clinical experiences as well as assist athletic training students and preceptors in developing plans/goals for the students' learning experiences.

Diversity in Experiences

The 2012 CAATE standards require athletic training programs to provide the athletic training student with opportunities to engage in patient care with different populations as well as in different allied health care settings.⁸ This is a standard that our findings support because they illustrate the positive affect clinical experience diversity can have on professional development. In a previous study examining readiness to enter the workforce, Mazerolle and Benes⁵ reported that the athletic training student values diversity in clinical experiences because it provided confidence in decision-making skills and readiness to manage any situation due to prior experience. Moreover, having multiple experiences in various settings and sports with different preceptors allows athletic training students to better understand which settings they are suited for and to experience different styles of practice that helps them visualize their own practice. These findings support other research in the field examining the importance of multiple experiences in the professional development of athletic training students and the importance of a variety of experiences in helping students develop a professional identity.^3,16,24 Athletic training programs must develop experience systems that provide students with as many meaningful clinical experiences as possible during their time in the program.

Limitations

Despite reaching data saturation with the sample, this study involved a small sample representing only 4 schools in NATA District 1. The sampling method was convenience sampling, which might have resulted in like-minded programs and participants in addition to the limited number. However, due to the qualitative nature of the design, the results are not intended to be generalized to a larger population. Further research should be done on additional populations. Additionally, most athletic training students had only two clinical experiences; it would be interesting for future studies to examine students with different numbers of clinical experiences. Findings from this study highlight the important role that clinical experiences have on the professional development of the athletic training student. Future studies should continue to examine this important component of athletic training programs.