Support Received During the Transition to Practice for the Secondary School Graduate-Assistant Athletic Trainer

Research Design

Our study was phenomenologic in nature, as a means to capture the experiences of our newly credentialed or licensed ATs as they transitioned into the secondary school setting. This method provided us with the backbone for obtaining rich details about our participants' lived experiences during their transition to independent clinical practice.¹⁹ Researchers¹⁹ have suggested using this method of inquiry when the purpose is closely linked to the experiences of a particular group and when commonalities are being examined.

Participants

Fourteen recently credentialed ATs (2 men, 12 women; age = 23.0 ± 2.0 years) participated in our study. All participants held graduate assistantships and were working in either the secondary school setting or both the clinic and the secondary school settings. We limited involvement to those with a graduate assistantship because we expected those individuals had experienced a different transition than did ATs employed full time in the secondary school setting. Previous transition-to-practice and socialization literature^10–12 suggests that a baseline of support is available to those in graduate assistantships, which is why we focused on this group. Our participants reported spending, on average, 28 ± 6 hours each week providing medical care in the secondary school. All but 2 had had a clinical education experience in the secondary school setting before being employed as a graduate assistant. We provide individual information for each participant in the Table.

Table. Participant Demographics

Abbreviations: F, female; M, male.

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Instrumentation and Procedures

A semistructured interview guide (Appendix) was used during our interview sessions, which lasted approximately 30 to 40 minutes. The interview guide allowed us to dialogue with our participants freely while using a set of standard interview questions for consistency. All 3 authors (S.M.M., S.E.W., J.L.K.) interviewed participants; thus, the structure of the guide ensured consistency. We were also in constant communication regarding the interviews as a means to ensure that we asked similar questions of all participants. Before obtaining institutional review board approval, we invited an external researcher to review the interview guide. The external researcher was an athletic training educator who supervised ATs in a graduate program that placed students in the secondary school setting. The peer-review process is paramount in qualitative research, as it supports the rigor and credibility of the procedures.¹⁹ We used the researcher's feedback to improve the clarity and content of the interview guide and to ensure we would meet our research aims. Before data collection, we pilot tested the instrument with 2 newly credentialed ATs who were practicing in the secondary school setting. Their feedback provided minor edits to help improve the flow of the interview and interpretation of the responses. Data collected in the pilot test were not used for analyses, as the 2 ATs had been practicing clinically for longer than 1 year.

After institutional review board approval was granted, we recruited through a purposeful-sampling¹⁹ procedure that allowed us to gain access to participants who had less than 1 year of clinical practice as an AT. Using our professional networks, we contacted program directors of Commission on Accreditation of Athletic Training Education–accredited professional bachelor's and master's programs to gain access to potential participants who met the inclusion criteria of being credentialed or licensed for less than 1 year and working in the secondary school setting for at least 20 hours per week. Additionally, we recruited participants during the 2015 National Athletic Trainers' Association Clinical Symposia & AT Expo. After the participant consented, a phone interview was scheduled. Each interview was recorded and transcribed verbatim for data analysis. Data saturation was met with our 14th interview. Saturation was established by our ongoing analyses, which encompassed memoing during each interview session. The memos served as impressions of key elements of each interview session, which allowed us to confirm saturation.

Data Analysis and Credibility

We followed the phenomenologic approach to data analysis²⁰ to make the most sense of the experiences related to support gained during the transition to clinical practice in the secondary school setting. The first 2 authors (S.M.M., S.E.W.) completed the process independently to establish rigor and reduce bias in the analyses. First, we read the interview transcripts holistically to gain an appreciation for the experiences of our participants. During these purposeful readings, we attempted to bracket our presuppositions regarding what we felt our participants might need or experience during the transition process.¹⁹ Also, for the analysis, we needed to remain open to emergent findings during our readings of the data, a concept referred to as intuition.^19(p193) This process allowed us to become immersed in the findings and identify key experiences related to the transition process. Our analyses were also ongoing, using a constant-comparison process to link our data together. We used multiple readings of our data to ensure an accurate description.²⁰ Authors S.M.M. and S.E.W. exchanged coding schematics electronically and then verbally discussed the coding. Negotiations about content occurred, including labeling of the textual data that were not content. Agreement was reached and is reflected in the final presentation of the data.

We were able to establish credibility by following the guidelines established for a phenomenologic study,¹⁹ which included an adaptable but planned interview framework, specific analysis procedures, and credibility mechanisms. Our credibility strategies included our peer review of the study design before data collection, researcher triangulation during our analysis of the data, and member checks (ie, having participants verify the accuracy of the transcription process before data analysis).^19,20

Past Mentors and Professional Educational Training

Our participants discussed the importance of their past mentors and preceptors who provided them the chance to engage in autonomous learning opportunities. Such engagement allowed them to gain role understanding during their professional education and to receive continued support now that they were practicing independently. That is, our participants felt as though their educational experiences, specifically in the secondary school setting, along with those preceptors who offered clinical supervision, were instrumental in providing support. Past mentoring and exposure to the secondary school setting were important but not necessarily viewed as dependent on each other. Sue and Tina both said that “having someone” to reach out to, in particular “a past preceptor” as a resource or support system, was helpful. Dana often contacted her previous preceptors for support during her transition. In fact, she admitted that her former preceptor was a mentor:

I've kept in touch with many preceptors that I had through my undergrad. Some days, well, some of the very first injuries that I was in charge of as an athletic trainer, I sent a text like, you wouldn't believe this happened to me. They were like, but I'm sure you were ready. Just reassuring like that has been really helpful whether it ever played out or not just knowing that other athletic trainers that I may have look[ed] up to, that were there when I was learning are still there. I've never had an athletic trainer that I worked with or underneath of belittle me. They [are] always just super supportive.

Dana was not alone in her ability to reach out to her past preceptors to gain support and mentorship as she transitioned. Marla felt that having access to past preceptors who served as mentors was helpful and reduced the feeling of being isolated in clinical practice, which can happen in this practice setting:

Also I've stayed in pretty good contact with a couple of my former preceptors, so when I have questions about stuff, even my own high school athletic trainer. If I'm not sure if something is being done the way that it's supposed to be or if I said, “Oh well, would this work that way?” “Have you ever seen this before, that kind of thing?” I have someone to like bounce ideas off of. I'm not just alone.

Our participants believed their past preceptors were an additional resource for their transition to the secondary school setting. That is, preceptors were receptive to and helpful in providing support, guidance, and reassurance for their transition into clinical practice within the secondary school setting.

Having independence while being directly supervised was also mentioned as important in the transition to the secondary school setting. Renee and Ruthie discussed how their preceptors recognized they needed to think for themselves and perform duties as credentialed ATs. Marla discussed the influence of her preceptor during her final clinical education experience:

During my last rotation, my preceptor was really good about seeing me as a senior, the year that is going to be you [taking control]. You need to start being comfortable with taking the lead on things and not looking over your shoulder every time you do an evaluation and all those kinds of things and really knowing your skill and being sure of yourself. If you are not sure of yourself, why would anybody else be sure of what you're telling them?

Doris had a similar experience:

As a senior in undergrad, basically in any athletic training program, your goal is to ideally practice independently. My preceptor did a really good job of letting me run the show as he called it. He would just sit back. He had other roles within the school too, but he was always there when I was there. He just let me kind of take over the clinical side of things. That was pretty fun, and I think it helped in building my confidence with working with the high school now.

Much like Doris, Helen attributed her confidence during her transition to the secondary school setting to her preceptor. Helen's preceptor provided experiences before certification that translated to her ability to function as a credentialed AT:

My preceptor did [play a role in my transition]. For example, when I was at [XX] High School during my senior year of college, their athletic trainer was always there pretty much watching over me. He was like, I trust you, and I know you can handle this. But, being the athletic trainer, I want to know. I have to keep an eye on you too, but he would let me interact with parents. He would let me interact with ADs [athletic directors]. He would let me interact with the athletes too. I got a diverse interaction with people.

Helen's quote also illustrates the importance of direct exposure to performing many different skills while in the secondary school setting as a way to gain support during the transition to the setting. Dana said, “If I hadn't had some rotations at a high school, I think there would have been other things that caught me off guard.” Regarding the transition to the secondary school setting, Carol noted, “It is good to have a previous experience with the high school, because what I found in my undergraduate [clinical education] is high school is a completely different breed than college.”

Past mentors in combination with the secondary school experience were viewed as important factors in the transition to the secondary school setting, as summed up by Marla:

They [my preceptors] did a really good job at that school of getting me prepared for working in the high school setting. That way when I got here and got into my high school position, it didn't feel new. Some of my classmates who are in high schools have never worked in high schools before, and they're just like I don't even know what do to with them. How do you talk to them? I'm like, they're people. You talk to them like they're people. I think that made it just a little bit easier. It was something that I was used to. It was, I'm used to dealing with parents and the coaches, and sometimes freshmen are whiney. Sometimes they're going to do this and that sort of thing. I know I personally had a great transition. I think a lot of that was just because of the very last rotation that I had. They wanted to make sure when I left there that I was solid, especially after I found out I was going to be at a high school.

Capitalizing on previous experiences with preceptors who allowed autonomous practice during clinical education was helpful for the transitioning AT in the secondary school setting.

Current Networks

Our participants spoke about having current networks of professionals who provided support and mentorship as they transitioned to the secondary school setting. The networks included medical care providers, such as athletic training faculty and peer graduate students, as well as those individuals who were considered constituents of the setting, such as coaches, student-athletes, and athletic directors.

Past Mentors and Professional Educational Training

Mentoring is a common tactic used by graduate programs to support the transition to practice of newly credentialed ATs,¹² and therefore, it is not surprising that our participants recognized their former mentors and preceptors as resources to help them transition to practice. Furthermore, mentoring relationships are founded on the premise that a lifelong relationship is formed^2,22; thus, our results suggest that this is indeed the case, as our participants sought advice and support from these individuals even after graduation. Being honest, trustworthy, respectful, humanistic, and accessible are essential attributes of a mentor.²³ Once in this relationship, the mentee likely feels at ease reaching out, despite the lack of daily interactions. As Kram²⁴ suggested, the mentoring relationship is often redefined once the mentee gains the confidence and skills to succeed. Moreover, a fundamental aspect of clinical education and supervision by a preceptor is providing role modeling and mentoring to the student²⁵; as a result, effective mentoring may help support the transitioning AT as he or she recalls past support and applies it to the current situation. In fact, it has been suggested that a clinical mentor or preceptor is the critical link to helping a student become ready to transition into autonomous clinical practice.²⁶ The terms mentorship and preceptorship are often used interchangeably, and at times rightfully so, as preceptors who are viewed as mentors inspire and promote professional commitment in mentees and stimulate them to develop pride in their future role.²⁷

Our findings also illustrate that an AT who is provided with autonomous learning opportunities before transitioning to clinical practice feels prepared to practice independently. This is likely because he or she has real-time exposure and learns to apply the skills necessary to transition to clinical practice. A realistic clinical education experience offers students an awareness of their future roles; through self-discovery and active engagement, they assimilate into their roles.²⁸ The process of assimilation often occurs through legitimation, which is frequently spearheaded by a preceptor.²⁸ Preceptors can profoundly influence role transition because they serve as gatekeepers to real-time learning and exposure to the skills and functions of an AT.²⁹ In addition to the influence of preceptors, engaging in clinical experiences in the secondary school setting itself was perceived as assisting in our participants' transitions. The secondary school culture is different than the collegiate setting (eg, patients are minors, there is increased interaction with school administration and parents), and this exposure allowed the participants to model their preceptors when navigating the setting. Educational standards³⁰ require athletic training programs to offer students a diversified experience, and our research shows how clinical experience in the secondary school setting provides educational value.²⁸ As more ATs are employed in the secondary school setting and demand grows, programs should continue to involve preceptors who practice in the secondary school setting. Moreover, initial attractors to athletic training include exposure to the role of the AT during athletic participation in secondary school, as many recruits recognize the influence their secondary school AT had on the decision to pursue this career.³¹ Again, mentors and direct exposure can be helpful in the transition to clinical practice, as they provide awareness and understanding of role expectations.

Current Networks

An attractor to the graduate-assistant position is continued practice as an AT in a supported role.^14,32 Inevitably and despite meeting the standards for clinical practice, a newly credentialed AT desires continued support and guidance. Transition from student to practitioner is considered challenging not only within athletic training but also in other health care professions such as nursing^1,2: nurses cite significant stress when graduating from their baccalaureate programs. Mentorship, thus, has been the primary means to reduce this stressful period for nurses and ATs alike.^1,2,9

Our findings suggest that mentorship developed organically as the graduate-assistant AT had resources such as program faculty, preceptors, and peers for support and additional learning. Previous literature^12,14 has suggested that this is a benefit of the graduate-assistant model in the transition to credentialed AT. The graduate-assistant model will soon dissolve as the professional master's model is phased in; however, practical applications can be drawn from the benefit of the graduate-assistant role. Simply, the idea is founded on apprenticeship, whereby the newly credentialed AT is still reviewed as a trainee but is able to function with more independence. This is true, too, for newly credentialed nurses, as they are often paired with a more experienced nurse (preceptor) for support during the transition.^1–3 The basis of the relationship is that the newly credentialed care provider has a supporter during the transition. Thus, although the graduate-assistant model has fundamental elements that may create a more transparent means to facilitate mentorship, future offerings such as doctorate of athletic training and fellowship programs can, much like the graduate model, support transition to practice through mentoring. Professional discourse with peers and faculty helped the transitioning AT gain legitimation from those who had role understanding and role congruency. Legitimation is simply the process whereby the AT can gain acceptance into the role via engagement in the role, feedback, and support.³²

Gaining legitimation from various stakeholders on the sports medicine team is critical in the socialization process,³² and this finding echoed true for our participants. Our participants shared the importance of gaining the trust and support of their administrators, coaches, and student-athletes. In fact, they felt comfortable in transitioning because these individuals provided awareness of and feedback on their role within the secondary school setting. Initial confidence may be low as ATs gain exposure to their new environment; however, feeling welcomed and supported by their coworkers enables them to transition. Role perceptions and understanding are facilitated by coworkers,³³ which was also true for our participants in the secondary school setting. Successful role performance is necessary for ATs as they become socialized into their future roles,³² and this is often accomplished by forging relationships and assuming ownership over the process. Although legitimation is often founded on feedback provided by those who are in a position that the student or practitioner aspires to, Klossner³² noted that legitimators for athletic training students can be student-athletes, coaches, preceptors, and peer mentors.