Exploring the Perceptions of Newly Credentialed Athletic Trainers as They Transition to Practice

Overall Preparation in Education

Participants felt that transition to practice was reviewed in their professional undergraduate or graduate programs by discussions of budgeting, insurance, and professionalism. Specifically, this content was covered didactically during their organization and administration or capstone course. Marie, who completed a professional baccalaureate degree and was working in the secondary school/clinic/hospital setting, described how she and her classmates discussed their entry into the profession based on the setting they would be practicing:

We had an administration class where we talked about the different administrative duties you would have to do, so administrative things like how to do a budget plan, or the preparticipation forms, drug testing, and the different varieties of those things. We talked about taking our BOC and applying to grad school or going into the workplace. We talked about what everyone was doing and what different settings expected as an athletic trainer.

Victor, currently an intern practicing at the National Collegiate Athletic Association (NCAA) Division III level and enrolled in a professional baccalaureate program, cited the administration and organization class in which professionalism was discussed as part of their future roles as health care providers:

One thing they really stressed was professionalism, making sure you have those boundaries in the way that you act, speak, and even the way you dress, make sure you're taking it seriously, and that they can trust you're part of the health care team.

A few participants reported that they read and discussed articles about employers' expectations in their professional preparation. Pamela, who was a GA in the junior college setting and from a professional baccalaureate program, stated:

We talked about it [transition to practice] a little bit in our senior seminar class, or our senior clinical. We had to read an article similar to this study about things that new certified athletic trainers felt like they were lacking in, or what other professionals felt newly certified athletic trainers lacked in. . . . I was able [to] look through that article and say, “Okay, this is something I should focus on, whereas this is something I don't need to focus on.”

Skyler, who was practicing in the secondary school setting as an intern and graduated from a professional master's program, shared similar experiences of reading the literature. “We would go through a bunch of journal articles, and 1 or 2 of them that we did was on transitioning. We'd talk about them and kind of talk about ideas of what to do.”

Matt, who completed a professional baccalaureate degree and was working in the secondary school setting, learned about transition to practice and other professional development topics during his last semester in a capstone course, which he found very valuable:

We did a semester of professional development administrative information. It covered any questions or topic areas from documentation to insurance and referral processes to BOC preparation. It was a catchall class. It was super helpful.

For these participants, transition to practice was addressed through various administrative and professional development discussions.

Preceptors' Facilitation of Autonomy and Engagement in the Role

In addition to classroom activities, participants felt that preceptors influenced their transition to practice. Clinical education also provided a foundation for gaining an understanding of the expectations they would face when they transitioned to clinical practice. This facilitation by their preceptor assisted in their transition by allowing independence as a student while still being supervised. This in turn enabled the participants to feel more prepared to enter the workforce. Leanne, who completed a professional baccalaureate degree and was an intern in the secondary school setting, described how her preceptor provided her with independence but also supervision:

I felt more prepared than she did [another GA at the same location], probably because of my experiences. I took the reins for the second semester of last year. I had my preceptor on hand if I needed her. She was in the room at all times, but she just let me take over the whole team, and that's something I wanted to try to see, to test the waters, to see what I could do on my own. So she let me do that so I felt a little more prepared. She kind of loosened the reins on me and let me do what I wanted to do.

Sophia, who completed a professional baccalaureate degree and was working in the secondary school/clinic/hospital setting, had a similar experience with her preceptor:

If I had questions, he was there, but whenever I would present my therapies or treatments I wanted to incorporate, I would have to explain to him why I wanted to do that or why I thought it would benefit my athletes. So the last 2 months of my rotation, I was basically running the men's volleyball and men's soccer team by myself with him watching because he trusted me that much. I had already gotten comfortable with being by myself. I had been around the block in my senior year, so I was more comfortable entering that particular role than some people were.

Suzanne, who completed a professional baccalaureate program and was practicing in the Division III setting, was encouraged by her preceptor to communicate with coaches and physicians, which she felt helped prepare her for her transition:

I worked with the football team. Because we were seniors, [my preceptor] really let us step forward and go to him and say, “Hey, this is what's going on with such and such,” and he'd say, “Okay, go to the coach and tell them and tell them why,” so we could get that experience. We got used to doing things ourselves like that. My last rotation, I had with the doctor. The doctor would give me tips and different things to look for with evaluations, and then [I learned] how to speak to the doctor. It was more little things like that to prepare for the transition, rather than necessarily talking [with preceptors or faculty] about “you should expect this or you should expect that.”

Some participants described how their preceptors impeded their transition. Tiffany, who was working in the Division III setting and graduated from a professional master's program, commented:

When I was a student, the injury happened near me. It was a knee twisting, and I bent down to evaluate it. The certified [AT] that was there pushed me out of the way. I never had the chance to evaluate an [anterior cruciate ligament] injury right exactly when it happened. So sometimes thinking about that moment and thinking if I would've been able to test that myself, I would've been more prepared to be a certified alone and to do something out on the field. So I feel like there were some times when I was a student when I could've learned more or they could've prepared me more, but it wasn't allowed.

Galina, who graduated from a professional baccalaureate program and was a GA in the performing arts setting, also felt her preceptor could have done more to prepare her for the transition to practice:

It's meant to be very experimental with stepping out on your own and trying to see if you're doing the right thing. Maybe you should do that more as a preceptor. Let your students make decisions as long as you're not going to seriously hurt anyone and just see what happens, rather than constantly giving reassurance that, yes or no, you're doing the right thing.

Preceptors are a vital part of an athletic training student's preparation. They can either create experiences to further educate and prepare students or impede the transition as well as limit patient encounters during professional preparation.

Formal Orientation

Sixteen participants (47%) described formal orientation. Thirteen were in the collegiate or university setting and 2 in the secondary school setting. During this orientation, they met staff members, toured campus, reviewed policies and procedures manuals, and pursued a variety of other activities. The orientation was interactive in that participants were expected to read through the policies and procedures either before or during the meeting and to communicate with various individuals during the orientation. Andrea, a GA, reported a 2-week orientation period during which she met with her supervisors and a physician on campus and then received a binder of procedural information to further orient her to her roles:

I sat down with the recreational director and the assistant and also the coordination clinical support team. They gave me a binder and reviewed how everything worked, and I asked questions. We have a student health center, so I had a meeting with the physician.

Galina, another GA, described a 5-day orientation in which she and other students in the postprofessional athletic training program reviewed the policies and procedures manual: “We went over the manual of the policies and procedures and emergency action plans and just all of the details that don't really change from year to year.”

In addition to learning the policies and procedures related to patient care, orientation for some also consisted of learning the nuances of their specific institution. Leanne, an intern at a secondary school, commented:

We had a week and a half of intern orientation, which included human resources material. They gave us a computer to use and showed us all of the programs that are pretty unique that we have to use. Then we had time every day with our direct mentors in our departments we're all working in. I met with the head athletic trainer, and then we would talk about certain topics, the software that we needed to use for injury tracking, and everything like that. I had to learn the EAP [emergency action plan], and the location where ambulances needed to go and what to do in any sort of scenario we have. Other than that, they took me through each of the athletic training rooms and showed me what was different.

Participants reported that the orientation provided expectations for day-to-day activities, such as patient referrals, EAP review, concussion protocols, spine boarding, and physician clinics. Like others, Victor, an intern in the Division III setting, was e-mailed the policies and procedures manual to review before orientation. He stated:

A lot of it was expectations for day-to-day stuff. We have 2 physicians that come in every week, so who will be seen, what kind of people will be seen, how that works. Referrals, where the different clinics are located, and where EAPs are. We did a separate one for just the EAPs for the different facilities, and we actually met with EMS [emergency medical services] and went through spine boarding, special situations like football, and how we do things like helmet removal. That's the kind of stuff we do before we get started.

Some participants received information during their orientations and then reviewed these procedures in a meeting. Wendy, a staff AT in the Division III setting, explained:

[We received information like] here's the concussion management plan. Here's everything we do. Here's the 5-step policy. Here's the EAP. Here's how we deal with that, here's how we stock things, and here's how we track everything. It wasn't overwhelming. We were going through it bit by bit, but it was still comprehensive.

Huell, a GA in the Division I setting, described a similar orientation during which many policies, procedures, and duties were discussed and the facilities were toured, but no policies and procedures handbook was provided:

We went over the formal preparation orientation and a facility tour where I would be [practicing], then a brief overview. Have you ever worked SportsWare? Do you remember how to use it? Then just following up with physician notes, key things we're looking for and making sure we're passing it off to a physician to review. [We also] organized file folders to have all the information in 1 place. Besides the concussion protocol, there wasn't any formal handout or book. There was a lot of hands on, “Hey, we're going to set up this, like here is this how we are going to do this and work through this.”

Our findings suggest those in the collegiate setting engaged in a formal orientation where they were introduced to various individuals they would work with, learned about policies and procedures, and were able to ask questions for further clarification.

Informal Orientation

Eighteen (53%) participants described informal orientations. Eleven were in the secondary school setting, 4 in the collegiate or university setting, 2 in the clinic or hospital and professional sport setting, and 1 worked in multiple settings. Many reported being immediately immersed in their roles after brief meetings with supervisors and tours. They learned many of the details of their position as they gained experience. Marie, a secondary school/clinic/hospital AT, said another AT employed through the same company helped her “adjust to the high school setting,” but aside from a tour by the athletic director, she “didn't really have anything else.” Skyler, who was working as an intern in the secondary school setting, described her orientation with her supervisor:

I got an orientation of where things are. I got a tour and was introduced to the staff, but as far as a lot of the policies and procedures, a lot of that was never gone through. It was just day to day. It's like this came up today, so this is what we're doing. I don't have an exact job description in many ways. It's a feeling-out process. I have never seen the policies and procedures manual. I don't know why it wasn't more or if it was just left out because they don't have it. I really don't know.

Walter, also in the secondary school setting, had a similar experience:

There was a brief orientation with the athletic trainer that was leaving. She introduced me to the coaches. I familiarized myself with the high school and where everything was. As far as anything else goes, I'm pretty much just picking it up on the fly. There hasn't been any formal orientation or anything.

Some secondary school ATs who were employed through a hospital reported procedural orientations through the hospital, which included patient confidentiality, Health Insurance Portability and Accountability Act (HIPAA), human resources, and other specific items. Lydia, working in the secondary school setting, commented, “[We reviewed OSHA [Occupational Safety and Health Administration] and stuff, more for nurses and those types of employees, so it didn't really apply to the high school setting.” She met with the previous AT for a tour, but an AT at a different high school helped her learn how to order supplies because she did not have a policies and procedures manual, stating, “I didn't have anything specific or formal.” Jack shared a similar experience of an orientation through the hospital, but it did not cover day-to-day information about his position in the secondary school setting:

I did not get much training for the position, whether it was from the hospital or the school. My mentality and the way I practice or perform my duties is completely derivative from my education experience I had at my university.

Some participants in the collegiate setting, primarily Division III or junior colleges, also had informal orientations. Gretchen, a GA at a Division III university, noted:

We didn't have an orientation. We showed up and started working. As far as going through procedures, it was learn as you go. The second year GA with football showed me the ropes. It wasn't a formal process or anything.

Gretchen did receive the EAP before beginning in her role, but it was not practiced. She stated, “For emergency action stuff, it was e-mailed to us, and we just had to read it and sign a paper that we had read it, but it wasn't officially done before we started working.” George, a GA at the NCAA Division III level, had a similar orientation that lasted 1 day but then was oriented to his role over the next weeks. Pamela, GA at a junior college, described her orientation as “we'll go over it when we get there kind of a thing” and was immediately immersed; however, the first few times she performed job duties, such as completing purchase orders or insurance clinic forms or setting up appointments, her supervisor walked her through the process.

Formal Mentors

Participants were assigned mentors who provided support and guidance as they transitioned into their roles. Formal mentors were often supervisors and ranged from ATs to administrators at their institutions. Formal mentors would either set aside specific times to interact with the mentee or they had an open-door policy for the mentee to reach out to the mentor. Gretchen, a GA, remarked:

After our staff meeting, our head [AT] pulls the GAs into the office just to say, “How's everything going?” If we have any frustrations with work, school, or anything, it's a time that we can just talk about it and get it off of our chest. It's a really supportive atmosphere that helps you cope with the transition from undergrad to graduate school and from being a student to becoming a certified. It was tough to transition, but it went smoothly because I had support.

Leanne, who was an intern at a secondary school, also had an assigned mentor, an experienced AT in her setting, with whom she met regularly:

My direct mentor acts sort of almost as a second family for me here. He's made it very clear that he'll help me through anything, and we'll meet weekly just to discuss how things are going. It's not even just athletic training, but life in general. “How are classes going? Can I help you apply for graduate assistantships or jobs next year?” He's been an immense help.

Some participants were not assigned mentors, but they had access to their supervisors, who served as mentors. Francesca, who worked in a secondary school, was not assigned a mentor, but she still felt valued by her employers due to their support. Her supervisor, an AT, would stop by her setting to make sure she was doing well. She also described how she could go to him and ask questions as she made the transition:

I was a little intimidated, and I had a lot of anxiety for the solid first 2 weeks I was working. I asked a lot of questions, and I'm sure my supervisor, he never said he got annoyed with all of my questions, but every now and then, I'm sending him 6, 7 text messages a day and calling him at least twice a day to make sure I knew what I was doing. He was always very understanding of that transition and of my anxieties of wanting to do well.

Carmen, a GA at the Division III level, also felt she could contact her supervisors for advice:

Either of the 2 head ATs, they have been very open to me calling them whenever I need them, and I do it quite often, even if it's just to bounce a question off of them in regards to an injury or something like that. They understand it's a little scary, and they are the ones with experience. They made that clear from the get go, to call them anytime with any questions, and there were no stupid questions. I feel very comfortable talking to them about anything.

Many participants, especially in the secondary school setting, did not have assigned mentors or even anyone available to mentor them, but they would often reach out to a supervisor for patient care questions or an administrator at the secondary school, such as an athletic director, with procedural questions specific to that setting. Skyler mentioned a few people she reached out to for help as she transitioned into her role:

If it's a doctor referral, then I would go back to my supervisor who's at the college because I just moved here, so I don't know any of the doctors. If it's administration or paperwork, I go back to the athletic director and his staff and figure out from there, and if they can't answer, they'll direct me to someone who can answer it.

Lydia, in the secondary school/clinic/hospital setting, contacted different people depending on her needs. She stated, “If it's policies and procedures, I'll ask the athletic director, but if it's about like an injury or rehab question, I will text and call another athletic trainer and ask them.”

Peer Mentors

Peer mentoring occurred with those participants who were not assigned mentors. Participants would reach out to peer ATs, whether fellow GAs or ATs at other secondary schools in the same athletic conference. Todd, a secondary school AT, noted:

I have contact with the other [ATs] in the area. I actually talk to them quite a bit. There's actually a pretty good tight-knit group of high school athletic trainers out where I live, so it's been nice to have. We step in and support each other when we need to.

Some GAs had assigned mentors, but they said that they would reach out to their peers for help before they contacted their supervisors. Saul, a GA in the secondary school setting who had an assigned mentor, also used his peer ATs for support and confirmation as he made the initial transition into his role:

For the first couple of weeks I was in grad school, practically every decision I made, I called other athletic trainers that I'm here with here at [institution], and I talked things out, and they would do the same. My phone literally died at practice one day because it was a 2-a-day practice, and we questioned every little thing we were doing. After 2-a-days were over, we were pretty much set because we had some pretty hard things happen to a lot of our classmates. Thank goodness I didn't have anything that happened, just listening to other people about how they handled situations and then hearing about how they handled it improperly, and them getting repercussions because of it, that actually helped too, because you're like, “Gosh, that's what I would do.”

Some participants had assigned mentors who were not available, so they would instead reach out to peers or prior preceptors. Galina, a GA, felt her supervisor was very busy, so she often reached out to peers for help with smaller concerns:

I try to be as independent as possible because my mentor is very busy with other commitments that he has on campus. If it's something a little minor, then I'll talk to my classmates about it, especially the GA who's with modern dance since dance is a lot different than a traditional sport.

Support and mentoring for our participants were valued and assisted in their transition to practice. Participants were able to ask questions, seek advice, and discuss various topics during these first few months of clinical practice.