The Size and Scope of Collegiate Athletic Training Facilities and Staffing

Procedures

This study received institutional review board approval, and the data were collected from a sample of ATs from across the United States. To recruit participants, we first developed an e-mail list of persons responsible for overseeing athletic training services (eg, director of sports medicine, head AT, associate athletic director) at institutions governed by the NCAA and the NAIA by reviewing publicly accessible Web sites. This review identified 1235 valid e-mail addresses for persons responsible for overseeing athletic training services at all levels of the NCAA and the NAIA. A recruitment e-mail was then sent to all potential participants explaining the purpose of the study, providing informed consent information, and including a hyperlink to the online survey. Two reminder e-mails were sent to the same e-mail list at 2-week intervals.

The hyperlink in the recruitment e-mail directed participants to an informed consent page. This page explained the study's purpose and indicated that participants would not be asked for any identifiable information that would link them to the responses provided. The page also stated that participants could discontinue the survey at any time and were free to skip any question in the survey. Lastly, the informed consent page made clear that only the AT overseeing athletic training services should complete the survey and that no incentive would be provided for participating in the study.

To limit duplicate responses, settings were established in the survey software that limited 1 Internet protocol address to 1 survey entry. At the end of the data-collection period, we reviewed all surveys to determine both the completeness of responses and whether any duplicate entries existed. We identified 1 response from an AT who did not meet the inclusion criteria and 10 sets of identical responses. These responses were subsequently removed, resulting in a total of 523 responses from the 1235 valid e-mail addresses contacted. An additional 45 responses were removed because they failed to fully answer the questions assessing the square footage of their facilities. Removing these responses resulted in a sample of 478 to be used for analyses and a validated response rate of 38.7%.

Instrumentation

Data Analysis

All statistical analyses were conducted using SPSS (version 22; IBM Corp, Armonk, NY). As appropriate, data are reported as mean ± standard deviation (SD) or as count (%). We entered the data from 478 completed surveys and calculated descriptive statistics for each participant (ie, age, sex, level of education, time in the current position, time at the current institution, years as a certified AT) and the associated institution (ie, number of varsity student-athletes, number of men's and women's varsity teams, athletic classification, primary conference affiliation). Descriptive statistics were also calculated for staffing (ie, full time, part time, noncertified), quantity of facilities (central, satellite, and game day), and size of facilities (central, satellite, and game day). Then mean differences in staffing and facilities were examined among the 4 levels of intercollegiate competition using χ² analyses, Pearson correlations, and analyses of variance (ANOVAs). Levene tests were conducted before ANOVAs were completed to determine the appropriate post hoc test. In significant ANOVA models, Tukey post hoc analyses were calculated when equal variances were assumed and Tamhane post hoc analyses were used when equal variances were not assumed.

Respondents

As previously stated, recruitment efforts resulted in 478 ATs (response rate = 38.7%, n = 478 of 1235) who completed all aspects of the survey for data analyses. By division, the sample comprised 146 ATs (30.5%) working at DI institutions, 103 (21.5%) at DII institutions, 159 (33.3%) at DIII institutions, and 70 (14.6%) at NAIA institutions. In comparison, the total membership of the NCAA and NAIA comprised 1350 total institutions, with 345 DI institutions (25.5%), 307 DII institutions (22.7%), 438 DIII institutions (32.4%), and 250 NAIA institutions (18.5%). Therefore, the sample obtained was generally proportional to the overall distribution of collegiate institutions. As displayed in Table 1, responses were received from all 10 NATA districts at all competition levels except for the NAIA, which lacked respondents from Districts 1 and 2. The majority of survey respondents were male (n = 325, 68%) and had completed a master's degree (n = 420, 87.9%). The mean age of the overall sample was 42.4 ± 9.9 years (range, 24–69 years); participants had been certified for 18.47 ± 9.4 years (range, 0–45 years) and had been employed at their institution for 11.66 ± 9.1 years (range, 0–47 years).

Table 1.  National Athletic Trainers' Association (NATA) District Affiliations of Participating Schools

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Institutions

Institutional Composition

A summary of the total number of student-athletes, men's teams, and women's teams at each of the 4 collegiate levels is provided in Table 2. As both the number of teams and the total number of athletes affect athletic training facility needs, these variables were important to assess and compare. Given the typical large squad size of football teams, additional data regarding the football status of all participating schools were collected. Of the 146 DI institutions, 67.1% (n = 98) sponsored a varsity football program. Approximately 54% (n = 53) of these programs competed in the FBS. More than half (n = 56, 54.4%) of the DII institutions sponsored a varsity football program. Approximately 51% (n = 81) of the DIII institutions sponsored varsity football, and just over one-third of NAIA institutions in the sample (n = 24, 34.3%) sponsored varsity football. A trend of declining levels of offering a football program was noted in the sample when moving from the DI to the NAIA level.

Table 2.  Athletes and Sponsored Teams by Competition Level

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Staffing

Staffing Levels

A complete summary of staffing across each of the 4 levels of competition is shown in Table 3. All institutions reported employing 1 or more full-time ATs, and declining mean values for full-time ATs were noted from DI to NAIA. The use of part-time ATs was not universal. A number of institutions reported that they did not employ ATs on a part-time basis, including 19.2% (n = 28) of DI schools, 52.0% (n = 53) of DII schools, 78.0% (n = 124) of DIII schools, and 68.6% (n = 48) of NAIA schools.

Table 3.  Athletic Training Staffing Levels by Competition Level

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The evaluation of athletic training students within schools was limited to those institutions with CAATE-accredited programs. Therefore, the results reported for this variable included only those schools. At 60 DI institutions (41%), athletic training students assisted in providing health care within their athletic training facilities. Approximately one-third (n = 33, 32.4%) of DII schools had assistance from athletic training students. Only 27 (16.9%) of the DIII schools reported assistance from athletic training students, as did 14 NAIA schools (20%). For this variable as a whole, the mean values for athletic training students showed declining numbers from the DI to the NAIA level.

Employment of work-study students on an hourly basis was another staffing method used by many but not all institutions. As with the athletic training student variable, the mean values for work-study students as reported in Table 3 were determined from only those schools relying on work-study students in their athletic training programs. At the DI level, just more than half the schools (n = 75, 51.3%) used work-study students to assist with daily operations. These levels rose to 63.1% (n = 65) for DII and 71.6% (n = 114) at DIII schools, but the employment of work-study students dropped to 52.8% (n = 37) at the NAIA schools.

Size and Scope of Facilities

A complete summary of data regarding both the number and size of athletic training facilities across each of the 4 levels of competition is provided in Table 4.

Table 4.  Athletic Training Facilities by Competition Level

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Facility Improvements and Satisfaction

A total of 62.8% (n = 300) of participants indicated that their athletic training facilities had been expanded or renovated in the previous 5 years. Of the overall sample, 44.6% (n = 213) specified that improvements to the athletic training facilities had been approved by upper-level administration (eg, board of regents). Respondents at more than half (n = 77, 52.7%) of DI institutions reported improvements in the past 5 years and 48.6% (n = 71) noted that future improvements had been approved. Among DII schools, 59.2% (n = 61) of participants cited recent renovations and 40.8% (n = 42) stated that facility renovations had been approved. The majority of DIII institutions (n = 98, 61.6%) had undergone recent renovations, and less than half (n = 69, 43.4%) had received approval for renovations. Finally, 64.3% (n = 45) of NAIA schools had recently renovated their facilities, and 44.3% (n = 31) had approved plans to improve the facilities.

Three survey questions used a scaled response to assess satisfaction with the current facilities. Participants in the overall sample reported a slightly positive change (mean ± SD = 3.6 ± 1.1) in their facility during the previous 5 years. They also gave neutral responses to being able to provide the necessary level of care (3.4 ± 1.2) and having a facility that met the needs of the staff and athletes (3.0 ± 1.2). Although no distinct trend of increasing or decreasing mean values within the levels of competition was evident (Table 5), the lowest values for each of the 3 facility satisfaction items were at the DII level.

Table 5.  Quality and Satisfaction of Athletic Training Facilities by Competition Level

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Respondents at NAIA institutions (mean ± SD = 3.8 ± 1.1) and DIII institutions (3.7 ± 1.0) reported higher mean scores for overall changes to their facilities when compared with DII schools (3.3 ± 1.0; F_3,438 = 3.4, P = .017). No other differences occurred among institutional levels for opinions of facility changes. Analysis of variance regarding the ability to provide necessary care to patients showed differences in mean values (F_3,438 = 3.5, P = .016). The mean value for DI schools (3.6 ± 1.1) was higher than that for DII schools (3.1 ± 1.2), and DIII schools (3.5 ± 1.2) also had a higher mean value than DII schools. Similarly, participants at DI institutions (3.2 ± 1.3) reported higher levels of overall satisfaction with facilities and equipment than those at DII schools (2.7 ± 1.2; F_3,436 = 4.2, P = .006). Post hoc testing failed to identify any additional differences among competition levels for overall satisfaction.

Staffing Levels

Although an instrument²⁰ exists to determine the full-time equivalent needed to provide appropriate athletic training services at the collegiate level, the researchers sought only to quantify the actual number of ATs on staff. We reported results in this manner to provide ATs and administrators with another point of comparison by competition level. Division I athletic training staffs reported treating an average of 408 student-athletes with 6 full-time ATs and 3 part-time ATs. The staffing levels at the DI level were larger than those reported at any other level of competition. However, staffing sizes at this level were slightly lower than those identified in previous research.⁶ Because earlier examinations of staffing levels addressed only FBS members of DI, these differences were not unexpected. Football Bowl Subdivision institutions typically have more resources, which could result in the ability to staff additional ATs.⁷

Further investigation of staffing patterns among the levels of competition identified several interesting findings. First, only a moderate positive correlation was present between staffing levels and the number of student-athletes. In the sample, participants at DII and NAIA institutions reported providing care to similar numbers of student-athletes. However, these institutions employed similar numbers of part-time ATs, whereas DII institutions employed more full-time ATs. This result suggests that ATs at NAIA institutions are being asked to provide care to comparable numbers of student-athletes with fewer staffing resources. It should be noted that the increased numbers of athletic training staff at DII institutions could reflect a higher prevalence of football programs. In the sample, 52% of DII institutions sponsored a football program, compared with 32% of NAIA institutions.

Staffing differences between DI and DIII institutions were also noted. Although the average numbers of students receiving care were similar, DIII institutions had fewer full-time and part-time staff members. Previous researchers^21,22 have observed that a lack of staffing resulted in increased work-life conflict and increased workloads for ATs at the DI level. Therefore, it is possible that ATs at other levels of competition could have work-life conflicts and workloads that are greater than those at the DI level based on decreased staffing levels. Even though we did not measure either weekly workload or work-life conflict, further exploration of these factors based on collegiate level is warranted.

Although the employment of BOC-certified ATs is foundational to providing athletic training services, we also assessed the contributions of athletic training students and work-study students. Athletic training students from CAATE-accredited programs work under the supervision of a preceptor (eg, an AT) who must be present to directly intervene if necessary. Therefore, they should not be considered an independent work force. However, work-study students support certified ATs on an hourly basis and do not have supervision mandates. To our knowledge, this is the first published study to assess support roles. It is interesting that the analyses failed to identify differences in the average number of athletic training students providing support. This finding could indicate the small proportion of CAATE-accredited programs at the DIII and NAIA levels. However, differences in work-study students were identified, with DI and DIII institutions employing more students than DII and NAIA schools.

Facilities

As expected, respondents at DI institutions reported having more central athletic training facilities and more total space than those at all other levels of competition. In fact, the average square footage reported for the central athletic training facilities at DI institutions was more than double that reported at any other level. Similar results were associated with satellite athletic training facilities. Participants at DI schools reported more than double the total number of satellite facilities and total square footage when compared with those at the other levels of competition. To put this into context, DIII institutions were providing care to a comparable number of student-athletes as DI schools with approximately 2 fewer total facilities available (1 central athletic training facility, 1 satellite athletic training facility) and approximately one-third of the total space (DI = 7173 ft² [666 m²] versus DIII = 2781.5 ft² [258.4 m²]).

Based on the variable sizes and scopes of athletic training facilities, future researchers should seek to develop a formula for determining the appropriate size of an athletic training facility. This formula should account for anticipated changes in the athletic department (eg, increased number of athletes, addition of teams) over time to provide ATs with an idea of the space needed to accommodate both current and future athletic training requirements. Such an approach should account for feedback from athletic training staff regarding athletic training facility satisfaction and specifications for additional space. This approach to space recommendation formulations has been adopted in the development of other sport facilities,^17,23,24 and it should be considered an important next step in athletic training facility research.

Other differences between central and satellite athletic training facilities among the remaining levels of competition (ie, DII, DIII, NAIA) were not as pronounced. Despite differences in staffing and the number of student-athletes treated, participants at institutions not competing at the DI level reported comparable numbers of central and satellite athletic training facilities on campus. The size of these facilities was also similar among the DII, DIII, and NAIA levels, with the lone exception being that the central athletic training facilities at DII schools had more square footage than those at the NAIA level (729.2 versus 422.5 ft² [67.7 versus 39.3 m²]). Finally, game-day facilities were not a common feature among intercollegiate institutions in the sample. In fact, respondents at only 23% of the schools described having facilities specifically for game-day use. However, a small and select group of staff at 7 schools reported multiple game-day facilities (between 3 and 6 separate facilities) at their institutions. Although no differences were found related to the size or number of game-day athletic training facilities, these facilities should be monitored in the future, as they could become a point of differentiation among schools in the “facility arms race.”^25,26

Results associated with storage and office space were comparable with those related to the other athletic training facilities. Respondents at DI schools reported a greater number of offices and more storage areas than at all other levels. However, the differences with regard to total office square footage were not as pronounced. No differences in total office space were identified between DI and DII institutions, though staff at both reported more office space than at the other 2 levels of competition. The average storage space of 696.5 ft² (64.7 m²) reported by DI institutions was more than the average spaces of the remaining 3 levels of competition combined (DII = 253.8 ft² [23.6 m²], DIII = 224.9 ft² [20.9 m²], NAIA = 209.0 ft² [19.4 m²]). Although we did not assess satisfaction with storage and office areas as components of collegiate athletic training facilities, this factor should be explored further, as well as the effect these facilities have on daily athletic training operations.

The final portion of this study addressed the condition of the athletic training facilities and the level of satisfaction that participants had with those facilities. Recent investments in athletic training facility renovation were common, with more than 60% of the sample reporting that athletic training facility renovations had been completed within 5 years of the survey. This type of facility investment was consistent with the findings of the exploration of DI strength and conditioning facilities by Judge et al.¹⁶ Respondents indicated that another 40% of the schools had received approval to improve some aspect of their athletic training facilities in the near future. Although a majority of athletic training facilities had been improved recently and staff members were positive about the changes to their facilities, the idea that their facilities were meeting the needs of the staff and student-athletes was rated as neutral at all 4 competitive levels. Despite the differences in staffing and facilities, these feelings transcended the sample, with an overall mean of 3.0 (ie, neutral) for this variable on the 5-point Likert scale. This outcome suggests that the athletic training facilities were meeting only the current needs of their sports medicine team and that further renovations may be warranted. This result should be reexamined in the future to determine if the planned renovations identified in the current study prompted a more positive outlook on the athletic training facilities associated with collegiate sports.

Limitations and Future Research

Despite the strengths of our study, some limitations should be noted. We used a cross-sectional study design, which limits the inferences that can be made and prevents the assessment of changes in facilities over time. Participants in this study self-reported and estimated the sizes of all of their facilities. We expected that the ATs participating in this study would know or be able to determine the exact sizes of their facilities. However, it is possible that respondents erred by providing inaccurate estimates of their facility size. To obtain better estimates, we provided respondents with multiple spatial examples in the survey. The results are also limited because we studied a convenience sample of ATs from across the United States. Yet the data set obtained was proportional to the overall composition of member institutions at these levels of competition. We also did not ask institutions to evaluate staffing levels based on the Appropriate Medical Coverage of Intercollegiate Athletics (AMCIA) recommendations and guidelines.²⁰ A previous group⁶ reported confusion in using the AMCIA document correctly, and our focus was on quantifying existing levels outside that context. Future investigators should determine if the AMCIA recommendations are being met in the various divisions of the NCAA and among NAIA members.

Because we wanted to explore differences among all levels of competition, we did not evaluate differences between the FBS and Football Championship Subdivision within the NCAA's DI level. Failing to evaluate differences among DI institutions could have resulted in an imprecise evaluation of staffing and facilities at that level. Research¹⁶ on ancillary areas of the athletic department suggests that differences between these 2 levels within DI could exist. Future researchers should focus on identifying differences in staffing and facilities within this division, which could further reflect the role that football plays in athletic training facilities' size and staffing. Athletic training program budgets were not directly assessed. Examinations of other intercollegiate facilities^16,25,26 suggest that facility differences might be associated with budget disparities. Therefore, future explorations of athletic training facilities should determine if facility differences are also directly associated with budgetary discrepancies within and perhaps outside of the athletic departments within the institutions.

Limitations related to the survey used to collect the data also existed. Although the survey items were based on previous research,^16–18 we did not assess the validity or reliability of the items we created. Future authors should seek to validate the items included in the survey to ensure accuracy. We also did not ask respondents to evaluate their satisfaction with equipment and supplies separately or with individual facilities. Therefore, it is possible that respondents reported an overall satisfaction level while being dissatisfied with some aspects. Creating separate items to more accurately assess satisfaction levels in these areas would be useful. Finally, only 1 person on each campus rated overall satisfaction with the athletic training facilities. It is possible that the respondent's opinion of the facilities did not represent the overall opinion of the athletic training staff.