Preceptor Orientation Strategies for Professional Athletic Training Students Before Beginning Clinical Education

Expectations of ATSs.

Most participants used initial orientation and onboarding as a mechanism for outlining the expectations they have for ATSs in providing patient care. It is important to note that participants expressed a clear difference in the expectations of ATSs based on their progression within curriculum of the athletic training program (eg, first semester versus fourth semester). Throughout their comments, participants shared consensus that expectations for novice students (first semester or year) emphasized the development of clinical and soft skills (eg, practicing obtaining patient history, beginning clinical examination) and socialization within the athletic training profession (eg, engaging with patients and other staff, setting up clinic or venue for practice). Conversely, participants commonly reported that expectations for second-year students emphasized the application and integration of clinical skills, where the expectations of second-year ATSs were higher.

Related to outlining expectations for novice students, many participants noted that asking questions throughout the clinical experience was crucial to learning. As Jerry stated: “It’s really about whether they [novice ATS] can follow directions and rules and learn to ask questions. . . this shows if the [ATS] is engaged. This also shows maturity in the student.”

Similarly, Leslie explained how her expectations for novice and advanced students aligned with their progression through the program:

My expectations [in the first semester] are just for them to take initiative. That’s probably my biggest thing and to go along with what they are learning in their program. So if they have done lower leg [evaluation] in class, then they should definitely try lower leg evaluations in clinic. I don’t expect them to do something clinically that they haven’t covered in their education yet.

Mutually sharing expectations of one another (preceptor and ATS) creates continuity between the 2. As April stated:

I want to know their expectations for me, and I share my expectations for them. That’s the 1 thing that I emphasize. We have an expectations worksheet that our clinical coordinator sends out, and the expectations worksheet basically outlines like what to expect from your preceptor and what your preceptor can expect from you, and it even breaks it down for us to review together.

Setting clear expectations for novice ATSs is important, the preceptor should be communicating and outlining these expectations during initial orientation.

Policies, Procedures, Logistics of Site.

Regardless of their practice setting, most participants reported using orientation to outline key policies, procedures, and logistics of their site. The emphasis of the initial orientation allowed ATSs to become familiar with the site, where equipment and supplies are located, and what will be used most frequently. This orientation also focused on explaining the emergency action plan (EAP) and the role of the ATS during an emergency.

Participants expressed the importance of using orientation to become familiar with the setup of the clinic. During this time, ATSs were able to get an understanding of where equipment and supplies are located, and how the clinic runs. As Donna shared:

Typically. . . I will introduce myself, talk a little bit about the sports that I oversee and that they’ll most likely encounter as well as a tour of the facilities and different spaces in the building that the student should be familiar with, also dress code. I tend to also kind of go through coaches. So there’s different coaches that run practices and run their programs different ways, and I try to make sure that my students are sensitive to that, just like I try to be sensitive to the way that things are run, and we also in that conversation talk about our emergency action and our involvement with public safety and different resources that we use, our health center and our orthopaedic office, and those types of things that we utilize on a pretty regular basis.

Similarly, reviewing the EAP and role of the ATS during an emergency was also identified as crucial, to ensure ATSs know their roles and responsibilities during an emergency situation. As Anne stated:

I spend a bit of time reviewing and discussing the EAP. I think they have to understand the EAP and their role in the EAP. I make sure they [ATSs] know where emergency equipment is and have a general understanding of how the athletic training room operates so they can assist in an emergency situation.

Participants also highlighted that familiarity in clinic operations can prevent any miscommunication or confusion later during the clinical experience, creating a smooth transition for the ATS to begin providing patient care. As Tom stated:

For the initial orientation meeting, I want to get them as familiar as possible with the setting so that they don’t have to worry about where everything is or where do I need to go to find this. This really establishes a foundation of comfort so they can just kind of go [in patient care] based off what they already know.

For some participants, outlining site-specific policies, procedures, and logistics occurred in 1 day, while others indicated this was ongoing for multiple days or throughout the clinical experience.

Developing Autonomy.

Most participants emphasized using orientation as the starting point for discussing opportunities for increased student autonomy during clinical experiences. This autonomy allowed the student to grow as a clinical practitioner, requiring increased critical thinking and clinical problem solving in preparation for autonomous clinical practice.

As a preceptor, it is important to outline expectations for autonomy during the initial orientation, within early days of the clinical experience, or both. Several participants outlined how they scaffolded learning experiences to increase students’ opportunities for autonomy. This intentional structuring of patient care encounters supported students in developing their own approach to patient care. As Donna stated:

I’ve tried to incorporate the idea of scaffolding in our initial meeting. My intent is that the week to couple weeks, depending on how quickly [the student] acclimates to this space, they tend to do more observational type activities, or I do a lot more guiding in the first couple of weeks and then as I feel more comfortable that they know what they’re doing. And as they start to feel more comfortable with the athletes, with the people, with the treatments, and the rehabs that we’re implementing, then I try to do more individualized work and, as I get more comfortable with their skills, have them take care of something on their own with my supervision. And then, if there’s a particular athlete or athletes that they’re doing well with and have gotten, you know, good feedback from, I might have them kind of more consistently work with those athletes to give them a little bit more continuity to their care. So that way, they’re kind of following 1 athlete and 1 injury or multiple injuries throughout their time to give them a little bit of a sense of that autonomy.

Interestingly, participants did not identify how ongoing discussions of autonomy were facilitated. Participants did indicate that they provide increased opportunities for autonomy and how this autonomy affects the student’s development. As Ron shared:

To give up control [to an ATS] sometimes is a little scary, just because I’m nervous myself about the care provided, so how can I trust someone else? But I think, really allowing for some of that autonomy within the [ATSs], especially as they have the educational tools, they have the educational resources, as I make sure that they know that I am there to support them.

Building Clinical Skills.

Many participants agreed that discussing expectations of clinical skill development is important during the initial orientation. This discussion included expectations in providing patient care and how feedback is provided when the student is struggling. Participants emphasized that building clinical skills occurs on a continuum and that there will always be more to learn even as a seasoned athletic trainer. Despite this, few participants included building clinical skills as a continuous process within their initial orientation. This is important to note because this conversation during orientation can set the expectation for ATSs’ continued improvement and growth in building clinical skills.

Some participants noted not including this in orientation so students were not overwhelmed or scared before beginning patient care. As Cameron stated:

I don’t want to crush them [novice ATSs] because they have such a short period to learn. I do my best to not be overbearing and to just be very. . . provide guidance and help and encouragement to continue to improve and build their clinical skills every day they are here.

Similarly, Anne believed that orientation is not the best time to share that building clinical skills is an ongoing and continuous process. As she shared:

At some point, we do have the conversation that you’re probably never going to achieve full competency as a student or even as a professional. . . you’re still working to improve your clinical skills, and if you think you’ve achieved them, you probably haven’t, and you should try again.

Another aspect of developing clinical skills not discussed during orientation included opportunities for supervised autonomy. Several participants shared how they provide ATSs the opportunity to take a lead role in providing patient care and letting them figure it out. Participants outlined how they scaffold patient care experiences to provide increased autonomy throughout the experience. As Tom commented:

I think going heavier with the supervisions on the front end. . . it’s probably the best way. Trial by fire is probably the style that I go by, have the student follow me and everything that I do, and so they can see and get a good picture of how things are moving. And then that way, when they’re later into the clinical experience, they can act autonomously, providing care autonomously but still under my supervision.

Though not a part of the initial orientation, it is important for preceptors to let the student know of their expectations for increased responsibility in patient care. The only way for students to be successful with increased levels of autonomy is to ensure clarity in expectations, which should begin during initial orientation and continue throughout the clinical experience.

Verbal and Nonverbal Communication.

Both verbal and nonverbal communication are important topics included in orientation and onboarding of novice ATSs but maintained throughout the clinical experience. However, no participant identified how communication was discussed during orientation nor throughout the clinical experience. Many participants identified specific communication cues (verbal and nonverbal) used by ATSs, not only to articulate their needs from the preceptor but also to communicate differently with patients. Specifically, participants identified several nonverbal cues they have picked up over the years indicating when a student needs guidance. As Leslie shared:

Body language is a key indicator of knowing when the student needs some guidance. This could be a variety of things such as their facial gesture or even the way they are moving around. . . when they start to pause and look at me uncomfortably, I know I need to step in and help.

Another cue signaling that assistance was needed is the tone of the ATS’s voice. Several participants noted that students start using filler words or that their voices get lower when they start to get stuck. At other times, the student’s statements start sounding like questions rather than definitive statements. As Tammy stated:

If they seem to be lost, if they are circling around the same thing, or if they are lost in their evaluation, their statements end less confidently and more in a questioning tone. They are asking as a means of seeking validation.

An important aspect of communication that nearly every participant discussed was being able to communicate with a patient in a manner they could understand. This aspect of communication was identified as a component of orientation. As health care professionals, complicated medical jargon is used when describing either an injury or intervention plan. Participants shared that the ATS has a responsibility to communicate in a way that the patient will understand and follow. As Manny stated: “It is important for an [ATS] to be able to share information in a way that is digestible for a student-athlete.”

Building Patient Rapport.

Every participant reported including the importance of building rapport with a patient during initial orientation and onboarding. This included the role of ATSs in providing care for the patient at a time in their career when they are struggling but also providing strategies to create a positive relationship, allowing the patient to be receptive and more comfortable with the ATS as their health care provider. Building rapport included understanding how to interact with patients in a professional manner, being mindful that every patient has unique needs. As Leslie stated:

I expect them to be very professional but also create a rapport with the athletes they care for. I want them to be, you know, overall respectful and culturally sensitive to the patient’s needs.

Building rapport often means earning the trust of the patient. Rapport will be built through open and honest communication, where both parties are comfortable with one another. Participants shared that, as rapport continues to be built, the relationship between the student and patient will grow as well. Tammy shared these thoughts: “They [ATSs] have to earn the trust of the students [patients], and the students also have to essentially earn the trust of the [ATS]. This relationship is a 2-way street.”

One indicator identified by participants to signal that the ATS has established positive rapport with patients was that patients will begin to actively seek out the ATS to provide care. Participants noted that patients often communicate more with the ATS than they do themselves, and the process of them working together is natural. As Leslie stated:

I really find large success in if my athletes are also actively utilizing my students. It means that my students are doing well, and it means that they have created good rapport with the athletes. Success is when you can tell that student-athletes are also actively comfortable.

Empathy.

Demonstrating empathy is a skill ATSs will continue to refine throughout their careers. Thus, empathy is not just discussed during orientation but a topic that participants reviewed throughout the clinical experience. Being able to listen and understand the patient’s needs is important, allowing an ATS to treat the patient holistically. An important aspect of demonstrating empathy was asking questions with a purpose and taking time to process what is being said by the patient. Participants emphasized throughout the clinical experience that ATSs should not ask questions because that is what they were taught to do but ask questions because they care. As Ron shared:

I discuss the importance of good communication skills. . . to be able to have empathy to practice active listening is important. I stress not to ask a question because you have to ask a question; ask a question to learn the next piece of information. How does that information then fit into the [patient] puzzle of what’s going on?

Although empathy is a skill that is extremely difficult to teach, participants hope that ongoing conversations throughout the clinical experience will provide pivotal insights or skills in improving empathy through their mentorship. As Walter stated:

We’re hoping we’re preparing them for independent practice, you know, not just in terms of clinical skills but in terms of patient-centered care and how it’s important that you have your competent clinician, but it’s just as important and those essential skills that are harder to judge the event, like empathy and leadership and your interaction styles and all those other things.

Initiative.

Though initiative is introduced during orientation and onboarding, participants expressed that initiative is another topic brought up multiple times throughout the clinical experience. Ultimately, participants expressed that it is up to ATSs to demonstrate initiative to make the most out of their learning experience. Participants noted that engaged and focused students were perceived as students that will have a better clinical experience than an ATS less engaged and having to be told what to do.

Participants raved about ATSs that consistently ask questions about the care being provided, a sign of engagement and a strong desire to learn. As Leslie stated:

The enthusiasm and organization that [students] have coming in to the experience will tell you a lot. You know, if they take initiative to ask questions and learn what I am doing, as opposed to just going through the motions or having to be asked or told what to do, those that take initiative are the students that really get a lot out of the experience.

Asking questions is often perceived as a sign of professional growth within a student. Multiple participants expressed that, once a student starts asking to do more in patient care, it shows that he or she is ready to learn new skills. As Craig stated:

When they start taking initiative. . . they start asking, “Hey, I’d like to run this rehab by you,” or, “Hey, I was wondering if I could do this is today with the patient,” they show they can be trusted to start doing more.

Participants also explained that taking initiative is crucial for the workflow with an athletic training clinic. Having a student that can identify what needs to be done without having to be told what is do is beneficial for the overall facility operations. As April stated:

I expect a lot, and most of what I expect is about taking initiatives. We discuss this at the beginning, and I provide examples about what that looks like in the clinical setting. So I usually tell my students, I’m like, “You will go into the [athletic training] facility, and there will be students standing around, and then there will be patients just standing there waiting for one of the faculty members.” And I tell my students, “My expectation is that that will never be the case when we are in the room, so I never want to see you standing around. There’s always something to do, and if you’re not sure what it is, then you should be coming up to make myself or another faculty member and asking, ‘What is it that I could work on right now,’ or, ‘What can I help with?’”

Time Management.

Time management was identified as an important component of professionalism discussed during orientation. Interestingly, participants only noted revisiting time management when a student struggled with maintaining balance. Participants stated that, as graduate students, ATSs balance competing priorities, such as classes, clinical education requirements, outside employment, but also time needed for themselves. Despite time management being a crucial skill, participants acknowledged that ATSs are doing their best to balance their responsibilities. As Tammy shared:

I think that their work-life balance is affected because they’re older, and because it’s a master’s program, they want to be able to provide for themselves, so going to school, family occasions, personal relationships. . . They’re expected to process and learn information as master students, but it’s a lot of information. So we see some struggle with time management and balance, often overwhelming themselves.

A topic often not discussed during orientation was outside employment. As graduate students, ATSs often have fewer opportunities for scholarships and financial aid beyond student loans. For many ATSs, the financial needs to pay rent and meet basic food needs encroach on academic requirements. Multiple participants shared how the need for outside employment meant reduced availability for clinical education. As April stated:

I also see that a lot of these situations the students are put in that have been out of their control, such as financial, you know, that they have to work a job or sometimes 2 jobs in order to afford housing, afford tuition. . . and so there’s a lot more to balance their time management right compared to a student 10 years ago.

Unfortunately, most participants noted that time management was the aspect of professionalism that ATSs struggled to master as a student. Although many participants stated this as a challenge, none were able provide a solution for how to support students to overcome their struggles. As Walter shared:

I mean, look, the biggest challenge for students today is time management. They have so much going on, it’s tough for them to figure out to balance it all. I don’t have the good answer, but I’m hoping someone can come up with that answer.

Repetition of Skills.

To build confidence, many participants stressed the importance of skill repetition during orientation and throughout the clinical experience. For mastery of clinical skills to occur, students must practice that skill multiple times. Clinical skills are mastered over time, and some skills require significantly more time to practice before improvements are achieved; however, building clinical skills through repetition also builds confidence. As Tom stated:

Repeated demonstration of skills results [in] success over time, baby steps, getting incrementally better, and tasks being accomplished correctly. Through these steps, I see students’ confidence also [increases] day by day.

An important part of building confidence included pushing students beyond their comfort zone. While not discussed during initial orientation, this was discussed as students progressed through the clinical experience. Many participants stated that students often continue to repeat clinical skills because they are comfortable to the students; however, for growth to occur, students need to be pushed to practice skills they are not comfortable with. More exposure to the repetition of unfamiliar skills will result in increased confidence. As Hank stated:

And then when I know that it’s time to say, look. . . you got to get comfortable with this. You’re going to see tons of feet injuries through your career, and if you’re going to be successful with these patients. You have to practice.

Adaptability.

During orientation, the importance of adaptability is stressed but reemphasized throughout the duration of the clinical experience. Participants expressed their sincere interest in being effective clinical teachers; however, they recognized that it is not possible to prepare ATSs for every patient scenario they may encounter during clinical practice. Many participants even shared their own shortcomings in clinical practice, identifying patient care scenarios they have not encountered, underscoring the importance of being open and adaptable. As Sam commented:

I think it’s just the willingness to be open to change. There has to be the willingness to continue to learn and grow throughout the experience. This is so important to learn as a student because adaptability will be needed all through your [athletic training] career.

An aspect of adaptability that is stressed throughout the clinical experience is that ATSs need to be open to learning new skills or doing specific clinical skills differently than they were instructed in class. Participants noted that ATSs often struggle with translating the knowledge learned in the classroom or laboratory into clinical practice with patients. At certain times, the knowledge translates well, but more frequently, it will not. Participants expressed the need to reiterate that different ways to perform clinical skills exist and that this is part of the learning process. Novice students need to be open to learning new methods of performing skills because every patient is unique. As Anne shared:

The ability to adapt and work well under pressure is a must. You must adapt to unknown circumstances to provide the best patient care you can. Not having all the knowledge is fine, but having enough information to figure out a way is essential.