The Evolution of Athletic Training Education

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The Evolution of Athletic Training Education

• Michelle A. Cleary PhD, ATC
• Director and Clinical Education Coordinator
• Entry-Level Graduate Athletic Training Education
  Program
• University of Hawaii, Manoa
• clearym_at_hawaii.edu
• www.hawaii.edu/kls/atsm
• 2009 HATA Symposium Keynote Address
• Honolulu, HI

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Agenda

• My Background Experience
• Where has AT Education Been?
• Where is AT Education Now?
• Where is AT Education is Going?
• What is Going on with AT Education at The
  University of Hawaii, Manoa?
• Time for more Questions and hopefully some Answers

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Background Experience

• ATC for since 1993
• 7 years clinical experience
• 8 years as Program Director
• Entry-Level Masters
• Post-Professional Masters
• Involved with accredited AT programs since 1988
• University of New Mexico, Temple University
• Approved Clinical Instructor (ACI) and Clinical
  Instructor Educator (CIE)

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What have I been doing?

• Exertional Heat Illness Research
• Risk Factors for Heat Stroke
• Acclimatization
• Effects of Dehydration and Hyperthermia
• 14 papers published
• 30 national presentations
• Consensus Statements
• Book Chapter

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Where has AT Education Been?

• Curriculum Model - 1959
• Initial attempt to identify a specific body of
  knowledge for athletic trainers
• Courses in existence within physical education
• Emphasis on teaching credential
• Packaging" of relevant courses available in
  related academic areas
• Delforge Behnke, JAT 1999
• Required 800 clinical hours
• Internship required 1200 hours

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Many Changes along the Way!

• 1969 First programs Approved by NATA
• Content evolved specific to AT
• 1970 first Certification Exam
• Multiple routes available
• 1983 Competencies in Athletic Training
• Developed by Professional Education Committee
• 1986 NATA requires major designation
• 1990 AMA recognition as health care profession
• 2014 CAATE requires degree designation

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And then there was. Accreditation!

• 1998 Transition from NATA Approved programs
• Joint Review Committee on Educational Programs in
  Athletic Training (JRC-AT)
• Commission on Accreditation of Allied Health
  Education Programs (CAAHEP)
• Commission on Higher Education Accreditation
  (CHEA)
• 2006 JRC-AT became independent from CAAHEP
• Commission on Accreditation of Athletic Training
  Education (CAATE)
• Delforge Behnke, JAT 1999

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Pros and Cons

• Benefits of Accreditation
• Standardized educational program requirements
• Professional Recognition
• External peer review by a highly regarded,
  specialized, independent accreditation agency
• Formalized Clinical Education and Experiences
• Accountability to the student to prepare for BOC
  Exam
• Drawbacks of Accreditation
• Massive amounts of paperwork!
• Accountability to ensure students are prepared
  for BOC Exam

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Where We Are Now.

• Athletic Training Educational Competencies
• Document used as a guide by administrative,
  academic, and clinical program personnel
• Structures the didactic and clinical education
  experiences of their students.
• Minimum requirements for students entry-level
  education.
• Competencies Knowledge, Proficiencies Skill
• Clinical Proficiencies holistic ability

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CAATE Requirements

• The Competencies are used for
• Curriculum development
• Education of students enrolled in an accredited
  entry-level education program.
• Serve as a guide for learning experiences leading
  to a students eligibility to challenge the BOC,
  Inc. Examination.

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Required Content Areas

• Acute care of injury and illness
• Risk management and injury prevention
• Therapeutic exercise
• Therapeutic modalities
• Pathology of injuries and illnesses
• Diagnosis of injuries and illnesses
• CAATE Standards 12-07-07

• Nutritional aspects of injury and illness
• Psychosocial intervention and referral
• Medical conditions
• Pharmacology
• Health care administration
• Professional development and responsibility
• Professional Behaviors

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Clinical Education

• Practicum Skills Lab
• Clinical Experience Clinical Proficiency
  evaluation in Lab and in Clinical Setting
• Goals of Clinical Experience
• Clear expectations - syllabus
• Opportunistic learning possible
• Skills evaluated by ACI
• Continuous Quality Improvement
• ACI training every 3 years
• Evaluation of Student by ACI
• Evaluation of ACI/ Site by student
• Evaluation of Site by CEC

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Competency Review and Revision

• Reviewed every five years
• Revised by the NATA Education Councils
  Professional Education Committee/Council
• formerly the Entry-Level Education Committee
• Must remain up-to-date
• Must reflect current evidence-based theory and
  practice
• Important for Professional Recognition

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Professional Recognition

• An athletic trainers educational background
  and clinical exposure prepare them to care for a
  very specific population of athletes.
  Educational requirements of the athletic trainer
  are not sufficient for athletic trainers to be
  able to differentiate health conditions and
  medical pathologies.. An athletic trainer is not
  qualified to identify or provide services to
  individuals who have underlying health
  conditions, medical pathologies, or contributing
  factors to their injuries.

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SB 1129, Relating to Athletic Trainers

• Ultimately, the physical therapy community is
  committed to health care provided by qualified
  health care practitioners within their scope of
  education and training. We support licensure of
  allied health professionals scope of practice
  based on a national, standardized training
  curriculum to ensure that the consumers are
  receiving quality and safe care.

Ann Frost, P.T., President of the Hawaii Chapter
American Physical Therapy Association (HAPTA)
and member of HAPTAs Legislative Committee
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Rapid Changes in AT Education

• Undergraduate professional education cannot
  accommodate an adequate amount of
  pre-professional preparation in basic sciences
• 95 of professional education programs are at
  the undergraduate level
• Most require 5 or more years to complete
• 70 of ATs hold a Masters degree or higher
• The number of graduate professional education
  programs is rapidly increasing
• Wilkerson et al. ATEJ 2006

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Total AT compared to PT programs
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Increases in AT programs last 10 years
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Rapid Increase in Entry-Level Programs

• 1999
• 91 accredited UG programs
• 2 accredited G programs
• 2009
• 344 accredited UG programs (? 74)
• 19 accredited G programs (? 89)
• Only 6 in Western US
• CAATE website, accessed June 5, 2009

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Why the Rapid Increase?

• 1996 internship route to BOC certification
  discontinued in order to
• Standardize athletic training education
• Enhance consistency with professional preparation
  of other health care professions
• Jan 2004 BOC no longer accepts internship route
  applications

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Where are We Going?

• NATA Future Objectives
• May 2004, the NATA-BOD developed an Educational
  Degree Task Force
• Purposes
• Is a degree in Athletic Training in the best
  interests of the profession?
• Should entry level remain an undergraduate degree
  or should it be raised?
• Walters, NATA News, 2004

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Educational Degree Task Force

• By 2014, all Athletic Training programs must
  offer an AT Degree, not a major
• Must be a degree in athletic training (without
  modifiers) listed as the degree subject area in
  institutional academic publications and on
  student official transcripts.
• i.e., Bachelor of Arts in Athletic Training
• The task force recommends that entry to the
  profession continue to be at the undergraduate
  level

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Why Entry-Level Masters?

• Allow time for completion of Pre-Professional
  Requirements
• Complete required foundational coursework first
• Build upon previous Observation Experience
• Provide options to late discovery students
• Most require 5 years to graduate
• Consistent with other health care professions
• Inculcate evidence-based practice
• More mature learners
• Focused study and clinical experiences

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Why a Masters Degree?

• Higher Salary
• ATCs with a Masters degree make 3,942 more per
  year than ATCs with Bachelors degree
• NATA News, April 2003
• 70 of ATs have Masters
• Considered for jobs over BS degree, even if MS is
  not required

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Why a Masters Degree?

• Job marked demands it
• Better Jobs
• High profile and high paying positions in
  athletic training are often held by those with
  experience and a graduate degree
• Ingersoll Geick, 2003

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Why a Masters Degree?

• More Opportunities
• College/University athletic training positions
  (as of 06-17-03)
• Masters required 31
• Masters preferred 36
• Bachelors only 15
• Ingersoll Geick, 2003

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What is in the Future?

• Evidence-Based Practice
• Problem-Based Learning
• Diverse Clinical Settings
• Technology Infused Curricula
• Computer-Based Testing
• Health Information Technologies
• Distance Education
• International Outreach

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Continuum of Learning

• Pre-Professional Education
• Professional Education
• Entry-Level Programs (BS or MS)

• Post-Professional Education
• Advanced Masters
• PhD

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What is going on at UH?

• Pre-Professional Education
• BS in Kinesiology and Rehabilitation Science
• Professional Education
• MS in Entry-Level Athletic Training

• Post-Professional Education
• MS in Post-Professional Athletic Training
• PhD in Education
• Specialization in Kinesiology and Rehabilitation
  Science

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Entry-Level Education

• Pre-Professional Option
• BS in Kinesiology and Rehabilitation Science
• Accelerated 3 2 BS-MS Program
• Combined degree program
• Pending approval, available Spring 2010
• Professional Education Program
• CAATE accredited curriculum
• MS in Kinesiology and Rehabilitation Science
• Entry-Level Athletic Training

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Pre-Professional Option

• For students interested in a Career in AT
• KRS students - Freshmen or Transfer Students
• Non-Kinesiology College Graduates
• International Bridge Program
• For students who must complete
• Required pre-requisites
• 200 hr Volunteer/ Observation Hours

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Pre-Professional Requirements
The following MUST be completed before Admission
to the Professional Education program PHYL
301/L Human Anatomy Physiology I PHYL
302/L Human Anatomy Physiology II KLS
353 Structural Kinesiology KLS 354 Exercise and
Sport Physiology KLS 432 Emergency Care for
Professional Rescuer OR CPR/ AED
for Professional Rescuer current card 200
hours Observation Experience Tape ankle / wrist,
RICE, wound care, etc.
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Additional Pre-Professional Requirements

• The following courses should be completed before
  Admission to the Program
• PSY 100 Survey of Psychology
• KLS 152 Weight Training
• KLS 395 Personal Health Wellness
• KLS 463 Sport Biomechanics
• KLS 460 Nutrition Exercise in Sport
• KLS 415 Prevention Care of Athletic Injuries

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Admission to Professional Education Program

• Priority Admission February 15
• Regular Admission April 1
• Apply to Graduate Division
• 3.0 GPA
• GRE scores
• Program Application
• Professional Goal Statement
• Cover letter / Resume
• 3 Letters of Recommendation
• Experience Voucher Form
• Transcripts

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Accelerated BS/MS 3 2 Option

• Years 1 - 3
• Freshman/Transfer Student Admission
• BS in Kinesiology Rehabilitation Science
• Select AT Career Pathway
• Students complete Pre-Professional requirements
• Pre-requisite courses and clinical observation
  hours
• Years 4 5
• Priority Admission to MS Program
• Professional Education Program
• BOC Exam

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Professional Education Program

• CAATE Accredited Curriculum
• Formal classroom instruction (didactic)
• Skills Lab (Practicum) instruction
• Clinical Experience
• Clinical Research (evidence-based practice)

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Required Course Sequence
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2nd Year Course Sequence
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Clinical Education Plan

• Pre-Professional Requirements
• 200 hours Observation in AT Clinic
• Must learn basic skills
• Professional Education Requirements
• 8 Rotations of 7-weeks/ 140 hours each (4
  semesters)
• Intensives
• Contact/equipment, Upper, Lower, Rehab, Gen Med
• Settings
• On-/off-campus, University, High School, Clinic
• Total 1200 hours

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Affiliated Clinical Sites (14)

• On Campus Traditional Setting
• University of Hawaii, Manoa
• Off Campus Traditional Setting
• Castle High School
• Chaminade University
• Hawaii Pacific University
• Kamehameha School
• Mililani High School
• Moanalua High School
• Punahou School
• Radford High School
• St. Louis School

• Rehabilitation Setting
• Elam Sports Oahu
• Rehab Therapy Partners
• General Medical Setting
• Manoa Family Practice
• Queen Emma Clinic (The Queens
  
• Medical Center)
• Sites Pending
• Kaiser Sports Medicine

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Program Success
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• Questions?

2009 Graduates