The Evolution of Athletic Training Education

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Introduction

Early civilizations shows little evidence of highly organized sports. It was not until the rise of Greek civilization that strongly organized sports began to evolve. Establishment of the Panhellenic Games, which were originally religious festivals the most famous of which were the Olympic Games in time produced medical personnel to assist the athlete in reaching optimum performance. Many of the roles that emerged during this early period are the same in modern societies (Arnheim, 1993).

With the appearance of the professional athlete in Athenian society, the gymnastes came into existence. These men trained their pupils in the skills and techniques of the sports of their day and a rudimentary knowledge of anatomy, physiology, and dietetics to keep the athletes in good condition. Later the medical gymnastai appeared on the scene. Their concern was conditioning the athlete and maintaining them at a high peak of physical efficiency. Possessing some knowledge of diet, rest and exercise and the effect that each has on physical development and performance they used common modalities of their time (baths, exercise, powders).

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Perhaps the greatest of all Greek medical professionals was Herodicus of Megara who was considered a physician as well as what modern society would call an athletic trainer. He performed his duties almost 300 years before Galen, and his chief claim to fame is that was the teacher of Hippocrates who was to become the "father of modern medicine". As far as can be determined Herodicus of Megara was the first physician to recommend exercise as a method of treatment (Arnheim, 1993).

Today, Certified athletic trainers (AT's) are healthcare professionals who collaborate with physicians to optimize activity and participation of patients and clients. Athletic training encompasses the prevention, diagnosis and intervention of emergency, acute and chronic medical conditions involving impairment, functional limitations and disabilities. Athletic training is recognized by the American Medical Association (AMA) as a healthcare profession. There are 6 practice domains in athletic training. They include, prevention; clinical evaluation and diagnosis; immediate care; treatment, rehabilitation and reconditioning; organization and administration; and professional responsibility (Board of Certification forthe Athletic Trainer, 2007-2010).

The three governing bodies of athletic training include The National Athletic Trainers' Association (NATA), the Commission on Accreditation of Athletic Training Education (CAATE) and the Board of Certification (BOC). The NATA is the national membership organization for the profession of athletic training. The Board of Certification, Inc. (BOC) was incorporated in 1989 to provide a certification program for entry-level Athletic Trainers (ATs). The BOC establishes and regularly reviews both the standards for the practice of athletic training and the continuing education requirements for BOC Certified ATs. The BOC has the only accredited certification program for ATs in the US. The BOC began as a committee of the NATA until it was separately incorporated in 1989. Finally the Commission on Accreditation of Athletic Training Education (CAATE) is the agency responsible for the accreditation of 350+ professional (entry-level) athletic training educational programs. The American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), the American Orthopedic Society for Sports Medicine (AOSSM) and the National Athletic Trainers' Association (NATA) cooperate to sponsor the CAATE and collaborate to develop the Standards for Entry-Level Athletic Training Educational Programs.

Chronological History of Athletic Training:

1950: First Meeting of the National Athletic Trainers' Association

1955: NATA Committee on Gaining Recognition appointed

1959: First athletic training curriculum model approved by the NATA

1969: NATA Professional Education Committee (PEC) and NATA Certification Committee developed (former subcommittees of Committee on Gaining Recognition). First undergraduate athletic training curriculums approved by NATA

1970: First national certification examination administered by NATA Certification Committee

1972: First graduate athletic training curriculum approved by NATA

1980: NATA resolution requiring athletic training major, or equivalent, approved by the NATA Board of Directors

1990: Athletic training recognized by as an allied health care profession by the American Medical Association (AMA).

1991: Essential and Guidelines for an Accredited Education Program for the Athletic Trainer approved by the AMA Council on Medical Education

The Joint Review Committee on Education Programs in Athletic Training (JRC-AT) formed

1994: First entry-level athletic training education programs accredited by the AMA Committee on Allied Health Education and Accreditation (CAHEA). Commission on Accreditation of Allied Health Education Programs (CAAHEP) formed and replaced CAHEA as entry level athletic training education program accreditation agency.

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NATA Education Task Force appointed

1996: NATA Education Task Force recommendations approved by NATA Board of Directors

NATA Education Council formed

2006: JRC-AT becomes independent from CAAHEP and changes its name to the Commission on Accreditation of Athletic Training Education (CAATE).

CAATE becomes agency responsible for the accreditation of 368 undergraduate and graduate athletic training education programs

Background

The evolution of athletic training education in the United States is closely intertwined with the history and development of the National Athletic Trainers' Association (NATA). The NATA was founded with a stated purpose to "build and strengthen the profession of athletic training through an exchange of ideas, knowledge, and methods of athletic training." Beginning with this mission statement, athletic training education has continually benefited from the vision, wisdom, and nurturing of numerous NATA members. Shortly after the NATA was founded in 1950, several events that led to the development of athletic training education programs began to unfold. In 1955, William E. Newell at Purdue University became the first athletic trainer to be appointed to the position of National Secretary of the NATA, a position that subsequently became known as the Executive Director. One of Newell's first significant acts was to appoint a committee on Gaining Recognition, which established a forum through which the seeds of athletic training education were planted. As subsequent events revealed, this committee was the forerunner of the NATA Professional Education Committee, the committee that was to oversee athletic training education program development and approval for nearly 3 decades. From this modest beginning athletic training education can be traced through 60 years of change, maturity and emergence as a highly regarded avenue for the preparation of allied health care professionals.

Development of a curriculum model:

Under Newell's leadership as chair, the Committee on Gaining Recognition focused its attention on professional advancement. In 1956, the NATA Board of Directors authorized the committee to study avenues through which the professionalization of athletic training could be enhanced. Athletic training education along with the national certification of athletic trainers, was chosen as the major vehicle. One of the committees initial endeavors was the development of a model curriculum for the professional preparation of athletic trainers. In 1959, after 3 years of work, the committee's recommendations for an educational program were approved by the NATA Board of Directors. Course requirements included in the 1959 athletic training curriculum model included the following:

Prerequisite Courses:

Biology/ Zoology (8 semester hours)

Physics and/or Chemistry (6 semester hours)

Social Sciences (10 semester hours)

Electives

There were also specific and recommended course requirements, if they have not already been met in the above categories. These specific course requirements included the following:

Specific Courses:

Anatomy

Physiology

Physiology of Exercise

Applied Anatomy and Kinesiology

Laboratory Physical Science (6 hours of Physics and/or Chemistry)

Psychology (6 semester hours)

Coaching Techniques

First Aid and Safety

Nutrition of Foods

Remedial Exercise

Organization and Administration of Health and Physical Education

Personal and Community Hygiene

Techniques of Athletic Training

Advanced Techniques of Athletic Training

Laboratory Practices (6 hours of equivalent)

Recommended Courses:

General Physics

Pharmacology

Histology

Pathology

A review of the first athletic training curriculum model adopted in 1959 revealed 2 important features that were directly related to the employability of athletic trainers in the late 1950's and the 1960's. The major feature was an emphasis on the attainment of a secondary-level teaching credential. Largely because of a recognized need for employment of athletic trainers at the secondary school level, the curriculum was designed to prepare the student not only as an athletic trainer but also as a high school teacher, primarily in the areas of health and/ or physical education. Aside from the specified courses listed above, athletic training students were required to complete prerequisites for a teaching credential as defined by their respective colleges and universities. A second major feature of the curriculum was the inclusion of courses that represented prerequisites for acceptance to schools of physical therapy suggested by the American Physical Therapy Association. Perhaps because Newell was both a physical therapist and an athletic trainer, Newell recommended that students pursue a physical therapy degree as a method of further study and as a means of professional growth and employability.

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Based on the premise that development of a specialized common body of knowledge is a prime characteristic of a profession, some observations can be made regarding the contributions of the athletic training curriculum model proposed by the NATA in 1959. Although the development of the curriculum represented an important initial attempt to identify a specific body of knowledge for athletic trainers, a review of the curriculum reveals that it comprised primarily of course work that already existed in 4-year colleges and universities, particularly in departments of physical education or health. With the exception of an advanced athletic training course and laboratory practice in athletic training, the proposed curriculum contained few courses that distinguished it from a typical major in physical education. Essentially the curriculum represented a packaging of the most relevant courses available in related academic areas, rather than an attempt to add new educational experiences based on the identification of learning outcomes specific to athletic training. This early approach to education of athletic trainers is understandable, however, considering that the athletic training educator had not yet emerged on the academic scene. Because of the paucity of qualified instructors and specific athletic training course work, it is also understandable that continuation of the athletic training student's academic preparation through schools of physical therapy was encouraged.

Emergence of Athletic Training Education Programs:

The 10 year period after development of the original curriculum model in 1959 represented a significant void in the implementation of athletic training education programs. During the 1960's, only a few colleges and universities responded to the call for curriculum development. Nevertheless, the seeds of athletic training education began to sprout during the late 1960's. It was not until 1969, however that the first undergraduate athletic training education programs were officially recognized by the NATA. In 1968, a survey of physical education department administrators in colleges and universities throughout the United States revealed that less than one half were aware of the proposed curriculum. It became clear that implementation of athletic training education programs needed a renewed emphasis. In 1969, the Committee on Gaining Recognition, which by now had become known as the Professional Advancement Committee, was divided into 2 subcommittees, the Subcommittee on Professional Education and the Subcommittee on Certification. Sayers "Bud" Miller from the University of Washington was appointed Chair of the Subcommittee on Professional Education, which subsequently evolved into the NATA Professional Education Committee. Despite the slow progress, the Professional Education Committee evaluated and recommended NATA recognition of the first undergraduate athletic training education programs in 1969 at Mankato State University, Indiana State University, Lamar University and University of New Mexico. Thus the NATA curriculum evaluation and approval process was born. During the late 1960's, graduate athletic training curriculums also began to emerge, although eh NATA approval of the first graduate athletic training education programs at Indiana State University and the University of Arizona did not occur until 1972.

Paralleling emergence of the first undergraduate athletic training education programs in the late 1960's, a national certification examination was in the process of development by the NATA Certification Committee, formerly the Subcommittee on Certification. Under the chairmanship of J. Lindsy McLean, Jr from the University of Michigan, the NATA Certification Committee administered the first certification examination in 1970. Subsequently, graduation from an NATA approved athletic training education program (undergraduate or graduate) became one of 4 avenues through which eligibility for certification could be attained. During the ensuing years, completion of an apprenticeship program, graduation from a school of physical therapy, and a special consideration route such as a minimum of 5 years as an "actively engaged" athletic trainer were also established as avenues for certification. With the development of the first certification examination in 1970, athletic training education and national certification began to form parallel, complementary paths to future growth and development. In retrospect, the development of the first NATA approved athletic training education programs and implementation of a certification examination were 2 historically significant events in the professionalization of athletic training, especially as related to community recognition and sanction. As a prime example, the American Medical Association in a 1967 resolution, publicly recognized the importance of the professionally prepared athletic trainer and commended the NATA for its efforts to upgrade professional standards. Similarly, during the next several years, public recognition of the NATA certification process came from various state medical associations, the Joint Commission on Competitive Safeguards and Medical Aspects of Sports and the American Association for Health, Physical Education and Recreation.

Proliferation of NATA Approved Curriculums:

From a historical perspective, the 1970's represented the period of the greatest proliferation of athletic training education programs. In the 12 year period after the NATA recognized the first undergraduate athletic training education programs, the number of curriculums in colleges and universities throughout the country grew steadily, from 4 in 1969 to 62 by 1982. As of June 1982, NATA approved undergraduate programs existed in 33 states. Meanwhile, 9 NATA approved graduate athletic training education programs had been developed. Although the original 1959 curriculum model continued as the basis for undergraduate curriculum approval during the early 1970's the NATA Professional Education Committee continually reviewed and revised course work and clinical experience requirements. As relevant learning experiences evolved and the number of NATA approved undergraduate athletic training education programs increased, expanded opportunities for study specific to athletic training became available to an increasing number of students. Thus, there appeared to be less of a need for athletic training curriculums to include prerequisites for admission to physical therapy schools. Although attendance at physical therapy schools was still encouraged as a means of enhancing professional growth, the subject matter of athletic training began to assume a separate identity. By the mid 1970's a revised athletic training curriculum had evolved which included the following:

Revised Athletic Training Courses:

Anatomy (1 course)

Physiology (1 course)

Physiology of Exercise (1 course)

Applied Anatomy and Kinesiology (1 course)

Psychology (2 courses)

First aid and safety (1 course)

Nutrition (1 course)

Remedial Exercise (1 course)

Personal, community and school health (1 course)

Basic athletic training (1 course)

Advanced athletic training (1 course)

Laboratory or practical experience in athletic training to include a minimum of 600 total clock hours under the direct supervision of a certified athletic trainer.

A comparison of this curriculum with the initial 1959 curriculum model indicates a transition from reliance on schools of physical therapy to a focus on courses considered, at the time to be the most specific to athletic training. Although still recommended as a basis for professional preparation in athletic training, extensive course work in subjects such as chemistry and physics typically required by physical therapy programs was no longer required as a condition of curriculum approval by the NATA. These fundamental curriculum revisions were incorporated into the Guidelines for Development and Implementation of NATA Approved Undergraduate Athletic Training Education Programs, one of the first comprehensive documents governing NATA approval of athletic training education programs. In a related endeavor during the 1970's standards and guidelines governing NATA approval of graduate athletic training education programs were formalized and included in an analogous document also referred to as the Guidelines.

The original 1959 athletic training curriculum model required a course of study leading to a secondary-level teaching credential in physical education or health. Consequently, course work in pedagogy and coaching methods was specified. During the 1970's however it became increasingly clear that high school teaching opportunities in physical education and health were limited. In reality, a teaching certificate in one of these 2 disciplines perhaps served to limit rather than enhance employment of certified athletic trainers at the high school level. The response to this realization was elimination of the requirement that athletic training students pursue a teaching credential in physical education or health. Nevertheless, the emphasis on obtaining a secondary teaching credential was retained throughout the 1970's. Although students in NATA approved undergraduate programs were permitted to pursue the academic major of their choice, completion of requirements for a high school teaching certificate remained as a condition of program approval. This requirement was retained until 1980 after which completion of requirements for a secondary teaching credential was left to the discretion of the student. As a condition of NATA approval, however, colleges and universities sponsoring undergraduate athletic training education programs were still required to offer all courses leading to a secondary- level teaching credential.

A critique of the curriculum model that evolved in the 1970's indicates limited but discernible progress toward identification of specialized common body of knowledge for certified athletic trainers. The elimination of course requirements that were considered to more relevant to physical therapy or physical education than to athletic training serves as an example. Specifying a minimum number of clinical experience hours under the direct supervision of a certified athletic trainer further illustrates a move toward specialized learning experiences. Aside from the establishment of minimum clinical experience requirements, however, no subject matter areas were added to the original 1959 curriculum. Thus, revisions of the 1959 curriculum model that emerged during the 1970's represented an effort to eliminate irrelevant or minimally relevant content rather than an attempt to add new innovative learning experiences. Despite the limited addition of curriculum offerings the effect of these changes was to narrow the focus of athletic training education to a core of courses that could at least, theoretically contribute the most to attainment of athletic training competencies.

In a related project during the 1970's, the NATA Professional Education Committee formalized a list of behavioral objectives that identified desired learning outcomes for the athletic training student. This endeavor represented a significant early step toward the identification of a specialized body of knowledge. Using the 11 required courses that were revised in the 1970's model as a framework, the NATA Professional Education Committee developed a list of behavioral objectives for each course. In addition, a skill competency checklist was developed to guide and monitor development of the student's clinical skills. Because the scope of the behavioral objectives was dictated and restricted by the existing content of required courses, the behavior objectives did not represent a true competency based approach to education of athletic training students. Nevertheless, with identification of relevant courses and development of corresponding learning objectives, the NATA Professional Education Committee began to identify a unique body of knowledge for the certified athletic trainer. In retrospect, the behavioral objectives developed during the 1970's provided a conceptual stimulus to the formulation of the Competencies in Athletic Training subsequently developed by the Professional Education Committee in 1983.

Development of the Athletic Training Major:

During the late 1970's it became apparent to the NATA Professional Education Committee that the increasing level of expertise expected of certified athletic trainers as health care professionals brought with it an obligation to provide educational programs with a broader and more relevant base. The impracticality of providing the desired scope of educational experiences within the confines of academic specializations and concentrations was also recognized. Before his untimely death in 1981, Sayers "Bud" Miller, chair of the Professional Education Committee, proposed the concept of an academic major in athletic training. His creative thinking and vision provided a powerful stimulus for major changes in athletic training education in the 1980's. As the number of NATA approved undergraduate programs proliferated during the 1970's and these programs expanded their course offerings the concept of an athletic training major became increasingly viewed as a reasonable and realistic educational goal. In June 1980, the NATA Board of Directors approved a resolution calling for all NATA approved undergraduate athletic training education programs to offer a major field of study in athletic training by July 1, 1986. As subsequent events demonstrated this resolution provided a major catalyst for the most significant changes in athletic training education to date.

Following Sayers Miller death, the concept of an athletic training major was kept alive under the leadership of John Schrader from Indiana State. Soon after that, Gary Delforge from the University of Arizona was appointed as chair. At least 10 colleges and universities had either received institutional approval for program development or had implemented an athletic training major by 1982. Several other schools were in the planning and developmental stages. Receptivity to the concept of an athletic training major among deans and department heads in colleges and universities with NATA approved undergraduate programs was further substantiated by the results of a Professional Education Committee survey conducted during the 1981-1982 academic year. Support from 62 administrators from colleges and universities was nearly unanimous.

With substantial support from college and university administrators as an incentive, the NATA Professional Education Committee began to develop strategic plans for approval of undergraduate education programs as academic majors. In 1982 the NATA Board of Directors approved a revised timetable for development and implementation of an athletic training major. The original 1980 resolution requiring that an athletic training major be fully implemented in all NATA approved undergraduate programs by July 1986 was revised to require that college and university officials be "in the process" of program development by this date. Subsequently, in June 1982 the Board of Directors approved a policy requiring withdrawal of NATA approval if college or university personnel failed to meet the July 1986 deadline. Correspondingly, procedures to demonstrate compliance were approved. To be considered in the process of developing an athletic training major, an institution sponsoring an NATA approved undergraduate program was required to submit a letter from the administrator of the sponsoring department attesting to initiation of program planning and the intent to meet the implementation deadline. Additional required documents included a list of program goals and objectives, strategies for meeting the stated goals and objectives and implementation progress reports. As part of the revised timetable for implementation of an athletic training major, the NATA Board of Directors extended the original deadline to July 1990. This policy applied to all colleges and universities with undergraduate athletic training education programs initially approved by the NATA before July 1986. In addition the Board of Directors adopted a policy that after July 1986, initial NATA approval would be given only to programs that met the standards for an academic major.

Following the establishment of a realistic timetable for implementation, the Professional Education Committee turned its attention to development of the components of an athletic training major. The Committee's efforts culminated in publication of the 1983 edition of the Guidelines for Development and Implementation of NATA Approved Undergraduate Athletic Training Education Programs. This document contained the standards for development of undergraduate programs as academic majors. Publication of the Guidelines initiated the transformation of NATA approved undergraduate athletic training education programs specializations or concentrations to more comprehensive academic majors. A primary consideration that guided the development of the 1983 Guidelines was the concept of an equivalent academic major. Realizing the difficulty in obtaining administrative approval of new academic programs in some colleges and universities, the Professional Education Committee developed the following definition of an equivalent athletic training major, which was approved by the NATA Board of Directors in February 1982: "A course of study on athletic training which is at least equivalent to the minimum number of semester/quarter hours which constitutes a major in the educational unit in which the athletic training education program is housed. The athletic training education program must also be designed so that students are provided with adequate opportunity to meet NATA specified behavioral objectives".

As a guide to curriculum development the Professional Education Committee offered a definition of an equivalent major as applied to a hypothetical situation. The committee's interpretation stipulated that, if a program of study in athletic training existed in a department of physical education that required a minimum of 45 semester units did not provide adequate opportunity for students to attain NATA specified behavioral objectives.

The policy allowing for NATA approval of an equivalent major precluded the need for an athletic training education program to receive institutional approval as a degree-granting program, thus facilitating implementation. Nevertheless, undergraduate programs receiving NATA approval as equivalent majors were held to the same standards as degree-granting programs with regard to the scope and relevancy of course offerings. The flexibility allowed by the equivalent major facilitated identification of relevant course offerings in the sponsoring department or allied departments, addition of appropriate courses if necessary and incorporation of these courses into an existing bachelor's degree program.

In addition to the athletic training major, the 1983 Guidelines incorporated 2 major features that represented conceptual changes in curriculum design. The first feature was inclusion of specialized subject matter requirements, rather than specific courses. This design included the following:

Specialized Subject Matter in Athletic Training:

Prevention of athletic injuries/ illnesses

Evaluation of athletic injuries/ illnesses

First aid and emergency care

Therapeutic modalities

Therapeutic exercise

Administration of athletic training programs

Human anatomy

Human physiology

Exercise physiology

Kinesiology/ biomechanics

Nutrition

Psychology

Personal/ community health

Instructional methods

In contrast with the curriculum design based on specified courses, the subject matter approach permitted greater flexibility in the development of educational experiences with varying degrees of emphasis on specific learning outcomes. The required subject matter could be developed as separate courses or incorporated as instructional units within existing courses depending on determination of the appropriate emphasis. Developed during the 1981-1982 academic year, the Competencies in Athletic Training represented the second major component of the 1983 Guidelines. These Competencies, which replaced the behavioral objectives developed during the 1970's were based on the performance domains of a certified athletic trainer identified in the first role delineation study conducted by the NATA Board of Certification in 1982. Incorporation of the subject matter requirements and athletic training competencies into the 1983 Guidelines represented an effort to promote the development of true competency-based athletic training education programs.

AMA Recognition and CAHEA Accreditation:

During the late 1980's, preliminary work began that led to a milestone in the professional growth of athletic training education. In June 1990, the American Medical Association (AMA) formally recognized athletic training as an allied health care profession. Several preliminary steps related to accreditation of entry-level athletic training education programs preceded AMA recognition. Efforts to obtain AMA recognition began with a decision by the NATA Board of Directors to seek accreditation of entry level programs by the AMA Committee on Allied Health Education and Accreditation (CAHEA). As per AMA policy, formal recognition as an allied health care profession was necessary prerequisite for educational program accreditation by CAHEA. Thus, AMA recognition was sought for the primary purpose of programmatic accreditation through the CAHEA process.

In October 1990, CAHEA staff members and NATA Professional Education Committee representatives met to form a review committee, one of the individual committees responsible for review of allied health care education programs accredited by CAHEA. Various medical and allied health organizations involved in sports medicine were contact to assess their interest as potential cosponsors. As a result, the American Academy of Family Physicians and the American Academy of Pediatrics joined the AMA and the NATA in appointing representatives to form a joint review committee, formally called the Joint Review Committee on Educational Programs in Athletic Training (JRC-AT). Subsequently, in January of 1995 the American Orthopedic Society for Sports Medicine joined the JRC-AT as a new cosponsor. During the 8 year period after the initial formation of the JRC-AT, Robert Behnke served in a dual capacity as the first chair of the JRC-AT and as chair of the NATA Professional Education Committee until the election of Peter Koehneke from Canisius College as chair of the JRC-AT in January 1998 and until disbandment of the NATA Professional Education Committee in June 1998.

Once organized, the first task of the JRC-AT was the development of standards and guidelines to govern JRC-AT review and CAHEA accreditation of entry-level programs. This process was greatly facilitated by previous NATA Professional Education Committee efforts. With some modifications, the Guidelines for the Development and Implementation of NATA Approved Undergraduate Athletic Training Education Programs served as a basis for development of a new document, particularly as related to curriculum content and design. Basic concepts related to course subject matter requirements and the academic major in athletic training were incorporated. In addition, the Competencies in Athletic Training developed by the NATA Professional Education Committee in 1983 was retained as a companion document. In cooperation with CAHEA staff members, the JRC-AT incorporated the major provisions of the NATA Guidelines into a standardized CAHEA format. Subsequently, essentials and Guidelines for an Accredited Education Program for the Athletic Trainer was approved by the cooperating organizations and the AMA CME on December 6, 1991.

With completion of the Essentials, the mechanisms for JRC-AT program review were in place. In June 1993, the NATA Professional Education Committee discontinued its approval process for undergraduate athletic training education programs and in February 1994 the first 2 entry-level athletic training education programs at Barry University and High Point University were accredited by CAHEA. Accreditation of athletic training education programs by CAHEA was short lived. In October 1992, the AMA proposed the establishment of a new free standing agency for the accreditation of education programs in allied health care professions. As proposed by the AMA, CAHEA was disbanded and in July 1994, the AMA became a cosponsor rather than the primary sponsor of a new independent agency, the Commission on Accreditation of Allied Health Education Programs (CAAHEP). As was the case with CAHEA, the United States Department of Education recognized CAAHEP as an accreditation agency for educational programs in the allied health professions. Changes in federal regulations, however, led to voluntary discontinuation of United States Department of Education recognition in 1998. Private sector recognition of CAAHEP came from the Commission on Higher Education Accreditation (CHEA), a new organization formed by university presidents after disbandment of the Council on Postsecondary Education Accreditation in 1993.

Although the CAHEA Essentials became known as Standards and CAHEA review committees were referred to in the CAAHEP system as committees on accreditation, the CAAHEP accreditation procedures remained essentially the same as those used by CAHEA. Because of the similarities in the review process, accreditation of entry-level athletic training education programs continued without interruption during the transition from CAHEA to CAAHEP. During the 4 year period after CAHEA accreditation of the first 2 programs in 1994, athletic training education programs previously approved by the NATA were reviewed and accredited as new programs. As of June 1998, 82 entry level programs had been accredited by CAAHEP including 68 previously NATA approved undergraduate programs. With scheduling of additional programs for review during the fall 1998, the transition from the NATA education program approval to CAAHEP accreditation of entry level educational programs was compelte.

During the mid 1990's, 2 related policy changes by the NATA Board of Directors and the NATA Board of Certification affected entry level and graduate athletic training. First, the NATA Professional Education Committee implemented the policy that as of August 1996, NATA approval of graduate athletic training education programs would be granted only to those programs that offered "advanced" learning experiences beyond those required for CAAHEP accreditation of an entry-level athletic training education program. Correspondingly in June 1998 the NATABOC discontinued "completion of an NATA approved graduate athletic training program" as a route to certification. As a consequence, NATA approval of graduate level programs required admission of students who had completed all the requirements to sit for the certification examination or applicants who were NATABOC certified. Although CAAHEP policies permitted accreditation of entry level programs at the graduate level, these NATA and NATABOC policy changes established a clear distinction between entry level program accreditation by CAAHEP and advanced graduate program approval by the NATA. With discontinuation of NATA approved graduate athletic training education programs as a route to certification, further standardization of entry-level education requirements for certified athletic trainers was achieved. At the same time, however, advanced learning opportunities were encouraged through continued NATA recognition of graduate programs.

The delineation between entry-level and postcertification athletic training education in 1996 established new parameters for advanced learning and research at the graduate level. As indicated in the Guidelines for Development and Implementation of NATA Approved Graduate Athletic Training Education Programs, research and scientific inquiry are considered distinguishing characteristics of graduate education. Despite this emphasis, Osternig in 1998 noted that research in athletic training had "evolved much more slowly than practice and education". He referred to research as the "missing ingredient" in the pursuit of professionalism. In 1991, however research was given a significant boost with the establishment of the NATA Research and Education Foundation (NATA-REF), later referred to as the "Foundation". As the result of an aggressive fund-raising campaign during the 1990's the NATA-REF sponsored numerous research projects and awarded a significant number of academic scholarships. As evidenced by the number of publications in the Journal of Athletic Training research productivity among certified athletic trainers increased dramatically during the 1990's. By the end of the decade, research was no longer viewed as a missing ingredient, and athletic training education had added a new dimension.

In 1997, a second major policy change by the NATABOC also represented significant step forward toward standardization of education requirements for certified athletic trainers. In December 1996, the NATA Board of Directors adopted several recommendations submitted by the NATA Education Task Force an ad hoc task force appointed in June 1994 to address the education and professional preparation for certified athletic trainers. Among the 18 recommendations submitted to and subsequently approved by the Board of Directors was the recommendation that the NATA and the NATABOC work together to institute a requirement to take effect in 2004 that in order to be eligible for NATABOC certification all candidates must possess a baccalaureate degree and have successfully completed a CAAHEP accredited entry level athletic training education program. Pending implementation of this policy in 2004 current internship route to NATABOC certification would be discontinued. With the elimination in the early 1980's of physical therapy programs and the special consideration route to certification with discontinuation in 1998 of advanced graduate athletic training education programs and with the impending elimination of the internship route, CAAHEP accredited entry-level athletic training education programs will become the only avenue to NATABOC certification. As noted by the NATA Education Task Force in 1996 this consolidation was proposed to standardize athletic training education and enhance consistency with professional preparation in other allied health disciplines. With this explanation, the Task Force recognized the contributions of a standardized education system to the development of a specialized common body of knowledge among certified athletic trainers.

The Education Task Force and Education Council:

With the formation of the Education Task Force in June 1994, the NATA extended the foundation for growth in athletic training education. The Education Task Force was charged with reviewing all aspects of athletic training education including undergraduate, graduate and continuing education. Additionally the NATA Board of Directors challenged the task force to present recommendations that would "influence the decisions the NATA Board of Directors must make concerning the future direction of athletic trainer education and professional preparation." Furthermore, the Board of Directors proclaimed that there should be "no limitations in this task force's scope of evaluations and/or recommendations."

Presented with these challenges the Education Task Force began an exhaustive 2 year study with John Schrader from Indiana University and Richard Ray from Hope College as cochairs. After identification of major issues and an analysis of future challenges in athletic training education, the task force formulated and presented 18 recommendations, with supporting rationale, to the NATA Board of Directors in December 1996. All Task Force recommendations were adopted. As directed, the task force addressed the wide range of education issues related to curriculum design, preparation of athletic training educators, program accreditation and coordination of NATA education functions.

One of the Education Task Force recommendations was based on an identified need to "streamline the educational functions of the NATA". Concerned about duplication of educations services among various NATA committees and related groups, the task force recommended the creation of an Education Council to serve as the "clearinghouse for educational policy, development and delivery". In March 1996, the Education Council was formed to implement the Education Task Force recommendations, including continued dialogue with the Committee on Accreditation, the review committee for entry-level athletic training in the CAAHEP accreditation system. As proposed, approval of advanced graduate athletic training education programs now referred to as "accreditation" remained with the NATA. Accordingly, a revised document Standards and Guidelines for the Development and Implementation of NATA Accredited Graduate Athletic Training Education Programs was developed in 1997. With development of new Standards, NATA accreditation of graduate athletic training education programs was implemented.

Following the creation of Education Council, the NATA Professional Education Committee was officially disbanded in June 1998, after guiding the development of athletic training education for the previous 28 years. Under the chairmanship of Chade Starkey from Northeastern University, the Executive Committee of the Education Council established 3 standing committees to address education issues at various levels: entry-level education, advanced graduate education, and continuing education. With this structure and with the appointment of ad hoc committees to revise the Competencies in Athletic Training and review clinical education, the Education Council was organized to provide continued leadership in the professional preparation of certified athletic trainers.

Athletic Training Education Programs Today

To date there are 368 Commission on Accreditation of Athletic Training Education (CAATE) programs in the United States at both the undergraduate and graduate levels. By the year 2015 all athletic training students graduating in the field of athletic training will have a Bachelor of Science in Athletic Training (BSAT) or a Master of Arts or Science in Athletic Training (MAATor MSAT). The American Academy of Family Physicians (AAFP), The American Academy of Pediatrics (AAP), the American Orthopedic Society for Sports Medicine (AOSSM), and the National Athletic Trainers' Association, Inc. (NATA), cooperate to sponsor the CAATE and to collaboratively develop the Standards for Entry-Level Athletic Training Educational Programs.

These Standards of education, which include objective criteria and academic requirements for accredited programs in Athletic Training, require not only specific and defined processes, but also programmatic outcomes for the evaluation. The Standards are reviewed on a periodic basis to assure currency and relevance; input of not only the sponsoring agencies, but also the colleges and universities, as well as Athletic Trainers who utilize the services of the CAATE or who employ the graduates of CAATE accredited programs.

Imbedded in the Standards are the NATA Educational Competencies and Clinical Proficiencies (NATA Competencies). The NATA Competencies are the intellectual property of the NATA and are designed to delineate a standardized educational content required by an entry-level Athletic Trainer. The review process for the NATA Competencies is similar to that of the Standards.

Successful completion of a CAATE-accredited educational program is a criteria used to determine a candidate's eligibility for the Board of Certification (BOC) examination. To assure continued acceptance of CAATE-accredited program graduates, the BOC also reviews and accepts the CAATE Standards as sufficient to prepare entry-level Athletic Trainers to meet the required Standards of Practice and to contain all pertinent learning and skills needed to protect the public. The Board of Certification is a NOCA-recognized certifying agency for Athletic Training. NOCA (National Organization for Competency Assurance) promotes excellence in competency assurance for practitioners in all occupations and professions.

As a member of CAAHEP, the JRC-AT was recognized by the Council on Higher Education Accreditation (CHEA), and was a member of the trade association for specialized accreditors, Association of Specialized Professional Accreditors (ASPA), as well as was recognized by the Association of Schools of Allied Health Professions (ASAHP). In 2007, CAATE applied to become an independent member of ASPA and was invited to participate in several ASAHP forums. The CAATE also continued to attend all CHEA-sponsored events and began the necessary steps to gain CHEA-recognition.

Athletic Training Courses Today:

Prerequisite Courses:

Human Anatomy (2 courses/ 2 labs)

Human Physiology (2 courses/ 2 labs)

Introduction to Athletic Training (1 course)

Functional Anatomy (1 course)

Personal Health (1 course)

Core Courses:

Foundations of Athletic Training (1course/ 1 lab)

Emergency Medicine for the Athletic Trainer (1course/ 1 lab)

Exercise Physiology (1 course/ 1 lab)

Biomechancis (1 course/ 1 lab)

Orthopedic Assessment of Injury & Illness (4 courses/ 4 labs)

Therapeutic Modalities (1 course/ 1 lab)

Nutrition (1 course)

Pharmacology (1 course)

Strength and Conditioning (1 course)

Motor Development (1 course)

Rehabilitation and Psychosocial Intervention of Injury/ Illness (1 course/ 1 lab)

Medical Aspects of Sports Related Injury/ Illness (2 courses)

Administration of Athletic Training Programs (1 course)

Along with these prerequisite courses, core courses and the required general education courses from the University to fulfill a degree, the athletic training student must complete between 1,000 and 1,200 clinical education hours.

Conclusions: The Future of Athletic Training:

Because of the rapid growth in the field of athletic training, employment settings for certified athletic trainers (AT's) have expanded a great deal over the past 10 years. The expanding job market has been met with an increase in the number of Commission on Accreditation of Athletic Training Education (CAATE) accredited athletic training education programs nationwide. There are currently 368 undergraduate and graduate athletic training education programs in the country. Some of the employment settings for AT's include professional and collegiate sports, secondary and intermediates schools, sports medicine clinics, hospital ER and rehab clinics, occupational settings, fitness centers and physician offices. Many of the positions that are assumed by the AT are in a leadership capacity, yet as much as the athletic training profession has grown, there is still no formal leadership courses or training to prepare athletic trainers for these roles.

As athletic training moves out of its humble roots from the 1950's and continues to grow to one of the fastest growing professions of the new era, it is obvious that leadership will be an important aspect in athletic training and thus leadership training and skills will be important for athletic trainers. The Role Delineation Study, 4th Edition for the Entry Level Athletic Trainer conducted by the Board of Certification identifies leadership as one of the roles of the certified athletic trainer. According to the study, athletic trainers are responsible for managing human resources to provide efficient and effective health care and educational services. Employers also are aware of the need for leadership from athletic trainers and look for leadership skills when hiring them. In addition, program directors report the opportunity to lead as one of the most beneficial aspects of their job.

Although leadership has been extensively studied in many contexts and within many populations, to date very little research has been conducted on leadership in athletic training. Five articles dealing with some faction of leadership (eg, job satisfaction, career pathway) have been published in the Journal of Athletic Training. Of these 5 articles, only 2 have focused specifically on leadership. The authors of both manuscripts used research from other disciplines to make inferences regarding athletic training. To date, no original research has been conducted on the leadership practices of athletic trainers.

Effective leadership is important to the profession of athletic training, because leaders can positively influence job satisfaction and perception of the importance of a job. Effective leaders also help to reduce the level of perceived stress of athletic trainers. In a profession in which long hours and lack of control can lead to burnout, leaders are essential to fostering a positive work environment that minimizes turnover. Athletic training leaders appear to be practicing the behaviors that positively influence people and the work environment.

As the profession of athletic training grows and expands, so do the athletic training education program curriculum models and the administrators and instructors that facilitate the athletic training education programs. During the past 2 decades the expanding roles and responsibilities of athletic training education program directors (ATEPD's) of athletic training education programs (ATEP's) in colleges and universities has lead to a multifaceted position that has increased in complexity and workload. The requirements of the position as an ATEPD have evolved to include a myriad of responsibilities in program administration and management, teaching, research and service. The responsibilities include, but are not limited to student recruitment and retention, mentoring, clinical education, accreditation requirements, assessment, scholarly activity, and committee work. Also, the position may include continued responsibility in the clinical role as an athletic trainer.