THE RELATIONSHIP BETWEEN FIRST TIME BOARD OF CERTIFICATION
PASSING RATE AND ENTRY-LEVEL PROFESSIONALS’ PRECEIVED
CONFIDENCE UPON LENGTH OF ATHLETIC TRAINING CLINICAL
EDUCATION

A THESIS
Submitted to the Faculty of the School of Graduate Studies
and Research
of
California University of Pennsylvania in partial
fulfillment of the requirements for the degree of
Master of Science

by
Megan Little

Research Advisor, Dr. Linda P. Meyer
California, Pennsylvania
2012

ii

iii

ACKNOWLEDGEMENTS

First, I want to say thank you to God for blessing me
with the opportunity to accomplish all that I have done.
Second, I want to thank my family for all the support you
have given me. My 4 parents and 7 siblings have offered me
tons of support and love. Aunty Jo, thank you for being so
supportive of me in every decision I have made – that has
not gone unnoticed. I want to thank my CalU and LC
classmates and professors for all of your help and support.
You are all great (especially Dr. Meyer, Dr. Ellen West,
Dr. Barnhart and Dr. Tom West)! I would not be where I am
today without you all. I want to thank the Brown family for
being a major means of support over the past 3 years. You
all have always been there to support me – even when I did
not deserve your love and support. Thank you all for that.
Anson, you are the final individual that I would like to
thank. You are amazing and have been a true blessing in my
life. I love you to death and cannot put in words how much
I want to thank you for everything (big and small) you have
done for me over the past 3 years. You are an incredible
individual; this thesis, graduation, and entire year would
have not been possible without you. Thank you.

iv
TABLE OF CONTENTS
Page
SIGNATURE PAGE

. . . . . . . . . . . . . . . ii

AKNOWLEDGEMENTS . . . . . . . . . . . . . . . iii
TABLE OF CONTENTS
LIST OF TABLES
INTRODUCTION
METHODS

. . . . . . . . . . . . . . iv

. . . . . . . . . . . . . . . vi

. . . . . . . . . . . . . . . . 1

. . . . . . . . . . . . . . . . . . 6

Research Design
Subjects

. . . . . . . . . . . . . . 6

. . . . . . . . . . . . . . . . . 7

Preliminary Research. . . . . . . . . . . . . 8
Instruments . . . . . . . . . . . . . . . . 9
Procedures

. . . . . . . . . . . . . . . . 9

Hypotheses

. . . . . . . . . . . . . . . . 10

Data Analysis
RESULTS

. . . . . . . . . . . . . . . 10

. . . . . . . . . . . . . . . . . . 11

Demographic Data . . . . . . . . . . . . . . 11
Hypothesis Testing

. . . . . . . . . . . . . 12

Additional Findings . . . . . . . . . . . . . 15
DISCUSSION . . . . . . . . . . . . . . . . . 19
Discussion of Results . . . . . . . . . . . . 20
Conclusions . . . . . . . . . . . . . . . . 24
Recommendations. . . . . . . . . . . . . . . 26

v
REFERENCES . . . . . . . . . . . . . . . . . 28
APPENDICES . . . . . . . . . . . . . . . . . 29
APPENDIX A: Review of Literature

. . . . . . . . 30

Introduction . . . . . . . . . . . . . . . . 31
Commission on Accreditation of Athletic
Training Education

. . . . . . . . . . . . . 32

Board of Certification

. . . . . . . . . 39

Other Professions’ Education
Student Confidence

. . . . . . . . . 42

. . . . . . . . . . . . 43

Theories Based on Teaching Techniques . . . 45
Summary . . . . . . . . . . . . . . . . . . 48
APPENDIX B: The Problem . . . . . . . . . . . . 50
Statement of the Problem . . . . . . . . . . . 51
Definition of Terms . . . . . . . . . . . . . 51
Basic Assumptions . . . . . . . . . . . . . . 52
Limitations of the Study . . . . . . . . . . . 52
Significance of the Study

. . . . . . . . . . 53

APPENDIX C: Additional Methods .

. . . . . . . . 54

Online Survey (C1) . . . . . . . . . . . . . . 55
IRB: California University of Pennsylvania (C2) . . 70
REFERENCES
ABSTRACT

. . . . . . . . . . . . . . . . 82

. . . . . . . . . . . . . . . . . 86

vi
LIST OF TABLES

Table

Title

Page

1

Success on Board of Certification Exam
Based on Athletic Training Clinical
Education Length . . . . . . . . . . . 12

2

Mean Confidence Score Based on Athletic
Training Clinical Education Length . . . . 14

3

Mean Confidence Rankings (SD,
Significance level) by Athletic
Training Practice Domain . . . . . . . . 15

4

Frequency of Tools Used To Prepare For
Board of Certification Exam . . . . . . . 16

5

Overall Entry-Level Preparedness As a
Certified Athletic Trainer Based on
Clinical Education Length (mean,
standard deviation) . . . . . . . . . . 18

1

INTRODUCTION

The purpose of this study was to analyze if a
relationship exists between the length of clinical
education experience and student confidence to enter the
work field and first time Board of Certification (BOC)
passing rates in recently certified athletic trainers.
Examining this relationship was important for athletic
training education analysis and growth. If a relationship
existed between the variables in this study, programs could
use this information to adapt their curriculum and
potentially better their BOC first time passing rate. The
relationships studied in this research project have the
potential to change athletic training education in the
entry-level setting, and thus have a large impact on the
profession. Research has been conducted on all of the
individual variables reviewed within this study, but no
research has been found to determine how these variables
affect each other if at all.
The Commission on Accreditation of Athletic Training
Education (CAATE) is the agency that sets the standards for
both graduate and undergraduate athletic training entrylevel education. A significant amount of research has been

2
performed to analyze the effectiveness and applicability of
the CAATE standards. One set of researchers, Williams and
Hadfield,3 examined both didactic and clinical education and
how they relate to the BOC exam. The researchers then used
this information to determine the most appropriate
curriculum for educating students on the six athletic
training practice domains; these include prevention,
clinical evaluation and diagnosis, immediate care,
treatment rehabilitation and reconditioning,
administration, and professional responsibility. The
researchers did this via a survey that was sent to evaluate
how certified athletic trainers learned the information
within the six domains, and determine the number of clinic
education rotations, grade point average (GPA) requirement,
faculty responsibilities, faculty terminal degrees, and
other variable. This study found that student pass rates on
the BOC exam are greatly affected by the faculty that teach
the students. The number of faculty who hold terminal
degrees within their educational program affected the
students’ passing rates more than the way the students
learned the information within the domains. The type of
presentation the professors used (oral lecture, hands-onlearning, and others) and the level of degree that the
professors had affected the passing rate on the BOC exam

3
more than the number of times the information was
presented. This is important when examining the reasoning
behind the pass rates within an athletic training education
program.
Another research study, conducted by Weidner and
Laurent,2 was aimed directly at the evaluation techniques
CAATE uses to critique clinical education sites. The
authors used standards that were already set for the use of
evaluating physical therapy sites and combined them with a
newly developed evaluation form more suited for athletic
training. The subjects within this study were program
directors, clinical instructors, and students from 28
different accredited entry-level athletic training
education programs. The measurements that were collected
were in the form of the respondents’ critiques of the
clinical sites. These were then rated to identify relevant,
practical, and high-quality clinical education. This study
determined that the tools used for evaluating these sites
should be used as guidelines rather than minimal criteria
due to the fact that they are subjective in nature.2
One study, by Stiller-Ostrowski et al, evaluated the
level of preparation recently certified athletic trainers
had in the practice domain of Psychosocial Intervention and
Referral. This qualitative design used athletic trainers

4
from differing undergraduate athletic training education
programs and current job settings. Interviews were
transcribed and analyzed to find that these professionals
had very limited experience in this area. This was an area
in which these individuals claimed to struggle. Areas of
weakness are important to know and analyze to improve the
quality of athletic training education.3
The level at which a person has been prepared for a
situation can affect how confident he or she is in handling
it. In addition to being prepared to deal with a situation,
student confidence is also reliant on the ability of
him/her to critically think through an issue. The purpose
of a study by Leaver-Dunn et al4 was to evaluate the
tendency of undergraduate athletic training students to
think critically in certain situations. The authors
suggested that professors stimulate the process of critical
thinking within the classroom. The stimulation of critical
thinking within the classroom is important because the
tactics are used in the classroom they then can be
implemented in clinical education to decrease the amount of
downtime and make the clinical experience more rewarding.
The results of the present study help to guide
athletic training education. This study will show if
relationships exist among aspects of education that can be

5
adapted and modified. To a practicing clinician who works
with students, this study might highlight the level of
perceived importance of his/her job to senior level
students. To an educator, this study may encourage program
adaptations or flexibilities. Analysis such as what these
researchers did is extremely important for the continued
development within the discipline of athletic training.
This study is significant to the growth and
development of athletic training education in that it
analyzed potentially existing relationships in an effort to
determine what curriculum is best for the success of the
student. The results of this study may help to change
athletic training education.

6

METHODS

The primary purpose of this study was to examine the
relationship of length of clinical education on student
confidence and first time Board of Certification passing
rate. This section includes the following subsections:
research design, subjects, instruments, procedures,
hypotheses, and data analysis.

Research Design

This descriptive research utilized a survey style
design. The independent variable for this study was the
length, in years, of the clinical education experience of
students who have graduated from an accredited entry-level
athletic training education program.

This condition had

two levels: less than three years and greater than or equal
to three years.

The dependent variables were student

confidence and self-reported performance of the first
attempt at the Board of Certification exam. A panel of
experts and a preliminary group of participants reviewed

7
this survey prior to data collection to improve the
instrument’s validity and reliability.

Subjects

The participants used for this study were 1,000
randomly selected certified athletic trainers who are
members of the National Athletic Trainers’ Association and
over the age of 18 years old. The NATA selected and
electronically distributed the survey to these members that
have specific attributes according to their databases. The
specific attributes necessary to qualify to participate in
this study include having graduated from a CAATE accredited
program and have been certified through the Board of
Certification within the past two calendar years. The first
three questions of the survey determined participants’
eligibility to participate in the study. If participants
did not qualify, they were thanked for their time and their
survey was immediately terminated.
Each participant was asked to complete an online
survey (Appendix C1). This survey consisted of eighteen
questions that were answered using a five-point Likert
scale, a six-point ranking scale, or yes or no answers.
Informed consent was assumed by his/her completing the

8
survey. The study was approved by the Institutional Review
Board (Appendix C2, C3, C4) at California University of PA
prior to data collection.

Each participant’s identity

remained confidential and was not included in the study.

Preliminary Research

After the researcher created the survey, a panel of
experts evaluated it for individual question reliability
and validity. Necessary modifications were made and the
survey was sent to a preliminary group of participants on
two occasions with seven days between each viewing. This
preliminary research tested for consistency and reliability
of the survey questions. This sample of convenience group
of participants consisted of 15 subjects that met the
criteria of the study. The researcher was looking for
variance in answers from the first trial to the second
within each participant. Reliability was determined via
appropriate statistical analysis and questions with
moderate to weak correlation coefficients were modified or
deleted from the final survey instruments.

9

Instruments

An eighteen question survey (Appendix C1) evaluated
the relationship that length of clinical education has on
confidence and first-time Board of Certification passing
rate, using a 5-point Likert scale, 6-point ranking scale,
and yes or no questions.

Procedure

An email template explaining electronic informed
consent and a cover letter explaining the purpose of the
survey was compiled. All of the required information was
submitted to the National Athletic Trainers’ Association
(NATA) to be distributed to one thousand participants that
fit the criteria explained. Within the e-mail template,
there was a link to the online survey. Two weeks after the
NATA sent out the first email, a reminder email was drafted
and sent. At the end of the third week, the survey was
closed and the data was analyzed.

10
Hypotheses

The following hypotheses were based previous research
and the researcher’s intuition based on a review of the
literature.
1.

There will be no difference in first-time BOC
passing rate dependent upon clinical education
length.

2.

There will be no difference in confidence
dependent upon clinical education length.

Data Analysis

All data was analyzed using SPSS version 18.0 for
Windows at an alpha level of 0.05. The research hypotheses
were analyzed using a repeated measures analysis of
variance. A Chi-square test was used to examine the
relationship between first-time Board of Certification pass
rate and clinical education length. In addition, an
independent t-test was used to determine if a relationship
exists between confidence level and clinical education
length.

11

RESULTS

The following section contains the data collected
throughout this study via survey research. It is organized
into three subsections: Demographic Education Information,
Hypotheses Testing, and Additional Findings.

Demographic Information

One thousand members of the National Athletic
Trainers’ Association who met the qualification criteria
were chosen at random to participate in the survey. These
individuals received the cover letter along with a link to
the survey via the email address they had given to the NATA
via their demographic information. Two hundred and eighty
individuals attempted the survey. Of those individuals, 188
met the criteria to complete the entire survey. Of the 188
qualified individuals, 40.96% (n=77) stated they attended
an athletic training education program that had a clinical
education length of less than three years. The remaining
59.04% attended a Clinical Education program three years or

12
more in length. These statistics in addition to overall
Board of Certification success can be seen in Table 1.
Table 1. Success on Board of Certification Exam Based on
Athletic Training Clinical Education Length
Clinical Did Pass BOC on Did Not Pass
Total
Education
First Attempt
BOC on First
Length
Attempt
< 3 years
84
9
93
≥ 3 years
116
17
133

Hypothesis Testing

The following hypotheses were tested in this study.
All hypotheses were tested with a level of significance set
at α ≤ 0.05. A Chi-square analysis was completed to test
the first hypothesis. The second hypothesis was tested
using an independent t-test.
Hypothesis 1:

There will be no difference in first

time BOC pass rate dependent upon clinical education
length.
Conclusion: A chi-square test of independence was
performed to examine the potential relationship between
length of clinical education and first-time Board of
Certification passing rate. The relation between these
variables was not statistically significant, (Χ2(1)=.518, p>
.05).

13
In order to assess this hypothesis, participants were
asked to answer a yes or no question about their initial
success on the Board of Certification exam. Eighty-four
individuals who attended a clinical education program less
than three years in length reported to have passed the
Board of Certification exam on their first attempt. Nine
individuals from the same clinical education length group
reported to have not passed the Board of Certification exam
on their first attempt. One hundred sixteen participants
who attended a clinical education program of greater than
or equal too three years reported to have passed the Board
of Certification exam on their first attempt. Seventeen
participants in the same clinical education length group
reported to not have passed the Board of Certification exam
on their first attempt. Of the individuals whom
participated in a clinical education program of less than
three years, there was a reported 90.3% first-time Board of
Certification passing rate. Of the individuals whom
participated in a clinical education program of greater
than or equal to three years, there was a reported 87.2%
first time Board of Certification passing rate. There was
no statistical significance between these numbers
(Χ2(1)=.518, p >.05). Please refer to Table 1 for an outline
of these statistics.

14
Hypothesis 2:

There will be no difference in

confidence dependent upon clinical education length.
Conclusion:

An independent-samples t test was

calculated comparing the mean scores of the two clinical
education length groups in terms of individuals’ confidence
levels. No significant difference was found (-.477(218) =
.916, p > .05). The mean confidence score, which was
calculated by summing the scores from questions 8, 11, 13
and 14, of individuals with less than three years of
clinical education experience was (m = 16.3, sd = 2.46) not
significantly different from the mean of individuals with
greater than or equal to three years of clinical education
length (m = 16.4, sd = 2.57). The means and standard
deviations for this data are depicted in Table 2.

Table 2. Mean Confidence Score Based on Athletic Training
Clinical Education Length
Clinical
Confidence
Standard
Education
Score
Deviation
Length
< 3 years
16.3
2.46
≥ 3 years
16.4
2.57

There was one confidence-based question that was not
included in the overall confidence score. This was question
16 of the survey. This question assessed confidence level

15
through ranking each domain of athletic training (Table 3).
Overall, there is no significant difference between length
of clinical education levels and entry-level confidence.
The means and significance levels for each aspect of this
question can be seen in Table 3.

Table 3. Mean Confidence Rankings (SD, significance level)
by Athletic Training Practice Domain
ClinEd
Admin
EmResp
Eval
InjPrev
PsyInt
TherEx
1 (< 3
years)
2 (≥ 3
years)

4.8
(1.17,
.298)
4.9
(1.24,
.298)

2.8
(1.36,
.112)
2.5
(1.24,
.112)

1.8
(.98,
.247)
2.0
(1.06,
.247)

2.9
(1.07,
.792)
2.9
(1.45,
.792)

5.3,
(.94,
<.001*)
4.8,
(1.13,
<.001*)

3.2
(1.45,
.079)
3.5,
(1.48,
.079)

Confidence Ranking – 1=Most confident, 6=least confident
ClinEd=Clinical Education Length Group
Domains – Administration=Admin, EmResp=Emergency Response, Eval=Injury
Evaluation, InjPrev=Injury Prevention, PsyInt=Psychosocial
Intervention, TherEx=Therapeutic Exercise
*=Significance is <.05

Additional Findings

Other tests, besides those that satisfied the
hypotheses for this research, were completed on the data
gathered. The mean ranking position of psychosocial
intervention in terms of entry-level confidence (survey
question 16 depicted in Table 3) for those who reported to
have taken less than three years of clinical education was
5.45 with a standard deviation of .94. The mean score of

16
the same domain in the same question for those who reported
to have greater than or equal to three years of clinical
education was 4.95 with a standard deviation of 1.13. These
numbers are statistically significant with a significance
level of < .001. Secondly, a thorough examination of how
individuals prepared for the Board of Certification was
done. The results from this analysis can be seen in Table
4.
Table 4. Frequency of Tools Used To Prepare For Board of
Certification Exam
Initial ACES Rev OnTests PRev FacAd Pract Other
BOC
Bks
Ses
Ses
Exms
Success
Yes
20
161
132
72
104
83
70
No
2
21
17
12
13
19
5
Initial BOC Success=Passed the Board of Certification exam on the first
attempt, RevBks=Review Books, OnTests=Online Tests, PRevSes=Peer
Review Sessions, FacAdSes=Faculty Administered Sessions,
PractExms=Practical Exams

Based on the results of this survey question, review
books and online practice tests were the most popular tool
for preparation by those who passed on the first attempt.
Likewise, review books and practical exams were the most
popular tools used by individuals who did not pass the
Board of Certification exam on the first attempt.
Based on previous research, Approved Clinical
Instructors (ACIs) have shown to be key components in the
success of athletic training clinical education. According
to the data gathered, students who attended a program with

17
less than 3 years of clinical education stated with an
average ranking of 4.22 (standard deviation .97) that their
ACIs helped to improve their entry-level confidence. While
students whom attended a program with greater than or equal
to 3 years of clinical education stated with an average
ranking of 4.12 (standard deviation 1.15) that the ACIs
with who they worked alongside helped to improve their
entry-level confidence. These numbers are not statistically
different.
Second, individuals who attended a clinical education
program of less than three years reported a ranking of 4.2
with a standard deviation of .92 in terms of how well they
felt the clinical education portion of their athletic
training curriculum prepared them for the Board of
Certification exam. When asked the same question,
individuals who attended a program of greater than or equal
to 3 years in clinical education length, reported a mean
ranking score of 4.28 with a standard deviation of .863.
These numbers are not statistically different but they pose
an area for deeper analysis. Thirdly, students who reported
to have gone to a program of less than 3 years in clinical
education length stated that on average they spent just
under 80 percent of time (mean ranking of 3.82 with a
standard deviation of .87) doing hands-on activities while

18
at their clinical education site. Those participants who
attended a clinical education program that was greater than
or equal to 3 years in length reported to have spent 80
percent of time (mean ranking of 3.9 with a standard
deviation of .81) doing the same types of activities. These
numbers are not statistically different but rather
interesting because it evaluates the amount of time spent
doing hands-on activities in the clinical education
setting.
In regards to overall preparedness to enter the field
as a certified athletic trainer, each practice domain was
assessed. No statistical significance was found based on
clinical education length. The results for this analysis
(means and standard deviation) can be viewed in Table 5.
Table 5. Overall Entry-Level Preparedness As a Certified
Athletic Trainer Based on Clinical Education Length
(mean,standard deviation)
ClinEd Admin
EmResp
Eval
InjPrev PsyInt
TherEx
<3
4.8
2.95
1.61
2.87
5.44
3.24
years
(1.34)
(1.30)
(.89)
(1.08)
(.78)
(1.35
≥3
5.0
2.8
1.7(1
3.0
5.0
3.42
years
(1.36)
(1.25)
.04)
(1.34)
(.941)
(1.33)
Preparedness Ranking – 1=Strongly Disagree, 5=Strongly Agree
ClinEd=Clinical Education Length Group
Domains – Administration=Admin, EmResp=Emergency Response, Eval=Injury
Evaluation, InjPrev=Injury Prevention, PsyInt=Psychosocial
Intervention, TherEx=Therapeutic Exercise

19

DISCUSSION

The purpose of this study was to analyze if a
relationship existed between the length of the clinical
education experience and entry-level confidence along with
first time Board of Certification passing rates in athletic
training education. Examining this relationship is
important for athletic training education analysis and
growth. Determining whether a relationship exists between
the variables in this study could help programs adapt their
curriculum and potentially better their Board of
Certification first-time pass rate. The relationships
studied in this research project have the potential to
change athletic training education in the entry-level
setting and thus have a large impact on the profession.
In addition to potentially adapting athletic training
education, this study could impact the Commission on
Accreditation of Athletic Training Education (CAATE)
standards. This study can be added to the research that has
been conducted to assess the effectiveness and
appropriateness of standards within entry-level athletic
training education programs.1 The following discussion is

20
comprised of three subsections: Discussion of Results,
Conclusions, and Recommendations.

Discussion of Results

Based on the data gathered in this and previous
studies, no relationship exists between length of clinical
education and first-time Board of Certification passing
rate. This finding is similar to the findings of other
studies done in this area. One set of researchers, Williams
and Hadfield,3 examined both didactic and clinical education
and how they relate to the BOC exam. This study found that
the only influence on BOC passing rate is the number of
faculty with a terminal degree within a program. This being
said, there is no benefit in terms of certification rate to
network in order to create more ACIs clinical sites to
place students as sophomores. This could potentially mean
that, in terms of Board of Certification passing rate,
schools that pay their students for travel expenses or pay
ACIs/clinical sites for their time with extra or younger
students may be wasting their money. Secondly, the findings
of this study relate to the findings of research done in
other fields. One study by McClintock and Gravelee examined
American Board of Anesthesiology Examination performance

21
and factors that may affect it. Over two thousand
participants were included in this study. The results
demonstrated that pass rates were only higher when the exam
was taken while the students were still in training versus
being out for a year or more. The results went on to
explain that passing rates were not dependent on the
program that the individuals graduated from.
Although, as a whole, there is not a benefit to having
a longer clinical education program in terms of first-time
Board of Certification passing rate, there was a
statistically significant difference for individually
ranked confidence level of psychosocial intervention.
Individuals who attended a clinical education program less
than three years in length ranked psychosocial intervention
almost an entire rank less confident than those who
attended a longer program. It can be assumed that these
individuals are less confident in terms of psychosocial
intervention because they are exposed to fewer situations
in which it is used because they have a shortened program
and less time in the athletic training room. These findings
relate directly with the results of other studies. One
study, by Stiller-Ostrowski and Ostroski,5 evaluated the
level of preparation recently certified athletic trainers
had in the practice domain of Psychosocial Intervention and

22
Referral. Interviews were transcribed and analyzed to find
that these professionals had very limited experience in
this area. This was an area that these individuals claimed
to struggle. Based on this and other similar research the
results gathered from this study were expected and alarming
in the area of psychosocial intervention and referral.
Besides psychosocial intervention, there was no reported
difference in entry-level confidence based on length of
athletic training clinical education.
Based on the analysis of survey question eight
regarding how well ACIs prepared students for entry-level
positions in the field of athletic training, clinical
education length was not significant. This means that
students from one clinical education group felt equally
prepared by their ACIs as those from the other. One study
by Armstrong et al6 can partially explain these findings.
Armstrong et al’s study was completed to identify the
methods that ACIs use to evaluate students’ proficiencies.
The results of this study show that most clinical
proficiencies are evaluated in a simulation method
regardless of the length of the clinical education program
thus, students from varying programs are being evaluated in
the same way and potentially getting equal feedback. This
study suggests that in terms of proficiency evaluation,

23
there is no benefit to attending a program with longer
clinical education. The importance does not lie in the type
of clinical education evaluation but rather the quality of
ACI doing those evaluations.
Research suggests that having quality ACIs is as
important as having quality hands-on experiences. Quality
ACIs engage the students and utilize time wisely to
encourage constant growth and development as a professional
and an athletic trainer. The purpose of a study by LeaverDunn et al7 was to evaluate the tendency of undergraduate
athletic training students to think critically in certain
situations. The authors suggest that professors stimulate
the process of critical thinking within the classroom. This
is important because the tactics used in the classroom to
increase critical thinking can be implemented in clinical
education to decrease the amount of downtime and make the
clinical experience more rewarding. In addition, one study
by Caswell and Gould8 evaluated moral philosophies and
ethical decision-making within the field of athletic
training. This coincides with critical thinking in that it
requires athletic trainers and students to analyze their
decisions before they act. The researchers attempted to see
if athletic trainers changed their ethics approach to
specific situations based on who they were addressing and

24
what issues they were dealing with. This study found that
athletic trainers did not change ethics to address based on
specific situations. This being said, both clinical and
didactic athletic trainers do not change their approach
when dealing with certain situations thus they are not
teaching students how to adapt to situations in the
appropriate professional manner. This could explain why
individuals feel so much less confident in terms of
psychosocial intervention. Based on these previous research
studies, Approved Clinical Instructors and professors in
the classroom should utilize critical thinking tactics in
combination with psychosocial intervention strategies to
continue to develop their confidence.
The results from this study coincide with previous
research while still remaining unique and necessary.
Overall, this study has found results that add to the body
of knowledge and profession of athletic training.

Conclusions

Length of clinical education has no substantial
overall effect on first-time Board of Certification passing
rate and entry-level confidence. Based on the data
collected from the survey the first null hypothesis was

25
supported. There was no difference in first-time BOC
passing rate dependent upon clinical education length.
There was no statistical evidence to suggest that having a
longer clinical education program in anyway helps or
hinders ones performance on the Board of Certification
exam.
Secondly, with the exception of the psychosocial
intervention practice domain, there was no statistical
significance between length of clinical education and
entry-level confidence. The second null hypothesis is
supported. There was no difference in confidence dependent
upon Clinical Education length. Based on the survey
questions and the data gathered the only benefit to
attending a longer clinical education program is that
individuals report to be more confident in psychosocial
intervention than those that completed a shorter program.
These two findings, in combination with the additional
findings, show there is very little difference in attending
a program that consists of < 3 years or ≥ 3 years of
clinical education. Although there is no major difference
in clinical education programs based solely on their
length, this study is clinically significant in that
students can read this research and make education choices
knowing that clinical education length is not the

26
determining factor in first time Board of Certification
passing rate and entry-level confidence. Secondly,
educators can now assess the amount of student exposure to
psychosocial intervention in an effort to raise their
confidence in this domain. This is especially true of
programs with > 3 years of clinical education since
individuals who completed those programs reported less
confidence in this area. Also, the frequency and success of
students who used different Board of Certification study
techniques are noted in Table 2. These can be analyzed to
determined effectiveness and success for the use and
implementation in education programs of any length.

Recommendations

Based on this study and those completed in the past,
it is evident that more research needs to be completed in
the area of Athletic Training Clinical Education. Future
research should tackle many varying topics assessing a
variety of different individuals. Future research should
include a larger number of respondents. This study had less
than a 28% response rate. Future research should strive for
at least a 30% response rate. Secondly, future research
should include open-ended response questions. This would

27
allow for individuals to talk about very individual and
subjective concerns and to voice comments about specific
strong areas or shortcomings of their clinical education
program. Also, professors’ and program directors’ opinions
and suggestions should be heard. There are aspects of
education that can only be received via the educators.
Hearing from these varying individuals will give these
individuals the opportunity to not only voice strengths and
weaknesses about their work place but also the performance
of their students. By surveying these different
individuals, research will be done from a very different
perspective and can assess similar but unique variables.
There is much potential for growth and development in terms
of athletic training education. The potential for growth
also creates an unique and necessary opportunity for
research. This research should be completed to better the
discipline of athletic training.

28
REFERENCES

1.

Commission on accreditation of athletic training
education.
http://www.caate.net/imis15/CAATE/About/CAATE/About.as
px?hkey=1b198b36-7205-4b7f-9447-abd3800a3264. Accessed
October 3, 2011.

2.

Weidner TG, Laurent T. Selection and evaluation
guidelines for clinical education settings in athletic
training. J Athl Train. 2001;36(1):62-67.

3.

Williams RB, Hadfield OD. Attributes of curriculum
athletic training programs related to the passing rate
of first-time certification examinees. J Allied
Health. 2003 Winter;32(4):240-5.

4.

McClintock JC, Gravlee GP. Predicting success on the
certification examinations of the american board of
anesthesiology. Anesthesiology. 2010 Jan;112(1):212-9.

5.

Stiller-Ostrowski JL, Ostrowski JA. Recently certified
athletic trainers' undergraduate educational
preparation in psychosocial intervention and referral.
J Athl Train. 2009 Jan-Feb; 44(1): 67–75.

6.

Armstrong KJ, Weidner TG, Walker SE. Athletic training
approved clinical instructors' reports of real-time
opportunities for evaluating clinical proficiencies. J
Athl Train. 2009 Nov-Dec; 44(6): 630–638. doi:
10.4085/1062-6050-44.6.630.

7.

Leaver-Dunn D, Harrelson GL, Martin M, Wyatt T.
Critical-thinking predisposition among undergraduate
athletic training students. J Athl Train. 2002
Dec;37(4 Suppl):S147-S151.

8.

Caswell SV, Gould TE. Individual moral philosophies
and ethical decision making of undergraduate athletic
training students and educators. J Athl Train. 2008
Mar-Apr; 43(2): 205–214.

29

APPENDICES

30

APPENDIX A
Review of Literature

31

REVIEW OF LITERATURE

Accredited entry-level athletic training education
programs have two major academic components: didactic and
clinical learning. There is a vast amount of variance in
the delivery of both of these facets of education
throughout programs in the United States. Clinical
education is the main focus of this Review of Literature.
Entry-level athletic training programs must follow
certain standards to ensure they meet the needs set by
their accreditation agency. Although this agency sets
standards, they are entry-level criteria, with programs
often exceeding minimum standards.1 One aspect of these
minimum standards is the length of time that students are
involved in clinical education. Some programs offer the
three or fewer years of clinical experience while others
offer more than three years.1 This literature review will
examine if the length of a student’s clinical experience
has an impact on his/her career preparation. In addition,
the students’ overall confidence in their ability to work
in the field as an entry-level athletic trainer will be

32
reviewed in this document. Student confidence, entry-level
confidence and clinical education will be reviewed.
The purpose of this Review of Literature is to inform
the reader about different perspectives of athletic
training education and how they affect an entry-level
confidence in one’s abilities and skills. This will be
accomplished in the following sections: Commission on
Accreditation of Athletic Training Education (CAATE), Other
Professions’ Education and Student Confidence.

Commission on Accreditation of Athletic Training
Education

The Commission on Accreditation of Athletic Training
Education or CAATE was established to set basic and minimal
standards to be met by entry-level athletic training
education programs.1 These standards were acquired from both
objective and academic criteria. The standards are reviewed
and input is gathered from all agencies that sponsor CAATE,
colleges and universities, and athletic trainers who
utilize CAATE service or hire graduates of a CAATE
accredited program.1
This organization has standards for both didactic and
clinical education. The standards put forth by this

33
organization set a required minimum or “entry-level” that
programs can take and adapt. This allows for a level of
uniqueness within each program. Although this review will
focus mostly on clinical education, variability does exist
in didactic education. This occurs mostly because some
programs require students to take courses that others do
not. Some of these courses may include chemistry,
pharmacology, emergency medical technician training, sports
psychology, etc. These courses may add extra insight to an
area of athletic training but they are not required across
the board through CAATE standards. In addition to clinical
education, these are aspects of athletic training education
programs that may affect student confidence and Board of
Certification first time pass rate.
Much research has been conducted on the standards set
by CAATE. One research study, conducted by Weidner and
Laurent2, was aimed directly at the evaluation techniques
CAATE uses to critique clinical education sites. The
authors used standards that were already set for the use of
evaluating physical therapy sites and combined them with a
newly developed evaluation form more suited for athletic
training. The subjects within this study were program
directors, clinical instructors, and students from 28
different accredited athletic training programs from all

34
different districts across the country. The measurements
collected were in the form of the respondents’ critiques of
the clinical sites. These were then rated to see if they
were relevant, practical, and suggestive of high-quality
clinical education. This study found the tools that were
used for evaluating these sites should be used as
guidelines rather than required criteria due to the fact
that they are subjective in nature.
Subjectivity in athletic training education
accreditation is something many researchers have tried to
eliminate through the use of analysis and control groups. A
study3 attempted to do this by making the realm of athletic
training more business-like. The purpose of this study was
to apply a commonly used business tactic to improve entrylevel athletic training education program accreditation.
The data was synthesized and concluded that accreditation
is necessary to have a baseline of standards. Although at
times these regulations cause issues within programs, they
are the best way to ensure adequate education. This is
important when determining the entry-level standards that
should be present during clinical education. Although this
study found that business-like accreditation helps form
necessary standards, many personal and professional

35
opinions go into deciding what those minimal standards must
be in athletic training education.
Research has been completed to decide which
educational standards are best for athletic training. One
study in particular, conducted by Lauber et al,4 surveyed
over 300 individuals, some of which were program directors
and the others were clinical instructors. First, the
participants were presented with statements made by
clinical instructors. The participants then had to place
those statements into one of the following categories:
instructional, interpersonal, evaluative, personal, and
professional. This study showed that program directors and
clinical instructors differed greatly in their opinions
about which category each statement fell under. This shows
how professional colleagues vary greatly in their opinions
of subjective information. Also, this leads into the need
for critical evaluation and minimal CAATE standards for
clinical instructors to ensure professionalism during a
student’s clinical education experience.
Another study by Weidner and Henning5 was completed to
develop standards for the selection, training, and
evaluation of approved clinical instructors (ACIs). The
authors used seven criteria that were used for physical
therapy clinical instructors and added two more to set up

36
the criteria outline. A panel of researchers analyzed the
relevance of these criteria. This study found that the
original criteria could not be used to evaluate clinical
instructors for athletic training. Another set of criteria
was determined. It is important to know how to choose and
evaluate ACIs in order to ensure quality clinical
experiences.5-9
The importance of accreditation standards is not only
in place for athletic trainers, but also for students as
well. Peer assisted learning is a tool that is stressed in
many athletic training education programs. This prepares
students to be teachers or mentors within the profession.
The purpose of one study completed by Henning et al10 was to
examine the presence of peer-assisted learning in athletic
training clinical education and to identify the students’
perceptions about it. A convenience sample of 138 entrylevel athletic training students was taken at the National
Athletic Trainers’ Association in 2002. A survey was
conducted and the results showed that peer-assisted
learning was both present and beneficial in athletic
training education programs. Standards are set by CAATE on
the environment in which students can learn, but not
necessarily on who will be their teachers. Learning from
other students has shown to be beneficial.10

37
As noted above, programs are required to adhere to
minimum standards to ensure accreditation. In order to
maintain CAATE accreditation, students must complete
proficiencies in certain areas. These are skills that must
be taught on two separate occasions to students, and then
students demonstrate mastery in order to progress through
the program. One study, by Walker et al,11 evaluated the
methods that the entry-level athletic training programs use
to assess clinical proficiencies. This cross-sectional
study evaluated 201 program directors by surveying them on
eleven different educational tactics regarding the teaching
and performance of required competencies. Simulated
instruction was the most common educational tactic. These
simulations, however, did not always represent real life
situations. In order to provide better clinical education,
more real life experiences need to be simulated.
In addition, Barnum12 examined the ability of approved
clinical instructors to ask questions as a teaching
strategy. This was a qualitative case study of one
particular accredited athletic training education program.
It was determined that over two-thirds of the questions
asked by these professionals were considered low quality
based on the scale used to evaluate them. This shows that
not all tools used for education in the clinical setting

38
are actually useful. The purpose of another study was to
identify the methods and tools that approved clinical
instructors use to evaluate students’ proficiencies. This
cross-sectional design asked 135 athletic trainers to
complete a survey that characterized their responses on 15
proficiency evaluation techniques. The results of this
study show that most clinical proficiencies are evaluated
in a simulation method.13,14 This is important because
without ample quality clinical education, not all
simulations will be completed and thus not all techniques
can be learned.
The standards set by CAATE have been highly researched
for their effectiveness and appropriateness within entrylevel athletic training education programs. This agency
compiles minimum entry-level standards of equal importance
for didactic and clinical education. These standards are
reflective of, but set apart from other healthcare
professions. It is important to understand the uniqueness
of the standards developed and set for athletic training
education by CAATE. These standards are entry level and
required to maintain accreditation.1

39
Board of Certification (BOC)
In order to become a nationally certified athletic
trainer, one must not only graduate from a CAATE accredited
athletic training program, but also pass the Board of
Certification (BOC) examination. Many possible correlations
between undergraduate success in certain areas and success
on the BOC have been studied.
One set of researchers, Williams and Hadfield,15
examined both parts of the athletic training education
Program; didactic and clinical education. Both of these
parts have been examined and accredited by Commission on
Accreditation of Allied Health Education Program (CAAHEP)
to determine how they relate to the national certification
exam. The researchers then used this information to
determine the most appropriate curriculum for educating
students on all six athletic training educational domains
including prevention, clinical evaluation and diagnosis,
immediate care, treatment rehabilitation and
reconditioning, administration, and professional
responsibility. A survey was sent to evaluate how the
athletic trainers learned the information within the six
domains, number of clinic education rotations, GPA
requirement, faculty responsibilities, faculty terminal
degrees, etc. This study found that students’ passing rates

40
on the BOC exam are greatly affected by the faculty who
teach them. The number of faculty who hold terminal degrees
within their educational program affected the students’
pass rates more than their method of learning the
information within the domains. The type of teaching styles
the professors used and the academic degree that the
professors have affected the pass rate of the BOC exam more
than the number of times the information was presented.
This is important when examining the reasoning behind the
pass rates within an athletic training education program.
Another set of researchers, Starkey and Henderson,16
supported the idea that early test taking and clinical
experience are influential factors on overall test
performance. This is relevant when determining the
importance and necessary length of clinical education in
relation to confidence and readiness to enter the field of
athletic training. Another related and supporting article,
by Turocy et al,17 reported on research that was conducted
to examine if there was a relationship between grade point
average, number of clinical education hours, and
performance of the national certification exam. The data
collection forms were sent out in the mail along with a
consent form but then the exam scores were obtained from
Columbia Assessment Services. This study examined 270

41
first-time exam takers for the months of April and June in
1998. This study found there was not a difference between
the scores of men and women in any section of the exam.
There were, however, differences between the curriculum and
internship candidates on some sections of the exam and that
grade point average was a significant predictor of
performance on all parts of the exam.
Although it is evident that there is research
supporting the perceived correlations in athletic training
education, research that contradicts the correlations also
exists. One study17 determined the efficacy of clinical
experience relative to passing the exam. This study used a
survey-based design to collect data from 269 subjects. This
study concluded that total clinical hours and high-risk
sport experiences were not predictive of BOC exam scores.
Clinical hours completed above the required amount did not
correlate with a better score on the exam. Contradictory
information is important when evaluating the overall
relevance of a conclusion. Further analysis of the data and
future research should be conducted to form a stronger
conclusion.

42

Other Professions’ Education

Similar to athletic training, many other healthcare
professions have education programs that prepare their
students to take exams in order to gain all the rights and
responsibilities of that profession. Some healthcare fields
that require this include dentistry, anesthesiology,
gynecology, and optometry.
One study, by DeWald et al,18 within the field of
dentistry was conducted to review the effect of grade point
average (GPA) on National Board Examination performance.
Also, this study showed the relationship between taking a
dental hygiene review course and performance on the exam.
Although this study did not find a correlation between
performances on the exam and taking a review course there
was a correlation between GPA and test score. Another
similar study, by McClintock and Gravelee,19 examined
American Board of Anesthesiology Examination performance
and factors that may affect it. This study used over two
thousand participants. The results demonstrated that pass
rates were higher when the test was taken while the
students were still in training versus being out for a year
or more. Very similar studies and findings exists for a

43
large array of medical professions.20-25 These findings are
not new and can be used in athletic training education to
predict success on the Board of Certification exam.

Student Confidence

Self-confidence can be described as having trust in
one’s own powers and abilities. Students gain selfconfidence through education and positive feedback. In the
field of athletic training, confidence is necessary to
properly and safely complete the duties of the job. It is
important to understand and evaluate students’ selfconfidence in order to properly prepare them for their
careers as athletic trainers. Many research studies have
been performed to evaluate both direct and indirect
components of student confidence.
One study, by Caswell and Gould,26 evaluated moral
philosophies and ethical decision-making within the field
of athletic training. The purpose of this study was to
expand the research done in the area of ethics. Expansion
was done by describing undergraduate athletic training
students’ and educators’ philosophies and ethical decisionmaking abilities. Once the research was completed,
researchers investigated the effects of gender and level of

44
education on decision-making and ethical scores. This
stratified, multistage, cluster-sample correlation study
used undergraduate students and educators from 25
accredited programs. This study found that athletic
training ethics did not change to address sex-specific
needs. This being said, professors should take into account
their students’ own moral philosophies to facilitate the
most growth.26 In addition to reviewing how each individual
feels or responds to a situation, research on what the
athletic trainer was taught and how prepared he or she is
for a specific situation was evaluated as well.
One study, by Stiller-Ostrowski and Ostrowski,27
evaluated the level of preparation recently certified
athletic trainers had in the area of Psychosocial
Intervention and Referral. This qualitative design used 11
athletic trainers from differing undergraduate athletic
training education programs and current job settings.
Interviews were transcribed and analyzed to find that these
professionals had very limited experience in this area.
This was an area that these individuals claimed to struggle
with. Areas of weakness are important to know and be able
to analyze in order to improve the quality of athletic
training education. The level at which a person has been
prepared for a situation can affect how confident he or she

45
is in handling it. In addition to being prepared to handle
a situation, student confidence is also reliant on the
ability for one to critically think through an issue.
The purpose of a study by Leaver-Dunn et al28 was to
evaluate the tendency of undergraduate athletic raining
students to think critically in certain situations. Ninetyone students were involved in this study and the findings
showed that these students were inclined to think
critically. Although this relationship was evident it was
somewhat weak. The authors suggest that professors
stimulate the process of critical thinking within the
classroom. This is important because the tactics used in
the classroom to increase critical thinking can be
implemented in clinical education to decrease the amount of
downtime and make the clinical experience more rewarding.
Many aspects of education and personal growth play a
role in overall student confidence. Without a high level of
confidence an athletic trainer could act wrongfully in a
situation and cause serious harm or injury to an athlete.
Overall confidence is crucial in the field of athletic
training.

Theories Based on Teaching Techniques
Just as there are many different types of learners,

46
there are also many different types of teaching strategies.
Although, all of them hold the same goal of education in
mind they go about achieving it very differently. This too
has been a highly researched and very applicable topic in
athletic training.
One study, by Carr and Drummond,29 measured the
observations and perceptions of physical presence,
cooperation, and communication between clinical and
classroom instructors. Also, this study determined if these
differences had an effect on the students. A survey was
designed to assess the opinions of clinical instructors,
classroom instructors, and athletic training students. It
was found within this study that communication and
cooperation between clinical and classroom instructors had
a large effect on the education of the athletic training
students. Also, it was determined that having clinical
instructors be classroom instructors is beneficial to
students’ education as well. In addition to having the
instructors from didactic and clinical education overlap,
using different pedagogic styles has shown to be effective
as well.
Gould and Caswell30 reviewed the pedagogic styles of
athletic training professors and introduced some unfamiliar
styles to determine their effects on learning. This

47
correlation research study examined 10 different athletic
training education programs and found that different
educational methods work as tool for presenting information
but sex and academic role style differences should be
considered when adding these to a curriculum. The use of
these different styles not only increases the ability for
students to learn in different ways but it also broadens
their educational exposure and could potentially give them
an educational tool to use in the clinic or classroom with
other students.
As mentioned previously, a large portion of learning
in athletic training education can come from other students
within the clinical setting. Many of these experiences
include an older student teaching a younger or less
experienced student. This is very common and typical of
athletic training. This type of mentorship was researched
in entry-level athletic training students. In one study 16
interviews were conducted, some with athletic training
students and some with other individuals who were
considered to be mentors. The interviews were transcribed
and then analyzed using a coding process. The results
showed that students who claimed to have a mentor named
that person as their clinical instructor. It was stated
that the mentors must be reliable and approachable. This

48
being said, it is easy to see that clinical education is
important not only to gain experience but also to formulate
mentorship experiences that are important and obviously
memorable.

Summary

This literature review reveals many different findings
in terms of entry-level athletic training education. First,
the review exposes the need and purpose of the
accreditation standards set by CAATE.1 In addition, it
details the fact that these standards are simply minimum
entry-level requirements that can and should be surpassed.
This overachievement should be completed to ensure student
success on the BOC exam and to foster both individual
program and overall professional growth.
Second, the review highlights how other professions
can predict their students’ success on certification exams
based on classroom performance. This is a tool that can be
used within the athletic training education system. Low
pass rates may possibly correlate with a poor educational
program and thus should encourage change within the program
to increase success.

49
Finally, both student and entry-level confidence in
and out of the classroom were examined and showed the key
importance of mentorship within athletic training. All
three of these factors combined show that more research
needs to be done to determine what type of clinical
education program will provide the most education and
foster high entry-level confidence within entry level
athletic training education.

50

APPENDIX B
The Problem

51

STATEMENT OF THE PROBLEM

The purpose of this study was to analyze if a
relationship exists between the length clinical education
experience and entry-level confidence along with first-time
Board of Certification passing rates in athletic training
education. Examining this relationship was important for
athletic training education analysis and growth. If a
relationship existed between the variables in this study,
programs could use this education to adapt their curriculum
and potentially better their Board of Certification first
time pass rate. The relationships studied in this research
project had the potential to change athletic training
education in the entry-level setting and thus have a large
impact on the profession.

Definition of Terms The following definitions of terms will be defined for
this study:

52
1)

Undergraduate Student – a student in a university or
college setting who has not received his/her Bachelors
degree

2)

Graduate Student – a student in a university or
college setting who has receive his Bachelors degree
and is attempting to achieve a higher degree (this
differs greatly from the term “graduate”

3)

Entry Level - the lowest level job or ability;
suitable for a beginner in a particular field

4)

Confidence – belief in one’s powers or abilities

Basic Assumptions
The following were basic assumptions of this study:
1)

The subjects were honest when they completed their
surveys.

2)

The subjects answered questions to the best of their
ability.

3)

The questions were not leading or biased.

4)

All respondents were given adequate time to complete
the survey.

Limitations of the Study
The following were possible limitations of the study:

53
1)

Only graduates who have received their degree from an
accredited program and certification in the past two
years were studied; thus decreasing the subject pool.

2)

Not all individuals returned the survey.

3)

Other aspects of athletic training education affect
the pass/fail rate on Board of Certification exam.

Significance of the Study
The results of this study can help to guide athletic
training education. This study showed the relationships
that exist among aspects of education that can be adapted
and modified. To a practicing clinician who works with
students this study might highlight the level of perceived
importance of their job to entry-level athletic trainers.
To an educator, this study may encourage program
adaptations or flexibility. This study is extremely
important for the field of athletic training because it is
significant to the growth and development of athletic
training education programs in that it analyses potentially
existing relationships in an effort to determine what
curriculum is best for the success of the student. The
results of this study may help to change athletic training
education.

54

APPENDIX C
Additional Methods

55

APPENDIX C1
Online Survey

56

57

58

59

60

61

62

63

64

65

66

67

68

69

70

APPENDIX C2
Institutional Review Board –
California University of Pennsylvania

71

72

73

74

75

76

77

78

79

80

81
Institutional Review Board
California University of Pennsylvania
Morgan Hall, Room 310
250 University Avenue
California, PA 15419
instreviewboard@calu.edu
Robert Skwarecki, Ph.D., CCC-SLP,Chair

Dear Megan Little:
Please consider this email as official notification that your proposal titled "The
relationship between first time board of certification passing rate and entrylevel confidence upon length of athletic training clinical education”
(Proposal #11-027) has been approved by the California University of
Pennsylvania Institutional Review Board, with the following stipulation:
--:The cover letter/consent form must include text equivalent to “without penalty”
in the sentence referring to discontinuing participation.
Once you have revised the cover letter, you may immediately begin data collection.
You do not need to wait for further IRB approval. At your earliest convenience, you
must forward a copy of the cover letter for the Board’s records.
The effective date of the approval is 12/16/2011 and the expiration date is 12/15/2012.
These dates must appear on the consent form.

Please note that Federal Policy requires that you notify the IRB promptly regarding
any of the following:
(1) Any additions or changes in procedures you might wish for your
study (additions or changes must be approved by the IRB before
they are implemented)
(2) Any events that affect the safety or well-being of subjects
(3) Any modifications of your study or other responses that are
necessitated by any events reported in (2).
(4) To continue your research beyond the approval expiration date
of 12/15/2012 you must file additional information to be considered
for continuing review. Please contact instreviewboard@cup.edu
Please notify the Board when data collection is complete.
Regards,
Robert Skwarecki, Ph.D., CCC-SLP
Chair, Institutional Review Board

82
REFERENCES

1.

Commission on accreditation of athletic training
education.
http://www.caate.net/imis15/CAATE/About/CAATE/About.as
px?hkey=1b198b36-7205-4b7f-9447-abd3800a3264. Accessed
October 3, 2011.

2.

Weidner TG, Laurent T. Selection and evaluation
guidelines for clinical education settings in athletic
training. J Athl Train. 2001;36(1):62-67.

3.

Peer KS, Rakich JS. Accreditation and continuous
quality improvement in athletic training education. J
Athl Train. 2000;35(2):188-193.

4.

Lauber CA, Toth PE, Leary PA, Martin RD, Killian CB.
Program directors' and clinical instructors'
perceptions of important clinical-instructor behavior
categories in the delivery of athletic training
clinical instruction. J Athl Train. 2003;38(4):336341.

5.

Weidner TG, Henning JM. Development of standards and
criteria for the selection, training, and evaluation
of athletic training approved clinical instructors. J
Athl Train. 2004;39(4):335-343.

6.

Weidner TG, Henning JM. Importance and applicability
of approved clinical instructor standards and criteria
to certified athletic trainers in different clinical
education settings. J Athl Train. 2005;40(4):326-332.

7.

Weidner TG, Pipkin J. Clinical supervision of athletic
training students at colleges and universities needs
improvement. J Athl Train. 2002 Dec;37(4 Suppl):S241S247.

8.

Wolfe EW, Nogle S. Development of measurability and
importance scales for the NATA athletic training
educational competencies. J Appl Meas. 2002;3(4):43154.

9.

Miller MG, Berry DC. An assessment of athletic
training students' clinical-placement hours. J Athl
Train. 2002 Dec;37(4 Suppl):S229-S235.

83
10.

Henning JM, Weidner TG, Jones J. Peer-Assisted
learning in the athletic training clinical setting. J
Athl Train. 2006; 41(1): 102–108.

11.

Walker SE, Weidner TG, Armstrong KJ. Evaluation of
athletic training students' clinical proficiencies. J
Athl Train. 2008 Jul-Aug; 43(4): 386–395.

12.

MG Barnum. Questioning skills demonstrated by approved
clinical instructors during clinical field
experiences. J Athl Train. 2008 May-Jun; 43(3): 284–
292.

13.

Armstrong KJ, Weidner TG, Walker SE. Athletic training
approved clinical instructors' reports of real-time
opportunities for evaluating clinical proficiencies. J
Athl Train. 2009 Nov-Dec; 44(6): 630–638. doi:
10.4085/1062-6050-44.6.630.

14.

Berry DC, Miller MG, Berry LM. Effects of clinical
field experience setting on athletic training
students' perceived percentage of time spent on active
learning. J Athl Train. 2004 Jun;39(2):176-184.

15.

Williams RB, Hadfield OD. Attributes of curriculum
athletic training programs related to the passing rate
of first-time certification examinees. J Allied
Health. 2003 Winter;32(4):240-5.

16.

Starkey C, Henderson J. Performance on the athletic
training certification examination based on
candidates' routes to eligibility. J Athl Train. 1995
Mar;30(1):59-62.

17.

Turocy PS, Comfort RE, Perrin DH, Gieck JH. Clinical
experiences are not predictive of outcomes on the
NATABOC examination. J Athl Train. 2000 Jan;35(1):705.

18.

DeWald JP, Gutmann ME, Solomon ES. Effect of grade
point average and enrollment in a dental hygiene
National Board review course on student performance on
the National Board Examination. J Dent Educ. 2004
Jan;68(1):77-80.

19.

McClintock JC, Gravlee GP. Predicting success on the
certification examinations of the american board of
anesthesiology. Anesthesiology. 2010 Jan;112(1):212-9.

84
20.

Armstrong A, Dahl C, Haffner W. Predictors of
performance on the national board of medical examiners
obstetrics and gynecology subject examination. Obstet
Gynecol. 1998 Jun;91(6):1021-2.

21.

Bailey JE, Yackle KA, Yuen MT, Voorhees LI.
Preoptometry and optometry school grade point average
and optometry admissions test scores as predictors of
performance on the national board of examiners in
optometry part I (basic science) examination. Optom
Vis Sci. 2000 Apr;77(4):188-93.

22.

Platt LS, Turocy PS, McGlumphy BE. Preadmission
criteria as predictors of academic success in entrylevel athletic training and other allied health
educational programs. J Athl Train. 2001
Jun;36(2):141-144.

23.

Zaglaniczny KL. Factors which predict performance on
the national certification examination for nurse
anesthetists. AANA J. 1992 Dec;60(6):533-40.

24.

Fullerton JT, Severino R. Factors that predict
performance on the national certification examination
for nurse-midwives. J Nurse Midwifery. 1995 JanFeb;40(1):19-25. Erratum in: J Nurse Midwifery 1995
May-Jun;40(3):255.

25.

Bauchmoyer SM, Carr MP, Clutter JE, Hoberty PD.
Predicting academic and national board dental hygiene
examination performance based on academic factors. J
Dent Hyg. 2004 Winter;78(1):39-45.

26.

Caswell SV, Gould TE. Individual moral philosophies
and ethical decision making of undergraduate athletic
training students and educators. J Athl Train. 2008
Mar-Apr; 43(2): 205–214.

27.

Stiller-Ostrowski JL, Ostrowski JA. Recently certified
Athletic Trainers' undergraduate educational
preparation in psychosocial intervention and referral.
J Athl Train. 2009 Jan-Feb; 44(1): 67–75.

28.

Leaver-Dunn D, Harrelson GL, Martin M, Wyatt T.
Critical-thinking predisposition among undergraduate
athletic training students. J Athl Train. 2002
Dec;37(4 Suppl):S147-S151.

29.

Carr W, Drummond JL. Collaboration between athletic

85
training clinical and classroom instructors. J Athl
Train. 2002;37(suppl 4):S182-S188.
30.

Gould TE, Caswell SV. Stylistic learning differences
between undergraduate athletic training students and
educators: Gregorc mind styles. J Athl Train.
2006;41(1):109-116.

86

ABSTRACT
TITLE:

The Relationship Between First Time Board of
Certification Passing Rate and Entry-Level
Professionals’ Perceived Confidence Upon
Length of Athletic Training Clinical
Education

RESEARCHER:

Megan Little

ADVISOR:

Dr. Linda P. Meyer

DATE:

May 2012

RESEARCH TYPE: Masters Thesis
PURPOSE:

The purpose of this study was to analyze if
a relationship exists between the length
clinical education experience and entrylevel confidence along with first time Board
of Certification passing rates in athletic
training education.

PROBLEM:

Programs could use this education to adapt
their curriculum and potentially better
their students’ entry-level confidence and
Board of Certification first time pass rate.
The relationships studied in this research
project have the potential to change
athletic training education in the entrylevel setting and thus have a large impact
on the profession.

METHOD:

An online survey containing 18 questions was
randomly sent out to 1,000 members of the
Nation Athletic Trainers’ Association who
met the qualification criteria. A week
later, a reminder email was sent out from
the same organization. Finally, during the
third week a final email reminder was sent.
In total, 280 participants responded to the
survey.

FINDINGS:

There is no statistical significance between

87
length of clinical education and first time
Board of Certification passing rate
(Χ2(1)=.518, p>.05). Secondly, confidence is
not affected by length of clinical education
(-.477(218) = .916, p>.05). The only domain
that is affected in terms of confidence
based on length of clinical education is
psychosocial intervention (Table 3).
CONCLUSION:

There is no substantial overall effect on
first time Board of Certification passing
rate and entry-level confidence based on
length of clinical education. there was no
statistical significance between length of
clinical education and entry-level
confidence or length of clinical education
and first time Board of Certification
passing rate.