BURNOUT AMONG UNDERGRADUATE ATHLETIC TRAINING STUDENTS

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
Michelle L. Bowers

Research Advisor, Dr. Carol Biddington
California, Pennsylvania
2012

iii
ACKNOWLEDGEMENTS

First and foremost I would like to thank God. He is my
rock and my strength. I never would have made it to where I
am without Him. He has helped and guided me through the
storms of my life and has never left my side. He has
blessed me in so many ways and has placed the perfect
people in my life at just the right times. Thank You, Lord!
Next I would like to thank my parents Philip and
Melissa Bowers. Thank you for all of the sacrifices you
have made for me over the years, for all of the support
ever since I was little, and for believing in me the whole
way through. Your encouragement and support is what has
allowed me to be where I am. I never would have been able
to make it here without you. I would especially like to
thank you for pushing me and keeping me going when I wanted
to quit and take the easy way out. Thank you for making me
stick with it and listening to me complain to you the whole
way. I love you both!
I would also like to thank my thesis committee, Dr.
Carol Biddington, Dr. Joni Roh, and Dr. Taunya Tinsley.
Thank you for all of the guidance and direction throughout
the course of this project; it would not be what it is
without your help. I would like to send out a special
thanks to Dr. Biddington. Thank you for all of the time you
put in helping me and keeping me on task. I especially
appreciate all of your patience, kindness, support, and
motivation throughout this process. I would have never been
able to complete this without all of your help and
direction. Thank you!

iv
Next I would like to thank Dr. Tom West. Thank you for
all of the support and guidance with some tricky situations
that I had to encounter. You were very helpful,
encouraging, and reinforced what I knew needed to be done.
Your reassurance eased my distress and gave me the courage
to follow through. Thank you so much!
I would also like to thank Harry. You helped me get
through some pretty difficult moments. Many times you
allowed me to see things in a different way. Without you, I
would still be struggling with some of the tougher aspects
in my life. I cannot thank you enough for being there for
me, getting me through those rough spots, and making them
seem a little less rough. Thank you!
Finally, I would like to thank the students and staff
at the Burgettstown School District. It was a pleasure to
work with all of you this year and it was such a great
learning experience. Prior to working there I never
imagined I would like working at a high school setting, you
guys changed all that. I truly enjoyed having you as my
athletes and hearing about your future plans. Good luck to
all of you and thank you for such a great experience!

TABLE OF CONTENTS
Page
SIGNATURE PAGE

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

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

. . . . . . . . . . . . . . v

. . . . . . . . . . . . . . . vii

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

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

Research Design
Subjects

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

. . . . . . . . . . . . . . . . . 8

Instruments . . . . . . . . . . . . . . . . 8
Procedures

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

Hypotheses. . . . . . . . . . . . . . . . . 13
Data Analysis
RESULTS

. . . . . . . . . . . . . . . 14

. . . . . . . . . . . . . . . . . . 15

Demographic Data . . . . . . . . . . . . . . 15
Hypothesis Testing

. . . . . . . . . . . . . 24

Additional Findings . . . . . . . . . . . . . 30
DISCUSSION . . . . . . . . . . . . . . . . . 32
Discussion of Results . . . . . . . . . . . . 32
Implications to the Profession

. . . . . . . . 37

Recommendations. . . . . . . . . . . . . . . 38
Conclusions . . . . . . . . . . . . . . . . 39

vi
REFERENCES . . . . . . . . . . . . . . . . . 40
APPENDICES . . . . . . . . . . . . . . . . . 42
APPENDIX A: Review of Literature
Burnout

. . . . . . . . 43

. . . . . . . . . . . . . . . . . 46

Signs and Symptoms

. . . . . . . . . . . 48

Potential Causes of Burnout

. . . . . . . 50

Burnout in Healthcare Professionals. . . . . . . 52
Burnout in Athletic Training . . . . . . . 54
Burnout in Students . . . . . . . . . . . 57
Burnout Coping Strategies . . . . . . . . . 61
Instruments Used to Measure Burnout . . . . . 64
Summary . . . . . . . . . . . . . . . . . . 66
APPENDIX B: The Problem . . . . . . . . . . . . 69
Statement of the Problem . . . . . . . . . . . 70
Definition of Terms . . . . . . . . . . . . . 70
Basic Assumptions . . . . . . . . . . . . . . 72
Limitations of the Study . . . . . . . . . . . 72
Significance of the Study

. . . . . . . . . . 73

APPENDIX C: Additional Methods .

. . . . . . . . 74

Bowers Athletic Training Burnout Inventory (C1)

. 75

IRB: California University of Pennsylvania (C2) . . 81
Cover Letter (C3) . . . . . . . . . . . . . . 94
REFFERENCES . . . . . . . . . . . . . . . . . 96
ABSTRACT

. . . . . . . . . . . . . . . . . 99

vii

LIST OF TABLES

Table

Page

Year in the Program . . . . . . . . . . . . . 15

Demographics . . . . . . . . . . . . . . . . 15

Gender . . . . . . . . . . . . . . . . . . 16

Race . . . . . . . . . . . . . . . . . . . 16

Mean Construct Scores . . . . . . . . . . . . 17

Survey Question Frequencies and Percentages. . . . 18

Pearson-Product Moment Correlation Between The
Students’ Cumulative GPA and Emotional Exhaustion
and Depersonalization Scores . . . . . . . . . 24

Pearson-Product Moment Correlation Between The
Students’ Cumulative GPA and Administration
Responsibility Scores . . . . . . . . . . . . 25

Pearson-Product Moment Correlation Between The
Students’ Cumulative GPA and Time Commitment
Scores . . . . . . . . . . . . . . . . . . 25

10. Pearson-Product Moment Correlation Between The
Students’ Cumulative GPA and Organizational Support
Scores . . . . . . . . . . . . . . . . . . 26
11.

Pearson-Product Moment Correlation Between The
Students’ Cumulative GPA and Their Total Burnout
Scores. . . . . . . . . . . . . . . . . . . 26

12.

A 2 (Academic Level) x 2 (Gender) between-subjects
factorial MANOVA for Emotional Exhaustion and
Depersonalization . . . . . . . . . . . . . . 27

13.

A 2 (Academic Level) x 2 (Gender) between-subjects
factorial MANOVA for Administrative Responsibility. 28

14.

A 2 (Academic Level) x 2 (Gender) between-subjects
factorial MANOVA for Time Commitment . . . . . . 28

viii

15.

A 2 (Academic Level) x 2 (Gender) between-subjects
factorial MANOVA for Organizational Support. . . . 29

16.

A 2 (Academic Level) x 2 (Gender) between-subjects
factorial MANOVA for Total Burnout . . . . . . . 29

17.

Reliability for each Construct. . . . . . . . . 31

1
INTRODUCTION

Stress is a common factor in everyday life and can
lead to a wide variety of physical and emotional problems.
High levels of stress can have a negative effect on the
immune system, making an individual more susceptible to
illnesses, the autonomic nervous system, and the metabolic
system, all of which can lead to cardiovascular disease.
Too much stress can also lead to sleep deprivation, an
increased inflammatory reaction, which may be linked to
atherosclerosis in individuals who have no other
predisposing factors. These reactions occur when the body
tries to compensate for the added stress that is placed
upon it. When the body is no longer able to adapt to the
new stressors it begins to break down both physically and
mentally, which can lead to the syndrome, burnout.1
Burnout is a negative emotional reaction to one’s
work.2 This reaction has been characterized as a
multidimensional syndrome consisting of the following:
feelings of emotional exhaustion, depersonalization, a
reduced sense of personal accomplishment, role conflict,
role ambiguity, and role overload.1-7
All jobs and occupations come with certain levels of
stress. However, the majority of early research associated

2
with stress and burnout has focused on health care
professionals.1,4,8 Due to constant contact with people and
the associated emotional involvement with clients,
individuals in healthcare professions are more apt to
experience the high levels of stress that can lead to
burnout.4 Among these healthcare professionals are athletic
trainers.
Some factors that may contribute to the development of
burnout among athletic trainers that have been considered
within previous research have been age, gender, and the
amount of experience of the athletic trainer. Walter et al9
used the Maslach Burnout Inventory (MBI) to assess the
level of burnout among athletic training education program
directors and to determine the relationship between burnout
and various demographics related to their position. Results
indicated that emotional exhaustion scores were higher for
women as compared to men. However, emotional exhaustion
decreased as both men and women grew older and experience
levels increased. Personal accomplishment scores increased
as experience increased. Additionally, those who practiced
clinically more than 20 hours a week had higher
depersonalization scores, but this too, decreased with age.
Thus, indicating that females, those who are younger or
have less experience, and those who are employed at the

3
collegiate level or work more than 20 hours a week tend to
show greater signs of burnout.
Giacobbi,8 also examined the differences between age,
gender, and those with more or less post certification
experience by using the MBI in conjunction with the Stress
Appraisal Measure (SAM) to measure burnout and stress,
respectively. Results indicated that female athletic
trainers and athletic trainers working in the collegiate or
university settings showed increased signs of emotional
exhaustion, depersonalization, and personal accomplishment
which are associated with burnout. Occupational stress was
positively related to elements of burnout and somatic
health complaints, but negatively related to occupational
engagement. This means that as stress increased in the work
setting, somatic health complaints also increased,
conversely, as stress increased, occupational engagement
decreased. Burnout affects both men and women among various
settings. However, females, those who have less experience,
and those who are employed at the collegiate level tended
to show more elevated levels of the signs that are
associated with burnout.7-10
The demands of the athletic training profession also
transfer to the athletic training students. The purpose of
this study is to identify different factors that may lead

4
to burnout among undergraduate athletic training students.
Once these factors are identified, then burnout prevention
among this population can be best addressed.
Undergraduate students are faced with a variety of
stress which has not been previously published. Examples of
stress for the college students include the demands of
college classes, being newly independent, financial
concerns, and having difficulty with time management, among
other factors outside of their educational experience.11,12
With this level of personal and academic stress, burnout is
common among undergraduate students.10-12
A common factor that is associated with burnout among
students who enter the helping professions is idealism.12
Idealism refers to the extent to which an individual
identifies with the values and goals of the profession.12
There is a gap between idealistic expectations that
students have about the profession they are entering and
the realities of practice that they will soon be facing.
This gap is likely a cause of emotional exhaustion.12 Ngai
et al12 examined the effect of idealism, altruism, and
career orientation on emotional exhaustion among
undergraduate students in social work. Individuals who
scored high on idealism had a tendency to report higher
levels of emotional exhaustion. The high levels of idealism

5
allowed the students to feel a greater degree of
disappointment. This disappointment is what contributes to
emotional exhaustion; which is one of the subscales of
burnout.12
When students first begin thinking about their desired
career pathway, they have a tendency to have idealistic
thoughts, regardless of their chosen field. The inability
some students have to view their desired profession
objectively and realistically set them up for future
disappointment. They are not prepared for the challenges
and demands that will be placed upon them when they get
further into their educational program or when they are out
on their own. These new challenges and stressors combined
can build up and if they are not handled in a healthy
manner, can result in burnout.
One study13 evaluated the motivational factors among
students who attended an undergraduate institution. The
researchers found that students who were intrinsically
motivated, that is, their motivation for enrolling in
college was to experience the enjoyment of intellectual
discovery,13 had a tendency to experience lower levels of
burnout.

Furthermore, individuals who were extrinsically

motivated, or those who were motivated by a desired outcome
such as good grades or a better career, were more likely to

6
experience higher levels of burnout. It is difficult to
change what motivates a person, or how a person is
motivated. However, understanding how a person is motivated
and the predispositions that are associated with it may
help with finding appropriate prevention or coping
techniques for job stress or disappointment as well as
burnout.
Specific to undergraduate athletic training students
one study14 examined the relationship between burnout,
gender, year in school, and sport assignment. The
researcher found that juniors in the athletic training
education program had a tendency to have higher burnout
scores; however, sport assignments did not have an affect
on the scores. Results also indicated, contradictory to
previous research,7-10 that gender did not have an affect on
burnout scores.
This study will attempt to answer the following
questions in regards to burnout in athletic training
students. Is there a relationship between a student’s
cumulative GPA and burnout scores? Is there a difference
between academic levels (junior versus senior) for burnout
scores? Is there a difference between gender for burnout
scores?

7
METHODS

The primary purpose of this study is to examine
burnout among undergraduate athletic training students at
accredited athletic training education programs (ATEP) in
the United States. The secondary purpose of this study is
to determine reliability for the survey.

The researcher

examined the potential causes of burnout among this
population. The subsections are as follows:

research

design, subjects, instruments, procedures, hypotheses, and
data analysis.

Research Design

The present study is a descriptive study that examined
the burnout scores among undergraduate athletic training
students (ATS) who are members of the National Athletic
Training Association (NATA) using the Bowers Athletic
Training Burnout Inventory (BATBI) (Appendix C1). The
independent variables include the students’ year in school,
gender, and cumulative GPA. The students’ year in school
has only two levels, junior or senior. This does not
include the number of credits, but their status within the

8
ATEP. The dependent variable is burnout scores, which was
measured by the BATBI with a Chronbach’s alpha of .685.

Subjects

The researcher contacted the National Athletic
Training Association (NATA) requesting that this survey be
sent to 1,000 randomly selected athletic training students
from the total number of 6,105 ATS nationwide using a
Listserve. The subjects consisted of 112 junior and senior
ATS from ATEP nationwide. Students that were not either a
junior or senior were eliminated from the study. Informed
consent was implied when the individual clicked on "agree",
completed the survey, and clicked on "send". All students
had the right not to participate in the study.

Instruments

The data was collected by the use of the Bowers
Athletic Training Burnout Inventory (BATBI) (Appendix C1).
The BATBI was a revised version of the Athletic Training
Burnout Inventory (ATBI)15 specific for athletic training
students. The ATBI was developed based off of the Maslach
Burnout Inventory (MBI) and was designed to assess burnout

9
scores among certified athletic trainers who worked at an
institute with an athletic training education program. In
order for the BATBI to pertain to athletic training
students, the last section, consisting of items 40 through
50 were omitted because ATS would not be able to answer
them properly. When creating the ATBI, each item was
analyzed though an item-to-total correlation to determine
the percentage of variability for each item to the specific
construct.16 The Chronbach’s alpha for all constructs
(emotional exhaustion/depersonalization, administrative
responsibility, time commitment, and organizational
support)of the original ATBI was equal to or more than
.80.15
The BATBI consists of 42 items, there are also six
demographic questions. Items in the original ATBI that
addressed “athletic trainer” were changed to say “athletic
training student”. Items that addressed “work” were changed
to say “clinical”. Items 19 and 23 from the original ATBI
were omitted because they pertained specifically to
certified athletic trainers. Item 8 of the original ATBI
was changed from “athletic training” to “athletic training
education program”. Item 28 of the original ATBI was
revised to say “peers” instead of “coworkers”. Item 29 of
the revised ATBI was added using the same wording as item

10
28, but addressing supervisors instead of peers. Items 25,
31, 38, and 41 were added using the same wording as the
original ATBI, but they addressed Approved Clinical
Instructors (ACI) instead of coaches. The items that
addressed coaches were kept as they were.
The BATBI is comprised of four constructs (emotional
exhaustion/depersonalization, administrative
responsibility, time commitment, and organizational
support). The first construct, emotional exhaustion and
depersonalization include items 1-14. Construct two, how
the students interpret his/her administrative
responsibilities was assessed by items 15-19. How the
athletic training students viewed his/her time commitment
to the clinical aspect of their education was construct
three and was assessed by items 20-23. Finally, construct
four consisted of items 24-42 assessed organizational
support.
The original author of the ATBI did not identify a
score indicating burnout.16 However, higher burnout scores
indicate higher burnout for that individual. The range of
scores was from 42 to 252 in the BATBI. The students were
instructed to check the box marked “1 never true” if they
never experienced the stated feeling. If they experienced
the feeling, then they were asked to mark the box that best

11
described that feeling by selecting the appropriate number
from a six-point Likert scale, “2 mostly not true”, “3
sometimes not true”, “4 sometimes true”, “5 mostly true”,
and “6 always true” for each item.16 The majority of the
items of the BATBI were changed, as required by the IRB,
from having a negative connotation to a positive one to
reduce any added stress to the participants. These items
included 1-5, 7, 8, 10, 11, 14-16, 18-20, 22, 23, 26-33,
39-42. In order to keep the scoring consistent with the
original ATBI, the items that were changed had their value
reversed. For example, question one “I am comfortable
performing the duties of an athletic training student” was
changed from the original ATBI to have a positive
connotation. When scoring this question, a “never true”
response was given a value of 6 instead of 1, and an
“always true” response was given a value of 1 instead of 6.
A value of 2 became 5, 3 became 4, and vice versa. The
participants also completed a demographic section that
contained questions regarding their age, accumulative GPA,
year in school, gender, and race. Once the survey was
returned, an analysis was conducted to determine the
reliability of the modified instrument. Construct one,
emotional exhaustion and depersonalization has a
Chronbach’s alpha of .661, construct two, administrative

12
responsibility has a Chronbach’s alpha .733, time
commitment, which is construct three, has a Chronbach’s
alpha of .778, construct four, organizational support, has
a Chronbach’s alpha of .594, and the total inventory has a
Chronbach’s alpha of .685.
A limitation to address is the validity of the BATBI.
After submitting the IRB application, the IRB requested
that questions be changed from negative statements to
positive statements to minimize stress upon the
participant. The items that remained the same as the
original ATBI are 6, 9, 12, 13, 17, 21, 24, 25, 34-38.
Changes were made and the IRB approval was provided. A
review by a panel of experts on the BATBI was not performed
prior to sending to the athletic training students.

Procedures

The IRB application for this study was sent to the
California University of Pennsylvania Institutional Review
Board (IRB) and received approval (Appendix C2). The
researcher utilized www.surveymonkey.com to create a direct
link to the survey. A cover letter (Appendix C3) was sent
via email, explaining the purpose of the study to the
selected undergraduate athletic training students. The

13
researcher contacted the NATA, requesting that this survey
be sent to 1000 randomly selected athletic training
students across the nation. A link in the cover letter
provided the athletic training students with direct access
to begin the survey. The researcher determined when to send
out the surveys and allowed ample time to complete the
survey.

After one week, a follow up email was sent by the

NATA to those ATS that had been randomly selected by the
Listserve.

Hypotheses

The following hypotheses were based on previous
research and the researcher’s intuition based on a review
of the literature.
1. There is a relationship between athletic training
student's cumulative GPA and a) emotional exhaustion
and depersonalization scores, b) administrative
responsibility scores, c) time commitment scores, d)
organizations support, and e) total burnout scores.
2. There is a difference between athletic training
student's academic levels (Junior and Senior) for a)
emotional exhaustion and depersonalization scores, b)
administrative responsibility scores, c) time

14
commitment scores, d) organizations support, and e)
total burnout scores.
3. There is a difference between gender for a) emotional
exhaustion and depersonalization scores, b)
administrative responsibility scores, c) time
commitment scores, d) organizations support, and e)
total burnout scores.

Data Analysis

1. A Pearson Product Moment Correlation was used to
determine if there was a relationship between a
Students’ cumulative GPA and total burnout scores.
2. A factorial MANOVA was used to determine if there was
a difference between academic levels (junior versus
senior) and gender for a) emotional exhaustion and
depersonalization scores, b) administrative
responsibility scores, c) time commitment scores, d)
organizations support, and e) total burnout scores.

15
RESULTS

Demographic Data

National Athletic Trainers’ Association (NATA)
undergraduate student members (N =112) voluntarily
participated in this study.

The athletic training student

population was 6,105, the recommended sample size for this
population was 361.

Therefore, the return rate was 31%.

Table 1 represents the athletic training students’ year in
the program. The majority of the students’ who responded
were seniors in the program.
Table 1. Year in the Program
Classification
Frequency
Junior
45
Senior
67

Percent
40.20
59.80

Table 2 represents the athletic training students’ age
and cumulative grade point average. The average age for
students who responded was 21 years old, with the oldest
being 28 years. The average GPA for the students was 3.44,
with the lowest GPA at a 2.75.
Table 2. Demographics
Classification
Age
GPA

Range
20-28
2.75-4.0

Mean ± SD
21.49 ± 1.34
3.44 ± 0.3

16
Table 3 represents the students’ gender. Of the
students who responded to this survey, over half where
female which accounted for 66.10%.
Table 3. Gender
Classification
Male
Female

Frequency
38
74

Percent
33.90
66.10

Table 4 represents the students’ race. A large number
of athletic training students were white who responded with
88.40%. Of the students who responded to this national
survey, 11.70% were of different racial or ethnic
background.
Table 4. Race
Classification
White
Asian
Brazilian
Hispanic
Middle-Eastern
Multiple races
Black/African-American

Frequency
99
4
1
2
2
2
2

Percent
88.40
3.60
0.90
1.80
1.80
1.80
1.80

Table 5 represents the mean and standard deviation for
each construct. The mean of each construct was within three
points of half of the total points possible for that
construct, including the total burnout scores.

17
Table 5. Mean Construct Scores
Construct
Range
Emotional
31-65
Exhaustion/
Depersonalization

Mean ± SD
40.34±6.42

Administrative
Responsibility

6-25

12.38± 2.99

Time Commitment

8-22

13.82± 3.58

Organizational
Support

47-86

60.53± 5.24

Total Burnout

109-190

127.06± 12.87

Table 6 represents the response frequency and
percentages for each survey question.

18
Table 6. Survey Question Frequencies and Percentages
Never
True

Mostly not
True

Sometimes
Not True

Sometimes
True

Mostly
True

Always
True

Construct 1:
Emotional
Exhaustion/
Depersonalization

9.3%

7.2%

9.0%

16.4%

37.8%

20.6%

Q1: I am
comfortable
performing the
duties of an
athletic training
student.

1
.9%

5
4.5%

70
62.5

35
30.4%

Q2: I do not feel
emotionally
exhausted when I
leave clinical.

6
5.4

16
14.3%

19
17.0%

26
23.2%

45
40.2%

Q3: I do not feel
fatigued when I
think about facing
another day of
clinical.

9
8.0%

17
16.1%

23
20.5%

29
25.9%

32
27.7%

2
1.8%

Q4: I treat all of
my athletes as if
I care about them.

1
.9%

2
1.8%

47
42.0%

62
55.4%

Q5: Working with
athletes all day
has not become a
strain for me.

6
4.5%

5
7.1%

4
12.5%

3
15.2%

48
41.1%

19
19.6%

Q6: I feel I have a
positive influence
on my athletes

1
.9%

3
2.7%

16
14.3%

60
53.6%

32
28.6%

Q7: I have become
more sympathetic
when dealing with
athletes.

4
3.6%

6
5.4%

13
11.6%

27
24.1%

55
49.1%

7
6.3%

Question

19
Table 6. Survey Question Frequencies and Percentages
(continued)
Never
True

Mostly not
True

Sometimes
Not True

6
6.3%

19
16.1%

15
13.4%

20
17.9%

33
30.4%

19
16.1%

4
3.6%

13
11.6%

32
28.6%

56
50.0%

7
6.3%

Q10: I do not feel
that I am at the
end of my rope
professionally

12
10.7%

7
4.1%

9
8.0%

11
8.9%

38
33.9%

35
31.3%

Q11: I care what
happens to all of
my athletes

1
.9%

5
4.5%

32
28.6

73
65.2%

Q12: Some of my
athletes blame me
for their injuries

91
81.3%

19
17.0%

1
.9%

Q13: I feel I have
a positive
influence on my
coaches

5
4.5%

9
8.0%

41
37.5%

37
32.1%

15
13.4%

Q14: I feel my
workload is fine
with my teams

3
2.7%

10
8.9%

20
17.9%

25
22.3%

42
37.5%

12
10.7%

Question
Q8: I do not
worry that the
athletic training
education program
is hardening me
emotionally
Q9: I feel very
energetic while
working with my
athletes

Sometimes
True

Mostly
True

Always
True

20
Table 6. Survey Question Frequencies & Percentages
(continued)
Question

Never
True

Mostly not
True

Sometimes
Not True

Sometimes
True

Mostly
True

Always
True

Construct 2:
Administrative
Responsibility

1.4%

4.5%

2.9%

21.6%

46.8%

24.1%

Q15: I feel that I
have the right
amount of athletes
under my direct
care

1
.9%

7
6.3%

5
4.5%

27
24.1%

57
50.9%

15
13.4%

Q16: I feel I can
handle the duties I
am required to
perform

1
.9%

13
11.6

58
51.8%

40
34.8

Q17: I wish I had
more one-on-one
time with my
athletes

3
2.7%

14
11.6%

6
5.4%

45
43.8%

27
21.4%

17
15.2%

Q18: I can handle
the amount of
paperwork.

2
1.8%

1
.9%

3
3.6%

22
18.8%

57
50.9%

27
24.1%

Q19: I can handle
the clinical
responsibilities.

1
.9%

3
2.7%

1
.9%

11
9.8%

59
52.7%

37
33.0%

Construct 3: Time
Commitment

3.4%

11.0%

13.6%

26.1%

29.3%

17.0%

Q20: I can work the
weekends and
holidays

3
2.7%

12
10.7%

25
22.3%

41
36.6%

19
17.0%

Q21: I wish I could
spend more time
with my family

1
.9%

6
5.4%

4
3.6%

37
33.0%

22
19.6%

42
37.5%

Q22: I have time to
get things done

5
4.5%

17
15.2%

27
24.1%

34
30.4%

2
1.8%

Q23: I feel the
hours I provide
athletic training
services are fine

5
4.5%

14
12.5%

18
16.1%

28
25.0%

34
30.4%

13
11.6%

21
Table 6. Survey Question Frequencies and Percentages
(continued)
Question

Never
True

Mostly not
True

Sometimes
Not True

Sometimes
True

Mostly
True

Always
True

Construct 4:
Organizational
Support

1.4%

1.9%

5.6%

12.8%

36.8%

38.9%

Q24: I have a
positive
professional
relationship with
my COACHES

1
.9%

2
1.8%

18
16.1%

51
45.5%

38
33.9%

Q25: I have a
positive
professional
relationship with
my ACI

1
.9%

2
1.8%

3
2.7%

6
5.4%

33
29.5%

67
59.8%

Q26: The athletic
department values
the athletic
training program

3
2.7%

5
4.5%

8
7.1%

24
21.4%

39
34.8%

33
29.5%

5
4.5%

24
21.4%

47
42.0%

31
27.7

Q28: I feel
comfortable when I
ask a PEER(s) a
question

1
.9%

2
1.8%

12
10.7%

44
39.3%

52
46.4%

Q29: I feel
comfortable when I
ask a SUPERVISOR(s)
a question

1
.9%

2
1.8%

3
2.7%

13
11.6%

55
49.1%

38
33.9%

1
.9%

6
5.4%

23
20.5%

37
33.0%

34
30.4%

11
9.8%

Q27: I feel my job
expectation has
been clearly
communicated by
the administration

Q30: I feel
COACHES always
have realistic
expectations of my
clinical
responsibilities

22
Table 6. Survey Question Frequencies and Percentages
(continued)
Never
True

Mostly not
True

Sometimes
Not True

Sometimes
True

Mostly
True

Always
True

Q31: I feel my ACI
always has
realistic
expectations of my
clinical
responsibilities

2
1.8%

1
.9%

8
7.1%

12
10.7%

50
44.6 %

39
34.8%

Q32: I am not
afraid of making
mistakes while
performing my
athletic training
duties

3
2.7%

20
17.9%

16
14.3%

23
20.5%

41
36.6%

9
8.0%

Q33: I am allowed
to utilize all of
my knowledge while
treating an athlete

2
1.8%

10
8.9%

12
10.7%

42
37.5%

44
39.3%

Q34: I clearly
understand the
level of
responsibility I
have regarding the
treatment of an
athlete

2
1.8%

3
2.7%

8
7.1%

40
35.7%

59
52.7%

Q35: My
supervisor(s)
communicate changes
in our policies and
procedures

1
.9%

6
5.4%

20
17.9%

35
31.3%

50
44.6%

Q36: The athletic
training department
communicates to me
any changes in the
treatment protocol
of athletes.

1
.9%

2
1.8%

5
4.5%

15
13.4%

51
45.5%

38
33.9%

Question

Table 6. Survey Question Frequency and Percentages
(continued)
Question
Q37: My COACH(es)
respect my
decisions
Q38: My ACI
respects my
decisions

Never
True

Mostly not
True

Sometimes
Not True

Sometimes
True

Mostly
True

Always
True

1
.9%

3
2.7%

9
8.0%

29
25.9%

54
48.2%

16
14.3%

3
2.7%

9
8.0%

63
56.3%

34
30.4%

3
2.7%

Q39: Coaches
reinforce the
importance of
treatment when
athletes become
non-compliant

3
2.7%

8
7.1%

28
25.0%

48
42.9%

22
19.6%

Q40: My coach(es)
never blame me for
my athletes’
injuries

3
2.7%

2
1.8%

2
1.2%

10
8.9%

26
23.2%

69
61.6%

Q41: My ACI never
blames me for my
athletes’ injuries

3
2.7%

1
.9%

2
1.8%

11
9.8%

95
84.8%

Q42: I am expected
to report new
injuries to the
head athletic
trainer

4
3.6%

1
.9%

2
1.8%

3
2.7%

18
16.1%

84
75.0%

Total Burnout

3.9%

6.4%

7.8%

12.7%

37.7%

25.2%

Hypothesis Testing

All hypotheses were tested at an alpha level of .05.
Hypothesis 1: There is a relationship between athletic
training student's cumulative GPA and a) emotional
exhaustion and depersonalization scores, b) administrative
responsibility scores, c) time commitment scores, d)
organizations support, and e) total burnout scores.
A Pearson correlation coefficient was calculated for the
relationship between the students’ cumulative GPA and
emotional exhaustion and depersonalization scores,
administrative responsibility scores, time commitment
scores, organizations support, and total burnout scores.
a) A significant correlation was not found between GPA and
the students’ emotional exhaustion and depersonalization
scores (r(110)=.102,P>.05). Emotional exhaustion and
depersonalization is not related to GPA (Table 7).
Table 7. Pearson-Product Moment Correlation Between The
Students’ Cumulative GPA and Emotional Exhaustion and
Depersonalization Scores
Variable
n
r
P
GPA & Emotional
112
.102
.285
Exhaustion/
Depersonalization
Scores

25
b) A significant correlation was not found between GPA
and the students’ administrative responsibility (r(110)=.122,P>.05). Administrative responsibility is not related
to GPA (Table 8).
Table 8. Pearson-Product Moment Correlation Between The
Students’ Cumulative GPA and Administration Responsibility
Scores
Variable
n
r
P
GPA &
112
.122
.201
Administrative
Responsibility
Scores

c) A significant correlation was not found between GPA and
the students’ time commitment scores (r(110)=.038,P>.05).
Time commitment is not related to GPA (Table 9).
Table 9. Pearson-Product Moment Correlation Between The
Students’ Cumulative GPA and Time Commitment Scores
Variable
n
r
P
GPA & Time
112
.038
.694
Commitment
Scores

d) A significant correlation was not found between GPA and
the students’ organizational support (r(110)=.159,P>.05).
Organizational support is not related to the students’ GPA
(Table 10).

26
Table 10. Pearson-Product Moment Correlation Between The
Students’ Cumulative GPA and Organizational Support Scores
Variable
n
r
P
GPA &
112
.159
.094
Organizational
Support
Scores

e) A significant correlation was not found between GPA and
the students’ total burnout scores (r(110)=.098,P>.05).
Total burnout scores are not related to the students’ GPA
(Table 11).
Table 11. Pearson-Product Moment Correlation Between The
Students’ Cumulative GPA and Their Total Burnout Scores
Variable
n
r
P
GPA & Total
112
.098
.306
Burnout
Scores

Hypothesis 2: There is a difference between athletic
training student's academic levels (Junior and Senior) for
a) emotional exhaustion and depersonalization scores, b)
administrative responsibility scores, c) time commitment
scores, d) organizations support, and e) total burnout
scores.
Hypothesis 3: There is a difference between athletic
training students’ gender for a) emotional exhaustion and
depersonalization scores, b) administrative responsibility
scores, c) time commitment scores, d) organizations
support, and e) total burnout scores.

27
A 2 (Academic Level) x 2 (Gender) between-subjects
factorial MANOVA was calculated comparing a) emotional
exhaustion and depersonalization scores, b) administrative
responsibility scores, c) time commitment scores, d)
organizations support, and e) total burnout scores for
academic levels of the students’ (junior or senior) and
their gender. The main effect of academic levels on
emotional exhaustion and depersonalization scores was not
significant (F(1,108)=.391,P>.05). The main effect of gender
on emotional exhaustion and depersonalization scores was
not significant (F(1,108)=.278,P>.05). The interaction
between gender and academic level on emotional exhaustion
and depersonalization scores was not significant
(F(1,108)=.006,P>.05) (Table 12).
Table 12. A 2 (Academic Level) x 2 (Gender) betweensubjects factorial MANOVA for Emotional Exhaustion and
Depersonalization
Type II Sum
Source
df
MS
F
of Squares
Year
16.465
1
16.465
.391
Gender
11.686
1
11.686
.278
Year x Gender
.271
1
.271
.006
Error
4543.469
108
42.069

P
.533
.599
.936

b) The main effect of academic level on administrative
responsibility was not significant (F(1,108)=1.54,P>.05).
The main effect of gender on administrative responsibility
was not significant (F(1,108)=.729,P>.05). The interaction

28
between gender and academic level on administrative
responsibility was not significant (F(1,108)=1.12,P>.05)
(Table 13).
Table 13. A 2 (Academic Level) x 2 (Gender) betweensubjects factorial MANOVA for Administrative Responsibility
Type II Sum
Source
df
MS
F
P
of Squares
Year
13.883
1
13.883
1.544
.217
Gender
6.557
1
6.557
.729
.395
Year x Gender
10.076
1
10.076
1.120
.292
Error
971.224
108
8.993

c) The main effect of academic level on time commitment
was not significant (F(1,108)=.003,P>.05). The main effect
of gender on time commitment was not significant
(F(1,108)=.012,P>.05). The interaction between gender and
academic level on time commitment was not significant
(F(1,108)=.032,P>.05) (Table 14).
Table 14. A 2 (Academic Level) x 2 (Gender) betweensubjects factorial MANOVA for Time Commitment
Type II Sum
Source
df
MS
F
of Squares
Year
.036
1
.036
.036
Gender
.154
1
.154
.012
Year x Gender
.423
1
.423
.032
Error
1423.695
108
13.182

P
.958
.914
.858

d) The main effect of academic level on organizational
support was not significant (F(1,108)=.481,P>.05). The main
effect of gender on organizational support was not
significant (F(1,108)=.05,P>.05). The interaction between

29
gender and academic level on organizational support was not
significant (F(1,108)=.117,P>.05) (Table 15).
Table 15. A 2 (Academic Level) x 2 (Gender) betweensubjects factorial MANOVA for Organizational Support
Type II Sum
df
MS
F
Source
of Squares
Year
13.480
1
13.480
.481
Gender
1.391
1
1.391
.050
Year x Gender
3.269
1
3.269
.117
Error
3028.853
108
28.045

P
.490
.824
.733

The main effect of the academic level was not
significant on total burnout scores (F(1,108)=.058,P>.05)
The main effect for gender was also not significant on
total burnout scores(F(1,108)=.159,P>.05) (Table 16).
Finally, the interaction between gender and academic level
on total burnout scores was not significant
(F(1,108)=.139,P>.05). Thus, it appears that neither
academic year nor gender has any significant effect on
burnout scores.
Table 16. A 2 (Academic Level) x 2 (Gender) betweensubjects factorial MANOVA for Total Burnout
Type II Sum
Source
df
MS
F
of Squares
Year
9.920
1
9.920
.058
Gender
26.958
1
26.958
.159
Year x Gender
23.545
1
23.545
.139
Error
18343.553
108
169.848

P
.809
.691
.710

30
Additional Findings

The secondary purpose of this study was to determine
the reliability of the BATBI. A Chronbach’s alpha analysis
was performed to measure the internal consistency of the
BATBI. Chronbach’s alpha comprises a number of items that
make up a scale designed to measure a single construct
(e.g. stress), and it determines the degree to which all
items are measuring the same construct. A Chronbach’s alpha
analysis was performed on each construct and the total
score. The first construct measured the student’s emotional
exhaustion combined with depersonalization and had a
reliability of .661. The second construct measured the
students’ administrative responsibilities and had a
reliability of .733. The third construct measured the
students’ time commitment and had a reliability of .778.
The fourth construct measured organizational support and
had a reliability of .594. The reliability for the total
burnout score had a reliability of .685.

The total score

and all constructs except the organizational support had
moderate reliability (Table 17).

31
Table 17. Reliability for each Construct
Construct
Chronbach’s Alpha
Emotional
.661
Exhaustion/
Depersonalization
Administrative
Responsibilities

.733

Time Commitment

.778

Organizational
Support

.594

Total

.685

32
DISCUSSION

The following discussion section consists of three
subsections: discussion of results, implications to the
profession, recommendations, and conclusions.

Discussion of Results

The purpose of this study was to examine burnout
scores among undergraduate athletic training students who
are a member of the National Athletic Trainers’ Association
(NATA) to determine if burnout was dependent upon a
student’s GPA, year in the program (junior or senior), or
gender.
It was initially hypothesized that burnout scores
would be related to the athletic training students’ GPA.
This assumption was based on previous research that
suggested individuals who are extrinsically motivated, or
are motivated by outside factors are more likely to
experience burnout than individuals who are intrinsically
motivated.13 Being concerned with obtaining and maintaining
a good GPA would be an extrinsic motivational factor. The
stress associated with maintaining a good GPA would suggest
a higher risk for burnout and individuals who had a higher

33
GPA would be more likely to experience burnout on one or
more of the subscales of burnout. Statistical analysis for
this study did not find a significant relationship between
total burnout scores and GPA for undergraduate athletic
training students, which is contradictory to previous
research.13 There was also no significance between the
students’ GPA and any of the individual constructs within
the survey.
It was also originally hypothesized that burnout
scores would depend on the students’ year in the program
(junior or senior). This was based on previous research
that supported higher burnout in younger and less
experienced individuals.7-10 One researcher had found that
juniors reported a high degree of burnout three times more
likely than sophomores and seniors.14 However, statistical
analysis for this study did not present a significant
relationship between academic level and total burnout
scores, contradictory to the previous research.14
The final hypothesis was that burnout scores would be
dependent on the students’ gender. This assumption was
based upon previous research that supported that there was
a significant difference between males and females.7-10
Statistical analysis for this study did not support burnout
scores being dependent on the students’ gender. However,

34
there was another researcher, Addis,14 who specifically
examined burnout among undergraduate athletic training
students. The results of Addis’ study also indicated that
gender did not have an effect on burnout.14 It is possible
that the gender differences among athletic trainers that
affect burnout arise later in life as was found in the
study of program directors.9
In addition to examining the results, it is important
to understand the data and how the respondents reflect the
profession. An interesting component that was reported in
the demographic section that was specific to gender
indicated that almost two thirds of the respondents were
female in what used to be considered a male dominated
profession. The national membership is almost 50/50 in
regards to gender. This could mean that women are becoming
more prevalent in the athletic training profession, that
females are more likely to take a survey, or are more
likely to be a member of the NATA.
The mean scores for each construct of the BATBI as
well as the mean total burnout score were all within three
points of half of the highest possible score for that
construct. The burnout scores included emotional exhaustion
and depersonalization(40.34±6.42), administrative
responsibility (12.38±2.99), time commitment scores

35
(13.82±3.58), organizational support (60.53± 5.24) and
total burnout scores (127.06±12.87). This indicates that on
average, junior and senior undergraduate athletic training
students have a moderate risk for experiencing burnout.
There could be several reasons why the results of this
study were not as expected. One of the reasons may have
been because the survey questions were changed to avoid any
additional emotional stress to the participants, which may
have decreased the reliability of the survey. Also, the
validity of the survey was not determined prior to sending
it to the participants, which could be a concern.
It is also possible that many students who had a lower
GPA did not respond to the survey or could have been
embarrassed to put their true GPA. Also, many programs have
a minimum GPA requirement to stay in the athletic training
education program. There were very few GPAs reported that
were on the lower side so it is difficult to determine if
there would be a relationship between burnout and GPA.
The differences that were found between this study and
Addis14 could be attributed to a few factors. Addis’ study
was conducted at schools only in Pennsylvania, where this
study was nationally represented. Also, it was not until
after 2006 that a rule was put in place where undergraduate
ATS are limited to 20 hours of clinical. This would allow

36
students to have more time for their academic studies or
more time to spend how they wanted, which can help relieve
some stress. Another change that occurred between 2006 and
this study, is the role of the ATS and their required
supervision. Athletic training students used to be allowed
to travel with their assigned teams without the supervision
of their ACI and only needed to be in walky-talky distance
of their ACI while covering practices and events at their
home field. Athletic training students are now not allowed
to do those things and have to be insight of their ACI
while performing the duties of an ATS regardless of their
year in the program. The policy changes that were made
regarding the role of ATS and the weekly limit of hours
they are allowed to put in seem to have positive effects on
the students’ stress levels when comparing this study with
Addis. Strides in this direction should be continually
made.
A strength of this study is that it is a nationwide
study; therefore it would not only pertain to athletic
training students in one geographical area, but across the
country. A limitation to address is the validity of the
BATBI. After submitting the IRB application, the IRB
requested that questions be changed from negative
statements to positive statements to minimize stress upon

37
the participant. The items that remained the same as the
original ATBI are 6, 9, 12, 13, 17, 21, 24, 25, 34-38.
Changes were made and the IRB approval was provided. A
review by a panel of experts on the BATBI was not performed
prior to sending to the athletic training students.

Implications to the Profession

The findings of this study demonstrate that all junior
and senior athletic training students, regardless of age or
gender show some signs of burnout. Some measures could be
taken by program directors to try to help with further
prevention of burnout among undergraduate students. A
preventative program that could be introduced would be a
mentorship program, where underclassmen, i.e. freshman and
sophomores, are assigned to a junior or senior. This will
help the underclassmen feel more comfortable in the
athletic training setting and encourage them to ask
questions and get involved. Developing the confidence to
ask questions early on will allow them to carry this
throughout their educational experience and may reduce
their stress level and signs of burnout.

38
Recommendations

Based on the results of this study burnout scores were
not dependent on gender. This is also supported in previous
research that examined the undergraduate athletic training
population.14 However, it is refuted by research that
examined certified athletic trainers, which suggests that
females tend to have higher burnout scores. Further
research should be conducted examining burnout scores among
female undergraduate athletic training students and female
certified athletic trainers. There could be extrinsic
factors that come into play once a female hits a certain
point in her life, such as having a family and the workfamily conflict that can potentially arise, or simply being
certified versus being a student may place different kinds
of stress on them. Also, once a person graduates and
becomes certified, they lose that close network of fellow
athletic trainers and their support system decreases at the
same time other or responsibilities increase.
Another recommendation would be to modify the tool that
was used to measure burnout scores among this population.
Individual questions with low correlations could be deleted
to strengthen the reliability numbers, have a panel of
experts in the field review the instrument, and determine

39
the validity. Once these revisions are made, it is
recommended to perform this same study and compare results.

Conclusions

Based on the results of this study it cannot be
concluded that GPA, year in the program (junior or senior),
or gender has an affect on burnout scores among
undergraduate athletic training students. However, it can
be concluded that on average, undergraduate athletic
training students show signs of burnout regardless of their
GPA, academic level, or gender.
While the results of this study were not as expected, it
adds to the current literature on burnout among
undergraduate athletic training students, as well as
address some potential areas athletic training education
programs could improve to decrease unnecessary stress to
the ATS. This study also provided the beginning of an
instrument to measure burnout of undergraduate athletic
training students.

40
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instrument to describe burnout among collegiate
athletic trainers. J Athletic Training. February
2008;43(1):62-69.

16.

Clapper D. Determining burnout levels of certified
athletic trainers employed in the big ten athletic
conference (Unpublished master's thesis). Graduate
School of the Ohio State University. 2005.

APPENDICES

APPENDIX A
Review of Literature

44
REVIEW OF LITERATURE

Stress is a common factor in everyday life. The term
stress does not always imply a threatening change; it could
also be associated with intense pleasure.1 Without stress
there would be very little constructive activity or
positive change.1 In order to maintain a healthy life one
must have a balance of stress. Too little stress can cause
a “rusting out”, where the individual is not being
challenged which results in feelings of stagnation and
boredom.1,2 Too much stress can cause an individual to feel
overwhelmed by the demands placed upon them.1-3 When the
amount of stress that is perceived exceeds an individual’s
ability to cope for an extended period of time, then the
body begins to break down both physically and mentally.1-3
One specific emotional concern is burnout.3
Burnout is a syndrome related to physical and
emotional exhaustion that leads to a negative self-concept,
negative job or sport attitudes, and a loss of concern for
the feelings of others.1 An inability to manage or
effectively cope with large amounts of negative stressors
is what ultimately leads to burnout. The stressors that the
person experiences are a result of an imbalance between a
person’s demands and resources.2,3 Demands that a person is

45
faced with can be internal or external. Internal demands
typically come in the form of desired goals, personal
standards, or unconscious motives, among others.3 External
demands can result from athletic competition, external
conflict, or demands from the employment setting.
Burnout can be seen in various occupations and
professions. It can be very detrimental to an individual’s
performance at work as well as their overall health.
Dealing with stress in a positive way may help reduce that
risk of burnout and potentially increase quality of life
for a person.1
Certified Athletic Trainers are subjected to large
amounts of stress for an extended period of time. Burnout
has been an increasing problem in the athletic training
profession in various settings.4-8 Burnout has also been
reported among undergraduate athletic training students.7,8
Previous research that examined the causes of burnout has
found that personal characteristics, motivational factors,
and work-family conflict, among others, may all be
predispositions to a person experiencing burnout.2,3 However
there has been little research to examine potential
prevention techniques among undergraduate athletic training
students. This literature review will examine: (1) Burnout;
which will examine the signs and symptoms and potential

46
causes of burnout, (2) Burnout in healthcare professionals;
which also covers burnout in athletic training and burnout
in students, (3) Burnout coping strategies, and (4)
Instruments used to measure burnout.

A summary of the

review will also be provided.

Burnout

The human body has a particular response pattern to
stress. This response is known as General Adaptation
Syndrome (GAS) and it is to help ensure that a state of
homeostasis will be maintained when stress is placed upon
it.9 There are three stages in GAS, the alarm reaction,
resistance development, and the exhaustion phase.
The alarm reaction phase is the body’s initial
response to the stressor. It is the beginning of the cycle
and activates the body’s protective processes. Initially,
the body is very inefficient reacting to the demands placed
on it, and results in a general decline in resistance.9,10 As
the body starts to adapt to the stressor, it begins to
increase its functional capacity above normal. This is
known as resistance development. The body is increasing its
ability to meet the new demands that are being placed on
it. If the body remains under continual exposure to the

47
stressor then its ability to resist will decline below
normal levels and a state of exhaustion will occur.9,10
Exhaustion can have a variety of negative physical and
emotional consequences.1 When the body is subjected to large
amounts of stress it responds in the way previously
described, but when the stress is not removed, then the
body begins to break down, both physically and emotionally,
one emotional concern is burnout.1
All jobs and occupations come with certain levels of
stress. When there is a high level of stress for an
extended period of time, burnout can occur. Burnout can
result from a negative emotional reaction to one’s work.6
Burnout has been characterized as a multidimensional
syndrome consisting of three areas which include: feelings
of emotional exhaustion, depersonalization, a reduced sense
of personal accomplishment.4,11,12 Central features of burnout
are often a loss of interest or withdrawal in previously
enjoyable activities and a loss of motivation.2,3,13,14
Burnout is also highly associated with physical fatigue and
cognitive weariness, which refers to feelings of slow
thinking and reduced mental agility.5

48
Signs and Symptoms
Burnout has a variety of signs and symptoms associated
with it. Each case of burnout is different because each
individual is different and the responses in various cases
are not always the same. However, the cardinal feature of
burnout is a psychological and emotional withdrawal from a
formally sought after or enjoyable activity.2,3,14 The
individual may experience feelings of depression,
helplessness, and anger. These feelings may transpire into
other aspects of the person’s life and they may feel
resentment towards anyone who tries to make demands.2,3
Burnout has been characterized as a multidimensional
syndrome consisting of six areas which include: emotional
exhaustion, depersonalization, a reduced sense of personal
accomplishment, role conflict, role ambiguity, and role
overload. Emotional exhaustion occurs when an individual
feels extremely overwhelmed by the demands of their life.15
The person’s physical and emotional recourses are depleted
and they feel like they are unable to engage in their
personal or professional life, and it becomes difficult for
them to complete tasks.8,11,15,16
Depersonalization is an indifferent or negative
attitude toward one’s clients or work.8,11 The indifference
will cause the person to not put forth as much effort into

49
tasks, as a result they will start to isolate themselves
and pull away from the important people in their life out
of fear of letting them down.8 Depersonalization can lead to
feelings of reduced personal accomplishment. Reduced
personal accomplishment is a tendency to evaluate oneself
negatively, especially with regard to one’s work with
patients.8,11 The individual will start thinking that their
contribution is no longer important or significant and will
start to develop a “why bother” attitude.8
Role conflict occurs when an individual is unable to
set priorities. They try to divide their time equally
between a number of different tasks instead of placing
emphasis on things that are more important.15 Attempting to
do everything at once causes them to feel fatigued and
exhausted.8 Role ambiguity arises when an individual does
not understand what is expected of them, which causes them
to feel that their job is not meaningful.15 Role conflict
and role ambiguity can then lead to role overload. Role
overload takes place when a person has a large amount of
work to accomplish but keeps adding more tasks to their
list due to their inability of saying no to people.15
Individuals can experience all six of the components of
burnout, or only a few of them. A person does not have to
experience all of the symptoms previously described to be

50
suffering from burnout. These components can lead to more
physical and emotional health problems if not properly
addressed.
Some of the more serious symptoms include sleep
deprivation, an increased inflammatory reaction, potential
impairment to reproductive systems, and cardiovascular
disease. Sleep deprivation can occur because a person
experiencing burnout usually has difficulty “winding down”
at the end of the day and due to that they have trouble
falling asleep and the quality of their sleep is also
diminished.5 Sleep deprivation in and of itself has its own
negative health consequences. An increased inflammatory
reaction may be linked to atherosclerosis in individuals
who do not have any other predisposing factors. Burnout can
also lead to cardiovascular disease because of its negative
effect on the autonomic nervous system, the metabolic
system, and the immune system.

Potential Causes of Burnout
Just as burnout has a variety of signs and symptoms,
it also has a variety of potential causes. When a person is
faced with a particular demand, resources are mobilized to
meet it. However, when there is an imbalance between the
level of demands and the availability of resources, stress

51
occurs.2,3,14 Many times when demands are not met, guilt and
anxiety, self-derogation, or loss of self-esteem can
occur.2,3 If this level of stress continues for an extended
period of time, burnout is often the result.
There are two types of factors, personal and
environmental, that have been linked to burnout. Personal
factors include personality traits and perceived stress
levels. Each person reacts to similar situations in
different ways. It is a person’s perception of the balance
or imbalance between demands and resources, that determines
the level of stress a person experiences.2,3 Other personal
factors that contribute to a predisposition to experiencing
burnout include irrational beliefs concerning the meaning
and importance of success, individual differences in
personality, and motivation.2,3
Those who are more intrinsically motivated or are
self-determined tend to experience lower levels of
burnout.3,17 Most people who partake in an activity do so
because they find it interesting, enjoyable, and
satisfying.17 Individuals who are motivated by external
factors or are motivated primarily because they want to
avoid disappointment or negative outcomes tend to
experience higher levels of burnout.3,17

52
Situational or environmental factors that may
predispose people to burnout are low personal autonomy, low
levels of social support, overload, injustice, inequity,
under rewarded, and job complexity among others.3,5,18,19
Social support often acts like a buffer against high levels
of stress.3,18,19 Work-family conflict is also a big factor
that may lead to burnout. The inability to have an
appropriate balance of a one’s personal and professional
life can be very detrimental and lead to a large amount of
stress that can eventually lead to burnout if it is not
resolved.

Burnout in Healthcare Professionals

Healthcare professionals are faced with many stressors
that are unique to their profession. One particular
stressor is being faced with ethical difficulties. These
difficulties can be associated with a troubled conscience.20
When working with an elder population, depending on the
occupational role, nurses are faced with situations where
the right answer is not always clear cut. This “grey area”
may lead to a negative effect on one’s conscience.
Juthberg et al20 surveyed 50 registered nurses (RNs)
and 96 nurse assistants (NAs) to examine a pattern of

53
perception of conscience and burnout in relation to
occupational belonging. They found that the majority of NAs
viewed their conscience as a “guide” for difficult
decisions, and was therefore an asset. However, if a RN or
NA was experiencing stress of conscience (stress that is
related to a troubled conscience) they seemed to also be
experiencing high levels of emotional exhaustion.
One study compared individual differences in social
comparison orientation (SCO) to determine if SCO can
predict the development of burnout in nurses over one year
period.21 Social comparison refers to the process of
evaluating one’s own characteristics by relating them to
the characteristics of others. A person can make upward or
downward comparisons. Upward comparisons are when
comparisons are made with others who are performing better
than oneself, while downward comparisons are with those who
are performing worse than one’s self. There were 93 nurses
that completed the same survey twice. What the researchers
found was that upward comparisons were reported more often
the first time they took the survey and it evoked a
positive emotion. This showed to decrease burnout levels
the second time they completed the survey. Those who made
upward comparisons, but a negative emotion was evoked
showed to increase the level of burnout by the second time

54
they took the survey. According to their findings, the data
suggests that it is not necessarily the SCO that predicts
the level of burnout in nurses, but the emotions that are
evoked by the upward or downward comparisons.
Healthcare professionals are exposed to a variety of
stressors that non-healthcare professionals do not
experience, as well as many that are not seen in many other
professions. Comparing performance with others has been
something that people have done since a young age. However,
once they get older and their career depends on out
performing others, the level of stress increases. This is
seen in every profession. What is unique with healthcare is
that a bad performance will not only have a negative affect
on a person’s career, but potentially a negative affect on
someone else’s life.

Burnout in Athletic Training
Athletic training is a very demanding profession with
consistently high levels of stress from various aspects of
the job. Some examples of stressors that an athletic
trainer has to deal with on almost a daily basis are being
pressured by a coach to clear an athlete for participation,
limited personal and financial resources, and long work
days, just to name a few. Athletic training is still a

55
profession that is not fully understood by the general
public, or even understood by coaches and athletes. Due to
this lack of understanding athletic trainers are often
unrecognized and unappreciated for the effort and care they
provide. This makes athletic trainers more susceptible to
burnout.4
Due to the high incidence of burnout among athletic
trainers there has been a variety of research studies
conducted to try to determine the specific causes of
burnout. Kania et al12 used a cross-sectional survey to
examine the relationship between personal and environmental
characteristics and burnout among ATCs at NCAA
institutions. They found that of the personal
characteristics, stress level was predictive of emotional
exhaustion, depersonalization, and personal accomplishment,
the three subscales of burnout; while leisure time was only
predictive of personal accomplishment. The environmental
characteristics they examined were pressure from the
coaches, injury type and frequency, and the number of
sports covered by the athletic trainer. Pressure from the
coach to medically clear an athlete was the only
environmental characteristic that is predictive of the
three subscales. Injury-type and frequency was predictive
of emotional exhaustion, the number of sports the athletic

56
trainer was responsible for was predictive of
depersonalization, and the number of athletes that they
were responsible for was predictive of personal
achievement.
Other factors that have been considered within
previous research have been age, gender, and the amount of
experience an athletic trainer has. Walter et al6 wanted to
assess the level of burnout in athletic training education
program directors and to determine the relationship between
burnout and various demographics related to their position.
They found that emotional exhaustion scores were higher for
women than for men. However, emotional exhaustion decreased
as they grow older and experience levels increased.
Personal accomplishment scores increased as experience
increased. They also found that those who worked more than
20 hours a week had higher depersonalization scores, but
this too, decreased with age.
The purpose of the study conducted by Giacobbi5 was to
assess the prevalence of occupational burnout, engagement,
and somatic health complaints of athletic trainers in
various employment settings. The researcher also wanted to
examine the differences between men and women, those with
more or less post certification experience, and their age.
The author concluded that female athletic trainers and

57
athletic trainers working in the collegiate or university
settings showed more signs of burnout. Occupational stress
was positively related to elements of burnout and somatic
health complaints, but negatively related to occupational
engagement.
Burnout affects both men and women among various
settings. However, females, those who have less experience,
and those who are employed at the collegiate level tend to
show more severe signs of burnout.5,6

Burnout in Students
Undergraduate students are faced with a variety of new
kinds of stress that many have never experienced before
such as the demands of college classes, being newly
independent, financial concerns, and having difficulty with
time management, among other things.22,23 Granted, these are
not concerns for all undergraduate students, but they are
rather common. With this high level of personal and
academic stress, burnout is common among undergraduate
students, in general.
Additional to these concerns, idealism is a common
factor that is associated with burnout among students who
enter helping professions.24 Idealism refers to the extent
to which an individual identifies with the values and goals

58
of the profession. There is a gap between idealistic
expectations that students have about the profession they
are entering and the realities of practice that they will
soon be facing, this gap is a likely cause of emotional
exhaustion.24 Ngai et al24 examined the effect of idealism,
altruism, and career orientation on emotional exhaustion
among social work undergraduates. Individuals who scored
high on idealism had a propensity to report higher levels
of emotional exhaustion. The high levels of idealism
allowed the students to feel a greater degree of
disappointment; which is what contributes to emotional
exhaustion.

Positive career orientation was defined as a

combination of career attitudes that incorporates favorable
perceptions of one’s ability to express oneself in the
world of work through a successful career in one’s chosen
profession.24 This research showed that positive career
orientation is negatively related to emotional exhaustion.
That is, those who have a positive career orientation or a
realistic view of their desired profession has been shown
to experience lower levels of emotional exhaustion.
The researchers conducting this study defined altruism
as an enduring tendency to think about the welfare of
others, to feel concern and empathy for them, and to act in
such a way that benefits others. Individuals who think in

59
this way have a tendency to cope well with stressors as
well as regard challenges as learning and development
opportunities.25 This research showed that altruism
displayed a negative relationship with emotional
exhaustion, but it did not seem to produce a unique effect
due to its high correlation with career orientation.24 This
research shows the need for students to develop a
combination of more realistic views with a positive career
orientation, as well as a healthy desire to want to help
other individuals.
One study17 looked at the motivational factors among
students who attend an undergraduate institution. The
researchers found that students who were intrinsically
motivated, that is, their motivation for enrolling in
college was to experience the enjoyment of intellectual
discovery,17 had a tendency to experience lower levels of
burnout.

They also found those individuals who were

extrinsically motivated, or those who were motivated by a
desired outcome such as good grades or a better career,
were more likely to experience higher levels of burnout.
How a person is motivated is difficult to change. However,
if more is understood about their motives and the
predispositions that are associated with it, it may help
with finding the proper prevention or coping techniques.

60
When students first begin thinking about their desired
career pathway, they have a tendency to have idealistic
thoughts, regardless of their chosen field. The inability
some students have to view their desired profession
objectively and realistically set them up for future
disappointment. They are not prepared for the challenges
and demands that will be placed upon them when they get
further into their educational program or when they are out
on their own. These new challenges and stressors can build
up and if they are not handled in a healthy manner, it can
result in burnout.
Another researcher14 examined burnout scores among
undergraduate athletic training students. The researcher
examined the relationship between burnout and the students’
year in the program, gender, and sport assignments by using
the MBI-Human Service Survey (MBI-HSS). Results indicated
that the students’ year in the program did have an affect
on burnout scores. Those who were in their junior year in
the program had higher burnout scores. The results also
showed that burnout scores did not depend on the student’s
sport assignment or their gender, which is contradictory to
previous research.

61
Burnout Coping Strategies

Burnout has affected many individuals from athletic
trainers, to hotel supervisors, and students. Because of
the vast amount of people that are affected by burnout,
there have been numerous studies to determine effective
ways to cope with burnout.18,19,26,27 Some of the most common
coping strategies include direct action, avoidance, and
adaptive avoidance coping.

18,19,26,27

Direct action or approach coping means that the
individual attempts to deal with the stressful situation by
either making an effort to alter the stressful situation or
their relationship to it.26,27 There are a variety of
techniques to do this. Examples of this include appraisalfocused (which means that the person takes a positive
acceptance of their role), seeking emotional support,
planning to resolve the stressor, and seeking
information.18,19
Research has determined the effectiveness of these
techniques. The studies that were examined had
contradictory findings. In two of the studies, direct
action or approach coping showed to have a positive effect,
that is, reduced burnout in the long run.19,26 One study
showed that this coping strategy reduced stress only part

62
of the time.19

The research has also showed that the

effectiveness of seeking social support depends on quality
of the support provided.18 A negative response can increase
the symptoms of burnout.
Avoidance-oriented coping strategies were also
considered in previous research studies. Avoidance is when
an individual will partake in activities or make cognitive
changes to avoid stress. This can include social diversion,
denial, behavioral and mental disengagement, as well as
seeking rewards from other activities.18,19,26,27 Some of the
researchers did not have results that showed either a
positive or negative effect of this coping strategy.
However, there are studies that have shown that the
avoidance coping was maladaptive and has a negative effect
on emotional exhaustion, depersonalization, and personal
accomplishment.18,18,27 This means that it was related to
higher levels of stress and burnout and is not an effective
coping technique for long term stress.17,26,27
Adaptive-avoidance is a technique that has not been
researched as much as other strategies, but is worth
mentioning. Adaptive-avoidance is a behavioral, not an
emotional, effort to avoid becoming too involved in the
stressful situation in order to secure their personal life
and health.19 This often includes diversion or

63
compartmentalizing one’s life. Individuals utilizing this
strategy would take time away from the stressful situation
for themselves.

The results of this study showed that

adaptive-avoidance did reduce the levels of burnout in the
short term.
The results of some of the studies that have been
conducted have shown that approach coping has beneficial
effects in the long term. However, research has also shown
that burnout has suppressed the adoption of a direct
approach coping strategy.19
The results within the research were inconsistent with
one another. Avoidance can lead to self-distraction, which
indicates that usual activities or interests are no longer
challenging or satisfying.18 This coping technique may lead
to a temporary fix, at least that might be what an
individual believes. However, when subjected to prolonged
periods of high level stress, burnout is likely to occur if
the stressor is not addressed. One study showed that
diversion, which is a form of adaptive-avoidance, has a
beneficial effect on mental health.19 This same study
suggested that burnout suppressed the adoption of an
approach coping strategy. This might suggest that direct or
approach coping might be more beneficial to more
individuals if they adopted that approach before stress

64
levels become too high. With this thought in mind,
avoidance may be beneficial for a short period of time,
using it only long enough to adopt a more direct coping
method.
Coping strategy utilization varies depending on
personality traits as well as a person’s occupation. The
effectiveness of coping techniques also depends on a number
of different variables. The inconsistency in results among
previous research suggests that more research is needed to
more accurately determine what technique is more effective
among different occupations and personality traits.

Instruments Used to Measure Burnout

The most popular instrument used to measure burnout is
the Maslach Burnout Inventory (MBI).16,28 Three versions of
the MBI have been developed which are as follows: the MBIHumans Services Survey (MBI-HSS), MBI- Educators Survey
(MBI-ES), and the MBI- General Survey (MBI-GS).16,28 The MBIHSS was developed to assess burnout among those in human
service professions. The MBI-ES was developed to assess
those working in educational settings. The MBI-GS allows
for the assessment of burnout among professionals who do
not have direct client contact.16,28 All three versions of

65
the MBI measure three components of burnout, emotional
exhaustion, depersonalization, and personal
accomplishment.16,28
Another tool, the Athletic Training Burnout Inventory
(ATBI) was evolved from the MBI to assess burnout among
athletic trainers.7,29 The ATBI measures emotional exhaustion
and depersonalization. Additionally, the ATBI measures
organizational support, time commitment, and administrative
responsibilities.7 Athletic training has many aspects that
are unique to the profession. The purpose for the
development of the ATBI was to assess burnout among
certified athletic trainers as well as for further
development of an instrument that will specifically test
athletic trainers in any setting.7

Summary

The understanding of burnout and ways to cope with
high levels of stress is important because it does not only
affect a person’s emotion, but their physical health and
wellbeing. When a person is unable to cope with the demands
placed upon them, then they may break down physically and
mentally. The cardinal sign of a person who is experiencing
burnout is withdrawal from previously enjoyable

66
activities.2,3,13,14 They also tend to experience feelings of
depression, helplessness, anger, and resentment towards
anyone who tries to make demands.2,3 Burnout can also affect
a person’s physical health. If it is not resolved, it can
lead to other health risks later on in a person’s life.
Due to the fact that no two people are the same,
people can experience the same situation, but react in
completely different ways. It is a perception that the
individual has of the imbalance between the demands placed
on them and the resources that are needed to meet those
demands that leads to high levels of stress and ultimately
burnout.2,3
Athletic training is a very demanding profession with
consistently high levels of stress from various aspects of
the job. It is still a profession that is not fully
understood by the general public or even by coaches and
athletes. Due to this lack of understanding athletic
trainers are often unrecognized and unappreciated for the
effort and the care they provide. This makes athletic
trainers more susceptible to burnout.4 Burnout affects both
men and women among various settings. However, it is
females, those who are younger or have less experience, and
those who are employed at the collegiate level or work more

67
than 20 hours a week, that tend to show greater signs of
burnout.5,6,14
Students also tend to experience significantly high
levels of stress. When students first begin thinking about
their desired career pathway, they have a tendency to have
idealistic thoughts. The inability some students have to
view their desired profession objectively and realistically
makes it difficult for them to prepare for the challenges
and demands that will be placed upon them. These new
challenges and stressors can build up and if they are not
handled in a healthy manner, it can result in burnout.
Healthcare professionals are faced with many stressors
that are unique to their profession. One particular
stressor is being faced with ethical difficulties that may
lead to a troubled conscience.20 Some of the situations they
encounter do not have a clear cut correct answer. What is
unique with healthcare is that a bad performance will not
only have a negative effect on a person’s career, but
potentially a negative effect on someone’s life.
Due to the vast amount of people that are affected by
burnout, there have been numerous studies to determine
effective ways to cope with burnout.18,19,26,27 Coping
strategies utilization varies depending on personality
traits as well as a person’s occupation. The effectiveness

68
of coping techniques also depends on a number of different
variables. By understanding what burnout is, what causes or
predisposes a person to experiencing it, and the other
various aspects that are associated with it, will help
determine effective ways to prevent burnout.

APPENDIX B
The Problem

70
THE PROBLEM

Statement of the Problem
Stress is a common factor in everyday life and can
lead to a wide variety of physical and emotional problems.
Health care professionals are more apt to experience the
high levels of stress that can lead to burnout. Among these
healthcare professionals are athletic trainers. The demands
of the athletic training profession also transpire down to
the athletic training students as well. The purpose of this
study is to identify different factors that may lead to
burnout among undergraduate athletic training students. The
secondary purpose of this study is to determine reliability
for the survey.

Once these factors are identified, then

burnout prevention among this population can be addressed.

Definition of Terms
The following definitions of terms will be defined for
this study:
1)

Burnout- a multidimensional syndrome consisting of
three subscales: feelings of emotional exhaustion,
depersonalization, and a reduced sense of personal
accomplishment.11,12

71
2)

Depersonalization- An indifferent or negative attitude
toward one’s clients or work.11,16

Emotional Exhaustion- an overextension and depletion
of one’s physical and emotional resources and feel
like they are unable to engage in their work.11,16

Reduced Personal Accomplishment- is a tendency to
evaluate oneself negatively, especially with regard to
one’s work with patients.11,16

Role Conflict- When an individual is unable to
prioritize while taking on many tasks at once, causing
them to feel the need to accomplish them at the same
time.8,15

Role Ambiguity- is when an individual does not
understand what is expected of them causing them to
feel that their job is not meaningful.15

Role Overload-occurs when a person has a large amount
of work to accomplish and continues to add more tasks
to their list because they have difficulty saying no
to others.15

72
Basic Assumptions
The following are basic assumptions of this study:
1)

The participants will complete the survey honestly and
to the best of their ability.

The survey has reliability.

Only junior and senior students in an undergraduate
athletic training education programs will answer the
inventory.

Limitations of the Study
The following are possible limitations of the study:
1)

The sample is limited to junior and senior athletic
training students.

Not having correct email addresses for completing the
survey.

The NATA will send the survey out to 1000 registered
ATEP students which include Freshman, Sophomore,
Junior, and Senior students.

The survey was amended to accommodate the California
University of Pennsylvania Institutional Review Board.
A panel of experts did not review the survey to ensure
the validity of the Bowers Athletic Training Burnout
Inventory prior to it being sent to the participants.

Significance of the Study
Different occupations are associated with various
levels of job stress. Increased stress for a prolonged
period can lead to burnout. This is especially seen in
health care professionals including athletic training.4
Previous research has been conducted to examine burnout
among undergraduate students as well as undergraduate
athletic training students (ATS). This study will examine
the burnout among undergraduate ATS in accredited athletic
training education programs and factors that may predispose
them to burnout. This study is significant because once the
potential causes of burnout for ATS are determined, then
ways to prevent burnout can be examined. This may make it
possible for undergraduate ATS to avoid burnout all
together and will help the profession of athletic training
continue to expand.

APPENDIX C
Additional Methods

APPENDIX C1
Bowers Athletic Training Burnout Inventory

76
Bowers Athletic Training Burnout Inventory

Are you 18 years or older?
Yes

What year are you in the Athletic training Education
Program?
Freshman
Sophomore
Junior
Senior

What is your age?

What is your gender?
Male

Female

What is your race?
White
Black or African American
American Indian or Alaskan Native
Asian
Native Hawaiian or other Pacific Islander
From multiple races
Some other race (please specify)

77
Question
Q1: I am comfortable
performing the duties of an
athletic training student.
Q2: I do not feel emotionally
exhausted when I leave
clinical.
Q3: I do not feel fatigued
when I think about facing
another day of clinical.
Q4: I treat all of my athletes as
if I care about them.
Q5: Working with athletes all
day has not become a strain
for me
Q6: I feel I have a positive
influence on my athletes
Q7: I have become more
sympathetic when dealing
with athletes.
Q8: I do not worry that the
athletic training education
program is hardening me
emotionally
Q9: I feel very energetic while
working with my athletes
Q10: I do not feel that I am at
the end of my rope
professionally
Q11: I care what happens to
all of my athletes
Q12: Some of my athletes
blame me for their injuries

Never
True

Mostly Sometimes Sometimes Mostly Always
not
Not True
True
True
True
True

78
Question
Q13: I feel I have a positive
influence on my coaches
Q14: I feel my workload is fine
with my teams
Q15: I feel that I have the right
amount of athletes under my
direct care
Q16: I feel I can handle the
duties I am required to
perform
Q17: I wish I had more oneon-one time with my athletes
Q18: I can handle the amount
of paperwork.
Q19: I can handle the clinical
responsibilities.
Q20: I can work the weekends
and holidays
Q21: I wish I could spend more
time with my family
Q22: I have time to get things
done
Q23: I feel the hours I provide
athletic training services are
fine
Q24: I have a positive
professional relationship with
my COACHES
Q25: I have a positive
professional relationship with
my ACI

Never
True

Mostly Sometimes Sometimes Mostly Always
not
Not True
True
True
True
True

79
Question
Q26: The athletic department
values the athletic training
program
Q27: I feel my job expectation
has been clearly
communicated by the
administration
Q28: I feel comfortable when I
ask a PEER(s) a question
Q29: I feel comfortable when I
ask a SUPERVISOR(s) a
question
Q30: I feel COACHES always
have realistic expectations of
my clinical responsibilities
Q31: I feel my ACI always has
realistic expectations of my
clinical responsibilities
Q32: I am not afraid of
making mistakes while
performing my athletic
training duties
Q33: I am allowed to utilize all
of my knowledge while
treating an athlete
Q34: I clearly understand the
level of responsibility I have
regarding the treatment of an
athlete
Q35: My supervisor(s)
communicate changes in our
policies and procedures

Never
True

Mostly Sometimes Sometimes Mostly Always
not
Not True
True
True
True
True

80
Question

Never
True

Mostly Sometimes Sometimes Mostly Always
not
Not True
True
True
True
True

Q36: The athletic training
department communicates to
me any changes in the
treatment protocol of
athletes.
Q37: My COACH(es) respect
my decisions
Q38: My ACI respects my
decisions
Q39: Coaches reinforce the
importance of treatment
when athletes become noncompliant
Q40: My coach(es) never
blame me for my athletes’
injuries
Q41: My ACI never blames me
for my athletes’ injuries
Q42: I am expected to report
new injuries to the head
athletic trainer

Approved by California University of Pennsylvania
Institutional Review Board. The IRB approval dates for this
project are from 02-06-2012 to 02-05-2013.

APPENDIX C2
Institutional Review Board –
California University of Pennsylvania

Proposal Number

Date Received

PROTOCOL for Research
Involving Human Subjects

Institutional Review Board (IRB) approval is required before
beginning any research and/or data collection involving human subjects

(Reference IRB Policies and Procedures for clarification)

Project Title Burnout Among Undergraduate Athletic Trainging Students
Researcher/Project Director

Michelle L. Bowers
E-mail Address BOW9158@calu.edu

Phone # 1-207-794-5396

Faculty Sponsor (if required) Carol Biddington
Department Health Science
Project Dates January 1, 2012 to December 1, 2012
Sponsoring Agent (if applicable) N/A
Project to be Conducted at California University of Pennsylvania via internet
Project Purpose:

Thesis

Research

Class Project

Keep a copy of this form for your records.

Other

83
Please attach a typed, detailed summary of your project AND complete items 2
through 6.
1. Provide an overview of your project-proposal describing what you plan to do and how you
will go about doing it. Include any hypothesis(ses)or research questions that might be
involved and explain how the information you gather will be analyzed. For a complete list of
what should be included in your summary, please refer to Appendix B of the IRB Policies and
Procedures Manual.
The following proposal involves a descriptive study that will examine the burnout levels
among undergraduate athletic training students (ATS) at accredited athletic training education
programs (ATEP), who are a member of the National Athletic Training Association (NATA).
The researcher will utilize surveymonkey.com to create a direct link to the survey. A cover
letter (Appendix C3) will be sent via email, explaining the purpose of the study to the
selected undergraduate athletic training students (ATS). A link in the cover letter will provide
the ATS with direct access to begin the survey. The researcher will contact the NATA,
requesting that this survey be sent to 1000 randomly selected ATS across the nation. The
researcher will determine when to send out the surveys and allow ample time to complete the
survey. After one week, a follow up email will be sent by the NATA to the selected ATS.
Hypotheses:
1. There will be a relationship between a Student’s cumulative GPA and the level of
burnout.
2. There will be a difference between academic levels (junior versus senior) for burnout
scores.
3. There will be a difference between gender for burnout scores.

2. Section 46.11 of the Federal Regulations state that research proposals involving human
subjects must satisfy certain requirements before the IRB can grant approval. You should
describe in detail how the following requirements will be satisfied. Be sure to address each
area separately.
a. How will you insure that any risks to subjects are minimized? If there are potential
risks, describe what will be done to minimize these risks. If there are risks, describe
why the risks to participants are reasonable in relation to the anticipated benefits.
There is a risk that the participants personal information might become public and/or
one of their answers might become public. In order to reduce this risk, their name and
school affiliation will not be asked. The surveys are completed online and they are
returned with out a name. Once the survey is returned, it will be downloaded and will
be password protected.
The possibility that one of the participants questions may become public is a minimal
risk considering the rewards. Determining potential factors that may predispose an
athletic training student to burnout will lead to finding ways to minimize burnout
among ATS.

84
b. How will you insure that the selection of subjects is equitable? Take into account
your purpose(s). Be sure you address research problems involving vulnerable
populations such as children, prisoners, pregnant women, mentally disabled persons,
and economically or educationally disadvantaged persons. If this is an in-class
project describe how you will minimize the possibility that students will feel coerced.
The National Athletic Training Association will randomly select 1,000 athletic
training students nationwide. The demographic section will be presented first, which
will include a question about age. If the student is not 18 or older they will not have
access to the survey and will be sent to a separate page thanking them for their
participation. There will also be a breif discription prior to the survey, stating that
participation may be discontinued at any time without penalty and the information
will be discarded.
c. How will you obtain informed consent from each participant or the subject’s legally
authorized representative and ensure that all consent forms are appropriately
documented? Be sure to attach a copy of your consent form to the project summary.
Consent is implied when the individual completes and returns the survey.
d. Show that the research plan makes provisions to monitor the data collected to insure
the safety of all subjects. This includes the privacy of subjects’ responses and
provisions for maintaining the security and confidentiality of the data.
The surveys are completed online and they are returned with out a name. Once the
survey is returned, it will be downloaded and will be password protected to ensure
the privacy of the participants.
3. Check the appropriate box(es) that describe the subjects you plan to use.

Adult volunteers

Mentally Disabled People

CAL University Students

Economically Disadvantaged People

Other Students

Educationally Disadvantaged People

Prisoners

Fetuses or fetal material

Pregnant Women

Children Under 18

Physically Handicapped People

Neonates

4. Is remuneration involved in your project?
5. Is this project part of a grant?
Title of the Grant Proposal
Name of the Funding Agency
Dates of the Project Period

Yes or

Yes or
No

No. If yes, Explain here.

If yes, provide the following information:

85
6.

Does your project involve the debriefing of those who participated?

Yes or

If Yes, explain the debriefing process here.
7. If your project involves a questionnaire interview, ensure that it meets the requirements of
Appendix
in the Policies and Procedures Manual.

86
California University of Pennsylvania Institutional Review Board
Survey/Interview/Questionnaire Consent Checklist (v021209)
This form MUST accompany all IRB review requests
Does your research involve ONLY a survey, interview or questionnaire?
YES—Complete this form
NO—You MUST complete the “Informed Consent Checklist”—skip the remainder
of this form
Does your survey/interview/questionnaire cover letter or explanatory statement include:
(1) Statement about the general nature of the survey and how the data will be
used?
(2) Statement as to who the primary researcher is, including name, phone, and
email address?
(3) FOR ALL STUDENTS: Is the faculty advisor’s name and contact information
provided?
(4) Statement that participation is voluntary?
(5) Statement that participation may be discontinued at any time without penalty
and all data discarded?
(6) Statement that the results are confidential?
(7) Statement that results are anonymous?
(8) Statement as to level of risk anticipated or that minimal risk is anticipated?
(NOTE: If more than minimal risk is anticipated, a full consent form is required—and
the Informed Consent Checklist must be completed)
(9) Statement that returning the survey is an indication of consent to use the data?
(10) Who to contact regarding the project and how to contact this person?
(11) Statement as to where the results will be housed and how maintained? (unless
otherwise approved by the IRB, must be a secure location on University premises)
(12) Is there text equivalent to: “Approved by the California University of
Pennsylvania Institutional Review Board. This approval is effective nn/nn/nn and
expires mm/mm/mm”? (the actual dates will be specified in the approval notice from
the IRB)?

87
(13) FOR ELECTRONIC/WEBSITE SURVEYS: Does the text of the cover letter
or explanatory statement appear before any data is requested from the participant?
(14) FOR ELECTONIC/WEBSITE SURVEYS: Can the participant discontinue
participation at any point in the process and all data is immediately discarded?

88
California University of Pennsylvania Institutional Review Board
Informed Consent Checklist (v021209)
This form MUST accompany all IRB review requests
Does your research involve ONLY a survey, interview, or questionnaire?
YES—DO NOT complete this form. You MUST complete the
“Survey/Interview/Questionnaire Consent Checklist” instead.
NO—Complete the remainder of this form.
1. Introduction (check each)
(1.1) Is there a statement that the study involves research?
(1.2) Is there an explanation of the purpose of the research?
2. Is the participant. (check each)
(2.1) Given an invitation to participate?
(2.2) Told why he/she was selected.
(2.3) Told the expected duration of the participation.
(2.4) Informed that participation is voluntary?
(2.5) Informed that all records are confidential?
(2.6) Told that he/she may withdraw from the research at any time without
penalty or loss of benefits?
(2.7) 18 years of age or older? (if not, see Section #9, Special Considerations
below)
3. Procedures (check each).
(3.1) Are the procedures identified and explained?
(3.2) Are the procedures that are being investigated clearly identified?
(3.3) Are treatment conditions identified?
4. Risks and discomforts. (check each)
(4.1) Are foreseeable risks or discomforts identified?
(4.2) Is the likelihood of any risks or discomforts identified?
(4.3) Is there a description of the steps that will be taken to minimize any risks or
discomforts?
(4.4) Is there an acknowledgement of potentially unforeseeable risks?
(4.5) Is the participant informed about what treatment or follow up courses of
action are available should there be some physical, emotional, or psychological harm?
(4.6) Is there a description of the benefits, if any, to the participant or to others
that may be reasonably expected from the research and an estimate of the likelihood
of these benefits?
(4.7) Is there a disclosure of any appropriate alternative procedures or courses of
treatment that might be advantageous to the participant?
5. Records and documentation. (check each)

89
(5.1) Is there a statement describing how records will be kept confidential?
(5.2) Is there a statement as to where the records will be kept and that this is a
secure location?
(5.3) Is there a statement as to who will have access to the records?
6. For research involving more than minimal risk (check each),
(6.1) Is there an explanation and description of any compensation and other
medical or counseling treatments that are available if the participants are injured
through participation?
(6.2) Is there a statement where further information can be obtained regarding the
treatments?
(6.3) Is there information regarding who to contact in the event of researchrelated injury?
7. Contacts.(check each)
(7.1) Is the participant given a list of contacts for answers to questions about the
research and the participant’s rights?
(7.2) Is the principal researcher identified with name and phone number and
email address?
(7.3) FOR ALL STUDENTS: Is the faculty advisor’s name and contact
information provided?
8. General Considerations (check each)
(8.1) Is there a statement indicating that the participant is making a decision
whether or not to participate, and that his/her signature indicates that he/she has
decided to participate having read and discussed the information in the informed
consent?
(8.2) Are all technical terms fully explained to the participant?
(8.3) Is the informed consent written at a level that the participant can understand?
(8.4) Is there text equivalent to: “Approved by the California University of
Pennsylvania Institutional Review Board. This approval is effective nn/nn/nn and
expires mm/mm/mm”? (the actual dates will be specified in the approval notice from
the IRB)
9. Specific Considerations (check as appropriate)
(9.1) If the participant is or may become pregnant is there a statement that the
particular treatment or procedure may involve risks, foreseeable or currently
unforeseeable, to the participant or to the embryo or fetus?
(9.2) Is there a statement specifying the circumstances in which the participation
may be terminated by the investigator without the participant’s consent?
(9.3) Are any costs to the participant clearly spelled out?
(9.4) If the participant desires to withdraw from the research, are procedures for
orderly termination spelled out?

90
(9.5) Is there a statement that the Principal Investigator will inform the participant
or any significant new findings developed during the research that may affect them
and influence their willingness to continue participation?
(9.6) Is the participant is less than 18 years of age? If so, a parent or guardian must
sign the consent form and assent must be obtained from the child
Is the consent form written in such a manner that it is clear that the
parent/guardian is giving permission for their child to participate?
Is a child assent form being used?
Does the assent form (if used) clearly indicate that the child can freely refuse
to participate or discontinue participation at any time without penalty or coercion?
(9.7) Are all consent and assent forms written at a level that the intended
participant can understand? (generally, 8th grade level for adults, age-appropriate for
children)

91
California University of Pennsylvania Institutional Review Board
Review Request Checklist (v021209)
This form MUST accompany all IRB review requests.
Unless otherwise specified, ALL items must be present in your review request.
Have you:
(1.0) FOR ALL STUDIES: Completed ALL items on the Review Request Form?
Pay particular attention to:
(1.1) Names and email addresses of all investigators
(1.1.1) FOR ALL STUDENTS: use only your CalU email
address)
(1.1.2) FOR ALL STUDENTS: Name and email address of your
faculty research advisor
(1.2) Project dates (must be in the future—no studies will be approved
which have already begun or scheduled to begin before final IRB approval—
NO EXCEPTIONS)
(1.3) Answered completely and in detail, the questions in items 2a through
2d?
2a: NOTE: No studies can have zero risk, the lowest risk is
“minimal risk”. If more than minimal risk is involved you MUST:
i. Delineate all anticipated risks in detail;
ii. Explain in detail how these risks will be minimized;
iii. Detail the procedures for dealing with adverse outcomes
due to these risks.
iv. Cite peer reviewed references in support of your
explanation.
2b. Complete all items.
2c. Describe informed consent procedures in detail.
2d. NOTE: to maintain security and confidentiality of data, all
study records must be housed in a secure (locked) location ON
UNIVERSITY PREMISES. The actual location (department, office,
etc.) must be specified in your explanation and be listed on any
consent forms or cover letters.
(1.4) Checked all appropriate boxes in Section 3? If participants under the
age of 18 years are to be included (regardless of what the study involves) you
MUST:
(1.4.1) Obtain informed consent from the parent or guardian—
consent forms must be written so that it is clear that the
parent/guardian is giving permission for their child to participate.
(1.4.2) Document how you will obtain assent from the child—
This must be done in an age-appropriate manner. Regardless of
whether the parent/guardian has given permission, a child is
completely free to refuse to participate, so the investigator must
document how the child indicated agreement to participate
(“assent”).

92
(1.5) Included all grant information in section 5?
(1.6) Included ALL signatures?
(2.0) FOR STUDIES INVOLVING MORE THAN JUST SURVEYS,
INTERVIEWS, OR QUESTIONNAIRES:
(2.1) Attached a copy of all consent form(s)?
(2.2) FOR STUDIES INVOLVING INDIVIDUALS LESS THAN 18
YEARS OF AGE: attached a copy of all assent forms (if such a form is used)?
(2.3) Completed and attached a copy of the Consent Form Checklist? (as
appropriate—see that checklist for instructions)
(3.0) FOR STUDIES INVOLVING ONLY SURVEYS, INTERVIEWS, OR
QUESTIONNAIRES:
(3.1) Attached a copy of the cover letter/information sheet?
(3.2) Completed and attached a copy of the
Survey/Interview/Questionnaire Consent Checklist? (see that checklist for
instructions)
(3.3) Attached a copy of the actual survey, interview, or questionnaire
questions in their final form?
(4.0) FOR ALL STUDENTS: Has your faculty research advisor:
(4.1) Thoroughly reviewed and approved your study?
(4.2) Thoroughly reviewed and approved your IRB paperwork? including:
(4.2.1) Review request form,
(4.2.2) All consent forms, (if used)
(4.2.3) All assent forms (if used)
(4.2.4) All Survey/Interview/Questionnaire cover letters (if used)
(4.2.5) All checklists
(4.3) IMPORTANT NOTE: Your advisor’s signature on the review request
form indicates that they have thoroughly reviewed your proposal and verified
that it meets all IRB and University requirements.
(5.0) Have you retained a copy of all submitted documentation for your records?

Appendix C3
Cover Letter

Date
Dear Fellow Athletic Training Student:
My name is Michelle L. Bowers, ATC and I am currently a graduate student at California
University of Pennsylvania pursing a Master of Science in Athletic Training. Part of the graduate
study curriculum is to complete a research thesis through conducting research. I am conducting
survey research to examine the levels of burnout among undergraduate athletic training
students at accredited athletic training education programs.
Undergraduate athletic training students who are enrolled in an accredited athletic training
program and are a member of the National Athletic Training Association (NATA) are being asked
to participate in this research; however, your participation is voluntary and you do have the
right to choose not to participate. You also have the right to discontinue parti
participation
cipation at any
time during the survey completion process at which time your data will be discarded. The
California University of Pennsylvania Institutional Review Board has reviewed and approved this
project. The approval is effective 02/06/12 and expire
expires 02/05/13.
All survey responses are anonymous and will be kept confidential, and informed consent to use
the data collected will be assumed upon return of the survey. Aggregate survey responses will
be housed in a password protected file on the CalU camp
campus.
us. Minimal risk is posed by
participating as a subject in this study. I ask that you please take this survey at your earliest
convenience as it will take approximately 20 minutes to complete. If you have any questions
regarding this project, please feel free to contact the primary researcher, Michelle L. Bowers,
ATC at bow9158@calu.edu. You can also contact the faculty advisor for this research Carol M.
Biddington, EdD by fax (724.938.4454)
724.938.4454) or email (biddington@calu.edu).
biddington@calu.edu). Thank you in advance
for your participation. Please click the following link to access the survey
(https://www.surveymonkey.com/s/ZR7FZZQ).
Thank you for taking the time to take part in my thesis research. I greatly appreciate your
yo time
and effort to help educate our fellow student and certified athletic trainers.
Sincerely,

Michelle L. Bowers, ATC
Primary Researcher
California University of Pennsylvania
250 University Ave
California, PA 15419
207.794.5396
Bow9158@calu.edu

96
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Giacobbi P. Low burnout and high engagement levels in
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Pisarik C. Motivational orientation and burnout among
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Dyrbye L, Thomas M, Harper W, et al. The learning
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Polman R, Borkoles E, Nicholls A. Type D personality,
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ABSTRACT
Title:

BURNOUT AMONG UNDERGRADUATE ATHLETIC
TRAINING STUDENTS

Researcher:

Michelle L. Bowers, ATC

Advisor:

Dr. Carol M. Biddington

Purpose:

The purpose of this study was to examine
burnout scores of undergraduate athletic
training students to determine if burnout
scores were dependent upon students’ GPA,
academic level, and gender. The secondary
purpose of this study was to determine the
reliability of the Bowers Athletic Training
Burnout Inventory.

Methods:

A descriptive research study was conducted
using the BATBI. Subjects consisted of 112
junior and senior undergraduate athletic
training students from accredited athletic
training education programs (ATEP)
nationwide, who were a member of the
National Athletic Trainers’ Association
(NATA). The survey was sent to the ATS via
email using the NATA’s Listserve.

Findings:

There was no significant correlation between
GPA and the students’ total burnout scores.
There were no differences between junior and
senior athletic training students and gender
for burnout scores. The BATBI was found to
have moderate reliability with a Chronbach
alpha of .685.

Conclusion:

After reviewing the results of this study it
cannot be concluded that GPA, academic
level, or gender has an effect on
Undergraduate ATS’ burnout scores.