i CERTIFIED ATHLETIC TRAINERS’ PERCEPTIONS ON THEIR UNDERGRADUATE APPROVED CLINICAL INSTRUCTORS’ PROFESSIONAL EFFECTIVENESS 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 Abby Passaro Research Advisor, Dr. Linda P. Meyer California, Pennsylvania 2013 ii iii ACKNOWLEDGEMENTS I am thankful to have the opportunity to obtain a Master of Science degree in Athletic Training from California University of Pennsylvania. I would like to thank my committee chairperson Dr. Linda P. Meyer and the remaining members of my committee, Dr. Carol Biddington and Dr. Michael Meyer for their help and guidance with this thesis process. Also, I want to thank Dr. Thomas West for being there to answer questions and providing guidance when it was needed. The amount of support I have received from my classmates is much appreciated. We have become a fantastic support system for each other and they have kept me determined throughout this process. My family has always been supportive and they remind me to stay positive and have never doubted my abilities. My Godmother, Dr. Joan Reale, has helped me with many aspects of this process and has provided me with the support I needed. I could not be more thankful for how much she always believes in me. I have kept my faith throughout this entire process and I am looking forward to what may come in the future. Thank you to everyone who played a part in this journey. iv TABLE OF CONTENTS Page SIGNATURE PAGE . . . . . . . . . . . . . . . ii AKNOWLEDGEMENTS . . . . . . . . . . . . . . . iii TABLE OF CONTENTS LIST OF TABLES INTRODUCTION METHODS . . . . . . . . . . . . . . iv . . . . . . . . . . . . . . . vi . . . . . . . . . . . . . . . . 1 . . . . . . . . . . . . . . . . . . 4 Research Design . . . . . . . . . . . . . . 4 . . . . . . . . . . . . . . . . . 5 Preliminary Research. . . . . . . . . . . . . 6 Instruments . . . . . . . . . . . . . . . . 7 Procedures 9 Subjects . . . . . . . . . . . . . . . . Research Question Data Analysis RESULTS . . . . . . . . . . . . . 10 . . . . . . . . . . . . . . . 10 . . . . . . . . . . . . . . . . . . 11 Demographic Information. . . . . . . . . . . . 11 Research Question Testing . . . . . . . . . . 14 Additional Findings . . . . . . . . . . . . . 15 DISCUSSION . . . . . . . . . . . . . . . . . 16 Discussion of Results . . . . . . . . . . . . 16 Conclusions . . . . . . . . . . . . . . . . 22 Recommendations. . . . . . . . . . . . . . . 23 v REFERENCES . . . . . . . . . . . . . . . . 24 APPENDICES . . . . . . . . . . . . . . . . . 26 APPENDIX A: Review of Literature . . . . . . . . 27 Introduction . . . . . . . . . . . . . . . . 28 Approved Clinical Instructor Communication Skills . . . . . . . . . 29 . . . . . . . . . . . 31 Interpersonal Relationships . . . . . . . . . 32 Instructional skills . . . . . . . . . . . 35 Supervisory and Administrative Skills . . . . . 37 Evaluation of Performance . . . . . . . . . 41 Clinical Skills and Knowledge . . . . . . . . 44 Summary . . . . . . . . . . . . . . . . . . 47 APPENDIX B: The Problem . . . . . . . . . . . . 48 Statement of the Problem . . . . . . . . . . . 49 Definition of Terms . . . . . . . . . . . . . 49 Basic Assumptions . . . . . . . . . . . . . . 52 Limitations of the Study . . . . . . . . . . . 52 Delimitations of the Study . . . . . . . . . . 53 Significance of the Study . . . . . . . . . . 53 APPENDIX C: Additional Methods . . . . . . . . . 55 IRB: California University of Pennsylvania (C1) . . 56 Evaluation of Athletic Training Approved Clinical Instructor’s Professional Effectiveness Survey (C2) 70 Cover Letter (C3) . . . . . . . . . . . . . . 81 vi REFERENCES . . . . . . . . . . . . . . . . . 83 ABSTRACT . . . . . . . . . . . . . . . . . 85 vii LIST OF TABLES Table Title Page 1 Fall Semester Clinical Rotation Assignment . . 12 2 Approved Clinical Instructor Gender 3 National Athletic Trainers’ Association . . . . 12 Membership District . . . . . . . . . . . 13 4 College/University Division Size . . . . . . 13 5 Descriptive Results . . . . . . . . . . . 14 6 Reliability Data . . . . . . . . . . . . 15 1 INTRODUCTION The purpose of this thesis study was to determine athletic training approved clinical instructors’ professional effectiveness based on six previously researched standards. A secondary purpose was to determine the reliability for each of the six standards. Clinical education includes numerous clinical teaching and evaluating opportunities for student growth that are the responsibility of the approved clinical instructor (ACI). The National Athletic Trainers’ Association (NATA) defines the ACI as being an appropriately credentialed professional providing instruction and evaluation of Educational Competencies.1 Weidner and Henning2 state that the ACI should provide supervised acquisition, practice, and evaluation of athletic training students during clinical education. Their research suggested that all approved clinical instructors should work in a similar manner and cover related material. However, according to research, many certified athletic trainers who serve as ACIs have not had a proper, pedagogic focus of study to teach to the best of their abilities.2 An athletic trainer who is well-prepared and knowledgeable in the clinical setting, does not 2 automatically make him or her the best candidate to serve as an ACI. Weidner and Henning’s2 research developed a set of standards and associated criteria which to base the selection, training, and evaluation of ACIs in the clinical setting. Weidner and Henning2 define the term ‘standards’ as a level of requirement, excellence, or attainment. Further, they define ‘criteria’ as items on which a judgment or decision can be based for the attainment of a standard. The defined standards include communication skills, interpersonal relationships, instructional skills, supervisory and administrative skills, evaluation of performance, clinical skills and knowledge, and legal and ethical behavior. The listed standards are important to fully understand obligations and requirements of an ACI in athletic training clinical education.2 Additional research by Weidner and Henning3 reports that an important component for creating quality clinical education is training educators on how to evaluate, instruct, and teach students. Raab et al4 recognized specific abilities that should be addressed in athletic training clinical education. These abilities included thinking critically, solving problems, and oral communication skills. The ACI must help prepare the entry-level students with the certain qualities and 3 employability skills needed for professional success. Raab et al4 clarifies that the ACI should gain the knowledge needed to become effective in their position by demonstrating and teaching students interpersonal skills. It is critical that the entry-level athletic training student can look to his or her ACI as a mentor. The research by Phan et al5 recognized that one of the most prominent parts of clinical education is the ACI. Approved clinical instructors are to become an effective mentor by demonstrating attributes that would apply to a clinician, educator, and that of an effective communicator. Research by Phan et al5 showed that ACIs who recognize a balance between autonomy and guided practice will provide an effective learning environment for students. The current thesis study analyzed Weidner and Henning’s standards in an effort to show their appropriateness for evaluating ACIs in clinical education. The results of this thesis research may assist the approved clinical instructor with professional effectiveness. 4 METHODS The primary purpose of this research was to examine the perception of newly certified athletic trainers on their undergraduate approved clinical instructors’ professional effectiveness. Professional effectiveness was based on the following six standards: communication skills, interpersonal relationships, instructional skills, supervisory and administrative skills, evaluation of performance, and clinical skills and knowledge. A secondary purpose was to determine the reliability for each of the six standards. This section will include the following subsections: research design, subjects, instruments, preliminary research, procedures, research question, and data analysis. Research Design This thesis study utilized a descriptive research design. There are six variables within the current study. The variables came from the standards in Drs. Weidner and Henning’s questionnaire from the research titled "Development of Standards and Criteria for the Selection, Training, and Evaluation of Athletic Training Approved 5 Clinical Instructors".2 Each of the variables, or standards, were evaluated by the questions containing the associated criteria of each standard. The associated criteria are items on which decisions can be based for the attainment of a standard. The researcher took the scores of the questions, or associated criteria, to calculate the average score for each standard. Subjects Participants in this thesis study consisted of certified athletic trainers (N=77) from the Career Starter membership category of the NATA. The NATA Research Survey Service administered the survey to 1,000 members chosen at random. Career Starter category holds newly certified regular members. These individuals are held in the Career Starter category for the first full membership billing cycle following certification, but they cannot currently be students. The subjects are over the age of 18 and have graduated from an athletic training education program accredited by Commission on Accreditation of Athletic Training Education (CAATE). The subjects are also certified by the Board of Certification. Informed consent was assumed by the 6 subject’s participation in the survey. Each participant’s identity was anonymous in the study. Preliminary Research The original questionnaire2 that was utilized in the research was initially tested for validity using the Delphi technique. The Delphi panel members consisted of athletic training education experts and were not aware of each other’s responses. The panel was made up of program directors of entry-level athletic training education programs that are accredited by Commission on Accreditation of Allied Health Education Programs (CAAHEP). This commission accredited athletic training education programs prior to the current governing body known as CAATE. A total of 16 panelists completed all of the responsibilities in the study.2 The 16 panelists had to be a program director as of February 2003, completed a doctoral degree, served a minimum of five years supervising athletic training students, and hold interest in serving as a Delphi panelist.2 The Delphi technique determined the components of professional effectiveness which developed the validity of the study by Weidner and Henning.2 The study was deemed 7 valid because of the relevancy of the standards by those who are experts in clinical education. The study is also deemed valid because the panel both identified and agreed on the essential standards.2 This current thesis study determined the reliability for the standards of communication skills, interpersonal relationships, instructional skills, supervisory and administrative skills, evaluation of performance, and clinical skills and knowledge. Instruments The instrument used was a survey titled “Evaluation of Athletic Training Approved Clinical Instructors’ Professional Effectiveness” (Appendix C1). The survey originated as a questionnaire by Drs. Weidner and Henning in their research titled "Development of Standards and Criteria for the Selection, Training, and Evaluation of Athletic Training Approved Clinical Instructors".2 Permission was received via e-mail from the primary author, Dr. Thomas Weidner, to modify the questionnaire to use as a survey for this research. The modified survey consisted of 34 total questions within two primary sections. The first section contains 8 five demographic questions which included: Age (participants were at least 18 years of age), NATA district, NCAA or NAIA Division school where the education was received, first clinical rotation assignment from fall semester of final academic year, and gender of the approved clinical instructor from the participants first clinical rotation of fall semester of their final academic year. The second section included 29 questions that dealt with the following six of the seven original standards from Drs. Weidner and Henning’s questionnaire: communication skills, interpersonal relationships, instructional skills, supervisory and administrative skills, evaluation of performance, and clinical skills and knowledge.2 Legal and Ethical Behavior, from the seven original standards, was not included in this research because it was not a component of the researcher’s interest. The study was distributed through SurveyMonkey™ by the NATA. The second section of questions used a Likert scale. The scale was on a range from 1 to 5, with 1 being never and 5 being always. 9 Procedures The researcher obtained approval from the Institutional Review Board at California University of Pennsylvania (Appendix C2) before any research was conducted. The researcher contacted the NATA Research Survey Service on the NATA website. The materials required by the Survey Service were the Institutional Review Board approval documentation, Word (.doc) version of survey, and targeted survey participants. The survey was distributed through an email to 1,000 randomly selected certified athletic trainers in the Career Starter membership category of the NATA. The online survey took approximately 15 minutes to complete. The NATA distributed the survey to the participants through a link in an email. The participants received the email to open the survey through the computer program SurveyMonkey™. Each email contained a cover letter (Appendix C3) explaining the purpose of the study as well as risks and benefits of participation and informed consent. At the end of the third week, the data was collected and analyzed. 10 Research Question The research question asked in the current study is as follows: What is the perception of certified athletic trainers on their undergraduate approved clinical instructor’s professional effectiveness for communication skills, interpersonal relationships, instructional skills, supervisory and administrative skills, evaluation of performance, and clinical skills and knowledge? Data Analysis All data was analyzed by SPSS version 18.0 for windows. The research question was analyzed using descriptive statistics of mean, standard deviation and range of scores. The reliability for communication skills, interpersonal relationships, instructional skills, supervisory and administrative skills, evaluation of performance, and clinical skills and knowledge was determined by using a Chronbach Alpha analysis. 11 RESULTS This research addressed the professional effectiveness of approved clinical instructors based on a set of standards. These standards included: communication skills, interpersonal relationships, instructional skills, supervisory and administrative skills, evaluation of performance, and clinical skills and knowledge. Participants completed a survey titled “Evaluation of Athletic Training Approved Clinical Instructor’s Professional Effectiveness”. This survey is a modified version of the "Development of Standards and Criteria for the Selection, Training, and Evaluation of Athletic Training Approved Clinical Instructors".2 The following results section is divided into three sections: demographic information, research question testing, and additional findings. Demographic Information The survey was sent to 1,000 Career Starter members of the NATA. Out of the 1,000 members, 13% (N=77), completed the survey. The following information reveals demographic and descriptive data found within the current thesis study. 12 Table 1 illustrates the clinical rotation assignment the participants had during their fall semester of their final academic year as an undergraduate student. Table 1. Fall Semester Clinical Rotation Assignment Clinical Rotation Basketball Cheerleading Cross Country Football Medical Rotation Off-Campus High School Physical Therapy Clinic Soccer Swimming and Diving Volleyball Wrestling Total Frequency 11 1 3 24 2 11 4 12 3 3 3 77 Percent 14.3 1.3 3.9 31.2 2.6 14.3 5.2 15.6 3.9 3.9 3.9 100.0 Of the 77 participants, 39 had an ACI who was male and 38 had an ACI who was female for the reported clinical rotation assignment (Table 2). Table 2. Approved Clinical Instructor Gender Gender Male Female Total Frequency 39 38 77 Percent 50.6 49.4 100.0 13 Table 3 illustrates the participants belonging to each NATA District. Table 3. NATA Membership District District District District District District District District District District District District Total Frequency 4 13 10 15 6 5 5 7 10 2 77 1 2 3 4 5 6 7 8 9 10 Percent 5.2 16.9 13.0 19.5 7.8 6.5 6.5 9.1 13.0 2.6 100.0 Participants were also asked from what Division College/University they received their bachelor’s degree. Table 4 illustrates how many participants were from each NCAA OR NAIA Division. Table 4. College/University Division Size Division NCAA Division NCAA Division NCAA Division NAIA Division NAIA Division Total I II III I II Frequency 40 18 13 4 2 77 Percent 51.9 23.4 16.9 5.2 2.6 100.0 14 Research Question Testing The research question is: What is the perception of newly certified athletic trainers on their undergraduate approved clinical instructor’s professional effectiveness for communication skills, interpersonal relationships, instructional skills, supervisory and administrative skills, evaluation of performance, and clinical skills and knowledge? As illustrated in Table 5, the research question was analyzed using descriptive statistics of mean, standard deviation, and range of scores. Table 5. Descriptive Results Standard Communication Skills Interpersonal Relationships Instructional Skills Supervisory Skills and Knowledge Evaluation of Performance Clinical Skills and Knowledge Range 3.2 Minimum 1.8 Maximum 5.0 Mean 4.4 SD 0.7 2.8 2.2 5.0 4.6 0.6 4.0 1.0 5.0 4.1 1.0 2.5 2.5 5.0 4.4 0.7 3.5 1.5 5.0 4.4 0.8 3.0 2.0 5.0 4.7 0.6 15 Additional Findings The secondary purpose of this study was to determine the reliability of the six standards. A Chronbach Alpha analysis was used to determine the reliability for communication skills, interpersonal relationships, instructional skills, supervisory and administrative skills, evaluation of performance, and clinical skills and knowledge. Table 6 illustrates the reliability analysis of the six standards associated with the survey. Reliability is considered high if a score is 0.8 and above. Table 6. Reliability Data Standards Communication Skills Interpersonal Relationships Instructional Skills Supervisory Skills and Knowledge Evaluation of Performance Clinical Skills and Knowledge Chronbach Alpha Reliability Analysis .942 .943 .965 .872 .935 .897 16 DISCUSSION The results of this research may help entry-level athletic training education programs with evaluating approved clinical instructor’s professional effectiveness. The following discussion is comprised of three subsections: discussion of results, conclusions, and recommendations. Discussion of Results The data results used descriptive statistics to analyze the associated criteria of the six standards. The mean scores were calculated based on the survey’s 5-point Likert scale. The findings in this study are similar to other studies completed in this area of topic. Clinical skills and knowledge received the highest mean score out of the six standards. The current thesis results showed that ACIs are usually demonstrating proper clinical skills with a mean score of 4.7 on a 5 point Likert scale. The results may imply that ACIs are appropriately completing clinical education units and continually increasing their knowledge. Effective clinical skills and knowledge, according to Weidner and Henning,2 are demonstrated when the ACI is fully 17 capable of teaching and evaluating students’ clinical competencies. Also, the ACI’s knowledge and skills are current and based on science and evidence-based practice. Research by Sibold6 recognizes that if the ACI can demonstrate making sensible decisions, the students may have increased self-confidence thus leading to better patient outcomes. Appropriate clinical competence can be demonstrated by offering students a clear understanding of clinical decisions. Sibold6 clarifies that it is significant for the athletic trainer to use critical thinking skills to make appropriate decisions in the clinical setting. The next highest ranked standard was interpersonal relationships. The current thesis results discovered that ACIs are usually adequate in interpersonal relationships with a mean score 4.6 on a 5 point Likert scale. The results suggest that the ACI is demonstrating interpersonal relationships thus preparing the students for employer expectations. According to Weidner and Henning,2 appropriate interpersonal relationships are accomplished by being a professional mentor and demonstrating professional relationships. The ACI should have an open and approachable demeanor when working in a clinical setting. Research by Raab et al4 recognizes that employer expectations will 18 include interpersonal skills and being a quality health care provider. The ACI must help prepare entry-level students with the certain qualities and employability skills needed for professional success.4 Potteiger et al7 reveal that personal characteristics is an area that athletic training education programs are not improving in and interpersonal expectations are lacking. The results from the current thesis research revealed that ACIs are usually proper supervisors of athletic training students. Supervisory and administrative skills received a mean score of 4.4 on a 5 point Likert scale. Weidner and Henning2 state that supervisory and administrative skills are demonstrated by encouraging athletic training students to arrive at clinical decisions on their own. Also, the students should be presented with clear performance expectations throughout the entire learning process. Effective supervisory skills also include supervising the athletic training students during formal acquisition, practice, and evaluation of clinical competency.2 Rich8 suggests that ACIs have difficulty taking advantage of learning opportunities when they occur. In some cases, an ACI is not able to interact with the student due to other job constraints. Other job responsibilities 19 demand the ACI’s attention and therefore, the ACI is not focusing on supervising the student.8 The current thesis research discovered that the participants felt their ACIs were usually evaluating their performance appropriately. Evaluation of performance resulted in a mean score of 4.4 on a 5 point Likert scale. To effectively evaluate athletic training student’s performance, Weidner and Henning2 recommend the ACI approaches the evaluation process as constructive and educational. The ACI should recognize students’ knowledge, skills, and behaviors as they relate to specific goals and objectives of the clinical experience. Also, the ACI participates with the students in evaluations that are formative and summative which provide ongoing feedback and overall performance.2 Martin’s9 research discussed how documenting student competencies can be a challenge for some ACIs. There is a need for better evaluating techniques of athletic training student’s strengths and weaknesses. The current thesis research discovered that the participants felt their ACI was usually effective in communication. Communication skills resulted in a mean score of 4.4 on a 5 point Likert scale. As recognized by Weidner and Henning,2 communication skills involve incorporating professional discussions with 20 athletic training students in the clinical setting. The ACI should provide constructive formative and summative feedback to athletic training students. Also, the ACI should receive and respond to feedback from the program director, clinical education coordinator, and athletic training students.2 Researcher Carr10 found that certified athletic trainers felt under prepared in the ability to communicate in the professional setting. The participants in the study suggested that the lack of preparation in communication was due to their educational programs. The standard that was ranked lowest according to its mean value was instructional skills. Instructional skills resulted in a mean score of 4.1 on a 5 point Likert scale. In demonstrating instructional skills, Weidner and Henning2 recommend the ACI to be enthusiastic about teaching and must employ a variety of teaching styles to meet individual student’s needs. The ACI can also be effective by creating learning opportunities that promote critical thinking and problem solving.2 Ristori et al11 research emphasized that how an ACI decides to teach may have an impact on the students’ ability to learn. It was concluded that of the 13 ACIs surveyed in their research, the ACIs were all able to identify with students’ learning styles.11 The current thesis research was consistent with the 21 literature because the subjects reported that their ACIs were usually effective instructors. The mean scores of the six standards all fell between a mean score of 4.1 and 4.7 on a 5 point Likert scale. Unfortunately, important skills that should be consistently demonstrated by the ACI did not receive the highest mean. Instructional skills had the lowest mean score (4.1 out of 5) when compared to the other six standards evaluated. It should be significant for the ACI to properly instruct an athletic training student in the clinical setting. If an entry-level student is not properly instructed, he or she may risk failure in an emergency situation due to poor problem-solving skills. Poor instructional skills could ultimately be the result of an ACI having poor communication skills. Communication skills also ranked on the lower end of the mean scores (4.4 out of 5) when comparing the average results of the six standards. A lack of effective communication from the ACI may result in further concerns for the entry-level athletic training student. Without proper demonstration of communication skills, the student may be at risk for not being able to form professional discussions with other students, athletes, colleagues, etc. Evaluation of performance and supervisory skills and 22 knowledge also received a mean of 4.4 which shows there is room for improvement in these areas. The ACI should work to improve on these standards to better the education for entry-level students. Conclusions Approved clinical instructors are responsible for utilizing clinical education time wisely to encourage growth and development as a professional. After reviewing the results of this thesis study as well as the literature, the researcher found that approved clinical instructors are usually effective in athletic training clinical education. This conclusion was determined based on the mean scores from the survey and the 5-point Likert scale. The survey was also deemed highly reliable by using Chronbach Alpha analysis on the associated standards. According to the survey Likert scale, the mean scores of each standard are in accordance with the number four which can be associated with the result “usually”. Overall, the current thesis study has found results that add uniqueness to the knowledge and profession of athletic training. 23 Recommendations Based on this study and those completed in the past, it is clear that more research needs to be completed in the area of athletic training clinical education and approved clinical instructors. Research recommendations would be to continue to use survey research to gain the perspective of students and how they perceive their approved clinical instructor. This thesis study had a 13% (N=77) response rate. Future research should include a larger number of respondents and also provide open-ended response questions. Subjective concerns about students’ experience with an approved clinical instructor could be received well with open-ended responses. There is much potential for growth and development in terms of athletic training education. The potential for growth also creates a unique and necessary opportunity for research. This research should be completed to better evaluate the effectiveness of the approved clinical instructor in athletic training education. 24 REFERENCES 1. CAATE Clinical Education Terminology. National Athletic Trainers' Association Web site. http://www.nata.org/caate-clinical-educationterminology. Accessed November 2012. 2. Weidner T, Henning J. Development of standards and criteria for the selection, training, and evaluation of athletic training approved clinical instructors. J Athl Train. 2004;39(4):335. 3. Weidner T, Henning J. Importance and applicability of approved clinical instructor standards and criteria to certified athletic trainers in different clinical education settings. J Athl Train. 2005;40(4):326-332. 4. Raab S, Wolfe B, Gould T, Piland S. Characterizations of a quality certified athletic trainer. J Athl Train. 2011;46(6):672-679. 5. Phan K, McCarty C, Mutchler J, Van Lunen B. Clinical preceptors' perspectives on clinical education in post-professional athletic training education programs. Athl Train Ed J. 2012;7(3):103-114. 6. Sibold J, Geisler P. A three-question framework to facilitate clinical decision making. Athl Train Ed J. 2012;7(1):11-17. 7. Potteiger K, Brown C, Kahanov L. Altering the athletic training curriculum: a unique perspective on learning over time. Athl Train Ed J. 2012;7(2):60-69. 8. Rich V. Clinical instructors' and athletic training students' perceptions of teachable moments in an athletic training clinical education setting. J Athl Train. 2009;44(3):294-303. 9. Martin M, Grant-Ford M. Utilizing web-based technology to track athletic training proficiencies. Athl Ther Today. 2007;12(4):40-43. 25 10. Carr W, Volberding J. Employer and employee opinions of thematic deficiencies in new athletic training graduates. Athl Train Ed J. 2012;7(2):53-59. 11. Ristori C, Eberman L, Tripp B, Kaminski T. Athletic training student learning style. IJATT. 2011;16(2):3337. 26 APPENDICES 27 APPENDIX A Review of Literature 28 Review of Literature Entry-level athletic training education programs focus on clinical education for a large portion of students’ learning and experience. Clinical education in an entrylevel athletic training program is responsible for practice and evaluation of the National Athletic Trainers’ Association (NATA) Clinical Proficiencies.1 According to the NATA, Clinical Education is defined as the application of knowledge and skills, learned in classroom and laboratory settings, to actual practice on patients under the supervision of an Approved Clinical Instructor (ACI).1 The clinical proficiencies, created by the NATA’s Educational Council, require much responsibility from a certified athletic trainer. Clinical education includes numerous clinical teaching and evaluating opportunities that are provided by the ACI. Weidner and Henning’s study2 developed a set of standards which to base the selection, training, and evaluation of ACIs in the clinical setting. Weidner and Henning2 define standards as a level of requirement, excellence, or attainment. Criteria are defined as items on which a judgment or decision can be based for the attainment of a standard. 29 These defined standards include communication skills, interpersonal relationships, instructional skills, supervisory and administrative skills, evaluation of performance, and clinical skills and knowledge. The listed standards are important for fully understanding obligations and requirements of clinical education.2 Additional research by Weidner and Henning3 informs that an important component for creating quality clinical education is training educators on how to evaluate, instruct, and teach the students. The purpose of this Review of Literature is to inform the reader about what it means to be effective in the associated standards and criteria when evaluating an approved clinical instructor. This research will be accomplished in the following sections: Approved Clinical Instructor, Communication Skills, Interpersonal Relationships, Instructional Skills, Supervisory and Administrative Skills, Evaluation of Performance, and Clinical Skills and Knowledge. Approved Clinical Instructor The NATA defines the ACI as being an appropriately credentialed professional who can provide instruction and 30 evaluation of Educational Competencies and/or Clinical Proficiencies.1 The ACI will have an influence on how athletic training students’ learn and advance in their knowledge and skills in the clinical setting. In 2004, Weidner and Henning2 suggest that all approved clinical instructors should work in a similar manner and cover related material. However, according to research, many certified athletic trainers who serve as ACIs have not had a proper, pedagogic focus of study to teach to the best of their abilities. A well-prepared and knowledgeable athletic trainer in the clinical setting does not automatically make him or her best candidate to serve as an ACI.2 In 2005, Weidner and Henning’s3 research makes a valid point that not only should students be evaluated; but, approved clinical instructors should also be evaluated. The questionnaire that contains Weidner and Henning’s2 developed standards and criteria was administered to evaluate ACIs in different clinical education settings. Their research suggested there was no significant difference in work setting. The research did discover that the ACI was having difficulty balancing the role of clinician and clinical instructor which negatively influenced the effectiveness of the ACI.3 31 Communication Skills Effective communication skills in the clinical setting can be accomplished through several tasks. Communication includes incorporating professional discussions with athletic training students in the clinical setting.2 Also, communicating with athletic training students in a nonconfrontational and positive manner. The ACI should also provide constructive formative and summative feedback to athletic training students. Communication from an ACI should include open-ended questions and directed problem solving. Also, the ACI should receive and respond to feedback from the program director, clinical education coordinator, and athletic training students.2 Research completed by Raines4 showed that preceptors in the nursing profession desire faculty support and feedback when dealing with the students and curriculum. Communication is an important factor to nursing students’ success and could be accomplished in the athletic training profession. Communications with school of nursing faculty was a key aspect in nurses’ willingness to serve as preceptors. Proper communication may have made nursing students’ successes with clinical skills easier to accomplish.4 32 Carr5 wanted to explore the opinions of employers and employees about the level of preparation new athletic training graduates had for a professional career. Communication was the most common deficit according to employers and employees. Communication with patients, coaches, parents, and other employees is important. Lack of interpersonal communication was a weakness of new graduates. Carr’s5 research also found that certified athletic trainers felt under prepared in the ability to communicate in the professional setting. The participants in the study suggested that the lack of preparation in communication was due to their educational programs. Participants then suggested athletic training education programs should incorporate opportunities for communicating with others as a daily objective.5 The ACI must communicate better within the clinical experience to subsequently help the students communicate better. Interpersonal Relationships The ACI should demonstrate appropriate and professional interpersonal relationships. According to Weidner and Henning,2 this is accomplished by forming and modeling professional relationships with athletic training students, colleagues, patients, athletes, and 33 administrators. It is also accomplished by demonstrating respect and being a positive role model and mentor for athletic training students. Lastly, the ACI has an open and approachable demeanor when working in a clinical setting. The ACI may have to monitor a group of students and must demonstrate the ability to relate to multiple students at a time.2 Raab et al4 recognized specific abilities that should be addressed in athletic training clinical education. These abilities included thinking critically, solving problems, and oral communication skills. The ACI must help prepare the entry-level students with the certain qualities and employability skills needed for professional success. Raab et al4 clarifies that the ACI should gain the knowledge needed to become effective in their position by demonstrating and teaching students interpersonal skills. Raab et al6 compared nursing and physical therapy professions and how they have characteristics that define quality care and professional performance. The abilities studied in these professions include the commitment to learn, interpersonal skills, communication, and professionalism.6 If the profession of athletic training is going to continue to advance, building interpersonal relationships is important. 34 The ACI should illustrate concern for the student as a learner and as a person2. After 13 interviews from certified athletic trainers, Raab et al6 revealed five traits that make a quality athletic trainer. A quality athletic trainer means caring about patients and who they interact with, communication by expressing care and providing feedback, commitment to the profession and availability to whom they instruct, integrity by being loyal to whom they interact with, and the knowledge needed to be a proficient clinician.6 These abilities strengthen the opportunity for an athletic trainer to create a professional relationship with athletic training students. According to Potteiger et al7, employers have reported that personal characteristics are important. These characteristics would include leadership skills, selfconfidence, and interpersonal skills. The researchers of this study mention that personal characteristics is an area that athletic training education programs are not improving in and interpersonal expectations are lacking. Therefore, education programs must consistently prepare students to meet the technical educational standards as well as employer expectations.7 If these are skills that are practiced, then the ACI can demonstrate to students how to feel more comfortable in the clinical setting. 35 In the nursing profession, preceptors are showing a prosperous relationship with nursing students and new nurses. Research by Raines4 discussed that nurse preceptors facilitate learning and build confidence in nursing students. All of the nurses who participated in the study by Raines4 have experienced working with nursing students in the clinical area between three and 24 years. Nurse preceptors are the bridge needed between classroom education and the experiences students need to prepare for the clinical work environment. Preceptors have gained great recognition in academic settings due to their positive impact on the preparation of nursing students for realworld practice. Through proper role modeling and guidance, nursing students have developed knowledge, clinical skills, and professional attitudes from their preceptors.4 Instructional Skills To demonstrate effective instructional skills, Weidner and Henning2 mention that the ACI should be enthusiastic about teaching and must employ a variety of teaching styles to meet individual student’s needs. The ACI should also help athletic training students progress toward reaching goals and objectives. The ACI may modify learning experiences based on individual’s strengths and weaknesses. 36 The ACI can also be effective by creating learning opportunities that promote critical thinking and problem solving.2 Athletic training educators should strive to connect classroom learning with clinical education learning. Research by Sibold8 proposed a three-question framework for practical clinical decision making in therapeutic modalities and rehabilitation contexts. The three questions included asking about the treatment goal, the target tissue, and the modality that meets the need. Sibold8 defines critical thinking as the ability to make purposeful, self-regulatory judgments. Within the clinical setting, critical thinking skills will help the students make more sensible decisions and subsequently gain clinical confidence.8 To create fairness and equality with the students involved in the clinical setting, Ristori et al9 completed research on student learning styles and the importance of recognizing those different styles. It is important to be able to relate to different learning styles of athletic training students. An ACI may not know how to communicate in a way that is beneficial to the students, which could negatively influence students’ learning opportunities. The research also emphasized that how an ACI decides to teach 37 may have an impact on the students’ ability to learn. It was concluded that of the 13 ACIs surveyed in this research, they were all able to identify with students’ learning styles.9 A study by Henning and Weidner10 recognized the topic of peer-assisted learning and its effectiveness as a learning technique. A survey was administered as a selfreport tool to athletic training students. Results were that 66% of the students said they practice clinical skills with other athletic training students and 60% reported that it was easy to learn with peers. The research encourages peer-assisted learning because the students reported that it was beneficial.10 Supervisory and Administrative Skills According to Weidner and Henning,2 The ACI can demonstrate effective supervisory and administrative skills by encouraging athletic training students to arrive at clinical decisions on their own. Also, the students should be presented with clear performance expectations throughout the entire learning process. The ACI should effectively complete evaluation forms in a timely fashion. Effective supervisory skills also include supervising the athletic training students during formal acquisition, practice, and 38 evaluation of clinical proficiencies. Finally, the ACI should be sure students understand policies and procedures of the clinical settings.2 The ACI may have multiple responsibilities within the athletic training program and it can be difficult to manage their time well and still complete all tasks. Entry-level athletic training students should be given purposeful clinical instruction. Anderson11 discusses the importance of safety aspects and how pre and postscreenings, emergency plans, and environmental policies are important for protecting athletes. In order to be able to assist in injury prevention, athletic training students must have the knowledge and skills to recognize symptoms and help in high risk scenarios that may include lifethreatening problems. If the students are guided well enough to help with situations in the clinical setting, daily tasks can run more smoothly and they can be more successful with prevention and safety. To perform tasks independently, students must understand their priorities and responsibilities based upon their ACI expectations.11 Dealing with the difficulty of balancing the role of clinician and ACI, researcher Rich12 suggests that ACIs have difficulty taking advantage of learning opportunities when they occur. In some cases, an ACI is not able to interact 39 with the student due to daily constraints of other responsibilities that come along with the job. These constraints and barriers should be managed and dealt with so that no student is missing a learning opportunity. Other job responsibilities demand the ACI’s attention and therefore, the ACI is not focusing on supervising the student.12 Rich12 also recognizes that several barriers occur between the ACI and athletic training students. These barriers include lack of time, busy caring for athletes, ACI is performing other tasks and duties, and lack of student initiative. If the ACI cannot manage tasks and time, he or she is less likely to engage in meaningful clinical activities, discuss clinical progression, and discuss student performance.12 The aim of an integrative review by Omansky13 was to describe the nurses’ experience when functioning as an undergraduate nursing student preceptor. Omansky13 discovered that there is little research regarding the nurse preceptor’s experience in the work setting. The study covered 1,486 nurse preceptors who worked with undergraduate nursing students. Research discovered that nurse preceptors experience role ambiguity, role conflict, and role overload. If there can be fewer conflicts and 40 issues with role strain as a supervisor, the nurse preceptor and the ACI can provide a better learning environment. Role conflict is created when certain responsibilities dealing with students interferes with the responsibilities of patient care. To have successful administrative skills, a preceptor, and an ACI, must be able to manage their time with a variety of tasks. Omansky13 discovered that some nurse preceptors were never shown a preceptor guideline. This caused anxiety because nurse preceptors felt they were unsure of how to be a proper supervisor. The role of a preceptor is to guide student nurses from the theory of nursing to the application of nursing theory. With a proper definition of what makes a nurse preceptor, future generation of nurses can be appropriately guided by their preceptor. By recognizing the nurse preceptor role, there can be a positive impact on role conflict.13 A study performed by Craig14 at Northern Arizona State University discusses how the 300+ accredited undergraduate athletic training education programs have limited clinical opportunities. In Northern Arizona State University, they utilize the entire state for clinical placement sites. The research says those opportunities provide benefits to the students and the research wishes to persuade programs to 41 consider expanding clinical placement sites. Another benefit listed is that the ratio of student to approved clinical instructor can be 1:1, compared to most situations where it is 2:1 or more. The senior athletic training class of Northern Arizona State University mentioned that with one-on-one attention, there can be enhanced learning and mentoring.14 In conclusion to this research; there was an increase in confidence and professionalism which was documented by the alumni survey data.14 Unfortunately, oneon-one attention is not always an option and an ACI must be able to appropriately interact with multiple students at a given clinical site.2 Evaluation of Performance To effectively evaluate athletic training student’s performances, Weidner and Henning2 state that the ACI should approach the evaluation process as constructive and educational.2 The ACI should recognize students’ knowledge, skills, and behaviors as they relate to specific goals and objectives of the clinical experience. Lastly, the ACI participates with the students in evaluations that are formative and summative which provide ongoing feedback and overall performance.2 42 The entry-level athletic training students can be critiqued on how well they are learning in the clinical setting based on how well they complete certain tasks. Injury evaluations and other paperwork can be completed independently while still being guided by a certified athletic trainer. Students should feel confident enough to complete daily tasks as needed to fulfill daily evaluation requirements. The clinical rotation assignment is an important factor in entry-level athletic training education programs. During the clinical assignment, the students should have an understanding of their objectives and requirements to complete. Documenting clinical skills and competencies is critical for identifying student’s level of performance. In research done by Martin,15 a web-based program for evaluating athletic training students has shown to be innovative for athletic training education programs. It is a user-friendly electronic process that will increase the amount of evaluations students receive from their ACIs. Properly evaluating athletic training students’ skill progression and competence development is critical. Martin’s15 research discussed how documenting student competencies can be a challenge for some ACIs. However, by 43 using a web-based database, it will be easier to evaluate students. With web-based technology for evaluation, athletic training student can know their strengths and weaknesses on a regular basis. The significance of this research is that the athletic training education program, specifically the ACI, can monitor students’ progress more closely.15 Athletic training students will evaluate and treat patients as they go through the athletic training education program. Patients will have a variety of conditions, injuries, and illnesses, but it does not mean students are being challenged. Research by Walker16 discussed how clinical proficiencies are to represent the integration of clinical skills and decision-making abilities to prepare for professional careers. Rather than documenting the clinical proficiencies based off of clinical performance, ACIs will simulate a scenario for students to answer from. The research by Walker16 recommends evaluating students’ clinical proficiencies by using a standardized patient. This means, using an individual who can appropriately portray signs and symptoms of a condition for students to examine.16 According to Armstrong,17 more standardized evaluations will help ACIs better evaluate student’s clinical skills 44 and confidence in knowledge and abilities. A scenario created by a standardized patient can guide the ACI to a fair means of assessment to provide formative and summative feedback. Within this research, there was success in using a standardized patient for evaluation of clinical progression.16,17 Clinical Skills and Knowledge According to Weidner and Henning,2 The ACI should demonstrate clinical skills and knowledge that meet and surpass athletic training education competencies and clinical proficiencies. These effective clinical skills are demonstrated when the ACI is fully capable of teaching and evaluating students’ clinical proficiencies. Also, the ACI’s knowledge and skills are current and based on science and evidence-based practice. The ACI must also continue participation in continuing education programs.2 Clinical education requirements are organized so that students can actively learn and interact with instructors and patients. It is necessary for approved clinical instructors in the athletic training field to demonstrate appropriate clinical abilities. Sibold8 clarifies that it is significant for the athletic trainer to use critical thinking skills to make appropriate decisions in the 45 clinical setting. The ability to understand and demonstrate clinical proficiencies in clinical practice is important for the development of clinical decision making. It is vital for the ACI to demonstrate the knowledge needed to make clinical decisions. If an athletic trainer has a great amount of knowledge, it is not uncommon that he or she lacks the ability to make clinical decisions. An ACI should be able to make clinical decisions to aid in problem solving. Students should be taught by their ACI on how to reach sensible decisions in the clinical setting. If the ACI can demonstrate making sensible decisions, the students may have increased self-confidence thus leading to better patient outcomes. The ACI should not assume that students understand clinical decision making by simply observing actions. Appropriate clinical competence can be demonstrated by offering students a clear understanding of clinical decisions.8 Researcher Phan et al18, notes that other health care professions, including physical therapy and nursing, are becoming more structured and organized in developing constructive learning experiences in clinical education. Clinical education requires the ability to transfer knowledge and apply learned concepts in new situations. The framework of other health care professions has provided a 46 base on how to approach athletic training clinical education. Phan et al18 recognized that one of the most prominent parts of clinical education is the ACI. Approved clinical instructors are to become an effective mentor by demonstrating attributes that would apply to a clinician, educator, and that of an effective communicator. Research shows that ACIs who recognize a balance between autonomy and guided practice will provide an effective learning environment for students.18 Potteiger et al7 mentioned that other evaluations of educational standards and the opportunity to practice skills can be done through evidenced-based practice. Evidenced-based practice is an important feature of clinical education and is something that can be incorporated in to accredited entry-level athletic training programs. The research declares that evidence-based practice will teach the students to apply the research evidence with his or her clinical observations to make for the best decision making. The use for evidence-based practice includes a foundation for delivery care, developing clinical questions, answering clinical questions, and to interpret clinical outcomes to assess patient status. If a student uses evidence-based practice 47 it is hopeful that they will feel more confident in their decisions and answers in the clinical setting.7 Summary The literature review reveals different findings in terms of being an approved clinical instructor (ACI) in the athletic training education program. The literature depicts what it means to be effective in the following standards: communication skills, interpersonal relationships, instructional skills, supervisory and administrative skills, evaluation of performance, and clinical skills and knowledge. Research is continuing to advance involving how an ACI should perform in the clinical setting. The ACI plays a significant role in the professional development and education of athletic training students. Therefore, it is critical to evaluate the professional effectiveness of an approved clinical instructor. 48 APPENDIX B The Problem 49 STATEMENT OF THE PROBLEM The purpose of this research was to determine the perception of newly certified athletic trainers on their undergraduate approved clinical instructors’ (ACI) professional effectiveness. This research examined if the ACI is effectively performing their role in the clinical setting within the following six standards: communication skills, interpersonal relationships, instructional skills, supervisory and administrative skills, evaluation of performance, and clinical skills and knowledge. There is minimal athletic-training based research that analyzes athletic training students’ perception of ACIs and their effectiveness in the clinical setting. Athletic training education programs could use this research to potentially better the professional effectiveness of the ACI. Definition of Terms The following definitions of terms will be defined for this study: 1) Approved Clinical Instructor - An appropriately credentialed professional identified and trained by a Clinical Instructor Educator to provide instruction and evaluation of the Athletic Training Educational 50 Competencies and/or Clinical Proficiencies.1 The ACI may not be a current student within the Athletic Training Education Program.1 2) Athletic Training Student – Entry-level student in the Athletic Training Education Program who is working towards a Bachelors degree at a college/university.1 3) Clinical Education - The application of knowledge and skills, learned in classroom and laboratory settings, to actual practice on patients under the supervision of an ACI.1 4) Clinical Skills and Knowledge - Appropriate clinical competence is demonstrated through clinical decision making and professional approaches to problem solving.2 5) Communication Skills - Effective communication should be nonthreatening and provide a clear and honest perception of student’s abilities.2 Demonstrating active listening skills, asking open-ended questions, and clearly explaining clinical problems and expectations in a comprehensible manner is also effective means of communication.2 51 6) Evaluation of Performance - Effective evaluation and assessment skills identify student progress, strengths and weaknesses.2 7) Instructional Skills - Effective instructional skills means being knowledgeable on basic educational principles regarding clinical teaching.2 Being effective means recognizing different teaching and learning styles and encouraging critical thinking and problem solving skills.2 8) Interpersonal Relationships - A positive and effective interpersonal relationship means showing professional behavior and being a professional role model and mentor.2 Interpersonal qualities include being enthusiastic, positive, friendly, honest, approachable, and show interest and concern for students as a learner.2 9) Preceptor – A teacher or instructor more commonly used to describe an instructor in the clinical setting of nursing, physical therapy, and other health related fields. 10) Supervisory and Administrative Skills - Effective supervision is remaining readily accessible and serving as a resource for students.2 An effective administrative 52 skill is time management and completing all necessary tasks.2 Basic Assumptions The following are basic assumptions of this study: 1) The subjects completed the survey honestly and to the best of their ability. 2) The subjects completed the survey based on their own individual experiences. 3) The questions were not leading or biased. 4) All respondents were be given adequate time to complete the survey. Limitations of the Study The following are possible limitations of the study: 1) Only those who are a member of the National Athletic Trainers’ Association Career Starter category were being studied which decreased the subject pool. 2) The subjects may not have been able to recall the information needed to successfully answer the survey questions. 3) The list of subject email addresses may not have been correct. 53 Delimitations The following are possible delimitations of the study: 1) The subjects who participated in the survey were Career Starter membership category of the National Athletic Trainers’ Association. 2) The subjects who participated in the survey were recently certified athletic trainers. 3) The subjects who participated in the survey were evaluating a previous approved clinical instructor from their first clinical rotation of fall semester of their final academic year. Significance of the Study The only athletic training research-based standards published are those by Drs. Weidner and Henning. Individuals, who were once entry-level athletic training students, will rate their approved clinical instructor’s professional effectiveness based on the developed standards. This thesis study was significant for assessing guidelines in selecting, training, and evaluating ACIs. The results of this research may help to better guide the approved clinical instructor (ACI) in the clinical setting. 54 The study showed what standards and criteria the ACI is performing well in, and where improvements were necessary. 55 APPENDIX C Additional Methods 56 APPENDIX C1 Institutional Review Board – California University of Pennsylvania 57 58 59 60 61 62 63 64 65 66 67 68 69 Institutional Review Board California University of Pennsylvania Morgan Hall, Room 310 250 University Avenue California, PA 15419 instreviewboard@calu.edu Robert Skwarecki, Ph.D., CCC-SLP,Chair Dear Ms. Passaro: Please consider this email as official notification that your proposal titled "Certified Athletic Trainers' Perceptions on their undergraduate approved clinical instructors' professional effectiveness” (Proposal #12-063) has been approved by the California University of Pennsylvania Institutional Review Board as submitted. The effective date of the approval is 3/27/13and the expiration date is 3/26/14. These dates must appear on the consent form . Please note that Federal Policy requires that you notify the IRB promptly regarding any of the following: (1) Any additions or changes in procedures you might wish for your study (additions or changes must be approved by the IRB before they are implemented) (2) Any events that affect the safety or well-being of subjects (3) Any modifications of your study or other responses that are necessitated by any events reported in (2). (4) To continue your research beyond the approval expiration date of 3/26/14 you must file additional information to be considered for continuing review. Please contact instreviewboard@calu.edu Please notify the Board when data collection is complete. Regards, Robert Skwarecki, Ph.D., CCC-SLP Chair, Institutional Review Board 70 APPENDIX C2 EVALUATION OF ATHLETIC TRAINING APPROVED CLINICAL INSTRUCTOR’S PROFESSIONAL EFFECTIVENESS SURVEY 71 72 73 74 75 76 77 78 79 80 81 Appendix C3 Cover Letter 82 Dear Fellow Certified Athletic Trainer: My name is Abby Passaro 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 determine the perception of certified athletic trainers on their undergraduate approved clinical instructor’s professional effectiveness in clinical education. The survey will be generated through SurveyMonkey.com and will be distributed to the National Athletic Trainers’ Association Career Starter membership category. Your participation is voluntary and you do have the right to choose not to participate. You also have the right to discontinue participation 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 3/27/13 and the expiration date is 3/26/14. 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. The survey responses will be housed in a password protected file on the Cal U campus. 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 15 minutes to complete. If you have any questions regarding this project, please feel free to contact the primary researcher Abby Passaro at pas7374@calu.edu or 412-758-9591. You can also contact the faculty advisor for this research (Linda Meyer, EdD, LAT, ATC, meyer@calu.edu). Thank you in advance for your participation. Please click the following link to access the survey (www.surveymonkey.com/s/JKGVVZ3). Thank you for taking the time to take part in my thesis research. I greatly appreciate your time and effort put into this task. Participants for this survey were selected at random from the NATA membership database according to the selection criteria provided by the student doing the survey. This student survey is not approved or endorsed by NATA. It is being sent to you because of NATA’s commitment to athletic training education and research. Sincerely, Abby Passaro, LAT, ATC Primary Researcher California University of Pennsylvania 250 University Ave California, PA 15419 pas7374@calu.edu 83 REFERENCES 1. CAATE Clinical Education Terminology. National Athletic Trainers' Association Web site. http://www.nata.org/caate-clinical-educationterminology. Accessed November 2012. 2. Weidner T, Henning J. Development of standards and criteria for the selection, training, and evaluation of athletic training approved clinical instructors. J Athl Train. 2004;39(4):335. 3. Weidner T, Henning J. Importance and applicability of approved clinical instructor standards and criteria to certified athletic trainers in different clinical education settings. J Athl Train. 2005;40(4):326-332. 4. Raines D. Nurse preceptors' views of precepting undergraduate nursing students. J Nurs Educ Pers. 2012;33(2):76-79. 5. Carr W, Volberding J. Employer and employee opinions of thematic deficiencies in new athletic training graduates. Athl Train Ed J. 2012;7(2):53-59. 6. Raab S, Wolfe B, Gould T, Piland S. Characterizations of a quality certified athletic trainer. J Athl Train. 2011;46(6):672-679. 7. Potteiger K, Brown C, Kahanov L. Altering the athletic training curriculum: a unique perspective on learning over time. Athl Train Ed J. 2012;7(2):60-69. 8. Sibold J, Geisler P. A three-question framework to facilitate clinical decision making. Athl Train Ed J. 2012;7(1):11-17. 9. Ristori C, Eberman L, Tripp B, Kaminski T. Athletic training student learning style. IJATT. 2011;16(2):3337. 10. Henning J, Weidner T, Jones J. Peer-assisted learning in the athletic training clinical setting. J Athl Train. 2006;41(1):102-108. 84 11. Anderson B. Policies and philosophies related to risk management in the athletic setting. Athl Ther Today. 2006;11(1):10-16. 12. Rich V. Clinical instructors' and athletic training students' perceptions of teachable moments in an athletic training clinical education setting. J Athl Train. 2009;44(3):294-303. 13. Omansky G. Staff nurses' experiences as preceptors and mentors: an integrative review. J Nurs Mgt. 2010;18(6):697-703. 14. Craig D. Development of statewide clinical sites for an at education program. IJATT. 2012;17(3):25-29. 15. Martin M, Grant-Ford M. Utilizing web-based technology to track athletic training proficiencies. Athl Ther Today. 2007;12(4):40-43. 16. Walker S, Armstrong K. Standardized patients, part 1: teaching interpersonal and clinical skills. IJATT. 2011;16(2):38-41. 17. Armstrong K, Walker S, Jarriel A. Standardized patients, part 3: assessing student performance. IJATT. 2011;16(4):40-44. 18. Phan K, McCarty C, Mutchler J, Van Lunen B. Clinical preceptors' perspectives on clinical education in post-professional athletic training education programs. Athl Train Ed J. 2012;7(3):103-114. 85 ABSTRACT Title: Certified Athletic Trainers’ Perceptions on Their Undergraduate Approved Clinical Instructors’ Professional Effectiveness RESEARCHER: Abby Passaro ADVISOR: Dr. Linda P. Meyer DATE: May 2013 RESEARCH TYPE: Master’s Thesis CONTEXT: There is minimal athletic-training based research that analyzes athletic training students’ perception of ACIs and their effectiveness in the clinical setting. Athletic training education programs could use this research to potentially better the effectiveness of the ACI. OBJECTIVE: The purpose of this study was to determine the perception of certified athletic trainers on their undergraduate approved clinical instructor’s professional effectiveness in clinical education. Professional effectiveness was determined based on the following standards: communication skills, interpersonal relationships, instructional skills, supervisory and administrative skills, evaluation of performance, and clinical skills and knowledge. SETTING: An email was sent out to Career Starter members of the National Athletic Trainer’s Association. The email contained a link to the survey to be completed on an internet based program at the students own discretion. 86 PARTICPANTS: An online survey containing 29 questions and 5 demographic questions was randomly sent to 1,000 members of the National Athletic Trainers’ Association who met the qualifying criteria. In total, 77 participants responded to the survey. INTERVENTION: The survey originated from Drs. Weidner and Henning’s questionnaire from the research titled "Development of Standards and Criteria for the Selection, Training, and Evaluation of Athletic Training Approved Clinical Instructors". Research was approved by the Institutional Review Board. The survey was created on a web server called Survey Monkey™ and sent via email using the National Athletic Trainers’ Association Research Survey Services. A cover letter explaining the survey was attached in the email. MAIN OUTCOME MEASURES: The research question tested was analyzed using descriptive statistics of mean, standard deviation, and range of scores. RESULTS: The mean and standard deviation for the six standards based on a 5-point Likert scale were as follows: Communication Skills, 4.4 ± 0.7; Interpersonal Relationships, 4.6 ± 0.6; Instructional Skills, 4.1 ± 1.0; Supervisory and Administrative Skills, 4.4 ± 0.7; Evaluation of Performance, 4.4 ± 0.8; Clinical Skills and Knowledge, 4.7 ± 0.6. CONCLUSION: The study concluded that based on the survey scale, approved clinical instructors (ACI) are usually demonstrating professional effectiveness in the clinical setting. The 87 survey’s associated six standards were all deemed reliable by using a Chronbach Alpha analysis.