admin
Fri, 02/09/2024 - 19:48
Edited Text
CALIFORNIA LEGISLATORS’ AND SUPERINTENDENTS’ PERCEPTION OF
ATHLETIC TRAINING
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
Curt B. Snyder
Research Advisor, Dr. Linda P. Meyer
California, Pennsylvania
2012
ii
iii
ACKNOWLEDGEMENTS
I would like to thank the following individuals for
their contributions to my thesis:
My thesis committee: Dr. Linda Meyer for her extensive
knowledge and encouragement throughout this study; Dr. Bill
Biddington for his attention to detail, particularly with
grammar and formatting; Dr. Jamie Weary for her
contributions and recommendations for this study as well as
shared clinical knowledge throughout the year with the
football team.
Dr. Tom West, a big thank you, for all of his advice
and continued support throughout the research process, and
for his mastery of MS Word.
Ms. Carolyn Robinson and her work study students for
both making my survey presentable and preparing my survey
to be mailed. Without Ms. Carolyn this year would not have
been nearly as fun as it was.
Mr. James Daley, I’m very grateful for all you have
done for me. You always had the time to sit and talk as
well as providing me with sound advice. You, sir, are a
role model who I look up to and aspire to emulate in my
career.
iv
Jeremy Shepherd, I have to thank for introducing me to
CalU and the graduate program. I also appreciate the
influence you provided regarding my research and hope my
study is a positive follow up from yours.
Joey Tamburo and Preston Anderson for being as good of
friends as you can ask for. It was a fun ride from the pact
to the baseball games. Matthew Strahm, Jon Ayon, and
Brandon Angulo, you guys are my best friends and I couldn’t
have done it without you. I would also like to thank my
classmates, friends from home, and the football players
that pestered me into keeping my blond moustache for over a
year, it is a proud accomplishment.
I would like to finish with a very special thank you
to my parents, Lynn and Glyn, my siblings, Clint, Colt and
Katelyn, and my niece Ashlan for all the love and support
you have given me in my life and I would not be here if not
for each of you.
v
TABLE OF CONTENTS
Page
SIGNATURE PAGE
. . . . . . . . . . . . . . . ii
AKNOWLEDGEMENTS . . . . . . . . . . . . . . . iii
TABLE OF CONTENTS
LIST OF TABLES
INTRODUCTION
METHODS
. . . . . . . . . . . . . . iv
. . . . . . . . . . . . . . . vii
. . . . . . . . . . . . . . . . 1
. . . . . . . . . . . . . . . . . . 7
Research Design
Subjects
. . . . . . . . . . . . . . 7
. . . . . . . . . . . . . . . . . 8
Preliminary Research. . . . . . . . . . . . . 9
Instruments . . . . . . . . . . . . . . . . 10
Procedures
. . . . . . . . . . . . . . . . 12
Hypotheses
. . . . . . . . . . . . . . . . 13
Data Analysis
RESULTS
. . . . . . . . . . . . . . . 14
. . . . . . . . . . . . . . . . . . 15
Demographic Data . . . . . . . . . . . . . . 15
Hypothesis Testing
. . . . . . . . . . . . . 19
Additional Findings . . . . . . . . . . . . . 22
DISCUSSION . . . . . . . . . . . . . . . . . 27
Discussion of Results . . . . . . . . . . . . 27
Conclusions . . . . . . . . . . . . . . . . 36
Recommendations. . . . . . . . . . . . . . . 38
vi
REFERENCES . . . . . . . . . . . . . . . . .
41
APPENDICES . . . . . . . . . . . . . . . . .
43
APPENDIX A: Review of Literature
. . . . . . . .
44
Introduction . . . . . . . . . . . . . . . .
45
History of Athletic Training. . . . . . . . . .
46
National Athletic Trainers’ Association . . . .
47
The Athletic Trainer as a Health . . . . . .
50
Care Provider
Role Delineation
. . . . . . . . . . . .
50
. . . . . . . . . . . . . . .
51
Board Certification Exam . . . . . . . . .
53
Employment Settings . . . . . . . . . . .
54
State Regulation in the United States . . . .
59
Perceptions of Athletic Training . . . . . .
64
Athletes . . . . . . . . . . . . . . . .
64
Orthopedic Surgeons
67
Education
. . . . . . . . . .
Secondary School Administrators
. . . . .
68
. . . . . . . . . . . . . . . .
70
. . . . . . . . . . . . . . . . .
71
Coaches
Summary
APPENDIX B: The Problem.
. . . . . . . . . . .
74
Statement of the Problem . . . . . . . . . . .
75
Definition of Terms.
. . . . . . . . . . . .
76
Basic Assumptions . . . . . . . . . . . . . .
77
vii
Limitations of the Study.
. . . . . . . . . .
78
Significance of the Study
. . . . . . . . . .
78
APPENDIX C: Additional Methods . . . . . . . . .
80
Athletic Training Survey (C1) . . . . . . . . .
81
Athletic Training Cover Letter (C2)
. . . . . .
85
IRB: California University of Pennsylvania (C3) . .
87
REFERENCES
ABSTRACT
. . . . . . . . . . . . . . . .
100
. . . . . . . . . . . . . . . . .
105
viii
LIST OF TABLES
Table
Title
Page
1
Frequency of Return
15
2
Frequency for Gender
16
3
Frequency for Age
16
4
Frequency of Years at Current Position
17
5
Frequency that Participated in Sports
17
6
Sustained an Injury
17
7
Have Children High School Age or Older
18
8
Children Injured Part. In Athletics
18
9
Utilized the Services of an AT
18
10
Hypothesis I Results
19
11
Hypothesis II Results
20
12
Hypothesis III Results
22
13
Domain I: Prevention
23
14
Domain II: Clinical Eval. and Diagnosis 23
15
Domain III: Immediate Care
24
16
Domain IV: Treatment, Rehab., Recond.
24
17
Domain V: Organization and Admin.
25
18
Domain VI: Professional Responsibility
25
19
AT Employment Information
26
20
AT Employment Information cont.
26
1
INTRODUCTION
California is one of three states that currently has
no state regulation for the profession of athletic
training. This is a problem for not only the profession but
also for patients whom are either under the care of someone
who is not trained to provide needed health care services
or actually has no one supervising a given event. As of
2002, only 62% of California high schools had an athletic
trainer (AT) on campus at least part time.1 Not only are
participants at risk of receiving improper healthcare, but
there is a liability risk present for ATs, legislators,
school district superintendents, coaches and athletic
directors whom assume care for these students.
The purpose of this study was to assess current
California legislator’s and school district
superintendent’s perception of the roles and
responsibilities of certified athletic trainers. As of now
there is no state licensure, registration, or certification
in place to regulate the practice of athletic training in
the state of California. If we were able to assess the
current knowledge and perceptions of CA legislators and
superintendents about the benefits of the profession, it
2
would help to guide and educate the efforts by the
California Athletic Training Association (CATA), National
Athletic Trainers’ Association (NATA), and Board of
Certification (BOC) to obtain state regulation to both
protect professionals working in the field as well as the
athletes participating in sports.
Athletic training is practiced by health care
professionals who are certified by the BOC to work under
the direction of physicians to optimize activity and
participation of patients and clients. Athletic training
encompasses the prevention, diagnosis, and intervention of
emergency, acute, and chronic medical conditions involving
impairment, functional limitations, and disabilities.2
Students who want to become certified athletic trainers
must earn a minimum of a bachelor's degree from a
university that is accredited by the Commission on
Accreditation of Athletic Training Education (CAATE).
Accredited programs' curricula include formal instruction
in areas such as injury/illness prevention, first aid and
emergency care, assessment of injury/illness, human anatomy
and physiology, therapeutic modalities, and nutrition.
Classroom learning is enhanced through clinical
education experiences. More than 70% of certified athletic
trainers hold at least a master’s degree.2 In 1990, the
3
American Medical Association (AMA) recognized the
profession of athletic training as an allied health care
profession. Further, in 1998, the AMA recommended that all
high schools provide athletic training services.3 The NATA,
BOC, and CAATE have become more efficient in management,
regulation, and progression of the profession.
There are different types of state-level regulation
including: licensure, certification, registration,
exemption, and no regulation. To further clarify, licensure
is a form of credentialing, administered by state
government to protect the public and regulate a practice of
trade or profession. Certification is more a form of title
protection, established by state law or professional
association, to show that practitioners have necessary
knowledge and skills to protect the public.4 Registration is
a type of system that requires qualified members of a
profession to register with the state to be able to
practice. There are three states that currently have no
licensure; they are California, Alaska, and Hawaii in where
there is an absence of any form of law protection, either
for the practitioner or the public. Obviously, it is of
benefit for everyone involved with athletic training, be it
the actual ATs or those under the care of ATs, to have a
form of state regulation to protect all parties involved.4
4
There are legal parameters the certified athletic
trainer has to abide by and work under. Statutory,
regulatory, and case law comprise the three categories of
law that are separate from an organization which any given
athletic trainer is employed. Statutory law can be
legislation at both the federal and state level that is
also known as public law. State laws are much more specific
and have a greater impact on athletic trainers. Athletic
trainers must be able to locate laws governing their
practice in their respective state to protect themselves.
Regulatory laws are a series of rules composed by a state
or federal agency such as the Drug Enforcement Agency.
Finally, case laws are opinions of judges that come from
litigation dealing with a specific issue. Case laws form
the basis for state laws.5
Fortunately, there are only a few states, such as
California, where athletic training is practiced and is not
licensed and individuals are still calling themselves ATs
without the education or the qualifications necessary to
practice sports medicine.6 It is believed that uniformity of
state regulation, increase in public knowledge, and an
increase in professional recognition will all benefit the
profession and those under the care of an athletic trainer.6
5
Increasingly, ATs are managing the health of
physically active populations that are not only limited to
young competitive athletes, but also industrial workers,
military personnel, public safety personnel, entertainment
groups, and patients of a healthcare delivery organization.7
Given this development, ATs need to improve their focus and
embrace the role as healthcare professionals instead of
settling with the stereotype as someone who merely tapes
ankles. This can occur by not only educating the public,
but also seeking and implementing evidence based medicine
and clinical epidemiology in practice.
The purpose of this study, specifically, was to
analyze the perception of those in power in the state of
California to assist CATA, NATA, and the BOC’s efforts to
pass legislation in favor of professional recognition for
athletic training and ultimately the public. In a study by
Gould and Deivert8, research was completed on administrators
in Ohio. It was shown that while 73% of administrators were
very concerned about legal-liability issues, only 55% of
those thought they should hire an AT, at least part-time.8
Even still, administrators in Ohio are not willing to
allocate sufficient funds for employing ATs which leads
Gould and Deivert to believe that they have an inaccurate
6
knowledge of the value of athletic training, as evidenced
by inadequate compensation and low employment rates.8
The data obtained from this study provides insight to
the knowledge of legislators and superintendents of ATs’
education requirements, scope of practice, and professional
roles. Ideally, the data could suggest if the respondents
have the current facts and information showing that ATs are
qualified health care professionals and should be a
necessary entity in every secondary school in the state.
Passing state law is necessary to provide the appropriate
health care to all student athletes, as well as protecting
qualified ATs. Ideally, this information will be used as
instruction to guide legislative and educational efforts in
California.
The objective now is to increase the public’s
awareness of the profession. It is not known which
technique will best serve this purpose. It has been
recommended that ATs separate themselves from other
professions with similar titles by changing the name in
which they refer to themselves, such as being called
athletic therapists instead.6 The main goal is to inform and
educate the public that ATs are indeed health care
professionals and should be perceived as such.
7
METHODS
The purpose of this study was to examine the
perception of California legislators and school district
superintendents knowledge on the profession of athletic
training. The goal was to provide the California Athletic
Training Association (CATA) and NATA with survey results
that can aid the effort in pursuing state regulation in
California. The methods section describes how this research
was carried out and includes the following: research
design, preliminary research, subjects, instruments,
procedure, hypotheses, and data analysis.
Research Design
A descriptive research design was used with an
Athletic Training Survey (ATS) (Appendix C1) to conduct
this study.
The dependent variable was the subject’s
perception of the roles and responsibilities of certified
athletic trainers. The independent variables included the
subject’s employment position, contact with an athletic
trainer, whether the subject has or has not participated in
8
sports, and whether the subject currently has or has had a
child who has participated in sports in high school or
college. The strength of this study was that the survey has
been previously used and validated and was employed in this
research to identify the perceptions of California, instead
of West Virginia as it was used in a previous study. Due to
this prior validation, the survey was not changed for its
use in this study. The limitations in this study include
the possibility of emails or addresses being incorrect,
possibility of a low response rate due to the use of email
and Survey Monkey, and the possibility that someone other
than the intended subject complete the survey.
Subjects
The subjects (N=620) that were used for this study
were California’s legislators (N=120), senators (N=40),
assembly members (N=80), and secondary school
superintendents (N=620). The researcher chose to use the
United State Postal Service (USPS) to mail a copy of the
ATS and cover letter to the California legislators. As for
the superintendents, an email was sent with a link to
surveymonkey.com to complete the survey to be able to reach
the 620 superintendents. Included in the email was a cover
9
letter (Appendix C2) introducing the researcher, as well as
explaining the purpose of the study. All surveys were
anonymous and were kept completely confidential at all
times. Data collected via pen and paper instrument were
stored in a locked filing cabinet in the graduate athletic
training program director’s office. The Informed Consent
was assumed upon completion and submission of the survey.
The risk for participating in this study was minimal. The
study was approved by the Institutional Review Board
(Appendix C3) at California University of Pennsylvania.
Each participant’s identity remained confidential and was
not included in the study.
Preliminary Research
There was no preliminary research completed due to the
ATS having been used in a prior study with subjects in West
Virginia. The researcher has chosen to use the identical
survey to gain insight on the perceptions of California
legislators’ and superintendents’ knowledge of the athletic
training profession and to potentially allow for comparison
of data between the two states. A preliminary study for
this project was not required because the original survey
was validated through all the questions deriving directly
10
from the six domains of athletic training defined in the
BOC Role Delineation Study 5th edition9 (RDS), which outlines
the roles and responsibilities of a certified athletic
trainer, (AT). Validity and reliability were already tested
in two phases. The first phase was completed by a panel of
experts assembled by the BOC in November, 2002 to identify
the domains, task, knowledge, and skills consistent with
the essential elements of athletic training.9 The second
phase required a sample from 5,000 ATs to review and
validate the work of the panel, in particular, to evaluate
the “importance and criticality” for the proposed domains
and tasks by way of a survey.9 The results of the survey
validated the domains and tasks identified by the panel of
experts.9
Instruments
The researcher implemented a previously used survey
with questions derived from the six domains of athletic
training described in the BOC RDS 5th ed.9 Demographic
information was collected and included: gender, age,
current position, and years of experience as a California
Legislator or Superintendent. There were also additional
demographic questions regarding previous participation in
11
athletics, injury history resulting from playing sports,
and if the services of an AT were also asked of the survey
participants. Along with these demographic questions, there
were a series of questions that related to the survey
participant’s children and his/her participation in
athletics. Following the demographic questions, the survey
contained 35 Likert scale questions derived from the six
domains as defined in the BOC RDS 5TH ed,9 with a Likert
scale ranging from: 1 – strongly disagree, 2 – somewhat
disagree, 3 – no opinion, 4 – somewhat agree, and 5 –
strongly agree. The answers of the surveys were analyzed
using an independent sample t-test to examine the
hypothesis. The current survey received no nomenclature
changes due to the desire to compare the results received
in this study to the prior data.
The ATS (Appendix C1) was distributed by the
researcher to each chosen California legislator via USPS
and each superintendent using email with a link to
surveymonkey.com. Distribution of the survey to the
superintendents using email was chosen due to cost
effectiveness and the ability to survey all California
superintendents with the number of subjects being quite
large.
12
Procedure
The researcher applied for approval from the
Institutional Review Board (IRB) at California University
of Pennsylvania (Appendix C3) before any research was
conducted. A cover letter was also written to inform the
subjects of the purpose, directions, potential risks, and
obtain informed consent. The study was distributed through
both USPS and email. The 120 legislators received the
survey and cover letter via the USPS. The 620
superintendents received a link to the survey on survey
monkey via email. The names and mailing addresses of all
California senators and assembly members were obtained from
California legislature website available at:
http://www.leginfo.ca.gov/yourleg.html. The contact
information was obtained for all California superintendents
through an online database accessed from the California
Board of Education at:
http://www.cde.ca.gov/ds/si/ds/pubschls.asp. There were 120
copies of the survey that were mailed via USPS to each
California legislator containing a cover letter, ATS
(Appendix C1), and a postage paid, pre-addressed envelope
13
to return the completed survey to the researcher at
California University of Pennsylvania. The ATS was emailed
by the researcher to each California legislator and
superintendent with the cover letter. Postage for the study
was allotted from the graduate athletic training program
budget. The survey was designed to take less than ten
minutes to complete.
Hypotheses
The following hypotheses were based on previous
research and the researcher’s intuition based on a review
of the literature.
1.
California superintendents will not have a
significantly different score than legislators on the
survey assessing athletic trainers’ roles and
responsibilities.
2.
California superintendents and legislators who have
participated in sport will not have a significantly
different score than those whom have and/or do not.
3.
California superintendents and legislators who have at
least one child who has or is currently participating
in athletics will not have a significantly different
score than those who have and/or do not.
14
Data Analysis
An independent samples t-test was performed to compare
the California legislators’ answers to the superintendents’
responses. All data was analyzed by SPSS version 18.0 for
windows at an alpha level of 0.05.
The research hypothesis
was analyzed by SPSS version 18.0 for Windows with a level
of significance of 0.05.
15
RESULTS
The following section will reveal demographic data and
hypothesis testing obtained through the Athletic Training
Survey.
Demographic Information
The ATS was sent to a total of 620 California
superintendents. The California legislators are made up of
80 Assembly Members and 40 Senators. The 120 California
superintendents consisted of individuals across the state
that provided their contact email to the California Board
of Education. A total of 132 surveys were returned
resulting in an overall completion rate of 18%. Table 1 is
a breakdown of the frequency of return by position.
Table 1. Frequency of Return
Position
Frequency (%)
Superintendents
113 (22.6)
Legislators
19
(15.8)
16
Table 2 represents the frequency for the gender of the
participants whom returned the survey by position.
Table 2. Frequency for Gender
Gender
Superintendent (%)
Females
Males
Legislator (%)
21 (21.2)
78 (78.6)
6 (40.0)
9 (60.0)
Table 3 reports the frequency for participants grouped
by age class for both positions. There were 18 individuals
who did not provide their age on the returned survey but
their results were still analyzed.
Table 3. Frequency for Age
Age
Superintendent (%)
< 39
40-49
50-59
60-69
>70
17
24
58
13
1
(15.1)
(21.2)
(51.3)
(11.5)
( 1.9)
Legislator (%)
9
2
6
2
0
(47.3)
(10.5)
(31.6)
(10.5)
(0)
Table 4 reports the frequency for individuals grouped
by classes for the total number of years at their current
position. All participants who returned the survey had been
at their current position for greater than one year.
17
Table 4. Frequency of Years at Current Position
Years
Superintendent (%)
Legislator (%)
1-5
6-10
11-15
16-20
>21
68
20
5
4
1
(69.4)
(20.4)
( 5.0)
( 4.0)
( 1.0)
12(80.0)
2 (13.4)
1 ( 6.7)
0 (0)
0 (0)
Table 5 represents responses given to the survey
question that asked if the individual participated in
school sponsored athletics in high school or college.
Table 5. Frequency that Participated in Sports
Participation
Superintendent (%)
Legislator (%)
Yes
No
79 (80.6)
19 (19.4)
13 (86.7)
2 (13.3)
Table 6 shows those individuals who sustained an
injury while participating in athletics in high school or
college.
Table 6. Sustained an Injury
Injured
Superintendent (%)
Yes
No
56 (57.1)
42 (42.9)
Legislator (%)
5 (33.3)
10(66.7)
Table 7 examines those survey participants who have
children that are high school age or older.
18
Table 7. Have children High School Age or Older
Children
Superintendent (%)
Legislator (%)
Yes
No
66 (67.3)
32 (32.7)
6 (42.9)
8 (57.1)
Table 8 shows those with children who participate(d)
in athletics in high school or college and sustained an
injury while playing sports.
Table 8. Children Injured Participating in Athletics.
Injured
Superintendent (%)
Legislator (%)
Yes
No
45 (50.0)
50 (52.6)
3 (25.0)
9 (75.0)
Table 9 illustrates those participants and their
children that were injured participating in athletics whom
utilized the services of an athletic trainer.
Table 9. Utilized the Services of an athletic trainer (AT).
AT Services
Superintendent (%)
Legislator (%)
Yes
No
49 (51.0)
47 (49.0)
5 (38.5)
8 (61.5)
19
Hypothesis Testing
The hypothesis was tested using an alpha level of .05.
Hypothesis 1: California superintendents will not have
a significantly different score than legislators on the
survey assessing athletic trainers’ roles and
responsibilities.
An independent-samples t test was calculated comparing
the mean score of participants who identified themselves as
superintendents to the mean score of participants who
identified themselves as legislators. No significant
difference was found (t(111)=.766, p > .05). The mean of
the superintendents (4.152 ± .475) was not significantly
different from the mean of legislators (4.046 ± .671).
Table 10. Hypothesis Results
Position
N
Superintendents
Legislators
98
15
M
4.1526
4.0457
SD
T
P
.766
.445
.47457
.67069
20
Conclusion: The hypothesis was supported. There was no
significance between California superintendents’ and
legislators’ perceptions of athletic training.
Hypothesis 2. California superintendents and
legislators who have participated in sport will not have a
significantly different score than those who have and/or do
not.
An independent-samples t test was calculated comparing
the mean score of participants whom identified themselves
as having participated in sports to the mean score of
participants whom identified themselves as not having
participated in sports. No significant difference was found
(t(111)= 1.487, p > .05). The mean of the subjects who had
participated in sports (4.172 ± .510) was not significantly
different from the mean of subjects who have not
participated in sports (3.992 ± .451).
Table 11. Hypothesis 2 Results
Participation
N
M
Yes
No
92
21
4.1718
3.9921
SD
t
P
1.487
.140
.51012
.45056
21
Conclusion: The hypothesis was supported. There was no
significance showing that California superintendents and
legislators who participated in sports altered their
perception of athletic training.
Hypothesis 3:
California superintendents and
legislators who have at least one child who has or is
currently participating in athletics will not have a
significantly different score than those who have and/or do
not.
An independent-samples t test was calculated comparing
the mean score of participants who identified themselves as
having a child who has or is currently participating in
sports to the mean score of participants who identified
themselves as not having children who have participated in
sports. No significant difference was found (t(102)=.518, p
> .05). The mean of the subjects who have children who have
or currently participate in sports (4.161 ± .479) was not
significantly different from the mean of the subjects who
do not have children who participate in sports (4.11 ±
.473).
22
Table 12. Hypothesis 3 Results
Child
N
M
Participation
Yes
67
4.1610
No
37
4.1104
SD
t
P
.518
.606
.47919
.47261
Conclusion: The hypothesis was supported. There was no
significance showing that California superintendents and
legislators who have children that have or currently
participate in sports which altered their perception of
athletic training.
Additional Findings
Tables 13-20 show the means of each of the 35 Likert
questions. Each table includes question from the ATS for
which of the six domains it represents. The six domains
include: prevention; clinical evaluation and diagnosis;
immediate care; treatment, rehabilitation, and
reconditioning; organization and administration; and
professional responsibility.
23
Table 13. Domain I: Prevention
ATS
Superintendent
Question
Mean (SD)
Legislator
Mean (SD)
Difference
Mean
12
4.45 ( .76)
4.40 ( .83)
.05
13
4.40 ( .87)
4.00 ( .93)
.40
14
4.62 ( .77)
4.33 ( .90)
.29
15
3.92 (1.17)
3.87 (1.30)
.05
16
4.25 ( .90)
4.50 (1.07)
-.25
17
4.90 ( .42)
4.53 ( .83)
.37
18
4.37 ( .83)
4.00 ( .76)
.37
19
4.33 ( .81)
3.93 (1.22)
-.60
20
4.81 ( .51)
4.60 ( .63)
.21
1- Strongly disagree, 2- Somewhat disagree, 3- No opinion, 4- Somewhat
agree, 5- Strongly agree
Table 14. Domain II: Clinical Evaluation and Diagnosis
ATS
Superintendent
Legislator
Difference
Question
Mean (SD)
Mean (SD)
Mean
21
3.79 (1.20)
3.73 (1.03)
.06
22
4.32 (1.07)
3.73 (1.39)
-.41
23
4.85 ( .46)
4.53 ( .92)
.32
24
3.76 (1.39)
4.00 (1.00)
-.24
25
4.12 (1.00)
3.73 (1.22)
.39
1- Strongly disagree, 2- Somewhat disagree, 3- No opinion, 4- Somewhat
agree, 5- Strongly agree
24
Table 15. Domain III: Immediate Care
ATS
Superintendent
Legislator
Question
Mean (SD)
Mean (SD)
Difference
Mean
26
4.86 ( .48)
4.73 ( .59)
.09
27
4.67 ( .72)
4.40 ( .74)
.27
28
4.31 (1.10)
3.67 (1.11)
.64
29
4.32 (1.31)
3.80 (1.47)
.52
1- Strongly disagree, 2- Somewhat disagree, 3- No opinion, 4- Somewhat
agree, 5- Strongly agree
Table 16. Domain IV: Treatment, Rehab., Reconditioning
ATS
Superintendent
Legislator
Difference
Question
Mean (SD)
Mean (SD)
Mean
30
4.84 ( .53)
4.67 ( .49)
.17
31
4.63 ( .65)
4.67 ( .49)
-.04
32
3.78 (1.27)
3.47 (1.19)
.31
33
3.84 (1.23)
3.53 (1.30)
.31
34
3.56 (1.31)
3.87 (1.06)
-.31
35
4.01 (1.09)
4.20 ( .78)
-.19
36
4.08 (1.06)
4.07 ( .92)
.01
37
3.48 (1.41)
4.07 ( .92)
-.59
38
3.78 (1.28)
4.20 ( .86)
-.42
39
4.26 ( .93)
4.20 ( .86)
.06
1- Strongly disagree, 2- Somewhat disagree, 3- No opinion, 4- Somewhat
agree, 5- Strongly agree
25
Table 17. Domain V: Organization and Administration
ATS
Superintendent
Legislator
Difference
Question
Mean (SD)
Mean (SD)
Mean
40
3.20 (1.38)
3.87 ( .92)
-.67
41
2.77 (1.42)
2.93 (1.28)
-.16
42
4.29 ( .84)
3.87 (1.19)
.42
1- Strongly disagree, 2- Somewhat disagree, 3- No opinion, 4- Somewhat
agree, 5- Strongly agree
Table 18. Domain VI: Professional Responsibility
ATS
Superintendent
Legislator
Difference
Question
Mean (SD)
Mean (SD)
Mean
43
4.84 ( .51)
4.40 ( .91)
.44
44
4.93 ( .33)
4.67 ( .49)
.26
45
2.80 (1.31)
3.29 (1.07)
-.49
46
3.20 (1.24)
3.27 (1.22)
-.07
1- Strongly disagree, 2- Somewhat disagree, 3- No opinion, 4- Somewhat
agree, 5- Strongly agree
Table 19 represents questions 47 and 48. Only
California superintendents were asked to respond to this
question. Question 47 asked if the superintendent employs
an athletic trainer in his/her school district.
26
Table 19. Athletic Trainer Employment Information
ATS Question
Superintendent (%)
Yes
47
No
48 (49.0)
50 (51.0)
Table 20 was also only asked to California
superintendents. It was also only to be responded to given
a “yes” answer on question 47. The purpose of this question
was to determine if each individual superintendent whom
employed an athletic trainer in his or her school district
knew if the athletic trainer was a BOC certified athletic
trainer.
Table 20. Athletic Trainer Employment Information
ATS Question
48
Superintendent (%)
Yes
No
25 (53.2)
3 (6.4)
Unknown
19 (40.4)
27
DISCUSSION
The discussion section is divided into three
subsections: discussion of the results, conclusions, and
recommendations for future research.
Discussion of Results
The purpose of this study, specifically, was to
analyze California superintendents’ and legislators’
perception of athletic training. The Athletic Training
Survey (ATS) (Appendix C3) was used in a prior study,
surveying West Virginia administrators and legislators.
The ATS was derived from the RDS 5th ed. and utilized
35 Likert style questions where 1- Strongly disagree, 2Somewhat disagree, 3- No opinion, 4- Somewhat agree, and 5strongly agree. The ATS also began with ten demographic
questions. The questions were taken directly from the six
domains of athletic training in the Role Delineation Study
5th ed. (RDS), it was the belief of the researcher that all
Likert questions should have been answered with a “5-
28
strongly agree”. Also, because all questions were taken
from the RDS, there were no purposely misleading questions
out of the ATs scope of practice. The goal of the study was
to identify the current perception of the subjects and what
they believe the capabilities of an AT is able to perform
according to the domains from RDS.
This study found that while California superintendents
had a higher overall mean average score than legislators,
there was not a statistically significant difference
between the two groups. It was the belief of the researcher
that because superintendents were responsible for hiring
athletic trainers they would score significantly higher on
the ATS than legislators.
To follow this hypothesis, the researcher wanted to
differentiate California superintendents and legislators
who have participated in sport, in high school or college,
and to see if potential contact with an athletic trainer
through sport participation may or may not affect their
perception of athletic training. The results of the study
showed that administrators who replied yes to sport
participation had a higher mean score, but again there was
not enough of a difference to yield significance. The final
hypothesis tested by the researcher was to determine if
there was a significantly different score between
29
administrators’ who have at least one child who has or is
currently participating in athletics and those who have
children that do not participate in athletics. As before,
with the administrators sports participation, the
participants with children who have at least one child who
has or is currently participating in athletics had a higher
mean average score than those who do not; but it was not
enough to show a statistical significance.
It is the belief of the researcher that due to the
fact that there is a new bill, SB 1273 (introduced in
2012), which will provide licensure for ATs in California
currently going before vote in front of California
legislators, that may have increased awareness of the AT
profession for these individuals. In a similar study by
Gould and Deivert,8 it reported similar results that while
administrators in NATA District Four had an accurate
knowledge of the athletic training profession, they did not
have enough of an appreciation of the value of an AT to
allocate enough resources to employ an AT.8 Although none of
the hypotheses were reported to be statistically
significant, all of the subjects generally scored higher
than a “4 - somewhat agree” on a vast majority of the
questions.
30
In the 35 Likert questions, there were a variety of
questions from each of the six domains of AT as defined by
the RDS. The means, standard deviation, and difference in
means are labeled in tables 13 through 18. The first domain
of athletic training is Prevention, more specifically
prevention of injury and conditions. In this section, there
were nine questions outlining responsibilities of an AT.
Only two questions, question 15 and 19, were found to have
mean scores lower than “4- somewhat agree”. Question 15
asked if ATs were qualified to make custom protective
devices and both superintendents and legislators scored
below 4.0 with an average mean of 3.92 ± 1.17 and 3.87 ±
1.30, respectively. Question 19 asked the subjects whether
an AT has the ability to recognize the signs and symptoms
of an eating disorder which elicited an average mean
response from legislators of 3.93 ± 1.22. In all but two of
the nine questions, question 16 and 19, superintendents had
a higher mean score than the legislators. In questions 16
and 19, the legislators’ average mean was .25 and .60
higher, respectively. In all, the scores were very positive
by both groups of participants in regards to the perception
of ATs capabilities to prevent injuries and monitor
conditions.
31
Domain two of the ATS addressed five questions
addressing an ATs ability to complete clinical evaluation
and diagnosis of athletic injuries. Each question but one,
question 23, reported a response of below 4.0 by at least
one group of the subjects. Despite this, there were no
responses reported below a 3.7. Question 21, which asks if
an AT is capable of taking a medical history of a patient,
was the only question to lead both groups to score an
average mean below 4.0, 3.79 ± 1.00 and 3.73 ± 1.22 by
superintendents and legislators, respectively. The
researcher found this interesting due to evaluation and
diagnosis being a major part of the ATs clinical
responsibilities.
Domain three of the ATS contained four questions
asking subjects about an ATs ability to perform immediate
care such as perform CPR and applying a splint to a
fractured limb. Legislators were the only subjects to score
below a 4.0 on two questions, question 28 and 29. Question
28 asked if ATs can apply a splint to a fractured limb in
which legislators responded with an average mean score of
3.67 ± 1.11. Question 29 implored the subjects to find out
if ATs are capable of immobilizing spinal cord injuries, in
which legislators responded an average mean of 3.80 ± 1.47.
The researcher found it interesting that both
32
superintendents and legislators thought ATs are more
capable of immobilizing spinal cord injuries than they are
able to splint a fractured limb. Granted, both cases can be
handled poorly but the severity of a mishandled spinal cord
injury can have much more serious outcomes. Overall, the
responses were positive in regards to both groups of
participants’ perception of an ATs ability to provide
immediate care in a variety of scenarios.
There were 10 questions that comprised domain four,
which is the section containing questions regarding
treatment, rehabilitation, and reconditioning of athletic
injuries. Of the 20 responses, only eight were between a
3.4 and 3.9 with the rest being above 4.0. Questions 32-34
had the lowest combination of scores with both subjects
scoring between the 3.4-3.9 range on each question.
Questions 32-34 addressed an ATs ability to use electrical
stimulation, ultrasound, and therapeutic massage on
injuries. It was interesting to the researcher to see that
with half of the questions legislators scored higher than
superintendents with a range between .04-.42 above that of
what the superintendents responded.
Domain five of the ATS had three questions pertaining
to the organization and administration roles of an AT. This
section contained the lowest scores in regards to
33
perception of ATs. Question 40 addressed an ATs ability to
establish policies and procedures for the delivery of
healthcare which resulted with superintendents responding
with an average mean of 3.20 ± 1.38 and legislators
responding 3.87 ± .92. Question 41 asked if ATs can manage
a healthcare facility in which superintendents and
legislators responded with an average mean of 2.77 ± 1.42
and 2.93 ± 1.28, respectively. As seen, both of these
questions had the legislators having a higher perception of
the capabilities of ATs. It is the belief of the researcher
that due to the fact that superintendents employ ATs in a
secondary school setting, they may not believe that they
are capable of establishing policies or managing a
facility.
The final four questions posed to both groups of
participants come from domain six. Professional
responsibility of ATs is the topic for these four
questions. Question 45, which asks if ATs should have the
ability to seek reimbursement by insurance companies for
services, saw superintendents and legislators respond with
an average mean of 2.80 ± 1.31 and 3.29 ± 1.07,
respectively. Question 46 asked if ATs are capable of
reducing workers compensations claims in an industry
setting. Superintendents responded with an average mean of
34
3.20 ± 1.24 and legislators had an average mean of 3.27 ±
1.22. It is the opinion of the researcher that while the
participants had a positive perception in terms of
professional conduct and keeping medical records, they did
not believe ATs are very valuable in the industrial
setting. This may be attributed to the fact that
administrators are not aware of all the different settings
an AT is capable of working.
Tables 19-20 represented questions only asked of the
superintendents. Employment information was gathered from
each superintendent to assess if the certification status
of employed ATs was known by secondary school
administrators. Question 47 asked superintendents if they
employed an AT in their respective school district. Those
who said yes were asked if the AT they employ is nationally
certified by the Board of Certification (BOC). Of the 48
superintendents that responded “yes” to employing an
athletic trainer, 25 (53.2%) said yes they are certified, 3
(6.4%) said no they are not, and 19 (40.4%) said it was
unknown whether or not the individual is BOC certified. The
researcher found this data the most interesting out of the
entire study due to the fact that because there is no
regulation of athletic training in California, it is not
35
required of anyone calling themselves an AT to provide
proof of certification.
The researcher is concerned because California is one
of three states that currently has no state regulation for
the profession of athletic training. This is a problem for
not only the profession, but also for patients whom are
under the care of someone who is not trained to provide
these health care services. As of 2002, only 62% of
California high schools had an athletic trainer on campus
at least part time.1 Not only are participants at risk of
receiving improper healthcare, but there is a major
liability concern present for athletic trainers,
legislators, superintendents, coaches and athletic
directors whom assume care for these students. It is the
goal of the bill, SB 1273, is to provide licensure and
regulation of athletic training in the state of California.
Currently, since California is one of the few remaining
states that does have any regulation, those people who are
not nationally certified by the BOC they are relocating to
California to practice because there are no regulations
there to stop them.
The results of this study were solely gathered from
California superintendents and legislators. Subjects were
also given the option to allow a staffer to complete and
36
return the survey in order to potentially increase the
amount of responses. The researcher received two phone
calls and four emails from legislators’ staffers informing
the researcher that their respective legislator did not
complete surveys and the staffer also would not. The
researcher also received surveys both in the form of hard
copy and online via survey monkey. Also, due to the
researcher’s desire to potentially compare results to a
prior study, was unable to change the format of the
questions in the ATS but was able to add extra questions
for additional data and information from the
superintendents.
Conclusions
The results indicate that a lack of legislation and
regulation for athletic training in California cannot be
attributed to a negative perception on the roles and
responsibilities of ATs. Despite all three hypotheses not
resulting in statistically significant data, quality
information was still retrieved from the study. In domains
one through four of the ATS, very accurate results were
reported for both California superintendents and
legislators with most average mean scores above 4.0.
37
Domains 5-6 showed a decline in average mean scores in
comparison with the previous four domains due to subjects
decreased appreciation of ATs in regards to organization,
administration, and professional responsibilities.
Prior legislative efforts have not received the
desired attention or approval due to the poor economic
status in the United States and more specifically in the
state of California. Bills in the past were thrown out on
the basis of having any type of economic impact on
taxpayers. The latest attempt was the bill, SB 1273, did
not receive the necessary amount of votes to be put into
effect. The bill would have provided licensure and
regulation for ATs while not costing the taxpayers any
money due to all costs coming from fees assigned to ATs.11
The bill is necessary to protect the public from people who
now may be relocating to California, if not already there,
who call themselves ATs without the credential to do so.
This is not only dangerous for the profession, but for
people under the care of these individuals as they hold
people’s safety, welfare, and health in their hands.11
Hopefully, with the incessant efforts to gain
legislation of athletic training in the state of
California, administrator’s knowledge of ATs professional
capabilities, domains five and six, will increase. Ideally,
38
a bill will soon be introduced and passed that will make
the profession of athletic training licensed and regulated
as it should be, and as it is already being done in the 47
other states.
The results found in this study on California
legislators’ and superintendents’ knowledge of athletic
training was nearly identical to the results from the same
survey used on West Virginia legislators and
superintendents. The subjects in both states had a solid
knowledge base of domains one through four, and the
subjects also shared the lack of knowledge of domains five
and six. These shared results bode well for California
because West Virginia has since passed legislation in favor
of regulating the profession of athletic training in their
state.
Recommendations
The purpose of this study was to provide CATA, NATA,
and the BOC information assisted their efforts in gaining
legislation for the profession of athletic training in
California. The researcher intends to provide a copy of
this document to CATAs email correspondent to provide the
association with the results found in this study. The
39
researcher only obtained a return rate of 18% on the survey
and an increased response rate is desired for more accurate
results, thus, finding a technique or method to have more
subjects respond to the survey. Ideally, more legislators
versus staffers would respond to gain more insight on their
thinking since they are making the legislative decisions in
the state.
In future studies, the researcher desires additional
questions to legislators posing potential reasons as to why
they have voted against previous bills that addresses
athletic training regulation. This information would be
valuable to CATA’s efforts and aid them in tailoring the
bill to be passed. Another interesting study would be to
compare the answers of secondary school superintendents and
athletic directors in California. It was difficult to
obtain a comprehensive list of California superintendents
and it is the researcher’s opinion that it would be even
more difficult to gather the contact information of
California secondary school athletic directors.
A previous suggestion to alter the ATS was to remove
the answer choice 3-no opinion from the Likert scale
forcing respondents to choose a particular side on any
given question without the option to answer no opinion. The
Likert scale has five answer choices: 1- Strongly disagree,
40
2- Somewhat disagree, 3- No opinion, 4- Somewhat agree, and
5- Strongly agree. The researcher did not make this
alteration for this study due to the desire to potentially
compare the results from this study with the prior study.
Another possibility may be to have an equal number of
questions for each Domain given that Domains one and four
each had more questions that Domains five and six combined.
If any future studies were to be completed for
California or any other state the researcher believes it is
necessary to use a more comprehensive survey to gather more
applicable data that may serve to better aid growth in the
profession across the country.
41
REFERENCES
1.
Feder K, Frey C, Sleight J, Pendergraph B, Smallman D.
Medical Coverage of High School Athletes in
California. Athletic Training & Sports Health Care: J
Practicing Clinician [serial online]. March
2010;2(2):61-65. Available from: SPORTDiscus with Full
Text, Ipswich, MA. Accessed November 27, 2011.
2.
National Athletic Trainers’ Association. Athletic
Training. Available at: http://www.nata.org/athletictraining. Accessed November 28, 2011.
3.
Wham Jr. G, Saunders R, Mensch J. Key Factors for
Providing Appropriate Medical Care in Secondary School
Athletics: Athletic Training Services and Budget. J
Athl Train [serial online]. January 2010;45(1):75-86.
Available from: SPORTDiscus with Full Text, Ipswich,
MA. Accessed July 5, 2011.
4.
Board of Certification. State Regulation. Available
at:
http://www.bocatc.org/index.php?option=com_content&vie
w=article&id=113&Itemid=121. Accessed November 28,
2011.
5.
Mickle A. The Legal Parameters Defining the Role of
the Certified Athletic Trainer. Athl Ther Today [serial
online]. January 2007;12(1):10-15. Available from:
SPORTDiscus with Full Text, Ipswich, MA. Accessed July
5, 2011.
6.
Rello M. The importance of state regulation to the
promulgation of the athletic training profession. J
Athl Train [serial online]. April 1996;31(2):160-164.
Available from: SPORTDiscus with Full Text, Ipswich,
MA. Accessed July 5, 2011.
7.
Wilkerson G. A Vision for the Future of the Athletic
Training Profession. Athl Ther Today [serial online].
November 2007;12(6):1-3. Available from: SPORTDiscus
with Full Text, Ipswich, MA. Accessed July 5, 2011.
8.
Gould T, Deivert R. Secondary-school administrators'
knowledge and perceptions of athletic training. Athl
42
Ther Today[serial online]. January 2003;8(1):57-62.
Available from: SPORTDiscus with Full Text, Ipswich,
MA. Accessed July 5, 2011.
9.
National Athletic Trainers’ Association Board of
Certification, Inc. Role Delineation Study. 5th
Edition. Omaha, NE: Board of Certification; 2006.
10.
Claiborne T, Su-I H, Cappaert T. Certified Athletic
Trainers Provide Effective Care in the High School
Setting. Athl Ther Today [serial online]. March
2007;12(2):34-38. Available from: SPORTDiscus with
Full Text, Ipswich, MA. Accessed July 5, 2011.
11.
Official California Legislative Information. Bill
Information. Available at:
http://www.leginfo.ca.gov/cgibin/postquery?bill_number=sb_1273&sess=CUR&house=B&aut
hor=lowenthal. Accessed April 9, 2012.
43
APPENDICES
44
APPENDIX A
Review of Literature
45
REVIEW OF LITERATURE
The profession of athletic training has evolved
greatly from the beginning of the profession in the early
1900s until now. It was not until 1950 when the National
Athletic Trainers’ Association (NATA) was established to
provide athletic trainers with a national governing body.
Respect and acknowledgement of the profession grew even
greater still when it was identified as an allied health
care profession by the American Medical Association (AMA)
in 1990.
Even with a national board of certification
examination, accredited university programs and state
regulation, athletic trainers still confront the image of
being someone who only provides ankle tape jobs and water
as opposed to health care professionals. The NATA and its
members continue to work diligently to increase awareness
of the public on the qualifications and benefits of the
profession. This not only expands employment opportunities
but also serves to increase the level of health care
provided by a highly capable professional.1
46
History of Athletic Training
The history and evolution of athletic training has
been directly related to the growth of competitive sports.
The need for qualified health care professionals has
developed as the popularity of sport has increased across
the globe. The NATA was founded in 1950 to strengthen the
profession by connecting athletic trainers nationwide to
exchange ideas, knowledge, and methods of athletic
training.2
Historically, athletic trainers worked with only
student and professional athletes, but now the profession
has expanded far beyond the scope of solely athletics.
Although other medical conditions are less commonly
encountered, athletic trainers receive a broad education
that ensures competence in managing a wide variety of
neurological, cardiovascular, respiratory, digestive, and
dermatological conditions associated with physical
activity.
Increasingly, athletic trainers are managing the
health of physically active populations that are not
limited to young competitive athletes such as industrial
workers, military personnel, public safety personnel,
entertainment groups, and patients of a healthcare delivery
47
organization.1 Given this development, athletic trainers
need to do a better job of embracing the role of a
healthcare professional instead of settling as an ankle
taper. This can occur by not only educating the public, but
also seeking and implementing evidence based medicine and
clinical epidemiology in practice.
National Athletic Trainers’ Association
It was not until 1950 when athletic trainers were able
to form the National Athletic Trainers’ Association. Since
the inception of the NATA, the association has implemented
multiple facets to enhance and expand the profession. The
Journal of Athletic Training is one such development. The
journal is being used to educate its readers with current
and new information regarding athletic training. A Code of
Ethics was also published for the first time in 1950 and
was used to outline a variety of protocols to be
implemented and used by athletic trainers in the field.
The NATA also was the first to develop educational
standards to be used in both secondary schools and
universities. In the late 1950’s, the NATA Professional
Education Committee was created to oversee athletic
training education program development and approval.2 In
1959, the first educational program was approved by the
48
NATA Board of Directors. There were two important features
to increase employability. First, an emphasis was placed on
the attainment of a secondary-level teaching credential.
Second, the curriculum included many courses that were
prerequisites for physical therapy school.2 At the time,
having the ability to teach while having a science
background gave athletic trainers the best opportunity to
be employed at the high school setting.
The 1970s are seen as the period of greatest
proliferation of athletic training education.2 The year of
1969 marked the first year there was an undergraduate
athletic training education program. Also, 1970 marked the
first year a certification exam was given which was
developed by the NATA Certification Committee.2 The 12-year
period following the number of programs increased from four
to 62 by 1982. In the same time, nine graduate athletic
training education programs had been developed.2
In 1980, the NATA Board of Directors approved a
resolution calling for all undergraduate athletic training
education programs to offer a major field of study in
athletic training.2 This development was used as a catalyst
to implement further changes in athletic training programs
in the future. Due to deadline changes, it was finally
decided that by July 1, 1990 all previously approved
49
undergraduate athletic training programs must have an
athletic training major in place.2 The subject matter that
was required by the NATA Professional Education Committee
included: prevention and evaluation of athletic injuries,
therapeutic exercise and modalities, administration, human
anatomy and physiology, nutrition, and psychology among the
course content.2
Currently, the Commission on Accreditation of Athletic
Training Education (CAATE) provides accreditation standards
for athletic training education programs in colleges and
universities. In 1990, The Joint Review Committee on
Educational Programs in Athletic Training (JRC-AT) was
created as the primary review committee for athletic
training education programs. The JRC-AT created guidelines
as to how undergraduate programs would be developed and
implemented. The JRC-AT was a committee on Accreditation
under the Commission on Accreditation of Allied Health
Educational Programs (CAAHEP). Eventually in 2006, the JRCAT became independent from CAAHEP and changed its name to
the CAATE. The American Academy of Family Physicians
(AAFP), the American Academy of Pediatrics (AAP), the
American Orthopedic Society for Sports Medicine (AOSSM) and
the NATA work together to sponsor CAATE.2,3
50
The American Medical Association (AMA) played a
pivotal part in the profession of athletic training. In
1967, a few years prior to the establishment of the first
undergraduate athletic training program and a national
certification exam, the AMA commended the NATA on their
efforts to upgrade professional standards.2 The profession
reached a milestone when, in June of 1990, the AMA formally
recognized athletic training as an allied health
profession.2 To achieve this honor, the NATA had to seek
accreditation of the entry-level programs by the AMA
Committee on Allied Health Education and Accreditation
(CAHEA).2 The efforts of the NATA over the previous 40 years
to enhance the education programs provided the basis for
the AMA to recognize the profession.
The Athletic Trainer as a Health Care Provider
Role Delineation
Until 1989, the BOC was operated as a committee within
the NATA (NATABOC). The leaders of the NATA realized that
an independent entity was needed to set the standards for
practice of athletic training. Every five years the BOC
publishes the Role Delineation Study (RDS) to identify
essential knowledge and skills for the athletic training
51
profession. The RDS is made up of domains outlining
professional roles and responsibilities, while also serving
as the template for the board certification exam. The
domains include: injury/illness prevention and wellness
protection, clinical evaluation and diagnosis, immediate
and emergency care, treatment and rehabilitation, and
organizational and professional health and well being.4 The
purpose of the RDS is to give athletic trainers a base of
knowledge to provide quality health care.
Education
As has been already established, the accreditation
body for undergraduate athletic training programs is CAATE.
It is the mission of CAATE to provide premier accreditation
services to institutions that offer Athletic Training
programs, verifying that all CAATE accredited programs meet
standards for professional athletic training education and
support continuous improvement in the quality of athletic
training education.3 These standards of education, which
include objective criteria and academic requirements,
require not only specific and defined processes, but also
programmatic outcomes for the evaluations.3 Reviews are
conducted on a periodic basis for each school to ensure
each university is up to code. The standards that were
52
previously mentioned are made up of NATA Educational
Competencies and Clinical Proficiencies which are in turn
derived from the Role Delineation Study (RDS). The only way
for an individual to be eligible to sit for the BOC
examination is successful completion of a CAATE-accredited
educational program.3
Athletic training programs use multiple teaching
techniques to attempt to put students in an applicable
situation to test their knowledge. Out of three evaluation
techniques, real time, simulations, and standardized
patients, simulations were used most frequently.5 Gardiner
and Mensch6 studied the factors that are used to develop
athletic trainers. It is noted that in the end it is up to
each individual athletic trainer to be responsible for his
or her own development. The use of athletic training
organizations, professional points programs, student-mentor
programs, and implementing role models are all ways you can
help promote professional development in an athletic
training program. The experience each athletic training
student is different because the experiences and situations
each person experience are unique and cannot be
predetermined. Another variable noted was the amount of
effort the instructors put into seeking out more
information because an athletic training student is more
53
likely to imitate their superior or teacher. It is the
opinion of this author to encourage and expect professional
development from all their employees and students to
witness the greatest benefit.6
Board of Certification Exam
The Board of Certification, Inc. (BOC) has been
responsible for the certification of Athletic Trainers
(ATs) since 1969. The BOC was the certification arm of the
professional membership organization NATA until 1989 when
the BOC became an independent non-profit organization.2 It
is the mission of the BOC to provide exceptional
credentialing programs for healthcare professionals to
assure the protection of the public.2 The BOC is the only
accredited certification program in the United States (US).
The exam is made of multiple choice and hybrid questions
made up from the following domains: prevention, clinical
evaluation and diagnosis, immediate care, treatment,
rehabilitation and reconditioning, organization and
administration, and professional responsibility.7 The BOC
exam is comprised of multiple domains which requires
potential candidates to know a plethora of information that
serves to qualify athletic trainers as qualified health
care professionals.
Thus, for any person who successfully
54
completes a CAATE-accredited educational program to become
certified as an athletic trainer, they still must pass the
BOC exam to be able to practice as an athletic trainer.
Employment Settings and Additional Trainings
There are several requirements for ATs to maintain the
certification through the BOC. First and foremost, all ATs
have to adhere to the BOC Standards of Professional
Practice that can be located through the BOC website. An
annual certification fee must be paid to the BOC. All ATs
must maintain their emergency cardiac care competencies
which outline adult and pediatric cardiopulmonary
resuscitation (CPR), the use of an automated external
defibrillator (AED), airway obstruction, and barrier
devices. The final requirement for recertification is the
completion and reporting of Continuing Education Units
(CEUs).8 All ATs have to obtain 75 CEUs in the period of
every three years. Continuing Education Units are based on
contact hours, which are defined as the number of actual
clock hours spent in direct participation in a structured
education format as a learner.8 There are four categories
given to ATs to obtain their CEUs. The first, category A,
is made up of BOC approved provider programs such as
workshops, seminars, conferences, and allowed home study
55
courses. Category B is labeled as professional development
and is made up of BOC qualified examiner or model, EMT
initial training, speaker or panelist at a conference, and
author in things ranging from articles to textbooks.
Category C, is post-certification college/university
coursework, and is made up of official college/university
courses, and medical residency. The last option, category
D, is individual options such as activities by non-BOC
approved providers or watching multimedia. With category A
and C there are no CEU maximums and category B and D have a
50 and 20 CEU cap, respectively. The CEU caps are in place
to encourage members to participate in BOC approved
programs and to reward those who choose to further their
education with college coursework or a residency program.8
All members are required to document their CEUs online by
each member’s given deadline to be capable of
recertification.
Armstrong and Weidner9 analyzed the amount of
continuing education activities (CE) an athletic trainer
participates in, if the CE is formal or informal, and if
there is a perceived benefit, growth in knowledge or
practice, from participating in CE.9 From the survey, it was
determined that athletic trainers participate in more
informal CEs than formal. Informal CEs included reading the
56
athletic training journal while formal CEs had more to do
with workshops and conferences. In conclusion, it was
determined that informal CEs were more beneficial for
improving patient care and formal CEs did a better job at
enhancing knowledge. Further, Armstrong and Weidner
proposed the idea that informal CEs should be studied more
and should be considered for receiving credit.9
The field of athletic training provides ATs a variety
of fields from which to choose. Some examples include:
professional and collegiate sports, secondary and
intermediate schools, US military, sports medicine clinics,
hospital ER and rehab clinics, occupational settings,
fitness centers, and physician offices.7 The difficult part
for ATs is to find the setting which best suits the
individual. Each setting has its benefits and difficulties,
varying from budget concerns to autonomy, and a lot of
consideration should go into deciding on which setting best
fits the professional.
One area that is lacking in the amount of ATs employed
is the secondary schools. With over nine times as many
athletes participating in high school sports than college
sports, there needs to be more medical coverage not only
for safety and liability of athletes but also for the
financial benefits that an athletic trainer provides.10
57
Claiborne et al10, concerned about the relatively small
number of athletic trainers covering athletics in secondary
school considering the amount of athletes performed a
sports injury surveillance system at 16 public and private
schools around Toledo, Ohio. The study collected treatment
and rehabilitation data for over 780 injuries occurring
over a 3 year period. The requirement to be listed in the
data included an injury that caused the athlete to miss
more than one day of participation. The data was then used
to determine the frequency of injury given the sport.
Though subjective pain level decreased significantly
following treatments, it was shown that athletic trainers
were able to manage the variety of injuries seen in any
given sport.10
Most secondary schools struggle to supply sufficient
funds to properly run a sports medicine program. Studies
have been performed to examine the quality of care in
relation to the size of the sports medicine budget in
secondary schools. For example, Wham and Saunders et al
used a survey system that included over 132 questions of an
Appropriate Medical Care Assessment Tool (AMCAT) that was
sent via mail and email to 166 schools chosen across South
Carolina. In the data, it was found that utilizing athletic
training services and increasing the sports medicine budget
58
both showed a positive relationship with the quality of
medical care for the given high school.11 Meaning, the
schools that employed an athletic trainer were shown to
have a greater level of medical coverage as opposed to
having no sports medicine team, this is an obvious cause
and effect relationship. The study also showed the higher
the school’s sports medicine budget, or the ability to hire
more athletic trainers and improve facilities, also
increased the quality of care seen.
In a study surveying athletic directors in North
Carolina, Aukerman et al12 found that a majority of schools
only had a physician covering football games and most
coaches were not even certified in CPR. Only 56% of the
schools employed an athletic trainer either part time or
full time. The rest of the schools (44%) used teachers and
coaches to perform the sport medicine duties. The most
surprising bit of data from this study was that only 27% of
schools believed their medical coverage of athletic events
was adequate.12 Not only do athletic trainers help treat
injuries but they are essential in the case of managing a
catastrophic injury. In California, the results were much
the same. Feder et al13 reported that only 62% stated there
was an athletic trainer employed at least part time on
59
campus for sports coverage. Only 62% of football games were
even covered by a physician.13
The information given in the said studies is
frightening when you consider how many student athletes are
at risk with unqualified or no health care professional on
hand to provide medical care given the unfortunate
incurrence of an injury or emergency. There should be laws
in place to require all secondary schools to employ an AT
to provide health care services to not only serve the
athletes but to protect the given school from litigation.
State Regulation in the United States
California is one of three current states with no
state regulation whatsoever. The other two states without
regulation are Alaska and Hawaii, with Hawaii being exempt.
Exemption identifies a professional who is exempt from
licensure requirements of another profession. A specific
scope of practice is defined in the exemption statue of the
licensing requirement. Individuals do not register with the
state, but are held to the standards of the scope of
practice.14 There are different types of state regulation
including: licensure, certification, registration,
exemption, and no regulation. Licensure is the highest form
60
of credentialing, administered by the state to protect the
public and regulate a practice of trade or profession.
Certification is more a form of title protection,
established by state law or professional association, to
show that practitioners have necessary knowledge and skills
to protect the public. Registration is a type of system
that requires qualified members of a profession to register
with the state to be able to practice. No licensure is a
form of law protection where there are no laws in place for
either the practitioner or the public. Obviously, it is of
benefit for everyone involved with athletic training, be it
the actual athletic trainers or those under the care of an
athletic trainer, to have some sort of state law to protect
all parties involved.14
There are legal parameters the certified athletic
trainer must comply with in order to practice within the
legal guidelines. Statutory, regulatory, and case law make
up the three categories of law that are separate from an
organization which any given athletic trainer is employed.
Statutory law can be legislation at both the federal and
state level that is also known as public law. State laws
are much more specific and have a greater impact on
athletic trainers. Athletic trainers must be able to locate
laws governing their practice in their respective state to
61
protect themselves. Regulatory laws are a series of rules
composed by a state or federal agency such as the Drug
Enforcement Agency. Finally, case laws are opinions of
judges that come from litigation dealing with a specific
issue. Case laws form the basis for state laws.15
Since there are states, such as California, where
athletic training is practiced and is not credentialed,
there are still individuals calling themselves athletic
trainers without the education or the qualifications
necessary to practice sports medicine.16 Another result of
not having athletic training credentialing is that it
allows even certified athletic trainers to perform outside
their scope and outside of state laws which is illegal, to
say the least. It is believed that uniformity of state
regulation, increase in public knowledge, and an increase
in professional recognition will all benefit the profession
of athletic training.16
In opposition, those states where athletic training
is regulated, there is also a risk for more litigation to
occur. Athletic trainers should take warning, because
practicing as a credentialed health care professional also
means athletic trainers have independent potential
liability for alleged negligence even if their employer,
such as a state institution, has immunity from this type of
62
suit. Athletic trainers are also responsible for “upholding
the standard of care of an ordinary careful trainer”, which
includes communicating the severity of an injury to the
coach or athlete and the associated risks of participating
with a certain injury. If this is not done, the athletic
trainer is vulnerable to incur negligence liability.17,18
It is pivotal for the progression of athletic training
to stay up to date on current political affairs and issues
to have a more positive influence on bills advancing along
the branches of government.19 Due to this it falls on the
members of the NATA to support the efforts of the
organization in the expansion of athletic training in both
state and national government.
As recent as 2010, the NATA has filed a law suit
against the American Physical Therapy Association (APTA) in
regards to the APTA violating antitrust laws against the
defendant in an effort to unlawfully limit competition. One
issue in the lawsuit was physical therapists (PTs) not
allowing ATs to attend their conferences based on the
reasoning that educating ATs was not legal under a PT
license. In conclusion, the court found that both the NATA
and APTA were no longer allowed to refuse the other from
attending conferences, as well as adopting the practice of
mutual cooperation and communication in the future.20
63
All previous efforts by the NATA and the California
Athletic Training Association (CATA) to obtain regulation
in California have failed. Most recently the bill, SB 1273
(introduced in 2012), did not gain approval to provide both
licensure and regulation for athletic trainers within the
Medical Board of California.21 This bill is still receiving
massive overhauls by lawmakers as it moves further along
the process of passing the bill. The bill, as it is
written, would prohibit a person from practicing as an
athletic trainer or using certain titles without license
issued by the committee. The bill would require an
applicant for licensure to meet certain educational
requirements, pass a specified examination, hold specified
athletic trainer certification, possess emergency cardiac
care certification, and submit an application and
processing fee established by the committee.21 In essence,
the bill provides title protection to ensure only certified
athletic trainers are able to practice in the state of
California. As stated earlier, this protects not only the
profession and its members, but also those who are under
the care of certified athletic trainers.
64
Perceptions of Athletic Training in United States
During the entirety of the athletic training profession,
athletic trainers have constantly dealt with the general
public being unaware of the roles and responsibilities of
an athletic trainer. Even people familiar with sports and
exercise have no idea what it is athletic trainers actually
do resulting in professionals always being asked, “what is
it that you do?” Most commonly people confuse athletic
trainers with personal trainers. Another misconception is
people believing all that athletic trainers do is provide
water and ankle tape jobs to athletes. Obviously, this
confusing is very frustrating for not only individual
athletic trainers but also the NATA in its efforts to
expand the profession. There have been several studies done
analyzing the perceptions of different subjects who may
come in contact with an athletic trainer.
Athletes
Athletes are the primary patient population of
athletic trainers. Therefore, the perception of athletes on
athletic trainers is of importance to researches to make
sure the services expected or desired by most athletes are
sufficiently met. Unruh studied the difference between the
65
perceptions of male and female athletes, low and highprofile sports, and the differences between Division I and
division II athletes. Unruh22 sent questionnaires to 32
athletic training programs at 28 different National
Collegiate Athletic Association (NCAA) Division I & II
universities. Eighteen schools participated yielding a 56%
response. Through the 18 different schools, there were 343
student-athletes that participated in the survey. This
study determined that males had a high positive perception
of services received from their respective athletic trainer
in comparison to females; males at the Division I level
also had a higher perception of services received than did
those males at a Division II school. Unruh later performed
the same study with differing results seven years later in
2005.22
In 2005, Unruh et al23 again studied the level of
satisfaction collegiate student-athletes had with their
athletic trainer(s). The research team used a survey format
to 40 randomly selected National Collegiate Athletic
Association (NCAA) Division I and II universities reaching
out to 325 subjects. The subjects were randomly selected
from each participating universities athletic webpage and
varied across all sports. The survey contained matter from
the Role Delineation Study conducted by NATA to gauge the
66
satisfaction with the services provided by each subject’s
athletic trainer. Unruh et al found that men and women in
low-profile sports were generally less satisfied with the
services they received. Women in high-profile sports showed
the highest satisfaction.23
In a differing study, Bone and Fry24 studied the
influence an athlete's perception of his/her athletic
trainer has an impact on the rehabilitation process. The
subjects were 57 Division I athletes with a combination of
men and women whom received a survey after suffering and
injury causing them to miss no less than five days of
participation. Subjects who fit the criteria received two
types of surveys. The first used was a Social Support
Survey (SSS) to determine the level of emotional support
the subject believed he or she received during the
rehabilitation process. The second survey was a Sports
Injury Rehabilitation Beliefs Survey (SIRBS) which was
developed to measure the athlete’s belief in the
rehabilitation plan. The results from this study were most
athletes did not have a strong correlation unless they
perceived their injury to be of a more serious concern.23 In
that case, as in a longer term rehabilitation, the athlete
believed the athletic trainer had a more beneficial impact
on the recovery process.
67
Orthopedic Surgeons
Physicians, as well as orthopedic surgeons, have the
ability to play a pivotal role in the growth of athletic
training. When orthopedic surgeons and physicians have a
positive perception of athletic trainers it further
validates the profession of athletic training and creates
more employment opportunities. Storch and Stevens et al25
performed a quantitative, descriptive study to examine the
perception of orthopedic surgeons' perception of athletic
trainers. The subjects used were orthopedic surgeons located
in Mid-Atlantic U.S.25 Out of 400 surgeons randomly
selected, Storch et al25 received 101 responses for a 27.1%
response rate.25 As with the study performed by Gould et al27
the survey included demographic questions followed by
questions regarding hiring an ATC as a physician extender.27
Storch et al25 found that Mid-Atlantic orthopedic surgeons
had a more accurate perception of physician assistants. One
drawback that the surgeons had was the uncertainty about
billing for an athletic trainers' services.25 It is believed
by Storch et al25 that as the profession of athletic
training grows, there will be more opportunities to work in
a clinical setting.24,25
68
Secondary School Administrators
Secondary school administrators are responsible for
the hiring of athletic trainers for their school districts;
this alone is why the positive perception of athletic
training is so important. On the other hand, if secondary
school administrators were to have a negative perception of
athletic training that information would be detrimental to
the profession by a decreased perceived importance in
employing an athletic trainer.
Felling et al26 attempted to further research in the
public’s perception of athletic training roles and duties.
The purpose of this study was to improve on the research
design of past studies and gauge the awareness of
California high school administrators about the practice of
athletic training. A 24 question Likert-scale survey was
mailed to 596 principals and athletic directors in the
California school system. Two hundred and nineteen surveys
were returned yielding a 36.9% response rate. Overall,
athletic directors had a better grasp of the roles and
responsibilities of athletic trainers than principals did.
Larger differences were reported by schools that already
employed an athletic trainer, generally resulting in
stronger agreements when questioned about athletic training
69
roles. Felling et al concluded that it is difficult for
athletic trainers to be employed in settings in which
principals in particular do not understand the roles and
responsibilities of athletic trainers, which also means
they do not comprehend the potential benefit of the field.26
Gould and Deivert27 attempted to understand the
perceptions of secondary-school superintendents,
principals, and athletic directors on athletic training. The
research team targeted 10% of administrators in NATA
District Four, totaling 1,095 subjects. District Four is
made up of Illinois, Indiana, Minnesota, Michigan, Ohio,
and Wisconsin. Two hundred and thirty four usable surveys
were returned resulting in a 21% response rate. The survey
included general demographic questions, but the main
purpose was the familiarity each administrator had with the
job an athletic trainer does and each subject’s opinion if
they should employ an athletic trainer at their respective
secondary-school. The results showed that compared to past
studies the amount of athletic trainers employed in NATA
District Four has increased with greater appreciation of
athletic trainers. Still, only 55% of the surveyed
administrators were employed by a school that employed an
athletic trainer at least part time.27 Gould and Deivert
believed that the perception of athletic training has
70
gotten better over time but still remains insufficient, and
this is part of the reason for the low employment rates.27
Coaches
A positive relationship with coaches is an area of
great concern with all practicing athletic trainers. Due to
this there are several studies gauging the perception of
coaches and the associated satisfaction with the services
provided by the athletic trainer. Mensch et al28 performed a
qualitative research study to examine the perspective of
high school coaches toward athletic trainers and their
roles in a high school setting. There were 20 high school
varsity basketball coaches from 10 high schools chosen to
perform the survey. The survey focused on the services
received, the coach’s expectations, and the level of
satisfaction with each given coach. The athletic trainers
were also interviewed on their background, perceived
duties, and administration factors. The results showed that
coaches had unrealistic expectations of their athletic
trainers stemming from not understanding the athletic
trainers qualifications, as well as poor communication.28
The results from this study are not very strong as there
were a small number of subjects, as well as a vague survey
type.
71
Robbins and Rosenfeld29 studied the perceptions of
athletes’ on their social support provided by coaches and
athletic trainers throughout a season. Thirty five male and
female Division I athletes were surveyed using the Social
Support Survey (SSS), the same survey used during Bone et
al research study.23,28 Robbins and Rosenfeld surveyed the
subjects after they reached the criteria to be included in
this study. The results showed that pre-injury perceptions
were equal across all three social support individuals but
a big difference showed up during the rehabilitation phase.
While in rehab the subjects were more satisfied by the
support provided by their respective athletic trainer(s). In
some cases the subjects reported feeling more pressure to
hasten return to play from coaches before they believed
they were ready to be pushed.29
Summary
Athletic training is practiced by athletic trainers,
who are also health care professionals collaborating with
physicians to optimize activity and participation of
patients and clients. Athletic training encompasses the
prevention, diagnosis, and intervention of emergency,
acute, and chronic medical conditions involving impairment,
72
functional limitations, and disabilities. Students who want
to become certified athletic trainers must earn a degree
from an accredited athletic training curriculum. Accredited
programs include formal instruction in areas such as
injury/illness prevention, first aid and emergency care,
assessment of injury/illness, human anatomy and physiology,
therapeutic modalities, and nutrition. Classroom learning
is enhanced through clinical education experiences. More
than 70 % of certified athletic trainers hold at least a
master’s degree.7 Over the past century, the profession of
athletic training has progressed into being recognized by
the AMA. The NATA, BOC, and CAATE have become more
efficient in both management and progression of the
profession.
Currently, California is one of three states with no
state laws or regulation regarding the practice of athletic
training. Even with the efforts of national, regional, and
state associations, the level of state regulation has not
successfully progressed to the desired outcome. California,
along with Hawaii and Alaska, is one of the only three
states that are lacking any formal state regulation to
protect both the practitioner and the patient. California
has attempted to pass some sort of title protection with no
success in the past.
73
There is plenty of research analyzing multiple groups
and subjects perception of the roles and responsibilities
of an athletic trainer.
A majority of the research shows
the public has little to no understanding of not only the
responsibilities of an athletic trainer but also the
benefits of employing them. Although research does show
that most of the subjects that have come in contact with an
athletic trainers, such as a coach, athlete, and a
physician are very aware of the capabilities an athletic
trainer possesses from injury treatment to rehabilitation.
It is the view of the general public, including secondary
school administrators and state legislatures, that is
limiting the employment opportunities for athletic trainers
while also a negative impact on efforts to increase state
regulation.
The objective now is to increase the publics awareness
of the profession. It is not known which technique will
best serve this purpose. It has been recommended that
athletic trainers separate themselves from other
professions with similar titles by changing the name in
which they refer to themselves, such as being called
athletic therapists instead. The goal is to inform and
educate that athletic trainers are indeed health care
professionals and should be perceived as one.
74
APPENDIX B
The Problem
75
STATEMENT OF THE PROBLEM
California (CA) is one of three states that currently
have no state regulation for the profession of athletic
training. This is a problem for not only the profession but
also for secondary school athletes whom are either under
the care of someone who is not trained to provide needed
health care services or actually has no one supervising any
given event. This not only places participants at risk but
is a major liability concern for legislators,
superintendents, and athletic directors whom assume care
for these students.
The purpose of the study is to assess current
California legislator’s and superintendent’s perception of
the roles and responsibilities of certified athletic
trainers. As of now there is no state licensure,
registration, or certification present to practice athletic
training in the state of California. This is dangerous
because not all secondary schools are required to have a
certified athletic trainer on staff to provide health care
for student athletes. If we are able to assess the current
knowledge and perceptions of CA legislators and
superintendents about the benefits of the profession it
would help to guide and educate the efforts by the NATA and
76
BOC to obtain state regulation to both protect
professionals working in the field as well as athletes
participating in sports.
Definition of Terms
The following definitions of terms will be defined for
this study:
1)
Athletic training – Athletic training is the practice
of prevention, diagnosis, and care of emergency,
acute, and chronic medical conditions.
2)
Certified athletic trainer – health care professionals
that practice athletic training and have a national
certificate from the Board of Certification (BOC).
3)
National Athletic Trainers’ Association (NATA)– is the
professional membership association for certified
athletic trainers.
4)
Board of Certification (BOC) – is the accredited
certifying body for athletic trainers in the US. Also,
provides administrates the certification test for
athletic trainers.
5)
Commission on Accreditation of Athletic Training
Education (CAATE) – the agency responsible for
accreditation of athletic training education programs.
77
6)
Licensure – a form of credentialing, administered by
the state to protect the public and regulate a
practice of trade or profession.
7)
Certification – title protection, established by state
law or professional association, to show that
practitioners have necessary knowledge and skills to
protect the public.
8)
Registration – a type of system that requires
qualified members of a profession to register with the
state to be able to practice.
9)
Exemption - a professional who is exempt from
licensure requirements of another profession.
Individuals do not register with the state, but are
held to the standards of the scope of practice.
Basic Assumptions
The following are basic assumptions of this study:
1)
All respondents answered the survey honestly and to
the best of their knowledge of athletic trainers’
roles and responsibilities without outside assistance.
2)
The respondents had sufficient time to complete the
survey.
3)
The survey accurately represents the roles and
responsibilities of athletic training.
78
Limitations of the Study
The following are possible limitations of the study:
1)
The data is only limited to those who responded to the
survey.
2)
The survey was only sent to legislators and
superintendents in California.
3)
The survey may have been filled out by someone other
than the intended participant.
4)
The participants may have researched the answers.
Significance of the Study
The purpose of this study was to analyze the
perception of those in power in the state of California to
aid the NATA and BOC’s efforts to pass legislation in favor
of the profession of athletic training. The data obtained
from this study will provide insight to the knowledge of
legislators and superintendents of athletic trainers’
education requirements, scope of practice, professional
roles, and employment settings. Ideally, the data will show
if the respondents have the current facts and information
showing that athletic trainers are qualified health care
professionals that should be necessary in every secondary
school in the state. Passing state law is necessary to
79
provide the appropriate health care to all secondary school
student athletes as well as protecting qualified
professionals providing athletic training services.
Ideally, this information will be used as instruction to
guide legislative and educational efforts in California.
80
APPENDIX C
Additional Methods
81
APPENDIX C1
Athletic Training Survey
82
83
84
85
APPENDIX C2
Athletic Training Survey Cover Letter
86
March 26, 2012
Dear Legislator or Superintendent,
My name is Curt Snyder and I am currently a graduate student at the California University of
Pennsylvania pursuing a master’s degree in Athletic Training. I am sending this request again due
to a lack of responses from my initial mailing of this request. The quality of health care that is
provided to student athletes at the secondary school level has raised a cause for concern. Every
high school athlete should have the services of a licensed health care professional to create the
safest environment for sports. This is the reason I have chosen to study the perceptions of
California superintendents and legislators on Athletic Training. To study this I am using survey
research to analyze the current knowledge of the profession of Athletic Training in my home
State of California. The survey will focus on the roles and responsibilities of any given Athletic
Trainer. It is my goal that the data from this study be used to help aid the professional
advancement of Athletic Training in California to not only increase state regulation of the
profession, but also to increase the level of health care in secondary schools.
As a native of Imperial County in California, I have chosen to poll all state legislators and
selected secondary school superintendents as my subjects because I am concerned with the level
of health care provided to our student-athletes in our state. You have the right to choose not to
participate or discontinue participation at any time without penalty and all data will be discarded.
The California University of Pennsylvania Institutional Review Board has reviewed and approved
my survey and is effective 1/26/2012 and expires 1/25/2013.
The survey will be completed online via www.surveymonkey.com. The link to the survey is
https://www.surveymonkey.com/s/CCKGW28. All surveys are anonymous and will be kept
completely confidential at all times. All subjects must be over the age of 18. The survey results
will be stored on University servers in a password protected file. Your informed consent will be
assumed upon return of the survey. The risk for participating in this study is minimal. I ask that
you please complete the survey at your earliest convenience as it will take approximately 15
minutes to complete. Please complete the online survey by Friday, March 30, 2012. Please
feel free to contact me at sny4920@calu.edu or 760-562-9511. My thesis advisor’s name is Dr.
Linda Meyer, EdD, ATC and she may be contacted via email at meyer@calu.edu
Thank you in advance for taking the time to be part of my thesis research. Your participation in
this study will be added to data from previous research studies and will be used to increase the
quality of health-care available to all current and future student-athletes not only in California but
across the United States. Thank you again for taking the time to complete the survey.
Sincerely,
Curt Snyder
Curt Snyder, ATC
87
APPENDIX C3
Institutional Review Board –
California University of Pennsylvania
88
89
90
91
92
93
94
95
96
97
98
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 Curt Snyder:
Please consider this email as official notification that your proposal titled
"California legislators and superintendents perception of athletic training”
(Proposal #11-033) has been approved by the California University of
Pennsylvania Institutional Review Board as submitted,
The effective date of the approval is 1-26-2012 and the expiration date is 125-2013. These dates must appear on the consent form .
(1)
(2)
(3)
(4)
Advisory note: The online consent information page makes reference to
returning a paper survey, which is a logical inconsistency. Editing of the
consent page to eliminate this reference is recommended to improve
legibility and reduce potential participant confusion.
Please note that Federal Policy requires that you notify the IRB promptly
regarding any of the following:
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)
Any events that affect the safety or well-being of subjects
Any modifications of your study or other responses that are necessitated
by any events reported in (2).
To continue your research beyond the approval expiration date of 1-252013 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
99
100
REFERENCES
1.
Wilkerson G. A Vision for the Future of the Athletic
Training Profession. Athl Ther Today [serial online].
November 2007;12(6):1-3. Available from: SPORTDiscus
with Full Text, Ipswich, MA. Accessed July 5, 2011.
2.
Delforge G, Behnke R. The history and evolution of
athletic training education in the United States. J
Athl Train [serial online]. January 1999;34(1):53.
Available from: Academic Search Complete, Ipswich, MA.
Accessed July 5, 2011.
3.
Commission on Accreditation of Athletic Training
Education. About CAATE. Available at:
http://www.caate.net/imis15/CAATE/About/CAATE/About.as
px?hkey=1b198b36-7205-4b7f-9447-abd3800a3264. Accessed
November 28, 2011.
4.
National Athletic Trainers’ Association Board of
Certification, Inc. Role Delineation Study. 5th
Edition. Omaha, NE: Board of Certification; 2006.
5.
Walker S, Weidner T, Armstrong K. Evaluation of
Athletic Training Students' Clinical Proficiencies. J
Athl Train [serial online]. July 2008;43(4):386-395.
Available from: SPORTDiscus with Full Text, Ipswich,
MA. Accessed July 5, 2011.
6.
Gardiner A, Mensch J. Professionalism & ethics.
Promoting professional development in athletic
training. Athl Ther Today [serial online]. July
2004;9(4):30-31. Available from: CINAHL with Full
Text, Ipswich, MA. Accessed July 5, 2011.
7.
National Athletic Trainers’ Association. Athletic
Training. Available at: http://www.nata.org/athletictraining. Accessed November 28, 2011.
8.
Board of Certification. Recertification requirements.
Available
101
at:http://www.bocatc.org/images/stories/athletic_train
ers/recertificationrequirements2006-2011.pdf. Accessed
November 28, 2011.
9.
Armstrong K, Weidner T. Formal and Informal Continuing
Education Activities and Athletic Training
Professional Practice. J Athl Train [serial online].
May 2010;45(3):279-286. Available from: SPORTDiscus
with Full Text, Ipswich, MA. Accessed July 5, 2011.
10.
Claiborne T, Su-I H, Cappaert T. Certified Athletic
Trainers Provide Effective Care in the High School
Setting. Athl Ther Today [serial online]. March
2007;12(2):34-38. Available from: SPORTDiscus with
Full Text, Ipswich, MA. Accessed July 5, 2011.
11.
Wham Jr. G, Saunders R, Mensch J. Key Factors for
Providing Appropriate Medical Care in Secondary School
Athletics: Athletic Training Services and Budget. J
Athl Train [serial online]. January 2010;45(1):75-86.
Available from: SPORTDiscus with Full Text, Ipswich,
MA. Accessed July 5, 2011.
12.
Aukerman D, Aukerman M, Browning D. Medical coverage
of high school athletics in North Carolina. Southern
Medical Journal [serial online]. February
2006;99(2):132-136. Available from: MEDLINE with Full
Text, Ipswich, MA. Accessed July 5, 2011.
13.
Feder K, Frey C, Sleight J, Pendergraph B, Smallman D.
Medical Coverage of High School Athletes in
California. Athletic Training & Sports Health Care: J
Practicing Clinician [serial online]. March
2010;2(2):61-65. Available from: SPORTDiscus with Full
Text, Ipswich, MA. Accessed July 5, 2011.
14.
Board of Certification. State Regulation. Available
at:
http://www.bocatc.org/index.php?option=com_content&vie
w=article&id=113&Itemid=121. Accessed November 28,
2011.
102
15.
Mickle A. The Legal Parameters Defining the Role of
the Certified Athletic Trainer. Athl Ther Today
[serial online]. January 2007;12(1):10-15. Available
from: SPORTDiscus with Full Text, Ipswich, MA.
Accessed July 5, 2011.
16.
Rello M. The importance of state regulation to the
promulgation of the athletic training profession. J
Athl Train [serial online]. April 1996;31(2):160-164.
Available from: SPORTDiscus with Full Text, Ipswich,
MA. Accessed July 5, 2011.
17.
Herbert D. Athletic Trainers May Be Held to
Independent Standard of Care in Illinois. Sports
Medicine Standards & Malpractice Reporter [serial
online]. July 2010;22(3):33-37. Available from:
SPORTDiscus with Full Text, Ipswich, MA. Accessed July
5, 2011.
18.
Mitten M. Emerging legal issues in sports medicine: a
synthesis, summary, and analysis. St. John's Law
Review [serial online]. Winter 2002;76(1):33-36.
Available from: SPORTDiscus with Full Text, Ipswich,
MA. Accessed July 5, 2011.
19.
Craig D. Educating Students on Athletic Training
Political Involvement. Athl Ther Today [serial
online]. May 2009;14(3):36-38. Available from:
SPORTDiscus with Full Text, Ipswich, MA. Accessed July
5, 2011.
20.
Herbert D, Piccin J. NATA Antitrust Suit Against APTA
Settled. Exercise Standards & Malpractice Reporter
[serial online]. February 2010;24(2):17-26. Available
from: SPORTDiscus with Full Text, Ipswich, MA.
Accessed July 5, 2011
21.
Official California Legislative Info. Bill Documents.
Available at: http://leginfo.ca.gov/cgibin/postquery?bill_number=ab_374&sess=CUR&house=B&auth
or=hayashi. Accessed November 28, 2011
103
22.
Unruh S. Perceptions of Athletic Training Services by
Collegiate Student-Athletes: A Measurement of.. J Athl
Train [serial online]. October 1998;33(4):347.
Available from: SPORTDiscus with Full Text, Ipswich,
MA. Accessed July 5, 2011.
23.
Unruh S, Unruh N, Moorman M, Seshadri S. Collegiate
Student-Athletes' Satisfaction With Athletic Trainers.
J Athl Train [serial online]. January 2005;40(1):52.
Available from: SPORTDiscus with Full Text, Ipswich,
MA. Accessed July 5, 2011.
24.
Bone J, Fry M. The Influence of Injured Athletes'
Perceptions of Social Support From ATC son Their
Beliefs About Rehabilitation. J Sport Rehab [serial
online]. May 2006;15(2):156-167. Available from:
SPORTDiscus with Full Text, Ipswich, MA. Accessed July
5, 2011.
25.
Storch S, Stevens S, Allen A. Orthopedic Surgeons'
Perceptions of Athletic Trainers as Physician
Extenders. Athl Ther Today [serial online]. May
2007;12(3):29-31. Available from: SPORTDiscus with
Full Text, Ipswich, MA. Accessed July 5, 2011.
26.
Felling A, Kahanov L, Lilienthal S, Schilcher S. Free
Communications, Oral Presentations: Perceptions of
ATCs in the Workforce. J Athl Train [serial online].
April 2, 2004;39:S-21-S-22. Available from:
SPORTDiscus with Full Text, Ipswich, MA. Accessed July
5, 2011.
27.
Gould T, Deivert R. Secondary-school administrators'
knowledge and perceptions of athletic training. Athl
Ther Today [serial online]. January 2003;8(1):57-62.
Available from: SPORTDiscus with Full Text, Ipswich,
MA. Accessed July 5, 2011.
28.
Mensch J, Crews C, Mitchell M. Competing Perspectives
During Organizational Socialization on the Role of
Certified Athletic Trainers in High School Settings. J
104
Athl Train [serial online]. October 2005;40(4):333340. Available from: SPORTDiscus with Full Text,
Ipswich, MA. Accessed July 5, 2011.
29.
Robbins J, Rosenfeld L. Athletes' perceptions of
social support provided by their head coach, assistant
coach, and athletic trainer, pre-injury and during
rehabilitation. J Sport Behavior [serial online].
September 2001;24(3):277-297. Available from:
SPORTDiscus with Full Text, Ipswich, MA. Accessed July
5, 2011.
105
ABSTRACT
TITLE:
California Legislators’ and Superintendents’
Perception of Athletic Training
RESEARCHER:
Curt Snyder
ADVISOR:
Dr. Linda Meyer
DATE:
April 2012
RESEARCH
TYPE:
Master’s Thesis
PURPOSE:
The purpose of this study was to survey
California legislators and secondary school
superintendents to collect their perceptions
on the roles and responsibilities of a
certified athletic trainer (AT).
PROBLEM:
California (CA) is one of three states that
currently have no state regulation for the
profession of athletic training. This is a
problem for not only the profession but also
for secondary school athletes whom are
either under the care of someone who is not
trained to provide needed health care
services or actually has no one supervising
any given event. This not only places
participants at risk but is a major
liability concern for legislators,
superintendents, and athletic directors whom
assume care for these students.
METHOD:
A descriptive type design was used for this
study. The Athletic Training Survey was the
instrument used. Subjects were 640
California legislators and superintendents.
FINDINGS:
There were three separate hypotheses.
1. No significant difference was found
(t(111)=.766, p > .05). The mean of the
superintendents (4.152 ± .475) was not
106
significantly different from the mean of
legislators (4.046 ± .671).
2. No significant difference was found
(t(111)= 1.487, p > .05). The mean of the
subjects who had participated in sports
(4.172 ± .510) was not significantly
different from the mean of subjects who have
not participated in sports (3.992 ± .451).
3. No significant difference was found
(t(102)=.518, p > .05). The mean of the
subjects who have children who have or
currently participate in sports (4.161 ±
.479) was not significantly different from
the mean of the subjects who do not have
children who participate in sports (4.11 ±
.473).
CONCLUSION:
California legislators and superintendents
have accurate knowledge of the profession of
athletic training for Domains I – IV, but
have incorrect knowledge for Domains V and
VI.
ATHLETIC TRAINING
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
Curt B. Snyder
Research Advisor, Dr. Linda P. Meyer
California, Pennsylvania
2012
ii
iii
ACKNOWLEDGEMENTS
I would like to thank the following individuals for
their contributions to my thesis:
My thesis committee: Dr. Linda Meyer for her extensive
knowledge and encouragement throughout this study; Dr. Bill
Biddington for his attention to detail, particularly with
grammar and formatting; Dr. Jamie Weary for her
contributions and recommendations for this study as well as
shared clinical knowledge throughout the year with the
football team.
Dr. Tom West, a big thank you, for all of his advice
and continued support throughout the research process, and
for his mastery of MS Word.
Ms. Carolyn Robinson and her work study students for
both making my survey presentable and preparing my survey
to be mailed. Without Ms. Carolyn this year would not have
been nearly as fun as it was.
Mr. James Daley, I’m very grateful for all you have
done for me. You always had the time to sit and talk as
well as providing me with sound advice. You, sir, are a
role model who I look up to and aspire to emulate in my
career.
iv
Jeremy Shepherd, I have to thank for introducing me to
CalU and the graduate program. I also appreciate the
influence you provided regarding my research and hope my
study is a positive follow up from yours.
Joey Tamburo and Preston Anderson for being as good of
friends as you can ask for. It was a fun ride from the pact
to the baseball games. Matthew Strahm, Jon Ayon, and
Brandon Angulo, you guys are my best friends and I couldn’t
have done it without you. I would also like to thank my
classmates, friends from home, and the football players
that pestered me into keeping my blond moustache for over a
year, it is a proud accomplishment.
I would like to finish with a very special thank you
to my parents, Lynn and Glyn, my siblings, Clint, Colt and
Katelyn, and my niece Ashlan for all the love and support
you have given me in my life and I would not be here if not
for each of you.
v
TABLE OF CONTENTS
Page
SIGNATURE PAGE
. . . . . . . . . . . . . . . ii
AKNOWLEDGEMENTS . . . . . . . . . . . . . . . iii
TABLE OF CONTENTS
LIST OF TABLES
INTRODUCTION
METHODS
. . . . . . . . . . . . . . iv
. . . . . . . . . . . . . . . vii
. . . . . . . . . . . . . . . . 1
. . . . . . . . . . . . . . . . . . 7
Research Design
Subjects
. . . . . . . . . . . . . . 7
. . . . . . . . . . . . . . . . . 8
Preliminary Research. . . . . . . . . . . . . 9
Instruments . . . . . . . . . . . . . . . . 10
Procedures
. . . . . . . . . . . . . . . . 12
Hypotheses
. . . . . . . . . . . . . . . . 13
Data Analysis
RESULTS
. . . . . . . . . . . . . . . 14
. . . . . . . . . . . . . . . . . . 15
Demographic Data . . . . . . . . . . . . . . 15
Hypothesis Testing
. . . . . . . . . . . . . 19
Additional Findings . . . . . . . . . . . . . 22
DISCUSSION . . . . . . . . . . . . . . . . . 27
Discussion of Results . . . . . . . . . . . . 27
Conclusions . . . . . . . . . . . . . . . . 36
Recommendations. . . . . . . . . . . . . . . 38
vi
REFERENCES . . . . . . . . . . . . . . . . .
41
APPENDICES . . . . . . . . . . . . . . . . .
43
APPENDIX A: Review of Literature
. . . . . . . .
44
Introduction . . . . . . . . . . . . . . . .
45
History of Athletic Training. . . . . . . . . .
46
National Athletic Trainers’ Association . . . .
47
The Athletic Trainer as a Health . . . . . .
50
Care Provider
Role Delineation
. . . . . . . . . . . .
50
. . . . . . . . . . . . . . .
51
Board Certification Exam . . . . . . . . .
53
Employment Settings . . . . . . . . . . .
54
State Regulation in the United States . . . .
59
Perceptions of Athletic Training . . . . . .
64
Athletes . . . . . . . . . . . . . . . .
64
Orthopedic Surgeons
67
Education
. . . . . . . . . .
Secondary School Administrators
. . . . .
68
. . . . . . . . . . . . . . . .
70
. . . . . . . . . . . . . . . . .
71
Coaches
Summary
APPENDIX B: The Problem.
. . . . . . . . . . .
74
Statement of the Problem . . . . . . . . . . .
75
Definition of Terms.
. . . . . . . . . . . .
76
Basic Assumptions . . . . . . . . . . . . . .
77
vii
Limitations of the Study.
. . . . . . . . . .
78
Significance of the Study
. . . . . . . . . .
78
APPENDIX C: Additional Methods . . . . . . . . .
80
Athletic Training Survey (C1) . . . . . . . . .
81
Athletic Training Cover Letter (C2)
. . . . . .
85
IRB: California University of Pennsylvania (C3) . .
87
REFERENCES
ABSTRACT
. . . . . . . . . . . . . . . .
100
. . . . . . . . . . . . . . . . .
105
viii
LIST OF TABLES
Table
Title
Page
1
Frequency of Return
15
2
Frequency for Gender
16
3
Frequency for Age
16
4
Frequency of Years at Current Position
17
5
Frequency that Participated in Sports
17
6
Sustained an Injury
17
7
Have Children High School Age or Older
18
8
Children Injured Part. In Athletics
18
9
Utilized the Services of an AT
18
10
Hypothesis I Results
19
11
Hypothesis II Results
20
12
Hypothesis III Results
22
13
Domain I: Prevention
23
14
Domain II: Clinical Eval. and Diagnosis 23
15
Domain III: Immediate Care
24
16
Domain IV: Treatment, Rehab., Recond.
24
17
Domain V: Organization and Admin.
25
18
Domain VI: Professional Responsibility
25
19
AT Employment Information
26
20
AT Employment Information cont.
26
1
INTRODUCTION
California is one of three states that currently has
no state regulation for the profession of athletic
training. This is a problem for not only the profession but
also for patients whom are either under the care of someone
who is not trained to provide needed health care services
or actually has no one supervising a given event. As of
2002, only 62% of California high schools had an athletic
trainer (AT) on campus at least part time.1 Not only are
participants at risk of receiving improper healthcare, but
there is a liability risk present for ATs, legislators,
school district superintendents, coaches and athletic
directors whom assume care for these students.
The purpose of this study was to assess current
California legislator’s and school district
superintendent’s perception of the roles and
responsibilities of certified athletic trainers. As of now
there is no state licensure, registration, or certification
in place to regulate the practice of athletic training in
the state of California. If we were able to assess the
current knowledge and perceptions of CA legislators and
superintendents about the benefits of the profession, it
2
would help to guide and educate the efforts by the
California Athletic Training Association (CATA), National
Athletic Trainers’ Association (NATA), and Board of
Certification (BOC) to obtain state regulation to both
protect professionals working in the field as well as the
athletes participating in sports.
Athletic training is practiced by health care
professionals who are certified by the BOC to work under
the direction of physicians to optimize activity and
participation of patients and clients. Athletic training
encompasses the prevention, diagnosis, and intervention of
emergency, acute, and chronic medical conditions involving
impairment, functional limitations, and disabilities.2
Students who want to become certified athletic trainers
must earn a minimum of a bachelor's degree from a
university that is accredited by the Commission on
Accreditation of Athletic Training Education (CAATE).
Accredited programs' curricula include formal instruction
in areas such as injury/illness prevention, first aid and
emergency care, assessment of injury/illness, human anatomy
and physiology, therapeutic modalities, and nutrition.
Classroom learning is enhanced through clinical
education experiences. More than 70% of certified athletic
trainers hold at least a master’s degree.2 In 1990, the
3
American Medical Association (AMA) recognized the
profession of athletic training as an allied health care
profession. Further, in 1998, the AMA recommended that all
high schools provide athletic training services.3 The NATA,
BOC, and CAATE have become more efficient in management,
regulation, and progression of the profession.
There are different types of state-level regulation
including: licensure, certification, registration,
exemption, and no regulation. To further clarify, licensure
is a form of credentialing, administered by state
government to protect the public and regulate a practice of
trade or profession. Certification is more a form of title
protection, established by state law or professional
association, to show that practitioners have necessary
knowledge and skills to protect the public.4 Registration is
a type of system that requires qualified members of a
profession to register with the state to be able to
practice. There are three states that currently have no
licensure; they are California, Alaska, and Hawaii in where
there is an absence of any form of law protection, either
for the practitioner or the public. Obviously, it is of
benefit for everyone involved with athletic training, be it
the actual ATs or those under the care of ATs, to have a
form of state regulation to protect all parties involved.4
4
There are legal parameters the certified athletic
trainer has to abide by and work under. Statutory,
regulatory, and case law comprise the three categories of
law that are separate from an organization which any given
athletic trainer is employed. Statutory law can be
legislation at both the federal and state level that is
also known as public law. State laws are much more specific
and have a greater impact on athletic trainers. Athletic
trainers must be able to locate laws governing their
practice in their respective state to protect themselves.
Regulatory laws are a series of rules composed by a state
or federal agency such as the Drug Enforcement Agency.
Finally, case laws are opinions of judges that come from
litigation dealing with a specific issue. Case laws form
the basis for state laws.5
Fortunately, there are only a few states, such as
California, where athletic training is practiced and is not
licensed and individuals are still calling themselves ATs
without the education or the qualifications necessary to
practice sports medicine.6 It is believed that uniformity of
state regulation, increase in public knowledge, and an
increase in professional recognition will all benefit the
profession and those under the care of an athletic trainer.6
5
Increasingly, ATs are managing the health of
physically active populations that are not only limited to
young competitive athletes, but also industrial workers,
military personnel, public safety personnel, entertainment
groups, and patients of a healthcare delivery organization.7
Given this development, ATs need to improve their focus and
embrace the role as healthcare professionals instead of
settling with the stereotype as someone who merely tapes
ankles. This can occur by not only educating the public,
but also seeking and implementing evidence based medicine
and clinical epidemiology in practice.
The purpose of this study, specifically, was to
analyze the perception of those in power in the state of
California to assist CATA, NATA, and the BOC’s efforts to
pass legislation in favor of professional recognition for
athletic training and ultimately the public. In a study by
Gould and Deivert8, research was completed on administrators
in Ohio. It was shown that while 73% of administrators were
very concerned about legal-liability issues, only 55% of
those thought they should hire an AT, at least part-time.8
Even still, administrators in Ohio are not willing to
allocate sufficient funds for employing ATs which leads
Gould and Deivert to believe that they have an inaccurate
6
knowledge of the value of athletic training, as evidenced
by inadequate compensation and low employment rates.8
The data obtained from this study provides insight to
the knowledge of legislators and superintendents of ATs’
education requirements, scope of practice, and professional
roles. Ideally, the data could suggest if the respondents
have the current facts and information showing that ATs are
qualified health care professionals and should be a
necessary entity in every secondary school in the state.
Passing state law is necessary to provide the appropriate
health care to all student athletes, as well as protecting
qualified ATs. Ideally, this information will be used as
instruction to guide legislative and educational efforts in
California.
The objective now is to increase the public’s
awareness of the profession. It is not known which
technique will best serve this purpose. It has been
recommended that ATs separate themselves from other
professions with similar titles by changing the name in
which they refer to themselves, such as being called
athletic therapists instead.6 The main goal is to inform and
educate the public that ATs are indeed health care
professionals and should be perceived as such.
7
METHODS
The purpose of this study was to examine the
perception of California legislators and school district
superintendents knowledge on the profession of athletic
training. The goal was to provide the California Athletic
Training Association (CATA) and NATA with survey results
that can aid the effort in pursuing state regulation in
California. The methods section describes how this research
was carried out and includes the following: research
design, preliminary research, subjects, instruments,
procedure, hypotheses, and data analysis.
Research Design
A descriptive research design was used with an
Athletic Training Survey (ATS) (Appendix C1) to conduct
this study.
The dependent variable was the subject’s
perception of the roles and responsibilities of certified
athletic trainers. The independent variables included the
subject’s employment position, contact with an athletic
trainer, whether the subject has or has not participated in
8
sports, and whether the subject currently has or has had a
child who has participated in sports in high school or
college. The strength of this study was that the survey has
been previously used and validated and was employed in this
research to identify the perceptions of California, instead
of West Virginia as it was used in a previous study. Due to
this prior validation, the survey was not changed for its
use in this study. The limitations in this study include
the possibility of emails or addresses being incorrect,
possibility of a low response rate due to the use of email
and Survey Monkey, and the possibility that someone other
than the intended subject complete the survey.
Subjects
The subjects (N=620) that were used for this study
were California’s legislators (N=120), senators (N=40),
assembly members (N=80), and secondary school
superintendents (N=620). The researcher chose to use the
United State Postal Service (USPS) to mail a copy of the
ATS and cover letter to the California legislators. As for
the superintendents, an email was sent with a link to
surveymonkey.com to complete the survey to be able to reach
the 620 superintendents. Included in the email was a cover
9
letter (Appendix C2) introducing the researcher, as well as
explaining the purpose of the study. All surveys were
anonymous and were kept completely confidential at all
times. Data collected via pen and paper instrument were
stored in a locked filing cabinet in the graduate athletic
training program director’s office. The Informed Consent
was assumed upon completion and submission of the survey.
The risk for participating in this study was minimal. The
study was approved by the Institutional Review Board
(Appendix C3) at California University of Pennsylvania.
Each participant’s identity remained confidential and was
not included in the study.
Preliminary Research
There was no preliminary research completed due to the
ATS having been used in a prior study with subjects in West
Virginia. The researcher has chosen to use the identical
survey to gain insight on the perceptions of California
legislators’ and superintendents’ knowledge of the athletic
training profession and to potentially allow for comparison
of data between the two states. A preliminary study for
this project was not required because the original survey
was validated through all the questions deriving directly
10
from the six domains of athletic training defined in the
BOC Role Delineation Study 5th edition9 (RDS), which outlines
the roles and responsibilities of a certified athletic
trainer, (AT). Validity and reliability were already tested
in two phases. The first phase was completed by a panel of
experts assembled by the BOC in November, 2002 to identify
the domains, task, knowledge, and skills consistent with
the essential elements of athletic training.9 The second
phase required a sample from 5,000 ATs to review and
validate the work of the panel, in particular, to evaluate
the “importance and criticality” for the proposed domains
and tasks by way of a survey.9 The results of the survey
validated the domains and tasks identified by the panel of
experts.9
Instruments
The researcher implemented a previously used survey
with questions derived from the six domains of athletic
training described in the BOC RDS 5th ed.9 Demographic
information was collected and included: gender, age,
current position, and years of experience as a California
Legislator or Superintendent. There were also additional
demographic questions regarding previous participation in
11
athletics, injury history resulting from playing sports,
and if the services of an AT were also asked of the survey
participants. Along with these demographic questions, there
were a series of questions that related to the survey
participant’s children and his/her participation in
athletics. Following the demographic questions, the survey
contained 35 Likert scale questions derived from the six
domains as defined in the BOC RDS 5TH ed,9 with a Likert
scale ranging from: 1 – strongly disagree, 2 – somewhat
disagree, 3 – no opinion, 4 – somewhat agree, and 5 –
strongly agree. The answers of the surveys were analyzed
using an independent sample t-test to examine the
hypothesis. The current survey received no nomenclature
changes due to the desire to compare the results received
in this study to the prior data.
The ATS (Appendix C1) was distributed by the
researcher to each chosen California legislator via USPS
and each superintendent using email with a link to
surveymonkey.com. Distribution of the survey to the
superintendents using email was chosen due to cost
effectiveness and the ability to survey all California
superintendents with the number of subjects being quite
large.
12
Procedure
The researcher applied for approval from the
Institutional Review Board (IRB) at California University
of Pennsylvania (Appendix C3) before any research was
conducted. A cover letter was also written to inform the
subjects of the purpose, directions, potential risks, and
obtain informed consent. The study was distributed through
both USPS and email. The 120 legislators received the
survey and cover letter via the USPS. The 620
superintendents received a link to the survey on survey
monkey via email. The names and mailing addresses of all
California senators and assembly members were obtained from
California legislature website available at:
http://www.leginfo.ca.gov/yourleg.html. The contact
information was obtained for all California superintendents
through an online database accessed from the California
Board of Education at:
http://www.cde.ca.gov/ds/si/ds/pubschls.asp. There were 120
copies of the survey that were mailed via USPS to each
California legislator containing a cover letter, ATS
(Appendix C1), and a postage paid, pre-addressed envelope
13
to return the completed survey to the researcher at
California University of Pennsylvania. The ATS was emailed
by the researcher to each California legislator and
superintendent with the cover letter. Postage for the study
was allotted from the graduate athletic training program
budget. The survey was designed to take less than ten
minutes to complete.
Hypotheses
The following hypotheses were based on previous
research and the researcher’s intuition based on a review
of the literature.
1.
California superintendents will not have a
significantly different score than legislators on the
survey assessing athletic trainers’ roles and
responsibilities.
2.
California superintendents and legislators who have
participated in sport will not have a significantly
different score than those whom have and/or do not.
3.
California superintendents and legislators who have at
least one child who has or is currently participating
in athletics will not have a significantly different
score than those who have and/or do not.
14
Data Analysis
An independent samples t-test was performed to compare
the California legislators’ answers to the superintendents’
responses. All data was analyzed by SPSS version 18.0 for
windows at an alpha level of 0.05.
The research hypothesis
was analyzed by SPSS version 18.0 for Windows with a level
of significance of 0.05.
15
RESULTS
The following section will reveal demographic data and
hypothesis testing obtained through the Athletic Training
Survey.
Demographic Information
The ATS was sent to a total of 620 California
superintendents. The California legislators are made up of
80 Assembly Members and 40 Senators. The 120 California
superintendents consisted of individuals across the state
that provided their contact email to the California Board
of Education. A total of 132 surveys were returned
resulting in an overall completion rate of 18%. Table 1 is
a breakdown of the frequency of return by position.
Table 1. Frequency of Return
Position
Frequency (%)
Superintendents
113 (22.6)
Legislators
19
(15.8)
16
Table 2 represents the frequency for the gender of the
participants whom returned the survey by position.
Table 2. Frequency for Gender
Gender
Superintendent (%)
Females
Males
Legislator (%)
21 (21.2)
78 (78.6)
6 (40.0)
9 (60.0)
Table 3 reports the frequency for participants grouped
by age class for both positions. There were 18 individuals
who did not provide their age on the returned survey but
their results were still analyzed.
Table 3. Frequency for Age
Age
Superintendent (%)
< 39
40-49
50-59
60-69
>70
17
24
58
13
1
(15.1)
(21.2)
(51.3)
(11.5)
( 1.9)
Legislator (%)
9
2
6
2
0
(47.3)
(10.5)
(31.6)
(10.5)
(0)
Table 4 reports the frequency for individuals grouped
by classes for the total number of years at their current
position. All participants who returned the survey had been
at their current position for greater than one year.
17
Table 4. Frequency of Years at Current Position
Years
Superintendent (%)
Legislator (%)
1-5
6-10
11-15
16-20
>21
68
20
5
4
1
(69.4)
(20.4)
( 5.0)
( 4.0)
( 1.0)
12(80.0)
2 (13.4)
1 ( 6.7)
0 (0)
0 (0)
Table 5 represents responses given to the survey
question that asked if the individual participated in
school sponsored athletics in high school or college.
Table 5. Frequency that Participated in Sports
Participation
Superintendent (%)
Legislator (%)
Yes
No
79 (80.6)
19 (19.4)
13 (86.7)
2 (13.3)
Table 6 shows those individuals who sustained an
injury while participating in athletics in high school or
college.
Table 6. Sustained an Injury
Injured
Superintendent (%)
Yes
No
56 (57.1)
42 (42.9)
Legislator (%)
5 (33.3)
10(66.7)
Table 7 examines those survey participants who have
children that are high school age or older.
18
Table 7. Have children High School Age or Older
Children
Superintendent (%)
Legislator (%)
Yes
No
66 (67.3)
32 (32.7)
6 (42.9)
8 (57.1)
Table 8 shows those with children who participate(d)
in athletics in high school or college and sustained an
injury while playing sports.
Table 8. Children Injured Participating in Athletics.
Injured
Superintendent (%)
Legislator (%)
Yes
No
45 (50.0)
50 (52.6)
3 (25.0)
9 (75.0)
Table 9 illustrates those participants and their
children that were injured participating in athletics whom
utilized the services of an athletic trainer.
Table 9. Utilized the Services of an athletic trainer (AT).
AT Services
Superintendent (%)
Legislator (%)
Yes
No
49 (51.0)
47 (49.0)
5 (38.5)
8 (61.5)
19
Hypothesis Testing
The hypothesis was tested using an alpha level of .05.
Hypothesis 1: California superintendents will not have
a significantly different score than legislators on the
survey assessing athletic trainers’ roles and
responsibilities.
An independent-samples t test was calculated comparing
the mean score of participants who identified themselves as
superintendents to the mean score of participants who
identified themselves as legislators. No significant
difference was found (t(111)=.766, p > .05). The mean of
the superintendents (4.152 ± .475) was not significantly
different from the mean of legislators (4.046 ± .671).
Table 10. Hypothesis Results
Position
N
Superintendents
Legislators
98
15
M
4.1526
4.0457
SD
T
P
.766
.445
.47457
.67069
20
Conclusion: The hypothesis was supported. There was no
significance between California superintendents’ and
legislators’ perceptions of athletic training.
Hypothesis 2. California superintendents and
legislators who have participated in sport will not have a
significantly different score than those who have and/or do
not.
An independent-samples t test was calculated comparing
the mean score of participants whom identified themselves
as having participated in sports to the mean score of
participants whom identified themselves as not having
participated in sports. No significant difference was found
(t(111)= 1.487, p > .05). The mean of the subjects who had
participated in sports (4.172 ± .510) was not significantly
different from the mean of subjects who have not
participated in sports (3.992 ± .451).
Table 11. Hypothesis 2 Results
Participation
N
M
Yes
No
92
21
4.1718
3.9921
SD
t
P
1.487
.140
.51012
.45056
21
Conclusion: The hypothesis was supported. There was no
significance showing that California superintendents and
legislators who participated in sports altered their
perception of athletic training.
Hypothesis 3:
California superintendents and
legislators who have at least one child who has or is
currently participating in athletics will not have a
significantly different score than those who have and/or do
not.
An independent-samples t test was calculated comparing
the mean score of participants who identified themselves as
having a child who has or is currently participating in
sports to the mean score of participants who identified
themselves as not having children who have participated in
sports. No significant difference was found (t(102)=.518, p
> .05). The mean of the subjects who have children who have
or currently participate in sports (4.161 ± .479) was not
significantly different from the mean of the subjects who
do not have children who participate in sports (4.11 ±
.473).
22
Table 12. Hypothesis 3 Results
Child
N
M
Participation
Yes
67
4.1610
No
37
4.1104
SD
t
P
.518
.606
.47919
.47261
Conclusion: The hypothesis was supported. There was no
significance showing that California superintendents and
legislators who have children that have or currently
participate in sports which altered their perception of
athletic training.
Additional Findings
Tables 13-20 show the means of each of the 35 Likert
questions. Each table includes question from the ATS for
which of the six domains it represents. The six domains
include: prevention; clinical evaluation and diagnosis;
immediate care; treatment, rehabilitation, and
reconditioning; organization and administration; and
professional responsibility.
23
Table 13. Domain I: Prevention
ATS
Superintendent
Question
Mean (SD)
Legislator
Mean (SD)
Difference
Mean
12
4.45 ( .76)
4.40 ( .83)
.05
13
4.40 ( .87)
4.00 ( .93)
.40
14
4.62 ( .77)
4.33 ( .90)
.29
15
3.92 (1.17)
3.87 (1.30)
.05
16
4.25 ( .90)
4.50 (1.07)
-.25
17
4.90 ( .42)
4.53 ( .83)
.37
18
4.37 ( .83)
4.00 ( .76)
.37
19
4.33 ( .81)
3.93 (1.22)
-.60
20
4.81 ( .51)
4.60 ( .63)
.21
1- Strongly disagree, 2- Somewhat disagree, 3- No opinion, 4- Somewhat
agree, 5- Strongly agree
Table 14. Domain II: Clinical Evaluation and Diagnosis
ATS
Superintendent
Legislator
Difference
Question
Mean (SD)
Mean (SD)
Mean
21
3.79 (1.20)
3.73 (1.03)
.06
22
4.32 (1.07)
3.73 (1.39)
-.41
23
4.85 ( .46)
4.53 ( .92)
.32
24
3.76 (1.39)
4.00 (1.00)
-.24
25
4.12 (1.00)
3.73 (1.22)
.39
1- Strongly disagree, 2- Somewhat disagree, 3- No opinion, 4- Somewhat
agree, 5- Strongly agree
24
Table 15. Domain III: Immediate Care
ATS
Superintendent
Legislator
Question
Mean (SD)
Mean (SD)
Difference
Mean
26
4.86 ( .48)
4.73 ( .59)
.09
27
4.67 ( .72)
4.40 ( .74)
.27
28
4.31 (1.10)
3.67 (1.11)
.64
29
4.32 (1.31)
3.80 (1.47)
.52
1- Strongly disagree, 2- Somewhat disagree, 3- No opinion, 4- Somewhat
agree, 5- Strongly agree
Table 16. Domain IV: Treatment, Rehab., Reconditioning
ATS
Superintendent
Legislator
Difference
Question
Mean (SD)
Mean (SD)
Mean
30
4.84 ( .53)
4.67 ( .49)
.17
31
4.63 ( .65)
4.67 ( .49)
-.04
32
3.78 (1.27)
3.47 (1.19)
.31
33
3.84 (1.23)
3.53 (1.30)
.31
34
3.56 (1.31)
3.87 (1.06)
-.31
35
4.01 (1.09)
4.20 ( .78)
-.19
36
4.08 (1.06)
4.07 ( .92)
.01
37
3.48 (1.41)
4.07 ( .92)
-.59
38
3.78 (1.28)
4.20 ( .86)
-.42
39
4.26 ( .93)
4.20 ( .86)
.06
1- Strongly disagree, 2- Somewhat disagree, 3- No opinion, 4- Somewhat
agree, 5- Strongly agree
25
Table 17. Domain V: Organization and Administration
ATS
Superintendent
Legislator
Difference
Question
Mean (SD)
Mean (SD)
Mean
40
3.20 (1.38)
3.87 ( .92)
-.67
41
2.77 (1.42)
2.93 (1.28)
-.16
42
4.29 ( .84)
3.87 (1.19)
.42
1- Strongly disagree, 2- Somewhat disagree, 3- No opinion, 4- Somewhat
agree, 5- Strongly agree
Table 18. Domain VI: Professional Responsibility
ATS
Superintendent
Legislator
Difference
Question
Mean (SD)
Mean (SD)
Mean
43
4.84 ( .51)
4.40 ( .91)
.44
44
4.93 ( .33)
4.67 ( .49)
.26
45
2.80 (1.31)
3.29 (1.07)
-.49
46
3.20 (1.24)
3.27 (1.22)
-.07
1- Strongly disagree, 2- Somewhat disagree, 3- No opinion, 4- Somewhat
agree, 5- Strongly agree
Table 19 represents questions 47 and 48. Only
California superintendents were asked to respond to this
question. Question 47 asked if the superintendent employs
an athletic trainer in his/her school district.
26
Table 19. Athletic Trainer Employment Information
ATS Question
Superintendent (%)
Yes
47
No
48 (49.0)
50 (51.0)
Table 20 was also only asked to California
superintendents. It was also only to be responded to given
a “yes” answer on question 47. The purpose of this question
was to determine if each individual superintendent whom
employed an athletic trainer in his or her school district
knew if the athletic trainer was a BOC certified athletic
trainer.
Table 20. Athletic Trainer Employment Information
ATS Question
48
Superintendent (%)
Yes
No
25 (53.2)
3 (6.4)
Unknown
19 (40.4)
27
DISCUSSION
The discussion section is divided into three
subsections: discussion of the results, conclusions, and
recommendations for future research.
Discussion of Results
The purpose of this study, specifically, was to
analyze California superintendents’ and legislators’
perception of athletic training. The Athletic Training
Survey (ATS) (Appendix C3) was used in a prior study,
surveying West Virginia administrators and legislators.
The ATS was derived from the RDS 5th ed. and utilized
35 Likert style questions where 1- Strongly disagree, 2Somewhat disagree, 3- No opinion, 4- Somewhat agree, and 5strongly agree. The ATS also began with ten demographic
questions. The questions were taken directly from the six
domains of athletic training in the Role Delineation Study
5th ed. (RDS), it was the belief of the researcher that all
Likert questions should have been answered with a “5-
28
strongly agree”. Also, because all questions were taken
from the RDS, there were no purposely misleading questions
out of the ATs scope of practice. The goal of the study was
to identify the current perception of the subjects and what
they believe the capabilities of an AT is able to perform
according to the domains from RDS.
This study found that while California superintendents
had a higher overall mean average score than legislators,
there was not a statistically significant difference
between the two groups. It was the belief of the researcher
that because superintendents were responsible for hiring
athletic trainers they would score significantly higher on
the ATS than legislators.
To follow this hypothesis, the researcher wanted to
differentiate California superintendents and legislators
who have participated in sport, in high school or college,
and to see if potential contact with an athletic trainer
through sport participation may or may not affect their
perception of athletic training. The results of the study
showed that administrators who replied yes to sport
participation had a higher mean score, but again there was
not enough of a difference to yield significance. The final
hypothesis tested by the researcher was to determine if
there was a significantly different score between
29
administrators’ who have at least one child who has or is
currently participating in athletics and those who have
children that do not participate in athletics. As before,
with the administrators sports participation, the
participants with children who have at least one child who
has or is currently participating in athletics had a higher
mean average score than those who do not; but it was not
enough to show a statistical significance.
It is the belief of the researcher that due to the
fact that there is a new bill, SB 1273 (introduced in
2012), which will provide licensure for ATs in California
currently going before vote in front of California
legislators, that may have increased awareness of the AT
profession for these individuals. In a similar study by
Gould and Deivert,8 it reported similar results that while
administrators in NATA District Four had an accurate
knowledge of the athletic training profession, they did not
have enough of an appreciation of the value of an AT to
allocate enough resources to employ an AT.8 Although none of
the hypotheses were reported to be statistically
significant, all of the subjects generally scored higher
than a “4 - somewhat agree” on a vast majority of the
questions.
30
In the 35 Likert questions, there were a variety of
questions from each of the six domains of AT as defined by
the RDS. The means, standard deviation, and difference in
means are labeled in tables 13 through 18. The first domain
of athletic training is Prevention, more specifically
prevention of injury and conditions. In this section, there
were nine questions outlining responsibilities of an AT.
Only two questions, question 15 and 19, were found to have
mean scores lower than “4- somewhat agree”. Question 15
asked if ATs were qualified to make custom protective
devices and both superintendents and legislators scored
below 4.0 with an average mean of 3.92 ± 1.17 and 3.87 ±
1.30, respectively. Question 19 asked the subjects whether
an AT has the ability to recognize the signs and symptoms
of an eating disorder which elicited an average mean
response from legislators of 3.93 ± 1.22. In all but two of
the nine questions, question 16 and 19, superintendents had
a higher mean score than the legislators. In questions 16
and 19, the legislators’ average mean was .25 and .60
higher, respectively. In all, the scores were very positive
by both groups of participants in regards to the perception
of ATs capabilities to prevent injuries and monitor
conditions.
31
Domain two of the ATS addressed five questions
addressing an ATs ability to complete clinical evaluation
and diagnosis of athletic injuries. Each question but one,
question 23, reported a response of below 4.0 by at least
one group of the subjects. Despite this, there were no
responses reported below a 3.7. Question 21, which asks if
an AT is capable of taking a medical history of a patient,
was the only question to lead both groups to score an
average mean below 4.0, 3.79 ± 1.00 and 3.73 ± 1.22 by
superintendents and legislators, respectively. The
researcher found this interesting due to evaluation and
diagnosis being a major part of the ATs clinical
responsibilities.
Domain three of the ATS contained four questions
asking subjects about an ATs ability to perform immediate
care such as perform CPR and applying a splint to a
fractured limb. Legislators were the only subjects to score
below a 4.0 on two questions, question 28 and 29. Question
28 asked if ATs can apply a splint to a fractured limb in
which legislators responded with an average mean score of
3.67 ± 1.11. Question 29 implored the subjects to find out
if ATs are capable of immobilizing spinal cord injuries, in
which legislators responded an average mean of 3.80 ± 1.47.
The researcher found it interesting that both
32
superintendents and legislators thought ATs are more
capable of immobilizing spinal cord injuries than they are
able to splint a fractured limb. Granted, both cases can be
handled poorly but the severity of a mishandled spinal cord
injury can have much more serious outcomes. Overall, the
responses were positive in regards to both groups of
participants’ perception of an ATs ability to provide
immediate care in a variety of scenarios.
There were 10 questions that comprised domain four,
which is the section containing questions regarding
treatment, rehabilitation, and reconditioning of athletic
injuries. Of the 20 responses, only eight were between a
3.4 and 3.9 with the rest being above 4.0. Questions 32-34
had the lowest combination of scores with both subjects
scoring between the 3.4-3.9 range on each question.
Questions 32-34 addressed an ATs ability to use electrical
stimulation, ultrasound, and therapeutic massage on
injuries. It was interesting to the researcher to see that
with half of the questions legislators scored higher than
superintendents with a range between .04-.42 above that of
what the superintendents responded.
Domain five of the ATS had three questions pertaining
to the organization and administration roles of an AT. This
section contained the lowest scores in regards to
33
perception of ATs. Question 40 addressed an ATs ability to
establish policies and procedures for the delivery of
healthcare which resulted with superintendents responding
with an average mean of 3.20 ± 1.38 and legislators
responding 3.87 ± .92. Question 41 asked if ATs can manage
a healthcare facility in which superintendents and
legislators responded with an average mean of 2.77 ± 1.42
and 2.93 ± 1.28, respectively. As seen, both of these
questions had the legislators having a higher perception of
the capabilities of ATs. It is the belief of the researcher
that due to the fact that superintendents employ ATs in a
secondary school setting, they may not believe that they
are capable of establishing policies or managing a
facility.
The final four questions posed to both groups of
participants come from domain six. Professional
responsibility of ATs is the topic for these four
questions. Question 45, which asks if ATs should have the
ability to seek reimbursement by insurance companies for
services, saw superintendents and legislators respond with
an average mean of 2.80 ± 1.31 and 3.29 ± 1.07,
respectively. Question 46 asked if ATs are capable of
reducing workers compensations claims in an industry
setting. Superintendents responded with an average mean of
34
3.20 ± 1.24 and legislators had an average mean of 3.27 ±
1.22. It is the opinion of the researcher that while the
participants had a positive perception in terms of
professional conduct and keeping medical records, they did
not believe ATs are very valuable in the industrial
setting. This may be attributed to the fact that
administrators are not aware of all the different settings
an AT is capable of working.
Tables 19-20 represented questions only asked of the
superintendents. Employment information was gathered from
each superintendent to assess if the certification status
of employed ATs was known by secondary school
administrators. Question 47 asked superintendents if they
employed an AT in their respective school district. Those
who said yes were asked if the AT they employ is nationally
certified by the Board of Certification (BOC). Of the 48
superintendents that responded “yes” to employing an
athletic trainer, 25 (53.2%) said yes they are certified, 3
(6.4%) said no they are not, and 19 (40.4%) said it was
unknown whether or not the individual is BOC certified. The
researcher found this data the most interesting out of the
entire study due to the fact that because there is no
regulation of athletic training in California, it is not
35
required of anyone calling themselves an AT to provide
proof of certification.
The researcher is concerned because California is one
of three states that currently has no state regulation for
the profession of athletic training. This is a problem for
not only the profession, but also for patients whom are
under the care of someone who is not trained to provide
these health care services. As of 2002, only 62% of
California high schools had an athletic trainer on campus
at least part time.1 Not only are participants at risk of
receiving improper healthcare, but there is a major
liability concern present for athletic trainers,
legislators, superintendents, coaches and athletic
directors whom assume care for these students. It is the
goal of the bill, SB 1273, is to provide licensure and
regulation of athletic training in the state of California.
Currently, since California is one of the few remaining
states that does have any regulation, those people who are
not nationally certified by the BOC they are relocating to
California to practice because there are no regulations
there to stop them.
The results of this study were solely gathered from
California superintendents and legislators. Subjects were
also given the option to allow a staffer to complete and
36
return the survey in order to potentially increase the
amount of responses. The researcher received two phone
calls and four emails from legislators’ staffers informing
the researcher that their respective legislator did not
complete surveys and the staffer also would not. The
researcher also received surveys both in the form of hard
copy and online via survey monkey. Also, due to the
researcher’s desire to potentially compare results to a
prior study, was unable to change the format of the
questions in the ATS but was able to add extra questions
for additional data and information from the
superintendents.
Conclusions
The results indicate that a lack of legislation and
regulation for athletic training in California cannot be
attributed to a negative perception on the roles and
responsibilities of ATs. Despite all three hypotheses not
resulting in statistically significant data, quality
information was still retrieved from the study. In domains
one through four of the ATS, very accurate results were
reported for both California superintendents and
legislators with most average mean scores above 4.0.
37
Domains 5-6 showed a decline in average mean scores in
comparison with the previous four domains due to subjects
decreased appreciation of ATs in regards to organization,
administration, and professional responsibilities.
Prior legislative efforts have not received the
desired attention or approval due to the poor economic
status in the United States and more specifically in the
state of California. Bills in the past were thrown out on
the basis of having any type of economic impact on
taxpayers. The latest attempt was the bill, SB 1273, did
not receive the necessary amount of votes to be put into
effect. The bill would have provided licensure and
regulation for ATs while not costing the taxpayers any
money due to all costs coming from fees assigned to ATs.11
The bill is necessary to protect the public from people who
now may be relocating to California, if not already there,
who call themselves ATs without the credential to do so.
This is not only dangerous for the profession, but for
people under the care of these individuals as they hold
people’s safety, welfare, and health in their hands.11
Hopefully, with the incessant efforts to gain
legislation of athletic training in the state of
California, administrator’s knowledge of ATs professional
capabilities, domains five and six, will increase. Ideally,
38
a bill will soon be introduced and passed that will make
the profession of athletic training licensed and regulated
as it should be, and as it is already being done in the 47
other states.
The results found in this study on California
legislators’ and superintendents’ knowledge of athletic
training was nearly identical to the results from the same
survey used on West Virginia legislators and
superintendents. The subjects in both states had a solid
knowledge base of domains one through four, and the
subjects also shared the lack of knowledge of domains five
and six. These shared results bode well for California
because West Virginia has since passed legislation in favor
of regulating the profession of athletic training in their
state.
Recommendations
The purpose of this study was to provide CATA, NATA,
and the BOC information assisted their efforts in gaining
legislation for the profession of athletic training in
California. The researcher intends to provide a copy of
this document to CATAs email correspondent to provide the
association with the results found in this study. The
39
researcher only obtained a return rate of 18% on the survey
and an increased response rate is desired for more accurate
results, thus, finding a technique or method to have more
subjects respond to the survey. Ideally, more legislators
versus staffers would respond to gain more insight on their
thinking since they are making the legislative decisions in
the state.
In future studies, the researcher desires additional
questions to legislators posing potential reasons as to why
they have voted against previous bills that addresses
athletic training regulation. This information would be
valuable to CATA’s efforts and aid them in tailoring the
bill to be passed. Another interesting study would be to
compare the answers of secondary school superintendents and
athletic directors in California. It was difficult to
obtain a comprehensive list of California superintendents
and it is the researcher’s opinion that it would be even
more difficult to gather the contact information of
California secondary school athletic directors.
A previous suggestion to alter the ATS was to remove
the answer choice 3-no opinion from the Likert scale
forcing respondents to choose a particular side on any
given question without the option to answer no opinion. The
Likert scale has five answer choices: 1- Strongly disagree,
40
2- Somewhat disagree, 3- No opinion, 4- Somewhat agree, and
5- Strongly agree. The researcher did not make this
alteration for this study due to the desire to potentially
compare the results from this study with the prior study.
Another possibility may be to have an equal number of
questions for each Domain given that Domains one and four
each had more questions that Domains five and six combined.
If any future studies were to be completed for
California or any other state the researcher believes it is
necessary to use a more comprehensive survey to gather more
applicable data that may serve to better aid growth in the
profession across the country.
41
REFERENCES
1.
Feder K, Frey C, Sleight J, Pendergraph B, Smallman D.
Medical Coverage of High School Athletes in
California. Athletic Training & Sports Health Care: J
Practicing Clinician [serial online]. March
2010;2(2):61-65. Available from: SPORTDiscus with Full
Text, Ipswich, MA. Accessed November 27, 2011.
2.
National Athletic Trainers’ Association. Athletic
Training. Available at: http://www.nata.org/athletictraining. Accessed November 28, 2011.
3.
Wham Jr. G, Saunders R, Mensch J. Key Factors for
Providing Appropriate Medical Care in Secondary School
Athletics: Athletic Training Services and Budget. J
Athl Train [serial online]. January 2010;45(1):75-86.
Available from: SPORTDiscus with Full Text, Ipswich,
MA. Accessed July 5, 2011.
4.
Board of Certification. State Regulation. Available
at:
http://www.bocatc.org/index.php?option=com_content&vie
w=article&id=113&Itemid=121. Accessed November 28,
2011.
5.
Mickle A. The Legal Parameters Defining the Role of
the Certified Athletic Trainer. Athl Ther Today [serial
online]. January 2007;12(1):10-15. Available from:
SPORTDiscus with Full Text, Ipswich, MA. Accessed July
5, 2011.
6.
Rello M. The importance of state regulation to the
promulgation of the athletic training profession. J
Athl Train [serial online]. April 1996;31(2):160-164.
Available from: SPORTDiscus with Full Text, Ipswich,
MA. Accessed July 5, 2011.
7.
Wilkerson G. A Vision for the Future of the Athletic
Training Profession. Athl Ther Today [serial online].
November 2007;12(6):1-3. Available from: SPORTDiscus
with Full Text, Ipswich, MA. Accessed July 5, 2011.
8.
Gould T, Deivert R. Secondary-school administrators'
knowledge and perceptions of athletic training. Athl
42
Ther Today[serial online]. January 2003;8(1):57-62.
Available from: SPORTDiscus with Full Text, Ipswich,
MA. Accessed July 5, 2011.
9.
National Athletic Trainers’ Association Board of
Certification, Inc. Role Delineation Study. 5th
Edition. Omaha, NE: Board of Certification; 2006.
10.
Claiborne T, Su-I H, Cappaert T. Certified Athletic
Trainers Provide Effective Care in the High School
Setting. Athl Ther Today [serial online]. March
2007;12(2):34-38. Available from: SPORTDiscus with
Full Text, Ipswich, MA. Accessed July 5, 2011.
11.
Official California Legislative Information. Bill
Information. Available at:
http://www.leginfo.ca.gov/cgibin/postquery?bill_number=sb_1273&sess=CUR&house=B&aut
hor=lowenthal. Accessed April 9, 2012.
43
APPENDICES
44
APPENDIX A
Review of Literature
45
REVIEW OF LITERATURE
The profession of athletic training has evolved
greatly from the beginning of the profession in the early
1900s until now. It was not until 1950 when the National
Athletic Trainers’ Association (NATA) was established to
provide athletic trainers with a national governing body.
Respect and acknowledgement of the profession grew even
greater still when it was identified as an allied health
care profession by the American Medical Association (AMA)
in 1990.
Even with a national board of certification
examination, accredited university programs and state
regulation, athletic trainers still confront the image of
being someone who only provides ankle tape jobs and water
as opposed to health care professionals. The NATA and its
members continue to work diligently to increase awareness
of the public on the qualifications and benefits of the
profession. This not only expands employment opportunities
but also serves to increase the level of health care
provided by a highly capable professional.1
46
History of Athletic Training
The history and evolution of athletic training has
been directly related to the growth of competitive sports.
The need for qualified health care professionals has
developed as the popularity of sport has increased across
the globe. The NATA was founded in 1950 to strengthen the
profession by connecting athletic trainers nationwide to
exchange ideas, knowledge, and methods of athletic
training.2
Historically, athletic trainers worked with only
student and professional athletes, but now the profession
has expanded far beyond the scope of solely athletics.
Although other medical conditions are less commonly
encountered, athletic trainers receive a broad education
that ensures competence in managing a wide variety of
neurological, cardiovascular, respiratory, digestive, and
dermatological conditions associated with physical
activity.
Increasingly, athletic trainers are managing the
health of physically active populations that are not
limited to young competitive athletes such as industrial
workers, military personnel, public safety personnel,
entertainment groups, and patients of a healthcare delivery
47
organization.1 Given this development, athletic trainers
need to do a better job of embracing the role of a
healthcare professional instead of settling as an ankle
taper. This can occur by not only educating the public, but
also seeking and implementing evidence based medicine and
clinical epidemiology in practice.
National Athletic Trainers’ Association
It was not until 1950 when athletic trainers were able
to form the National Athletic Trainers’ Association. Since
the inception of the NATA, the association has implemented
multiple facets to enhance and expand the profession. The
Journal of Athletic Training is one such development. The
journal is being used to educate its readers with current
and new information regarding athletic training. A Code of
Ethics was also published for the first time in 1950 and
was used to outline a variety of protocols to be
implemented and used by athletic trainers in the field.
The NATA also was the first to develop educational
standards to be used in both secondary schools and
universities. In the late 1950’s, the NATA Professional
Education Committee was created to oversee athletic
training education program development and approval.2 In
1959, the first educational program was approved by the
48
NATA Board of Directors. There were two important features
to increase employability. First, an emphasis was placed on
the attainment of a secondary-level teaching credential.
Second, the curriculum included many courses that were
prerequisites for physical therapy school.2 At the time,
having the ability to teach while having a science
background gave athletic trainers the best opportunity to
be employed at the high school setting.
The 1970s are seen as the period of greatest
proliferation of athletic training education.2 The year of
1969 marked the first year there was an undergraduate
athletic training education program. Also, 1970 marked the
first year a certification exam was given which was
developed by the NATA Certification Committee.2 The 12-year
period following the number of programs increased from four
to 62 by 1982. In the same time, nine graduate athletic
training education programs had been developed.2
In 1980, the NATA Board of Directors approved a
resolution calling for all undergraduate athletic training
education programs to offer a major field of study in
athletic training.2 This development was used as a catalyst
to implement further changes in athletic training programs
in the future. Due to deadline changes, it was finally
decided that by July 1, 1990 all previously approved
49
undergraduate athletic training programs must have an
athletic training major in place.2 The subject matter that
was required by the NATA Professional Education Committee
included: prevention and evaluation of athletic injuries,
therapeutic exercise and modalities, administration, human
anatomy and physiology, nutrition, and psychology among the
course content.2
Currently, the Commission on Accreditation of Athletic
Training Education (CAATE) provides accreditation standards
for athletic training education programs in colleges and
universities. In 1990, The Joint Review Committee on
Educational Programs in Athletic Training (JRC-AT) was
created as the primary review committee for athletic
training education programs. The JRC-AT created guidelines
as to how undergraduate programs would be developed and
implemented. The JRC-AT was a committee on Accreditation
under the Commission on Accreditation of Allied Health
Educational Programs (CAAHEP). Eventually in 2006, the JRCAT became independent from CAAHEP and changed its name to
the CAATE. The American Academy of Family Physicians
(AAFP), the American Academy of Pediatrics (AAP), the
American Orthopedic Society for Sports Medicine (AOSSM) and
the NATA work together to sponsor CAATE.2,3
50
The American Medical Association (AMA) played a
pivotal part in the profession of athletic training. In
1967, a few years prior to the establishment of the first
undergraduate athletic training program and a national
certification exam, the AMA commended the NATA on their
efforts to upgrade professional standards.2 The profession
reached a milestone when, in June of 1990, the AMA formally
recognized athletic training as an allied health
profession.2 To achieve this honor, the NATA had to seek
accreditation of the entry-level programs by the AMA
Committee on Allied Health Education and Accreditation
(CAHEA).2 The efforts of the NATA over the previous 40 years
to enhance the education programs provided the basis for
the AMA to recognize the profession.
The Athletic Trainer as a Health Care Provider
Role Delineation
Until 1989, the BOC was operated as a committee within
the NATA (NATABOC). The leaders of the NATA realized that
an independent entity was needed to set the standards for
practice of athletic training. Every five years the BOC
publishes the Role Delineation Study (RDS) to identify
essential knowledge and skills for the athletic training
51
profession. The RDS is made up of domains outlining
professional roles and responsibilities, while also serving
as the template for the board certification exam. The
domains include: injury/illness prevention and wellness
protection, clinical evaluation and diagnosis, immediate
and emergency care, treatment and rehabilitation, and
organizational and professional health and well being.4 The
purpose of the RDS is to give athletic trainers a base of
knowledge to provide quality health care.
Education
As has been already established, the accreditation
body for undergraduate athletic training programs is CAATE.
It is the mission of CAATE to provide premier accreditation
services to institutions that offer Athletic Training
programs, verifying that all CAATE accredited programs meet
standards for professional athletic training education and
support continuous improvement in the quality of athletic
training education.3 These standards of education, which
include objective criteria and academic requirements,
require not only specific and defined processes, but also
programmatic outcomes for the evaluations.3 Reviews are
conducted on a periodic basis for each school to ensure
each university is up to code. The standards that were
52
previously mentioned are made up of NATA Educational
Competencies and Clinical Proficiencies which are in turn
derived from the Role Delineation Study (RDS). The only way
for an individual to be eligible to sit for the BOC
examination is successful completion of a CAATE-accredited
educational program.3
Athletic training programs use multiple teaching
techniques to attempt to put students in an applicable
situation to test their knowledge. Out of three evaluation
techniques, real time, simulations, and standardized
patients, simulations were used most frequently.5 Gardiner
and Mensch6 studied the factors that are used to develop
athletic trainers. It is noted that in the end it is up to
each individual athletic trainer to be responsible for his
or her own development. The use of athletic training
organizations, professional points programs, student-mentor
programs, and implementing role models are all ways you can
help promote professional development in an athletic
training program. The experience each athletic training
student is different because the experiences and situations
each person experience are unique and cannot be
predetermined. Another variable noted was the amount of
effort the instructors put into seeking out more
information because an athletic training student is more
53
likely to imitate their superior or teacher. It is the
opinion of this author to encourage and expect professional
development from all their employees and students to
witness the greatest benefit.6
Board of Certification Exam
The Board of Certification, Inc. (BOC) has been
responsible for the certification of Athletic Trainers
(ATs) since 1969. The BOC was the certification arm of the
professional membership organization NATA until 1989 when
the BOC became an independent non-profit organization.2 It
is the mission of the BOC to provide exceptional
credentialing programs for healthcare professionals to
assure the protection of the public.2 The BOC is the only
accredited certification program in the United States (US).
The exam is made of multiple choice and hybrid questions
made up from the following domains: prevention, clinical
evaluation and diagnosis, immediate care, treatment,
rehabilitation and reconditioning, organization and
administration, and professional responsibility.7 The BOC
exam is comprised of multiple domains which requires
potential candidates to know a plethora of information that
serves to qualify athletic trainers as qualified health
care professionals.
Thus, for any person who successfully
54
completes a CAATE-accredited educational program to become
certified as an athletic trainer, they still must pass the
BOC exam to be able to practice as an athletic trainer.
Employment Settings and Additional Trainings
There are several requirements for ATs to maintain the
certification through the BOC. First and foremost, all ATs
have to adhere to the BOC Standards of Professional
Practice that can be located through the BOC website. An
annual certification fee must be paid to the BOC. All ATs
must maintain their emergency cardiac care competencies
which outline adult and pediatric cardiopulmonary
resuscitation (CPR), the use of an automated external
defibrillator (AED), airway obstruction, and barrier
devices. The final requirement for recertification is the
completion and reporting of Continuing Education Units
(CEUs).8 All ATs have to obtain 75 CEUs in the period of
every three years. Continuing Education Units are based on
contact hours, which are defined as the number of actual
clock hours spent in direct participation in a structured
education format as a learner.8 There are four categories
given to ATs to obtain their CEUs. The first, category A,
is made up of BOC approved provider programs such as
workshops, seminars, conferences, and allowed home study
55
courses. Category B is labeled as professional development
and is made up of BOC qualified examiner or model, EMT
initial training, speaker or panelist at a conference, and
author in things ranging from articles to textbooks.
Category C, is post-certification college/university
coursework, and is made up of official college/university
courses, and medical residency. The last option, category
D, is individual options such as activities by non-BOC
approved providers or watching multimedia. With category A
and C there are no CEU maximums and category B and D have a
50 and 20 CEU cap, respectively. The CEU caps are in place
to encourage members to participate in BOC approved
programs and to reward those who choose to further their
education with college coursework or a residency program.8
All members are required to document their CEUs online by
each member’s given deadline to be capable of
recertification.
Armstrong and Weidner9 analyzed the amount of
continuing education activities (CE) an athletic trainer
participates in, if the CE is formal or informal, and if
there is a perceived benefit, growth in knowledge or
practice, from participating in CE.9 From the survey, it was
determined that athletic trainers participate in more
informal CEs than formal. Informal CEs included reading the
56
athletic training journal while formal CEs had more to do
with workshops and conferences. In conclusion, it was
determined that informal CEs were more beneficial for
improving patient care and formal CEs did a better job at
enhancing knowledge. Further, Armstrong and Weidner
proposed the idea that informal CEs should be studied more
and should be considered for receiving credit.9
The field of athletic training provides ATs a variety
of fields from which to choose. Some examples include:
professional and collegiate sports, secondary and
intermediate schools, US military, sports medicine clinics,
hospital ER and rehab clinics, occupational settings,
fitness centers, and physician offices.7 The difficult part
for ATs is to find the setting which best suits the
individual. Each setting has its benefits and difficulties,
varying from budget concerns to autonomy, and a lot of
consideration should go into deciding on which setting best
fits the professional.
One area that is lacking in the amount of ATs employed
is the secondary schools. With over nine times as many
athletes participating in high school sports than college
sports, there needs to be more medical coverage not only
for safety and liability of athletes but also for the
financial benefits that an athletic trainer provides.10
57
Claiborne et al10, concerned about the relatively small
number of athletic trainers covering athletics in secondary
school considering the amount of athletes performed a
sports injury surveillance system at 16 public and private
schools around Toledo, Ohio. The study collected treatment
and rehabilitation data for over 780 injuries occurring
over a 3 year period. The requirement to be listed in the
data included an injury that caused the athlete to miss
more than one day of participation. The data was then used
to determine the frequency of injury given the sport.
Though subjective pain level decreased significantly
following treatments, it was shown that athletic trainers
were able to manage the variety of injuries seen in any
given sport.10
Most secondary schools struggle to supply sufficient
funds to properly run a sports medicine program. Studies
have been performed to examine the quality of care in
relation to the size of the sports medicine budget in
secondary schools. For example, Wham and Saunders et al
used a survey system that included over 132 questions of an
Appropriate Medical Care Assessment Tool (AMCAT) that was
sent via mail and email to 166 schools chosen across South
Carolina. In the data, it was found that utilizing athletic
training services and increasing the sports medicine budget
58
both showed a positive relationship with the quality of
medical care for the given high school.11 Meaning, the
schools that employed an athletic trainer were shown to
have a greater level of medical coverage as opposed to
having no sports medicine team, this is an obvious cause
and effect relationship. The study also showed the higher
the school’s sports medicine budget, or the ability to hire
more athletic trainers and improve facilities, also
increased the quality of care seen.
In a study surveying athletic directors in North
Carolina, Aukerman et al12 found that a majority of schools
only had a physician covering football games and most
coaches were not even certified in CPR. Only 56% of the
schools employed an athletic trainer either part time or
full time. The rest of the schools (44%) used teachers and
coaches to perform the sport medicine duties. The most
surprising bit of data from this study was that only 27% of
schools believed their medical coverage of athletic events
was adequate.12 Not only do athletic trainers help treat
injuries but they are essential in the case of managing a
catastrophic injury. In California, the results were much
the same. Feder et al13 reported that only 62% stated there
was an athletic trainer employed at least part time on
59
campus for sports coverage. Only 62% of football games were
even covered by a physician.13
The information given in the said studies is
frightening when you consider how many student athletes are
at risk with unqualified or no health care professional on
hand to provide medical care given the unfortunate
incurrence of an injury or emergency. There should be laws
in place to require all secondary schools to employ an AT
to provide health care services to not only serve the
athletes but to protect the given school from litigation.
State Regulation in the United States
California is one of three current states with no
state regulation whatsoever. The other two states without
regulation are Alaska and Hawaii, with Hawaii being exempt.
Exemption identifies a professional who is exempt from
licensure requirements of another profession. A specific
scope of practice is defined in the exemption statue of the
licensing requirement. Individuals do not register with the
state, but are held to the standards of the scope of
practice.14 There are different types of state regulation
including: licensure, certification, registration,
exemption, and no regulation. Licensure is the highest form
60
of credentialing, administered by the state to protect the
public and regulate a practice of trade or profession.
Certification is more a form of title protection,
established by state law or professional association, to
show that practitioners have necessary knowledge and skills
to protect the public. Registration is a type of system
that requires qualified members of a profession to register
with the state to be able to practice. No licensure is a
form of law protection where there are no laws in place for
either the practitioner or the public. Obviously, it is of
benefit for everyone involved with athletic training, be it
the actual athletic trainers or those under the care of an
athletic trainer, to have some sort of state law to protect
all parties involved.14
There are legal parameters the certified athletic
trainer must comply with in order to practice within the
legal guidelines. Statutory, regulatory, and case law make
up the three categories of law that are separate from an
organization which any given athletic trainer is employed.
Statutory law can be legislation at both the federal and
state level that is also known as public law. State laws
are much more specific and have a greater impact on
athletic trainers. Athletic trainers must be able to locate
laws governing their practice in their respective state to
61
protect themselves. Regulatory laws are a series of rules
composed by a state or federal agency such as the Drug
Enforcement Agency. Finally, case laws are opinions of
judges that come from litigation dealing with a specific
issue. Case laws form the basis for state laws.15
Since there are states, such as California, where
athletic training is practiced and is not credentialed,
there are still individuals calling themselves athletic
trainers without the education or the qualifications
necessary to practice sports medicine.16 Another result of
not having athletic training credentialing is that it
allows even certified athletic trainers to perform outside
their scope and outside of state laws which is illegal, to
say the least. It is believed that uniformity of state
regulation, increase in public knowledge, and an increase
in professional recognition will all benefit the profession
of athletic training.16
In opposition, those states where athletic training
is regulated, there is also a risk for more litigation to
occur. Athletic trainers should take warning, because
practicing as a credentialed health care professional also
means athletic trainers have independent potential
liability for alleged negligence even if their employer,
such as a state institution, has immunity from this type of
62
suit. Athletic trainers are also responsible for “upholding
the standard of care of an ordinary careful trainer”, which
includes communicating the severity of an injury to the
coach or athlete and the associated risks of participating
with a certain injury. If this is not done, the athletic
trainer is vulnerable to incur negligence liability.17,18
It is pivotal for the progression of athletic training
to stay up to date on current political affairs and issues
to have a more positive influence on bills advancing along
the branches of government.19 Due to this it falls on the
members of the NATA to support the efforts of the
organization in the expansion of athletic training in both
state and national government.
As recent as 2010, the NATA has filed a law suit
against the American Physical Therapy Association (APTA) in
regards to the APTA violating antitrust laws against the
defendant in an effort to unlawfully limit competition. One
issue in the lawsuit was physical therapists (PTs) not
allowing ATs to attend their conferences based on the
reasoning that educating ATs was not legal under a PT
license. In conclusion, the court found that both the NATA
and APTA were no longer allowed to refuse the other from
attending conferences, as well as adopting the practice of
mutual cooperation and communication in the future.20
63
All previous efforts by the NATA and the California
Athletic Training Association (CATA) to obtain regulation
in California have failed. Most recently the bill, SB 1273
(introduced in 2012), did not gain approval to provide both
licensure and regulation for athletic trainers within the
Medical Board of California.21 This bill is still receiving
massive overhauls by lawmakers as it moves further along
the process of passing the bill. The bill, as it is
written, would prohibit a person from practicing as an
athletic trainer or using certain titles without license
issued by the committee. The bill would require an
applicant for licensure to meet certain educational
requirements, pass a specified examination, hold specified
athletic trainer certification, possess emergency cardiac
care certification, and submit an application and
processing fee established by the committee.21 In essence,
the bill provides title protection to ensure only certified
athletic trainers are able to practice in the state of
California. As stated earlier, this protects not only the
profession and its members, but also those who are under
the care of certified athletic trainers.
64
Perceptions of Athletic Training in United States
During the entirety of the athletic training profession,
athletic trainers have constantly dealt with the general
public being unaware of the roles and responsibilities of
an athletic trainer. Even people familiar with sports and
exercise have no idea what it is athletic trainers actually
do resulting in professionals always being asked, “what is
it that you do?” Most commonly people confuse athletic
trainers with personal trainers. Another misconception is
people believing all that athletic trainers do is provide
water and ankle tape jobs to athletes. Obviously, this
confusing is very frustrating for not only individual
athletic trainers but also the NATA in its efforts to
expand the profession. There have been several studies done
analyzing the perceptions of different subjects who may
come in contact with an athletic trainer.
Athletes
Athletes are the primary patient population of
athletic trainers. Therefore, the perception of athletes on
athletic trainers is of importance to researches to make
sure the services expected or desired by most athletes are
sufficiently met. Unruh studied the difference between the
65
perceptions of male and female athletes, low and highprofile sports, and the differences between Division I and
division II athletes. Unruh22 sent questionnaires to 32
athletic training programs at 28 different National
Collegiate Athletic Association (NCAA) Division I & II
universities. Eighteen schools participated yielding a 56%
response. Through the 18 different schools, there were 343
student-athletes that participated in the survey. This
study determined that males had a high positive perception
of services received from their respective athletic trainer
in comparison to females; males at the Division I level
also had a higher perception of services received than did
those males at a Division II school. Unruh later performed
the same study with differing results seven years later in
2005.22
In 2005, Unruh et al23 again studied the level of
satisfaction collegiate student-athletes had with their
athletic trainer(s). The research team used a survey format
to 40 randomly selected National Collegiate Athletic
Association (NCAA) Division I and II universities reaching
out to 325 subjects. The subjects were randomly selected
from each participating universities athletic webpage and
varied across all sports. The survey contained matter from
the Role Delineation Study conducted by NATA to gauge the
66
satisfaction with the services provided by each subject’s
athletic trainer. Unruh et al found that men and women in
low-profile sports were generally less satisfied with the
services they received. Women in high-profile sports showed
the highest satisfaction.23
In a differing study, Bone and Fry24 studied the
influence an athlete's perception of his/her athletic
trainer has an impact on the rehabilitation process. The
subjects were 57 Division I athletes with a combination of
men and women whom received a survey after suffering and
injury causing them to miss no less than five days of
participation. Subjects who fit the criteria received two
types of surveys. The first used was a Social Support
Survey (SSS) to determine the level of emotional support
the subject believed he or she received during the
rehabilitation process. The second survey was a Sports
Injury Rehabilitation Beliefs Survey (SIRBS) which was
developed to measure the athlete’s belief in the
rehabilitation plan. The results from this study were most
athletes did not have a strong correlation unless they
perceived their injury to be of a more serious concern.23 In
that case, as in a longer term rehabilitation, the athlete
believed the athletic trainer had a more beneficial impact
on the recovery process.
67
Orthopedic Surgeons
Physicians, as well as orthopedic surgeons, have the
ability to play a pivotal role in the growth of athletic
training. When orthopedic surgeons and physicians have a
positive perception of athletic trainers it further
validates the profession of athletic training and creates
more employment opportunities. Storch and Stevens et al25
performed a quantitative, descriptive study to examine the
perception of orthopedic surgeons' perception of athletic
trainers. The subjects used were orthopedic surgeons located
in Mid-Atlantic U.S.25 Out of 400 surgeons randomly
selected, Storch et al25 received 101 responses for a 27.1%
response rate.25 As with the study performed by Gould et al27
the survey included demographic questions followed by
questions regarding hiring an ATC as a physician extender.27
Storch et al25 found that Mid-Atlantic orthopedic surgeons
had a more accurate perception of physician assistants. One
drawback that the surgeons had was the uncertainty about
billing for an athletic trainers' services.25 It is believed
by Storch et al25 that as the profession of athletic
training grows, there will be more opportunities to work in
a clinical setting.24,25
68
Secondary School Administrators
Secondary school administrators are responsible for
the hiring of athletic trainers for their school districts;
this alone is why the positive perception of athletic
training is so important. On the other hand, if secondary
school administrators were to have a negative perception of
athletic training that information would be detrimental to
the profession by a decreased perceived importance in
employing an athletic trainer.
Felling et al26 attempted to further research in the
public’s perception of athletic training roles and duties.
The purpose of this study was to improve on the research
design of past studies and gauge the awareness of
California high school administrators about the practice of
athletic training. A 24 question Likert-scale survey was
mailed to 596 principals and athletic directors in the
California school system. Two hundred and nineteen surveys
were returned yielding a 36.9% response rate. Overall,
athletic directors had a better grasp of the roles and
responsibilities of athletic trainers than principals did.
Larger differences were reported by schools that already
employed an athletic trainer, generally resulting in
stronger agreements when questioned about athletic training
69
roles. Felling et al concluded that it is difficult for
athletic trainers to be employed in settings in which
principals in particular do not understand the roles and
responsibilities of athletic trainers, which also means
they do not comprehend the potential benefit of the field.26
Gould and Deivert27 attempted to understand the
perceptions of secondary-school superintendents,
principals, and athletic directors on athletic training. The
research team targeted 10% of administrators in NATA
District Four, totaling 1,095 subjects. District Four is
made up of Illinois, Indiana, Minnesota, Michigan, Ohio,
and Wisconsin. Two hundred and thirty four usable surveys
were returned resulting in a 21% response rate. The survey
included general demographic questions, but the main
purpose was the familiarity each administrator had with the
job an athletic trainer does and each subject’s opinion if
they should employ an athletic trainer at their respective
secondary-school. The results showed that compared to past
studies the amount of athletic trainers employed in NATA
District Four has increased with greater appreciation of
athletic trainers. Still, only 55% of the surveyed
administrators were employed by a school that employed an
athletic trainer at least part time.27 Gould and Deivert
believed that the perception of athletic training has
70
gotten better over time but still remains insufficient, and
this is part of the reason for the low employment rates.27
Coaches
A positive relationship with coaches is an area of
great concern with all practicing athletic trainers. Due to
this there are several studies gauging the perception of
coaches and the associated satisfaction with the services
provided by the athletic trainer. Mensch et al28 performed a
qualitative research study to examine the perspective of
high school coaches toward athletic trainers and their
roles in a high school setting. There were 20 high school
varsity basketball coaches from 10 high schools chosen to
perform the survey. The survey focused on the services
received, the coach’s expectations, and the level of
satisfaction with each given coach. The athletic trainers
were also interviewed on their background, perceived
duties, and administration factors. The results showed that
coaches had unrealistic expectations of their athletic
trainers stemming from not understanding the athletic
trainers qualifications, as well as poor communication.28
The results from this study are not very strong as there
were a small number of subjects, as well as a vague survey
type.
71
Robbins and Rosenfeld29 studied the perceptions of
athletes’ on their social support provided by coaches and
athletic trainers throughout a season. Thirty five male and
female Division I athletes were surveyed using the Social
Support Survey (SSS), the same survey used during Bone et
al research study.23,28 Robbins and Rosenfeld surveyed the
subjects after they reached the criteria to be included in
this study. The results showed that pre-injury perceptions
were equal across all three social support individuals but
a big difference showed up during the rehabilitation phase.
While in rehab the subjects were more satisfied by the
support provided by their respective athletic trainer(s). In
some cases the subjects reported feeling more pressure to
hasten return to play from coaches before they believed
they were ready to be pushed.29
Summary
Athletic training is practiced by athletic trainers,
who are also health care professionals collaborating with
physicians to optimize activity and participation of
patients and clients. Athletic training encompasses the
prevention, diagnosis, and intervention of emergency,
acute, and chronic medical conditions involving impairment,
72
functional limitations, and disabilities. Students who want
to become certified athletic trainers must earn a degree
from an accredited athletic training curriculum. Accredited
programs include formal instruction in areas such as
injury/illness prevention, first aid and emergency care,
assessment of injury/illness, human anatomy and physiology,
therapeutic modalities, and nutrition. Classroom learning
is enhanced through clinical education experiences. More
than 70 % of certified athletic trainers hold at least a
master’s degree.7 Over the past century, the profession of
athletic training has progressed into being recognized by
the AMA. The NATA, BOC, and CAATE have become more
efficient in both management and progression of the
profession.
Currently, California is one of three states with no
state laws or regulation regarding the practice of athletic
training. Even with the efforts of national, regional, and
state associations, the level of state regulation has not
successfully progressed to the desired outcome. California,
along with Hawaii and Alaska, is one of the only three
states that are lacking any formal state regulation to
protect both the practitioner and the patient. California
has attempted to pass some sort of title protection with no
success in the past.
73
There is plenty of research analyzing multiple groups
and subjects perception of the roles and responsibilities
of an athletic trainer.
A majority of the research shows
the public has little to no understanding of not only the
responsibilities of an athletic trainer but also the
benefits of employing them. Although research does show
that most of the subjects that have come in contact with an
athletic trainers, such as a coach, athlete, and a
physician are very aware of the capabilities an athletic
trainer possesses from injury treatment to rehabilitation.
It is the view of the general public, including secondary
school administrators and state legislatures, that is
limiting the employment opportunities for athletic trainers
while also a negative impact on efforts to increase state
regulation.
The objective now is to increase the publics awareness
of the profession. It is not known which technique will
best serve this purpose. It has been recommended that
athletic trainers separate themselves from other
professions with similar titles by changing the name in
which they refer to themselves, such as being called
athletic therapists instead. The goal is to inform and
educate that athletic trainers are indeed health care
professionals and should be perceived as one.
74
APPENDIX B
The Problem
75
STATEMENT OF THE PROBLEM
California (CA) is one of three states that currently
have no state regulation for the profession of athletic
training. This is a problem for not only the profession but
also for secondary school athletes whom are either under
the care of someone who is not trained to provide needed
health care services or actually has no one supervising any
given event. This not only places participants at risk but
is a major liability concern for legislators,
superintendents, and athletic directors whom assume care
for these students.
The purpose of the study is to assess current
California legislator’s and superintendent’s perception of
the roles and responsibilities of certified athletic
trainers. As of now there is no state licensure,
registration, or certification present to practice athletic
training in the state of California. This is dangerous
because not all secondary schools are required to have a
certified athletic trainer on staff to provide health care
for student athletes. If we are able to assess the current
knowledge and perceptions of CA legislators and
superintendents about the benefits of the profession it
would help to guide and educate the efforts by the NATA and
76
BOC to obtain state regulation to both protect
professionals working in the field as well as athletes
participating in sports.
Definition of Terms
The following definitions of terms will be defined for
this study:
1)
Athletic training – Athletic training is the practice
of prevention, diagnosis, and care of emergency,
acute, and chronic medical conditions.
2)
Certified athletic trainer – health care professionals
that practice athletic training and have a national
certificate from the Board of Certification (BOC).
3)
National Athletic Trainers’ Association (NATA)– is the
professional membership association for certified
athletic trainers.
4)
Board of Certification (BOC) – is the accredited
certifying body for athletic trainers in the US. Also,
provides administrates the certification test for
athletic trainers.
5)
Commission on Accreditation of Athletic Training
Education (CAATE) – the agency responsible for
accreditation of athletic training education programs.
77
6)
Licensure – a form of credentialing, administered by
the state to protect the public and regulate a
practice of trade or profession.
7)
Certification – title protection, established by state
law or professional association, to show that
practitioners have necessary knowledge and skills to
protect the public.
8)
Registration – a type of system that requires
qualified members of a profession to register with the
state to be able to practice.
9)
Exemption - a professional who is exempt from
licensure requirements of another profession.
Individuals do not register with the state, but are
held to the standards of the scope of practice.
Basic Assumptions
The following are basic assumptions of this study:
1)
All respondents answered the survey honestly and to
the best of their knowledge of athletic trainers’
roles and responsibilities without outside assistance.
2)
The respondents had sufficient time to complete the
survey.
3)
The survey accurately represents the roles and
responsibilities of athletic training.
78
Limitations of the Study
The following are possible limitations of the study:
1)
The data is only limited to those who responded to the
survey.
2)
The survey was only sent to legislators and
superintendents in California.
3)
The survey may have been filled out by someone other
than the intended participant.
4)
The participants may have researched the answers.
Significance of the Study
The purpose of this study was to analyze the
perception of those in power in the state of California to
aid the NATA and BOC’s efforts to pass legislation in favor
of the profession of athletic training. The data obtained
from this study will provide insight to the knowledge of
legislators and superintendents of athletic trainers’
education requirements, scope of practice, professional
roles, and employment settings. Ideally, the data will show
if the respondents have the current facts and information
showing that athletic trainers are qualified health care
professionals that should be necessary in every secondary
school in the state. Passing state law is necessary to
79
provide the appropriate health care to all secondary school
student athletes as well as protecting qualified
professionals providing athletic training services.
Ideally, this information will be used as instruction to
guide legislative and educational efforts in California.
80
APPENDIX C
Additional Methods
81
APPENDIX C1
Athletic Training Survey
82
83
84
85
APPENDIX C2
Athletic Training Survey Cover Letter
86
March 26, 2012
Dear Legislator or Superintendent,
My name is Curt Snyder and I am currently a graduate student at the California University of
Pennsylvania pursuing a master’s degree in Athletic Training. I am sending this request again due
to a lack of responses from my initial mailing of this request. The quality of health care that is
provided to student athletes at the secondary school level has raised a cause for concern. Every
high school athlete should have the services of a licensed health care professional to create the
safest environment for sports. This is the reason I have chosen to study the perceptions of
California superintendents and legislators on Athletic Training. To study this I am using survey
research to analyze the current knowledge of the profession of Athletic Training in my home
State of California. The survey will focus on the roles and responsibilities of any given Athletic
Trainer. It is my goal that the data from this study be used to help aid the professional
advancement of Athletic Training in California to not only increase state regulation of the
profession, but also to increase the level of health care in secondary schools.
As a native of Imperial County in California, I have chosen to poll all state legislators and
selected secondary school superintendents as my subjects because I am concerned with the level
of health care provided to our student-athletes in our state. You have the right to choose not to
participate or discontinue participation at any time without penalty and all data will be discarded.
The California University of Pennsylvania Institutional Review Board has reviewed and approved
my survey and is effective 1/26/2012 and expires 1/25/2013.
The survey will be completed online via www.surveymonkey.com. The link to the survey is
https://www.surveymonkey.com/s/CCKGW28. All surveys are anonymous and will be kept
completely confidential at all times. All subjects must be over the age of 18. The survey results
will be stored on University servers in a password protected file. Your informed consent will be
assumed upon return of the survey. The risk for participating in this study is minimal. I ask that
you please complete the survey at your earliest convenience as it will take approximately 15
minutes to complete. Please complete the online survey by Friday, March 30, 2012. Please
feel free to contact me at sny4920@calu.edu or 760-562-9511. My thesis advisor’s name is Dr.
Linda Meyer, EdD, ATC and she may be contacted via email at meyer@calu.edu
Thank you in advance for taking the time to be part of my thesis research. Your participation in
this study will be added to data from previous research studies and will be used to increase the
quality of health-care available to all current and future student-athletes not only in California but
across the United States. Thank you again for taking the time to complete the survey.
Sincerely,
Curt Snyder
Curt Snyder, ATC
87
APPENDIX C3
Institutional Review Board –
California University of Pennsylvania
88
89
90
91
92
93
94
95
96
97
98
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 Curt Snyder:
Please consider this email as official notification that your proposal titled
"California legislators and superintendents perception of athletic training”
(Proposal #11-033) has been approved by the California University of
Pennsylvania Institutional Review Board as submitted,
The effective date of the approval is 1-26-2012 and the expiration date is 125-2013. These dates must appear on the consent form .
(1)
(2)
(3)
(4)
Advisory note: The online consent information page makes reference to
returning a paper survey, which is a logical inconsistency. Editing of the
consent page to eliminate this reference is recommended to improve
legibility and reduce potential participant confusion.
Please note that Federal Policy requires that you notify the IRB promptly
regarding any of the following:
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)
Any events that affect the safety or well-being of subjects
Any modifications of your study or other responses that are necessitated
by any events reported in (2).
To continue your research beyond the approval expiration date of 1-252013 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
99
100
REFERENCES
1.
Wilkerson G. A Vision for the Future of the Athletic
Training Profession. Athl Ther Today [serial online].
November 2007;12(6):1-3. Available from: SPORTDiscus
with Full Text, Ipswich, MA. Accessed July 5, 2011.
2.
Delforge G, Behnke R. The history and evolution of
athletic training education in the United States. J
Athl Train [serial online]. January 1999;34(1):53.
Available from: Academic Search Complete, Ipswich, MA.
Accessed July 5, 2011.
3.
Commission on Accreditation of Athletic Training
Education. About CAATE. Available at:
http://www.caate.net/imis15/CAATE/About/CAATE/About.as
px?hkey=1b198b36-7205-4b7f-9447-abd3800a3264. Accessed
November 28, 2011.
4.
National Athletic Trainers’ Association Board of
Certification, Inc. Role Delineation Study. 5th
Edition. Omaha, NE: Board of Certification; 2006.
5.
Walker S, Weidner T, Armstrong K. Evaluation of
Athletic Training Students' Clinical Proficiencies. J
Athl Train [serial online]. July 2008;43(4):386-395.
Available from: SPORTDiscus with Full Text, Ipswich,
MA. Accessed July 5, 2011.
6.
Gardiner A, Mensch J. Professionalism & ethics.
Promoting professional development in athletic
training. Athl Ther Today [serial online]. July
2004;9(4):30-31. Available from: CINAHL with Full
Text, Ipswich, MA. Accessed July 5, 2011.
7.
National Athletic Trainers’ Association. Athletic
Training. Available at: http://www.nata.org/athletictraining. Accessed November 28, 2011.
8.
Board of Certification. Recertification requirements.
Available
101
at:http://www.bocatc.org/images/stories/athletic_train
ers/recertificationrequirements2006-2011.pdf. Accessed
November 28, 2011.
9.
Armstrong K, Weidner T. Formal and Informal Continuing
Education Activities and Athletic Training
Professional Practice. J Athl Train [serial online].
May 2010;45(3):279-286. Available from: SPORTDiscus
with Full Text, Ipswich, MA. Accessed July 5, 2011.
10.
Claiborne T, Su-I H, Cappaert T. Certified Athletic
Trainers Provide Effective Care in the High School
Setting. Athl Ther Today [serial online]. March
2007;12(2):34-38. Available from: SPORTDiscus with
Full Text, Ipswich, MA. Accessed July 5, 2011.
11.
Wham Jr. G, Saunders R, Mensch J. Key Factors for
Providing Appropriate Medical Care in Secondary School
Athletics: Athletic Training Services and Budget. J
Athl Train [serial online]. January 2010;45(1):75-86.
Available from: SPORTDiscus with Full Text, Ipswich,
MA. Accessed July 5, 2011.
12.
Aukerman D, Aukerman M, Browning D. Medical coverage
of high school athletics in North Carolina. Southern
Medical Journal [serial online]. February
2006;99(2):132-136. Available from: MEDLINE with Full
Text, Ipswich, MA. Accessed July 5, 2011.
13.
Feder K, Frey C, Sleight J, Pendergraph B, Smallman D.
Medical Coverage of High School Athletes in
California. Athletic Training & Sports Health Care: J
Practicing Clinician [serial online]. March
2010;2(2):61-65. Available from: SPORTDiscus with Full
Text, Ipswich, MA. Accessed July 5, 2011.
14.
Board of Certification. State Regulation. Available
at:
http://www.bocatc.org/index.php?option=com_content&vie
w=article&id=113&Itemid=121. Accessed November 28,
2011.
102
15.
Mickle A. The Legal Parameters Defining the Role of
the Certified Athletic Trainer. Athl Ther Today
[serial online]. January 2007;12(1):10-15. Available
from: SPORTDiscus with Full Text, Ipswich, MA.
Accessed July 5, 2011.
16.
Rello M. The importance of state regulation to the
promulgation of the athletic training profession. J
Athl Train [serial online]. April 1996;31(2):160-164.
Available from: SPORTDiscus with Full Text, Ipswich,
MA. Accessed July 5, 2011.
17.
Herbert D. Athletic Trainers May Be Held to
Independent Standard of Care in Illinois. Sports
Medicine Standards & Malpractice Reporter [serial
online]. July 2010;22(3):33-37. Available from:
SPORTDiscus with Full Text, Ipswich, MA. Accessed July
5, 2011.
18.
Mitten M. Emerging legal issues in sports medicine: a
synthesis, summary, and analysis. St. John's Law
Review [serial online]. Winter 2002;76(1):33-36.
Available from: SPORTDiscus with Full Text, Ipswich,
MA. Accessed July 5, 2011.
19.
Craig D. Educating Students on Athletic Training
Political Involvement. Athl Ther Today [serial
online]. May 2009;14(3):36-38. Available from:
SPORTDiscus with Full Text, Ipswich, MA. Accessed July
5, 2011.
20.
Herbert D, Piccin J. NATA Antitrust Suit Against APTA
Settled. Exercise Standards & Malpractice Reporter
[serial online]. February 2010;24(2):17-26. Available
from: SPORTDiscus with Full Text, Ipswich, MA.
Accessed July 5, 2011
21.
Official California Legislative Info. Bill Documents.
Available at: http://leginfo.ca.gov/cgibin/postquery?bill_number=ab_374&sess=CUR&house=B&auth
or=hayashi. Accessed November 28, 2011
103
22.
Unruh S. Perceptions of Athletic Training Services by
Collegiate Student-Athletes: A Measurement of.. J Athl
Train [serial online]. October 1998;33(4):347.
Available from: SPORTDiscus with Full Text, Ipswich,
MA. Accessed July 5, 2011.
23.
Unruh S, Unruh N, Moorman M, Seshadri S. Collegiate
Student-Athletes' Satisfaction With Athletic Trainers.
J Athl Train [serial online]. January 2005;40(1):52.
Available from: SPORTDiscus with Full Text, Ipswich,
MA. Accessed July 5, 2011.
24.
Bone J, Fry M. The Influence of Injured Athletes'
Perceptions of Social Support From ATC son Their
Beliefs About Rehabilitation. J Sport Rehab [serial
online]. May 2006;15(2):156-167. Available from:
SPORTDiscus with Full Text, Ipswich, MA. Accessed July
5, 2011.
25.
Storch S, Stevens S, Allen A. Orthopedic Surgeons'
Perceptions of Athletic Trainers as Physician
Extenders. Athl Ther Today [serial online]. May
2007;12(3):29-31. Available from: SPORTDiscus with
Full Text, Ipswich, MA. Accessed July 5, 2011.
26.
Felling A, Kahanov L, Lilienthal S, Schilcher S. Free
Communications, Oral Presentations: Perceptions of
ATCs in the Workforce. J Athl Train [serial online].
April 2, 2004;39:S-21-S-22. Available from:
SPORTDiscus with Full Text, Ipswich, MA. Accessed July
5, 2011.
27.
Gould T, Deivert R. Secondary-school administrators'
knowledge and perceptions of athletic training. Athl
Ther Today [serial online]. January 2003;8(1):57-62.
Available from: SPORTDiscus with Full Text, Ipswich,
MA. Accessed July 5, 2011.
28.
Mensch J, Crews C, Mitchell M. Competing Perspectives
During Organizational Socialization on the Role of
Certified Athletic Trainers in High School Settings. J
104
Athl Train [serial online]. October 2005;40(4):333340. Available from: SPORTDiscus with Full Text,
Ipswich, MA. Accessed July 5, 2011.
29.
Robbins J, Rosenfeld L. Athletes' perceptions of
social support provided by their head coach, assistant
coach, and athletic trainer, pre-injury and during
rehabilitation. J Sport Behavior [serial online].
September 2001;24(3):277-297. Available from:
SPORTDiscus with Full Text, Ipswich, MA. Accessed July
5, 2011.
105
ABSTRACT
TITLE:
California Legislators’ and Superintendents’
Perception of Athletic Training
RESEARCHER:
Curt Snyder
ADVISOR:
Dr. Linda Meyer
DATE:
April 2012
RESEARCH
TYPE:
Master’s Thesis
PURPOSE:
The purpose of this study was to survey
California legislators and secondary school
superintendents to collect their perceptions
on the roles and responsibilities of a
certified athletic trainer (AT).
PROBLEM:
California (CA) is one of three states that
currently have no state regulation for the
profession of athletic training. This is a
problem for not only the profession but also
for secondary school athletes whom are
either under the care of someone who is not
trained to provide needed health care
services or actually has no one supervising
any given event. This not only places
participants at risk but is a major
liability concern for legislators,
superintendents, and athletic directors whom
assume care for these students.
METHOD:
A descriptive type design was used for this
study. The Athletic Training Survey was the
instrument used. Subjects were 640
California legislators and superintendents.
FINDINGS:
There were three separate hypotheses.
1. No significant difference was found
(t(111)=.766, p > .05). The mean of the
superintendents (4.152 ± .475) was not
106
significantly different from the mean of
legislators (4.046 ± .671).
2. No significant difference was found
(t(111)= 1.487, p > .05). The mean of the
subjects who had participated in sports
(4.172 ± .510) was not significantly
different from the mean of subjects who have
not participated in sports (3.992 ± .451).
3. No significant difference was found
(t(102)=.518, p > .05). The mean of the
subjects who have children who have or
currently participate in sports (4.161 ±
.479) was not significantly different from
the mean of the subjects who do not have
children who participate in sports (4.11 ±
.473).
CONCLUSION:
California legislators and superintendents
have accurate knowledge of the profession of
athletic training for Domains I – IV, but
have incorrect knowledge for Domains V and
VI.