The Effect of the Model of Organizational Infrastructure on Collegiate Athletic Trainer Job Satisfaction: A Critically Appraised Topic

in International Journal of Athletic Therapy and Training
Emily A. Hall PhD, LAT, ATC * , 1 , Dario Gonzalez MS, LAT, ATC * , 1 and Rebecca M. Lopez PhD, LAT, ATC, CSCS * , 1
View More View Less
  • 1 University of South Florida

Clinical Question: Does the medical model of organizational structure compared to either the academic or traditional models have a greater influence on job satisfaction and quality of life in collegiate athletic trainers? Clinical Bottom Line: Based on the quality of the person-oriented evidence available, the recommendation to adopt the medical model for athletic training staff would receive a Strength of Recommendation Taxonomy (SORT) grade of B.

Clinical Scenario

Several studies14 have examined collegiate athletic trainer job satisfaction from various angles. In addition, advocating for patient-centered medicine has been a prevalent topic in the healthcare community at large. However, research examining the organizational hierarchy of collegiate athletic training is limited. There are currently three models of organizational infrastructure in the collegiate athletic training setting: the traditional athletics model, the academic model, and the medical model.5 The traditional model is defined as having the athletic training staff as part of the athletics department and the head athletic trainer (AT) reports to the athletics director. The academic model is where ATs and athletic training educators are part of the athletic training education program. The medical model is defined as having the athletic training staff aligned with the campus health services; specifically, the head AT reports to another healthcare professional.5 The organizational infrastructure that employs collegiate athletic trainers may have an effect on athletic trainer job satisfaction and quality of life.510 Coaches at the collegiate level often have a substantial amount of power and influence over almost every decision involving their teams, including medical decisions.6,7,9,10 Research into the organizational model of collegiate athletic training staffs has shown that at some institutions coaches have taken advantage of their athletics director to attempt to influence medical decision making and the hiring and firing of athletic trainers.5,7,9,10 In addition, many athletic trainers have cited issues related to their organizational infrastructure that have negatively impacted their professional commitment and satisfaction.5,7,9,10 Changing the reporting structure could alleviate the coaches’ control over the athletic trainer’s clinical practice and medical decisions. This Critically Appraised Topic (CAT) will determine if the medical model provides the collegiate athletic trainer with the best job satisfaction and quality of life compared to the traditional and academic models based on the current research.

Focused Clinical Question

Does the medical model of organizational structure compared to either the academic or traditional models have a greater influence on job satisfaction and quality of life in collegiate athletic trainers?

Search Strategy

A computerized search was performed in September 2018 through November 2019. The search terms used were:

  1. Patient/client group: collegiate athletic trainer, sports medicine staff
  2. Intervention/assessment: medical model of organizational infrastructure
  3. Comparison: academic model OR traditional athletics model
  4. Outcome: athletic trainer job satisfaction OR quality of life OR work-life balance

Other search term combinations included: “traditional model in collegiate athletic training”; “medical model in collegiate athletic training”; “academic model in collegiate athletic training”; “models of collegiate athletic training”;

Sources of Evidence Searched

  1. PubMed
  2. Google Scholar
  3. Web of Science
  4. Reference lists of related articles

Inclusion Criteria

  1. Studies that assessed the relationship between the model of organizational infrastructure and athletic trainer job satisfaction, quality of life, or work-life balance
  2. Answers of “yes” to 75% of the applicable questions on the Mixed Methods Appraisal Tool (MMAT)11
  3. Limited to English language studies
  4. Limited to peer-reviewed articles published between 2008–2019

Exclusion Criteria

  1. Studies that did not examine a model of organizational infrastructure as it relates to athletic trainer job satisfaction, quality of life, or work-life balance
  2. Studies that focused on other healthcare professions
  3. Studies published prior to 2008

Evidence Quality Assessment

The MMAT11 was used to assess the quality of evidence for the studies included in this CAT. The MMAT has sections for qualitative, randomized controlled, nonrandomized controlled, observational, and mixed-methods studies, and has demonstrated a high internal consistency as well as interrater reliability.12 Studies reviewed in this CAT were deemed high quality if the studies met all applicable criteria on the MMAT.

Results of Search

The initial search of the literature returned 11 possible articles related to the clinical question. Five studies5,6,8,9,13 met the inclusion criteria and were selected for this CAT. Of the six articles not selected, one was a consensus statement and five did not examine a model of organizational infrastructure as the main intervention. The design of the selected studies included were: three qualitative studies, one mixed-methods study, and one cross-sectional study. Research into the model of organizational infrastructure of collegiate athletic trainers is a fairly recent trend, and thus the available literature is limited. The five studies selected were all published from 2015–2018. The results from the studies included in this CAT can likely be generalized to all collegiate athletic trainers as the participants in each study were all employed by a National Collegiate Athletic Association (NCAA) institution. It is important to note that there was participant overlap in three of the studies,5,8,9 but they were all included based on the different purposes of each study.

Results of Evidence Quality Assessment

All of the studies5,6,8,9,13 included in this review (Table 1) examined how the model of organizational infrastructure can impact collegiate athletic trainer job satisfaction and the level of care that they provide to their patients. Each study answered “yes” (Table 2) to all of the questions of the applicable study design. Thus, we believe the studies are valid and the results are applicable.

Table 1

Studies Included

Study
CharacteristicsMazerolle et al.5Goodman et al.9Eason et al.8Baker and Wilkerson6Mazerolle et al.13
Article titleOrganizational Infrastructure in the Collegiate Athletic Training Setting, Part I: Quality-of-Life Comparisons and Commonalities Among the ModelsOrganizational Infrastructure in the Collegiate Athletic Training Setting, Part II: Benefits of and Barriers in the Athletics ModelOrganizational Infrastructure in the Collegiate Athletic Training Setting, Part III: Benefits of and Barriers in the Medical and Academic ModelsComparison of Athletic Trainer Stress and Job Satisfaction with Different Models of Care DeliveryExploring the Effect of the Medical Model

Organizational Structure on Collegiate Athletic

Trainers’ Quality of Life: A Case Study
Participants59 collegiate ATs8 collegiate ATs16 collegiate ATs44 collegiate ATs13 collegiate ATs
Study designMixed-methods (cross-sectional and qualitative study)Qualitative studyQualitative studyCross-sectional studyQualitative study
ResultsCommonalities included communication and effective work-life balance strategies. TM worked more hours, were less satisfied with pay, and received less support from superiors.Benefits reported were role identity and role congruence. Barriers reported were role strain, staffing concerns, and work-life balance.Benefits of MM: Role congruency and work-life balance. Barriers of MM: role conflict.

Benefits of AM: Role congruency. Barriers of AM: Role strain and work-life balance.
ATs in TM had significantly greater stress scores, lower salary ranges, worked more hours, and reported more job dissatisfaction than ATs in the MM.Role congruity: 92% of participants were aware of their role within the organization

Work time control: 77% identified the positive influence this model has on their work experience

Collegial relationships: 100% agreed the relationships within the staff supports the patient-centered model
ConclusionOrganizational infrastructure may play a role in mediating various sources of conflict but, regardless, ATs need to be effective communicators, have support networks in place, and possess time-management skills.Participants express positives such as relationships and identity, but work-life balance and misaligning values with other athletics staff remain issues.MM provides better alignment of patient care and wellbeing for ATs. AM removes athletics staff conflict, but faculty responsibilities bring role incongruence.MM provides AT best environment for high job satisfaction, lower stress, higher salaries, and ability to offer patient-centered care.MM creates an environment that is conducive to work-life balance due to clear role identify, flexible work schedules, and supportive staff.
Support for the questionYesYesYesYesYes

Abbreviations: AM = academic model; AT = athletic trainer; MM = medical model; RTP = return to play; TM = traditional model.

Table 2

Questions of the Applicable Study Design

CategoryQuestionMazerolle et al.5Goodman et al.9Eason et al.8Baker and Wilkerson6Mazerolle et al.13
1. Qualitative1.1 Is the qualitative approach appropriate to answer the research question?N/AYesYesN/AYes
1.2 Are the qualitative data collection methods adequate to address the research question?N/AYes; examined role congruence, role strain, and work-life conflictYes; examined role congruence, role conflict, work-life balance, and patient careN/AYes
1.3 Are the findings adequately derived from the data?N/AYesYesN/AYes
1.4 Is the interpretation of results sufficiently substantiated by data?N/AYesYesN/AYes
1.5 Is there coherence between qualitative data sources, collection, analysis and interpretation?N/AYesYesN/AYes
2. Quantitative randomized controlled trials2.1 Is randomization appropriately performed?N/AN/AN/AN/AN/A
2.2 Are the groups comparable at baseline?N/AN/AN/AN/AN/A
2.3 Are there complete outcome data?N/AN/AN/AN/AN/A
2.4 Are outcome assessors blinded to the intervention provided?N/AN/AN/AN/AN/A
2.5 Did the participants adhere to the assigned intervention?N/AN/AN/AN/AN/A
3. Quantitative nonrandomized3.1 Are the participant’s representative of the target population?N/AN/AN/AN/AN/A
3.2 Are measurements appropriate regarding both the outcome and intervention (or exposure)?N/AN/AN/AN/AN/A
3.3 Are there complete outcome data?N/AN/AN/AN/AN/A
3.4 Are the confounders accounted for in the design and analysis?N/AN/AN/AN/AN/A
3.5 During the study period, is the intervention administered (or exposure occurred) as intended?N/AN/AN/AN/AN/A
4. Quantitative descriptive4.1 Is the sampling strategy relevant to address the research question?N/AN/AN/AN/AN/A
4.2 Is the sample representative of the target population?N/AN/AN/AN/AN/A
4.3 Are the measurements appropriate?N/AN/AN/AN/AN/A
4.4 Is the risk of nonresponse bias low?N/AN/AN/AN/AN/A
4.5 Is the statistical analysis appropriate to answer the research question?N/AN/AN/AN/AN/A
5. Mixed methods5.1 Is there an adequate rationale for using a mixed-methods design to address the research question?YesN/AN/AYesN/A
5.2 Are the different components of the study effectively integrated to answer the research question?YesN/AN/AYes, quantitative stress scores and qualitative interview responsesN/A
5.3 Are the outputs of the integration of qualitative and quantitative components adequately interpreted?YesN/AN/AYesN/A
5.4 Are divergences and inconsistencies between quantitative and qualitative results adequately addressed?YesN/AN/AYesN/A
5.5 Do the different components of the study adhere to the quality criteria of each tradition of the methods involved?Yes, both components are of high qualityN/AN/AYes, both components are of high qualityN/A

Clinical Bottom Line

Strength of Recommendation

Based on the quality of the person-oriented evidence available,5,6,8,9,13 the recommendation to adopt the medical model for athletic training staff would receive a Strength of Recommendation Taxonomy (SORT) grade of B. Evidence is needed based on the exploration of patient satisfaction and quality of life on the organizational infrastructure models currently used. There is a need to further explore the effect of adopting the medical model on these outcomes for ATs, patients, and other stakeholders to ensure that our profession can provide the best patient-centered care possible.

Implications for Practice, Education, and Future Research

The studies5,6,9 reviewed in this CAT identified issues with the traditional athletics model of organizational infrastructure that have the potential to have a significant negative impact on the job satisfaction of collegiate ATs and the level of care that they are able to provide to their patients. The most glaring issue with the traditional athletics model is the reality of perceived pressure from coaches and athletics department administrators on ATs, which can negatively affect the medical decision-making process.57,9,10 In a study that surveyed 900 NCAA clinicians, comprised of ATs and physicians, more than half reported being pressured by a coach to prematurely return an athlete to play after sustaining a concussion.10 The same study revealed that female clinicians reported experiencing greater pressure when compared to their male counterparts, and that clinicians at schools under the traditional athletics model experienced greater pressure from coaches than those at a school under the medical model.10 This pressure affects role incongruity, defined as the misalignment of expectations, and role conflict, which is defined as incompatible expectations.5 In the traditional athletics model, athletic trainers are in the same organizational hierarchy as coaches, often with the athletic director at the top.5,9 This reality can lead to increased role strain in collegiate athletic trainers, as they may fear for their job status if perceived to be going against a coach’s wishes.57,9

In addition to attempting to influence medical decision making, coaches have the potential to negatively influence the work-life balance of ATs working in the traditional athletics model.57,9 Commonly-reported work-life balance issues in collegiate ATs include inconsistent practice and workout scheduling, long hours, a severe lack of vacation or sick days, and a lack of administrative support.3,5,9 In contrast, ATs employed in the medical model of organizational infrastructure report better role congruity and decreased work-related stress.5,8,13 ATs in the medical model, on average, work fewer hours and report higher salaries than those in the traditional athletics model.5,6 Unlike in the traditional athletics model, where an athletic director often serves as the highest ranking member of an athletic training staffs’ organizational hierarchy, ATs employed in the medical model report to a physician or other healthcare professional.57,10,13 Placing ATs in a separate organizational hierarchy makes it more difficult for coaches to negatively infringe on the medical decision-making process.7,8,10 ATs working in the medical model also report increased opportunities for interprofessional and collaborative practice.14 This multi-disciplinary approach, such as a chiropractor and AT working together on a patient with low back pain, has been shown to result in improved patient care.14 In addition to decreasing potential role conflict in ATs, the medical model increases a student-athlete’s ability to receive patient-centered care.68,10 ATs and their supervisors in the medical model are able to hold the long-term health of their patients as a central treatment goal.68

The final model of organizational infrastructure, the academic model employs ATs as a part of an academic program within a university system, requiring ATs to teach classes.8 In the academic model, the top of the AT’s organizational hierarchy is an academic dean or department chair.8 Similarly to the medical model, the academic model addresses potential coach influence in medical decision making by housing ATs in a separate organizational hierarchy.8 While some ATs employed in the academic model expressed enjoying the mixture of teaching and clinical practice, some ATs experienced an increase in role conflict and felt they were being pulled in two different directions. This role conflicts resulted in clinicians struggling to maintain a high quality of work in their various responsibilitites.8 Overall, the academic model provides better opportunity for patient-centered care when compared to the traditional athletics model, but this model may add work-life balance issues to the AT with the additional responsibilities associated with teaching.8

Based on the appraisal of the existing research in this area, it appears that the medical model resulted in higher job satisfaction and quality of life compared to the traditional athletics model and academic model. However, the research in this area lacks high-quality evidence. Future research opportunities related to this topic should include patient perspectives and further investigation of AT compensation and work-life balance implications. This CAT should be reviewed in 2 years or whenever additional information is published that may prove to bolster or weaken the clinical bottom line.

CAT Kill Date: July 2022

CATs have limited life and should be revisited approximately 2 years after publication (see https://doi.org/10.1123/ijatt.2018-0093).

References

  • 1.

    Brumels K, Beach A. Professional role complexity and job satisfaction of collegiate certified athletic trainers. J Athl Train. 2008;43(4):373378. PubMed ID: 18668170 doi:10.4085/1062-6050-43.4.373

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Mazerolle SM, Eason CM, Pitney WA. Athletic trainers’ barriers to maintaining professional commitment in the collegiate setting. J Athl Train. 2015;50(5):524531. PubMed ID: 25761133 doi:10.4085/1062-6050-50.1.04

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Mazerolle SM, Goodman A, Pitney WA. Achieving work-life balance in the National Collegiate Athletic Association Division I setting, part I: the role of the head athletic trainer. J Athl Train. 2015;50(1):8288. PubMed ID: 25343530 doi:10.4085/1062-6050-49.3.88

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Mazerolle SM, Eason CM. The organizational climate in collegiate athletics: an athletic trainer’s perspective. J Athl Train. 2018;53(1):8897. PubMed ID: 29251534 doi:10.4085/1062-6050-52.12.24

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Mazerolle SM, Eason CM, Goodman A. Organizational infrastructure in the collegiate athletic training setting, part I: quality-of-life comparisons and commonalities among the models. J Athl Train. 2017;52(1):1222. PubMed ID: 27874297 doi:10.4085/1062-6050-51.12.19

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Baker CS, Wilkerson GB. Comparison of Athletic Trainer Stress and Job Satisfaction with Different Models of Care Delivery. Int J Athl Ther Train. 2018;23(4):150155. doi:10.1123/ijatt.2016-0110

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Courson R, Goldenberg M, Adams KG, et al. Inter-association consensus statement on best practices for sports medicine management for secondary schools and colleges. J Athl Train. 2014;49(1):128137. PubMed ID: 24499040 doi:10.4085/1062-6050-49.1.06

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Eason CM, Mazerolle SM, Goodman A. Organizational infrastructure in the collegiate athletic training setting, part III: benefits of and barriers in the medical and academic models. J Athl Train. 2017;52(1):3544. PubMed ID: 27977302 doi:10.4085/1062-6050-51.12.25

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Goodman A, Mazerolle SM, Eason CM. Organizational infrastructure in the collegiate athletic training setting, part II: benefits of and barriers in the athletics model. J Athl Train. 2017;52(1):2334. PubMed ID: 27977301 doi:10.4085/1062-6050-51.12.24

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Kroshus E, Baugh CM, Daneshvar DH, Stamm JM, Laursen RM, Austin SB. Pressure on sports medicine clinicians to prematurely return collegiate athletes to play after concussion. J Athl Train. 2015;50(9):944951. PubMed ID: 26207440 doi:10.4085/1062-6050-50.6.03

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Hong QN, Pluye P, Fàbregues S, et al. Mixed methods appraisal tool (MMAT), version 2018. IC Canadian Intellectual Property Office, Industry Canada; 2018.

    • Search Google Scholar
    • Export Citation
  • 12.

    Pace R, Pluye P, Bartlett G, et al. Testing the reliability and efficiency of the pilot Mixed Methods Appraisal Tool (MMAT) for systematic mixed studies review. Int J Nurs Stud. 2012;49(1):4753. PubMed ID: 21835406 doi:10.1016/j.ijnurstu.2011.07.002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Mazerolle SM, Gerhart ST, Eason CM. Exploring the effect of the medical model organizational structure on collegiate athletic trainers’ quality of life: a case study. Athl Train Sports Health Care. 2018;10(4):158168. doi:10.3928/19425864-20180201-01

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Hankemeier D, Manspeaker SA. Perceptions of interprofessional and collaborative practice in collegiate athletic trainers. J Athl Train. 2018;53(7):703708. PubMed ID: 30102070 doi:10.4085/1062-6050-308-17

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

If the inline PDF is not rendering correctly, you can download the PDF file here.

The authors are with Morsani College of Medicine, University of South Florida, Tampa, FL, USA.

Hall (eannehall@usf.edu) is corresponding author.
  • 1.

    Brumels K, Beach A. Professional role complexity and job satisfaction of collegiate certified athletic trainers. J Athl Train. 2008;43(4):373378. PubMed ID: 18668170 doi:10.4085/1062-6050-43.4.373

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Mazerolle SM, Eason CM, Pitney WA. Athletic trainers’ barriers to maintaining professional commitment in the collegiate setting. J Athl Train. 2015;50(5):524531. PubMed ID: 25761133 doi:10.4085/1062-6050-50.1.04

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Mazerolle SM, Goodman A, Pitney WA. Achieving work-life balance in the National Collegiate Athletic Association Division I setting, part I: the role of the head athletic trainer. J Athl Train. 2015;50(1):8288. PubMed ID: 25343530 doi:10.4085/1062-6050-49.3.88

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Mazerolle SM, Eason CM. The organizational climate in collegiate athletics: an athletic trainer’s perspective. J Athl Train. 2018;53(1):8897. PubMed ID: 29251534 doi:10.4085/1062-6050-52.12.24

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Mazerolle SM, Eason CM, Goodman A. Organizational infrastructure in the collegiate athletic training setting, part I: quality-of-life comparisons and commonalities among the models. J Athl Train. 2017;52(1):1222. PubMed ID: 27874297 doi:10.4085/1062-6050-51.12.19

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Baker CS, Wilkerson GB. Comparison of Athletic Trainer Stress and Job Satisfaction with Different Models of Care Delivery. Int J Athl Ther Train. 2018;23(4):150155. doi:10.1123/ijatt.2016-0110

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Courson R, Goldenberg M, Adams KG, et al. Inter-association consensus statement on best practices for sports medicine management for secondary schools and colleges. J Athl Train. 2014;49(1):128137. PubMed ID: 24499040 doi:10.4085/1062-6050-49.1.06

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Eason CM, Mazerolle SM, Goodman A. Organizational infrastructure in the collegiate athletic training setting, part III: benefits of and barriers in the medical and academic models. J Athl Train. 2017;52(1):3544. PubMed ID: 27977302 doi:10.4085/1062-6050-51.12.25

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Goodman A, Mazerolle SM, Eason CM. Organizational infrastructure in the collegiate athletic training setting, part II: benefits of and barriers in the athletics model. J Athl Train. 2017;52(1):2334. PubMed ID: 27977301 doi:10.4085/1062-6050-51.12.24

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Kroshus E, Baugh CM, Daneshvar DH, Stamm JM, Laursen RM, Austin SB. Pressure on sports medicine clinicians to prematurely return collegiate athletes to play after concussion. J Athl Train. 2015;50(9):944951. PubMed ID: 26207440 doi:10.4085/1062-6050-50.6.03

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Hong QN, Pluye P, Fàbregues S, et al. Mixed methods appraisal tool (MMAT), version 2018. IC Canadian Intellectual Property Office, Industry Canada; 2018.

    • Search Google Scholar
    • Export Citation
  • 12.

    Pace R, Pluye P, Bartlett G, et al. Testing the reliability and efficiency of the pilot Mixed Methods Appraisal Tool (MMAT) for systematic mixed studies review. Int J Nurs Stud. 2012;49(1):4753. PubMed ID: 21835406 doi:10.1016/j.ijnurstu.2011.07.002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Mazerolle SM, Gerhart ST, Eason CM. Exploring the effect of the medical model organizational structure on collegiate athletic trainers’ quality of life: a case study. Athl Train Sports Health Care. 2018;10(4):158168. doi:10.3928/19425864-20180201-01

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Hankemeier D, Manspeaker SA. Perceptions of interprofessional and collaborative practice in collegiate athletic trainers. J Athl Train. 2018;53(7):703708. PubMed ID: 30102070 doi:10.4085/1062-6050-308-17

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 21 21 0
Full Text Views 284 284 62
PDF Downloads 118 118 21