The Evolution of the Athletic Training Profession

in Kinesiology Review

Athletic training is a health care profession with roots in athletics and kinesiology that has evolved into a critical component of contemporary sports medicine. The aim of this article is to review the history and evolution of the athletic training profession, contextualize the current state of athletic training education and research, and address priorities and challenges that the athletic training profession must confront if it is to continue to thrive. Specific challenges include addressing health disparities in sports medicine, increasing the diversity of the athletic training profession, clearly delineating athletic training’s place in the health care arena, and increasing salaries and retention of athletic trainers in the profession.

Athletic training as a profession traces back to Ancient Greece with the birth of athletics (Ebel, 1999). The Greeks viewed Herodicus, a physician and a mentee of Hippocrates, as an athletic trainer (AT; Ebel, 1999). During the dark ages, athletic training went dormant until the 1800s (Ebel, 1999; Kutz, 2019) when coaches and physicians often served in the role of an AT. The 1950s is said to be the time that athletic training began its transformation as a profession (Kutz, 2019). The rapid evolution of this profession is noted by its absence in Brooks’ (1981) Perspectives on the Academic Discipline of Physical Education, which provides a compelling reason to include athletic training in this special issue on the current status of the academic discipline of kinesiology.

The evolution of athletic training and athletic training education is very closely related to the evolution of the National Athletic Trainers’ Association (NATA; Delforge & Behnke, 1999). The NATA was founded to “build and strengthen the profession of athletic training through the exchange of ideas, knowledge, and methods of athletic training” (O’Shea, 1980 as cited in Delforge & Behnke, 1999, p. 53). After the establishment of the NATA (Delforge & Behnke, 1999), athletic training grew and continues to grow as practice settings expand and the number of ATs increases. ATs are now defined by the NATA (2020) as

Health care professionals who render service or treatment, under the direction of or in collaboration with a physician, in accordance with their education and training and the state’s statutes, rules, and regulations. As a part of the health care team, services provided by athletic trainers include primary care, injury and illness prevention, wellness promotion and education, emergent care, examination and clinical diagnosis, therapeutic intervention, and rehabilitation of injuries and medical conditions.

Athletic training has undergone many changes and includes multiple educational reforms, expansions within scope of practice, and international recognition (Kutz, 2019). The professional growth and development of the profession can be attributed to the emergence of practitioners as experts in sports health care, community recognition, the development and accreditation of education programs, the credentialing of the AT (Delforge & Behnke, 1999), and formalization of the clinical education process (Weidner & Henning, 2002).

The ATs are now recognized as leading researchers in many areas of health care, including exertional-related heat illnesses, sudden death in sport, musculoskeletal injuries, and sport-related concussion. Many health care providers, athletic organizations, and legislators turn to the NATA position statements for best practices on multiple facets of health and safety for the physically active. In addition to research and best practices, ATs serve as consultants in legal matters and work with legislators to impact athletic training practice and health care in their own states and locales. Many ATs serve as a voice for the health and safety of athletes and physically active individuals of all ages and in all arenas.

This article serves as a perspective of the evolution of the profession of athletic training and its role in kinesiology. The history of athletic training is briefly described with a focus on athletic training education as the core of professional growth. Notable events in the profession are highlighted along with an increased emphasis on collaboration with other providers, the future direction of the profession, and contemporary topics that impact sports, safety, health promotion, and wellness. There is a discussion on prominent research themes as well, including health disparities, therapeutic interventions, head injuries/concussion, musculoskeletal injuries, emergency procedures, exertional heat illnesses/hydration, and patient-reported outcomes in athletic training.

History of Athletic Training

Groundwork

The evolution of athletic training can be traced back many decades and as far as Ancient Greece (Ebel, 1999). Many people served as the pioneers of the profession starting in the 1800s and laid the foundation for the profession (Figure 1). In 1881, the first “athletic trainer” James Robinson was hired by Harvard University (Ebel, 1999; Kutz, 2019), and 6 years later in 1887, the University of Texas at Austin hired Henry “Doc” Reeves, an African American who was later inducted into the Longhorn Athletics Hall of Fame (Kutz, 2019). In 1914, Dr. Samuel E. Bilik, a physician at the University of Illinois, who is often referred to as the father of athletic training, published one of athletic training’s first texts, Athletic Training. In the 1920s, Charles and Frank Cramer promoted the profession through their pharmaceutical company, Cramer Products Co. (Ebel, 1999; Kutz, 2019).

Figure 1
Figure 1

—The early years in athletic training. AT = athletic trainer; NATA = National Athletic Trainers’ Association.

Citation: Kinesiology Review 10, 3; 10.1123/kr.2021-0027

The NATA was originally formed in 1938 but disbanded until the late 1940s when regional groups of ATs began to reorganize (Ebel, 1999; Kutz, 2019). One of the most notable events, and arguably the beginning of athletic training as we know it today, occurred in 1950 when Cramer Chemical Co. sponsored the first national clinic, and the NATA was officially founded with 100 members (Ebel, 1999; Kutz, 2019). In the early 1980s, the NATA officially incorporated and soon surpassed 10,000 members. In 1990, the AMA recognized athletic training as a health care profession (Delforge & Behnke, 1999; Weidner & Henning, 2002), nearly 10 years after the publication of Brooks’ Perspectives on the Academic Discipline of Physical Education. In 2020, there were 56,554 Board of Certification (BOC)–certified ATs, a testament to the rapid growth of the profession (BOC, 2020).

Serving to advocate, engage, and develop the profession of athletic training, the NATA has functioned as the building block of the profession and has historically provided oversight in education, certification, corporate governance, standards of practice, and directing health and safety through publications, such as position statements and consensus statements. As the profession grows, the role of the NATA has evolved (Figures 13), and other related organizations have emerged to serve and ensure quality athletic training services are being provided.

Figure 2
Figure 2

—The evolution of the athletic training profession 1950–1999. AT = athletic training; BOC = Board of Certification; NATA = National Athletic Trainers’ Association; AMA = American Medical Association; CAAHEP = Commission on Accreditation of Allied Health Programs.

Citation: Kinesiology Review 10, 3; 10.1123/kr.2021-0027

Figure 3
Figure 3

—The evolution of the athletic training profession 2000–2022. CAATE = Commission on Accreditation of Athletic Training Education; CAAHEP = Commission on Accreditation of Allied Health Education Programs; BOC = Board of Certification; NATA = National Athletic Trainers’ Association.

Citation: Kinesiology Review 10, 3; 10.1123/kr.2021-0027

Notable Developments

Athletic training has evolved slowly, gradually, and significantly since 1980. Much of the change observed since that time was envisioned—at least partially—by the profession’s leaders between 1960 and 1980 (Figure 2). The following themes best describe this process of evolution:

  1. a.Shift in viewing athletic training as an “athletic occupation” toward viewing it as a “health care profession.”

The ATs were almost exclusively employed in professional and university athletic settings when the profession was formally established. Secondary schools slowly added ATs for their athletic programs over time. This sector remains the professions’ highest priority employment sector as there are over five million high school athletes whose health and safety can be safeguarded through the presence of ATs.

These settings can be contrasted to those in which ATs are now found. While professional, university, and high school athletes still comprise a large fraction of the athletic training profession’s patient population, people from a much wider spectrum of the citizenry now benefit from health care provided by ATs. The NATA reports, for example, that ATs now deliver health care services to patients in 16 categories and 52 subcategories (NATA, 2018a). Included among these are patients in public safety and military roles, industrial workers, and hospitals and clinics providing a full range of patient-care services.

  1. b.Shift from the AT as a generalist sharing knowledge and skill with other medical and nonmedical persons to the ATs as health care specialist producing and using knowledge specific to a particular realm of the body of knowledge.

Prevention, care, and rehabilitation of athletic injuries featured prominently in the general rubrics of athletic training practice at the doorstep of the professions’ rapid professionalization 40 years ago. While these dimensions of practice remain important in the professional (i.e., entry level) education of ATs, patients in 2021 are served by ATs who have a much broader range of health care knowledge and skill. Of particular note is the evidence-based concussion management provided by ATs. This area of practice has been developed in part by original research conducted by ATs that now directs the standards of practice for many health care providers. The athletic training profession has promulgated scientifically sound, peer reviewed, evidence-based position statements in 30 areas of health care practice. These are supplemented by 19 NATA official statements on a wide range of issues. Fourteen consensus statements developed in cooperation with other health care and related professions provide coordinated “best practice” advice for health care providers, patients, and their families (NATA, 2020).

  1. c.Shift from athletic training as a predominantly homogenous, male occupation to a profession engaged in equally by men and women and increasingly concerned with openness to diversity, equity, and inclusion.

The athletic training profession of 1980 and earlier was almost exclusively composed of White men. Women began to swell the ranks of ATs as Title IX began to expand opportunities for girls and women to participate in athletics and thus gain exposure to that fraction of the profession that served high school and university athletes. In 2015, approximately 20% of the NATA membership was composed of non-White ATs (Grantham, 2015). Athletic training education programs now include information for practitioners in training on cultural competence and cross-cultural communication and acknowledge that there is underrepresentation of minority groups.

  1. d.Shift from prevention, care, and rehabilitation services provided by ATs almost exclusively to professional and university athletes on a nonreimbursable basis to comprehensive health care services provided across the life course, and increasingly reimbursable by third-party payers.

Historically, ATs have been paid a salary for their services by the institutions that employ them. Most ATs are still compensated in this way. This stands in contrast to the ways that many other health care professionals are compensated through third-party reimbursement models. Athletic training is beginning a slow, gradual shift toward the third-party reimbursement model. Several states have lowered or eliminated barriers to reimbursement, and efforts are being made to make this available in every state where it is permitted by athletic training credentialing laws. (NATA, 2020c). This important shift will expand access to athletic training services to anyone for whom ATs’ services are appropriate.

  1. e.Shift in athletic training as a profession allied principally with athletic/physical education/kinesiology institutions and associations to athletic training as a profession increasingly aligned with health care/medical institutions and associations.

The athletic training profession of the mid–late 20th century was principally allied to organizations and institutions concerned with physical activity and competitive athletics. With the AMA’s 1990 recognition of athletic training as an allied health care profession, athletic training began to increasingly seek common cause with health care organizations. Athletic training still has deep and abiding relationships with athletics-oriented organizations like the National Collegiate Athletic Association, the National Federation of State High School Associations, various professional sports leagues, and the U.S. Olympic Committee. But a review of the Youth Sport Safety Alliance reveals “more than 200 organizations ranging from parent advocate groups and research institutes to health care and professional associations and youth sports leagues” (Youth Sports Safety Alliance, 2018). Furthermore, the NATA now formally cooperates with such health care organizations as the American Physical Therapy Association, the Orthopedic Society for Sports Medicine, the American Academy of Family Physicians, and the American Medical Society for Sports Medicine.

  1. f.Shift from athletic training as an unregulated occupation to athletic training as a regulated profession.

In its earliest days, athletic training was a wholly unregulated profession. This began to change when the NATA recognized the importance of a standards-based credentialing system intended to protect members of the public from ATs who were insufficiently educated or whose knowledge and skill had not been found to meet the standard expected of an entry-level professional. The certification program initiated by the NATA in the late 1960s was later adopted in style by various states that sought to assure the public that ATs were capable, competent health care professionals. As of this writing, every state in the United States requires ATs to be state credentialed (licensed, registered, or state certified) except California, where legislative efforts have been ongoing for many years. Current efforts in state regulation seek to expand their practice acts to allow provision of athletic training services to a broader patient population than the “athletes” specified in the early years of state regulation.

  1. g.Shift from athletic training professional preparation as an undergraduate interest area to athletic training professional preparation as multitiered graduate specialty focus.

As athletic training became more professionalized, its leaders recognized that educational standards would have to be elevated if the profession was going to take its place alongside other health care disciplines. The earliest educational standard for certification eligibility included a college degree, the successful completion of seven core courses, and a clinical component totaling at least 1,800 hr of supervised practice. Commonly referred to as the “apprenticeship” or “internship” route to national certification eligibility, this was eventually replaced by a competency-based academic major (or its equivalent) in athletic training. The profession is now in the final stages of transitioning the entry-level undergraduate standard to a master’s degree requirement for exam eligibility. Furthermore, ATs have access to formal continuing education in the form of academic and clinical doctoral degrees, accredited residencies and specialty certifications.

  1. h.Shift from athletic training as a North American phenomenon to athletic training as an increasingly worldwide phenomenon.

Athletic training (and athletic therapy as it is known in Canada) was almost exclusively a North American phenomenon in its early years. The principal connection of U.S. ATs with the wider world prior to the late 1990s was through the Olympic movement. While the United States continues to serve as the center of gravity for the profession, it can no longer claim athletic training as its exclusive purview. What was once a mostly American profession is now represented by professional societies of ATs and therapists in eight nations, each of which is collectively represented by the World Federation of Athletic Training and Therapy (World Federation of Athletic Training and Therapy, 2019). This process is being refined to one whereby individuals from the United Kingdom, Ireland, Canada, and the United States have their academic credentials reviewed on an individual basis in order to qualify to take another country’s credentialing exam. It is anticipated that the number of countries engaged in this reciprocal arrangement will increase in the coming years.

  1. i.Shift from athletic training as a profession whose interests were almost solely represented by the NATA to one with a variety of purpose-built 501(c)(3) organizations responsible for narrow, limited, and specialized functions.

Since the mid-20th century, the profession has been represented by the NATA. The NATA served as a centralized voice for ATs at every level and domain of practice. As AT credentialing and educational quality became increasingly technical, the NATA spun off several areas of its portfolio in order to concentrate on member services and advocacy. Credentialing of ATs is now the purview of the independent BOC®. Educational standards, quality, and accreditation are ensured by the Commission on Accreditation of Athletic Training Education (CAATE). The NATA Research and Education Foundation is the philanthropic arm of the profession, providing scholarships, steering the profession’s research agenda and grant making, and providing continuing education for the profession’s nearly 45,000 members. The NATA, BOC, CAATE, and Foundation cooperate together on issues of mutual interest through the Strategic Alliance—a group committed to the athletic training profession and the delivery of quality health care to the public.

Athletic Training Education

Athletic training today is far from the internship or “apprenticeship” hours one once had to fulfill in order to become an AT. The profession has evolved from accumulation of internship hours to rigorous curriculum and professional education at the master’s degree level.

The NATA originally served to approve athletic training programs, with the first athletic training curriculum established in 1959 (Weidner & Henning, 2002). As the profession grew, the NATA recognized the need for credentialing ATs and created the NATA BOC in 1971 when the first certification exam was given (Ebel, 1999; Kutz, 2019). From the 1970s until the early 2000s, the NATA-BOC offered different routes to become a certified AT, including completion of an approved program (including 600–800 clinical experience hours) or completing 1,800 clinical experience hours in an “apprenticeship” or 1,500 hr as an internship (Grace, 1999). In 1989, the NATA relinquished any responsibility within the certification process and incorporated the NATA-BOC to avoid any conflicts of interest between the member association and the public protection role that serves as the central purpose of national certification (Grace, 1999). The BOC now establishes the standards for the practice of athletic training and the continuing education requirements for the BOC Certified Athletic Trainer (BOC, 2020a).

In 1990, the initial development of standards for accreditation for athletic training education was done by the Joint Review Committee on Educational Programs in Athletic Training and the NATA. The Commission on Accreditation of Allied Health Education Programs accepted and adopted the standards in June of 1991 (Weidner & Henning, 2002). By 2004, the NATA-BOC eligibility requirements consisted of all students completing a Commission on Accreditation of Allied Health Programs accredited entry-level athletic training education program usually at the bachelor’s degree level.

The Joint Review Committee on Educational Programs in Athletic Training became independent from Commission on Accreditation of Allied Health Programs and incorporated as the CAATE, which is recognized as an accrediting agency by the Council of Higher Education Accreditation in June 2006 (NATA, 2020). Traditionally, athletic training programs were housed under kinesiology in schools of education. Current accreditation requirements for graduate-level professional programs require that programs administratively align with units that house other health care professional education programs (Commission on Accreditation of Athletic Training Education, 2018).

The CAATE accredits all levels of athletic training education, including professional athletic training education (entry-level programs) and residency programs (Commission on Accreditation of Athletic Training Education, n.d.). Currently, the CAATE accredits more than 360 professional athletic training programs, 16 postprofessional degree programs, and 10 residencies with many others seeking accreditation (Commission on Accreditation of Athletic Training Education, n.d.).

Professional Master’s Degree

In May 2015, the CAATE, with the support of the other members of the Strategic Alliance, announced that the required degree for professional education and eligibility for the BOC examination would change to the master’s degree level. This degree transition is being gradually implemented, with the last students entering baccalaureate programs in 2022 (Commission on Accreditation of Athletic Training Education, 2018).

New standards, effective in 2020, direct professional education at the master’s degree level (Commission on Accreditation of Athletic Training Education, 2018). These standards detail the requirements for achieving and maintaining accreditation. One segment of the standards includes required curricular content. Broadly, programs must demonstrate that each student is competent in each curricular content standard in the context of actual patient care. The standards center around the following content areas: core competencies, development of care plans; examination, diagnosis, and intervention; prevention, health promotion, and wellness; and health care administration.

The core competencies describe behaviors that are central to providing quality health care: patient-centered care, interprofessional practice, evidence-based practice, quality improvement, health care informatics, and professionalism. Development of a care plan for the patient involves a systems approach to examination and treatment of patients with health conditions commonly seen in athletic training practice. These care plans include assessment of the patient on an ongoing basis, integrating patient- and clinician-reported outcomes, setting functional goals for the patient, and making timely decisions on discharge and referral. Examination, diagnosis, and treatment spans emergency care of life-threatening health conditions to postoperative rehabilitation. All components of patient care are addressed, including patient education, integration of a wide variety of interventions (e.g., therapeutic exercise, joint mobilization, orthotics, casting), education on pharmaceutical agents, and when referral to another provider is warranted. Two areas, concussion and behavioral health, are specifically identified as an educational necessity and are areas of research in athletic training. Identification and management of patients with concussions are emphasized, especially important given the public health concern of significant consequences and the frontline availability of ATs. The increase in behavioral health needs, including emergency planning, warrants specific training in this content area. Prevention of injury and illness has been at the foundation of athletic training since the very early years. Developing and implementing strategies to mitigate long-term health conditions while developing programs to help reduce risk of injury is at the core of this foundation. Finally, students must master administrative functions associated with health care delivery, which include resource management, navigating health insurance, and daily operations of a unit providing athletic training services.

State Regulation

As the profession of athletic training and the AT’s role in health care expanded, ATs began gaining statutory recognition and regulation at the state level. Licensure and certification ensure health professionals meet specific standards and continue to maintain their competence (Institute of Medicine [US] Committee on the Health Professions Education, 2003).

In 1971, Texas became the first state to have state mandated regulation for ATs and in 1977 Georgia mandated licensure. Since then, state-level regulations for ATs are at the forefront of the NATA Governmental Affairs Committee and the Governmental Affairs Committees of each athletic training state association. State-level AT regulations in the form of licensure or other regulation is now mandated in 49 states and the District of Columbia; 47 states have licensure bills, two have certification bills, and California continues efforts to add licensure (NATA, n.d.).

Degree of Integration of Athletic Training With Other Disciplinary Areas

Athletic training as a health care discipline lies centrally under the clinical practice umbrella of “sports medicine.” By legal standards, ATs work in collaboration with physicians; however, the medical specialty of the directing physician is not legally limited. Most often, ATs directing physicians are either board certified in orthopedic sports medicine or are primary care practitioners (e.g., pediatricians, family medicine physicians). Recently, more primary care physicians have earned a certificate of advanced qualification in sports medicine. The strong connection of athletic training to the medical disciplines of orthopedics and, to a lesser extent, physical medicine and rehabilitation exists because the majority of sport- and exercise-related health conditions are musculoskeletal injuries. Because nonmusculoskeletal health conditions are also common in athletes and other physically active patients, ATs also frequently work in conjunction with physicians who specialize in internal medicine, neurology, cardiology, and emergency medicine. ATs have been described as primary care sports medicine providers; however, specialization certainly occurs as individual ATs gain long-term experience in specific practice settings.

Because of the prevalence of musculoskeletal injuries stemming from sport and exercise, many ATs engage their patients in therapeutic exercise and rehabilitation activities. These clinical practice activities often parallel services provided by physical therapists. While many ATs are employed in outpatient rehabilitation clinics where ATs and physical therapists work together in treating patients, disputes between the two professions have occurred on occasion, particularly in regards to lobbying efforts related to legislation aimed to define the scope of clinical practice of ATs. In recent years, the NATA and American Physical Therapy Association have entered into multiple agreements aimed at strengthening interprofessional cooperation and improving the quality of patient care (NATA, 2018; Sitzler, 2021).

Outside of the health care arena, many ATs, especially those working in elite sport, have extensive collaborations with strength and conditioning specialists and sports scientists whose primary goals are to improve athletes’ sports performance. In this role, ATs provide an important bridge between the sports performance team members and sports medicine providers to ensure athletes’ health and well-being needs are fully addressed in demanding, competitive environments.

Research Trends in Athletic Training

ATs have made substantial contributions to sports medicine research in recent decades. Particular areas of advancement have been in the areas of health disparities, sport-related concussion, exertional heat illness, and musculoskeletal injury prevention and management, therapeutic interventions, and behavioral health. This research has often been multidisciplinary in nature spanning the fields of kinesiology, medicine, and public health.

Health Disparities

The ATs can play a helpful role in better understanding and crafting solutions for various health disparities based on race, gender, socioeconomic status, and other group identifiers. This work will require partnership with epidemiologists, health educators, health system leaders, and public policy makers. ATs’ roles as prehospital, “first point of contact” providers places them prominently among those disciplines that can ensure that all citizens enjoy the form of liberty to be found in freedom from group-related illness and injury (Noel-London et al., 2018; Post et al., 2019; Winkelmann et al., 2020).

Sport-Related Concussion

Sport-related concussion research has been built on foundations from the disparate disciplines of neuropsychology, motor control, and biomechanics. A better understanding about recognition, diagnosis, and management of those with sports-related concussion is central to much interdisciplinary research that involves ATs. Risk mitigation, including the impact of rule changes and sports participation guidelines are informed by research conducted by an AT (Broglio et al., 2014).

Exertional Heat Illness

Research related to how the human body responds to intense exercise in the heat has bridged the disciplines of exercise physiology and emergency medicine. Areas of research, including hydration, heat acclimatization, body cooling, work-to-rest ratios based on environmental conditions, exercise heat tolerance, and exertional heat illnesses, have greatly expanded our understanding of this topic. The prevention, recognition, and treatment of exertional heat stroke (EHS) have received considerable research attention in recent years with areas of focus, such as assessing the validity of different modes to determine core body temperature (and the establishment of rectal temperature as the gold standard), the effectiveness of different cooling modalities for rapid reduction of body temperature (cold water immersion [CWI] is most effective), and the need to bring body temperature down as fast as possible to limit number of minutes of severe hyperthermia to <30 min and the ensuing policy adaptations of cool first, transport second (Casa et al., 2015).

Musculoskeletal Injury and Prevention Strategies

Musculoskeletal injury research, while often grounded in the principles of clinical biomechanics, has also drawn on principles central to orthopedics and physical medicine and rehabilitation. Likewise, the importance of establishing sports injury patterns through large-scale injury surveillance studies and documenting patient-reported outcomes in the context of clinical trials have led athletic training researchers and clinicians to be fundamental contributors to important advances in the fields of epidemiology, evidence-based practice, and health psychology.

Therapeutic Interventions

In the area of therapeutic interventions, ATs are engaged in both laboratory-based, well-controlled studies, and point-of-care research that directly informs clinical practice (Lam et al., 2020). Practice-based research networks using electronic medical records form the foundation for gathering extensive data on intervention effectiveness.

Future Directions of Athletic Training

Athletic training will continue to evolve and refine its niche in health care with significant shifts expected in practice settings, models of care delivery, translational research, professional pathways, and expansion into the public health arena.

Changing Practice Settings

Historically, ATs primarily worked in traditional settings associated with high school, colleges and universities, and professional sports. As the number of ATs continues to rise, employment opportunities have expanded to physician practices, the military, hospitals, outpatient rehabilitation clinics, and the performing arts. This expansion is expected to continue as the value of ATs is quantified. For example, an examination of the outcomes associated with embedding AT services in Air Force military training revealed a 25% reduction in attrition secondary to lower-extremity health conditions for an estimated savings of over $10 million (Fisher et al., 2020). Adding an AT to a physician-run sports medicine clinic increased patient throughput by over 20%, improving the earning potential of the clinic (Nicolello, 2017).

Independent Medical Care Models

The ATs in secondary schools and colleges and universities have traditionally been hired through departments of athletics and are often supervised and/or evaluated by administrators or coaches who have a vested interest in wins and losses. This supervisory structure creates a potential conflict of interest in that the performance of the AT (and their subsequent job security) may be influenced by metrics more related to sports outcomes and less related to patient outcomes. Return-to-play decisions are especially vulnerable to this conflict of interest. ATs report that their medical decisions are subject to perceived pressure from coaches (Pike Lacy et al., 2020). Now, the National Collegiate Athletics Association charges institutional leaders to “create an administrative system where athletics healthcare professionals—team physicians and ATs—are able to make medical decisions with only the best interests of student-athletes at the forefront” (National Collegiate Athletics Association, 2013, p. 8).

Making this philosophical approach to patient-centered care explicit has resulted in a reconfiguration of administrative structures to models that align with health care delivery rather than sports. Alignment with institutions’ other health care units, such as student health services and university health systems, will likely become the norm, especially given evidence that such alignment decreases clinician patient load (Baugh et al., 2020), improves clinician job satisfaction (Eason et al., 2017), and reduces legal risk (Rapp & Ingersoll, 2019).

Professional Pathways: Residencies, Fellowships, Clinical Doctorates, and Specialty Certification

Formal educational opportunities for ATs will continue to expand with the growth of residency programs, fellowships, specialty certification, and clinical doctorate degrees. These pathways offer specialization in the discipline and provide practicing ATs with a structured and externally recognized career pathway.

Accredited residency programs, typically 12–15 months in duration and designed for practicing ATs, feature structured clinical and didactic instruction in a focused area of clinical practice, including prevention and wellness, urgent and emergent care, primary care, orthopedics, rehabilitation, behavioral health, pediatrics, and performance enhancement (Commission on Accreditation of Athletic Training Education, 2018). Fellowship programs, even more specialized than residency programs, will likely be developed in the coming years. Specialty certification, a process culminating in an examination, will develop to recognize and validate this advanced education. The BOC has established a Specialty Council to guide the development and credentialing of ATs in an area of specialization. The first specialty certification is in orthopedics (BOC, n.d.).

The opportunities to obtain clinical doctorates are expected to grow both to serve practicing ATs and provide clinically relevant faculty for professional programs—the scholarly clinician. Influenced by the transition to professional education at the master’s degree level (Van Lunen et al., 2021), Doctor of Athletic Training programs are offered in both online and residential versions and emphasize advanced clinical development, leadership, and scholarship.

Expanding Public Health’s Role

The ATs will contribute more in the public health arena in the coming years. The emphasis on prevention in athletic training education makes this evolution from efforts targeting the individual to population-based initiatives. Athletic training research in areas pertaining to public health issues, including areas like osteoarthritis (Palmieri-Smith et al., 2017) and injury prevention (Root et al., 2019), combined with a long history of injury surveillance point to important connections to population-based health (Hoffman et al., 2019). Development of health care delivery systems for secondary school athletes with a broader, data-guided approach—across a school district, for example—extends the impact of AT services and more broadly impacts health (Shanely et al., 2019). These types of initiatives are expected to grow as the health care system’s emphasis on both access to care and preventive care grows.

Hot Topics and Big Questions

Athletic training developed into a profession closely allied to sport, physical education, and the broader subfields of kinesiology. We hope that the readers of this paper can clearly discern that the profession has evolved into a bona fide health care profession. Its future is in the world of health care. Athletic training has since evolved academically to schools and departments outside of kinesiology in some places but the collaboration between the two disciplines will remain strong. What follows will help readers better understand the challenges related to this future state.

As we consider the future of the athletic training profession as of this writing in 2021, we must take a close look at five big issues currently being confronted by athletic training educators. These issues, and how they are resolved, will play an important role in the future strength of the profession and the competencies of the professionals. It is critical to note that the inclusion of these as “hot topics” does not infer that these issues are inherently negative; instead, we pose them as challenges and opportunities for continued growth. If these topics are adequately addressed, the profession will be in a much better place 10 years from now as compared with where it is now. Confronting these tough issues head on will likely create tension among some who do not see change as necessary, but we and seven current athletic training educators nationally with whom we spoke feel strongly that these are critical challenges that must be addressed. Five hot topics for the near future of the athletic training educational process include the following topics.

The Move to an Entry-Level Graduate Educational Model

One of the two most dramatic shifts in the educational process of athletic training is currently unfolding. About 20 years ago, the profession went through another major change when it moved to requiring accreditation of educational programs and funneled the options to sit for the exam to a single option of graduating from an accredited program that underwent a rigorous process of approval to be a credentialed athletic training program. That shift caused much distress for some traditionalists who believed the foundation of the educational process should be hands-on learning and the accumulation of “hours” in the field. The shift toward a structured process of core competencies that needed to be delivered in a formal educational setting was a big step in moving the profession in line with other health care programs. Now we stand at a similar seismic shift. If an educational program is going to continue with offering an accredited athletic training program, they must shift toward an entry-level graduate program (MSAT) and no longer can be accredited via an undergraduate athletic training program. This change brings about many issues that must be addressed. In the past, many students chose athletic training as a major as an undergraduate student in an accredited program and pursued the certification exam upon graduation. Many often did not plan to stay in the athletic training profession as the long-term career option, they simply pursued an undergraduate major that would be interesting and offer the opportunity to take prerequisites that would apply for the ultimate career objective (e.g., PT, OT, RN, MD, PA).

The shift in educational pathway to become an AT eliminates all of these students who would have traditionally sought the profession. If someone enrolls in a graduate athletic training program now, it is hoped that they chose athletic training as the long-term career pathway. This shift will cause a short-term decrease in ATs nationally but will help long term by creating a situation in which those we are educating will have the ambition to utilize the knowledge, skills, and experiences that are being imparted during the accredited graduate program. Many traditional athletic training programs will not be able to continue in this model for various reasons. Some of these reasons are logistical; for example, the school does not offer graduate programs so simply cannot move into this model. Others will drop because the short-term decrease in student numbers will not be economically feasible for supporting the faculty/costs inherent in running the program. Others will not continue because they had been running athletic training simply as an incentive of recruiting undergraduate students onto campus and no longer have this as a viable strategy. Innovative programs will still bring interested students on campus and offer pre-AT programs and 3 + 2 accelerated degree structures so that they recruit undergraduate students and retain those students as graduate students.

The next 5–10 years will certainly be transitional for the educational model and the profession as a whole. We believe the modifications to the educational model will enhance many elements that will bring us in line with our peer medical professions, such as PT, PA, OT, and RN. When salaries, retention, and job satisfaction are enhanced, these educational changes will prove to have been wise, as discussed below.

Salary and Retention

Another important issue facing the recruitment of AT students is the current salaries of athletic training professionals. Given that ATs start at a much lower income than their peers in other allied health professions and have lower midcareer average salaries, many prospective students shy away from athletic training. Some of the starting salaries currently being offered to entry-level ATs are not commensurate with their education and qualifications, partly as a result of a system that has accredited too many athletic training programs and sent too many young professionals into the field willing to accept these poor salaries. The best way to combat low salaries in a flooded market is to decrease supply and increase the quality of those remaining. Given the elimination of some athletic training programs and the decrease in the number of nationwide grads per year, the equation will begin to shift so that the AT professional has a stronger negotiating position from which to discuss salary and other job-specific incentives. All of these factors will also likely increase retention because, if salary is comparable and job satisfaction is high, the incentive to move to a lateral job position for a better salary will decrease.

Diversity in the Profession

Like other health care professions, expanding diversity in the profession is a significant challenge to athletic training. Lack of diversity is one of the most important issues facing the athletic training profession. A close look at the numbers is critical in understanding the need to mobilize for change. Adams et al. (2021) take a deep dive into the current racial background of the United States as a whole and how it compares with the current make-up of the athletic training profession. The data provide a glimpse into why the profession has recently begun to prioritize diversity, equity, and inclusion (Adams et al., 2021). The paper reports (p. 129),

As of June 2020, 81.17% (n = 30 895) of the NATA’s 38 063 members identified as non-Hispanic White. Only 3.79% (n = 1441) identified as non-Hispanic Black or African American, 5.27% (n = 2007) as Hispanic, 4.1% (n = 1561) as Asian or Pacific Islander, 2.1% (n = 799) as multiple ethnicities, and 2.42% (n = 920) as other.

In a profession where many ATs regularly work with a patient population that is extremely diverse, those providing the services are far less diverse than the populations they are serving and the country as whole by a very wide margin. Examining all the reasons for this disparity is beyond the scope of this paper. Athletic training and AT educators have recognized the need to increase focus on diversity, equity, and inclusion and are working to ensure this focus remains in the future. Most recently, the NATA created a LGBTQ + Advisory Committee and the associated “Safe Space Ally” training (Adams et al., 2021). Furthermore, the NATAs Ethnic Diversity Advisory Committee continues to advocate for cultural sensitivity and cultural competence for the AT. One example of this is the development of the NATA’s six-phase Diversity, Equity, and Inclusion Response Plan (Adams et al., 2021). Most other peer health care professions face similar struggles in the realm of having a diverse population of professionals (Perrin, 2003).

Some options to assist with diversity, equity, and inclusion in athletic training education programs would be to increase the diversity of the athletic training faculty ranks so that all students being recruited can feel more comfortable. In addition, looking to add programs at colleges that have strong traditions of serving diverse populations would increase access to those who are considering the profession. Also, as Adams et al. (2021) note, we need to consider specific elements of the selection process of getting into programs, such as the Graduate Record Examination (GRE) requirement and the BOC exam to examine if racial biases in the standardized testing process makes it harder for certain individuals to enter the profession. Standardized testing has been a controversial topic for many years (Clayton, 2016). Arguments have been made that the cost of the GRE score alone can be a limiting factor for some students who wish to apply to graduate school. Preparation for the exam can also be costly, given the number of required books and the desire for private tutors (Clayton, 2016). Miller and Stassun (2014) state that we rely far too heavily on these exams for admissions into graduate programs even though the exam is a poor predictor of capable students and restricts women and minorities into the sciences. Some schools are eliminating the GRE as a requirement for admission or at least moving it to an optional undertaking.

These are important steps to eliminate a testing process that offers no credible benefit to identifying future ATs. An added benefit of the move to the entry-level graduate education programs will hopefully be that many of the diverse populations currently being served as athletes in the collegiate setting can now pursue athletic training as a career goal post undergraduate education. Previously, nearly all collegiate athletes could not pursue athletic training while also being a college athlete because the time demands of both endeavors often made the educational programs impossible for athletes to pursue (especially at Division I athletic programs).

Marketing the Profession and Clearly Delineating Our Place in the Health Care System

A constant struggle of the athletic training profession has been the process of marketing to and educating the public about what we do and how these services can enhance the health care model and efficiently reduce costs. Geisler (2018) speaks to the issue of recruiting athletic training students and some of the historical concepts that have to be addressed. Some of the struggles have been said to stem from what some say is the misleading name of the profession. We have delivered countless sessions to prospective students and their parents who are looking at college options and/or major choices and have to explain what an AT is. The name “trainer” is often connected with personal trainer, a professional who works to enhance the fitness and health of a client by developing proper exercise regimens. This misunderstanding makes it difficult for people to realize that ATs are licensed health care professionals.

If we had a crystal ball and could see the future from 50 years ago, it certainly may have been wise to change the name of the profession to “athletic therapist” or some other clever name that captures the gamut of what ATs actually do. In recent years, the profession came to realize that a name change at this juncture would be a disservice to all of the recent efforts to advance the profession. Given this, we need to work hard in the educational setting to market the profession well so that we educate the public about the exciting prospects within the profession of athletic training. One great example of the amazing ability of ATs is that they are specifically trained to prevent sudden death during physical activity, whether for an athlete, warfighter, or laborer, an AT is eminently qualified to identify and provide initial care for head injuries, EHS, cardiac emergencies, exertional sickling, and many other potentially fatal events. This fact, in and of itself, is a major marketing tool for the profession: No other health care profession is on-site as these emergencies occur and is ready to respond immediately.

In addition, it is key that we correct individuals who speak of athletic training as inferior to other health care professions. It is likely that since the health care profession of athletic training emanated from athletics instead of out of the traditional hospital-based health care model, we have been left trying to work our way into the traditional health system. Some infrastructure stratifications have also placed ATs below other similar health care professionals to the detriment of all involved. As an example, an AT should not be reporting to a PT as a matter of course. It is critical that we continue efforts in this regard. In addition, a few states still do not have athletic training licensure, and it will prove to be a critical aspect of future professional stature that this is rectified.

Preceptors and Professionals Staying Up to Date With Current Best Practices

A constant struggle we face in our profession is the seeming constant presence of ATs who are not actively keeping up with best practices. The work of the Korey Stringer Institute has clearly shown that many key educational items are not being implemented by a large number of ATs. For example, the concept of CWI to treat EHS can be examined. When CWI is utilized immediately following collapse and the patient’s body temperature is lowered to <104 °F in under 30 min, there has been 100% survivability from EHS. This information has been widely shared for the past 20 years in NATA sponsored consensus statement, position statements, and education competencies. Yet, recent evidence by Kerr et al. (2019) has shown that approximately 50% of ATs working at the high school level recently reported not using CWI to treat EHS. In 2011, the educational competencies for ATs were updated to include the addition of various acute care skills to help stabilize a patient before emergency medical services transport an athlete (Commission on Accreditation of Athletic Training Education, 2011). The new competencies went beyond Basic Life Support CPR certification and included measuring core body temperature, CWI, and simple airway adjunct devices to name a few.

We ask why are life-saving skills like this often not being taught in programs or implemented in the field? When we are working diligently to add ATs to every high school in America, it is imperative that they implement best practices. The BOC standards of professional practice state that all ATs are required to maintain continued competence (BOC, 2016). The BOC maintenance requirements state that due to the ever-changing world of health care and athletic training, continuing education requirements are meant to ensure ATs explore new knowledge in specific content areas and master new athletic training-related skills and techniques (Board of Certification, Inc., 2021). The BOC (2021) certification maintenance requirements state that with the advancements made in athletic training, it is the ongoing responsibility of every AT to maintain a minimal level of competence (that of an entry level AT) regardless of the setting in which they are working.

Many of the authors of this paper went through our educational programs before the advent of portable automatic external defibrillators, CWI, wet-bulb globe temperature, sickle-cell trait knowledge, and yet what we learned in school does not dictate our current clinical practice. We are held to a professional standard of delivering the best health care as it is known currently. State athletic training associations, the NATA, state license boards, and others need to hold the profession accountable to meet the highest standard so that the public comes to expect these standards will be met by all ATs. It is also critical that every athletic training education program in America incorporates these best practice items into the yearly training with preceptors.

Conclusion

Athletic training has undergone many changes since its “early years” and is far from being a collection of coaches and ancillary staff that specialize in stretches and massages. Now recognized health care professionals, ATs serve as a vital part of the health care team and are often the first to recognize, manage, and treat injuries and illnesses. The growing body of original research in athletic training has led to advances in the clinical management of common sports injuries including concussion, musculoskeletal injuries, and exertional heat illness. As the profession transitions to a masters level degree, it is faced with numerous challenges, including recruiting students, competitive salaries, and establishing its place in the health care arena. The expansion of clinical settings for the AT has resulted in practicing within the medical model versus “athletics,” and students have many more opportunities postgraduation to pursue advanced practice within residencies, doctorate of athletic training programs, and clinical specialties. Athletic training will continue to grow and focus its efforts on quality educational opportunities that include clinical placements with a wide variety of opportunities and critical thinking elements for their students. The continued growth of the profession will bring about diversity in clinicians, cultural competence, and evidence-based practitioners.

References

  • Adams, W.M., Terranova, A.B., & Belval, L.N. (2021). Addressing diversity, equity, and inclusion in athletic training: Shifting the focus to athletic training education. Journal of Athletic Training, 56(2), 129133. PubMed ID: 33596597 https://doi.org/10.4085/1062-6050-0558-20

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Baugh, C.M., Kroshus, E., Lanser, B.L., Lindley, T.R., & Meehan, W.P. (2020). Sports medicine staffing across National Collegiate Athletic Association Division I, II, and III schools: Evidence for the medical model. Journal of Atheltic Training, 55(6), 573579. https://doi.org/10.4085/1062-6050-0463-19

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Board of Certification, Inc. (2016, May). BOC standards of professional practice. http://www.bocatc.org/system/document_versions/versions/60/original/boc-standards-of-professional-practice-2016-201710

    • Search Google Scholar
    • Export Citation
  • Board of Certification, Inc. (n.d.). Specialty certification. https://www.bocatc.org/at-specialties/specialty-certification/specialty-council/specialty-council

    • Search Google Scholar
    • Export Citation
  • Board of Certification, Inc. (2020). 2020 annual report. https://7f6907b2.flowpaper.com/2020BOCAnnualReport/#page=1

  • Board of Certification, Inc. (2021a). Maintain certification. https://www.bocatc.org/athletic-trainers/maintain-certification/continuing-education/continuing-education

    • Search Google Scholar
    • Export Citation
  • Board of Certification, Inc. (2021b). What is the BOC? https://www.bocatc.org/about-us/what-is-the-boc

  • Broglio, S.P., Contu, R.C., Gioia, G.A., Guskiewicz, K.M., Kutcher, J., Palm, M., & Valovich McCleod, T.C. (2014). National Athletic Trainers’ Association position statement: Management of sport related concussion. Journal of Athletic Training, 49(2), 245265. PubMed ID: 24601910 https://doi.org/10.4085/1062-6050-49.1.07

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Casa, D.J., DeMartini, J.K., Bergeron, M.F., Csillan, D., Eichner, E.R., Lopez, R.M., . . . Yeargin, S.W. (2015). National Athletic Trainers’ Association position statement: Exertional heat illnesses. Journal of Athletic Training, 50(9), 9861000. PubMed ID: 26381473 https://doi.org/10.4085/1062-6050-50.9.07

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Clayton, V. (2016, March 2). The problem with the GRE score. https://www.theatlantic.com/education/archive/2016/03/the-problem-with-the-gre/471633/

    • Search Google Scholar
    • Export Citation
  • Commission on Accreditation of Athletic Training Education. (n.d.-a). Historical overview. ∼https://caate.net/historical-overview/#:∼:text=The%20Joint%20Review%20Committee%20on,in%20Texas%20in%20October%201991.

    • Search Google Scholar
    • Export Citation
  • Commission on Accreditation of Athletic Training Education. (n.d.-b). Residency programs. https://caate.net/residency-programs

  • Commission on Accreditation of Athletic Training Education. (2011). 5th edition athletic training educational competencies. https://caate.net/wp-content/uploads/2014/06/5th-Edition-Competencies.pdf

    • Search Google Scholar
    • Export Citation
  • Commission on Accreditation of Athletic Training Education. (2018, January 9). 2020 Standards for accreditation of professional athletic training programs. https://caate.net/wp-content/uploads/2018/09/2020-Standards-for-Professional-Programs-copyedited-clean.pdf

    • Search Google Scholar
    • Export Citation
  • Delforge, G.D., & Behnke, R.S. (1999). The history and evolution of athletic training education in the United States. Journal of Athletic Training, 34(1), 5361. PubMed ID: 16558550

    • Search Google Scholar
    • Export Citation
  • Eason, C.M., Mazerolle, S.M., & Goodman, A. (2017). Organizational infrastructure in the collegiate athletic training setting, part III: Benefits of and barriers in the medical and academic models. Journal of Athletic Training, 52(1), 3544. PubMed ID: 27977302 https://doi.org/10.4085/1062-6050-51.12.25

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Ebel, R.G. (1999). Far beyond the shoe box: Fifty years of the National Atheltic Trainers’ Association. Forbes.

  • Fisher, R., Esparza, S., Nye, N.S., Gottfredson, R., Pawlak, M.T., Cropper, T.L., . . . Webber, B.J. (2020). Outcomes of embedded athletic training services within United States Air Force basic military training. Journal of Athletic Training, 56(2), 134140. https://doi.org/10.4085/1062-6050-0498.19

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Geisler, P.R. (2018). I wanna go to AT school (Said no one, ever). Journal of Athletic Training, 53(10), 921925. PubMed ID: 30339046 https://doi.org/10.4085/1062-6050-564-17.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Grace, P. (1999). Milestones in athletic trainer certification. Journal of Athletic Training, 34(4), 285291.

  • Grantham, J. (2015, February). Cultural competence and diversity in athletic training. NATA News. https://nata.org/stites/default/files/cultural-competence-diversity-athletic-training.pdf

    • Search Google Scholar
    • Export Citation
  • Hoffman, M.A., Johnson, S.T., & Norcoross, M.F. (2019). The intersection of athletic training and public health. Journal of Athletic Training, 54(2), 121 . PubMed ID: 30951382 https://doi.org/10.4085/1062-6050-54-02

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Institute of Medicine (US) Committee on the Health Professions Education. (2003). Chapter 5, Health professions oversight processes: What they do and do not do, and what they could do. In E. Knebel & A.C. Greiner (Eds.), Health professions education: A bridge to quality. National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK221526/

    • Search Google Scholar
    • Export Citation
  • Kerr, Z.Y., Scarneo-Miller, S.E., Yeargin, S.W., Grundstein, A.J., Casa, D.J., Pryor, R.R., & Register-Mihalik, J.K. (2019). Exertional heat-stroke preparedness in high school football by region and state mandate presence. Journal of athletic training, 54(9), 921928. PubMed ID: 31454289 https://doi.org/10.4085/1062-6050-581-18

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kutz, M.R. (2019). Leadership and management in athletic training: An integrated approach. Jones and Bartlett.

  • Lam, K.C., Welch Bacon, C.E., Sauers, E.L., & Bay, R. (2020). Point-of-care clinical trials in sports medicine research: Identifying effective treatment interventions through comparative effectiveness research. Journal of Athletic Training, 55(3), 217228. PubMed ID: 31618071 https://doi.org/10.4085/1062-6050-307-18

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Miller, C., & Stassun, K. (2014). A test that fails. Nature, 510(7504), 303304. https://doi.org/10.1038/nj7504-303a

  • National Athletic Trainers’ Association. (n.d.). Athletic training state regulatory boards. https://members.nata.org/gov/state/regulatory-boards/map.cfm

    • Search Google Scholar
    • Export Citation
  • National Athletic Trainers’ Association. (2018a, November). Explore NATA 2018 salary survey results. https://members.nata.org/members1/salraysurvey2018.results.cfm

    • Search Google Scholar
    • Export Citation
  • National Athletic Trainers’ Association. (2018b, December 19). NATA and APTA Commit to greater collaboration and joint efforts to promote quality care. https://www.nata.org/nr12092018

    • Search Google Scholar
    • Export Citation
  • National Athletic Trainers’ Association. (2020a). Athletic training glossary. https://www.nata.org/about/athletic-training/athletic-training-glossary

    • Search Google Scholar
    • Export Citation
  • National Athletic Trainers’ Association. (2020b). Education overview. https://www.nata.org/about/athletic-training/education-overview

  • National Athletic Trainers’ Association. (2020c). Introduction to third party reimbursement. https://www.nata.org/introduction-third-party-reimbursement

    • Search Google Scholar
    • Export Citation
  • National Athletic Trainers’ Association. (2020d). Statements. https://www.nata.org/news-publications/pressroom/statements

  • National Collegiate Athletics Association. (2013, August). 2013-2014 sports medicine handbook. Guideline 1B—Interdisciplinary Health Care Teams. https://www.ncaa.org/sites/default/files/SMHB%20Mental%20Health%20INterventions.pdf

    • Search Google Scholar
    • Export Citation
  • Nicolello, T.S. (2017). Patient throughput in a sports medicine clinic with the implementation of an athletic trainer: A retrospective analysis. Sports Health, 9(1), 7074. PubMed ID: 27799568 https://doi.org/10.1177/1941738116676452

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Noel-London, K., Beritback, A., & Beleue, R. (2018). Filling the gaps in adolescent care and school health policy-tackling health disparities through sports medicine integration. Healthcare, 6(4), 132. https://doi.org/10.3390/healthcare6040132

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Palmieri-Smith, R.M., DiStefano, L.J., Driban, J.B., Pietrosimone, B., Thomas, A.C., Tourville, T.W., & Athletic Trainers’ Osteoarthritis Consortium. (2017). The role of athletic trainers in preventing and managing posttraumatic osteoarthritis in physically active populations: A consensus statement of the Athletic Trainers’ Osteoarthritis Consortium. Journal of Athletic Training, 52(6), 610623. PubMed ID: 28653866 https://doi.org/10.4085/1062-6050-52.2.04

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Perrin, D.H. (2003, April). Why diversity is important. NATA News, pp. 2021.

  • Pike Lacy, A.M., Bownam, T.G., & Singe, S.M. (2020). Challenges faced by collegiate athletic trainers, part I: Organizational conflict and clinical decision making. Journal of Athletic Training, 55(3), 303311. https://doi.org/10.4085/1062-6050-84-19

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Post, E., Winterstein, A.P., Hetzel, S.J., Lutes, B., & McGuine, T.A. (2019). School and community socioeconomic status and access to athletic trainer services in Wisconsin secondary schools. Journal of Athletic Training, 54(2), 177181. PubMed ID: 30398929 https://doi.org/10.4085/1062-6050-440-17

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rapp, G.R., & Ingersoll, C.D. (2019). Sports medicine delivery models: Legal risks. Journal of Athletic Training, 54(12), 12371240. PubMed ID: 31642711 https://doi.org/10.4085/1062-6050-83-19

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Root, H.J., Frank, B.S., Denegar, C.R., Casa, D.J., Gregorio, D.I., Mazerolle, S.M., & Distefano, L.J. (2019). Application of a preventive training program implementation framework to youth soccer and basketball organizations. Journal of Athletic Training, 54(2), 182191. PubMed ID: 30855986 https://doi.org/10.4085/1062-6050-375-17

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Shanely, E., Thigpen, C.A., Chapman, C.G., Thorpe, J., Gilliland, R.G., & Sease, W.F. (2019). Athletic trainers’ effect on population health: Improving access to and quality of care. Journal of Athletic Training, 54(2), 124132. https://doi.org/10.4085/1062-6050-219-17

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Sitzler, B. (2021, February 4). NATA, APTA adopt joint policy principles. https://www.nata.org/blog/beth-sitzler/nata-apta-adopt-joint-policy-principles

    • Search Google Scholar
    • Export Citation
  • Van Lunen, B.L., Clines, S.H., Reems, T., Eberman, L.E., Hankemeier, D.A., & Welch Bacon, C.E. (2021). Employability in academe for athletic trainers with the Doctor of Athletic Training degree. Journal of Athletic Training, 56(3), 220226. https://doi.org/10.4085/1062-6050-0253.20

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Weidner, T.G., & Henning, J.M. (2002). Historical perspective of athletic training clinical education. Journal of Athletic Training, 37(Suppl. 4), S222S228.

    • Search Google Scholar
    • Export Citation
  • Winkelmann, Z.K., Games, K.E., Rivera, M.J., Neil, E.R., & Eberman, L.E. (2020). Athletic trainers’ knowledge and practice application of public health topics. Athletic Training Education Journal, 15(4), 308320. https://doi.org/10.4085/1947-380X-19-047

    • Crossref
    • Search Google Scholar
    • Export Citation
  • World Federation of Athletic Training and Therapy. (2019). https://www.wfatt.org

  • Youth Sports Safety Alliance. (2018). Alliance members. https://www.youthsportssafteyalliance.org/allianceMembers

Diakogeorgiou and Casa are with the Dept. of Kinesiology, University of Connecticut, Storrs, CT, USA; Diakogeorgiou is also with Athletic Training, and Casa, the Korey Stringer Inst., at the university. Ray is with the Dept. of Kinesiology, Hope College, Holland, MI, USA. Brown is with Boston University, Boston, MA, USA. Hertel is with the Dept. of Kinesiology, University of Virginia, Charlottesville, VA, USA.

Diakogeorgiou (eleni.diakogeorgiou@uconn.edu) is corresponding author.
  • View in gallery

    —The early years in athletic training. AT = athletic trainer; NATA = National Athletic Trainers’ Association.

  • View in gallery

    —The evolution of the athletic training profession 1950–1999. AT = athletic training; BOC = Board of Certification; NATA = National Athletic Trainers’ Association; AMA = American Medical Association; CAAHEP = Commission on Accreditation of Allied Health Programs.

  • View in gallery

    —The evolution of the athletic training profession 2000–2022. CAATE = Commission on Accreditation of Athletic Training Education; CAAHEP = Commission on Accreditation of Allied Health Education Programs; BOC = Board of Certification; NATA = National Athletic Trainers’ Association.

  • Adams, W.M., Terranova, A.B., & Belval, L.N. (2021). Addressing diversity, equity, and inclusion in athletic training: Shifting the focus to athletic training education. Journal of Athletic Training, 56(2), 129133. PubMed ID: 33596597 https://doi.org/10.4085/1062-6050-0558-20

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Baugh, C.M., Kroshus, E., Lanser, B.L., Lindley, T.R., & Meehan, W.P. (2020). Sports medicine staffing across National Collegiate Athletic Association Division I, II, and III schools: Evidence for the medical model. Journal of Atheltic Training, 55(6), 573579. https://doi.org/10.4085/1062-6050-0463-19

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Board of Certification, Inc. (2016, May). BOC standards of professional practice. http://www.bocatc.org/system/document_versions/versions/60/original/boc-standards-of-professional-practice-2016-201710

    • Search Google Scholar
    • Export Citation
  • Board of Certification, Inc. (n.d.). Specialty certification. https://www.bocatc.org/at-specialties/specialty-certification/specialty-council/specialty-council

    • Search Google Scholar
    • Export Citation
  • Board of Certification, Inc. (2020). 2020 annual report. https://7f6907b2.flowpaper.com/2020BOCAnnualReport/#page=1

  • Board of Certification, Inc. (2021a). Maintain certification. https://www.bocatc.org/athletic-trainers/maintain-certification/continuing-education/continuing-education

    • Search Google Scholar
    • Export Citation
  • Board of Certification, Inc. (2021b). What is the BOC? https://www.bocatc.org/about-us/what-is-the-boc

  • Broglio, S.P., Contu, R.C., Gioia, G.A., Guskiewicz, K.M., Kutcher, J., Palm, M., & Valovich McCleod, T.C. (2014). National Athletic Trainers’ Association position statement: Management of sport related concussion. Journal of Athletic Training, 49(2), 245265. PubMed ID: 24601910 https://doi.org/10.4085/1062-6050-49.1.07

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Casa, D.J., DeMartini, J.K., Bergeron, M.F., Csillan, D., Eichner, E.R., Lopez, R.M., . . . Yeargin, S.W. (2015). National Athletic Trainers’ Association position statement: Exertional heat illnesses. Journal of Athletic Training, 50(9), 9861000. PubMed ID: 26381473 https://doi.org/10.4085/1062-6050-50.9.07

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Clayton, V. (2016, March 2). The problem with the GRE score. https://www.theatlantic.com/education/archive/2016/03/the-problem-with-the-gre/471633/

    • Search Google Scholar
    • Export Citation
  • Commission on Accreditation of Athletic Training Education. (n.d.-a). Historical overview. ∼https://caate.net/historical-overview/#:∼:text=The%20Joint%20Review%20Committee%20on,in%20Texas%20in%20October%201991.

    • Search Google Scholar
    • Export Citation
  • Commission on Accreditation of Athletic Training Education. (n.d.-b). Residency programs. https://caate.net/residency-programs

  • Commission on Accreditation of Athletic Training Education. (2011). 5th edition athletic training educational competencies. https://caate.net/wp-content/uploads/2014/06/5th-Edition-Competencies.pdf

    • Search Google Scholar
    • Export Citation
  • Commission on Accreditation of Athletic Training Education. (2018, January 9). 2020 Standards for accreditation of professional athletic training programs. https://caate.net/wp-content/uploads/2018/09/2020-Standards-for-Professional-Programs-copyedited-clean.pdf

    • Search Google Scholar
    • Export Citation
  • Delforge, G.D., & Behnke, R.S. (1999). The history and evolution of athletic training education in the United States. Journal of Athletic Training, 34(1), 5361. PubMed ID: 16558550

    • Search Google Scholar
    • Export Citation
  • Eason, C.M., Mazerolle, S.M., & Goodman, A. (2017). Organizational infrastructure in the collegiate athletic training setting, part III: Benefits of and barriers in the medical and academic models. Journal of Athletic Training, 52(1), 3544. PubMed ID: 27977302 https://doi.org/10.4085/1062-6050-51.12.25

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Ebel, R.G. (1999). Far beyond the shoe box: Fifty years of the National Atheltic Trainers’ Association. Forbes.

  • Fisher, R., Esparza, S., Nye, N.S., Gottfredson, R., Pawlak, M.T., Cropper, T.L., . . . Webber, B.J. (2020). Outcomes of embedded athletic training services within United States Air Force basic military training. Journal of Athletic Training, 56(2), 134140. https://doi.org/10.4085/1062-6050-0498.19

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Geisler, P.R. (2018). I wanna go to AT school (Said no one, ever). Journal of Athletic Training, 53(10), 921925. PubMed ID: 30339046 https://doi.org/10.4085/1062-6050-564-17.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Grace, P. (1999). Milestones in athletic trainer certification. Journal of Athletic Training, 34(4), 285291.

  • Grantham, J. (2015, February). Cultural competence and diversity in athletic training. NATA News. https://nata.org/stites/default/files/cultural-competence-diversity-athletic-training.pdf

    • Search Google Scholar
    • Export Citation
  • Hoffman, M.A., Johnson, S.T., & Norcoross, M.F. (2019). The intersection of athletic training and public health. Journal of Athletic Training, 54(2), 121 . PubMed ID: 30951382 https://doi.org/10.4085/1062-6050-54-02

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Institute of Medicine (US) Committee on the Health Professions Education. (2003). Chapter 5, Health professions oversight processes: What they do and do not do, and what they could do. In E. Knebel & A.C. Greiner (Eds.), Health professions education: A bridge to quality. National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK221526/

    • Search Google Scholar
    • Export Citation
  • Kerr, Z.Y., Scarneo-Miller, S.E., Yeargin, S.W., Grundstein, A.J., Casa, D.J., Pryor, R.R., & Register-Mihalik, J.K. (2019). Exertional heat-stroke preparedness in high school football by region and state mandate presence. Journal of athletic training, 54(9), 921928. PubMed ID: 31454289 https://doi.org/10.4085/1062-6050-581-18

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kutz, M.R. (2019). Leadership and management in athletic training: An integrated approach. Jones and Bartlett.

  • Lam, K.C., Welch Bacon, C.E., Sauers, E.L., & Bay, R. (2020). Point-of-care clinical trials in sports medicine research: Identifying effective treatment interventions through comparative effectiveness research. Journal of Athletic Training, 55(3), 217228. PubMed ID: 31618071 https://doi.org/10.4085/1062-6050-307-18

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Miller, C., & Stassun, K. (2014). A test that fails. Nature, 510(7504), 303304. https://doi.org/10.1038/nj7504-303a

  • National Athletic Trainers’ Association. (n.d.). Athletic training state regulatory boards. https://members.nata.org/gov/state/regulatory-boards/map.cfm

    • Search Google Scholar
    • Export Citation
  • National Athletic Trainers’ Association. (2018a, November). Explore NATA 2018 salary survey results. https://members.nata.org/members1/salraysurvey2018.results.cfm

    • Search Google Scholar
    • Export Citation
  • National Athletic Trainers’ Association. (2018b, December 19). NATA and APTA Commit to greater collaboration and joint efforts to promote quality care. https://www.nata.org/nr12092018

    • Search Google Scholar
    • Export Citation
  • National Athletic Trainers’ Association. (2020a). Athletic training glossary. https://www.nata.org/about/athletic-training/athletic-training-glossary

    • Search Google Scholar
    • Export Citation
  • National Athletic Trainers’ Association. (2020b). Education overview. https://www.nata.org/about/athletic-training/education-overview

  • National Athletic Trainers’ Association. (2020c). Introduction to third party reimbursement. https://www.nata.org/introduction-third-party-reimbursement

    • Search Google Scholar
    • Export Citation
  • National Athletic Trainers’ Association. (2020d). Statements. https://www.nata.org/news-publications/pressroom/statements

  • National Collegiate Athletics Association. (2013, August). 2013-2014 sports medicine handbook. Guideline 1B—Interdisciplinary Health Care Teams. https://www.ncaa.org/sites/default/files/SMHB%20Mental%20Health%20INterventions.pdf

    • Search Google Scholar
    • Export Citation
  • Nicolello, T.S. (2017). Patient throughput in a sports medicine clinic with the implementation of an athletic trainer: A retrospective analysis. Sports Health, 9(1), 7074. PubMed ID: 27799568 https://doi.org/10.1177/1941738116676452

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Noel-London, K., Beritback, A., & Beleue, R. (2018). Filling the gaps in adolescent care and school health policy-tackling health disparities through sports medicine integration. Healthcare, 6(4), 132. https://doi.org/10.3390/healthcare6040132

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Palmieri-Smith, R.M., DiStefano, L.J., Driban, J.B., Pietrosimone, B., Thomas, A.C., Tourville, T.W., & Athletic Trainers’ Osteoarthritis Consortium. (2017). The role of athletic trainers in preventing and managing posttraumatic osteoarthritis in physically active populations: A consensus statement of the Athletic Trainers’ Osteoarthritis Consortium. Journal of Athletic Training, 52(6), 610623. PubMed ID: 28653866 https://doi.org/10.4085/1062-6050-52.2.04

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Perrin, D.H. (2003, April). Why diversity is important. NATA News, pp. 2021.

  • Pike Lacy, A.M., Bownam, T.G., & Singe, S.M. (2020). Challenges faced by collegiate athletic trainers, part I: Organizational conflict and clinical decision making. Journal of Athletic Training, 55(3), 303311. https://doi.org/10.4085/1062-6050-84-19

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Post, E., Winterstein, A.P., Hetzel, S.J., Lutes, B., & McGuine, T.A. (2019). School and community socioeconomic status and access to athletic trainer services in Wisconsin secondary schools. Journal of Athletic Training, 54(2), 177181. PubMed ID: 30398929 https://doi.org/10.4085/1062-6050-440-17

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rapp, G.R., & Ingersoll, C.D. (2019). Sports medicine delivery models: Legal risks. Journal of Athletic Training, 54(12), 12371240. PubMed ID: 31642711 https://doi.org/10.4085/1062-6050-83-19

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Root, H.J., Frank, B.S., Denegar, C.R., Casa, D.J., Gregorio, D.I., Mazerolle, S.M., & Distefano, L.J. (2019). Application of a preventive training program implementation framework to youth soccer and basketball organizations. Journal of Athletic Training, 54(2), 182191. PubMed ID: 30855986 https://doi.org/10.4085/1062-6050-375-17

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Shanely, E., Thigpen, C.A., Chapman, C.G., Thorpe, J., Gilliland, R.G., & Sease, W.F. (2019). Athletic trainers’ effect on population health: Improving access to and quality of care. Journal of Athletic Training, 54(2), 124132. https://doi.org/10.4085/1062-6050-219-17

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Sitzler, B. (2021, February 4). NATA, APTA adopt joint policy principles. https://www.nata.org/blog/beth-sitzler/nata-apta-adopt-joint-policy-principles

    • Search Google Scholar
    • Export Citation
  • Van Lunen, B.L., Clines, S.H., Reems, T., Eberman, L.E., Hankemeier, D.A., & Welch Bacon, C.E. (2021). Employability in academe for athletic trainers with the Doctor of Athletic Training degree. Journal of Athletic Training, 56(3), 220226. https://doi.org/10.4085/1062-6050-0253.20

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Weidner, T.G., & Henning, J.M. (2002). Historical perspective of athletic training clinical education. Journal of Athletic Training, 37(Suppl. 4), S222S228.

    • Search Google Scholar
    • Export Citation
  • Winkelmann, Z.K., Games, K.E., Rivera, M.J., Neil, E.R., & Eberman, L.E. (2020). Athletic trainers’ knowledge and practice application of public health topics. Athletic Training Education Journal, 15(4), 308320. https://doi.org/10.4085/1947-380X-19-047

    • Crossref
    • Search Google Scholar
    • Export Citation
  • World Federation of Athletic Training and Therapy. (2019). https://www.wfatt.org

  • Youth Sports Safety Alliance. (2018). Alliance members. https://www.youthsportssafteyalliance.org/allianceMembers

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 647 647 546
PDF Downloads 693 693 575