Educational Reform in Athletic Training: A Policy Analysis

Abstract

Objective:

To apply a policy-analysis framework to the athletic training educational reform policy that will be fully implemented by January 2004.

Data Sources:

Policy analysis is not a specific science. No one framework exists for conducting all policy analyses. I used literature from the education, policy analysis, and athletic training fields as data sources to provide background and to create a framework from which to conduct the policy analysis.

Data Synthesis:

Once the policy-analysis framework was selected, I began data synthesis, using several athletic training sources in support of the findings. The tension among the myriad stakeholders in this policy is clear. Although many see the benefits of accreditation, some experience hardships from the imposed policy.

Conclusions/Recommendations:

Of the 4 possible alternatives suggested, following the route currently under implementation (Committee on Accreditation of Health Education Programs accreditation) was the most agreeable solution. The goals as stated by the policy makers are attained by the policy. However, issues within the accreditation process itself need to be addressed. Of the many stakeholders in the reform effort, some will see little gain and have many hardships imposed on them. As the policy is implemented, unintended implications will likely arise, as with any new policy. Thus, I recommend that the National Athletic Trainers' Association develop a system dedicated solely to reducing the hardships faced by many of its members as the policy is implemented.

Athletic training education is in transition. The certification route for students is undergoing dramatic national reform via centralized control of the educational pathways that allow students to become eligible to sit for the National Athletic Trainers' Association Board of Certification (BOC) certification examination. Involved in this educational reform effort are many stakeholders: from students to certified athletic trainers (ATCs) to the National Athletic Trainers' Association (NATA) to the National Collegiate Athletic Association. With so many stakeholders and each having a different stake in the reform effort, tensions are bound to arise upon implementation of the new policy.

My purpose is to analyze the policy adopted by the NATA Board of Directors and the BOC to create one route to certification through entry-level Commission on Accreditation of Allied Health Education Programs (CAAHEP)-accredited athletic training education programs. This is not an analysis of the accreditation process itself but rather of the efficacy of the policy. Is it reaching its stated goals? Are positive or negative unintended implications (or both) being realized? Is each of the stakeholders in the policy satisfied? Is the policy necessary?

EDUCATIONAL REFORM

For some, the purpose of reform efforts is to close the gap between students who are learning and those who are not. For others, it is to hold teachers, ATCs, and administrators more accountable for the level of student learning in their classrooms and schools. And for yet others, reform efforts may be created to standardize educational practice across a district, state, or nation. Within this athletic training educational reform policy, the goal is to standardize educational practice and create a single route to certification.^1–3

When educational reform efforts call for change, the complexities of different views of stakeholders about the purpose of the reform emerge. Fullan⁴ described the complexity of educational reform efforts well:

How is change complex? Take any educational policy and start listing all the forces that could figure in the solution and that would need to be influenced to make for productive change. Then, take the idea that unplanned factors are inevitable—government policy changes, key leaders leave, important contact people are shifted to another role, recession reduces available resources, a bitter conflict erupts, and so on. Finally, realize that every new variable that enters the equation produces ten other ramifications, which in turn produce tens of other reactions and on and on.

Pascale⁵ stated, “Productive educational change roams somewhere between over-control and chaos.” With change as large in scope as the athletic training education reform, it is not surprising that some are feeling the chaos and others a sense of overcontrol.

How then does a policy analyst go about analyzing educational policy, in all of its complexity and chaos, with any degree of certainty about the outcomes? Stone⁶ viewed policy analysis as a constantly evolving, inherently value-laden art rather than a rational process.^6–8 To take on a policy analysis is to provide one view, among many available, about the efficacy of the policy. One person's policy analysis may provide very different outcomes than another person's analysis of the same policy, depending on how each individual's own values were imposed on the analysis process.

The reform effort is the change in the national structure of entry-level athletic training education programs (ATEPs). The scope of this reform is quite complex and currently incomplete. The complexity lies in the involvement of a service organization for the profession (the NATA); an independent certifying agency (the BOC), which determines eligibility standards for the certification examination; accreditation by an independent agency (CAAHEP) through its Joint Review Committee on Educational Programs in Athletic Training (JRC-AT), which oversees the accreditation process; the elimination of 1 of 2 routes for students to become ATCs; a change in the available student workforce in most athletic training rooms in colleges and universities (which may be viewed as positive or negative); and new roles for ATCs created by the reform—namely the increased need for academic ATCs.⁹

Some ATCs are resisting the complexity and variety of implications of the imposed reform. The reform is currently incomplete, as the deadline for full implementation of the new policy is January 2004. After this date, the only route to certification will be through a CAAHEP-accredited program. Institutions may continue to apply for accreditation after this date. Currently, 181 institutions are CAAHEP accredited, while 184 more are in candidacy.¹⁰

POLICY ANALYSIS

To many educational leaders, policy analysis is a “nervous-making topic.”⁷ It involves inquiry into whether decisions, values, and assumptions made by policy makers are appropriate to produce the desired change. Several definitions of policy analysis are provided, and a framework of policy analysis is discussed.

Ball¹¹ defined policy rather succinctly: “Policy is clearly a matter of the authoritative allocation of values. A policy projects images of an ideal society.” Fowler's⁷ definition of policy was “the dynamic and value-laden process through which a political system handles a public problem.” She further described policy analysis as “the evaluation of policies or decisions in order to arrive at the best policy or decision in light of given goals, constraints, and conditions.”

The classical definition of analysis is “a separating or breaking up of any whole into its parts, especially with an examination of these parts to find out their nature, proportion, function, interrelationship, etc.”¹² Munger⁸ reminded us that the word analysis comes from Greek roots meaning to loosen up or dissolve throughout. In applying this definition to the metaphor of loosening a knot, he identified policy analysis as a process for understanding the knot (simplifying complex problems) by focusing on the twists of the knot (parts of the whole) to get a better idea of the rope (nature of the whole). At times, impatient “knot whacking” or rushed analysis results in removal of the knot, or problem, but destroys the rope or entire policy.

The analysis of a policy before the outcomes are known is a valuable tool in avoiding undeserved blame or praise of policy decisions once outcomes are known. All policies, of course, change as they run the course to complete implementation. “All policies are mediated through the context in which they are implemented and are changed in the process.”⁷ Continual reflection, analysis, and adjustments while on the course to implementation only benefit the policy.

According to Stone,⁶ policy generally has 4 goals: equity, efficiency, security, and liberty. Equity is treating likes alike. Efficiency is obtaining the most output for a given input. Security is satisfying minimum human needs. Liberty is the ability to do as you wish as long as you do not harm others. All policies aspire to at least one of these goals and usually a combination.

Each goal may be viewed differently if one is working from a market, or individual-interest, model or from a polis, or community-interest model. For instance, creating one route to certification for athletic trainers may be good for the profession (polis or community view) overall but may be seen as devastating to individual university athletic training practitioners, who may lose most of their student staff (market or individual view). Stakeholder interest changes the perception of the policy. Thus, the policy may have been developed by the NATA in pursuit of equity and efficiency, although some individual members may view the policy as an encroachment on their liberty.

FRAMEWORKS OF POLICY ANALYSIS

Many different conceptions of policy-analysis frameworks exist. Because policies themselves are diverse and often vague, no one framework to apply to all policy analyses has been universally accepted.^7,8 My analysis will use the Munger⁸ 5 stages of policy analysis (Table 1).

Table 1.

Stages of Policy Analysis⁸

ACCREDITATION

Accreditation is defined as “a system for recognizing educational institutions and professional programs affiliated with those institutions for a level of performance, integrity, and quality which entitles them to the confidence of the educational community and the public they serve.”¹³ A more complete definition of accreditation is “a complex evaluative tool and voluntary enterprise that is self-regulatory which focuses on judging educational quality.”¹⁴ The overall purpose of accreditation is to improve educational quality. Accreditation was established by the medical profession in the early 1900s and has since been adopted by most professions.

Specialized accrediting agencies (as opposed to institutional accrediting agencies), such as CAAHEP, provide accreditation as a tool of professions. They accredit professional education programs rather than whole institutions. Their goals are to assure the public that practitioners who graduate from accredited programs have met some predetermined requirements and to assure students they will receive a specific education. Three generic forms of credentials are used in accreditation processes:

1. licensure or registration—issued by government agencies,

2. certification or registration—issued by professional organizations,

3. diplomas—issued by educational institutions for successful completion of organized programs of study.¹⁴

In the case of ATEP accreditation by CAAHEP, this specialized accreditation interacts with licensure (in most states) and voluntary certification to provide an extra measure of protection for the public. Although certification is voluntary, it is required by most employers and state licensing bodies. Thus, after full implementation of the new educational reform policy in January 2004, only those who graduate from accredited programs will be eligible for BOC certification, attain certification (we hope), and in most states, also possess a license to practice. “The ultimate test of specialized accreditation is whether graduates of the program are acceptable to members of the profession, credentialing bodies, and employers.”¹⁴ This ultimate test of the efficacy of the accreditation process will be fully evaluated after January 2004.

Athletic Training Education Program Accreditation Process

For an ATEP to gain accreditation, the process must be initiated by the chief academic officer of the institution applying for accreditation. An in-depth self-study must then be performed, commonly by the ATCs who will be involved in the academic portion of the program. This self-study process, “critically examines the program in structure and substance, judges the program's overall effectiveness relative to its mission, identifies specific strengths and deficiencies, and indicates a plan for necessary modifications and improvements.”¹⁵ The self-study takes a minimum of 1 to 2 years to complete.^16,17

Once the self-study is submitted, a site-visitation team visits the institution to assess the program's compliance with the Standards and Guidelines.¹⁸ These standards are the minimum quality required to attain CAAHEP accreditation and prepare students for employment as ATCs.¹⁶ Once the onsite visitation is completed, a final report is sent to the institution's ATEP program director and department chairperson from the JRC-AT. This report cites any discrepancies found between the program and the standards. The program is then given time to adjust for the stated discrepancies and submit its final report. From this point, the JRC-AT makes its final recommendation to CAAHEP, which officially grants or denies accreditation. Each institution applying for accreditation is responsible for the costs and fees associated with the application process. Once accredited, each program must submit an annual report to maintain accredited status. A full review of accreditation is performed at least every 5 years.¹⁸

ATHLETIC TRAINING EDUCATIONAL REFORM

An emphasis on athletic training education dates back to 1956.³ Many changes have occurred to the athletic training educational structure since this time. The current changes, to be implemented in January 2004, are some of the most comprehensive and dramatic to date.

The educational reform effort eliminates the internship route to BOC certification examination eligibility. As of January 2004, the only way for an interested student to become an ATC will be by completing a CAAHEP-accredited ATEP. For students at nonaccredited institutions, the coursework they take and the hours they may work under the supervision of an ATC will no longer count toward eligibility for the certification examination.

Goals of the Reform

This reform effort was adopted by the NATA and BOC for many reasons. The following list is not meant to be complete but presents some of the major goals set forth by the policy makers:

1. betterment of the profession;

2. betterment of the professional image;

3. competition in the health care arena;

4. adaptation to the expectations of the health care community;

5. adaptation to the proliferation of new work environments;

6. strengthening of the quality, reputation, and educational requirements of the ATC credential;

7. building a healthy, reasonable, and financially tolerable clinical learning environment for students;

8. integrating a clinical-education model based on measurable, standardized, and referenced learning objectives;

9. integrating competencies in education;

10. integrating clinical-education objectives;

11. improving clinical instruction;

12. taking the best elements of the internship and curriculum routes to form a single, better educational model;

13. resolving disparities in the preparedness of entry-level athletic trainers;

14. standardizing the route to certification.^1,2

Although some of these stated goals overlap each other, they are different in subtle ways. This list will help comprise the selected criteria to be used in the policy analysis.

POLICY ANALYSIS OF NATIONAL ATHLETIC TRAINERS' ASSOCIATION EDUCATIONAL REFORM

In this analysis of the NATA and BOC policy to use the CAAHEP accreditation process to credential entry-level ATEPs, I will utilize the Munger stages of analysis⁸ and include research by ATCs who have studied the process and related topics. First, it is important to identify the type of policy analysis to be employed and the stakeholders in the policy.

Fowler⁷ identified 4 types of policy analysis: monitoring, forecasting, evaluations, and prescriptions. Although the policy is not fully in effect until January 2004, many programs have gone through the process of accreditation. Thus, this will be an evaluative policy analysis.

Stakeholders in a policy are those who have something to gain or lose by implementation of the policy. Within one educational-reform effort, numerous stakeholders may have different views of the basic purpose of that reform. The scope of the ATEP educational-reform policy ensures many stakeholders. The more obvious stakeholders are the membership of the NATA, the NATA as an organization, the profession of athletic training as a whole, the BOC, institutions that employ ATCs, athletic training students, instructors of athletic training, athletic departments, and certainly the athletes and clients served. A few of the less obvious stakeholders are the National Collegiate Athletic Association, the National Association of Intercollegiate Athletics, and parents of students. Each stakeholder may have a different view of this policy and its underlying values.

As mentioned earlier, to take on a policy analysis is to provide one view, among many available, about the efficacy of the policy. One person's policy analysis may provide very different outcomes than another person's analysis of the same policy, depending on the values imposed on the analysis process. I must state my bias clearly: I am a direct stakeholder in the policy, an ATC with an ATEP currently in candidacy. Although I value the improved national status of the profession offered by this accreditation process, I am concerned about the potential unintended consequences.

APPLICATION OF POLICY-ANALYSIS STAGES

Recall the 5 stages of the Munger policy analysis framework (see Table 1). These stages will now be applied to the NATA and BOC educational-reform policy.

Stage 1: Problem Formulation

The overriding problem necessitating this reform policy is that the current athletic training education, which allows dual routes to certification, is not keeping pace with changes and improvements in other allied health professions.^1,2,9 The internship route has many inconsistencies, which allow for inconsistencies in the students who become ATCs via these routes. These students may attend several institutions and clinical sites before becoming ATCs. “Changes in our educational programs will bring our professional preparation in line with other health care educational practices and standards.”⁹

Several authors have compared internship-route students with curriculum (or accredited) program graduates on BOC certification examination success rates. Of the 3308 candidates who took the examination in 1991, curriculum candidates had higher passing percentages on all 3 portions (written: 68%, practical: 62%, written simulation: 69%) than did internship candidates (written: 53%, practical: 57%, written simulation: 55%).¹⁹

Starkey and Henderson²⁰ reported that curriculum graduates performed significantly better than internship candidates on a subsequent examination, with 24% of first-time internship candidates passing all 3 portions, compared with 32% of curriculum candidates. In 2001, of the 2595 candidates taking the examination for the first time, curriculum candidates again had higher passing percentages on all 3 portions (written: 64%, practical: 74%, written simulation: 65%) than did internship candidates (written: 27%, practical: 56%, written simulation: 51%).²¹

Massie²² found that most entry-level employed ATCs followed internship routes and that college graduates were being adequately prepared by their ATEPs for entry-level employment. However, students from curriculum programs were significantly different from internship-route students with regard to perceived preparedness for employment. The curriculum students felt better prepared by their ATEPs for employment.

Thus, internship-route students were reportedly being adequately prepared but not as well prepared to pass the BOC certification examination as curriculum-route students. More important for this policy analysis, having 2 significantly different routes to certification that produce significantly different abilities in students is an inconsistency and perhaps a liability to the profession. Further, the 2 routes have created a strong obstacle to legislative efforts attempting to create a common licensure standard for ATCs.

Stage 2: Selection of Criteria

In any policy analysis, the researcher's bias and values become most apparent simply by choosing which criteria are important and ranking their relative importance.⁸ The selected criteria share common goals among the previously cited research studies and authors^1,2,6,9:

1. one standardized route to certification;

2. alignment with educational progress of other allied health professions;

3. improved quality of educational programs;

4. strengthened quality, reputation, and educational requirements of the ATC credential;

5. improved recognition and respect of athletic training across domains;

6. improved clinical environments for students;

7. enhanced efficiency of the process;

8. enhanced equity of the process;

9. enhanced feasibility of the process.

Stage 3: Comparison of Alternatives

Four alternatives were identified:

1. keeping things as they are, with 2 routes to certification;

2. using the CAAHEP accreditation process;

3. using an NATA approval process as a singular route to certification;

4. using a different accrediting agency.

Before CAAHEP accreditation began in 1991, the NATA recognized programs as having met certain minimal educational requirements by approving them as official curriculum programs. Internships were not programs and not approved by the NATA as such but were simply an agreement between an ATC and a student. The NATA approval process began in 1969 and included completion of a self-study evaluation by a site-visit team and review of the site-visit final report by the NATA Professional Education Committee, which granted or withheld approved status.¹⁷ This process is very similar to the CAAHEP accreditation process. Just as the profession of physical therapy uses the Commission on Accreditation of Physical Therapy Education (CAPTE), a branch of the American Physical Therapy Association, to accredit its programs, one alternative is for the NATA to approve its own programs. The fourth alternative has been suggested as using the current JRC-AT as its own accrediting agency, independent from CAAHEP. Table 2 illustrates the criteria and alternatives in a matrix for easy comparison of the alternatives.

Table 2.

Criteria and Alternatives Matrix*

Some of these ratings are self-explanatory, while others beckon justification. Alternative 1 does little to improve the current situation, while the other 3 alternatives are beneficial. Thus, the ratings for keeping the status quo are lower, other than feasibility (no increased costs to keep doing the same thing). Poindexter¹⁷ found that the average increased cost to an institution for pursuing accreditation was $2000 (although many would assess this as a gross underestimate). Thus, alternatives 2, 3, and 4 were rated as good on the feasibility criterion.

Alternative 3 is rated as good in alignment with other health care professions in that it would increase the rigor of attaining the ATC credential and create 1 route to certification but would not be able to claim accreditation status. Therefore, alternative 3 is again rated as good in improving recognition of and respect for the profession.

Recall that efficiency is obtaining the most output for a given input. Efficiency for alternative 1 is rated as fair due to the output gained by the given input being fair. In other words, the performance on the BOC certification examination by current students of the status quo illustrates that such educational programs do, indeed, prepare students for employment as ATCs, as illustrated by Massie.²²

Alternatives 2 and 4 are rated as good on the efficiency criteria, as the substantial amount of time and paperwork required by the alternatives (input) have yet to be proven to create equally substantial gains on the BOC certification examination (output). Thus, some may argue that the cost is greater than the benefit. Alternative 3 is rated as excellent on the criterion of efficiency, as it may not require the amount of time and paperwork accreditation processes do (input) but could increase examination scores at least minimally (output). The amount of time and paperwork, however, could indeed match the requirements of an accreditation process.

This simple comparison of alternatives by the selected criteria illustrates that the CAAHEP accreditation alternative and the use of a different accrediting agency are both superior to maintaining the status quo. Yet the CAAHEP accreditation process and the use of a different accrediting agency rank very closely with the alternative of using an NATA approval process as a singular route to certification. The drawbacks of using the NATA approval process rather than an accreditation process are (1) NATA approval would not be recognized by the US Department of Education, (2) less gain in national recognition and respect in the allied health professions and the public in general without accreditation of some form, and (3) not having accreditation, whereas other allied health professions do.

Although these differences or drawbacks may seem slight, they are not. Note that the criterion of alignment with other allied health professions is ranked as the second most important. For many ATCs and me, this criterion is critical. The status gained in the allied health professions community by having all educational programs accredited is critical for the future of our profession.^1,2,9 Thus, the result of comparing alternatives with criteria is that both the CAAHEP accreditation process and using a different accreditation agency are the better of the 4 alternatives. Some would argue that the accreditation process itself needs to be changed or that CAAHEP may not be the right organization for accrediting ATEPs. Members of the profession are currently looking at using the JRC-AT, independent from CAAHEP, as the accrediting agency through the Council for Higher Education Accreditation (CHEA). The physical therapy profession currently accredits its educational programs through its own accrediting body (CAPTE), which is associated with CHEA.²³ Thus, this method of accreditation is not uncommon.

Stage 4: Consideration of Political and Organizational Constraints

Technically, this stage has already been enacted. The NATA and BOC have adopted the educational-reform policy and the stakeholders are, therefore, implementing it. Some institutions are pursuing accreditation, while others are not. The latter universities may still have athletic training students, but as of January 2004, these students will not be eligible to take the BOC certification examination.

Fullan⁴ suggested that, if a change effort is to endure through time, it must not be solely a top-down imposed change or solely a bottom-up grassroots effort. With a top-down imposed change, the implementers (who are commonly not at the top) may not “buy in” and support the change they are being forced to implement. Thus, in the long run, without the support of the implementers, the change effort fails. With a bottom-up change effort, initiated by the implementers, the difficulty is that it may not have support from the upper administration and may fail. Therefore, the most enduring change efforts are those that include elements of both top-down and bottom-up change.

A political constraint of this athletic training educational policy change is that it is essentially a top-down imposed change. The NATA Educational Task Force, whose members were appointed by the NATA, created the conceptual framework of the reform policy. (A bottom-up change effort would have been initiated and created by the membership.) They then took this policy and visited each district to query the membership for feedback.²⁴ Suggestions were used to refine the details of the reform policy. The Task Force then recommended the reform to the NATA Board of Directors in 1996, which accepted and recommended it to the BOC.² The independent BOC alone determines eligibility standards for the certification examination and could have rejected the proposed policy but approved it. Although the NATA leadership hoped to have buy in from all stakeholders, resistance was inevitable. Change is simply not popular with some people—even if it is for the betterment of the future of the profession.

Positive effects of the policy change (some already being realized and some only hypothesized) include more jobs created for ATCs, a higher level of care for athletes and other clients, improved educational experiences for students, greater consistency in educational experiences across the nation, greater success in obtaining licensure in numerous states, and a greater emphasis on the education of students rather than simply the use of students as a workforce. Other positive effects will certainly be added to this list.

At the same time, the imposed change may bring few benefits to some ATCs while imposing greater hardships—especially during this time of transition. Although some of these difficulties are necessary for change to occur, they are, nonetheless, hardships. For instance, at institutions unable to pursue accreditation for a myriad of reasons, athletic training students employed in athletic training rooms will no longer be able to count their hours toward certification and may leave. This may pose a great hardship for the ATC staff (especially if the institution is reluctant to provide increased funds to hire more ATCs), for the athletic department, and potentially for the athletes. This type of situation creates resistance to the change effort.

Dore et al²⁵ studied athletic trainers' perceptions of the effects of eliminating the internship route. When head athletic trainers were asked whether they thought the elimination of the internship route would be detrimental to the profession, 54% responded no, 45% responded yes, and 1% were undecided. This illustrates the resistance to the change effort and the effects of top-down imposed change on implementer buy in.

Each institution of higher education that employs ATCs to care for its athletes will be affected in some way by this change. The organizational constraints at each institution will vary. Some of the constraints may come in the form of denial of increased ATC staffing, denial of pursuing accreditation (administration does not support a new program), acceptance of pursuing accreditation but without appropriate funds, facility constraints that would not support an accredited program, or simply no one at the institution who wishes to take on the responsibility of leading the accreditation process. Other potential organizational constraints may come from the capacity of the JRC-AT and CAAHEP to manage the large volume of institutions pursuing accreditation.

Stage 5: Implementation and Evaluation of the Policy

Implementation and evaluation require the assessment of whether the policy achieved its stated goals. As a result, a complete program evaluation is not warranted at this point. However, 181 ATEPs are currently CAAHEP accredited, and many more are in the process.¹⁰ Thus, I will present the results from program evaluations of existing accredited programs. What cannot be presented is an accurate set of outcomes of the fully implemented policy.

Poindexter¹⁷ studied the effects of accreditation on undergraduate ATEPs. Specifically, he evaluated effects on curriculum, finances, enrollment, and faculty. Of the 14 programs surveyed, 12 program directors responded. Data were gathered from the year before and the year after accreditation. Accreditation had minimal effects on curriculum, finances, enrollment, and faculty. Specifically, 10 of the 12 programs did not have to change their curriculums from the NATA-approved curriculums to the accredited curriculums; finances averaged increased costs of around $2000, enrollment decreased by an average of 6%, and, faculty increased from an average of 6 to 7 ATCs. It is important to note that 10 of the 12 programs were already NATA approved and, thus, already had many of the CAAHEP accreditation requirements in place. For a non–NATA-approved program to go through the CAAHEP accreditation process would require much greater change and financial output.

The accreditation requirements were similar to those already established for NATA approval. One respondent indicated that there is “…no difference from the NATA approval process.” The program directors perceived some of the benefits of accreditation to be improved academic status, greater recognition and respect across campus and nationally, improved communication with administration, aid in student recruitment, a measure of quality, and a forced self-study.¹⁷ Poindexter's¹⁷ final suggestions were to streamline the accreditation process and decrease the amount of paperwork involved.

Gazzillo²⁶ studied the congruence of CAAHEP accreditation policies, institutional policies, and athletic training education policies within internship and curriculum programs. Not surprisingly, curriculum programs were congruent with both CAAHEP accreditation policies and institutional policies, whereas internship programs were not congruent with either. Because the NATA approval process was so similar to the CAAHEP accreditation process and curriculum programs had already gone through the NATA approval process but internships had not, the results confirmed the similarities. Gazzillo noted, “The primary resistance to developing athletic training education policy in accordance with CAAHEP standards appeared to lie within the area of institutional policy support.” Thus, identifying this organizational constraint is an important issue to address in further studies.

Proctor²⁷ studied selected characteristics of accredited ATEPs. The importance of this study was stated concisely in the conclusion:

It was anticipated that the change from the NATA approval process to the CAAHEP accreditation process would not have a major impact on programs. However, this study has shown that there exist inconsistencies in various standards that have led to significant variability in important program characteristics among programs. In some cases it may even be questioned as to whether or not some accredited programs have earned the privilege of being accredited.

Specifically, Proctor noted inconsistencies among interpretation of the standards by the site visitors as problematic. Terms such as adequate and sufficient are used repetitively in the Standards and Guidelines,¹⁸ creating a situation in which “interpretation of the criteria is left to the personal standards of the on-site visitors,” who carry their own biases into any evaluation. However, these terms are common in most accreditation guidelines and were used in the earlier NATA approval process. Therefore, these interpretation problems are not unique to this accreditation process. Proctor urged more precise wording of the Standards and Guidelines to eliminate some of the ambiguity in the accreditation process.²⁷ The JRC-AT has addressed and continues to address this issue.

DISCUSSION

Although the policy is not in full effect yet, it is reaching its stated goals. Of the alternatives presented in the analysis, both CAAHEP accreditation and the use of a different accrediting agency appear to be the best routes to achieving the stated goals of the NATA reform. Hence, the intended implications of the policy change are being realized. There will be 1 standardized route to certification; alignment with the educational progress of other allied health professions; improved quality of educational programs; stronger quality, reputation, and educational requirements of the ATC credential; improved recognition of athletic training across domains; and improved clinical environments for students.

Almost always, however, unintended implications of implemented policies arise. Those will become more apparent after January 2004, when full implementation of the policy takes place, and may include a shortage of ATCs in the future as fewer students qualify to sit for the BOC certification examination (especially during this time of transition), increased workloads on current ATCs, elimination of athletic training student staffs at nonaccredited institutions, increased burnout in the profession, increased costs to athletic departments at nonaccredited institutions, and further political division within the NATA between academicians and practitioners—2 stakeholders with different needs and different views of this policy. Conversely, a positive implication could be more jobs becoming available for ATCs as the student workforce is eliminated from athletic training rooms. These are only a few of the possible unintended implications and concerns of the new policy. Once the policy is fully implemented, future researchers should address possible implications such as these and others as they arise.

As policy implementation continues, the membership would be well served to have a system available for communicating any concerns or experiences with hardships. For example, having 1 system housed at JRC-AT headquarters dedicated only to this goal may be prudent, as opposed to the filtering that occurs when concerns are first registered with regional representatives and judged before being forwarded to the national level.

The goals of this athletic training education reform policy are both noble and just. They were adopted by the NATA and BOC in an effort to better our profession. Due to the national scope of the reform effort, the number of stakeholders is vast—each with his or her own needs and concerns about the policy. Most stakeholders are well served by the reform, but others face imposed hardships. As we approach January 2004, the NATA, BOC, and JRC-AT must listen to those facing increased hardships and work to minimize them. The goal of this policy analysis is within this same vein: to call attention to those aspects that are working and not working as the policy is implemented. I hope the information provided herein will help inform this process.