The Stress and Coping Responses of Certified Graduate Athletic Training Students

Abstract

Objective:

To assess the sources of stress and coping responses of certified graduate athletic training students.

Design and Setting:

We interviewed certified graduate athletic training students 3 times over a 9-month period. We transcribed the interviews verbatim and used grounded theory analytic procedures to inductively analyze the participants' sources of stress and coping responses.

Subjects:

Three male and 3 female certified graduate athletic training students from a postcertification graduate athletic training program volunteered to participate in this investigation. The participants were full-time graduate students, with a mean age of 23 years, who had worked an average of 1.5 years as certified athletic trainers at the time of the first interview.

Measurements:

We used grounded theory analytic procedures to inductively analyze the participants' sources of stress and coping responses.

Results:

A total of 6 general sources of stress and 11 coping dimensions were revealed. The stress dimensions were labeled athletic training duties, comparing job duties, responsibilities as student, time management, social evaluation, and future concerns. The coping responses were planning, instrumental social support, adjusting to job responsibilities, positive evaluations, emotional social support, humor, wishful thinking, religion, mental or behavioral disengagement, activities outside the profession, and other outcomes.

Conclusions:

Certified graduate athletic training students should be encouraged to use problem-focused (eg, seeking advice, planning) and emotion-focused (eg, positive evaluations, humor) forms of coping with stress.

In virtually all health care and human-service occupations (eg, education, social work, medicine), a clear link has been established among occupational stress, decreases in job satisfaction, signs and symptoms of burnout, and higher attrition rates.^1–6 The need to address issues related to the psychological well-being of athletic trainers has also become increasingly apparent.^7–9 For example, Hendrix et al⁷ used a battery of psychological measures and surveyed 118 certified athletic trainers from National Collegiate Athletic Association Division I institutions. The investigators observed high levels of perceived stress related to emotional exhaustion, depersonalization, and lower levels of personal accomplishment. They also noted high attrition rates experienced by athletic trainers and speculated that occupational stress was primarily responsible for these trends. Their findings were consistent with previous research in other helping professions,^1–6 as those with higher perceived-stress scores experienced more burnout symptoms. However, previous investigators have not examined how athletic trainers cope with stress.

Hunt⁸ recently expressed concern about stress and burnout in athletic training and offered specific lifestyle recommendations (eg, exercise, balance of work and leisure) to alleviate or prevent the symptoms of burnout. Unfortunately, the recommendations in the athletic training literature appear to be based on the findings from either the other helping professions, the intuitions of experienced athletic trainers, or both.^8,9 Relatively few authors have empirically investigated the sources of stress and coping responses experienced by practicing athletic trainers. Thus, more empirically based research is needed to supplement recommendations made to athletic trainers about how to cope with job-related stress. This information could lead to recommendations or educational interventions to enhance the quality of life and reduce occupational burnout and attrition rates within the athletic training profession.

Systematic empirical efforts aimed at documenting the sources of stress and coping responses of practicing athletic trainers could prove fruitful for a variety of reasons. First, Lazarus¹⁰ noted the need for researchers to systematically document the multitude of coping behaviors used by individuals in different contexts. These behaviors are particularly important for the unique context of athletic training because of the noted challenges experienced by practicing athletic trainers.^8,9 Second, because not all individuals succumb to stress, it is imperative for researchers to understand how individuals successfully adapt to stressful encounters.¹¹ Finally, of the most interest is the need to develop empirically based educational programs aimed at helping practicing athletic trainers cope with stress. We hope the present study will stimulate such efforts. Therefore, our purposes were to examine the sources of stress and coping responses of certified graduate athletic training students throughout the course of an academic year.

METHODS

Subjects

Six certified graduate athletic training students from a large National Collegiate Athletic Association Division I university volunteered for this investigation. The mean age of the 3 men and 3 women was 23 years; all participants were white. At the time of the study, all participants worked in high school or collegiate settings (or both) and supervised 2 to 7 undergraduate athletic training students (mean = 3.28 supervisees). Before this study, the subjects had worked in various settings as undergraduate athletic training students, and 1 had worked with various US Olympic teams. All had worked for 1 to 2 years (mean = 1.5 years) as certified athletic trainers at the time of the first interview.

Procedure

The university institutional review board reviewed and approved the methods, procedures, and interview protocol for this study. The first author (S.R.) gained permission from the appropriate faculty to recruit and interview participants in the athletic training program, which had 22 graduate students. Because this is a postcertification graduate athletic training program, all students must be certified through the National Athletic Trainers' Association Board of Certification or be eligible for certification upon admission. Approximately half the students were in the first year of the 2-year program, whereas the other half were in their second year. Students are assigned to a high school, community college, or university team(s) or to a clinical or intramural position as a requirement for their assistantships. Upon graduation, the students receive a Master of Science degree.

We developed a semistructured interview guide at the beginning of the study to minimize interviewer bias and ensure that participants were asked the same questions in the same order.¹² We created the guide by closely examining the previous stress and coping literature and adapting the most relevant questions.¹³ Once we established the questions, we devised a series of elaborative probes to elicit further information from the participants.

Interview Procedures

The primary investigator, who had no previous relationship with any of the participants, conducted 3 interviews with the research participants. Before the first interview, we gave the participants explicit information about the nature of the interview process, issues related to confidentiality and anonymity, and the handling of tape-recorded interviews. Our purpose for the initial interview was to begin to establish trust and rapport with the participants, which, according to Fontana and Frey,¹² is imperative. Once a trusting relationship has been established, a participant should feel secure enough to share personal information with the researcher. The interviews took place at a time and location convenient for the researcher and the participant.

We transcribed all interviews verbatim and sent a copy of each transcribed interview (eg, member checks) to the participant, along with a 1-page summary of the content of the interviews.¹⁴ This member-checking procedure occurred during interviews 2 and 3, at which time we asked each participant to read the summary from the previous interviews to verify the accuracy of the interviewer's observations and make corrections and additions if necessary.

Data Analysis

We used grounded theory analytic procedures to analyze the interview transcripts.¹⁵ These procedures involve (1) the simultaneous collection and analysis of interview data, (2) comparative methods of analysis whereby participants' responses are compared among one another and within each participant, and (3) the integration of a theoretic framework. The analysis began with open or line-by-line coding, in which individual meaning units were closely examined, compared with other participants' responses, and coded for future analysis. Second, we identified specific quotes as raw data themes that pertained to the participants' specific and unique sources of stress and coping responses. These quotes and copies of transcripts were presented to an independent team of trained qualitative researchers (graduate students who had taken coursework in qualitative methods; several had conducted interview studies of their own) to test the accuracy of our observations. We next engaged in a constant comparative procedure in which different participants, events, situations, and experiences were compared within and among participants.¹⁵ Finally, familiarity with the stress and coping research literature and frequent discussions between the researchers and other individuals unaffiliated with the study allowed for the integration of research findings into a meaningful and easily interpreted theoretic framework. Thus, our procedures were consistent with an inductive-deductive approach, characteristic of previous grounded theory studies described in detail by Charmaz.¹⁵

Issues of Validity and Trustworthiness

We took a number of steps to establish validity and trustworthiness. These steps were intended to meet the trustworthiness criteria as outlined by Lincoln and Guba¹⁶ and Sparkes.¹⁴ First, we conducted 3 interviews with each participant to gain credible accounts of the stress and coping process. Thus, the longitudinal nature of the study allowed the interviewer to build a trusting relationship with the participants.¹² Second, trained qualitative researchers provided support and input during the data analysis. Their observations served as reliability checks and allowed the research team to address biases and explore discrepant cases. Third, we gave all participants written summaries of each interview to verify the accuracy of our conclusions. These procedures, known as member checks, have been discussed in the qualitative research literature.¹⁴ Finally, extensive quotations are provided in the upcoming section to allow readers to judge for themselves the accuracy and potential generalizability of the results.

RESULTS

The inductive analyses of the participants' sources of stress resulted in 6 general dimensions of stress, which were defined by progressively less abstract first-order themes originally derived from the participants' verbatim quotations or raw data themes. The following general dimensions of stress emerged from the interviews: athletic training duties (eg, supervisory role, injury care or prevention, documentation, communicating with others), comparing job duties, responsibilities as student (eg, assignments, coursework), time management (eg, athletic training, school work, daily living), social evaluation (eg, demonstration of ability, labeled as a student, self-presentation, pleasing others), and future concerns. A visual depiction of the participants' sources of stress is available from the second author (P.R.G.). A series of quotations that highlight these stress sources follows.

Athletic Training Duties

This general dimension of stress consisted of the more specific stress sources related to supervisory role, injury care or prevention, documentation, and communicating with others. Stress related to the supervisory role consisted of learning the role and working with students, supplies, and policies. Six participants viewed their supervisory role as a challenge. Three found “evaluating students” challenging, whereas another 2 reported “the teaching of students” was a challenge. Another aspect of the supervisory role viewed as a challenge by 2 of the participants was “establishing protocols in the training room.” This source of stress was illustrated by the following quote: “At the beginning of the year it was a bit of a challenge to get everybody in the swing of things …teaching them and setting up the logistics in the actual clinic of how we wanted it run and how we wanted the paperwork filled out.”

For the injury care or prevention stress source, 2 participants reported “getting kids healthy” was a challenge. Other raw data themes included “emergency state of care,” “severe injuries,” and “only so much that (we) can do.” Yet another common challenge subjects mentioned was the care of athletes. Responses in this category ranged from “making appointments for athletes” to “scheduling meals when on the road.” In high school settings, caring for athletes can be particularly challenging, as noted by the following quote from a participant: “If someone does get hurt, getting them to a doctor or an x-ray that sometimes is really frustrating. It's just hard, the kid wants to be fixed …sometimes there is only so much we can do as athletic trainers.”

Three subjects discussed stress sources related to maintaining documentation. These participants had difficulty “keeping up with paperwork,” and did not “see the need to complete some forms the university requires.” This theme was illustrated by the following quote:

I'm just like whoa you know, now being asked to do this and that and all the paperwork that we have …so much of it is for longitudinal studies …I'm not gonna do that when I'm on my own at my job, so it's just been a lot of extra stuff that I wouldn't be doing. I'm going to do the injury report and the follow-up but not keep attendance logs and all these follow-up questionnaires.

Communicating with coaches, parents and guardians, and athletes was a significant source of stress discussed by all subjects. For instance, “getting in contact with parents” and “reminding athletes to go to their doctor appointments” were commonly reported stress sources. Regarding working with coaches, a participant said, “I think sometimes trying to tell coach no they can't play …they just don't get it. They think they rested yesterday why can't they play today.”

Comparing Job Duties

Only one subject named challenges that fell within this general dimension. This participant reported she “puts out more” compared with others in the program and had more demands placed on her in the athletic trainining room, such as needing to “always wear khaki pants” and work “longer hours” than other athletic trainers.

Responsibilities as Student

Assignments, coursework, and demands of professors characterized this general dimension. It appeared that new graduate students were unaccustomed to the demands of graduate school, such as “research,” “class assignments,” or “thesis work.” One participant stated, “As far as the coursework it's not all due at once but it's always something is due so you can't really ever just sleep in on a Sunday.” Similarly, another individual said, “I think it is hard because the professors have a lot of demands on the master's students, like help out with you know other peoples' stuff, their own stuff, I think sometimes they forget we are master's students.”

Time Management

This general dimension was discussed as a source of stress for 5 participants. For instance, “changes in sport schedules” or “long work hours” at the various sites were mentioned. In addition, the participants also viewed lack of time to eat or sleep properly and “finding time to socialize with others outside the profession” a challenge. The general dimension of time management was illustrated by the following quote: “Finding enough time to sleep and eat. Uh, just like being a student you kind of want to still do the normal student things as far as going out and that sort of thing.”

Social Evaluation

This dimension consisted of themes that included demonstrating ability, being labeled as a student, self-presentation, and pleasing others. Only one participant reported demonstrating abilities was a challenge.

Being labeled as a student by parents and coaches was frustrating to 2 of the participants. The following individual expressed concern over being labeled a graduate student. Her concerns were compounded by her perception that she did not deserve this characterization, because she had worked in the private sector as an athletic trainer before graduate school: “So many times, despite the number of years that you have as an experienced [athletic trainer], the parents only see you as a graduate student and you have to sell yourself in that respect.”

The most commonly cited challenge related to the social-evaluation dimension was pleasing others, including “keeping parents happy,” “keeping coaches happy,” and “staying motivated.” The following quote indicated this concern for an individual: “If anything goes wrong they [student's advisor] are the ones that typically get the phone calls …so if anything goes wrong it goes to them and then on down to me …um, so there is a challenge in that way trying to keep everybody happy.”

Future Concerns

Three participants perceived future job concerns as a source of stress. These individuals stated they were “unsure of where I am going to be” and experienced stress from “applying for new position(s).”

The Coping Responses of Athletic Trainers

The participants reported a multitude of coping responses presented in the Figure. As with the organization of the stress sources described above, we outlined the participants' coping responses from the actual quotations on the far left of the Figure, followed by the more abstract first-order themes, and ending with the general dimensions of coping. In other words, each general dimension of stress was defined by more specific coping responses reported by the subjects. The discussion that follows will highlight the participants' coping responses with respect to the stress sources described above.

A conceptual framework representing the coping responses of certified graduate athletic training students. Continued on next page.

Planning

As shown in the Figure, scheduling, time management, organization, and delegation defined planning. Over the span of this study, all 6 participants stated they learned how to cope with the time demands of the profession through the use of planning activities. Planning was not widely reported as a coping strategy during the first interview but was discussed during interviews 2 and 3. One subject stated, “It [is] like trying to put in 28 hours a day instead of 24.” In an effort to reduce the negative impact of the time demands, all 6 participants stated they used at least 1 coping strategy coded as scheduling; for example, they used organizational tools such as Palm Pilots (Palm Inc, Milpitas, CA) and “daily planners” to keep track of their schedules. In addition, 4 participants learned how to “use free time wisely” and “make things more efficient” to save time. The following quote revealed how one individual learned to manage time through the use of scheduling and planners. Through the process of managing demands at work and school, this individual also gained greater appreciation for time: “My time is very limited with classes and work …it's using that free time a little more wisely. I think it [time constraints] just made me appreciate that time that I did have.”

Instrumental Social Support

Social support was an important form of coping for 5 of our participants. This higher-order theme consisted of the first-order themes of conversation and seeking advice. Stress that arose from job and school duties prompted all 6 subjects to seek advice from coaches, administrators, family, and friends. Specifically, 5 individuals sought advice on “dealing with parents,” “developing protocols,” and how to complete schoolwork. Two participants sought advice from others they thought would provide them with good information on how to deal with a specific problem. For instance, the following quotation revealed how a participant relied upon advice from her peers in the graduate program: “I would talk to fellow grad students about it and that was my stress relief …I just tell them what happened and they would give me suggestions for what to do and I always felt a lot better about it.”

Four participants engaged in coping responses classified as conversation under the higher-order theme of instrumental social support. Sometimes participants would speak with others just to “talk about things.” Subjects would have these conversations with their own parents, friends, coaches, and athletes' parents.

Adjusting to Job Responsibilities

All participants adjusted to job responsibilities by seeking information or changing their behaviors. Three subjects actively sought information about specific sources of stress. Regarding seeking information about establishing protocols, an individual said, “I don't feel I have the knowledge of things yet to really establish protocols I want to so I am constantly asking people for their input.”

One participant experienced stress when the parents of athletes did not understand her role as an athletic trainer. In response, she spoke with the athletes' parents and attempted to educate them about the athletic training profession: “I do a lot more professional relations with the parents …you know just sit down with them and talk to them a little bit about each kid at least once a week if I can.”

Positive Evaluations

As shown in the Figure, positive evaluations were defined by the first-order themes of viewing the whole picture and acceptance. One participant felt she worked with an excessive number of athletes. She interpreted this challenge in a positive manner: “I just think of it as a great learning experience …” Another athletic trainer said, “I just look at it positively like I am getting something more out of the situation. At least I am getting that experience. I am seeing things that other people are not.” Similarly, the following quotation indicated how this subject viewed her sources of stress as exciting and as a chance for growth. Consistent with previous stress and coping research with athletes, her positive evaluations appeared to reflect an optimistic view about her challenges¹⁷:

All the stress I get from athletic training I actually enjoy. That to me is an enjoyable stress because the pressure gives me an adrenaline rush …You know anytime you are dealing with stress to better yourself or better your position I don't think that's a bad stress, I think it's healthy.

Another coping strategy related to individual interpretations of stress was labeled as acceptance (see the Figure). Three participants used this type of strategy to remind themselves that “it's no big deal” and that “if it happens it happens” in response to worrying over things beyond their control. One participant stated, “If that is the worse thing that you have to do in your life then you are pretty damn lucky.”

Emotional Social Support

Emotional social support was characterized by attempts to seek emotional comfort in times of need. This coping response is different from instrumental social support in that subjects were not asking others for advice or suggestions, but rather they needed to express their feelings. This higher-order coping theme consisted of the first-order themes of venting and humor.

Five participants vented their emotions in a variety of ways, such as “yelling” at friends, “snapping at athletes,” and “getting angry.” One individual who vented to her family said, “Sometimes situations happen …I don't want to be griping all the time with my friends, so I'll call my mom and vent to her for a while.”

Humor

Three participants chose humor as a coping strategy. They stated they liked to “joke around” and “tease each other” to reduce stress. They reported humor was used inside the athletic training room with athletes as well as with other athletic trainers. When one subject talked with her friends about a stressful situation, they would “just laugh at it to make it better.” Although humor did not directly alter the stressful situation, it did allow the participants to view it in a different manner.

Wishful Thinking

Two individuals coped with stress by engaging in wishful thinking. In these instances, participants would “hope things will get better” and “hope for the best.” They engaged in wishful thinking when they perceived the stressful situations were outside their control. For instance, one subject “hoped for the best” when discussing a change in coaching staff; nothing would stop this change in personnel, so the more passive form of coping was used to alleviate concern.

Religion

Two participants mentioned they would “go to church” and “pray” when they experienced stress. Both used religion as a general coping mechanism and would turn to it when they “were straying off course.” Although this theme was not explored in greater detail during the interview process, precedents in the research literature support the use of religion as a coping strategy.¹⁸

Mental or Behavioral Disengagement

Mental or behavioral disengagement strategies were defined by the first-order themes of ignore the situation and avoid the situation. Three individuals hoped that by ignoring the situation it would “just go away.” For example, one subject was having difficulties with a coach during the preseason. At the time, the participant was not directly responsible for the care of the team. Instead of confronting the coach, the participant chose to ignore the situation. This participant stated, “I …tried to ignore it until their season officially started. I said I am not going to deal with it …not until I am directly responsible when they are in season.”

Similar to ignoring stressful situations, 2 individuals chose to avoid placing themselves in stressful situations. This method of coping was classified under the first-order theme of avoid the situation. Individuals who used this strategy reported that avoiding the situation was the best strategy. One such participant reported that “talking with other athletic trainers” outside work was adding stress and therefore opted to no longer “hang out with classmates.”

Activities Outside the Profession

Another way all 6 participants coped with their sources of stress was through participation in activities unrelated to the athletic training profession. The importance of this coping strategy cannot be underestimated. They engaged in activities including various forms of exercise, such as swimming and lifting weights, as well as in recreational activities, such as dancing and traveling. The following quotation was from one individual who, by all accounts, experienced relatively less stress than did the other participants: “I try to leave just to give myself a mental health evening …I have scheduled it in my day as if it were a class. On Tuesday and Thursday I am swimming …I like to travel a lot too and kind of do other things.”

Other Outcomes

During interview 1, all 6 subjects stated their professional goals were to work in the athletic training profession for university, Olympic, or professional teams. Although burnout was not a focus of this study, many participants stated that they were “burned out.” Several reported they were “burned out” from their sources of stress and work environments, and they needed a “break” or wanted to “get away” for a while. Most significantly, 2 of the 6 decided to leave the athletic training profession entirely. Of the 4 who remained, 2 wanted to teach athletic training, and the remaining 2 sought jobs as practicing athletic trainers.

DISCUSSION

Before this study, no authors had identified specific sources of stress experienced by athletic trainers. Hendrix et al⁷ hypothesized that high caseloads and more contact hours, locus of control, and role conflict were important sources of stress for athletic trainers. We documented many other sources of stress, including responsibilities as a student, time management, future concerns, and socially based sources of stress, such as comparing job duties and pleasing others. Two possible explanations for the observed differences between our study and that of Hendrix et al were the participants and the methods we used. All participants in our study were certified graduate athletic training students. They were relatively new to the profession and probably experienced sources of stress unique to beginners. For instance, many cited social evaluative sources of stress associated with a lack of confidence in their athletic training skills and wanting to please others, including supervisors and coaches. As the year progressed, they appeared to become more familiar with their job duties and more confident about their roles as athletic trainers. As a result, stress from social evaluation was cited less frequently during the last interview.

In addition, the nature of the interview procedures may have resulted in differences between this study and the findings of Hendrix et al.⁷ Although Hendrix et al relied on single-survey assessments, we conducted multiple interviews with participants over the course of an academic year. These in-depth procedures allowed for a closer examination of the entire stress and coping experience. Of the most concern here was the finding that 2 of the 6 participants decided to leave the profession entirely. It is difficult to pinpoint specific reasons for their decisions, but excessive stress and burnout appeared to be factors. For instance, one subject felt teaching athletic training would require fewer demands. As other individuals experienced more stress, they reflected upon their future goals and either became more dedicated to the profession or decided to pursue different occupations. Other possible reasons our participants experienced excessive stress may have included their lack of experience or lack of confidence in meeting the demands of the profession. More research is needed to fully understand the relationship between stress and burnout in the athletic training profession.

Coping

Although some of the participants' coping responses appeared to be more proactive (eg, planning, seeking advice), other behaviors were attempts to relieve emotional distress (eg, humor, venting). All these coping responses are appropriate and consistent with previous research with different populations (eg, undergraduate students, freshmen student-athletes, adults).^17,19–24 In terms of overall adaptation, we would argue that the combination of planning, adjusting to job responsibilities, positive evaluations, activities outside the profession, and social support could alleviate stress for many professionals. Specifically, planning, adjusting to job responsibilities, and seeking advice (eg, instrumental social support) are problem-focused forms of coping intended to directly alter or resolve the stressful situation. Emotional social support, venting, humor, and positive evaluations were emotion-focused forms of coping intended to relieve emotional distress and change the personal meaning of stressful encounters. Previous research findings support the relationship between positive reinterpretation, an emotion-focused form of coping, and psychological adjustment, and our results concur with these trends in the literature.^23,24 Similarly, planning and adjusting to job responsibilities emerged as important responses for our participants. In support of recommendations by Hunt,⁸ it was noteworthy that activities outside the profession were important coping responses for both subjects who decided to remain in the profession as practicing athletic trainers.

Applied Implications

Our results suggest several implications for individuals in leadership positions within athletic training contexts. First, athletic trainers should be encouraged to develop enriching social support systems, because others who are supportive, both in and out of the work context, may help them buffer the deleterious effects of stress. Individuals should be encouraged to seek out advice, suggestions, and overall support from a variety of individuals. Consistent with recommendations for athletic teams, group-based meetings that address athletic trainers' collective areas of concern (ie, common challenges, goals) might promote an atmosphere of trust and support.²⁵ These meetings might include a needs assessment to identify and anticipate specific concerns, challenges, and sources of stress within the work context. After problems are identified, more experienced athletic trainers could offer feedback and suggestions about how to cope with these concerns. Because previous research suggests that young adults' interpretations of stress are malleable,¹⁸ less experienced athletic trainers can likely learn and develop a variety of growth-oriented insights and interpretations from more experienced athletic trainers. Therefore, respected individuals in work contexts should offer their own interpretations about stress during formal mentoring meetings.

Athletic trainers could also be encouraged to document their sources of stress and coping responses with journaling techniques. Such techniques may enhance self-awareness of one's thoughts and feelings in specific work contexts. Consistent with cognitive behavioral techniques commonly used in counseling and sport psychology, self-awareness would appear to be a critical first step toward the identification of specific situations that elicit stress-related emotions.²⁶ Awareness of specific stressful situations allows individuals to plan ahead and develop problem-solving techniques. Thus, journaling should allow individuals to develop a “toolbox” of coping options for different situations. Over time, these responses should become more automated.

Finally, it is important to note that our participants experienced mild forms of stress typical of many students during this developmental period. Some athletic trainers may experience more severe emotional and psychological problems that would require professional help. Under these circumstances, athletic training supervisory staff should become familiar with the availability of mental-health services within their particular area. For instance, in university settings, licensed psychologists within health or counseling centers are prepared to work with a variety of issues that affect graduate and undergraduate students. Individuals employed in private settings are encouraged to explore other ways to refer individuals to professionals for the treatment of depression, severe anxiety, or other difficulties (eg, eating disorders, substance abuse, and so on).

Future Research Directions

Because of the nature of this study and the small sample size, the extent to which our results generalize to other athletic trainers is left for readers to determine. Scientific generalization takes on a very different meaning for the grounded theorist. For our purposes, we argue that the reader should judge the extent to which the findings here transfer to other athletic training populations.^14,15 Our findings illustrate only the sources of stress and coping responses of a small sample of graduate athletic training students enrolled in a National Collegiate Athletic Association Division I athletic training program. Although the findings may not fully transfer to other populations of athletic trainers, such as those who work in physical therapy offices for 10 years, they do provide a starting point for additional research. Perhaps the most pressing future research direction suggested from this study is the need to test coping interventions with athletic trainers in various settings.

Conclusions

Despite the small sample size as a limitation of our study, interesting and important findings emerged. To date, recommendations given to athletic trainers on how to reduce occupational stress have been based on personal experiences. We identified common sources of stress and coping responses among certified graduate athletic training students and provide a good starting point for future recommendations and research. Please view these findings as an invitation for future collaboration.