MULTI-STAKEHOLDER PERCEPTIONS OF YOUNG PROFESSIONALS' INTEGRATION DURING ROLE TRANSITION.

CONTEXT: The transition to autonomous clinical practice for early professionals (EPs) has been found to be a stressful time but no studies with multiple stakeholder groups have been completed. OBJECTIVE: Examine the perceptions of EPs' integration during role transition from multiple stakeholder groups. DESIGN: Qualitative study. SETTING: Online interviews. PARTICIPANTS: 17 EPs in the first 2 years of their first job post-certification (9 females, 8 males, age=26±5 years, experience=9.5±5 months), 16 supervisors and mentors of EPs (6 females, 10 males, age=52±11 years), and 10 faculty members and 8 preceptors (11 females, 7 males, age=43±10 years). DATA COLLECTION AND ANALYSIS: Participants completed semistructured interviews using a validated interview guide based on the current literature. We analyzed data using consensual qualitative research principles. Multiple analyst triangulation (n=3), member checking, and peer review served as trustworthiness strategies. RESULTS: We identified 4 themes that defined the integration of EPs during role transition. Integration of EPs was facilitated through role inductance and mentoring. EPs struggle finding balance to avoid burnout as they are new to the profession and feel obligated to exceed expectations from a coverage standpoint rather than focusing on the quality of care delivered. Finally, stakeholders suggested a timeline by which EPs become fully integrated into autonomous professional practice and understand all aspects of their role that typically takes anywhere from 1 to 3 years. CONCLUSIONS: EPs benefited from appropriate graded autonomy during clinical education to develop their clinical reasoning skills, confidence, and mentoring network with past preceptors. Ongoing personal and professional support is needed during the initial few years to ease EPs' role inductance while gaining more experience and establishing their clinician identity. Expectations for EPs should be reasonable to allow for the provision of quality care, adequate work-life balance, and integration into the profession without guilt.

Newly Credentialed Athletic Trainers' Perceptions of Their Transition to Practice.

CONTEXT: Newly credentialed athletic trainers (ATs) have reported stress and role ambiguity during the transition to practice. Previous researchers focused on their qualitative experiences, yet no investigators have explored how characteristics such as the setting or type of educational program affect the transition to practice. OBJECTIVE: To determine how newly credentialed ATs perceived their transition to practice. DESIGN: Cross-sectional study. SETTING: Online survey. PATIENTS OR OTHER PARTICIPANTS: Of 1835 newly credentialed ATs (18%) certified and employed between January and September, 332 completed the survey within 3 months of employment (129 men, 203 women; age = 23.58 ± 2.54 years). MAIN OUTCOME MEASURE(S): The survey consisted of demographic information (eg, employment setting, job title) and 3 sections: (1) comfort level during the transition (CL), (2) feelings of mentorship and support (MS), and (3) feelings of organizational transition. Participants identified their feelings of nervousness, support, and understanding organizational values using a Likert scale (1 = strongly disagree, 4 = strongly agree). Descriptive statistics were calculated for each survey item. Mann-Whitney U and Kruskal-Wallis (H) tests were used to determine associations between different demographic characteristics and responses regarding orientation and CL, MS, and feelings of organizational transition. RESULTS: Most participants agreed or strongly agreed that they felt nervous (n = 264, 79.2%) and that the transition was stressful (n = 227, 68.1%) but they felt prepared for their job (n = 262, 78.7%). No differences in CL were present among settings (H = 5.64, P = .228), job titles (H = 4.88, P = .087), or types of professional program (U = 6488, P = .279). Respondents who were assigned a mentor reported better perceptions of MS (U = 6250, P < .001). Most participants felt that supervisors adequately explained administrative procedures during orientation (n = 169, 54.3%) and felt they were adequately oriented to organizational values (n = 252, 75.7%). CONCLUSIONS: New ATs felt nervous when entering their new role, but having a mentor and receiving a detailed orientation helped alleviate stress during the transition to practice.

Challenges for Newly Credentialed Athletic Trainers During Their Transition to Practice.

CONTEXT: Understanding the challenges faced by newly credentialed athletic trainers (ATs) as they transition into clinical practice could assist employers and professional programs in developing initiatives to enhance this transition. OBJECTIVE: To explore the challenges faced by newly credentialed ATs during their transition from student to autonomous practitioner. DESIGN: Qualitative study. SETTING: Individual phone interviews. PATIENTS OR OTHER PARTICIPANTS: A total of 34 ATs certified between January and September 2013 participated in this study (18 women, 16 men; age = 24 ± 2 years; work settings = college, secondary school, clinic, and other). Data saturation guided the number of participants. DATA COLLECTION AND ANALYSIS: An interview guide was used. All interviews were recorded and transcribed verbatim. Data were analyzed via phenomenologic reduction, with data coded for common themes and subthemes. Trustworthiness was established via intercoder reliability, member checks, and peer review. RESULTS: Initially, participants had difficulty making decisions independently. However, making decisions and receiving positive feedback helped them develop confidence. Communication with coaches and parents was challenging, especially for those in the secondary school setting. Participants also experienced role ambiguity, as they were unsure of basic organizational and administrative structures and expectations. Mentor inaccessibility was the final challenge described by respondents. In particular, those in the secondary school setting and with part-time employment felt they did not have a supervisor or mentor whom they could contact for support and guidance. CONCLUSIONS: Professional programs should educate students on potential challenges to help them understand what they might encounter during the transition to clinical practice. Employers should provide clear expectations and job descriptions to alleviate some of the stress and role ambiguity. If a mentor is not provided by the employer, the newly credentialed AT should seek one to assist during the transition.

Orientation Process for Newly Credentialed Athletic Trainers in the Transition to Practice.

CONTEXT: Orientation is an important part of socialization and transition to practice, yet the orientation process for newly credentialed athletic trainers (ATs) is unknown. OBJECTIVE: To determine how newly credentialed ATs are oriented to their roles. DESIGN: Cross-sectional study. SETTING: Online survey. PATIENTS OR OTHER PARTICIPANTS: Three hundred thirty-two of 1835 newly credentialed ATs (18%) certified and employed between January and September of 2013 completed the survey (129 men, 203 women; age = 23.58 ± 2.54 years). DATA COLLECTION AND ANALYSIS: The survey consisted of demographic information (eg, employment setting, job title) and 2 sections: (1) orientation tactics and (2) usefulness of orientation tactics. For the first section, participants identified if various orientation tactics were included in their orientations (eg, policies and procedures review). For the second section, participants identified how useful each orientation tactic was on a Likert scale (1 = not useful, 4 = very useful). Descriptive statistics were calculated for each survey item. Mann-Whitney U and Kruskal-Wallis tests were used to determine differences between demographic characteristics and orientation tactics. A Bonferroni correction accounted for multiple comparisons. A panel of experts established the content validity of the survey. The Cronbach α was used to establish internal consistency (α = 0.802) Results: The most common orientation tactics were meeting with supervisors (n = 276, 82.9%) and staff members (eg, coaches; n = 266, 79.9%) and learning responsibilities (n = 254, 76.2%). The least common orientation tactics were simulation of the emergency action plan (n = 66, 19.8%) and preceptor development (n = 71, 21.3%); however, preceptor development was not applicable to many participants. The most useful orientation tactics were simulating the emergency action plan (3.45/4.0) and meeting with staff members (3.44/4.0). Participants who felt their orientation prepared them for their roles were exposed to more tactics during orientation (Mann-Whitney U = 17 212, P < .001). CONCLUSIONS: Many tactics were used to orient newly credentialed ATs to their roles, but orientations varied based on the practice setting.

Graduate-Assistant Athletic Trainers' Perceptions of the Supervisor's Role in Professional Socialization: Part II.

CONTEXT: Many new athletic trainers (ATs) obtain graduate-assistant (GA) positions to gain more experience and professional development while being mentored by a veteran AT; however, GA ATs' perceptions of the supervisor's role in professional development are unknown. OBJECTIVE: To explore the supervisor's role in the professional development of GAs in the collegiate setting. DESIGN: Qualitative study. SETTING: Phone interviews. PATIENTS OR OTHER PARTICIPANTS: A total of 19 collegiate GAs (15 women, 4 men; average age = 23 ± 0.15 years; National Collegiate Athletic Association Division I = 13, II = 3, III = 2; National Association of Intercollegiate Athletics = 2; postprofessional athletic training program = 5). DATA COLLECTION AND ANALYSIS: Data were collected via phone interviews and transcribed verbatim. Interviews were conducted until data saturation occurred. Data were analyzed through phenomenologic reduction. Trustworthiness was established via member checks and peer review. RESULTS: Three themes emerged: (1) GAs' expectations of supervisors, (2) professional development, and (3) mentoring and support. Participants expected their supervisors to provide mentorship, support, and feedback to help them improve their athletic training skills, but they also realized supervisors were busy with patient care responsibilities. Most participants felt their supervisors were available, but others believed their supervisors were too busy to provide support and feedback. Participants felt their supervisors provided professional development by teaching them new skills and socializing them into the profession. Furthermore, they thought their supervisors provided mentorship professionally, personally, and clinically. Supervisors supported the participants by standing behind them in clinical decisions and having open-door policies. CONCLUSIONS: The graduate assistantship allows new ATs to gain experience while pursuing professional development, mentorship, and support from a supervisor. The extent of development is highly dependent on the supervisor, but most supervisors mentor GAs. When looking for graduate assistantships, future GAs should seek positions in which supervisors actively provide mentoring and professional development.

Graduate-Assistant Athletic Trainers' Perceptions of Professional Socialization in the Collegiate Setting: Part I.

CONTEXT: Many newly credentialed athletic trainers (ATs) pursue graduate assistantships, which allow them to gain experience while being supervised by an experienced AT. The graduate-assistant (GA) ATs' perception of their socialization process into the collegiate setting is unknown. OBJECTIVE: To explore the professional socialization of GAs in the collegiate setting. DESIGN: Qualitative study. SETTING: Phone interviews. PATIENTS OR OTHER PARTICIPANTS: A total of 19 collegiate GAs (15 women, 4 men; average age = 23 ± 0.15 years; National Collegiate Athletic Association Division I = 13, II = 3, III = 2; National Association of Intercollegiate Athletics = 2; postprofessional athletic training program = 6) participated. DATA COLLECTION AND ANALYSIS: Data were collected via phone interviews and transcribed verbatim. Interviews were conducted until data saturation occurred. Data were analyzed through phenomenologic reduction. Trustworthiness was established via member checks and peer review. RESULTS: Four themes emerged: (1) role identity, (2) initial entry into role, (3) maturation, and (4) success. Before beginning their role, participants envisioned the assistantship as a way to gain independent experience while being mentored. They perceived themselves as the primary care providers for their athletic teams. Those who were immediately immersed into clinical practice adapted to their role quickly despite experiencing stress initially. Participants felt that a formal orientation process and a policies and procedures manual would have alleviated some of the initial stress. The GAs matured as they practiced clinically and developed confidence as they gained experience. Personal attributes, experience, and peer and supervisor support contributed to perceived success as GAs. Factors that hindered perceived success were lack of confidence, an unsupportive environment, and long hours. CONCLUSIONS: When looking for graduate assistantships, ATs should seek a position that allows them to practice independently and provides didactic educational opportunities while aligning with their athletic training philosophies.

Exploring the Perceptions of Newly Credentialed Athletic Trainers as They Transition to Practice.

CONTEXT: Research is limited on the transition to practice of newly credentialed athletic trainers (ATs). Understanding this transition could provide insight to assist employers and professional programs in developing initiatives to enhance the transition. OBJECTIVE: To explore newly credentialed ATs' experiences and feelings during their transition from student to autonomous practitioner. DESIGN: Qualitative study. SETTING: Individual phone interviews. PATIENTS OR OTHER PARTICIPANTS: Thirty-four ATs certified between January and September 2013 participated in this study (18 women, 16 men; age = 23.8 ± 2.1 years; work settings were collegiate, secondary school, clinic, and other). Data saturation guided the number of participants. DATA COLLECTION AND ANALYSIS: Participants were interviewed via phone using a semistructured interview guide. All interviews were recorded and transcribed verbatim. Data were analyzed through phenomenologic reduction, with data coded for common themes and subthemes. Credibility was established via member checks, peer review, and intercoder reliability. RESULTS: The 3 themes that emerged from the data were (1) transition to practice preparation, (2) orientation, and (3) mentoring. Transition to practice was rarely discussed during professional preparation, but information on the organization and administration or capstone course (eg, insurance, documentation) assisted participants in their transition. Participants felt that preceptors influenced their transition by providing or hindering the number and quality of patient encounters. Participants from larger collegiate settings reported more formal orientation methods (eg, review policies, procedures manual), whereas those in secondary school, clinic/hospital, and smaller collegiate settings reported informal orientation methods (eg, independent review of policies and procedures, tours). Some participants were assigned a formal mentor, and others engaged in peer mentoring. CONCLUSIONS: Employers could enhance the transition to practice by providing formal orientation and mentorship. Professional programs could prepare students for the transition by discussing how to find support and mentoring and by involving preceptors who provide students with opportunities to give patient care.

Influence of Postactivation Potentiation on Shot Put Performance of Collegiate Throwers.

The purpose of this investigation was to determine the acute effects of heavy and light implements on subsequent overhead back (OHB) shot put performance with a competition weight shot put. This investigation was designed to test the efficacy of heavy implements for potentiating subsequent OHB performance. Participants included 41 athletes (20.9 ± 1.18 years.) from 2 National Collegiate Athletic Association Division I schools in the Midwestern United States (n = 23 male and n = 18 female). Mean distance for OHB throw with a competition shot put was examined after treatment (control, light shot put warm-up, and heavy shot put warm-up) through repeated-measures analysis of variance (ANOVA) with post hoc Bonferroni-corrected post hoc analysis. Responses after treatment on the 10-cm visual analog scale (VAS) fatigue were examined through repeated-measures ANOVA and demonstrated a significant main effect for treatment on VAS fatigue (F = 16.463; p = 0.001). The heavy shot put warm-up resulted in the greatest mean performance over the course of the 3 attempts (14.39 ± 1.82 m) followed by the light shot put warm-up (14.18 ± 1.68 m) and the control (14.15 ± 1.70 m). Results of the repeated-measures ANOVA demonstrated a significant main effect for treatment in regard to average distance (F = 6.276; p = 0.003). Post hoc testing suggested that the heavy shot put warm-up resulted in significantly better mean OHB performance than either the light shot put warm-up (t = 2.983; p = 0.0048; ES = 0.472; power = 0.901) or the control shot put warm-up (t = 3.349; p = 0.0018; effect size [ES] = 0.513; power = 0.939). Subsequent analysis examined the relationship between reported fatigue accrued during the overweight shot put warm-up and the change in performance on the OHB throw when compared to the control condition. Analysis revealed that subjects who reported higher levels of VAS fatigue did not perform as well after the overweight treatment (p = 0.0274).

Supervising athletic trainers' perceptions of professional socialization of graduate assistant athletic trainers in the collegiate setting.

CONTEXT: Many newly credentialed athletic trainers gain initial employment as graduate assistants (GAs) in the collegiate setting, yet their socialization into their role is unknown. Exploring the socialization process of GAs in the collegiate setting could provide insight into how that process occurs. OBJECTIVE: To explore the professional socialization of GAs in the collegiate setting to determine how GAs are socialized and developed as athletic trainers. DESIGN: Qualitative study. SETTING: Individual phone interviews. PATIENTS OR OTHER PARTICIPANTS: Athletic trainers (N = 21) who had supervised GAs in the collegiate setting for a minimum of 8 years (16 men [76%], 5 women [24%]; years of supervision experience = 14.6 ± 6.6). DATA COLLECTION AND ANALYSIS: Data were collected via phone interviews, which were recorded and transcribed verbatim. Data were analyzed by a 4-person consensus team with a consensual qualitative-research design. The team independently coded the data and compared ideas until a consensus was reached, and a codebook was created. Trustworthiness was established through member checks and multianalyst triangulation. RESULTS: Four themes emerged: (1) role orientation, (2) professional development and support, (3) role expectations, and (4) success. Role orientation occurred both formally (eg, review of policies and procedures) and informally (eg, immediate role immersion). Professional development and support consisted of the supervisor mentoring and intervening when appropriate. Role expectations included decision-making ability, independent practice, and professionalism; however, supervisors often expected GAs to function as experienced, full-time staff. Success of the GAs depended on their adaptability and on the proper selection of GAs by supervisors. CONCLUSIONS: Supervisors socialize GAs into the collegiate setting by providing orientation, professional development, mentoring, and intervention when necessary. Supervisors are encouraged to use these socialization tactics to enhance the professional development of GAs in the collegiate setting.

Effects of transducer mass on intramuscular temperature during ultrasound treatments.

CONTEXT: A potential variable that could affect rate of temperature elevation with ultrasound is the pressure (mass) that is applied to the transducer head during application. Added pressure could compress the tissue, affecting density and the transmission of ultrasound energy. Little research has been completed to determine the effects of the amount of pressure applied during therapeutic ultrasound in vivo. OBJECTIVE: To determine the effects of different applied transducer mass on intramuscular temperature during an ultrasound treatment within the left triceps surae. DESIGN: Crossover clinical trial. SETTING: Human performance research laboratory. PARTICIPANTS: Convenience sample of thirteen healthy, college-age students. INTERVENTIONS: Three separate 3-MHz, 1.0-W/cm2 ultrasound treatments were administered 1.5 cm within the triceps surae. The independent variables were the linear temperature standards (0.5°C, 1.0°C, 1.5°C, and 2.0°C above baseline) and the 3 different applied pressures measured in grams (200 g, 600 g, and 800 g). MAIN OUTCOME MEASURES: A thermocouple probe was used to measure triceps surae temperature, and time to reach the temperature standards was recorded during the ultrasound treatments. A 4 × 3 repeated-measures analysis of variance (RM-ANOVA) was used to analyze the differences for temperature points (0.5°C, 1.0°C, 1.5°C, and 2.0°C) and transducer mass (200 g, 600 g, and 800 g) and with respect to time. RESULTS: The results of the RM-ANOVA showed no temperature-point and transducer-mass interaction (F6,72 = 1.69, P = .137) or main effect for mass (F2,24 = 1.23, P = .309). The time required to raise temperature 2°C was 209.1 ± 68.10 s at 200 g, 181.5 ± 61.50 s at 600 g, and 194.9 ± 75.54 s at 800 g. CONCLUSIONS: Under the conditions of this study, the amount of mass applied with the transducer during an ultrasound treatment does not ultimately affect the rate of tissue heating.

A Pilot Study Exploring the Quadratic Nature of the Relationship of Strength to Performance among Shot Putters.

The purpose of this pilot study was to examine the quadratic nature of the relationship between the strength and throwing distance in the shot put. A survey was sent to throws coaches with Master Coach or USA Track and Field Level III distinction to examine fifty-three collegiate and elite throwers (24 male, 29 female). The coaches reported the thrower's personal best shot put distance and preseason weight room 1RM for bench press, power clean, and squat exercises. Relationship between distance and 1RM was determined via general linear model polynomial contrast analysis and regression. Data analysis showed significant linear and quadratic trends for distance and 1RM power clean for both male (linear: p≤0.001, quadratic: p≤0.003) and female (linear: p≤0.001, quadratic: p=0.001) elite and collegiate shot put athletes. Analysis also provided a quadratic equation to compare personal best distance and 1RM power clean. The power clean was found to be more closely related to shot put distance as compared with squat and also with bench press, which is the least related. Based on the results of this investigation, in addition to strength exercises such as the squat and bench press, power exercises such as the power clean should also be incorporated into strength and conditioning programs of shot put athletes for optimal performance.