Editors and Readers,
Having finished the last weeks of the spring 2020 semester, never in my imagination did I envision having led a department and an athletic training program through a pandemic, a sudden shift to remote teaching and learning, and planning and strategizing for a Fall semester that may continue remotely. Like many readers of the Athletic Training Education Journal, I have been amazed at my students' resilience, have been concerned for the patients, preceptors, and partners in clinical practice that are essential to athletic training education, and have been relying on the innovative offers of support to continue teaching. Regrettably, during this most difficult time, I was also responsible for the difficult task of announcing the closure of a graduate professional education athletic training program, before it had even had the chance to enroll students. We were in the “teach-out phase” of our undergraduate program—one remaining class of seniors preparing to graduate in May 2020. We had spent the 2018 to 2019 and 2019 to 2020 academic years recruiting for an inaugural class in 2020. In February, before the pandemic, I was asked to reconsider starting the graduate program. Ultimately, it was decided: we would never finish the final step in the Substantive Change Process. We announced Voluntary Withdrawal of Accreditation and program closure in April 2020.
Given the uncertainty that the COVID-19 pandemic has foisted upon institutions of higher education, I suspect that other program directors and administrators are considering what may come. Unfortunately, I anticipate that others will be making similar announcements in the near future. As institutions of higher education are examining their financial status, anticipating a decline in enrollment and tuition revenue and increased costs for operational processes, administrators will be hard-pressed not to examine educational programming with a view toward return on investment (ROI). Though the mission of higher education is to teach, to discover, and to serve, in order to do so, it must also be able to function as a business, meeting its expenses and planning for the future. I offer this editorial (and eulogy of sorts) to (1) assist those who may be watching their athletic training program for signs of distress and (2) prepare those who remain for the continued turbulent times ahead. Readers are encouraged to consider the questions presented in the Table within their own institutional contexts.
Athletic training education has responded to previous periods of growth and change. Readers are encouraged to read the extensive review by Delforge and Behnke1 of the history and evolution of athletic training education published in 1999 to commemorate the 50th anniversary of the National Athletic Trainers' Association (NATA). These first 50 years were marked by growth, refinement, and recognition of the unique skill set that the athletic trainer brings to the sports medicine team. As athletic training neared its golden anniversary, the profession was poised for another moment of significant change. In 1997, the Education Reform Task Force's recommendations were formally endorsed by the NATA Board of Directors to establish the Education Council and set-in motion the elimination of the internship route to certification and the mandate that all programs be accredited by 2000. Institutions that had previously sponsored exam candidates for the Board of Certification (BOC) through the internship route to certification had to decide if they were going to pursue accreditation by the (then) Joint Review Committee on Educational Programs in Athletic Training and the Commission on Accreditation of Allied Health Education Programs to meet the 2004 deadline for BOC eligibility. Some colleges and universities chose not to pursue accreditation, while others committed the resources needed to meet the standards for initial accreditation. Between 2000 and 2004, the number of accredited programs doubled from 120 to over 250. Throughout the 2000s, improvements and adjustments were made to athletic training curriculum content, qualifications for preceptors and affiliated clinical sites, workloads and financial support, and establishment of program outcomes.
Moving ahead to 2009, during the Great Recession and soon thereafter, institutions of higher education experienced a wave of furloughs, budget cuts, and enrollment declines, but relatively few athletic training programs were eliminated. Programs successfully navigated the first round of re-accreditations and prepared for revisions to the Commission on Accreditation of Athletic Training Education (CAATE) Standards, the NATA Educational Competencies, and the BOC Practice Analysis. With the establishment of Standard 11 with the 2012 CAATE Standards, that programs must meet a 3-year aggregate first-time pass rate of 70% or greater, it was speculated by many that the number of professional athletic training programs would diminish as programs that were on probation or unsuccessful in meeting the standard would be eliminated. While some programs did voluntarily withdraw, the vast majority of programs responded by bolstering their curricula and improving student performance. But disparities existed in program outcomes; questions remained about the future of the profession and how to best prepare students for clinical practice.
In 2014, when the NATA Board of Directors published the Executive Committee for Education's White Paper, examining the professional degree level for athletic training, program directors and faculty were once more forced to consider the future and their place in it. With the Strategic Alliance's announcement in 2015 that athletic training education was moving to the master's degree level, another round of discussions had to take place at the program, department, school, and institutional levels. Over the last 5 years, institutions have announced voluntary withdrawal; others have begun the process of growing graduate programs, recognizing their potential impact on bottom lines. Others, with a history of postprofessional master's degree programs, began offering professional education programs as well as or in lieu of accredited postprofessional degrees.
So, in 2020, with the manner and structure of the coming academic year in question, program administrators and faculty are looking again at a monumental shift in athletic training education—not solely due to the implementation of the 2020 Standards for Accreditation for Professional Programs, the decision to discontinue accreditation of Post-Professional Degree Programs, and the revision to CAATE-accredited residency program and fellowship program standards. The impact of the novel corona virus, COVID-19, on higher education as a whole now places additional pressures on athletic training education and its processes.
Readers would do well to use the months ahead for introspection and planning. Two additional recruiting cycles remain in which entering students may choose between enrolling at an institution offering a 4-year undergraduate professional degree program, enrolling at an institution offering a 5- or 6-year combined preprofessional and professional degree program, or enrolling at an institution not affiliated with an athletic training program and decide to adjust their academic career plans. Higher education institutions, researchers, market analysts, and consulting firms spend considerable time, energy, and resources trying to understand the decision-making processes of traditional-aged high school graduates and their families. Similar efforts are made to understand undergraduate students who are balancing the options of applying to professional or graduate schools or entering the workforce. Alternatively, individuals in the labor market are also weighing the ROI of returning to school on a full-time or part-time basis to augment their earning potential, or change careers for improved personal fulfillment or family circumstances or as a result of job loss. Recruiting for an athletic training program regardless of degree level requires an understanding of the current landscape and the market for potential students.
When transitioning from an undergraduate program to a graduate program, program personnel spend considerable time preparing—conducting an environmental scan, negotiating with administration, developing a financial projection model, completing the substantive change applications or “mini self-study,” organizing curricula and marketing to future students. The launch of a new graduate program brings excitement and energy—a good story to tell and to showcase: an institution poised for growth.
Over the past 5 years, my faculty and I pursued a dual strategy, expanding our offerings in health, wellness, and exercise science while being creative and innovative in our athletic training curriculum. Our goals were to showcase all that undergraduate education should offer in preparing students for professional graduate study in the health sciences (critical thinking, quantitative and informed reasoning, ethical decision making, an understanding of the biopsychosocial determinants of health and health disparities, and the essential elements of humanity in the liberal arts), while simultaneously encouraging students to consider a career in athletic training to promote physical activity, to prevent and address the prevalence of chronic disease, to manage acute illness and injury, and to promote exercise as a therapeutic intervention. While navigating the self-study process and gaining a 10-year reaccreditation in 2019 and completing the degree transition process, I am confident in saying we tried our best.
Regrettably, this fall as applicants did not materialize, as program head count for the summer was tenuous, I had to make one of the most difficult decision of my career as an athletic training educator: to recommend closing my own program. How did we get there? As a program based in Cincinnati, Ohio, we are blessed to be located in a metropolitan region with a high population density. We have significant numbers of graduates from the surrounding region and robust clinical placement opportunities. We have over a 30-year history of graduating athletic trainers (ATs) for professional practice. The hospital systems in the region hire recent athletic training graduates in a variety of employment settings, and our students were able to find work easily. We have a robust network of affiliated clinical sites and an active advisory board. We had had such high aspirations and projections that making the transition would be fruitful and the right thing to do. We had completed the self-study as well as a business plan to demonstrate how we would fill our class and meet our benchmarks.
Unfortunately, as the months progressed in our recruitment cycle, the data has demonstrated expanding options for students, regionally and statewide, and declining interest in athletic training education at the graduate level. Cincinnati has more than 10 institutions of higher education in a 60-mile radius. Of those institutions, remarkably, 8 offered professional athletic training programs (4 public institutions: University of Cincinnati, Miami University [Ohio], Northern Kentucky University, and Wright State University; 4 private institutions: Xavier University, Thomas More University, Wilmington College, and Mount St. Joseph University). Three of the private institutions (1 National Collegiate Athletic Association Division I, 1 National Collegiate Athletic Association Division III, and 1 National Association of Intercollegiate Athletics) had already transitioned to the graduate level, having led the region with a year's head start, before my institution received final approval from the CAATE and the Higher Learning Commission. The 2 largest public universities (1 Football Bowl Subdivision Division I/Very High Research University and the other a Division I/Comprehensive Master's University) have transitioned or planned to transition but have delayed the start of their graduate programs. When we had originally proposed the Master of Athletic Training degree, there was 1 graduate professional program in Ohio (more than 5 hours away). By the time we were approved 2 years later and began recruiting, there were 11 graduate programs in the state (2 within our own county). Our program's historic niche had been to recruit traditional-aged students to the institution, with about half of those students also having plans to pursue graduate study in physical therapy. As we expanded our exercise science offerings, fewer students decided on athletic training as a career goal. This trend was also evident as the entering classes of athletic training students at the graduate professional programs in the state hovered at 10 students or less per cohort. Despite considerable efforts to market the athletic training program to undergraduate students at other like-sized institutions in surrounding states and connecting with pre-health students and advisors at larger universities, the numbers had not materialized.
In February, as my dean and I prepared the summer and fall schedules for 2020, answered questions from Admissions and the Provost's Office, and began preparing the annual department budget, there were few remaining justifications for continuing to offer an accredited professional athletic training education program. Faced with market saturation, declining interest both internally and externally, and the obvious costs of weathering an unknown time period of low enrollment, we determined that it was in the best interests of the institution to announce program closure.
It was the right thing to do for the well-being and future of my institution, but it was no less painful for myself, my students, and my colleagues. We made the decision based on data and the common good. Announcing program closure is much more reserved and measured than announcing a new program or expanded program offerings. It requires a delicate balance of showing compassion while also defending calculated decision making. Instead of celebrating an opening, announcing a program closure requires informing undergraduate students that their hoped-for destination will not be accepting students, perhaps announcing the elimination of faculty positions, and saying good-bye to trusted and respected colleagues. When advising students, faculty should be able to provide contingency plans and consider working with nearby programs to establish articulation agreements whereby students can pursue accelerated acceptance into another graduate athletic training program.
To be clear, the decision to close our athletic training program was made in the opening days of the Spring 2020 semester, before the stay-at-home orders were issued, before Fall 2020 semester formats were in question, before our fiscal year budget was devastated by having to return income from residence hall room and board, and before our enrollment projections for the Fall semester had become so much more critical. Despite recruitment efforts over the past 18 months, it was determined that the anticipated enrollment we needed in order to sustain the athletic training graduate program was not going to materialize without significant investment of time, talent, and money. Providing a high-quality, accredited health care professional program is costly and resource-intensive. As more programs have transitioned from the bachelor's degree level to the graduate level, the recruiting landscape has become more predictably difficult. Despite a strong reputation in the health sciences generally, and a history of preparing ATs, programs may not be able to draw undergraduate students from other institutions to meet expectations and financial plans to keep the education reasonably priced for students. Smaller, regionally focused, comprehensive liberal arts universities without broad brand recognition will struggle to recruit students for graduate education in athletic training. The ability to recruit students to newly accredited programs in physician assistant studies, for entry-level nursing, and for physical therapy requires investment, but for athletic training, more so. The varied stakeholders in athletic training education (the NATA, the CAATE, the newly formed Association of Athletic Training Educators [AATE], the faculty, the future employers, and the alumni of these programs) will need to focus considerable effort and resources toward marketing athletic training as a destination career to potential students whether they be traditional-aged undergraduate students or career changers resulting in an older student population.
So, as others are likely facing similar circumstances, now compounded by the ramifications of the COVID-19 pandemic, I encourage athletic training educators to take a hard look at their institutions' long-term well-being and the well-being of the remaining athletic training programs in their region to determine a path forward. I am certain that athletic training programs will continue to thrive and will take on the best elements of the programs that have closed and ensure their legacy.
With deepest regards and hope for future ATs, BC Charles-Liscombe.