Transition to clinical practice is a topic receiving substantial attention. Many reports have focused on the educational program's role and have stopped short of identifying the impact of the initial year of employment on desire to persist and future career goals.
To examine the career aspirations of athletic trainers in their first year of employment who graduated from professional master's programs.
Nine professional master's athletic training programs, variety of employment settings.
Seven men and 7 women (age = 25.6 ± 3.7 years).
A general inductive approach was used to analyze data from individual interviews conducted 6 and 12 months into the first year of clinical practice. Multiple-analyst triangulation and peer review ensured credibility.
Graduates of professional master's programs in athletic training plan to stay in the profession. However, newly credentialed athletic trainers do not plan to remain with their initial employer beyond 2 years; 11 of 14 participants (79%) stated their first job was transitional. The first year of employment did not change participants' perceptions, as the graduates knew upon taking their first job that it would be temporary. Though participants planned to change jobs, most (79%) planned to continue to engage in clinical practice as athletic trainers.
Understanding newly credentialed athletic trainers' perceptions of the impact of the first year of employment can provide educators and employers important insight to assist in retention and persistence of young professionals. Graduates regard their first years of employment as impermanent. However, the majority do not wish to leave clinical practice. Participants viewed their first job as a way to gain valuable experience that did not dissuade them from continuing in the field. Recent graduates demonstrated ambitions to experience different work settings and higher-level positions with greater responsibilities.
Newly credentialed professionals who have recently graduated from professional master's programs plan to maintain employment within clinical practice settings.
Newly credentialed professionals who have recently graduated from professional master's programs view their first job as transitional; and are willing to change employers.
Newly credentialed professionals who have recently graduated from professional master's programs are interested in gaining new experiences as an athletic trainer and career advancement.
As of 2018, the US Bureau of Labor Statistics1 recognized there were over 31 000 athletic training jobs available in the United States, with a projected 19% growth over the next 10 years. To fill these new positions and maintain employment in existing jobs, athletic training programs must prepare students to enter the profession while instilling in them passion for the profession and a desire to persist in the field. Athletic training students are known to develop confidence and appropriate professional socialization, gaining an understanding of their future career, within their athletic training programs.2–5 Confidence and socialization assist students in their preparation to enter the workforce and hopefully to persist in the field.2–5
In a large study of over 18 000 athletic trainers, Kahanov and Eberman6 identified a tendency for athletic trainers to exit the profession around the age of 30. The authors postulated that the “general decline” could be due to aspects of the profession that were “not desirable as people mature.”6 Additionally, female athletic trainers were found to leave the field of athletic training around the age of 28 years.6 These findings from 2011 were concerning. In the context of present-day professional education, which is nearing the end of the transition to the master's degree requirement, a maturing population of athletic trainers will be entering the workforce. Therefore, the career aspirations and future plans of this population require further evaluation.
Recruitment to the athletic training major, as well as persistence and retention to graduation, have previously been evaluated among professional bachelor's athletic training students.4,7 For example, introducing prospective students to athletic training professionals working in the secondary school setting has been a powerful recruiting recommendation. Observing high school athletic trainers offers prospective athletic training students the opportunity to have a firsthand look at a potential career path for the certified athletic training professional.7 With the move to the master's degree, this socializing agent may be less impactful, as students exposed to athletic trainers at the secondary school level will still need to earn an undergraduate degree before enrolling in a master's degree program. Additional socializing agents may exist for the graduate student population. In other published accounts of undergraduate student retention, hours worked, salaries, and work-life balance all functioned as detractors for persistence.4 Further, a lack of respect and understanding of the profession by the public was found to be detrimental to students' desires to continue in the field.4 It is unknown if these factors impact graduate students' persistence and desire to work as athletic trainers.
Transition to clinical practice has been a recent topic of substantial attention in athletic training.8–10 This research, however, has focused on the ability of students to transition successfully to their new positions, and has stopped short of identifying the impact of the initial year of employment on career persistence and future career goals. The primary objective of this study was to examine the career aspirations of athletic trainers who had graduated from a professional master's program and had completed 6 to 12 months of independent practice. Two research questions guided the study: (1) Do graduates of professional master's programs plan to stay in the athletic training profession after their first year of employment? (2) Does the first year of employment impact the long-term career aspirations of graduates from professional master's athletic training programs?
This longitudinal qualitative phenomenological study spanned the entire first year of employment for 14 graduates of athletic training professional master's programs. Participants were interviewed just before or immediately after graduation to determine their initial perceptions of their own readiness to enter the workforce.10 The same participants were interviewed twice more at approximately 6-month intervals during their first year of employment to continue investigating their perceptions of transition to practice.10 Data included in this paper were gleaned from the second and third interviews, which were completed when the participants were approximately 6 and 12 months, respectively, into their first employment position. We chose the last 2 interview time points to allow participants time to familiarize themselves with and work in their new position. Data were gleaned primarily from 3 interview questions asked during both the second and third interviews: (1) Do you see this position as a long-term employment setting? (2) Do you feel the same way as you did when you first took your job? (3) Do you see yourself working clinically long term?
The participants included 7 male and 7 female athletic trainers (age = 25.6 ± 3.7 years; Table) who attended and graduated from professional master's programs. Program director email addresses were gathered from the publicly available directory on the Commission on Accreditation of Athletic Training Education website. Recruitment emails were forwarded by program directors to students enrolled in the last semester of their academic program. The participants graduated from 9 different accredited professional master's athletic training programs from across the United States. These programs were housed in institutions that represented 7 of the 10 National Athletic Trainers' Association districts. Inclusion in the study required students to pass the Board of Certification exam and gain full-time employment as an athletic trainer. Initial employment settings for participants included high school (n = −5), collegiate (n = 6), professional sports (n = 2), and performing arts (n = 1).
Upon approval from the institutional review board, participants were gathered through a recruitment email sent to all program directors of accredited professional master's programs. The email requested that program directors forward a recruitment email to all students enrolled in the last semester of the program, about to embark upon professional practice. In the recruitment email, potential participants were asked to contact the primary investigator. Upon enrollment in the study, participants agreed to be interviewed 3 times throughout their initial year of employment, beginning just before or immediately after graduation. Individuals provided their consent to participate verbally before each interview.
A semistructured interview guide was created based on the research aims. The interview guide was reviewed for alignment to the research goals by the 4 members of the research team. The interview guide was piloted with 3 individuals; minor changes to flow and grammar were implemented after the piloting process. The pilot data were not used in the results. One-on-one interviews were completed by phone. Interviews were digitally recorded, and data were transcribed by a professional agency. Participants were assigned pseudonyms to protect their identities.
Data analysis followed a general inductive approach.11 Initially, 2 researchers individually read all transcripts, immersing themselves in the perspectives of the participants. Second readings of the transcripts included assigning codes, or labels, to segments of data. A codebook was maintained by the researchers to enable items of similar nature to be coded with the same label.11,12 After the completion of coding, the researcher combined related codes into categories and from the categories developed overarching themes to answer the research questions.11 Where possible and applicable, the answers to some questions were enumerated, allowing a quantitative component in the results.
Credibility was established after data saturation, which was deemed to have occurred with the 14th participant.13 Throughout the interviews, the researchers maintained memos that allowed a constant comparative process.12 When no new data were forthcoming from participants, saturation was deemed to have occurred and initial interviews and recruitment were discontinued.13 An additional stem to ensure trustworthiness and credibility was established through multiple-analyst triangulation. Multiple-analyst triangulation occurred as 2 different researchers engaged in their coding and categorization analysis process separately. After their individual analyses, the researchers compared their findings and came to an agreement on the final structure and nomenclature for the results.11
Researchers sought to determine if recent graduates of professional master's programs planned to stay in the athletic training profession and if the first year of employment impacted those plans. Analysis revealed 2 categories of responses, whereby many participants identified plans for career persistence as an athletic trainer while also forecasting a transition to other experiences within the profession.
Graduates of professional master's programs in athletic training do plan to stay in the athletic training profession. Participants mostly identified long-term goals of persevering in clinical practice. Eleven of 14 participants (79%) identified a desire to continue to engage in clinical practice for their foreseeable futures. For example, Courtney stated, “Yes. I think I could easily spend the next 10 years working this job and I would be pretty happy with it.” She continued about her passion for the profession: “I think I want to work as a clinical athletic trainer, hopefully until I'm 80, or until my body can no longer handle being an athletic trainer.” She also said, “I think clinical is where my love of athletic training comes from, and my favorite parts of athletic training are working with patients in a clinical setting. I don't think I'll ever get too far away from that.” When asked if she thought she would continue to practice clinically after her first year of employment, Tamara said, “I don't see myself doing anything other than athletic training. I never really have.” When posed the same question, Devan said,
Yeah. I don't see myself going more into the office, I come from a background of being an athlete, being a coach, and always being kind of what I call boots-on-the ground type of role. So that's where I see myself throughout my career is more involved, rather than necessarily moving into the realms of working like within an office, or working in more of a supervisory role.
Interestingly, the experience of the first year of clinical practice reinforced participants' desire to work in specific settings. Courtney said, “I definitely wasn't sure about the high school setting, and I wasn't sure if I was gonna like it. I think it has grown on me a lot. I've realized some of the advantages to it that other settings of athletic training don't have.” Likewise, Devan said, “Yeah, I do want to stay within the collegiate or high school setting. I don't necessarily see myself going into athletic training in the physician setting.” The impact of working clinically reinforced a desire to continue that work for our participants. Once they got into their first job, they enjoyed it. India stated, “I can't picture myself doing anything else. Before this year I would have said no, but I have actually really, I've really enjoyed it.”
Some participants identified eventual difficulties with the profession, but those did not dissuade them from committing to working clinically now. Tamara said,
I wouldn't want to not be clinically involved. I don't know. Would I want to start a family and all of that? That could really change the fact that maybe clinical's not best for me. I don't know. But right now, I have no ties, no nothing, so I can do what I want, which is also very nice.
Tamara identified other concerns, stating, “I have enjoyed it and I see it for a while. I don't know how long. I don't know where my life will take me. Salary comes into it.” Like Tamara, Marcus knew he wanted to continue working clinically, but was unsure exactly what that career might look like. When asked if he thought he would continue to work clinically he said, “Oh, sure. Absolutely. I just don't know how that's going to look. I still don't know. I have no idea. I've kind of given up on figuring that out. It's just what's going to come my way.”
After their first year of employment, participants identified a desire to continue working in clinical practice. Some participants were hoping to stay in the same setting, describing their first year of employment as reinforcing their desire to continue to pursue and build their careers in the field of athletic training.
Though participants identified a desire to stay in the profession of athletic training, a majority did not plan to remain with their initial employer beyond 2 years. Eleven of 14 (79%) indicated viewing their first job as transitional. For example, for Devan the first year of employment was seen as a place to gain confidence and become comfortable practicing. He said,
I see this as somewhere that I'm using as a way to transition into practice and to get hands-on experience, active hands-on experience in a collegiate setting so that then I'm able to be here, be somewhere where I'm comfortable and I'm happy until I find the right position to make the next step. Whether that's a step directly up or whether it's a step to another smaller school that has more resources or more ... puts me in a position to better network to eventually work my way to my goal.
Participants knowingly took on their first position as a springboard or bridge to future positions in the athletic training profession. Caleb said, “I took basically the first job that offered and they treat us well, things felt right. So, I wasn't necessarily like, ‘Oh this is where I want to be. I want to be in the high school setting.' But it was somewhere that I knew I could enjoy.” Caleb continued, saying, “When I took it [the job], I think in my mind I thought well this is just a springboard. This will jump start my career, this may not be where I'm at long term, but it's a start.” India knew she would be changing jobs, saying, “When I first started, I kind of thought well, this is just going to be a bridge position. I'm just going to try and only be here for a year, and I'll look for a position later.” Similarly, Ainsley said,
I see myself at least for 2 years, that's kinda my theoretical thought process but I mean I don't feel like I am sitting on something I am going to be at for 30 years right now. Not that I can't be at a great position and there's definitely some really cool things with it but just kinda in my heart, I don't necessarily feel like okay this is where I am called to sit and stay. So, I still have a little bit of restlessness not knowing where I am going to go or what I would do for long term right now.
Robert described a desire for upward career mobility. He said, “I love what I do, and I think I could see myself here for another year or 2. I definitely know I want to work in soccer but, I think that this is a first step. I'm hoping I would like to work my way up.” Robert also identified that the desire to change roles or work into positions with more responsibility may require frequent job changes or moving. He said,
I think that's one of the things just how this role goes is that, if you really want to move up, you have to be willing to move and to bounce around and to take positions and spend a year one place and then go another place and spend 2 years there. I would love to say that I would be here for a long time but I'm not really sure, to be honest.
Like Robert, Tamara envisioned a career with a leadership role and knew that would require job transition. She said,
I don't think there's a lot of room for growth for me here, and eventually I want to move on and be a head athletic trainer, work for a minor league baseball team, or something. That's not going to happen here. I think maybe another year, maybe 2, depending on how this new administration pans out. If I absolutely hate it, then I can always move. I'm not locked in forever.
Participants also sought transition to different locations. Ivan wanted to travel and said,
I'd like to just go to a different location. I'd like to see different parts of the country before I have to settle down. I mean, I would prefer a Division I university, but if I found a job that I wanted, or if I found a location that I wanted and it wasn't Division I, I still might take it.
For Marcus, the ability to live in different locations was important:
I don't care where I work, I want to be able to do other things and where I live is very important to me, and yeah, so secondary school's great. But so is professional sports, and so is the university and so is private practice, depending on if you get respected, if you get paid.
Staying in clinical practice was a long-term goal for our participants. Many participants articulated a desire to change jobs and continue working toward career advancement and were opened to making changes in their geographical location. They did not view their first job as a position they would stay in forever, though they were committed to working as athletic trainers.
Our study sought to determine the career aspirations of recent graduates of athletic training professional master's programs. Our findings suggest that graduates of professional master's programs plan to stay in the athletic training profession after their first year of employment. However, the participants did not commit to staying in their first job and were opened to changing jobs within the field of athletic training. Additionally, the first year of employment did not detract from the recent graduate's long-term career aspirations to continue working as athletic trainers. Persistence and transience in the field of athletic training are multifactorial.
The impact of age and sex have previously been identified as potential factors for exiting the profession, with women leaving the profession at a younger age than men.6 Our participants did not seem to identify with the concerns that had been articulated by Kahanov and Eberman.6 Female athletic trainers working in the Division I setting have been identified as a particular group questioning their persistence in the profession.14 The reasons women may leave the profession include desire for family, perceptions or experiences of work conflicts with motherhood, low salaries, and long working hours.14 Yet the female participants included in our study did not identify a desire to leave the profession. Women represent approximately half of National Athletic Trainers' Association membership and half of the participants in this study. Female graduates did not indicate different persistence practices than male graduates.
Clinical experiences can have both positive and negative impacts on the early careers of professionals.4,10,15,16 In a recently published study of this same cohort of newly credentialed athletic trainers, the importance of clinical experiences in their professional preparation program was identified as beneficial to success in their first year of employment.10 Benes and Mazerolle4 suggested that undergraduate athletic training students were aware of negative aspects of the profession but persisted because of the prevalence of positive factors that were on display during clinical education. Clinical experience has been found to positively impact student success and ability to transition to independent practice by allowing students to familiarize themselves with the role of an athletic trainer while developing confidence and autonomy with patients.10
Bowman and Dodge15 identified that professional bachelor's students suffered from stress and anxiety because of competition with peers in their programs, often felt overwhelmed, and suffered from negative interactions with preceptors. Additionally, professional master's students have identified frustration with a lack of engagement during clinical experiences.15 Factors that cause a student or young professional to have a negative impression of their future career could cause them to leave the field. When students are exposed to work-life balance problems and are aware of low salaries and monotonous clinical experiences, they have been known to become disenchanted with the pursuit of the profession.15 Though our participants were not students, these young professionals were recent professional master's graduates. They were not leaving the field immediately, but rather were committed to persisting in the profession. Like undergraduate students,4 our participants knew of issues they would face during their transition to full-time employment because they had been exposed to challenging situations during clinical education experiences.
For some, leaving the profession was not impacted by clinical education; rather, it was impacted by their employment setting and job requirements. An investigation of why individuals might choose to pursue a master's degree in athletic training but then decide to leave determined that those who left did so because of an inability to balance work and life, identifying factors of working hours and salaries to be the primary detractors.17 Heavy workload and burnout present 2 challenges that make work-life balance difficult and challenge the satisfaction of new professionals in their employment settings.18 Additionally, some athletic trainers have identified a perception that their position has low value in the workplace.17 These factors were not apparent within our participants. It is possible that as the transition to the master's level degree continues, so too may the trend of persistence for young professionals. Enthusiasm and passion for the patient population and work setting have been identified as reasons recent graduates maintain their commitment to the profession of athletic training.19 Our participants described instances of being similarly engaged in their positions, leading them to persist in the field.
Evidence of engagement in the profession through the desire to pursue a master's degree may predispose master's-program graduates to persistence in the field after retention in their graduate program. Professional master's athletic training programs have been found to have higher retention rates and career-placement percentages than their bachelor's counterparts.20 Program directors believe that retention is improved when programs initiate a secondary admissions process whereby students must apply to the athletic training major after their acceptance or admittance to the institution.2 For the master's cohort, this secondary application would occur in the selection of and eventual admittance to a graduate school. In applying these findings to our population, the act of pursuing graduate school and a master's degree certainly required an application and selection process, and thus signaled commitment to at least 2 years of higher education, initiating a professional commitment to the field. Program directors have previously identified an understanding of the importance of screening candidates at the master's level to admit students who already demonstrate an understanding of the field along with characteristics that will allow them to retain in the major and persist in the profession.21
Career goals and a dedication to the field have been important parts of persistence for undergraduate students.3 A 2009 survey22 of senior athletic training students from undergraduate programs found motivation to be a great contributor to persistence. As students' motivation to succeed increased, they were more likely to persist in the field of athletic training and less likely to change their major. The highly motivated students were also more confident in their abilities and career choice.22 Though recruitment and retention remain concerns for program directors in professional master's programs,21 these programs lend themselves to admitting, educating, and graduating a population of students inherently more committed to persistence by their pursuit of the master's-level degree.
Another reason for persistence of master's students in the profession of athletic training is affirming and positive relationships with preceptors and faculty.10 These relationships flourish at the master's level and facilitate transition to practice through mentoring networks.10 As graduates transition to autonomous practice, mentors can assist in their socialization and support them through validation of their choice of career path and endorsement of career plans.18 The impact of mentors is not unique to the field of athletic training. Physical therapists in their first year of employment have also identified that mentors established in the clinical education environment can continue to be influential during their initial years of practice.23 Further, new employees who are engaged in a supportive workplace structure are able to grow and gain confidence by continuing to develop under the tutelage of mentors, whereas those who do not have such relationships consider leaving the profession.23 As such, mentoring relationships and supportive environments assist recent graduates in finding success in their new jobs. Success and support, as articulated by our cohort of newly credentialed athletic trainers, lead to intention to stay in the profession.
The participants in our study were indeed determined to persist in the athletic training profession; though they were not looking to leave the field, they might change positions. Participants in our study were likely members of Generation Y, also known as millennials, and were on the cusp of Generation Z. A phenomenon that has been identified as being associated with millennials more than with previous generations is the concept of job-hopping.24,25 Members of the millennial generation are more likely to change jobs and to view changing jobs as an acceptable practice than members of other generations.24,25 It is hypothesized that Generation Z will be just as likely to view job-hopping as acceptable.26 There are limited published accounts of research related to job hiring and persistence for Generation Z, likely because this generation has newly begun working.
Athletic training is not the lone health care field wrestling with the transition experiences of newly accredited professionals. Nurses have difficulty transitioning to practice, finding their new settings initially disorientating.27 As the problem of retention and high turnover has troubled the nursing profession, Rush et al27 determined that retention was generally improved for those engaged in transition-to-practice programs compared with those who were not. The programs for transition by employers typically include preceptors/mentors, specific orientations, and opportunities for further education. Transition programs can help to build new graduates' confidence and improve workplace culture.27 Transition-to-practice programs such as those described by Rush et al27 may be similar to the graduate assistantship position in athletic training education, as many of the same attributes of orientation and mentoring are identified as preceding success for graduate assistantships.8 However, with the transition to professional preparation at the master's level, it is likely that graduate assistantship positions will decrease, leaving a lack of supportive environments for newly credentialed athletic trainers to pursue as initial employment options. Continued monitoring of newly credentialed athletic trainers' success in transitioning to practice is needed to provide greater context for these potential trends related to career persistence. The previously identified challenges of transitioning to practice did not dissuade this cohort of young professionals from persevering and creating career goals that aligned with the athletic training profession. Employers can consider understanding that new employees aim to transition.
Some limitations of the present study include a small sample size, limited time frame, and semistructured interview format. To truly understand the population, it would be beneficial for a larger pool of participants to provide insight into their experiences. Regarding time frame and the interview format, the participants engaged in a qualitative interview at set time points throughout their first year. The time at which the interview occurred could have impacted the answers of the participants. Alternative methods such as reflective journaling could be used to engage the participants more frequently and prompt introspection monthly or biweekly to truly capture the experience of their first year of employment. Lastly, 2 participants who completed the interviews were employed as interns and therefore potentially more likely to transition from their job at the conclusion of the intern contract.
Our findings suggest graduates of professional master's programs regard their first years of employment as transitional. Many recent graduates do not wish to leave clinical practice. Participants discussed intentions to gain experience in their first years of employment and then move on to experience different work settings or take on higher-level positions with greater responsibilities. Though a plethora of barriers and challenges as well as a lack of persistence have been identified with undergraduate athletic training programs, those negative issues may not impact professional master's graduates. Understanding the impact of the first year of employment on future career aspirations for newly credentialed athletic trainers can provide athletic training programs and employers with important insight to assist in retention and persistence. Continued research should focus on these initial years of employment and the perceptions of young professionals within them. Employers may maintain their new employees by creating a flexible workplace, providing a variety of opportunities for newly credentialed athletic trainers to experience and grow within the profession.