Professional identity formation and professionalism are hallmarks of health care professionals. Professionals establish their professional identity through assimilation into the profession by immersing themselves in the practice of the discipline. According to the National Athletic Trainers’ Association (NATA), “Athletic trainers (ATs) are highly qualified, multi-skilled health care professionals who render service or treatment, under the direction of or in collaboration with a physician, in accordance with their education, training and the state’s statutes, rules and regulations. As a part of the health care team, services provided by athletic trainers include primary care, injury and illness prevention, wellness promotion and education, emergent care, examination, clinical diagnosis, therapeutic intervention, and rehabilitation of injuries and medical conditions.”1 However, athletic training domains cannot be performed consistently without a moral compass delineating the expected behaviors contextualized in shared professional values. Professional identity anchors values, aspirations, and conduct within the profession. A strong, consistent professional identity enables professionals to gain the trust and respect of the medical community. Development of a moral compass requires a commitment to the shared professional values and behaviors that define what it means to be an AT through the evolution of a professional identity.
To facilitate the development of this moral compass, ATs adhere to codes of ethics and standards of professional practice through national and state organizations and certification agencies, respectively. These codes reflect the expected behaviors of those professionals who practice within the discipline. These guidelines delineate the responsibilities and obligations essential to health care practice, thereby reflecting the values and behaviors expected by those who entrust their care to us.2 Based on the nationwide membership research of the NATA Professional Responsibility in Athletic Training Committee, the NATA Board of Directors3 endorsed and articulated 5 shared professional values for ATs: caring and compassion, integrity, respect, competence, and accountability (CIRCA). This critical step demonstrates a commitment not only to its members but to society as well because the expected values and behaviors were chosen and clearly articulated.
Shared professional values encourage consistent behaviors and motivate compliance with ethical, legal, and regulatory guidelines.4 As intended outcomes, professionalism and professional identity emerge. These are not new concepts, as the Code of Hammurabi, Hippocratic Oath, and Maimonides Oath guided the field of medicine as early as 2000 BC,5 and professionalism and professional identity have gained increased attention in Commission on Accreditation of Athletic Training Education (CAATE), Board of Certification (BOC), and NATA documents. As members of the Strategic Alliance, each of these partners has professionalism as a fundamental tenet. Specifically, the BOC lists professionalism as one of its key organizational values, thereby explicitly establishing professionalism as an essential construct in protecting the public.6 Moreover, Sauers7 recommended that the CAATE follow the lead of the Accreditation Council of Graduate Medical Education8 in adopting professionalism as a core competency. As such, ATs would be educated in academic programs on the importance of carrying out professional responsibilities and adhering to ethical principles.
Similarly, the Carnegie Foundation emphasized the importance of professionalism in its report on the future of medical education. The Carnegie Foundation articulated that “professional identity formation—the development of professional values, actions, and aspirations—should be the backbone of medical education.”9 The Carnegie studies of the professions also showed that educational programs needed to pay more conscious attention to the formation of students’ professional identity in order to include the moral and ethical core of professional practice.10
In medical education, the term professional formation is used to describe professionalization. The Carnegie Foundation for the Advancement of Teaching9 defined professional formation in terms of 3 apprenticeships: cognitive, practical, and professional formation. The last is further described as that which engages students with the purpose and attitudes guided by professional community values.11 A long-standing construct that was identified more than a century ago, instruction in professional conduct requires both technical and cognitive skills and formal education in core professional values such as compassion, service, and altruism.11 In their most recent conceptualizations of expert practice in physical therapy, Black et al12 posited that professional formation is a key developmental process in novice-to-expert transitions. They characterized professional formation as a process that incorporates change within an individual, as well as social and professional enculturation, thus providing a scaffold for the achievement of professional competence grounded in social and moral engagement within the community of practice.12
Professionalism and professional identity emerge as essential elements in the educational preparation and careers of health care professionals. Professionalism encompasses specifically articulated values and behaviors integral to the specific discipline. Beginning in the educational processes of professional programs and extending through continuing education, an emphasis on infusing shared professional values and behaviors into professional mentoring and expectations will enhance the profession’s identity as a whole. Professional identity manifests as professionals develop consistent behaviors reflecting shared professional values as consistent expectations are met. These shared professional values and expected behaviors provide a strong foundation for the profession. Through athletic training’s shared professional values of CIRCA, the profession identifies and endorses behaviors aligned with these values. By clearly defining and explicitly articulating these values, ATs will have a common language for and expectation of specific professional behaviors. As an integral construct of the contract with society, this professionalism component helps to further refine the professional identity.
Professionals grow when grappling with the ambiguity of everyday life. Each day, ATs think critically, reason clinically, and decide appropriately on health care matters. Without shared professional values, it would be difficult to reflect the athletic training professional identity consistently. As ATs transition to practice from educational programs, a professional identity continues to evolve. Through deliberate, planned experiences during the educational process, the AT understands and appreciates what it means to think, act, and feel like an AT. Development of this professional identity is a dynamic process as professionals journey through the various stages of their careers. Professional identity sustains a profession because it communicates a powerful message to the health care community regarding who we are and what we stand for as a collective group.13 As a profession, the shared values will go beyond the content knowledge needed to be proficient, hence revealing the heart of the profession. Shared professional values are the cornerstone in most health care professions and define a distinctiveness within each group. As athletic training continues to evolve, professional identity ensures consistency. No longer can we segregate ourselves into different categories, such as secondary school, collegiate, and industrial ATs. Instead, we are all ATs sharing the same professional values, expecting the same professional behaviors, and reflecting the same professional identity.
Like many professions, athletic training is challenged by retention concerns. Chronic workplace stress escalates uncertainty and inconsistency.14 As an anchor to support our clinical practice, athletic training has worked diligently to embrace and integrate evidence-based practice. Evidence-based practice provides clarity and consistency about the clinical practice expectations defined for the profession. However, ethical and legal breaches create gaps in the moral expectations regarding the consistent professional behaviors expected across all settings. Shared professional values reduce ambiguous expectations in challenging situations by clearly defining expected behaviors. Through this rich understanding of expectations across the profession, chronic workplace stress is reduced and decision-making and retention in the profession are enhanced. These shared professional values transcend all we do as professionals and provide a common understanding to create a highly respected, collective professional identity.
Health care is competitive, and ATs are making great strides in advancing the scope of practice for the profession. With shared professional values being articulated and endorsed by the NATA, ATs now join a distinguished collective of health care providers who have advanced their disciplines through a commitment to these essential elements of professional identity. Like a rope with multiple strands intertwined, each strand can withstand some tension; yet it is much stronger when the strands are twisted together. Interconnections through these shared professional values will allow ATs to stand stronger and reflect a respected professional identity in the health care arena.
Editor’s note: Kimberly S. Peer, EdD, ATC, is a professor in the Department of Athletic Training and Sports Medicine at Kent State University and is the coordinator of the Interprofessional Leadership – AT Concentration doctoral program. A former Editor-in-Chief of the Athletic Training Education Journal, she serves on the NATA Committee on Professional Ethics and is the subchair of the ATEC Planning Committee.