Challenges Faced by Collegiate Athletic Trainers, Part I: Organizational Conflict and Clinical Decision Making

Abstract

Context Organizational conflict, particularly between coaches and medical professionals, has been reported in collegiate athletics. Different values create room for conflict between coaches and athletic trainers (ATs); however, ATs' experiences when making medical decisions are not fully understood. Objective To investigate the presence of organizational conflict regarding medical decision making and determine if differences exist across athletic affiliations. Design Cross-sectional study. Setting Collegiate athletics (National Collegiate Athletic Association [NCAA], National Association of Intercollegiate Athletics [NAIA], National Junior College Athletic Association [NJCAA]). Patients or Other Participants A total of 434 ATs responded (age = 27.7 ± 3.2 years, years certified = 5.2 ± 2.7), representing the NCAA Division I (DI; n = 199), Division II (DII; n = 67), Division III (DIII; n = 108); NAIA (n = 37); and NJCAA (n = 23) settings. Main Outcome Measure(s) The survey instrument contained quantitative measures and open-ended questions, with affiliation as our primary independent variable. Responses to Likert-scale questions (1 = strongly agree, 5 = strongly disagree) regarding organizational pressures within athletics served as the dependent variables. Kruskal-Wallis analysis-of-variance and Mann-Whitney U post hoc tests assessed differences in organizational conflict across affiliations. Open-ended questions were analyzed inductively. Results We obtained a 14.47% (434 of 3000) response rate. National Collegiate Athletic Association DI ATs disagreed less than NCAA DII and DIII and NJCAA ATs that they would worry about job security if turnover in the head coaching position occurred (P < .05). Regarding the influence of coaches on job performance, differences were found between NCAA DI and DIII and between DI and NJCAA ATs (P < .01). Visibility of the injury and situational factors influenced the level of perceived pressure. Conclusions Athletic trainers perceived pressure from coaches regarding medical decision making. Division I ATs placed greater emphasis on the role that coaches played in their job performance and job security. Athletic departments should consider transitioning to patient-centered models of care to better align values and reduce the external pressures placed on ATs.

Challenges Faced by Collegiate Athletic Trainers, Part II: Treating Concussed Student-Athletes

“…As part of a larger study investigating organizational conflict and health care decisions (part 1), 13 we collected data regarding the challenges faced by ATs when treating student-athletes with concussions. The National Athletic Trainers' Association provided a list of 3000 randomly selected ATs working in collegiate athletics in the fall of 2018.…”

“…We developed the questionnaire to answer our research questions in the current and larger study (part 1). 13 The questionnaire was built upon the aims of the study, as well as some of the previous literature, 1,3,14 social media reports, and editorial articles on the organizational culture surrounding player medical care and safety and health. Details on survey development and data collection can be found in part 1.…”

“…Details on survey development and data collection can be found in part 1. 13 The questions that served as the basis for this study are in the Table.…”

The Evolution of the Athletic Training Profession

“…Return-to-play decisions are especially vulnerable to this conflict of interest. ATs report that their medical decisions are subject to perceived pressure from coaches (Pike Lacy et al, 2020). Now, the National Collegiate Athletics Association charges institutional leaders to "create an administrative system where athletics healthcare professionals-team physicians and ATs-are able to make medical decisions with only the best interests of student-athletes at the forefront" (National Collegiate Athletics Association, 2013, p. 8).…”

Examining Social Structures and Cultural Norms that Influence Brain Injury Reporting in College Football

“…As one athletic trainer put it in a 2020 report, "I think the injury that I most commonly feel pressure from coaches [about] is concussions." 3 The complexity of the collegiate sports medicine landscape also has deep historical roots in American norms surrounding competitive athletics. While the social and structural factors that impede traumatic brain injury reporting are evident across a wide range of sports, they are in many ways best exemplified by college football.…”