Authors: Whitney Larson, M.S., ATC, Alyson Dearie, Ed.D., ATC, Larissa True, Ph.D., Brian Richardson, Ph.D., and Erik Lind, Ph.D.
Erik Lind, Ph.D.
1151 Professional Studies Building
State University of New York at Cortland
Cortland, NY 13045
Whitney Larson is an assistant athletic trainer with the Iona College Athletic Department in New Rochelle, NY, and provides coverage for a number of the school’s athletic teams.
Dr. Alyson Dearie is the Clinical Education Coordinator with the Athletic Training program at SUNY-Cortland.
Drs. Larissa True (Exercise Science), Brian Richardson (Coaching), and Erik Lind (Sports Studies) are all with the Kinesiology Department at SUNY-Cortland.
NCAA Head Coach Satisfaction with Athletic Trainers: Influence of Individual Athletic Trainer Characteristics and Team Factors
Considerable research exists which examines the relationship between head coach-athlete and athletic trainer-athlete. However, little is known about the perceived relationship between head coach-athletic trainer, specifically satisfaction with services provided. Purpose: This study examined head coach satisfaction with athletic trainers across National Collegiate Athletic Association (NCAA) divisions. Methods: Head coaches from a Division I, II, and III athletic department were surveyed regarding overall and dimensions of satisfaction of athletic training services. Results: No differences in Overall Satisfaction with athletic training services were noted. However, coaches assigned (a) a full-time athletic trainer reported significantly higher satisfaction in athletic trainer Knowledge/Ability than coaches with a graduate assistant and (b) a certified athletic trainer reported higher Communication scores. Moreover, Overall Satisfaction and Professionalism were different between male/female sport teams. Conclusions: Regardless of competitive level, NCAA head coaches appeared satisfied with services provided by the athletic training staff. Certain dimensions of satisfaction, however, were influenced by individual characteristics of the athletic trainer (i.e. full-time appointment; assigned certified athletic trainer). Likewise, team factors (i.e. sex of the team) also influenced satisfaction ratings with athletic training services. Applications in Sport: The findings may contribute to continued improvement of the NCAA head coach-athletic trainer relationship. Given the demands and responsibilities of each role, it is imperative to establish a trusting and positive relationship. Clearly delineating the needs and expectations both the head coach and athletic trainer are to address will only create a more productive work environment. Awareness of these findings will help inform the head coach-athletic trainer relationship by highlighting factors (e.g., access to full-time and certified athletic trainers) which can quickly facilitate the relationship. Conversely, the findings also identify potential issues (e.g., sex of the team) to address early to prevent a break down in the relationship.
Key words: Athletic Trainer, Accessibility, Communication, Head Coach, Knowledge
Athletic training has recently emerged as a recognized allied health profession and is gaining the respect of the general public (6). Athletic trainers work in diverse environments, including colleges, secondary schools, clinics, and industrial settings (2). Along with the requisite knowledge that has emerged from national governing bodies (8, 13),certain intra-individual characteristics of successful athletic trainers have also been identified (9, 16). Arguably, mastering these competencies and possessing these qualities contribute to the high overall satisfaction ratings towards athletic trainers, regardless of work setting. Individuals treated in clinics, high schools, colleges, and industrial settings (n = 5,238) all report consistent positive satisfaction scores (4). Additional findings among college athletes, however, suggest a more mixed trend. Specifically, there appear to be robust findings of higher perceived athlete satisfaction with athletic trainers of high- profile sports compared to lower profile sports, but findings are inconsistent between male (higher perception) compared with female (lower perception) athletes (17-18), irrespective of National Collegiate Athletic Association (NCAA) division.
While it is important for athletes to be satisfied with the services they receive, it is also important that coaches be satisfied as they rely on expertly delivered services. Athletic trainers and coaches are both members of the sports medicine team and establishing and maintaining a positive relationship is critical. It is important to note that “Certified athletic trainers are important assets…” to athletic teams (10; p. 388). Coaches have a significant amount of interaction with athletic trainers regarding the care of an athlete (12). This communication and subsequent cooperation are vital to providing stability and effective care to the athlete (1). Overall, the relationship between coaches and athletic trainers has been characterized as both professional and respectful (1). This mutual respect has been observed between coaches and athletic trainers at the high school level (1, 12). The literature on collegiate head coaches’ satisfaction with athletic training services, however, is limited. One study indicated that 88.9% of coaches at one NCAA school would choose to stay with the athletic trainer they were assigned if given the option to change (3). Overall, there is a lack of research on the coaches’ satisfaction with athletic training services across all three NCAA divisions. A better understanding of the head coach–athletic trainer dynamic might identify areas for improvement in the relationship and continue to inform the profession. The purpose of this study, therefore, was to determine the level of overall satisfaction and subcategories of satisfaction that head coaches across three athletic divisions report with their athletic training staff.
A convenience sample of 40 NCAA head coaches (response rate of 74%) from northeastern institutions representing Division I (n = 16; 12 male; 4 female), II (n = 11; 7 male; 4 female), and III (n = 13; 9 male; 4 female) schools comprising a total of 40 teams were surveyed. Given the question to better understand the relationship between head coaches and athletic trainers, descriptive characteristics or frequencies of both head coaches and athletic trainers are presented in Table 1.
Table 1. Descriptive statistics (mean±SD or count) for coaches and athletic training staff of Divisions I, II, and III athletic programs.
|Division I (n = 16)||Division II (n = 11)||Division III (n = 13)|
|Age of Coach (yrs)
Gender of Coach
Assignment of ATC
The current study used an instrument originally developed by Beer (3) in a slightly modified format to fit the current research question, and included changes in demographic questions and rewording of satisfaction statements. Table 2 presents samples of the 34 satisfaction questions and 4-point Likert response format plus N/O (no opportunity to observe), divided into four sections to reflect the different areas of satisfaction: (a) Professionalism; (b) Communication; (c) Knowledge/Ability; and (d) Accessibility.
Table 2. Satisfaction survey sample items measuring Professionalism, Communication, Knowledge/Ability and Accessibility.
|The certified athletic trainer is punctual during team activities. (Professionalism)||4||3||2||1||N/O|
|The certified athletic trainer informs the coach of the injured student athlete’s progress in a timely fashion. (Communication)||4||3||2||1||N/O|
|The certified athletic trainer is knowledgeable on injuries, rehabilitation, and other medical inquiries. (Knowledge/Ability)||4||3||2||1||N/O|
|The certified athletic trainer’s accessibility during competition or events. (Accessibility)||4||3||2||1||N/O|
After approval from the Institutional Review Board at a small Northeastern college, the Athletic Directors at each institution were contacted for permission to survey the head coaches during a coaches’ meeting. The survey packet contained the informed consent document and the survey. Completion of the survey took approximately 5-10 minutes. Participants were informed that all responses would be kept confidential. The lead researcher was available for questioning during this time and upon completion collected the packets.
To examine the primary questions of whether there is a difference across NCAA divisions in (a) overall satisfaction and (b) subcategories of satisfaction with athletic services, a series of one-way analysis of variance (ANOVA) were computed. The significance level for each ANOVA was set at α ≤ 0.05. Where significance was noted, a Tukey post-hoc test was computed to determine the source of the difference. Effect sizes for significant findings were computed as d = Mi-Mj/SDpooled.
Division I, II, and III coaches made up 40%, 27.5%, and 32.5% of the sample, respectively. Of the head coaches surveyed, 70% were male and 30% were female, 40% coached a male team, 50% coached a female team, and 10% coached both a male and female team. Ninety percent of the coaches had a Certified Athletic Trainer (ATC) assigned to their team. Of these coaches, 72% stated that their athletic trainer was a full-time staff member, compared to 18% who stated their athletic trainer was a Graduate Assistant athletic trainer. The majority of the ATCs were female (53%).
Results from the ANOVA (see Table 3) on Overall Satisfaction indicated no significant difference across NCAA division (F(2,37) = .108, p = .898). Likewise, there were no significant differences in Professionalism (F(2,37) = .060, p = .942), Communication (F(2,37) = .105, p = .901), Knowledge/Ability (F(2,37) = .651, p = .527), or Accessibility (F(2,37) = .991, p = .381) scores among each of the three divisions.
Table 3. Mean Satisfaction Scores for Overall, Professionalism, Communication, Knowledge/Ability, and Accessibility
Additional analyses were carried out to see if differences existed according to (a) the assignment of the certified athletic trainer, (b) status of the certified athletic trainer, (c) sex of the team, (d) sex of the certified athletic trainer, and (e) sex of the coach. Coaches with a certified athletic trainer assigned to their team had significantly higher (F(1,38) = 4.866, p = .034; ES = 1.14) Communication scores (n = 36, M = 25.81, SD = 3.39) than those who did not have an athletic trainer assigned to their team (n = 4, M = 21.75, SD = 4.50). Likewise, coaches with a full-time athletic trainer (n = 26, M = 29.69, SD = 4.09) reported significantly higher scores (F(1,34) = 9.797, p = .004; ES = .69) for satisfaction with Knowledge/Ability than those with a graduate assistant (n = 10, M = 24.60, SD = 5.08). Finally, Overall Satisfaction (F(1,34) = 4.527, p = .041; ES = .69) and the subcategory Professionalism score (F(1,34) = 4.451, p = .042; ES = .69) were significantly different for head coaches of male sports teams compared to female teams. No other significant differences were noted.
To date, investigations of the relationship between head coach and athletic trainer are scarce. The purpose of this study was to determine the satisfaction of NCAA head coaches with his or her athletic trainer and services. There were two primary research questions addressed in this study: (a) was there a difference in overall satisfaction and (b) were there differences in satisfaction subcategories (professionalism, communication, knowledge/ability, and accessibility) with athletic training services in schools representing the three NCAA divisions. The remainder of this section provides discussion organized by satisfaction subcategory.
While the hypothesis that there would be differences in Overall Satisfaction scores across NCAA divisions was not supported, this specific finding is, nonetheless, positive. In particular, NCAA head coaches report being satisfied with the individual and quality of services provided by their athletic training staff, regardless of NCAA division. These findings are consistent with previous research which suggested satisfaction with and wanting to retain athletic training staff (3). Interestingly, the sex of the team seemed to be an important factor on some of the satisfaction subcategories. Overall Satisfaction scores were reported as higher by head coaches of male teams than by those coaching female teams. This may be due to the fact that male sports are generally higher risk for injury than female sports (7) and may be given greater priority when it comes to athletic training coverage. Thus, male teams may have more exposure to athletic training than their female counterparts, possibly contributing to greater satisfaction.
The fifth domain of the BOC delineation study emphasizes the understanding for best practices and federal/state statutes (8). This includes business functions, management, documentation, and an understanding of the practice acts, as well as having a support/referral process for unhealthy lifestyle behaviors (8). The satisfaction subcategory of Professionalism was not rated significantly different across NCAA divisions. As with Overall Satisfaction, the sex of the team, however, seemed to be an important factor. Professionalism scores were reported as higher by head coaches of male teams than by those coaching female teams. While previous research has demonstrated that coaches and athletic trainers have a mutually respectful relationship (1), this current finding advances our understanding by highlighting the critical factor of the sex of the team and the need to consider it in the head coach–athletic trainer relationship.
Communication is necessary between members of the sports medicine team to maintain the safety and promote the recovery of the athlete (1). It is interesting to note that each of the five domains outlined in the role delineation study (8), which breaks down the responsibilities of athletic trainers, have some aspect of communication involved. Specifically, the third domain states that care of an athlete should be coordinated through appropriate communication with relevant individuals, coaching staff included (8). This is evidenced in the large effect size (ES = 1.14) for the subcategory of Communication when comparing teams assigned an ATC versus teams without an assigned ATC. Athletic trainers are viewed as non-threatening by athletes, and thus athletes may feel more comfortable discussing injury specifics with the ATC than the head coach (14). By providing injury-specific information to coaches, ATCs can help athletes and coaches communicate more efficiently (5). This finding may also contribute to the respectful relationship noted between head coach and athletic trainer (1).
Athletic trainers are tasked with educating not only athletes, but coaches, parents, school administrators, and other members of the health care team. In order to achieve such a task, an appropriate knowledge base is needed in areas such as behavioral risks, catastrophic risks, biomechanical risks, and environmental risks (8). Knowledge in these areas is then used to perform pre-participation screenings, fit personal protective equipment, apply taping and bracing, maintain or improve physical conditioning, and promote a healthy lifestyle (8). Not surprisingly, head coaches working with a full-time ATC reported higher Knowledge/Ability scores compared to head coaches with a graduate assistant ATC. This finding seems commonsensical in that full-time staff members generally have much more experience than graduate assistants. Consequently, these experiences inevitably lead to a greater expansion to the baseline knowledge which may explain why coaches indicated they trusted the decision-making ability of the full-time athletic training staff (15).
Athletic trainers are in a unique position that allows for significant interaction with athletes given the nature of the profession. When athletes are injured, they spend time before, during, and after practice working with athletic training staff. It has been noted that coaches preferred having direct contact with athletic trainers, such as having one available during practices (12). The satisfaction subcategory of Accessibility was the one measure that did not show any significant differences although some trends towards significance were noted with specific analyses. Division I (17.63±3.32) reported a
2-unit greater difference than Division II (15.00±7.03) and Division III (15.23±6.23) and less variance in scores. This seems to suggest that head coaches at Division I programs report adequate accessibility with his or her athletic training staff more so than that reported at the other two NCAA divisions. It is also worth mentioning that ATC assignment (p = .077) and sex of team (p = .055) neared significance. Thus, while Accessibility scores were similar across NCAA division, it may be that the assignment or sex of the team may impact the satisfaction with head coaches on this subcategory.
Head coaches at three NCAA division schools reported, in general, being satisfied with their ATCs and the services provided. It is promising for those in the workforce to note that their efforts are appreciated by those coaching the teams they serve. Mutual respect aside, it should be noted that the findings are limited to (a) one northeastern athletic department in each of the three major NCAA divisions, making generalizability difficult, and (b) the use of a slightly modified instrument. This second limitation is tempered by the fact that the current findings appear to support the findings of the original investigation (3) and the potential to use the instrument internally to periodically assess the head coach-athletic trainer relationship. Along the same lines, the total sample size was limited to 40 coaches, of which only 30% were female coaches. Given the paucity of research on this topic, continued instrument development and validation as well as increasing the numbers in Table 1 and expanding the number of athletic programs at each NCAA division level will only enrich the findings of the current study.
APPLICATIONS IN SPORT
There were some interesting findings that may inform continued improvement of the head coach-athletic trainer dynamic. Specifically, head coaches and athletic trainers may want to consider how subcategories of satisfaction, such as Communication between the head coach and ATC, can be addressed to optimize that dynamic in the head coach–athletic trainer relationship. For example, it has been suggested that athletic trainers may provide critical insight to team problems (10). Other investigations have noted the importance of communication between the head coach and athletic trainer in regards to the work-life balance of the athletic trainer (11). It could be argued that such balance may make for a more productive athletic trainer, which in turn would only strengthen the relationship.
Additionally, there appear to be other factors that may contribute to the quality of the head coach–athletic trainer relationship and these may need to be considered in the overall professional development of head coaches and athletic trainers. Head coaches should routinely provide attention and recognition of the athletic trainer’s time and effort. In return of the show of respect, athletic trainers become crucial contributors to the success of the head coach’s athletic program (10). Based on the current research, head coaches’ satisfaction is high with those providing athletic training services. While this might seem commonsensical, this investigation provides a critical first step in both quantifying the relationship and further clarifying how this relationship can be improved.
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