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"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." The practice of athletic training encompasses health promotion and wellness and examination, diagnosis, immediate care, and rehabilitation of clients/patients with emergent, acute, and chronic health conditions. Athletic trainers, sometimes called athletic therapists in other countries, use the best available evidence to provide patient-centered care. Collaborative care with other healthcare and wellness professionals is a central tenet of athletic training practice.
Athletic trainers function as integral members of the health care team in a wide variety of settings, including secondary schools (24%), colleges and universities (16%), clinics/hospitals (including physician practices) (18%), professional sports and performing arts (3%), industrial/corporate settings (3%), academia (3%), youth sports (1%), military/government/law enforcement (1%), and administration (3%). A state credential is required to practice athletic training in every state except California, which has no regulation. According to the National Athletic Trainers' Association, there are more than 58,000 athletic trainers around the world.
To practice athletic training in the United States, students must complete an accredited professional (also known as entry-level) athletic training education program, pass the Board of Certification (BOC) certification examination, and obtain a state credential (in all states except California). The Commission on Accreditation in Athletic Training Education (CAATE) is responsible for accrediting professional and residency education programs. CAATE accreditation signifies that the program has met an established set of criteria and has undergone an extensive peer-review process. Today, there are over 350 accredited professional programs and 11 accredited residencies in athletic training. Most professional programs are located in the United States. There is one accredited program in Spain and institutions in other countries have programs in development.
Previously, most professional education in athletic training occurred at the baccalaureate degree level but, as of a 2015 CAATE decision, all accredited programs must offer professional education at the master's degree level. The implementation timeline for this change states that no students may begin a baccalaureate-level professional program after 2022. The degree transition decision was informed by a 2014 analysis of the appropriate degree level that was conducted by the National Athletic Trainers' Association (NATA) Executive Committee on Education. The accreditation standards for professional education have been updated to align more closely with peer health care professions and to reflect graduate-level professional preparation.
In the 1950s, the National Athletic Trainers' Association (NATA) began the development of curricular standards to elevate and advance the profession. In 1969, the NATA formally approved curriculum standards and competencies for athletic training education programs across the United States. The educational standards and competencies were established by the NATA Board of Certification committee (BOC) in 1982. This committee also developed a credentialing exam for a nationally recognized credential. In 1989, the Board of Certification (BOC) became an independent, nonprofit organization. Today, certification through successful completion of the Board of Certification examination is a requirement for a state license.
The first athletic training curriculum was approved by the National Athletic Trainers' Association in 1959 and the number of athletic training programs began to grow throughout colleges and universities in the United States. In the early development of the major, athletic training was geared more towards preparing the student to both teach and provide athletic training services at the secondary level, emphasizing on health and physical education. This program was first introduced at the undergraduate level in 1969 to the schools of Mankato State University, Indiana State University, Lamar University, and the University of New Mexico.
The NATA's Professional Education Committee (PEC) was the first group charged with approving athletic training educational programs. Next, the American Medical Association's Committee on Allied Health Education and Accreditation (CAHEA) was given the responsibility in 1993 to develop educational requirements for entry-level education. A year later CAHEA was replaced with the Commission on Accreditation of Allied Health Education Programs (CAAHEP), which assumed oversight of the accreditation process. In 2003 the Joint Review Committee on Athletic Training became independent from CAAHEP and became an independent accrediting agency. Three years later JRC-AT officially became the Committee for Accreditation of Athletic Training Education, which accredits athletic training programs today.
After recognition from the American Medical Association (AMA) as an allied health care profession in 1990, athletic training continued to expand its educational competencies and curricula. Traditionally, there were two separate routes to eligibility for the credentialing exam: an internship model similar to nursing and other fellowship-type professions or completion of the requirements of an undergraduate athletic training program. In 2001, the internship model was discontinued. Since 2001, only individuals who have completed a professional program accredited by the Commission on Accreditation of Athletic Training Education (CAATE) are eligible for the Board of Certification examination.
To become an athletic trainer, a student must complete a program of study that meets the standards established by the CAATE and provides a basic level of health care competence. Professional programs must result in the granting of a degree in athletic training and be a minimum of 2 years of full-time study. Accreditation standards require students to engage in supervised client/patient care experiences, including a period of full-time clinical experience. These experiences are supervised by licensed healthcare providers and allow for students to engage in hands-on, real-time patient care. For entry into professional programs at the master's degree level, students must complete prerequisite coursework in biology, physics, chemistry, anatomy, physiology, and psychology.
Students who complete an accredited professional program are eligible to take the BOC certification examination. Individuals who have passed the examination may use the ATC® credential and are eligible to apply for a state credential, which is required to practice. California is currently the only state that does not require a credential to practice as an athletic trainer.
The BOC determines the domains of athletic training, which are reported in the BOC's Practice Analysis 7. The domains are used to define the current entry-level knowledge, skill, and abilities required to practice athletic training and forms the basis for the BOC examination. To maintain BOC certification, athletic trainers must verify completion of 50 continuing education units every 2 years, maintain continuous emergency cardiac care certification, pay an annual certification fee, and comply with the BOC Standards of Professional Practice, which define the essential duties and obligations of those holding the ATC® credential. Individual states may also require continuing education units and/or maintenance of BOC certification to maintain licensure.
Post-professional graduate athletic training degree programs are designed to prepare athletic trainers for advanced clinical practice, research, and scholarship. Options for post-professional study include post-professional master's degrees, residency programs, Doctorate in Athletic Training (DAT) degrees, and academic doctorates (usually PhDs and EdDs).
Post-professional degree programs are designed to expand the depth and breadth of the applied, experiential, and propositional knowledge and skills of athletic trainers. This expansion of knowledge is achieved through didactic, clinical, and research experiences. Currently, the CAATE accredits 8 post-professional master's programs and 1 doctoral degree program (DAT) in the United States. Many post-professional athletic training programs, master's and doctoral, maintain their degree programs without accreditation. This has led to the recent decision by the CAATE to discontinue accreditation of post-professional academic programs after December 31, 2026.
Athletic training residency programs are formal educational programs that offer structured curricula, including didactic and clinical components. Residency programs are designed to build upon and expand the athletic trainer's knowledge and experience in a specialized, focused area. The 8 specialty areas are: prevention and wellness, urgent and emergent care, primary care, orthopedics, rehabilitation, behavioral health, pediatrics, and performance enhancement.
The BOC Specialty Council provides oversight and development of specialty certification in athletic training. To earn the specialty certification, athletic trainers must complete a predetermined education and training process in a narrow area of focus and also pass an examination. The first specialty certification in Orthopedics is currently in development. Individuals or groups can "petition the BOC Specialty Council to recognize a specific area of athletic training practice as a specialty."
The practice of athletic training is regulated at the state level in 49 of the 50 US states and the District of Columbia. In all states with regulation, BOC certification is a requirement for a state credential. States may or may not require that credential holders maintain BOC certification after a state credential is obtained.
Athletic training in the United States began in October 1881 when Harvard University hired James Robinson to work conditioning their football team. At the time, the term "athletic trainer" meant one who worked with track and field athletes. Robinson had worked with track and field athletes and the name "athletic trainer" transferred to those working on conditioning these football players and later other athletes. Athletic trainers began to treat and rehabilitate injuries in order to keep the athletes participating. The first major text on athletic training and the care of athletic injuries was called Athletic Training (later changed to The Trainer's Bible) written in 1917 by Samuel E. Bilik. Early athletic trainers had "no technical knowledge, their athletic training techniques usually consisted of a rub, the application of some type of counterirritant, and occasionally the prescription of various home remedies and poultices". In 1918, Chuck Cramer started the Cramer Chemical Company (now Cramer Products) that produced a line of products used by athletic trainers and began publishing a newsletter in 1932 entitled The First Aider that is still produced today.
An early attempt at a national organization for athletic trainers was made in 1938 but was quickly disbanded. Attended by 101 athletic trainers, the modern National Athletic Trainers' Association (NATA) was formed in June 1950 in Kansas City, Missouri, during what was called the "First National Training Clinic."  The NATA's purpose was to enhance communication and sharing of knowledge among athletic trainers across the United States. The formation of the organization helped set professional standards and promoted professional recognition for the athletic training profession. In 1956, athletic training published its first journal of scholarly research, the Journal of the National Athletic Trainers' Association, known today as the Journal of Athletic Training. By 1957, the profession established a code of ethics and aligned itself with numerous professional organizations. Due in part to the work of William "Pinky" Newell, in 1967, the AMA recognized the NATA as a professional organization "worthy" of the support of the medical community. In 1990, the American Medical Association (AMA) recognized athletic training as an allied health care profession.
In its early days, athletic training was a predominantly male profession. The first female joined the NATA in 1966. In 1972, the first female took the Board of Certification exam. The passage of Title IX in 1972 opened doors for more women to enter the profession. By 1974, 15 of the 24 professional athletic training education programs accepted female students. In 2000, the NATA elected its first female president, Julie Max. Currently, over half of athletic trainers are female.
The Strategic Alliance is a group of athletic training organizations composed of the National Athletic Trainers' Association (NATA), the Commission on Accreditation of Athletic Training Education (CAATE), Board of Certification (BOC), and the NATA Research and Education Foundation. While each group has its own mission and vision, they work together to advocate for the profession of athletic training.
The National Athletic Trainers' Association (NATA) is a trade association open to membership by athletic trainers and athletic training students. The NATA Board of Directors is led by a president, vice president, and treasurer/secretary. The president is elected by a vote of all members. The 11-person Board of Directors is made up of a representative from each district and the president.
The NATA has divided the 50 states, the District of Columbia, Guam, American Samoa, Puerto Rico, and Virgin Islands into 10 districts. Each district has the task of selecting a representative to serve on the NATA Board of Directors and has its own policies and bylaws.
Each state has a separate organization with its own policies and bylaws. These organizations function to influence state regulation, provide continuing education, and promote the profession of athletic training.
The Board of Certification (BOC) oversees the credentialing and recredentialing process for athletic trainers. The BOC is governed by 9 directors, 6 athletic trainers, 1 physician, 1 public member, and 1 corporate/educational director. The president of the BOC is elected by the board members. The BOC is accredited by the National Commission for Certifying Agencies (NCCA).
The BOC determines eligibility requirements to sit for its national certification exam, a computer-based assessment that is offered during discrete testing windows throughout the year. The BOC also identifies continuing education requirements that credential holders must complete to maintain their certification. The BOC also has a Specialty Council focused on developing clinical specialties within the athletic training profession.
The Commission on Accreditation of Athletic Training Education (CAATE) is an organization that accredits professional, post-professional, and residency athletic training programs. The mission of the CAATE is to define, assess, and continually improve AT education. The CAATE is recognized by the Council for Higher Education Accreditation (CHEA).
The NATA Research and Education Foundation supports research efforts that impact healthcare. Through scholarships and grants, the Foundation supports education and research initiatives.
Multiple organizations exist to serve the unique needs of athletic trainers in specific practice or employment settings.
The National Collegiate Athletic Association's Independent Medical Care for College Students Best Practices Consensus Statement establishes a framework for patient centered care in college sports. The best practice guidelines state an institution's primary athletics health care providers (generally physicians and athletic trainers) must have clear autonomous authority for student-athlete health care, including return to play decisions. Independent medical care, including the designation of an Athletics Health Care Administrator, is a requirement for all NCAA member institutions in Division I, Division II and Division III according to NCAA Bylaws 18.104.22.168 and 22.214.171.124.
The 2017 Sports Medicine Licensure Clarity Act provides protections for sports medicine professionals, including athletic trainers, who provide certain medical services in a state that is secondary to the one in which they hold licensure. The act allows athletic trainers to provide health care services to an athlete, an athletic team, or athletic team members in a secondary state, under their primary athletic training licensure. Prior to the act, sports medicine professionals whose job required interstate travel had no legal protection when providing health care in states other than the state where they held licensure.
The NATA awards Safe Sports School recognition to secondary schools that provide an athletic trainer and acceptable health care resources to their student-athletes.
According to the Board of Certification, 1.4% of BOC-certified athletic trainers live outside of the United States. Because of differences in educational infrastructure, the role of the athletic trainer in other countries is often filled by other professionals, including physiotherapists, nurses, and physicians. The World Federation of Athletic Training & Therapy was established in June 2000 to provide an organization for associations working to improve healthcare for physically active individuals. Today, the WFATT includes 40 member associations from 10 countries on 4 continents.
This public awareness campaign is designed to advocate for athletic trainers by influencing public opinion and policy. This campaign aims to educate parents, student athletes, stakeholders, school administrators, and employers on the important role of athletic trainers in health promotion and safety.
Organized by the NATA, National Athletic Training Month occurs in March every year.
The Athletic Training Research Agenda, prepared by the Athletic Training Research Agenda Task Force and approved by the Strategic Alliance, promotes the advancement of the athletic training profession through clinically meaningful research that promotes high quality patient care. The agenda identifies 5 research priority areas: health care competency, vitality of the profession, health professions education, health care economics, and health information technology.