A
thletic training students (ATS), like other health care profession students, engage in both didactic and clinical learning, both of which require them to engage in their learning.1,2 Clinical education requires active learning by students while interacting with clinicians and patients in real-life sce-narios.3,4 The purpose of clinical educationis to provide students with opportunities to develop required pro-ficiencies that pertain to the health care of patients.3 The National Athletic Trainers’ Asso-ciation (NATA) Educa-tion Council identified clinical education as a primary concern during
education reform.4,5
Prior to this educa-tional reform in 2003, research suggested that 75% of an ATS’s clini-cal experience was unsupervised, which indicates that more supervision of clinical course work is needed.3 Furthermore, time and quality were not found to be equal indica-tors of clinical education effectiveness.3,6 The goals of clinical education reform in athletic training include the following: (a) building a healthy, reasonable, and financially tolerable clinical learning environment; (b) integrating a clinical education model based on measur-able, standardized, and referenced learning
Mary Barnum, EdD, Med, ATC, LAT, Report Editor
Athletic Training Student Learning Style
At eDUcAtIon
Cynthia A. Ristori, MS, ATC, LAT • Hommen Orthopedic Institute; Lindsey E. Eberman,
PhD, ATC, LAT • Indiana State University; Brady L. Tripp, PhD, ATC, LAT • University of
Florida; and Thomas W. Kaminski, PhD, ATC, FACSM • University of Delaware
objectives; (c) implementing competencies and clinical objectives; and (d) improving clinical instruction.7
In an effort to improve clinical instruc-tion, redefinition of the role of the Approved Clinical Instructor (ACI) was emphasized by the Commission on Accreditation of Athletic Training Education (CAATE) to improve the hands-on learning experiences provided to ATSs in the clinical environment.2,4 To help create a constructive hands-on learning expe-rience, the ACI assumes the role of instructor and facilitator.8 The ACI formally instructs and evaluates the ATS’s clinical proficiencies in classroom, laboratory, and/or during clini-cal experiences through direct supervision.8 Learning is facilitated by placing the ATSs in real-life situations where they can apply new knowledge.5
The manner in which an ACI prefers to teach may have an impact on the ability of ATSs to learn. Research findings have sug-gested that learning may improve when the preferred learning style of an ATS is matched to the teaching style of an ACI.2 When an ACI has knowledge of an ATS’s preferred learn-ing style, he or she can facilitate appropriate learning experiences1,2 and strengthen the quality of teaching.1,2,9 In the classroom, instructors using teaching strategies matched to individual learning styles have demon-strated improved student achievement.1,2,9-13 ATSs’ learning styles may differ between the traditional classroom setting and the clinical education setting, however.2,14
Approved clinical instructors can identify student learning styles.
Most athletic training students identify with a “diverger” learning style, suggesting they like to gather information from many different perspectives during problem solving in clinical education.
Learning style assessments may not be necessary for programs.
Key Points
The NATA Education Council has suggested that learning style assessment should be conducted early in the students’ academic experience to identify their preferred learning style and to provide them with information on learning style that may enhance their educational experiences.1,8 Thus, ATSs could work to maintain their strengths while working to address
weaknesses.1 When ACIs possess information about
their students’ learning styles, they may enhance clini-cal education experiences. Yet, formal identification of ATS learning styles is not yet a required practice. Because some learning style education is required during ACI training, many ACIs may be capable of identifying ATSs’ learning styles without conducting formal evaluations. The purpose of this research was to assess the relationship between ACIs’ estimates of ATSs’ learning styles and the actual learning styles of the ATSs.
Procedures and Findings
The variables analyzed by this investigation were (a) ACIs’ perceptions of ATSs’ learning styles on the basis of results from the ACI Student Assessment Questionnaire and (b) the ATSs’ learning styles on
the basis of results from the Kolb Learning Style Inventory.10
Participants
We solicited ACI contact information from CAATE-accredited athletic training education programs. Figure 1 depicts the sampling procedure that was used.
Instruments
ACI Student Assessment Questionnaire (SAQ). The SAQ included two components: (a) an 11-item demographic questionnaire and (b) a 12-item questionnaire that was used to obtain the ACIs’ perception of ATS learning styles. The latter component was a modified version of the Kolb Learning Style Inventory.10 The modified learn-ing style inventory (LSI) used wordlearn-ing to acquire ACIs’ perceptions of ATSs’ optimal learning styles (Table 1).5
Kolb LSI. KolB LSI is the Kolb Experiential Learning Theory (KELT) and guided development of the Kolb LSI.10,11 The KELT is based on the following concepts: (a) learning is best conceived as a process and not in terms of outcomes; (b) learning is relearning; (c) con-flict, differences, and disagreement are what drive the learning process; (d) learning is a holistic process of adapting over time; (e) learning results from
tions between the person and the environment; and (f) learning is the process of creating knowledge.11 The Kolb LSI was designed for adolescent and adult students.10 Recently, Version 3.1 of the Kolb LSI was developed to address criticisms and to provide new normative data for interpretation of results.10 The LSI is a 12-item questionnaire that directs respondents to rank four sentence endings, which correspond to four learning modes: (a) concrete experience, (b) reflective observation, (c) abstract conceptualization, and (d) active experimentation. Students engage any or all of the learning modes in various situations and the combination of modes results in a preferred learning style.10 The four learning modes relate to the following learning styles: converging, diverging, assimilating, and accommodating, respectively. A converger applies ideas and theories to practical uses. A diverger observes a situation from different perspectives. An assimilator understands a wide range of information and
restruc-tures it in a concise and logical manner. An accommo-dator primarily benefits from hands-on experiences.
Procedures
All CAATE-accredited athletic training education pro-gram directors were contacted by e-mail to request e-mail addresses for all current ACIs. Each identified ACI was provided with information about the investi-gation and directions for participation by e-mail. The message was sent in mid-September to allow some time for interaction between the ACI and ATS prior to completion of the SAQ. ACIs were not provided with any information about ATSs (with the exception of class rank), and they were asked not to complete the evaluation for any student who they had previously supervised. The e-mail message directed each ACI to complete the SAQ for each student under his or her supervision through an online survey website. Upon completion of the SAQ, the ACI was asked to provide
table 1. example Questions From Learning style Inventory Matched
to student Assessment Questionnaire
LSI Question and Responses SAQ Question and Responses
When I learn:
I like to deal with my feelings. I like to think about ideas. I like to be doing things. I like to watch and listen.
When my ATS learns:
He/she likes to deal with his/her feelings. He/she likes to think about ideas. He/she likes to be doing things. He/she likes to watch and listen. I learn best when:
I listen and watch carefully. I trust my hunches and feelings. I rely on logical thinking. I work hard to get things done.
My ATS learns best when:
He/she listens and watches carefully. He/she trusts his/her hunches and feelings. He/she relies on logical thinking.
He/she works hard to get things done. When I am learning:
I tend to reason things out. I am responsible about things. I am quiet and reserved.
I have strong feelings and reactions.
When my ATS is learning:
He/she tends to reason things out. He/she is responsible about things. He/she is quiet and reserved.
He/she has strong feelings & reactions. I learn by:
feeling doing watching thinking
My ATS learns by: feeling doing watching thinking When I learn: I get involved. I like to observe. I evaluate things. I like to be active.
When my ATS learns: He/she gets involved. He/she likes to observe. He/she evaluates things. He/she likes to be active.
the e-mail address for each ATS. The ATSs’ e-mail addresses were used to match each individual ATS to his or her respective ACI. The ATSs were then contacted by e-mail and asked to complete the LSI. The time elapsed from contact with an ACI to completion of the LSI by an ATS was approximately four weeks.
Statistical Analysis
The data were analyzed by SPSS (version 15.0; SPSS Inc, Chicago, IL). Unmatched ACI/ATS data were excluded from the analysis. The Wilcoxon signed-rank test was used to assess any difference between ACI ranking of ATS learning style and ATS self-ranking of learning style.3 The Kappa coefficient was calculated to assess agreement between ACI ranking and ATS self-ranking.
Findings
A total of 13 ACIs participated, 5 females (range = 23–37 years old) and 8 males (range = 26–36 years old). The ACIs averaged nine years of clinical practice and provided athletic training clinical services for foot-ball, soccer, lacrosse, softfoot-ball, ice hockey, field hockey, track, volleyball, basketball, and tennis at universities, colleges, and high schools. The average duration of the athletic training education programs was six semesters. The ACIs provided contact information for 38 ATSs, 23 of whom participated.
The Wilcoxon signed-rank test did not identify a significant difference between the matched pairs of values (Asymp sig= 0.679, 1-β = .690). Overall
agreement between ACI estimated learning style and ATS self-identified learning style was 78.26%, and the Kappa coefficient was 0.67. Figure 2 presents com-parisons of ACI estimates and ATS self-identification for each of the four learning styles.
Discussion
Clinical education provides opportunities for hands-on learning experiences that involve interaction between an ATS and ACI. Such experiences provide opportuni-ties for the ATS to develop competence,apply knowl-edge and skills to real-life situations, and facilitate hands-on learning in the clinical environment.2-5 The ACI facilitates learning, which should ensure compat-ibility between the student’s learning style and the ACI’s instructional strategy.1,2 Our purpose was to determine whether ACIs can effectively estimate the learning styles of individual ATSs, which would help them to develop effective instructional techniques, individualize time with students, and motivate and encourage students. Recognition of learning style and collaboration with the student positively influences the learning process and promotes self-directed learning.12 Continuing education may enhance the ability of ACIs to identify ATS learning styles.
Our investigation suggests that the diverging learning style is common among ATSs in the clinical setting, which contradicts the findings of previous investigations in clinical and didactic settings. Other researchers have suggested that ATSs prefer the active
experimentation mode of learning2 or that no specific learning style is preferred.13 The converging learning style was reported to be most common in a sample of over 2,000 Australian health care students.15 Physical therapy students have been reported to prefer the con-verging learning style, with active experimentation as the preferred mode of learning.16 A meta-analysis has indicated the existence of varied learning styles among nursing students.17 The studies included in the meta-analysis identified diverging, assimilating, and accom-modating as the most prominent learning styles.17 Previous studies have not had consistent findings relating to learning styles.13,15-17 Moreover, students may begin the learning experience as “all-arounders” and later conform to a specific learning style through socialization and training.17 The ATSs who participated in this investigation had been exposed to their learning environments for approximately two weeks when the LSI was completed, so they may have transitioned into the diverging learning style.
Our findings suggest that ACIs are able to identify ATSs’ learning styles, but it may have little impact on the ACI-ATS relationship. The modeling of professional behavior has been identified as the most helpful ACI characteristic.4 Involvement with students, being clear and organized, an emphasis on problem-solving, men-toring, good communication, positive attitude, and feedback have been identified as good ACI character-istics.4 Mentoring qualities may be far more important than the ability to identify a student’s learning style.
Limitations included the willingness of program directors to provide ACIs’ e-mail addresses and the willingness of contacted ACIs to provide ATSs’ e-mail addresses. Lack of variability in ATSs’ learning styles may have influenced our results. Future research needs to seek a larger sample of ATSs and should consider the amount of interaction time an ACI needs to accu-rately estimate an ATS’s learning style. Future research should also investigate the extent to which ACIs are willing to alter instructional methods to accommodate a student’s learning style.
Conclusions
ACIs appear to be capable of accurately identifying the preferred learning styles of ATSs, which suggests that learning style assessment prior to ATS/ACI interaction may not be necessary. Other aspects of the ATS/ACI relationship may be more important to assess in the
effort to ensure student success.
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Cynthia Ristori is an athletic trainer/physical extender at Hommen Orthopedic Institute in Miami, FL.
Lindsey Eberman is an assistant professor and Program Director of the entry-level Athletic Training Education Program at Indiana State University in Terre Haute.
Brady Tripp is a clinical assistant professor and Director of the Gradu-ate Athletic Training Education Program in the Department of Applied Physiology and Kinesiology at the University of Florida in Gainesville. Thomas Kaminski is a professor and Director of Athletic Training Education with the Department of Health, Nutrition, and Exercise Sciences at the University of Delaware in Newark.
