ATHLETIC TRAINING EDUCATION JOURNAL
Q National Athletic Trainers’ Association
www.natajournals.org
ISSN: 1947-380X
DOI: 10.4085/1947-380X-20-041
ORIGINAL RESEARCH
Perceptions of Leadership Competency Among Doctorate in Athletic
Training Graduates
Elena A. Robinson, DAT, LAT, ATC*†; Kenneth E. Games, PhD, LAT, ATC*; Lindsey E. Eberman,
PhD, LAT, ATC*; Matthew J. Rivera, DAT, LAT, ATC*
*Neuromechanics, Interventions, and Continuing Education Research (NICER) Laboratory, Indiana
State University, Terre Haute; †Department of Kinesiology and Sports Sciences, University of Nebraska
at Kearney
Objective: Assess DAT graduates’ perceived importance and confidence in performing personal leadership competencies
as well as the level of influence a DAT program had on the development of these competencies.
Design: Cross-sectional design.
Setting: A 73-item Web-based survey.
Patients or Other Participants: Seventy-seven DAT graduates, from a possible 205 graduates responded to the survey.
Forty-five respondents completed the survey (21.9%) and were included in this study (age ¼ 31.5 6 6.1 years; years since
graduating from DAT ¼ 1.13 6 0.90; years of experience ¼ 8.69 6 5.6; years employed at current job ¼ 3.00 6 4.04).
Intervention(s): Each participant completed a questionnaire with 7 demographic items and 66 items to assess perceived
importance, confidence, and influence of the DAT on 22 personal leadership competencies. The questionnaire was adapted
from the Leadership Development in Athletic Training instrument.
Main Outcome Measure(s): Descriptive statistics were used to characterize participant demographics and assess the
perceived importance, confidence, and influence of the DAT program on leadership competencies. Partial data were
included in the analysis.
Results: All competencies were rated as important or higher with critical thinking (mean ¼ 4.84 6 0.37) rated very important
(mode ¼ 5, n ¼ 37/45, 82.2%). Graduates were moderately confident or higher on all competencies with being credible
(mean ¼ 4.5 6 0.55) rated extremely confident (mode ¼ 5, n ¼ 23/45, 51.1%). Graduates indicated that the DAT was
extremely influential on their being future minded (mean ¼ 4.63 6 0.58; mode ¼ 5, n ¼ 29/45, 64.4%).
Conclusions: Doctor of Athletic Training graduates’ perceptions suggest that programs may be meeting the goal of
developing advanced practice leaders. Respondents indicated higher perceptions of confidence in competencies they
deemed as important. Respondents also indicated that DAT programs were influential in shaping their perceptions about
certain leadership competencies. Other factors may influence graduates’ perceptions outside of the DAT, such as previous
education and experience.
Key Words: Leadership competence, advanced practice leadership, health care leadership
Dr Robinson is currently Assistant Professor at the University of Nebraska at Kearney. Please address correspondence to Elena A.
Robinson, DAT, LAT, ATC, University of Nebraska at Kearney, 1410 W 26th Street, Kearney, NE 68449. erobinson2014@gmail.com.
Full Citation:
Robinson EA, Games KE, Eberman LE, Rivera MJ. Perceptions of leadership competency among doctorate in athletic training graduates.
Athl Train Educ J. 2022;17(1):86–95.
Athletic Training Education Journal
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Context: Within the athletic training profession, Doctor of Athletic Training (DAT) programs are expected to develop
advanced practice leaders; however, little is known about whether this is achieved.
Perceptions of Leadership Competency Among Doctorate in Athletic
Training Graduates
Elena A. Robinson, DAT, LAT, ATC; Kenneth E. Games, PhD, LAT, ATC; Lindsey E. Eberman, PhD, LAT, ATC; Matthew
J. Rivera, DAT, LAT, ATC
KEY POINTS
INTRODUCTION
Leadership is a quality that has been studied in a variety of
professions and is considered especially important for health
care and its advancement in individual patient care and
communities.1,2 While multiple definitions of leadership for
health care exist, one commonality among them is influence
and how influence is used to guide others in achieving a
common goal.3–5 Many positive outcomes with appropriate
leadership include enhanced patient outcomes and increased
ability to handle complex health care situations.6,7 Understanding and developing leadership competencies can lead to
attaining these desired outcomes and more.6,7 Some health
care disciplines such as occupational therapy, physical
therapy, nursing, and pharmacy already have rich histories
of leadership education and development.7 While some
leadership skills are transferable across different health care
disciplines, others are more context specific,7 and therefore,
each health care discipline should carry out research on
leadership competencies related to its specific body of
knowledge and skill. In addition, as each health care discipline
grows in its educational or training requirements, it is
pertinent to continue researching and expanding necessary
leadership competencies to fit advanced skills.
One health care discipline in particular, athletic training, has
previously explored leadership competence development in
professional-level programs, as leadership has long been
established as an important role for athletic trainers (ATs).7
The Board of Certification’s Practice Analysis, 7th Edition,
repeatedly emphasized the need for knowledge of leadership
theory and style as well as leadership skills among various
patient care situations and administrative duties in the athletic
training profession.8 Various studies9,10 in athletic training
have also established effective leadership as important for
developing professional values and identity, fostering positive
work environments that decrease turnover and increase job
satisfaction, increase perceived importance of the athletic
training profession, reinforce the profession’s credibility and
relationships among its communities and other health care
disciplines, and improve the quality of the work environment
Athletic Training Education Journal
The purpose of a DAT degree is different than a postprofessional master’s degree in that it contains advanced coursework
and research for progression of clinical expertise by broadening the level of knowledge and skillset for patient care and
advancing clinical scholarship.15–17 Altogether, completing
the outcomes of a DAT degree may meet the objective of
establishing advanced practice leadership within the practitioner.15
The development of advanced practice leadership has been
studied within other health care disciplines, specifically
nursing, since nursing’s educational pathways previously
transitioned in a similar manner as athletic training.15,18,19
Throughout the late 1990s and early 2000s, the American
Association of Colleges of Nursing recognized a need for
advanced nurse preparation to meet the needs of the everchanging complex clinical environment, which brought about
the Doctor of Nursing Practice degree.15 In a similar manner,
the athletic training profession faces a challenge of transitioning its professional degree and must now educate ATs to a
level of success in the dynamic environment of our health care
system.15 The DAT degree may be a solution in converging
entry-level ATs to advanced practice clinicians and provide a
smoother flow of knowledge among practitioners.15 However,
unlike the profession of nursing, advanced practice leadership
in the postprofessional space of athletic training has not yet
been examined. The purpose of this study was to assess the
perceived importance of personal leadership competencies for
DAT holders, the confidence that DAT graduates possessed
in performing personal leadership competencies, and the level
of perceived influence the DAT program had on developing
personal leadership competencies.
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Doctor of Athletic Training graduates rated similar
leadership competencies such as credibility, open mindedness, critical thinking, and knowledge higher in
importance and reported that they had greater confidence
in performing those leadership competencies.
Doctor of Athletic Training graduates rated their
programs as more influential for competencies they
considered more important.
A variety of factors, both in and out of a Doctor of
Athletic Training program, can affect perceptions of
importance, confidence, and program influence of certain
leadership competencies.
and patient care. As leadership plays an integral role in an
AT’s responsibilities, we need to understand the perceptions
and practices of leadership development within athletic
training programs. Foundational and personal leadership
competencies are often learned through controlled environments, such as professional athletic training programs, where
the student has the opportunity to foster creativity, communicate appropriately, build trust, collaborate, and model
desired ethics.6,11–13 Historically, professional athletic training
programs were completed at the baccalaureate degree level.14
Once athletic training students completed their professional
degree, they had the opportunity to gain experience by
working or continuing into a postprofessional master’s
program, which gave them the opportunity to advance their
education and training of foundational skills.14 However, due
to the recent transition of athletic training education, the
professional level of education, which included attaining a
baccalaureate degree, is ending, and the number of postprofessional master’s programs is diminishing.14 In their
places, professional master’s programs are providing professional athletic training education, while Doctor of Athletic
Training (DAT) and residency programs serve as the
predominant postprofessional pathways.14
Table 1. Example of a Leadership Competency7 With
the Competency Defined and Each of the 3 Associated
Questions on Importance, Confidence, and Influence
METHODS
Design
We used a cross-sectional design to assess perceived importance and confidence toward certain leadership competencies
for DAT degree holders, with 3 primary goals: (1) to identify
perceived leadership competencies that DAT degree holders
indicate are important, (2) to identify the level of confidence
that DAT degree holders have to perform these personal
leadership competencies, and (3) to identify the level of
influence the DAT degree holders believe their degree
program had on their perceived influence and confidence of
the personal leadership competencies. The study was deemed
exempt by the Indiana State University Institutional Review
Board.
Advocate: Takes responsibility for actions of others and
defends actions of others, acts when appropriate as an
advocate for others.
Question 1
Question 2
Participants were included if they were a credentialed AT
(Board of Certification certified, state licensed, or both) and a
graduate of a DAT program. If participants did not meet both
inclusion criteria, they were excluded from the study. Before
the start of data collection, participants provided informed
consent to participate.
Question 3
Instrument
We used a 73-item Web-based survey (Qualtrics). The survey
included demographic questions (7 items) as well as a section
focusing on personal leadership competencies (22 competencies). Each personal leadership competency was defined and
had 3 associated items (Table 1). Definitions of each
leadership competency were based off previous work in
athletic training7 and can be found in the Appendix. The first
question asked participants to rate their perception of
importance on each personal leadership competency. These
questions were rated on a 5-point Likert scale ranging from
(1) unimportant, (2) somewhat important, (3) neither important
nor not important, (4) important, and (5) very important. The
second associated item, listing the same leadership competency, asked participants to rate their confidence in performing
the personal leadership competency. These items were also
rated on a 5-point Likert scale: (1) not at all confident, (2)
slightly confident, (3) moderately confident, (4) very confident,
and (5) extremely confident. The final associated item asked
what level of influence the DAT program had on participants’
perceptions of importance and confidence in performing the
personal leadership competency. The associated 5-point
Likert scale was (1) not at all influential, (2) lightly influential,
(3) somewhat influential, (4) very influential, and (5) extremely
influential.
The 22 personal leadership competencies were adapted from
the Leadership Development in Athletic Training (LDAT)
instrument.7 This instrument had been previously validated,
consisting of a list of personal leadership competencies or
competencies considered important for each level of athletic
training education as well as research doctoral programs
(Doctor of Philosophy [PhD] and Doctor of Education
[EdD]).7 Previous research of the LDAT indicated internal
consistency at a ¼ .83–.97 and concurrent, construct, and
convergent validity for the tool.7 Validity of the LDAT was
established in 2 phases of a Delphi technique in which phase 1
established content validity (through literature review and
Athletic Training Education Journal
Abbreviation: DAT, Doctor of Athletic Training.
athletic training experts) and convergent validity which
demonstrated a positive relationship between important
leadership competencies for athletic training education and
those important for clinical practice (r ¼ 0.74, P ¼ .001).7
Phase 2 established convergent validity which demonstrated a
strong relationship between important leadership competencies for athletic training education and those important for
clinical practice (r ¼ 0.94, P ¼ .001).7 Phase 2 also established
construct validity (exploratory factor analysis, eigenvalues
1.0) and concurrent validity which established significantly
varied levels of importance in leadership competencies within
different levels of athletic training education (independent t
tests, 1-way analysis of variance, repeated-measures analysis
of variance, P .05).7 The personal leadership competencies
chosen for this study consisted of those indicated as important
for postprofessional master’s programs in athletic training
and academic doctoral programs (Appendix).7 These leadership competencies were chosen because, at the time of creation
of the LDAT tool, DAT programs were not included. Our
adapted tool was content validated by 2 external reviewers not
associated with the research team who have served as
researchers and clinicians with expertise in leadership and
survey development. The reviewers completed a content
analysis rubric in which they provided comments on item
modifications. We collected the feedback and made appropriate revisions to the survey. Internal consistency was
calculated using Cronbach’s a for each of the main outcome
measures: importance (a ¼ 0.895), confidence (a ¼ 0.876), and
influence of the DAT program (a ¼ 0.917).
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Participants
Rate your perception of importance of
advocacy for a DAT degree holder.
(1) Unimportant
(2) Somewhat important
(3) Neither important nor not important
(4) Important
(5) Very important
Rate your level of confidence in performing
advocacy.
(1) Not at all confident
(2) Slightly confident
(3) Moderately confident
(4) Very confident
(5) Extremely confident
What level of influence did your DAT
program have on your perception of
importance and confidence in performing
the leadership competency mentioned
above?
(1) not at all influential
(2) slightly influential
(3) somewhat influential
(4) very influential
(5) extremely influential
Figure.
Method flowchart from recruitment to enrollment of participants.
Each of the current 6 DAT program directors (as of spring–
summer 2019) were sent a recruitment e-mail that included a
link to the informed consent and the survey. We asked the
program directors to forward the email to graduates of their
respective programs. The recruitment e-mail was sent out 2
weeks in a row. It was confirmed through e-mail that 4 of the
6 program directors forwarded the recruitment e-mail to their
graduates. One program director indicated that he or she did
not have any graduates at the time of the data collection, and
1 program director did not respond to our request to forward
the e-mail and instrument. Since we did not have confirmation
that the email was sent to all DAT graduates, we also posted
on social media (Twitter) to supplement the recruitment
process. Two recruitment tweets were used daily for 5 weeks
to increase participation. The recruitment email contained
information about the survey as well as a hyperlink to the
survey. The survey was completed on a Web-based survey
system (Qualtrics; Figure).
Statistical Analysis
Descriptive statistics were used to identify characteristics of
central tendency (mean, mode, frequency) and variability
(standard deviation) for the demographic characteristics of
the participants and variables of interest. These variables
Athletic Training Education Journal
included importance of leadership competencies, level of
confidence in performing the competencies, and level of
influence the DAT program had on perception of importance
and confidence of competencies. Partial data analysis was
conducted for items that participants chose to omit from the
demographics section. All included participants completed the
demographic items. However, some participants chose not to
respond to select survey items, consistent with voluntariness in
human subject research.
RESULTS
The total number of DAT graduates at the time of data
collection was calculated by reaching out to program directors
to identify the number of graduates from each program. There
was a total of 205 DAT graduates of which 77 responded to
the survey, and 45 of those who responded (45/77, 58.4%
completion rate) consented to participate. Those 45 completed
the survey (45/205, 22.9% response rate) and were included in
the analysis (age ¼ 31.5 6 6.1 years; years since graduating
from the DAT ¼ 1.13 6 0.90; years of experience ¼ 8.69 6 5.6;
years employed at current job ¼ 3.00 6 4.04). When
considering the level of importance of leadership competencies
for DAT graduates, all 22 personal leadership competencies
were rated as important or higher, with critical thinking rated
as having the greatest level of importance (mean ¼ 4.84 6
0.37, mode ¼ 5, n ¼ 37/45, 82.2%; Table 2). Graduates
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Procedures
Table 2. Leadership Competencies Rated on Level of Importance for Doctor of Athletic Training Graduates With
Associated Frequencies, Means, and Standard Deviationsa
Neither
Important
Somewhat
nor Not
Unimportant Important Unimportant
(1)
(2)
(3)
a
1/43, 2.2%
1/44,
1/45,
1/45, 2.2%
1/43,
1/45, 2.2% 1/45,
2/44,
1/43,
3/43,
1/44, 2.2% 1/44,
2/40,
3/44,
3/43,
1/43, 2.2% 2/43,
3/40,
1/44, 2.2% 1/44,
1/41, 2.2% 7/41,
7/44,
9/42,
7/43,
10/40,
2.2% 10/44,
2.2% 11/45,
11/45,
2.2% 12/43,
2.2% 12/45,
4.4% 13/44,
2.2% 16/43,
18/43,
6.7% 13/43,
2.2% 19/44,
4.4% 18/40,
6.7% 19/44,
25/43,
6.7% 23/43,
4.4% 22/43,
6.7% 21/40,
2.2% 26/44,
15.6% 22/41,
15.6%
20%
15.6%
22.2%
22.2%
24.4%
24.4%
26.7%
26.7%
28.9%
35.6%
40%
28.9%
42.2%
40%
42.2%
55.6%
51.1%
48.9%
46.7%
57.8%
48.9%
Very
Important
(5)
37/44,
33/42,
35/43,
30/40,
33/44,
33/45,
33/45,
30/43,
31/45,
29/44,
26/43,
25/43,
27/43,
23/44,
20/40,
22/44,
18/43,
17/43,
18/43,
16/40,
16/44,
11/41,
82.2%
73.3%
77.8%
66.7%
73.3%
73.3%
73.3%
66.7%
68.9%
64.4%
57.8%
55.6%
60%
51.1%
44.4%
48.9%
40%
37.8%
40%
35.6%
35.6%
24.4%
M
SD
4.84
4.79
4.77
4.75
4.73
4.71
4.69
4.67
4.62
4.61
4.58
4.58
4.56
4.45
4.45
4.43
4.42
4.33
4.33
4.33
4.30
4.05
0.37
0.42
0.57
0.44
0.50
0.51
0.60
0.52
0.65
0.58
0.55
0.50
0.63
0.66
0.60
0.63
0.50
0.61
0.68
0.62
0.63
0.74
Items indicated in bold show where the associated leadership competency was rated the most along the Likert scale for importance.
indicated that they were moderately confident or more in
performing personal leadership competencies while indicating
that they have the most confidence in being ‘‘credible—to be
believable, honest, trustworthy, and ethical in dealings with
subordinates, peers, and supervisors’’ (mean ¼ 4.5 6 0.55;
mode ¼ 5, n ¼ 23/45, 51.1%; Table 3). Lastly, graduates
indicated that the DAT was somewhat influential or greater in
influencing the perceptions of importance and confidence
related to the personal leadership competencies. Doctor of
Athletic Training graduates indicated that their program was
extremely influential in their ability to be future minded (mean
¼ 4.63 6 0.58; mode ¼ 5, n ¼ 29/45, 64.4%; Table 4). Overall,
our results suggest that some personal leadership competencies are considered more important for DAT graduates than
others; those competencies considered more important were
also influenced greater by the DAT program.
DISCUSSION
Previous researchers on leadership development in athletic
training have focused on defining a timeline of leadership
development and the importance of leadership competencies
for athletic training practice and education.6,11–13,20–22 Foundational personal leadership competencies are often learned
within professional-level environments, where supervision and
controlled situations are included.6,11–13 The responsibility of
teaching advanced leadership competencies is then assumed
by postprofessional athletic training pathways, specifically
DAT programs, as graduates should be prepared to advance
patient care and athletic training education.16,21,22 Certain
leadership competencies are considered important for postAthletic Training Education Journal
professional education, specifically postprofessional AT master’s programs and academic doctoral programs.7 However,
the increased opportunity and diversity of experiences in
postprofessional education, including DAT programs and
Commission on Accreditation of Athletic Training Educationaccredited residency programs, have not been thoroughly
examined. Therefore, the present study examined the perceptions of personal leadership competencies among postprofessional DAT graduates.
Each graduate rated their perceptions of importance and
confidence of various leadership competencies as well as their
perception of influence of their respective DAT programs on
various leadership competencies. We found that DAT
graduates indicated some leadership competencies were more
important than others, and graduates specified greater
confidence in those same leadership competencies that they
indicated as more important. Leadership competencies rated
higher in importance were also rated higher in DAT program
influence.
Perceptions of Importance
In previous research, a delineation of leadership competencies
has been found in which some are perceived as more or less
important at various stages of AT education.7 Some leadership
competencies such as advocate, credible, delegates effectively,
disciplined, and applies known and attained knowledge were
considered important for inclusion within both professionallevel and postprofessional master’s of athletic training
programs.7 In addition, other leadership competencies like
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Critical thinker
Knowledgeable
Future minded
Open mindedness
Credible
Applies known and attained knowledge
Advocacy
Intentional leadership
Courageous leadership
Cultural sensitivity
Empowerment
Excellent written communication skills
Influencer
Crisis management
Utilizes appropriate leadership styles
Demonstrates scholarship
Improves morale
Disciplined
Ensures an awareness of mission
Willing to take appropriate risk
Delegates effectively
Leads quietly
Important
(4)
Table 3. Personal Leadership Competencies Rated on Level of Confidence in Performance From Doctor of
Athletic Training Graduate With Associated Frequencies, Means, and Standard Deviationsa
Not at all
Confident
(1)
Slightly
Confident
(2)
Moderately
Confident
(3)
a
20/44,
16/40,
24/44,
21/42,
17/44,
31/45,
19/41,
19/43,
27/45,
22/43,
25/43,
23/43,
20/43,
21/44,
16/45,
20/44,
17/43,
20/43,
22/43,
15/40,
20/40,
16/44,
44.4%
35.6%
53.3%
46.7%
37.8%
68.9%
42.2%
42.2%
60%
48.9%
55.6%
51.1%
44.4%
46.7%
35.6%
44.4%
37.8%
44.4%
48.9%
33.3%
44.4%
35.6%
Extremely
Confident
(5)
23/44,
21/40,
18/44,
18/42,
19/42,
12/45,
15/41,
16/43,
13/45,
14/43,
12/43,
13/43,
13/43,
11/44,
13/45,
10/44,
11/43,
8/43,
8/43,
9/40,
7/40,
5/44,
51.1%
46.7%
40.0%
40%
42.2%
26.7%
33.3%
35.6%
28.9%
31.1%
26.7%
28.9%
28.9%
24.4%
28.9%
22.2%
24.4%
17.8%
17.8%
20%
15.6%
11.1%
M
SD
4.50
4.45
4.36
4.36
4.25
4.22
4.20
4.19
4.16
4.16
4.09
4.09
4.05
3.93
3.91
3.91
3.88
3.84
3.84
3.83
3.78
3.57
0.55
0.64
0.57
0.62
0.75
0.52
0.72
0.73
0.67
0.69
0.75
0.81
0.79
0.85
0.85
0.74
0.82
0.72
0.79
0.78
0.83
0.73
Items indicated in bold show where the associated leadership competency was rated the most along the Likert scale for confidence
critical thinking, courageous leadership, and cultural sensitivity
were rated as more important for postprofessional master’s
programs than the professional level.7 Similarly, within our
study, DAT graduates rated some leadership competencies
such as credible, knowledgeable, advocate, and applies known
and attained knowledge as important. Other leadership
competencies such as critical thinking, courageous leadership,
and cultural sensitivity were rated even higher, indicating a
greater level of importance for DAT graduates. Some
leadership competencies considered important for AT education may be shared across the professional level, postprofessional master’s, and DAT programs, as all 3 types of programs
are focused on the clinical growth of an AT, whether
foundational or advanced.15
Also, similarity exists among the leadership competencies
rated important for DAT graduates and those considered
important in other allied health professions. Critical thinking
was thought to be the most important competency by the
participants in this study, which has also been considered
important for nurses and physicians.4,23 Critical thinking was
described as an essential skill that enhances nursing practice
by leading to a more creative and meaningful decision-making
process.23 Critical thinking, whether used alone or in
combination with other leadership competencies, helps give
a more meaningful assessment of information and refines the
solution process to specific problems when other solutions or
interventions are not effective.23 Other leadership competencies such as being decisive, having a strong knowledge base,
applying knowledge and evidence, and fostering vision were also
considered important for other health professions3 at a rate
like those described by the DAT graduates (knowledgeable,
future minded, and applies known and attained knowledge).
Athletic Training Education Journal
These similarities are expected, as leadership competencies
may be transferable across a variety of health care disciplines.
Shared leadership competencies across health care professions
may be necessary, as effective collaboration is expected among
health care providers.24 As the number of ATs in health care
administration continue to rise, it is imperative that DAT
graduates share similar personal leadership competencies as
leaders within other health care professions.16
While in this study, we show similarities of important
leadership competencies across other stages of AT education,7
variability is also present when comparing competency ratings
between the DAT and academic doctoral programs.7 While a
few leadership competencies such as advocacy, applies known
and attained knowledge, knowledgeable, and open minded7
are shared among our results, differences remain in perceived
importance of leadership competencies between academic
doctoral and DAT programs. One competency, demonstrates
scholarship, is rated important for academic doctoral programs7 but was not rated as important among DAT
graduates. This can be attributed to the different purposes
of each degree, as academic doctoral programs are typically
focused on research or education, while DAT programs
advance a practicing clinician’s level of knowledge and skillset
to better their patient care.15 The variability in perceived
importance of leadership competencies between these 2 types
of programs indicates a discipline-specific awareness of
leadership that is necessary when creating program content
and curricula. Within curricula, leadership competencies can
be selected for a variety of reasons. Some reasons may include
the program’s accreditation standards, anticipated circumstances of the students,25 career or professional expectations,
and previous needs or outcomes assessments from similar
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Credible
1/44, 2.2%
Open mindedness
3/40, 6.7%
Critical thinker
2/44, 4.4%
Knowledgeable
3/42, 6.7%
Cultural sensitivity
8/44, 17.8%
Applies known and attained knowledge
2/45, 4.4%
Leads quietly
7/41, 15.6%
Future minded
8/43, 17.8%
Advocacy
1/45, 2.2% 4/45, 8.9%
Disciplined
7/43, 15.6%
Empowerment
2/43, 4.4% 4/43, 8.9%
Excellent written communication skills 1/43, 2.2%
6/43, 13.3%
Improves morale
1/43, 2.2% 9/43, 20%
Demonstrates scholarship
1/44, 2.2%
11/44, 24.4%
Courageous leadership
1/45, 2.2% 15/45, 33.3%
Crisis management
14/44, 31.1%
Influencer
1/43, 2.2% 14/43, 31.1%
Intentional leadership
15/43, 33.3%
Ensures an awareness of mission
2/43, 4.4% 11/43, 24.4%
Willing to take appropriate risk
16/40, 35.6%
Utilizes appropriate leadership styles
3/40, 6.7% 10/40, 22.2%
Delegates effectively
1/44, 2.2% 22/44, 48.9%
Very Confident
(4)
Table 4. Personal Leadership Competencies Rated on Level of Influence From Doctor of Athletic Training
Program With Associated Frequencies, Means, and Standard Deviationsa
Not At All
Influential
(1)
Slightly
Influential
(2)
a
2/43,
3/44,
3/43,
6/40,
3/42,
4/45,
2/44,
3/43,
5/45,
6/45,
9/43,
10/43,
9/44,
9/40,
8/40,
8/44,
11/44,
13/43,
15/43,
16/41,
12/43,
16/44,
4.4%
6.7%
6.7%
13.3%
6.7%
8.9%
4.4%
6.7%
11.1%
13.3%
20%
22.2%
20%
20%
17.8%
17.8%
24.4%
28.9%
33.3%
35.6%
26.7%
35.6%
Very
Influential
(4)
12/43,
13/44,
16/43,
10/40,
18/42,
21/45,
19/44,
21/43,
20/45,
16/45,
16/43,
18/43,
15/44,
15/40,
20/40,
6/44,
13/44,
16/43,
15/43,
14/41,
12/43,
17/44,
26.7%
28.9%
35.6%
22.2%
40%
46.7%
42.2%
46.7%
44.4%
35.6%
35.6%
40%
33.3%
33.3%
44.4%
13.3%
28.9%
35.6%
33.3%
31.1%
26.7%
37.8%
Extremely
Influential
(5)
29/43,
27/44,
23/43,
23/40,
20/42,
20/45,
21/44,
18/43,
19/45,
21/45,
17/43,
15/43,
18/44,
15/40,
12/40,
24/44,
17/44,
12/43,
12/43,
10/41,
13/43,
7/44,
64.4%
60%
51.1%
51.1%
44.4%
44.4%
46.7%
40%
42.2%
46.7%
37.8%
33.3%
40%
33.3%
26.7%
53.3%
37.8%
26.7%
26.7%
22.2%
28.9%
15.6%
M
SD
4.63
4.5
4.42
4.38
4.36
4.36
4.34
4.30
4.27
4.22
4.14
4.12
4.11
4.10
4.10
4.02
4.00
3.88
3.86
3.80
3.74
3.61
0.58
0.73
0.73
0.84
0.73
0.65
0.78
0.71
0.75
0.93
0.83
0.76
0.90
0.85
0.71
1.29
0.96
0.88
0.92
0.84
1.05
0.87
Items indicated in bold show where the associated leadership competency was rated the most along the Likert scale for influence.
disciplines. While general leadership competencies may benefit
graduates of both a DAT and academic doctoral program,
adapting leadership curricula to the needs of the DAT degree
may enhance the formation of an advanced clinical leader.
competencies to be used while facing adversity, being exposed
to a variety of people, problem solving, making mistakes, and
struggling with unfamiliar situations.28
Perceptions of Influence
Perceptions of Confidence
We found that DAT graduates rated themselves higher in
confidence on leadership competencies they perceived as more
important. Such shared leadership competencies of credible,
open mindedness, critical thinker, and knowledgeable were
rated high in confidence and have also been associated with
advanced practice leadership within nursing and physician
practice.4,23 Other leadership competencies, such as ensures an
awareness of mission, willing to take appropriate risk, utilizes
appropriate leadership styles, and delegates effectively were
rated lower in confidence. Overall, the application of
leadership competencies may affect confidence of performing
said leadership competencies. While the sample in this study
was only about 1-year post-DAT graduation, the graduates
indicated several years of experience (8.69 6 5.6) and years
employed at current job (3.00 6 4.04), which can be a factor
in their levels of confidence with each leadership competency.
The graduates may have had the opportunity to clinically
practice while completing their DAT program, which in turn
gives them the ability to practice emphasized leadership
competence to one’s work setting. This can provide an
opportunity to either enhance or change leadership behavior26
due to the variety of experiences. While we did not measure
application of the leadership competencies in this study,
positive correlations have been found between clinical
experience and levels of confidence in other health care
disciplines.27 Experience allows for different leadership
Athletic Training Education Journal
Leadership training is often aimed at the ability to learn,
differentiate, and refine different leadership competencies
within different settings.29,30 It is imperative to provide
additional leadership development for both clinical and
academic leaders in health care to better prepare them for
new leadership roles.29 Learning environments that incorporate effective leadership development strategies may have
strong influence on individuals’ perceptions and confidence of
different leadership competencies. As previously mentioned,
the purpose of the DAT degree is to develop clinical leaders,
demonstrated by several DAT programs’ mission statements.
Programs describe themselves as a place to develop advanced
practice leaders,15,16,31 professional leadership,32 and clinical
or academic leaders.33 Therefore, advancing leadership
competence is an objective of DAT programs, and those
programs should be influential in the leadership competencies
they choose to emphasize.
One of the aims of our study was to explore the perceptions of
influence of the DAT programs on leadership competencies,
and differences between graduates’ ratings existed. We found
that graduates rated leadership competencies such as future
minded, demonstrates scholarship, intentional leadership, open
mindedness, and knowledgeable as more influenced by their
DAT program than others. This result indicates that
programs may have influenced a higher level of perceived
importance and confidence for those leadership competencies.
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Future minded
Demonstrates scholarship
1/44, 2.2%
Intentional leadership
1/43, 2.2%
Open mindedness
1/40, 2.2%
Knowledgeable
1/42, 2.2%
Applies known and attained knowledge
Critical thinker
2/44, 4.4%
Excellent written communication skills
1/43, 2.2%
Courageous leadership
1/45, 2.2%
Advocacy
1/45, 2.2% 1/45, 2.2%
Empowerment
1/43, 2.2%
Influencer
Credible
2/44, 4.4%
Utilizes appropriate leadership styles
1/40, 2.2%
Willing to take appropriate risk
Cultural sensitivity
3/44, 6.7% 3/44, 6.7%
Crisis management
3/44, 6.7%
Ensures an awareness of mission
2/43, 4.4%
Disciplined
1/43, 2.2%
Leads quietly
1/41, 2.2%
Improves morale
6/43, 13.3%
Delegates effectively
4/44, 8.9%
Somewhat
Influential
(3)
Another factor that may affect the influence DAT programs
have on leadership competencies is the graduates’ clinical
experiences as they complete the program. Behavior modeling
training (BMT) is like the social learning theory with an
emphasis on the transition of learned behaviors to the work
situation.36 The strategy of BMT ensures meaningful practice
and multidimensional context for leadership application by
presenting guidelines for emphasized leadership competencies,
creating environments of observation of effective modeling of
said competencies, practicing with the opportunity for
feedback, and transferring leadership competencies to the
work setting.36 Doctor of Athletic Training programs have the
capability of using BMT as students are credentialed and can
immediately apply emphasized leadership competencies in
their work settings. However, the relationship between the
program and the student’s workplace is often tangential and
out of the program’s control. As such, formal leadership
development activities should be incorporated throughout the
curricula. To intentionally choose activities or content in
curricula that can emphasize leadership competencies means
that program faculty must understand what leadership
competencies are perceived as most important for that level
of AT education. Although the DAT degree is a novel degree
and the potential of the leadership competencies in such
programs may not have been fully realized in this sample, the
results of this study can assist in providing a foundation for
bettering leadership development for AT education.
LIMITATIONS AND FUTURE RESEARCH
In this study, the sample of graduates were only about a year
post-DAT graduation. Therefore, the importance, confidence,
and influence of DAT programs may not have been fully
realized due to a lack of time to transition to clinical practice
leadership roles. We also acknowledge that, in this study, we
use perception data, and we were unable to verify if the
participants’ perceptions of their leadership competencies
match the performance of said leadership competencies.
Nevertheless, it is important to assess students’ perceptions
of their learning environment, as their environment can affect
their behavior, academic progress, learning outcomes, and
overall wellbeing.37 Previous researchers have established that
student perceptions of their learning environment can be
Athletic Training Education Journal
reliable as well as predictive of their learning.38,39 In this study,
we have established DAT holders’ perceptions of importance
and confidence of performing various leadership competencies
as well as their perceptions of their DAT program’s influence
of their perceived importance and confidence ratings. Understanding DAT graduates’ perceptions of various leadership
competencies may assist in exposing the level of success DAT
programs have at emphasizing leadership qualities for clinical
practice, even when there may be other influential factors
involved. The results of these perception data can also aid in
finding needs, problems, trends, and goals of the DAT learning
environment as well as establish baseline data for future
research or changes.40 With that said, we encourage all
researchers exploring leadership and leadership education in
athletic training to push the measurement beyond perception
into outcomes assessments of leader performance. Although
these studies are more complex, they will better inform how to
educate practice leaders.
Authors of future studies should investigate if importance
ratings are a result of DAT curricula, market demands, other
educational programs, or personal preferences. The relationship between building different levels of personal leadership
competence to having different career opportunities should
also be investigated in future research. Future researchers
should also investigate the degree of influence of DAT
programs on specific leadership competencies as well as
specific strategies programs use to teach, emphasize, or both
leadership development. Lastly, more research should be
performed to examine organizational and systems leadership,
as advanced practice in health care has an impact on not only
patients but also the health care professionals themselves and
their organizations.19
CONCLUSIONS
Graduates perceived certain leadership competencies as more
important than others, of which some were shared across
other levels of athletic training programs and other health care
professions. Doctor of Athletic Training graduates also
perceived greater confidence in leadership competencies they
considered more important. However, we are not able to
conclude that their DAT program was the only mechanism of
developing confidence in the leadership competencies. A
variety of factors such as immediate clinical application of
learned leadership competencies and experiences may influence graduates’ perceptions of confidence. Lastly, DAT
graduates indicated their programs were influential in
developing some leadership competence but more so with
the leadership competencies they thought were important and
for which they felt more confident. Altogether, with this
study, we are the first to investigate leadership competency
perceptions for DAT graduates, those aiming to be advanced
practice leaders. This study serves as a starting point for
leaders, educators, researchers, and regulators to continue to
evaluate the purpose, desired outcomes, and benchmarks for
success of DAT programs while also considering how to
effectively develop leadership competence outside of the DAT
through work experience.
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Definitions of Each Leadership Behavior7
Advocate
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Takes responsibility for actions of others and defends actions of others, acts when
appropriate as an advocate for others.
Applies known and attained Uses clinical evidence, research, and best practice in the promotion of the profession by
knowledge
professional communications (abstracts, poster presentations, lectures, etc), original
investigations, and literature reviews.
Courageous leadership
Has strong convictions and holds to convictions when faced with challenges.
Credible
Is believable, honest, trustworthy, and ethical in dealings with subordinates, peers, and
supervisors.
Crisis management
Effectively handles unforeseen crises and limits or corrects problems in a reasonable
amount of time (via problem solving and dialogue) and deals with conflict by providing
effective strategies for conflict resolution.
Critical thinker
Cognitive ability to make connections, integrate, and make practical application of different
actions, opinions, and information.
Cultural sensitivity
Promotes diversity in multiple contexts and aligns diverse individuals by creating and
facilitating diversity and provides opportunities for diverse members to interact in
nondiscriminatory manner.
Delegates effectively
Appropriately gives responsibility and authority to others in accomplishing desired tasks.
Demonstrates scholarship
Contributes to professional advancement by promoting and participating in scholarly
activity, such as conducting research, giving/hosting professional presentations,
participating in peer reviews, or writing articles.
Disciplined
Is consistent and steady in performing unpleasant or mundane tasks that provide longterm benefits.
Empowerment
Uses influence and interpersonal ability to promote and encourage personal growth of
others. Ensures transformation and development of others.
Ensures an awareness of
Understands and communicates how individual performance of others influences
mission
subordinate’s, peer’s, and supervisor’s perception of how the mission is being
accomplished.
Excellent written
Writes thoughts and ideas accurately, effectively, and succinctly to subordinates, team
communication skills
members, supervisors, other professionals, and collaborative community partners.
Future-minded
Has a forward-looking mentality and sense of direction and concern for where the
organization should be in the future.
Improves morale
Facilitates and encourages a positive attitude in peers, subordinates, and supervisors
toward their work and life.
Influencer
Uses interpersonal skills to ethically and non-coercively affect the actions and decisions of
others.
Intentional leadership
Assess and evaluates own leadership performance and is aware of strengths and
weaknesses. Takes intentional action toward continuous improvement of leadership ability.
Knowledgeable
Knows, understands, and is capable of performing the details and demands of tasks and
roles specific to the profession.
Leads quietly
Moves patiently, carefully, and incrementally. Doing what is ‘‘right’’ for the organization
while using modesty and restraint to accomplish goals.
Utilizes appropriate
Demonstrates the ability to implement and transition between varieties of leadership styles
leadership styles
(ie, transactional, charismatic, transformational, situational, servant, autocratic, laissezfaire, etc) when appropriate and when different situations dictate a diversity of
leadership styles. Can identify when it is appropriate to transition between leadership
styles with subordinates and peers and recognizes when superiors and other
professionals are transitioning between leadership styles.
Willing to take appropriate
Willing to accept a degree of uncertainty for the sake of implementing an idea, needed
risk
value, or to see a goal accomplished.
Open-mindedness
Willingness to discard old ways of doing things when evidence fails to support them.