Every profession carries with it the obligation of meeting societal standards and expectations.

As part of its professional duty, in 1995 the National Athletic Trainers' Association (NATA) commissioned a task force to examine all aspects of athletic training education and its effect on professional practice. Continually improving education and rigorous academic standards are required to help meet the challenges of expanding work settings and increased health care expectations. Also paramount among the forces of change is NATA's quest to become unparalleled in the quality of care we provide to athletes.

Following a two-year period of exhaustive information gathering and member feedback, the Education Task Force (ETF) forwarded 18 recommendations that were approved by the NATA Board of Directors in 1996 and announced to the NATA membership.

Currently, two routes exist to meet the NATA Board of Certification, Inc. (NATABOC) eligibility requirements. One is through a CAAHEP-accredited major and the other is through the work experience-based internship route.

As Jim Watson's February 14 guest editorial ("More time needed to assess NATA changes") accurately describes, one of the ETF recommendations was to eliminate the internship route to certification effective January 1, 2004, a seven-year period between the announcement and the enactment of this recommendation.

While many outstanding certified athletic trainers have entered the profession via the internship route and many institutions offer non-accredited athletic training majors, this route was pointed to as the weak link in our professional preparation. This has hindered athletic training from gaining respect within the health care community and has hindered licensure efforts needed to protect not only our profession, but also the public we serve.

Mr. Watson suggests that doing away with the internship route to certification will create a pool of institutions that holds a monopoly on athletic training professional preparation. The fact is students who desire to major in business will choose an institution that offers a business major; those who choose to major in nursing will attend an institution that offers an accredited nursing major. Students do not expect to major in business just because an institution has a business office or expect to become a nurse simply because a school's health service employs one. The presence of professionals on a college campus does not grant a license to have an academic major. Why should athletic training approach its education differently?

Accreditation is the "gold standard" for academic programs and is consistent with other professional majors. Athletic training is alone in the health care field by still offering a non-academic route of entry into the field. Most professions have long done away with non-accredited professional preparation.

The suggestion was made to improve the internship route to certification, an option that was investigated by the ETF. Ultimately, improvements meant tighter oversight of the coursework and clinical experiences that comprised the internship route. The type of oversight required for tightening the reins on the internship route necessitated accreditation, a process already in place.

Just as there were carefully planned and well carried out non-accredited AT programs, there were many that, in essence, exploited a student work force. NATABOC exam candidates discovered they lacked specific courses, did not have an appropriate mix of clinical experiences or -- in the worst case -- found that after four years of internship, their supervisors were not NATABOC-certified, thus making them ineligible for the examination.

Obviously, this construct opened the door to both personal and institutional liability. Furthermore, data maintained by the NATABOC demonstrate that curriculum candidates pass the examination at more than twice the rate of internship candidates. The decision to eliminate the internship route to certification was not taken lightly. The NATA and the NATABOC elected to eliminate the internship route to ensure the long-term viability of our profession.

The crux of Mr. Watson's arguments centers on the perceived loss of student assistance in the delivery of athletic training services. The elimination of the internship route to certification does not preclude institutions without an accredited athletic training program from incorporating the use of student assistants into their athletics health care delivery. A largely unrecognized fact is that the majority of students who serve as student athletic trainers in non-accredited programs never go on to take the certification exam. These students can still play a role in the health care coverage of intercollegiate athletics. However, if they choose to become eligible to sit for the NATABOC certification exam, they will have to pursue their professional preparation in an entry-level master's degree program in AT.

Unfortunately, the increased role of students in the health care of collegiate athletes is not a reflection of most athletics administrators' desire to educate future athletic trainers. This is more than likely the trickle-down effect of the increased workload placed on many athletic trainers as the number of sports increases, the size of teams grows, and the very fuzzy "off-season," where sports were once inactive, continues to shrink. Unfortunately, athletics health care was often overlooked in these decision-making processes.

What is the ultimate impact of the elimination of the internship route to certification on athletics health care? Consider the Commonwealth of Massachusetts, which essentially eliminated the internship route to licensure in 1998. Six institutions in Massachusetts sponsor an accredited AT program. The remaining institutions have been able to carry on their athletic training services without decreasing their standard of care.

The NCAA Executive Committee has charged the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports to review of the effects of NATA's changes on all three divisions and to create options for institutions that either cannot or will not develop an accredited AT program. Representatives of the NATA and NCAA recently met to discuss this charge and outline a joint effort to accomplish this goal. Over the next few months, this group will develop specific options and provide information that may be used by both athletic trainers and athletics administrators.

College athletes, regardless of their sport or level of competition, deserve health care from the best-prepared professionals available. That is the bottom line in the NATA's vision in our professional preparation and it should be the institutional bottom line for the welfare of student-athletes.