















































MANUSCRIPT TYPE


 EDITORIAL 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                                  Volume 7 – Issue 2 July 2024 

The Value of Using Validated Competency-Based Assessments Across 
the Career Span of an Athletic Trainer 
 
Matthew Drescher, PhD, DAT, LAT, ATC *; Lindsey Eberman, PhD, LAT, ATC† 
*North Dakota State University, Fargo, ND; †Indiana State University, Terre Haute, IN 

 
Content Focus 
Health Professions Education 
 
Correspondence 
1340 Administration Ave, Fargo, ND 58102 
E-mail: matthew.drescher@ndsu.edu 
 
Reference 
Drescher MD, Eberman LE. The Value of Using Validated Competency-Based Assessments Across the Career Span of an Athletic 
Trainer. Clin Pract Athl Train. 2024; 7(2):1-4. https://doi.org/10.31622/2024/0007.02.1 
 
COMMENTARY 

Background 

In educating students, there is an inherent need to quantify and track student performance over time. This 
quantification is typically done with an outcome of some type, such as an assessment rubric or grading 
criteria, from which subjective student performance is translated to an objective value. Traditionally, this 
objective value has been quantified as grades (on a numeric or alpha scale). To quantify those grades, 
assessments are given scores that contribute to the overall grade in a course or area of study. This method 
has proven so effective that it is the predominant way students are assessed in the United States, with high 
school and undergraduate students being categorized by their grade point average as a method to average 
a student’s performance over time or across content.1 Grades and their subsequent derivatives can be an 
effective method of quickly and easily expressing student performance and aptitude in a particular area of 
study. We must, though, examine the assumptions supporting the system's use of grading performance. First, 
we must define what is meant by “measure of learning.”  

Learning, as a concept is difficult to define, with conflicting definitions from different schools of thought.2 A 
more modern consensus is that learning is a process of gradual changes in behavior, mental processes, and 
critical thinking.2 How, then, do we objectively measure a continuous process? Historically, measures of 
learning were considered to be methods such as memorization, knowledge assessment, and behavioral 
observation, as these were seen to be analogs to learning as a permanent change in behavior.2 When 
discussing a more holistic measure of learning from a modern understanding, we should also consider 
including competency-based assessment and overall performance assessment as well as measures of 
knowledge and behavior. These measures reflect the more modern definition of learning and create a more 
complete representation of a student’s learning process. This is the foundational idea behind competency-
based education. 

When implementing competency-based education, there is an assumption that grades can still be applied 
as an accurate, objective measure of learning, whether using holistic student assessment or otherwise.1 
However, this assumption relies on an assessment method's reliability and the assessor's objectiveness, which 
can vary widely. Take, for example, an assessment of student knowledge on a traditional exam as a measure 
of learning. Such an assessment could objectively quantify a student’s learning in a numeric grade (and even 
transferred to an alpha-coded grade), given that the items on the exam were accurate and encompassed 

https://doi.org/10.31622/2024/0007.02.1


The Value of Using Validated Competency-Based Assessment Across the Career Span of an Athletic Trainer 

2 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                                  Volume 7 – Issue 2 July 2024 

expected content. Now consider the student’s final grade in the course. If this final grade is an average of 
all graded assessments in the course, then this should be an accurate assessment of their competence relative 
to the learning outcomes. However, indirect and subjective measurements, such as student participation or 
time-on-task, are frequently included in a final grade, making the final grade less reflective of knowledge 
and rather a reflection of both subjective and objective factors, diminishing its accuracy as an objective 
measure of learning. Other factors may also influence the objectiveness of grades, such as the study habits 
of students, different approaches to grading, or even students' motivations to receive a particular score or 
grade (e.g. contract grading). These factors indicate that grades might measure learning in certain situations 
but are not, and should not, be considered all-encompassing.  

To be clear, we do not suggest that all education should be moved to a competency-based education model 
and that traditional grading should be removed altogether. In higher education, numerous barriers block the 
adoption of such a model, from federal classification standards to educator training and buy-in. Still, in fields 
and professions where competency in a skill is a necessary requirement for practice, integrating competency-
based assessment strategies into more traditional education models can help bridge the gap between 
student course performance and competency in the field. In recent times, healthcare education programs 
have embraced the adoption of competency-based assessment methods, in lieu of traditional grading 
systems, to evaluate clinical competence. Competency-based assessment approaches are deemed more 
effective in evaluating the clinical application of skills in healthcare students.3 However, it is imperative to 
acknowledge that these approaches carry certain assumptions that must be considered for their effective 
implementation in practice. 

Namely, we must assume that competency-based assessment criteria are accurate and encompass the totality 
of a particular clinical skill or behavior. However, even when an assessment tool is critically appraised for 
its accuracy, there remains a level of subjectivity and bias within the tool, originating from its creator and 
assessor. To establish the validity of an assessment tool, it should ideally be based on a scientifically proven 
theory, and it should be validated. In athletic training, assessment tools have been created and validated 
based on the Dreyfus Model of Skill Acquisition,4,5 which is an established method for categorizing and 
evaluating skill acquisition.6 The Dreyfus model uses a 5-point scale, with each point characterizing a 
particular level of skill acquisition, from novice to expert.6 Using the Dreyfus model as a framework helps to 
validate the theoretical development of a competency-based assessment tool. 

For a model like this to work, however, a list of the skills and behaviors that correlate to practice must be 
identified and paired with the framework. A team of experts, or those who are knowledgeable about the 
skills and behaviors required to perform a task, should be consulted to develop the list of competencies that 
constitute the comprehensive practice, in this case, the comprehensive practice of athletic training. The use of 
experts, rather than an individual creator, helps to prevent bias and ensure that all aspects of a skill are 
accounted for. 

This can seem like a lot of work for an educator to implement into an existing program. However, much of 
the groundwork has already been completed. The Accreditation Council for Graduate Medical Education 
(ACGME) has created a list of core competencies, in alignment with the healthcare core competencies, that 
provide list of behaviors for each broad competency and subcompetency. The ACGME then applied the 
Dreyfus model framework to characterize the range of performance from novice to expert for each 
competency and sub-competency. This has also been done in the athletic training profession, whereby 4 
leaders in the profession developed The Athletic Training Milestones (AT Milestones). The AT Milestones were 
built similarly to the ACGME Milestones with the Dreyfus model framework applied across the core 
competencies and sub-competencies and are still in progress for some of the specialty areas of athletic 



The Value of Using Validated Competency-Based Assessment Across the Career Span of an Athletic Trainer 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                                  Volume 7 – Issue 2 July 2024 

training practice. Subsequently, a different group of researchers validated the AT Milestones using a 
conservative approach to establishing a content validity index using 12 additional experts in the field. The 
overall scale index was very high (0.99) and the 28 subcompetency items ranged from 0.83 to 1.00.4 One 
of the benefits of the AT Milestones is that they identify skills and establish the behaviors consistent with 
competence for all athletic trainers, not just athletic training students. This provides students with a clear 
pathway to competence and provides practicing clinicians with effective tools for assessing their clinical 
practice. These milestones should be used across the continuum of practice, from education through retirement, 
as a guidepost to competent clinical practice.4  

As with any assessment tool, assessment personnel should be trained. Untrained individuals might incorrectly 
evaluate, which could lead to a false sense of competence. An understanding of the rankings and their 
requisite behaviors, along with knowledge of the profession and activity being performed, is critical to 
accurate assessment. Proper training on the use of these tools helps to ensure alignment with tool design and 
to provide the individual being assessed with effective feedback on performance.  

In athletic training education, tools such as the AT Milestones are not frequently used,7 thus they are not yet 
a key metric for progression and matriculation. A validated tool can give educators confidence in assessing 
student performance and ensure that the totality of the behavior or skill is accounted for prior to graduation. 
Such a tool also provides students with a path to mastery and helps to show a progression of skills that can 
help them continue to learn based on their capability rather than their knowledge alone.3 A validated tool 
can also be used for student education by showing them what skills and behaviors are expected of them in 
the profession. Further, a competency-based assessment tool can be used across the career of a provider 
helping to ensure alignment with best practices across time. Finally, using a validated competency-based 
assessment tool allows students to shift their mindset from acquiring knowledge, as is promoted by traditional 
grading schemes, to applying such knowledge to clinical practice.8 

 

REFERENCES 

1. Cain J, Medina M, Romanelli F, Persky A. Deficiencies of traditional grading systems and recommendations 
for the future. Am J Pharm Educ. 2022;86(7):8850. doi:10.5688/ajpe8850 

2. Sehic S. Redefining the definition of learning from an educational aspect. Int J Inf Res Rev. 2020;7:6940-
6942. 

3. Mace KL, Bacon CEW. The future of health professions education: Considerations for competency-based 
education in athletic training. Athl Train Educ J. 2019;14(3):215-222. doi:10.4085/1403215 

4. Bacon CEW, Anderson BE, Cavallario JM, Van Lunen BL, Eberman LE. Content validation of the athletic 
training milestones: A report from the Association for Athletic Training Education Research Network. J Athl 
Train. 2023;58(5):483-487. doi:10.4085/1062-6050-0332.22 

5. Eberman, LE, Edler, JR. Developing, Validating and establishing reliability of a standardized patient 
evaluation eool to measure healthcare core competency. J Athl Train. 2020;55(6s):S-240. 
doi:10.4085/1062-6050-55.6s.S-1 

6. Rousse B, Dreyfus S. Revisiting the six stages of skill acquisition. Teach Learn Adult Ski Acquis Appl Dreyfus 
Dreyfus Model Differ Fields. Published online 2021:3-28. 

7. Imanipour M, Ebadi A, Monadi Ziarat H, Mohammadi MM. The effect of competency-based education on 
clinical performance of health care providers: A systematic review and meta-analysis. Int J Nurs Pract. 
2022;28(1):e13003. doi:10.1111/ijn.13003 



The Value of Using Validated Competency-Based Assessment Across the Career Span of an Athletic Trainer 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                                  Volume 7 – Issue 2 July 2024 

8. Welch Bacon CE, Anderson BE, Cavallario JM, Van Lunen BL, Eberman LE. Perceptions and use of the 
athletic training milestones in education: A report from the AATE Research Network. Clin Pract Athl Train. 
2024;7(2);XX-XX. doi: 

 


