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Teaching towards culturally responsive pedagogy in the CAATE accredited athletic training classroom

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Teaching towards culturally responsive pedagogy in the CAATE accredited athletic training classroom

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Running head: CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM

Teaching Towards Culturally Responsive Pedagogy in the CAATE Accredited Athletic Training
Classroom

By

Natalya Drukarova Denmark

A Dissertation Presented to the
FACULTY OF THE USC ROSSIER SCHOOL OF EDUCATION
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF EDUCATION

May 2019

2019 Natalya Drukarova Denmark

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
Acknowledgments
"We must take sides...neutrality helps the oppressor, never the victim...silence encourages the
tormentor, never the tormented...and action is the only remedy to indifference."
- Elie Weisel, Nobel Peace Prize Speech, 1986

There are many who deserve my gratitude for their contributions, support, and wisdom
throughout the last three years. It goes without saying that it takes a village and this dissertation
is dedicated to my village. I would like to thank the three groups of people without whom this
feat would not have been possible professionally and personally.
To my chair, committee and the profession of athletic training: Dr. Briana Hinga, Dr.
Angela Hasan and Dr. Shane Stecyk, thank you for ensuring that my work was clear,
professional, and truly faced how social justice can be tackled within athletic training. Your
guidance and feedback have been extremely important to me and taught me to always look
beyond the surface. Thank you to all of my athletic training mentors and warriors, your job is
never done and always inspiring.
To the 2016 Weekend Cohort: It would have been impossible for me to make as much
growth as a person, a scholar and educator without each of you. A special thank you to my
writing partner Dr. Randee Kirkemo for the constant motivation, idea sharing and support. Thank
you all for making the last three years a journey I will cherish for the rest of my life.
To my family and friends: I want to thank my circle for always keeping me grounded, for
supporting me, and for enduring my absence at times. To my life partner, the meal prepping, the
discussions, and the support of my weekend disappearances mean the world. To my parents, I
have always believed that I can reach for the highest accomplishments thanks to your hard work
and example. To my family and friends, your support knows no boundaries and has pushed me
through this process with love.

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
Table of Contents
List of Tables 4
List of Figures 5
Abstract 6
Chapter One: INTRODUCTION 7
Background of the Problem 7
Statement of the Problem 9
Purpose of the Study 11
Research Questions 12
Significance of the Study 13
Organization of the Study 14
Chapter Two: INTRODUCTION TO THE LITERATURE REVIEW 14
Theoretical Framework 15
Historical Framing 15
CRT, CRP, Communal Utility Value, and Emergent Strategy 17
CRT. 18
CRP. 20
Communal utility value. 21
Emergent strategy: Theory of change. 22
Connecting CRT, CRP, communal utility value, and emergent strategy. 23
Literature Review 24
Educator Cultural Identity 25
Cultural Humility 27
Fostering culturally aware athletic trainers. 28
Cultural “competence.” 28
CHAT 30
Teaching faculty to implement cultural education. 32
Community in Athletic Training Programs. 34
Patient-Centered Care Focus. 35
Conceptual Framework 37
Summary 38
Chapter Three: METHODOLOGY 40
Positionality 41
Setting 42
Participants 43
Data Collection and Instrument Protocols 44
Document Analysis 44
Problem-posing Open Dialogue 45
Observations 46
Interviews 47
Faculty. 47
Students. 48
Data Analysis 48
Limitations and Delimitations 49
Limitations 49

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
Delimitations 49
Credibility and Trustworthiness 50
Ethics 51
Chapter Four: RESULTS 53
ATP Course Case Study 54
Measures 54
Participants 59
Findings 62
Sub Question A: Customizing Education 62
Course objectives and assigned reading. 63
Planned classroom activities. 66
Faculty educational identity and teaching philosophy. 69
Sub Question B: How Do ATP Students Learn Cultural Competence? 71
Sub Question C: How Does This Process Align with CRP? 77
Tenet A: Academic success. 77
Tenet B: Cultural competence development and maintenance. 80
Tenet C: Developing a critical consciousness to challenge the status quo. 83
Sub Questions D: How Does This Process Support Communal Utility Value? 84
Principle 1: Goal setting. 84
Principle 2: Connecting educational experience to the students’ lives. 86
Principle 3: The feeling of helping others. 88
Closing 90
Chapter Five: DISCUSSION 91
Summary of Findings 92
Curriculum Customization 93
Cultural Competence Education in the AT Program 93
Alignment with CRP 94
Communal Utility Value 95
Recommendations for Practice 95
Implications 98
Implications for AT Programs 98
Implications for Research 99
Conclusion 100
References 101
Appendix A: Interview Protocol 110
Appendix B: Problem-Posing Open-Dialogue Questions 118

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
List of Tables

Table 1: Data Collection by Measure Page 58
Table 2: Participant Descriptions Page 61

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
List of Figures
Figure 1: Small actions influencing a larger system (Brown, 2017) Page 23
Figure 2: Activity system one Page 31
Figure 3: Conceptual framework Page 37

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
Abstract
This study applies the theoretical framework of critical race theory (CRT) through the
pedagogical lens of culturally responsive pedagogy (CRP) and communal utility value to
understand how cultural education is implemented in an athletic training program (ATP) course.
The purpose of this problem-posing case study is to understand how current instructional
practices in an ATP course align with CRP and communal utility value. The study was
conducted through the duration of the Fall 2018 semester and focused on document analysis,
open-dialogue, observations, and interviews with one faculty member and four students from
their classroom. CRT was used to analyze the data through a priori codes based on four themes
guided by the research questions. The findings demonstrated that race and culture are included in
the program’s instruction on the surface; to deepen these notions, however, faculty need to invest
in cultural humility and enact the tenets of CRP and communal utility value. Further, the findings
highlighted the educational strategies involved in teaching toward culturally responsive
education and how these strategies enhance students’ experience in delivering diverse patient-
centered care.

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
CHAPTER ONE
Introduction
This study explores how cultural competence, as defined by the National Athletic
Training Association (NATA) educational competencies, is embedded into athletic training
curriculum, how it aligns with culturally responsive pedagogy (CRP) as well as communal utility
value and how it is experienced by athletic training students (NATA, 2011). Many researchers
have shown the positive effects of CRP when implemented in science, technology, engineering,
and mathematics (STEM) classrooms with an increase in student motivation and the
representation for underserved communities (Daniel, 2016; Gay, 2002; Ladson-Billings, 2014;
Larke, 2013; Siwatu, 2007; Warren, 2018). The aim of a problem-posing case study approach is
to understand how a faculty member plans to meet NATA cultural competence competencies
through instruction, how the instruction represents CRP and communal utility value, and how
this translates to students’ understanding of cultural practice (Smith-Maddox & Solorzano,
2002). With the general population becoming more diverse, athletic training students need
preparation to work with diverse patients (Grantham, 2015; Nynas, 2015; Volberding, 2013).
Although many athletic training students are being exposed to culturally diverse populations
through experiential clinical education, CRP and communal utility value may not be modeled
clinically by preceptors, therefore it's even more important to provide the foundation of cultural
education academically (Larke, 2013; Marra et al., 2010).
Background of the Problem
The athletic training profession is highly regarded in providing health care in athletics,
the clinical setting, military, performance arts and industrial settings, which display a wide array
of cultural diversity (Mazerolle & Eason, 2016; NATA, 2018). Athletic training "encompasses

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
the prevention, examination, diagnosis, treatment and rehabilitation of emergent, acute or
chronic injuries and medical conditions, and is recognized by the American Medical Association
(AMA), Health Resources Services Administration (HRSA) and the Department of Health and
Human Services (HHS) as an allied health care profession," (NATA, 2018, para. 1). Accredited
athletic training programs (ATPs) are competency based and are governed by the Commission
on Accreditation of Athletic Training Education (CAATE). The CAATE requires that
educational competencies are implemented in each professional AT program and serve as a
companion document during accreditation reviews (NATA, 2011). The NATA defines cultural
competence within athletic training as follows: “health care providers who understand how
gender, race, ethnicity, sexual orientation, religion and socioeconomic status influence (medical)
outcomes and can positively or negatively impact the patient’s experience” (para. 2). Based on
the diverse population that athletic trainers serve, the cultural competence aspect of patient-
centered care was adapted into the educational competencies by the NATA and CAATE in 2011
under the foundational knowledge component (NATA, 2011). It is vital to incorporate cultural
competency into ATP curricula based on the representational disparities within the athletic
training profession. According to research conducted by NATA, 80.9% of registered athletic
training members from all job settings identified as white, while 30–60% of student athletes,
professional athletes, and clinical patients are persons of color (Grantham, 2015; NATA, 2018;
NCAA, 2018). In Volberding’s (2013) study, 87% of the athletic training students sampled were
white and based on survey results lacked cultural competence, which hinders the delivery of
culturally appropriate healthcare in diverse patient populations. The lack of diverse
representation within the athletic training profession calls for an integration of culturally

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
responsive education to provide an academic basis for the practice of culturally diverse patient-
centered care.
Although athletic training students are exposed to patient populations through clinical
education, several studies within the profession of athletic training cite that ATP curricula should
include cultural competence education (Marra et al., 2010; Nynas, 2015). Throughout this study
clinical education refers to the requirement of working in the profession at assigned clinical sites
with preceptors who help mentor and guide the athletic training students through clinical, as well
as professional concepts (NATA, 2018). It is insufficient to immerse athletic training students
into practice during clinical education and expect them to gain cultural competence. Smith-
Maddox and Solorzano (2002) stated that immersion experiences without classroom education
pose the problem of practitioners’ inability to acknowledge race and/or cultural differences.
When race and cultural differences are not acknowledged, the perpetuation of misunderstanding
is fostered and decreases the likelihood of successful interactions (Ladson-Billings, 2009; Smith-
Maddox & Solorzano, 2002). ATP cultural competence instruction in combination with clinical
education experience can begin to foster culturally appropriate patient-centered care. The aim of
this study is to understand how instruction is delivered and translated into clinical work.
Statement of the Problem
Since 2010, there have been few studies that cover cultural competence within the
athletic training profession and each of these studies suggest further research be completed in the
area of including cultural competence practice into the educational element of AT programs
(Marra et al., 2010; Nynas, 2015; Volberding, 2017). While the profession of athletic training
lacks research in culturally responsive classroom education, there have been many researchers
who have provided evidence for success in STEM fields through culturally responsive pedagogy

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
(Jett, 2013). This study reviews existing literature within athletic training as well as literature
from kindergarten through 12th grade (K-12), higher education, and other medical fields, such as
nursing to close the cultural competence education gap and bring value to the classroom
component of athletic training.
This study covers three main topics that review educator identity, cultural humility, and
cultural-historical activity theory (CHAT) as the theory of learning. It is implicitly understood
that for faculty and certified athletic trainers, professional development will be completed and
internalized (NASPA, 2017). Although professional development on cultural competence is not
required, research shows that it has a positive impact on interactions with students as found in
higher education literature (Tisdell, 2006; Van Lankveld, Schoonenboom, Volman, Croiset &
Beishuizen, 2017). Faculty with strong cultural identities successfully interact with students and
within educator communities (Van Lankveld et al., 2017). Strong educator identity can then lead
to the understanding of instruction and presents the ability to teach toward all cultures (Larke,
2013). To teach toward cultural education it is recommended that faculty establish cultural
humility and adapt syllabi, readings, as well as assignments to represent the classroom and/or
patient-centered care demographics (Gunn et al., 2013; Jett, 2013; Larke, 2013). Further, athletic
trainers’ practice within communities, including neighborhoods, specific job settings, and/or
professional associations. CHAT adds a further dimension to this study by bringing focus to
understanding the situations of students’ experiences both academically and personally (Foot,
2014). Within the framework of CRT, CRP and communal utility value the literature review
topics were explored and implemented through a problem-posing case study methodology
(Brown, 2017; Foot, 2014; Smith-Maddox & Solorzano, 2002).

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
Purpose of the Study
The purpose of this study is to use a problem-posing case study methodology to
understand current instructional practices in one ATP course as they relate to cultural
competence, as well as how including CRP and communal utility value is reflected in students’
experiences. The theories that frame this study include CRT as the overarching theoretical
framework of the pedagogical framework of CRP and communal utility value. These theories
allow for the power relationships between students and faculty to be examined through cultural
education which helps to inform instruction (Ladson-Billings, 1992; Smith-Maddox &
Solorzano, 2002; Yosso 2005; Brown, Smith, Thoman & Allen, 2015). The theoretical
framework of this study informs how educator identity, cultural humility, and CHAT can be
utilized as assets in the ATP classroom. While CRP has been extensively studied in K-12 settings
within STEM classrooms it has been studied less in healthcare professions at the university level
and specifically lacks research in the athletic training profession. This study focuses on
understanding how CRP and communal utility value impact ATP student’s understanding of
culturally competent patient-centered care delivery.
While the CRT, CRP, and communal utility value theories allow for the methodological
set up and framework for data collection, the emergent strategy theory guides the study in the
form of integrity and ethics as the theory of change. The theory of change, when explicitly
implemented, provides an ethical stance that determines the content of the research from
beginning to end with the participants and their story in mind (Tuck, 2009). The theory of change
proposed in this study can impact the way that faculty engage in instruction and relationships
with their students as well as the researcher (Brown, 2017). Faculty are an integral part of

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
educational outcomes for students, and deeper relationships with their own identity as well as the
identities of each student can create increased positive outcomes (Brown, 2017).
This problem-posing case study leads with document analysis and open-dialogue
conversations with the participating faculty member before each class observation to examine
current curricula and instruction based on direct conversations. Observations of the classroom
follow, and interviews with students as well as faculty participant are conducted. This holistic
case study allows the exploration of instruction and its effects on clinical practice through
qualitative research. Through the problem-posing case study approach, the academic
achievement debt is addressed by guiding Faculty to identify the cultural wealth within the
classroom, address curricula from cultural perspectives, and understand the students’ preparation
process for culturally appropriate patient-centered care (Ladson-Billings, 2006; Yosso, 2005).
Research Questions
The approach in this problem-posing case study is to capture the ATP course experience
holistically. To accomplish this, an overarching research question is presented and supported by
four sub questions to represent the topics within the findings. The following research questions
guide this case study:
1. What strategies are being used in one athletic training education program to prepare
students to provide culturally appropriate patient-centered care?
a. How does one athletic training program faculty member customize education to
meet the needs of students who will work with underrepresented populations?
b. Through what process do athletic training students learn cultural competence in
the AT program?
c. How does this process align with CRP?

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
d. How does this process support communal utility value?
The data analysis for this study is guided by this research question and the sub questions
to understand how instruction and cultural competence are implemented in a specific AT
program course through document analysis, open-dialogue, interviews, and observations.
Significance of the Study
The aim of this study is to add value to athletic training education under the foundational
section of cultural competence (NATA, 2011). Currently, the way AT programs present cultural
competence varies by program; it is also presented through continuing education and implicitly
through experiential education in the form of clinical education. By participating in this problem-
posing case study, the researcher and ATP faculty engaged in a dialogue about the state of the
current AT program and what can be enhanced within the curriculum, as well as instruction to
represent cultural competence (Smith-Maddox & Solorzano, 2002). Athletic training graduates
work in many job settings and provide patient-centered care to individuals with unique
backgrounds; therefore, it is important to ensure that ATP curricula reflect diverse patient-
centered care skills.
This study is significant because it takes the qualitative case study approach where
previous cultural competence studies within athletic training were quantitative, to gain a deeper
understanding of the ATP experience as it relates to cultural education (Merriam & Tisdell,
2016). Past quantitative research in athletic training has been survey based, while this study
examines the meaningful interactions that are fostered through education and clinical experience.
Three of four previously published NATA studies that focus on cultural competence call for the
educational component to incorporate cultural education (Marra et al., 2010; Nynas, 2015;
Volberding, 2013). This study aims to bring solutions through instruction and the students’

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
cultural experience to help prepare program participants for diverse patient-centered care (Yosso,
2005).
Organization of the Study
This study is presented in five chapters with the first chapter giving an overview and the
recent state of the athletic training educational program. Chapter two breaks down the framework
that is utilized to inform and guide the study and continues by covering the topics of educator
identity, cultural humility, and CHAT. The topics discussed in Chapter Two provide an outline
of the limitations in cultural competence research within the profession of athletic training and
methods that can enhance the preparation of athletic training graduates for diverse patient-
centered care delivery. Next, Chapter Three discusses the problem-posing case study
methodology that is used for data collection and analysis through document analysis, open
dialogue, observations, and interviews. Lastly, Chapter Four analyzes the data collection as it
relates to the research questions, and Chapter Five draws on the results and conclusions that add
value to the cultural education component of the athletic training profession.
CHAPTER TWO
Introduction to the Literature Review
The purpose of this literature review is to utilize the framework of CRT through the
pedagogical framework of CRP and communal utility value to understand the current state of the
AT program’s cultural competence curriculum and instruction. The fifth edition of the Athletic
training education competencies includes cultural competence within the section entitled
“Foundation behaviors of professional practice”; however, Marra et al. (2010) reported that
certified athletic trainers score less on cultural competence assessments based on scenario
questions than the self-reported survey type (NATA, 2011). Currently, there is limited empirical

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
research considering cultural competence, the educational structure, and how it translates to the
delivery of patient-centered care (Marra et al., 2010; Nynas, 2015). This review is completed by
specifically focusing on one athletic training program, which is an allied healthcare degree and in
the process of transitioning from a bachelor’s degree requirement to a master’s degree (NATA,
2018). The topics that are discussed in this review include faculty identity, cultural humility, and
CHAT, as they relate to athletic training program faculty, as well as the students they teach.
Ladson-Billings (2006) discussed how the achievement debt for underrepresented
students has increased over the years based on policies that have been established within the
educational system. Based on the historical achievement debt that is amplified within the STEM
field, the focus of this study relies on understanding the inclusion of culturally responsive
pedagogy and how students experience cultural education through the problem-posing case study
methodology (Ladson-Billings, 2009; NCES, 2017; Smith-Maddox & Solorzano, 2002). The
topics discussed in this literature review explain the current state of the athletic training
profession and how existing research in STEM as well as K-12 fields can be implemented to
enhance cultural competency education in AT programs. The goal of this study is to understand
how the faculty member currently tackles cultural competence through self-reflection, instruction
as it aligns with CRP, and communal utility value and how students experience cultural
education.
Theoretical Framework
Historical Framing
The achievement debt has increased over the years for underrepresented students, such as
students of color and immigrant students, compared to white students (Ladson-Billings, 2006).
The STEM field represents a higher achievement debt disparity than other higher education

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
fields for students of color (NCES, 2017). Ladson-Billings (2006) stated that the “historical,
economic, sociopolitical, moral decisions and policies that characterize our society” have
affected and created the achievement debt that we see today (p. 5). By that definition, it can be
understood that the STEM field has not been “created equally” for all races, nationalities, and
genders. The brilliance in STEM for underrepresented students has not been sustained in society
throughout the years, yet it needs to be, to start seeing a change in the demographics of
professionals within the career (Jett, 2013). When specifically discussing the profession of
athletic training, the same numbers are brought to light. The representation of certified athletic
trainers as reported by the NATA (2018) does not correlate with the cultural background of the
patients for whom they provide care (Grantham, 2015; Marra et al., 2010; Nynas, 2015).
The low numbers of underrepresented students graduating from STEM fields is in turn
fueling the continuation of the wealth debt. The profession of athletic training is making changes
to the educational structure by increasing the bachelor’s degree requirement to a master’s degree
requirement, which in theory will decrease the wage disparities for those who persist through the
professional education structure (NATA, 2018). Ladson-Billings (2006) reported that
underrepresented populations, especially African-American populations in the United States,
have sustained a huge blow to their wealth through the socio political and economic policies
created. In the case of AT programs, underrepresented students do not attempt to pursue and/or
do not persist in STEM fields because they were made to believe they could not (Levy, Heissel,
Richeson, & Adam, 2016). The students of color who do graduate from STEM fields suffer from
wage and wealth debt based on student loans, as well as wage disparities in their chosen STEM
careers (Ladson-Billings, 2006; Levy, Heissel, Richeson, & Adam, 2016).

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
Athletic training was recognized by the American Medical Association (AMA) as a
healthcare profession in 1990, which is very recent compared to the start of medical studies at
the university level in the 1220s (NATA, 2018; Vecchio, Tornali, Rampello, Migliore, Rigo, &
Armocida, 2013). Licensure, wages, and work hours have always been a great debate within the
athletic training community and contribute to the wealth debt in the United States (Ladson-
Billings, 2006; NATA, 2018). Due to the structure of athletic training education and licensure,
underrepresented students have fewer resources to complete clinical education and to navigate
through the nuances of ATP requirements (NATA, 2018; NCES, 2017). The curriculum within
AT programs also reflects a disparity in representation through utilizing textbooks that have been
written by mostly white males, which acts as a gatekeeper for students of color and how they
relate to the profession. Although athletic trainers work with diverse populations in athletics as
well as in clinic settings, the sports medicine community has continued to have significant
disparity in diverse representation professionally (Grantham, 2015; Marra et al., 2010). The
disparities in representation, achievement, and wealth debts are not easily dismantled; however,
according to Ladson-Billings (2006), change can be made by building relationships. CRT frames
the theoretical content of this study through the pedagogical framework of CRP and communal
utility value, with emergent strategy as the theory of change that binds the faculty member and
student relationships (Brown, 2017; Foot, 2014; Smith-Maddox & Solorzano, 2002).
CRT, CRP, Communal Utility Value, and Emergent Strategy
The theories that frame this study view current practice of academia as an accumulation
of historical racism and discrimination that needs to be disrupted through curricula and
instruction. CRT, CRP, and communal utility value frame this study because as a unit, these
theories help explore relationships, race, as well as the methods for creating change (Smith-

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
Maddox & Solorzano, 2002; Ladson-Billings, 1992; Brown, Smith, Thoman, & Allen, 2015).
CRT is utilized to reflect how race and culture are addressed in an ATP classroom through the
pedagogical framework of CRP and communal utility value (Smith-Maddox & Solorzano, 2002).
In this study, CRT and specifically problem-posing with a case study methodology is utilized to
understand the experience of students in the participating AT program and how cultural
competence is embedded in the education (Smith-Maddox & Solorzano, 2002). ATP education is
understood through the pedagogical lens of CRP and communal utility value, which provide the
educational goals for cultural competence (Brown, Smith, Thoman & Allen, 2015; Ladson-
Billings, 1992). Emergent strategy is then used as the theory of change to encourage incremental
changes that lead to monumental outcomes (Brown, 2017). The concepts between CRT, CRP,
communal utility value, and emergent strategy as the theory of change work hand in hand to
understand the collaborative actions that are associated with changing the status quo in higher
education (Brown, Smith, Thoman & Allen, 2015; Brown, 2017; Ladson-Billings, 1992; Smith-
Maddox & Solorzano, 2002). These theories guide the problem-posing case study approach used
in this study to understand the practice of culturally competent education within the AT program
at a coastal state university.
CRT. The founder of CRT, Derrick Bell, discussed the contradictions built into the law;
similarly, in education, these contradictions exist in the systemic approach higher education
institutions implement when discussing equity (Bell, 1976; Noblit, Hughes, & Cleveland, 2013).
In this study, the CRT lens focuses on higher education and utilizes the work of Smith-Maddox
and Solorzano (2002) to understand problem-posing case study methodology and Dr. Yosso’s
(2005) work on community cultural wealth. Through the seminal work of Dr. Bell, CRT can be
utilized in higher education to understand how academic institutions systematize students of

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
color and the curriculum that is provided (Smith-Maddox & Solorzano, 2002). The five tenets of
CRT through the higher education lens and community cultural wealth frame this study (Smith-
Maddox, 2002; Yosso, 2005). The five tenets of CRT, as discussed by Smith-Maddox and
Solorzano (2002), include the following:
1. Foreground race and racism in the curriculum.
2. Challenge the traditional paradigms, methods, texts, and separate discourse on race,
gender, and class by showing how these social constructs intersect to affect communities
of color.
3. Help us focus on the racialized and gendered experiences of communities of color.
4. Offer a liberatory and transformative method when examining racial, gender, and class
discrimination.
5. Use the transdisciplinary knowledge and methodological base of ethnic studies, women’s
studies, sociology, history, and the law to better understand the various forms of
discrimination.
In higher education, CRT is used to understand and transform structural and cultural
pieces of education that consist of racial power positions in and out of the classroom (Smith-
Maddox & Solorzano, 2002). Based on work by Solorzano and Yosso (2001), the basic five
elements of CRT in education are (a) the centrality of race and racism and their intersectionality
with other forms of subordination; (b) the challenge to dominant ideology; (c) the commitment to
social justice; (d) the centrality of experiential knowledge; (e) a transdisciplinary perspective
(Smith-Maddox & Solorzano, 2002). For the purpose of this case study, race and racism,
experiential knowledge, and the transdisciplinary perspective are discussed with the faculty
member during problem-posing work to establish a commitment to social justice (Smith-Maddox

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
& Solorzano, 2002). Because the athletic training profession delivers patient-centered care to
diverse populations, it is imperative to not only bring race and culture discussions to the
forefront, but also to discuss how the enrolled students bring community cultural wealth to the
classroom (Yosso, 2005).
When discussing cultural competence education in the health care profession, it is
important to note that the classroom itself is comprised of cultural wealth (Yosso, 2005).
According to Yosso (2005), cultural wealth consists of cultural, aspirational, familial, social,
navigational, resistant and linguistic capital. In the athletic training course, the composition of
the students can be used to study racial and cultural uniqueness to put cultural wealth to the
forefront. Utilizing the strengths of cultural wealth that exist within the diverse classroom will
encourage the commitment of purpose toward culturally competent patient-centered care (Yosso,
2005). By acknowledging each individual in the classroom as well as the assets that they bring to
this academic endeavor, the complex systems of institutions can start to understand student
voices and implement them into the curriculum (Brown, 2017; Yosso, 2005).
CRP. As part of the pedagogical framework under the umbrella of CRT, CRP focuses on
bringing race and culture to the forefront of education through cultural competence strategies.
CRP fosters teachers and faculty who are able to relate the course lessons to the cultural
backgrounds of their students (Jett, 2013; Ladson-Billings, 2009). This pedagogy focuses on
research of culturally inclusive pedagogy and how it has enhanced educational outcomes in
underrepresented students, especially those pursuing an education in STEM. CRP research helps
connect best practices to what is currently being implemented by faculty in AT programs. It is
evident that most of the research conducted previously is focused on the K-12 and STEM
settings. Although the process of incorporating CRP into curricula and instruction has been

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
shown to be effective in STEM education, based on athletic training literature it has not been
included in AT programs as it related to the educational competencies (Jett, 2013; NATA, 2011).
The key tenets of CRP as described by Ladson-Billings (1992) are: (a) students must experience
academic success; (b) students must develop and/or maintain cultural competence; (c) students
must develop a critical consciousness through which they challenge the status quo of the current
social order. These CRP tenets are used to understand the current status of the participating ATP
to assert how they align with the communal utility value process.
Communal utility value. The combination of CRP, as well as education toward
communal utility value to engage students in diverse patient-centered care ethics enhances the
education and retention of skilled healthcare providers (Brown et al., 2015; Garneau & Peppin,
2015; Harackiewicz et al., 2016; Smith et al., 2015). Through this pedagogical framework, the
students’ motivation is examined based on their experience with cultural education in the ATP
classroom. Motivation is often the deciding factor in educational and career choices. Adding
utility value to the educational system increases the success students experience in the classroom,
especially within the STEM field (Harackiewicz et al., 2016). Key principles of communal utility
value include: (a) the setting of short-term and long-term goals; (b) connecting educational
material to their own lives; (c) the feeling of helping others (Brown, Smith, Thoman, & Allen,
2015). Based on work by Brown, Smith, Thoman, Allen, & Muragishi (2015), increasing the
communal utility value in classroom education increased students’ motivation to pursue and
complete studies in a STEM field.
According to expectancy value a motivational utility value theory, career and educational
choices are based on how well a student believes they will do in the classroom and/or the career,
as well as the value of the career itself (Brown et al., 2015; Smith, Brown, Thoman, & Deemer,

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
2015). In the profession of athletic training, communal utility value refers to value in work with
others in the patient-centered care setting (Brown et al., 2015; Smith et al., 2015). Building
communal utility value that is patient care centered and that allows bonds to be formed cross-
culturally will have a positive impact on how ATP students approach diverse patient populations
(Brown et al., 2015; Smith et al., 2015). With CRT as the theoretical framework, the pedagogical
framework of CRP and communal utility value foster the understanding of educational strategies
used to teach toward cultural competence. The theory of change directs the theoretical and
pedagogical frameworks to emphasize the intentional practice of each strategy.
Emergent strategy: Theory of change. The CRT, CRP, and communal utility value
theories frame this study to guide the understanding of relationships as well as instructional
methods within the AT program. Emergent strategy is utilized to influence the theory of change.
The strategy works with small actions and connections to build complex systems (Brown, 2017).
Within this study, emergent strategy is used to connect with the ATP faculty at a coastal state
university, discuss their interactions with students, and understand how their instruction can
impact the patient-centered care provided by their students in the clinical education phase and in
their careers. Through the faculty problem-posing process, the focus on instruction capitalizes on
the intention of creating a deep and meaningful cultural awareness by enacting a flexible class
agenda and providing a safe space for the class to speak and listen (Brown, 2017). The goal of
this process is for the ATP faculty to be a part of the process within the “radical transformation,”
which ensures the honest implementation of small action changes within the classroom (Brown,
2017).

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM

Figure 1. Small actions influencing a larger system (Brown, 2017).
This model describes interconnectedness, collective sustainability, small-scale solutions,
process and outcome, collective leadership, and resilience through the connected images (Brown,
2017). Through emergent strategy dimensions, small actions result in both the academic system
and student system to start experiencing change based on the connections built through an open
communication fostered within the classroom (Brown, 2017; Smith-Maddox & Solorzano,
2002). Through the emergent strategy as the theory of change, the complex systems that exist in
the personal environment of students and the academic environment of faculty can begin to
interconnect and evolve (Brown, 2017).
Connecting CRT, CRP, communal utility value, and emergent strategy. The
theoretical framework of CRT, CRP, and communal utility value are used to understand how

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bringing culture to the forefront impacts student experiences (Smith-Maddox & Solorzano,
2002). Relationships have to be built between the faculty and students to successfully evaluate
and enhance how education influences the delivery of excellent patient-centered care to diverse
populations. These relationships can be built through small interactions and meaningful
connections based on the emergent strategy theory of change, utilizing trust, listening, and action
strategies (Brown, 2017). In the context of this study CRT, CRP, and communal utility value
work together to express the synergy between instruction and experience by creating an
understanding of identity, race, as well as curriculum structures that represent sensitivity to
cultural diversity (Brown, Smith, Thoman & Allen, 2015; Ladson-Billings, 1992; Smith-Maddox
& Solorzano, 2002; Yosso, 2005). An understanding of the pedagogical strategies can be honed
by reviewing the cultural aspects of identity, curriculum, and instruction as discussed through the
literature review topics.
Literature Review
This literature review focuses on faculty cultural and educator identity, cultural humility,
and CHAT as the learning theory. It is framed by CRT, CRP, and communal utility value to
understand how culturally responsive curriculum as well as instruction is experienced within the
AT program structure. By reviewing the cultural identity of faculty, the process of relating to
students and their teaching philosophy becomes evident (Gunn et al., 2013). Further, in the
cultural humility topic, the idea of white faculty teaching diverse classes through an inquisitive
and open lens is discussed (Isaacson, 2014). Next, CHAT as the learning theory fosters an
understanding of the relationship between faculty, students, and the educational structure (Foot,
2014). Current research focused on the athletic training profession shows that there is a lack of
studies discussing how the educational component includes cultural competence within the

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
coursework (Marra et al., 2010; Nynas, 2015). While the research within the athletic training
profession ranges from clinical assessments to classroom learning, it lacks empirical studies into
cultural competence within AT programs. The compilation of literature that is discussed consists
of work from K-12, higher education, STEM research, and medical field research, such as
nursing, and explores the best ways to engage in racial and cultural discourse within the
classroom.
This study is important to conduct because of the disparity in representation within the
athletic training profession. According to the 2017 NATA membership statistics 1,218 of 8,885
members (13%) working in the higher education setting consist of people of color (NATA,
2017). Although the NCAA is only one segment of intercollegiate athletics and the profession in
general, 41% of intercollegiate athletes across all divisions and sports are students of color
(NCAA, 2018). Through these statistics, it is evident that the disparity of representation between
the medical staff that serves student athletes and the student athlete population is extensive. It is
imperative now more than ever to ensure that the athletic training education system not only
invests in students of color but also produces student who understand cultural humility (Isaacson,
2015; Jett, 2013; Marra et al., 2010). This literature review informs AT program successes,
limitations and where further research is needed to enhance athletic training education.
Educator Cultural Identity
The disparity in representation between certified athletic trainers and the patient
population leads to the discussion of educator identity and the impact on classroom instruction.
Through the studies of Ladson-Billings (2014), it is understood that cultural relevance in
curricula allows for the reclaiming and restoration of cultural identity within the educational
system. In this section, the effects of cultural identity on faculty pedagogy and how professional

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
development is utilized to build identity are reviewed. Each higher education institution and
healthcare profession is independent in requiring professional development when it comes to
cultural training for their faculty and staff (NASPA, 2018). Often faculty are sent to conferences
in the hopes that they will attend the cultural training that is being offered (NASPA, 2018). In the
attempt to ensure that students are receiving a culturally responsive education in the AT
program, it is important to assert the professional identity of faculty and the professional
development received to enhance the teaching methods. Currently, the representation of athletic
training educators is over 80% white, which exasperates the achievement debt for students of
color within higher education AT programs and enhances the need to provide cultural training to
faculty (Ladson-Billings, 2009; NATA, 2017).
Faculty identity is strengthened through student interactions, a strong teaching
community, and professional development activities (Tisdell, 2006; Van Lankveld,
Schoonenboom, Volman, Croiset & Beishuizen, 2017). Van Lankveld et al.’s (2017) literature
review indicated that student interactions help faculty form their identity through student
feedback and recognition, which evoked job satisfaction. Although most studies in Van
Lankveld’s (2017) work showed identity growth with student interactions, there were also
several studies showing tensions when faculty faced student cultural differences and lack of
passion for the same subject. University faculty who have strong educator identities are more
interested in professional development and lifelong learning, which is sustained by a
collaborative colleague network (Abu-Alruz & Khasawneh, 2013; Tisdell, 2006; Van Lankveld
et al., 2017). It is imperative for ATP faculty to foster an educator identity that expresses passion
for the profession of athletic training, student interactions, and cultural sensitivity (Abu-Alruz &
Khasawneh, 2013; Richards & Ressler, 2017; Tisdell, 2006; Van Lankveld et al., 2017).

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
Cultural Humility
Part of building a strong educator identity is honing one’s own cultural humility.
Educators should understand the importance of building the ethic of cultural humility through
which they practice attentive listening and openness to diverse cultures (Foronda, Baptiste,
Reinholdt, & Ousman, 2016; Isaacson, 2014). It is important to note that with the majority of
ATP faculty identifying as white, cultural humility serves as the catalyst to provide cultural
competence education (NATA, 2018). Athletic training faculty and health care professionals
should strive towards cultural humility as opposed to cultural competence to ensure that the
process of cultural growth is continuous (Foronda et al., 2016). Foronda et al. (2016) described
cultural humility as a specific perspective through which individuals do not lean on learning
about specific cultures as the goal, but to strive to continuously engage in cultural learning that
understands power imbalances. According to work by Isaacson (2014) and Foronda et al. (2016),
activities that are recommended to exercise cultural humility include self-reflection and self-
critique in interactions with individuals from different backgrounds. The definition that Foronda
et al. (2016) came up in their work of understanding cultural humility states that through power
imbalances cultural humility is “a process of openness, self-awareness, being egoless, and
incorporating self-reflection and critique after interacting with diverse individuals” (p. 213).
Foronda et al. (2016) described the process of establishing cultural humility as creating a
space for lifelong learning that sustains mutual empowerment between faculty members and their
students in AT programs. Secondly, respect is a building block through the learning process that
solidifies trust. Next, a partnership is built between faculty and students that shifts the power
relationships. Lastly, ATP faculty with cultural humility have an optimal effect on instruction
and curriculum. Due to the systemic power imbalances in the field of higher education, white

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
faculty members are charged with constructing their cultural humility to ensure a true openness
towards diverse student interactions (Foronda et al., 2016). Faculty who can share their own
experience of navigating through cultural competence will have a better influence on their
students experience and how they approach patient-centered care (Grantham, 2015; Henderson,
Horne, Hills, & Kendall, 2018; Isaacson, 2014).
Fostering culturally aware athletic trainers. The understanding and implementation of
cultural humility for ATP faculty will increase their commitment toward cultural competence
education. Currently, the NATA promotes diversity and has special interest groups for members
who are interested in making an impact in promoting diversity in the athletic training profession.
The Ethnic Diversity Advisory Committee (EDAC) promotes the enrollment and retention of
ethnically diverse students and certified athletic trainers (NATA, 2018). The EDAC also
provides mentors, scholarships, and grants to ensure ethnic diversity in athletic training thrives
(NATA, 2017). Although there are no direct or required professional development opportunities
for ATP faculty, mentorship programs are available through the NATA, which are highly
promoted and encouraged by senior faculty (Bowman, 2016; Drake, 2014). Drake (2014) stated
that there is no formal leadership training for students or incoming leaders in the athletic training
profession. The research suggests that cultural professional development for ATP faculty is
obtained through conference sessions and opportunities provided by the institutions for whom
they work (Bowman, 2016; Drake, 2014). ATP educators who invest in cultural awareness
training will foster an educator identity that is culturally sound and therefore provide a well-
rounded approach to cultural competence education (Drake, 2014; Van Lankveld et al., 2017).
Cultural “competence.” By addressing the definition of cultural competence as it
relates to AT programs and is utilized within allied health care professions, the structure of CRP

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
and communal utility value in the classroom can be understood. Because the word competence in
itself suggests a met goal, cultural humility is a way to practice cultural competence education
(Foronda et al., 2016; Garneau & Pepin, 2015). According to Garneau and Pepin (2015), in the
healthcare field cultural competence is often seen as a response to popular culture as opposed to
a person’s living conditions and socioeconomic status. Garneau and Pepin (2015) offer a
constructivist definition of cultural competence:
A complex know-act grounded in critical reflection and action, which the health
care professional draws upon to provide culturally safe, congruent, and effective
care in partnership with individuals, families, and communities living health
experiences, and which takes into account the social and political dimensions of
care (p. 10).
It is important that cultural competence is seen as an evolving and ongoing process and not an
achieved goal (Garneau & Pepin, 2015; Grantham, 2015). Within the athletic training profession,
Grantham (2015) suggested that student athletic trainers and those new to the profession gain
practice through diversifying their employment and learning settings, as well as taking online
courses related to culture and athletic training. While gaining experience with real patients is
imperative, Henderson, Horne, Hills, and Kendall (2018) argued that it is critical to attain a
formal education in cultural and ethical knowledge to cultivate moral reasoning when treating
patients. The current disparity between provider representation and culturally diverse patients
creates the need for faculty to hone their identity and cultural humility to provide the best
resources for incoming ATP students (Grantham, 2015; Henderson et al., 2018).
The educational setting is the foreground of study and practice for healthcare in the
athletic training profession. Faculty identity, cultural humility and understanding of cultural

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
competence is important to increase the occurrence of culturally appropriate student interactions
and experience (Abu-Alruz & Khasawneh, 2013; Van Lankveld et al., 2017). Cultural and
educator identity is often built through experience, professional development, and a close
colleague network (Van Lankveld et al., 2017). Educators can foster cultural understanding in
their students through the constructivism definition and cultural humility by utilizing CHAT as a
theory of learning (Garneau & Pepin, 2015; Grantham, 2015; Jett, 2013).
CHAT
When faculty understand their identity as it relates to education and establish cultural
humility, they are able to provide instruction that is culturally sound (Isaacson, 2014; Tisdell,
2006; Van Lankveld et al., 2017). In this case study, Foot’s (2014) research of CHAT is used as
a theory of learning to depict the activity concepts of faculty and students in the higher education
setting, while utilizing the historical aspect of Vygotsky’s evolving theory, the addition of
culture by Griffin and Cole, as well as Engestrom’s CHAT model. The background of CHAT, as
discussed by Vygotsky (1978), is continuously evolving through collective learning actions.
CHAT provides the capability for faculty within “complex and professional practices” to
participate in reflective research (Foot, 2014; p. 330). Because CHAT centers around humans
acting collectively, humans using tools to learn and communicate, and community being central
to processing meaning, the model makes it possible to analyze the complexities of professional
work as it relates to curriculum in this study (Foot, 2014; Vygotsky, 1978). The CHAT theory is
then set in a way that allows the practitioner not only to focus on the direct components of a
situation, but to understand how the other components that are not readily seen influence the
situation (Foot, 2014). Based on this concept within the AT program, the faculty would
understand the students not only within the context of the academic demands and requirements,

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
such as clinical education, but also from the activities of personal and cultural living, such as
family and financial situations. CHAT calls on the historical relationships that form the lives of
the students within the AT program and how their backgrounds will reflect in their academic
endeavors (Foot, 2014). The contradictions that arise from these dual activities can foster
creative ways to implement solutions and build solid collaboration between students and faculty.
These solutions based on interconnecting activity systems will especially influence the cultural
understanding of underrepresented students within STEM fields, and AT programs in particular.

Figure 2. Activity system one (Engestrom, 1987).
Based on this model originally created by Engestrom (1987), two systems of subject,
tool, object, community of significant others, rules, and division of labor work together to build
the ultimate outcome. In this study, the first three activity dimensions for each system are as
follows: the subjects are students and a faculty member; the tools utilized are academic
curriculum and instruction; and the desired outcome is culturally competent delivery of patient-
centered care to diverse populations. The community of significant others for the student consists

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
of their family, neighborhood relations, friends, and other cultural affiliations; for the faculty it is
their academic family, significant others, and other cultural affiliations. Lastly, the students and
faculty member as well as their community affiliations are mediated by rules and division of
labor (Engestrom, 1990; Foot, 2014). Rules and division of labor help to establish how the
outcomes will be reached by both activity systems through the current educational system, what
work needs to be done to ensure cultural competence is represented in curriculum, by whom, and
what the roles such as power represent (Foot, 2014). The CHAT topic helps understand how the
theories of learning effect cultural education in the ATP course.
Teaching faculty to implement cultural education. Through CHAT as the learning
theory, the pedagogical framework of CRP and communal utility value make cultural education
strategies visible. Gunn et al. (2013) determined that when teachers are knowledgeable about
their own cultural identity as part of their community affiliations, they will become aware of the
other and different cultures within their classroom. As teachers become aware of the cultural
differences in their classrooms, they can provide contexts in which each culture is represented in
curricula and instruction (Gunn et al., 2013; Jett, 2013). In return, when the identity of a student
does not relate to the curricular content provided in the classroom, the student can feel as though
they are robbed of their identity. The common recommendation based on research is to add
culturally relevant content throughout the syllabus, assignments, and in instruction (Gunn et al.,
2013; Jett, 2013; Larke, 2013). In the Larke (2013) article, the author echoed Ladson-Billings’
(1992) work to state that culturally responsive teaching consists of three concepts: cultural
competence and understanding, critical consciousness, and academic success. Although the
majority of research is based on the K-12 setting, faculty in higher education STEM classrooms
who teach to cultural responsiveness, are critically conscious of student demographics, and teach

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
to the academic success of every student, which helps underrepresented students succeed in their
performance and transfer their acquired knowledge to patient-centered care (Ladson-Billings,
1992; Larke, 2013).
The impact of cultural education on students. From the CRP perspective, a
student is the most important entity in the equation of education, faculty, and curriculum (Jett,
2013). Underrepresented students thrive in an environment where their brilliance is affirmed and
their culture is something that is sustained and promoted (Jett, 2013; Paris, 2012). In the
California school system, as well as nationally, the purported “minority” student is surpassing
the diversity of teachers (Bustios & Siqueiros, 2018). In a recent report by Bustios and Siqueiros
(2018), the ratio of minority students in higher education is significantly disproportionate to that
of faculty and staff who identify as white. Because this ratio shows such great disparity in
representation, it is imperative that educators implement CRP and communal utility value into
their curricula, as well as instruction not only to meet the needs of culturally diverse students, but
also to increase success rates that foster future diverse educators and leaders (Bustios &
Siqueiros, 2018; Gunn et al., 2013; Jett, 2013; Larke, 2013).
When specifically discussing the STEM field, the representation of students of color is
lower than any other field of study in higher education (NCES, 2017). The National Athletic
Training Association (NATA) reported that 80.9% of registered members registered as white
(2015), which highlights a huge disparity in representation. Based on the statistics, it is even
more imperative to implement culturally responsive and relevant pedagogy within ATP courses.
Leonard, Brooks, Barnes-Johnson, and Berry (2010) discussed the importance of adding
culturally relevant content to the curriculum, for example, creating assignments that are
representative of community neighborhoods and populations. A mathematics study using CRP

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
resulted in student motivation and interest to pursue future careers within economical politics for
students of color (Leonard et al., 2010). Many theories exist in the realm of cultural activity
within classrooms; however, they are often minimized to an activity rather than embracing the
cultural pedagogy as a whole for curriculum creation and instruction (Ladson-Billings, 2014).
In a review, Ladson-Billings (2014) discussed the move forward from culturally relevant
pedagogy to culturally sustaining pedagogy, which reflects the globalization of higher education
classrooms and the multiplicity of identities and cultures (Paris, 2012). To pay back the debt
incurred through current academic systems, educators have to be willing to embrace teaching
culturally relevant material, create communities that enhance the education of underrepresented
students, and through a critical lens exam the continuous cultural evolution that is taking place in
education (Ladson-Billings, 2014; Larke, 2013; Jackson, 2013). While the goal of embedding
cultural experience into academics is to begin to close the achievement debt for underrepresented
student populations, students from all cultural backgrounds will benefit from cultural education
to enhance diverse patient-centered care in clinical athletic training settings.
Community in Athletic Training Programs. Athletic training as a profession holds
high regards for cultural awareness and promotes diversity; based on research through CAATE
and NATA, cultural competence is part of the educational competencies. However, there is no
research showing how it is implemented in the classroom (Marra et al., 2010; Nynas, 2015). One
example of the lack of cultural competence being displayed in AT programs is that the
demographics of AT programs do not include desegregated student data (NATA, 2018). The
profession of athletic training is currently going through educational changes while moving into
a master’s degree requirement (NATA, 2018). This educational change will increase the
opportunity to add communal utility value to class descriptions both formally and in the

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
admissions process. Brown et al. (2015) stated that adding communal text about helping others in
degree descriptions increased the interest and motivation for students to pursue a career in the
biomedical field. Furthermore, communal utility value is rooted in the patient-centered care
aspect of athletic training and is the motivating factor for recruitment into AT programs.
Patient-Centered Care Focus. By promoting communal utility value through classroom
and clinical education, athletic training students can gain motivation to persist in the athletic
training career and provide excellent patient-centered care (Brown et al., 2015; Smith et al.,
2015). Once athletic trainers complete their education, they become nationally certified and/or
licensed based on their geographical location (NATA, 2018). Athletic trainers work in a range of
settings from clinical offices to athletics within high school, colleges, and professional sports.
The patients that they serve represent 30–60% of racially diverse populations, and it is
imperative that athletic training students receive an education that promotes cultural awareness
(Grantham, 2015; Nynas, 2015; Volberding, 2013). To provide appropriate patient-centered care
to a diverse population, healthcare providers have to be aware of their cultural identities and
promote ethical care (Darnell & Hickson, 2015; Garneau & Pepin, 2015). Several studies have
been conducted on the cultural competence of certified athletic trainers and athletic training
students, showing that although they understand cultural differences, it does not transfer to
patient-centered care (Harriell, 2018; Marra et al., 2010; Volberding, 2015). Based on research
by Brown et al. (2015), adding communal utility value to athletic training education will help
students connect with the notion of working and helping others, which correlates with increased
success in patient-centered care of culturally diverse patients (Darnell & Hickson, 2015).
It is evident that communal utility value is linked to increased motivation for student
pursuing STEM fields (Brown et al., 2015; Smith et al., 2015). This is an important aspect of

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
diversifying the STEM field to increase the diverse representation of provider-to-patient ratio.
Researchers within the nursing and athletic training professions confirm that strong educational
practices that include cultural projects and experiential education within the community produce
students who are culturally aware (Darnell & Hickson, 2015; Garneau & Pepin, 2015; Marra et
al., 2010; Volberding, 2015). STEM programs that incorporate CRP, communal utility value, and
promote the brilliance of each student from all cultural backgrounds, specifically
underrepresented populations produce students who experience success as well as persistence in
their chosen career field.
This problem-posing case study takes place within an ATP classroom and has two types
of participants that include the faculty member as the primary subject and four students from
their classroom. The CHAT activity model concentrates on the faculty member and student
interactions while reviewing the course tools, including the syllabi, course readings, and
assignments (Foot, 2014; Ladson-Billings, 1992). Following the related tools, the rules of the
activity systems are bound within the higher education structure of assignments, tests, and grades
(Foot, 2014). The process of utilizing the curricular tools stems from the experience of each
subject and is often based on their historical experience with cultural education (Foot, 2014;
Larke, 2013). The dimensions within the two activity systems work together by forming
relationships, emphasizing each interaction and purposeful intentions of bringing race, culture,
and community to the forefront through CRT (Brown, Smith, Thoman & Allen, 2015; Foot,
2014; Ladson-Billings, 1992; Smith-Maddox & Solorzano, 2002).

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
Conceptual Framework

Figure 3. Conceptual framework visual.
This figure illustrates that CRT as the theoretical framework is an umbrella encasing the
pedagogical framework of CRP and communal utility value (Brown, Smith, Thoman, & Allen,
2015; Ladson-Billings, 1992; Smith-Maddox & Solorzano, 2002). This conceptual framework
represents how CRT interacts with the pedagogical strategies of CRP and communal utility value
to understand how culture is experienced in the ATP classroom. Emergent strategy is the
overarching theory of change ensuring that the researched and enacted actions build to increase

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
the scope of cultural competence practice within athletic training education (Brown, 2017). The
small interactions that compound over time between the ATP faculty and student complex
systems build radical change and redefine power (Brown, 2017; Smith-Maddox & Solorzano,
2002). Through emergent strategy actions, the theory of change can be implemented in the
context of this study by enacting intentional practices. These intentional practices are
implemented through research on identity, cultural humility, and CHAT as they affect cultural
learning strategies in the AT program. CRT, CRP, and communal utility value work in
congruence to solidify the relationship between curricula and student experience to build ATP
graduates who provide culturally competent patient-centered care.
Summary
Through the theoretical lens of CRT and the pedagogical framework of CRP as well as
communal utility value, it is evident that the students and faculty require interactions that lead to
success and cultural understanding in the STEM field (Brown, 2017; Foot, 2015; Isaacson, 2015;
Smith-Maddox & Solorzano, 2002). By engaging in small interactions that include relationship
building, curriculum and instruction that teach toward cultural responsiveness, community, as
well as cultural humility, the achievement debt in STEM programs for underrepresented students
can begin to decrease (Ladson-Billings, 2006). The literature review in this study is informed by
CRT, CRP, and communal utility value theories, which enhance the understanding of how
faculty identity and curricular preparation reflects the end result of excellent patient-centered
care for diverse populations through STEM education, specifically in ATP.
The literature review topics of faculty identity, cultural humility, and CHAT help to
understand the current state of athletic training education. These three topics work in synergy to
foster an understanding for the underrepresented student populations in STEM, as well as to

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
increase cultural awareness for white faculty and students who serve diverse patient populations.
Research shows that faculty who have formed a cultural and educator identity have higher levels
of job satisfaction and therefore can relate to diverse student populations to provide an effective
educational experience (Abu-Alruz & Khasawneh, 2013; Tisdell, 2006; Van Lankveld et al.,
2017). Second, through cultural humility the white faculty can improve students’ experience by
reflecting the cultural makeup of the student and patient populations through their personal
journey, as well as provide experiential experiences that prepare the students to work with
populations of color (Isaacson, 2015; Ladson-Billings, 2014; Larke, 2013; Jett, 2015; Jackson,
2013). Lastly, by enacting CHAT as the theory of learning, curricula can be understood as the
activity interaction between faculty and students (Brown et al., 2015). The review of identity,
cultural humility, and CHAT highlight where additional research needs to be conducted and what
literature studies can enhance the data collection of this study.
Cultural awareness through professional development is an insufficient process to create
competence in faculty and students (Darnell & Hickson, 2015; Garneau & Pepin, 2015; Marra et
al., 2010; Volberding, 2015). Formal education that includes culturally and ethically relevant
content, which evolves with generational changes as well as political and economic nuances will
further the success of students who pursue STEM education and provide patient-centered care to
culturally diverse populations (Garneau & Pepin, 2015). The collection of small actions that are
created through identity formation, sustainable culturally inclusive education, cultural humility,
and adding the value of helping others through community utility value will build concrete
relationships between students and faculty, which will impact the complex systems of academics
and the delivery of patient-centered care.

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
CHAPTER THREE
Methodology
The purpose of this study is to examine current instruction in one AT program classroom
and how it aligns with key practices that support equity through CRP, and communal utility
value. Using CRT as the theoretical framework, the current status of cultural competence
education has been investigated to understand how race and culture are implemented in
instruction (Smith-Maddox & Solorzano, 2002; Yosso, 2005). The research was conducted with
the principle’s CRT, CRP, and communal utility value utilizing problem-posing case study
methodology (Smith-Maddox & Solorzano, 2002). Using the problem-posing case study
approach discussed in Smith-Maddox and Solorzano’s (2002) work allowed the researcher to
understand the faculty's instructional methods, willingness to incorporate CRP and to understand
the students’ perception of the instruction as it relates to cultural competence (Foot, 2014;
Grantham, 2015). This methodology allowed for a holistic investigation, which ranged from the
educational structure of the classroom to the students’ understanding of diverse patient-centered
care. By building a relationship with an AT program faculty participant to unfold the journey of
culturally responsive education, the researcher unfolded the large complex system of the
institution to understand student experiences (Brown, 2017).
Qualitative methods were used for this study to understand the depth and breadth of the
relationship between faculty member, student, instruction, and patient-centered care delivery
(Merriam & Tisdell, 2016). The discourse between the faculty and researcher helped shape the
culturally responsive instruction for the Fall 2018 semester in the form of document analysis,
open dialogue, interviews, and observations. The student participation in this case study included
interviews and observations to understand how students learn cultural competence in the

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classroom and the strategies they utilize in the delivery of diverse patient-centered care. Merriam
and Tisdell (2016) described qualitative research as an ongoing knowledge construct based on
meaning making. Based on this notion, the problem-posing case study approach captures the
bounded system of the ATP educational structure, and specifically one clinical classroom
(Merriam & Tisdell, 2016).
The intent of this qualitative case study was to focus on faculty instruction and the
student interactions by conducting document analysis, open-dialogue conversations, interviews,
and observations. The open dialogue, interviews, and observations were recorded and annotated
to uncover emerging themes (Maxwell, 2013). The approach in this case study was to capture the
ATP experience holistically. To accomplish this, an overarching research question was presented
and supported by four sub questions to represent the subject participants and their experience
with instruction in cultural competence. The following research questions guide this case study:
1. What strategies are being used in one athletic training education program with the
intention to prepare students to provide culturally appropriate patient-centered care?
a. How does one athletic training program faculty member customize education to
meet the needs of students who will work with underrepresented populations?
b. Through what process do athletic training students learn cultural competence in
the AT program?
c. How does this process align with CRP?
d. How does this process support community utility value?
Positionality
According to Bang and Vossoughi (2016), it is important to explain the way one sees the
world because each individual brings a history, experiences, and relations to the research being

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conducted. My world view has been formed by my family’s holocaust survival and their efforts
to ensure a better future for the new generations. As a Jewish political refugee from the former
Soviet Union, I have experienced the refugee plight, poverty, learning English as a second
language, and the “assimilation” process. I am a first-generation college student in my family
and the first in the extended family to gain beyond a bachelor’s degree. Furthermore, the
combination of my personal life experience and the experience of working in the athletic training
profession, higher education field, and curriculum design in the healthcare field has informed my
knowledge and practice.
My professional practices are informed by my experience of graduating from an athletic
training program, as well as practicing in the profession for over five years on the frontlines at
the high school and collegiate levels. I also participate in policymaking by being a NATA
program and continuing education reviewer, as well a career education committee member for
over 10 years. Currently, I am designing healthcare curriculum that is culturally responsive, as
well as teaching introductory athletic training courses at the community college level. Because I
am passionate about the athletic training profession and view it through a critical lens,
conducting this problem-posing case study is a vehicle to continue my own journey through
cultural humility and cultural education.
Setting
This study was conducted within the kinesiology department at a coastal state university.
Specifically, the setting was a course for first-year athletic training students within the AT
program consisting of university juniors. In total, approximately 30 juniors and seniors
participate in the AT program annually. The state university had a student enrollment rate of
approximately 40,000 students for the 2018 school year. Of those enrolled, approximately 15 are

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admitted into the AT program on an annual basis. The AT program is a five-semester program
that takes place in the students’ junior and senior years and includes a commitment to 15–25
hours of clinical education outside of classroom hours. The AT program has been a part of this
state university since the 1970s and has maintained CAATE accreditation. This context allowed
for the research questions to be answered because it sets the bounded system within the
university classroom with access to the faculty participant and their students (Merriam & Tisdell,
2016). Through problem posing and interviews with the faculty, observations, as well as
interviews with the students, personal narratives were built to ensure that race was discussed as a
central topic and culture was understood through the personal lens of each participant (Smith-
Maddox & Solorzano, 2002). It is important to understand this study within one context because
it allows for the relationality to be built between the faculty participant and their students in one
classroom to analyze the role they each play in the educational structure (Brown, 2017). To
capture this problem-posing case study holistically, the observations and interviews were
conducted with one faculty participant and their assigned students.
Participants
To address the four sub research questions based on the subjects and experiences in this
case study, the participants include one ATP faculty participant and four ATP students from their
weekly clinical experience classroom. The university and participants were deliberately selected
to understand one specific context and how relationships are established within that setting. This
allowed the research questions to be answered using the problem-posing case study methodology
(Maxwell, 2013; Smith-Maddox & Solorzano, 2002). The qualities of the participants within this
study are directly related to the purpose of the study because they are willing to engage in
discourse about race, cultural identity, CRP, utility value, and patient-centered care. Maxwell

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(2013) suggested that the relationship between faculty and student, as well as the awareness of
the researcher’s role within the study are important aspects of data collection. In this problem-
posing case study, a relationship was built with the faculty participant and students during the
observation and interview phase that took place over the Fall 2018 semester.
Data Collection and Instrument Protocols
The researcher utilized four qualitative research instruments: document analysis, open
dialogue, observations, and interviews. The data-collection process began with reviewing the
ATP university website, class documents, such as syllabi, class readings, and assignments, to
understand the current class structure. Through the problem-posing case study methodology,
open dialogue was held with the faculty participant on three occasions to identify how culture
and race were addressed within instruction, analyze the structure of the curriculum, and ascertain
the utilized methods that include culturally responsive material (Smith-Maddox & Solorzano,
2002). Next, the observations of classroom instruction were conducted to evaluate the open-
dialogue results in action, to understand the faculty–student dynamic and student engagement.
Lastly, interviews were carried out with the faculty participant and four students to build a shared
understanding of the process of learning about cultural competence from classroom instruction
(Smith-Maddox & Solorzano, 2002). Based on the work by Smith-Maddox and Solorzano
(2002), this framework gave the faculty participant the opportunity to analyze, problem solve,
and theorize the cultural competence outcomes of future ATP graduates.
Document Analysis
Case studies are built from multiple sources of information collected over time with in-
depth data-collection methods including documentation (Creswell, 2013). The review of
documentation in this case study was imperative in understanding the current structure of the

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ATP course. The documentation that was analyzed included the program website, syllabi to
understand the athletic training topics that were addressed, class readings to review the authors
and cultural relevance, and assignments to examine what the students are practicing in the
classroom. The syllabus, readings, and assignments were reviewed for culturally responsive
content based on diverse populations. Further, the documentation analysis instrument was used
to inform the interview questions for the faculty participant. A final presentation by the students
was also utilized during the document analysis to understand how they incorporated the
knowledge gained throughout the semester. The documentation of the ATP course provided a
historical context for the observations and interviews (Merriam & Tisdell, 2016). After the
documentation was initially analyzed, a discussion was held with the faculty participant to
understand the structure and purpose of the assigned readings as well as classroom activities.
Problem-posing Open Dialogue
To create meaning and in-depth understanding of instruction through this case study,
open dialogue was implemented with the faculty participant. Open-dialogue discussions were
held with the faculty participant before each observation to understand the documentation that
was reviewed, the plan for the upcoming class period, and how they were planning to discuss
certain topics as they related to race and culture. Follow-up emails were also sent to discuss what
was observed when situations or discussions stood out. The dialogue focused on how CRP and
communal utility value are and can be incorporated into each topic of the lecture and/or clinical
lab work. The open dialogue also included what has worked in the past and what has not, what
the faculty participant feels comfortable tackling in regard to race and culture, as well as the best
methods to meet these goals. This instrument answered the research questions by focusing on
how curriculum is customized for diverse populations (Jett, 2013; Larke, 2013). The

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conversations also brought race and culture to the forefront as they relate to instruction (Smith-
Maddox & Solorzano, 2002). Through open dialogue the faculty participant and researcher were
able to tackle the meaning of race, CRP and communal utility value in athletic training,
specifically how instruction effects patient-centered care delivery. The open dialogue
conversations with the faculty participant also established topics for the ATP course observations
and interviews.
Observations
Based on Merriam and Tisdell’s (2016) work, observations can bring the “particular to
the general” to order into larger themes. The observations within the ATP classroom were
completed using an excel spreadsheet for note taking that is sectioned off by timestamps. The
observations were used to understand classroom instruction and patient-centered care,
specifically how racial and cultural topics are addressed. During the Fall 2018 semester two
observations occurred, one towards the beginning of the semester after the faculty participant
established relationships with the students and the second observation was mid semester to
capture current instruction, interactions and whether changes took place through the course of the
semester. A third observation was scheduled for the end of the semester, however was cancelled
due to a campus threat. The final observation was scheduled to view the student’s final
presentations based on the knowledge gained over the semester and was alternatively provided
through written format. The student participants shared their presentation with the researcher to
finalize the data collection process.
The observation instrument was informed through the theoretical framework of CRT, as
well as the pedagogical framework of CRP and communal utility value to answer the research
questions of educational strategies based on student experiences in cultural competence

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education (Merriam & Tisdell, 2016). Through observations the researcher was able to see how
the educational component is experienced by the students through the faculty’s instruction and
how the student is prepared to interact with their patients. The observations further helped
construct the interviews that were conducted with the faculty participant and students.
Interviews
Qualitative interviews in this study provide the “how” for cultural beliefs to be explored
in pedagogy (Merriam & Tisdell, 2016). The interview process included open-ended questions
for the faculty participant and students to understand how instruction is provided and perceived
in the form of cultural competence. The interview instrument informed the study by focusing on
the faculty participant and their instruction and how their student's perceive the instruction in
relation to cultural competence. The interview protocol for both the faculty participant and
student was created through the framework of CRT to establish relationality and systemic
structure (Smith-Maddox & Solorzano, 2002).
Faculty. After reviewing the class documents, class observations and holding open-
dialogue conversations with the faculty participant a formal interview was conducted. The
content of the questions focused on educator identity, cultural identity, CRP, cultural competence
as defined by the NATA (2011), curriculum, instruction, class readings, assignments, student
composition, communal utility value and patient-centered care. The faculty interview allowed
the course and ATP structure to be understood in the context of cultural competence through
instructional methods. The meaning within the faculty’s experience was explored and analyzed
to identify the current state of the athletic training program and their openness to further
culturally inclusive education.

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Students. The interview protocol for the students was revised and confirmed based on
the documentation and classroom observations. The interview topics included, curriculum and
instruction expectations, racial and cultural identity, as well as patient-centered care standards.
Through the interview process the communal utility value aspects and students’ personal
histories were established to support their role in the educational structure. The students
experience is utilized to understand how they perceive instruction in the AT program and
particularly the participating class, how they perceive their cultural identities are included in the
material, as well as how they use their acquired knowledge in the delivery of patient-centered
care. The analysis of student interviews provides an in depth look into how instruction translates
into knowledge and mastery.
Data Analysis
Critical Race Theory (CRT) is used as an analytical framework in this study to establish
the interaction and educational effects between faculty participant and student through the lens of
cultural identity to question patient-centered care competence for athletic training students
(Smith-Maddox & Solorzano, 2002). Using CRT as a framework, I analyzed documentation,
open-dialogue, observations, and interviews for examples of racial and cultural identity,
educational methods and cultural “competence” in classroom scenarios. CRT was used to elicit
personal narratives for the faculty participant and students that hone in on cultural experiences by
challenging traditional paradigms within the educational system (Smith-Maddox & Solorzano,
2002). The faculty participant and student experiences were explored through the Grounded
Theory approach, which recognizes and validates complex concepts while investigating and
generating theories connected to experience, specifically the classroom experience within the AT
program (Creswell, 2014; Patton, 2002; Strauss & Corbin, 2008). Constant Comparative Theory

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
within Grounded Theory was used to analyze data by identifying the curriculum structure within
the ATP course, the process of instruction and the experience of the students (Glaser & Straus,
1967; Strauss & Corbin, 1990).
With each of the four instruments data was analyzed using note taking, transcription, and
categorical coding through the ATLAS application. Through the data collection and analysis
process the identification of educator identity, discussions of race and culture within classroom
instruction, as well as the standards of communal utility value were identified (Merriam &
Tisdell, 2013). The responses from the faculty participant and students were compared across
subjects to gain an understanding of the transfer of knowledge from the classroom to patient-
centered care delivery. To analyze the data and cross-reference the outcomes with the
participants, the relationship between the researcher and involved parties was established through
the longevity of the study. Through ethical standing of the study anonymity and confidentiality is
maintained by utilizing pseudonyms, and not disclosing identifying information.
Limitations and Delimitations
Limitations
The limitations that present themselves within this case study include the institution
location and difference in demographics from other institutions with AT programs nationwide.
Access to ATs and institutions to understand the cultural education process within ATPs led to
the participation of one classroom at one institution.
Delimitations
The delimitation that is created within this study includes, the faculty participant having
prior interest in cultural diversity, which increases the willingness to participate and implement
CRP through the open-dialogue sessions.

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Credibility and Trustworthiness
Because qualitative research is based on different assumptions and worldviews the
credibility and trustworthiness in this study is defined through relational interactions. To ensure
credibility prolonged engagement and member checks were utilized. Prolonged engagement was
used while participating in a 16 week fall semester athletic training class to complete
observations of the faculty participant and student engagement (Merriam & Tisdell, 2009). A
member check was utilized after completing and analyzing the data results by holding
discussions with the study participants to confirm their agreement on the outcomes (Merriam &
Tisdell, 2009). Although this study was conducted in the AT program which is a recognized
healthcare profession as determined by the AMA, the educational and patient-centered care
contexts can be utilized within other healthcare programs (Merriam & Tisdell, 2009).
Dependability was ensured in this study by accurate record keeping and a match between
research and design. The dependability approach was established through accurate recording by
taking notes and voice recording all observations and interviews. The notes and transcribed
recordings were compared to analyze accuracy and remove inaccurate information (Merriem &
Tisdell, 2009). The second dependability measure, the match in research and design was assessed
by evaluating the design and the research questions and adapting each as needed to ensure
correlation (Merriam & Tisdell, 2009; Aslam, Georgiev, Mehta, & Kumar, 2012). Lastly,
confirmability was accomplished by audit trails within the documented updates to instruction,
course documents and research design documentation, as well as through data reconstruction
based on themes that emerge from the data collection (Merriam & Tisdell, 2009). Validity and
reliability were at the forefront of this qualitative study to confirm that the research findings
match reality (Merriam & Tisdell, 2016).

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Ethics
It is the researcher’s responsibility to conduct an ethical study by protecting the
participant’s rights and allowing them to feel comfortable in the setting. Based on reports by
Glesne (2011) and Rubin and Rubin (2012), the researcher must respect the participants, cause
no harm, provide informed consent, and maintain confidentiality. With those critical components
in mind this case study was prepared by including a confidentiality statement along with an
explicit statement for the participants to feel comfortable to opt out at any time during the study.
During the interview and observation process the participants were informed that this case study
is strictly for research purposes and would not be reported to their superiors (Merriam & Tisdell,
2016). This is important to discuss with the participants due to the nature of student-faculty
relationships. Further, observations were completed in an overt manner to avoid privacy
concerns (Merriam & Tisdell, 2016). The mindfulness of ethics throughout the case study and
reporting creates an analysis that fully represents the participants and the setting observed.
Qualitative research in the AT program helped to understand the nuances of classroom
education and how it affects the delivery of patient-centered care to racially and culturally
diverse populations (Tuck, 2009). The research participants included tfaculty and students from
one ATP course to assess the relationship between the curriculum and patient-centered care. The
researcher was integrated into the ATP classroom process through a problem-posing case study
approach while working with the faculty to discuss instructional methods and how they can be
culturally responsive, as well as through classroom observations (Tuck, 2009; Bang & Vougsini,
2016). The data was gathered through documentation, open-dialogue, observations and
interviews. The analysis was conducted by the researcher utilizing note taking, transcription
services, and ATLAS to code the observation data. The framing of the research when utilizing

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the CRT theoretical frameworks impacts ethics to ensure that the integrity of the framework and
research are upheld. Furthermore, the short-term benefits of this research in the athletic training
community is to establish an understanding on what is currently being done and what could
enhance the educational model in relation to cultural competence training, and long term to add
value to the community by incorporating the established benefits of CRP into ATP curriculum
(Tuck, 2009).
Bang and Vougsini (2016) discuss the importance of relational, historical and ethical
dimensions in research and the context of research. The relational dimension of the research
conducted in the AT program includes subject to subject interactions and communication
between the faculty participant, student and researcher. With this relational growth the
communication and understanding between the subjects will increase. New forms of knowledge
production and self will be formulated through the relational dimension (Bang & Vougsini,
2016, p. 179). Within the historical dimension the historical development of the athletic training
profession was reviewed to include the population demographics, previous cultural competence
research and the trajectory of the profession. It is also important to ensure that the subjects are
aware of the historical background of the athletic training profession and the context of the
higher education system. Lastly, the ethical dimension was represented in the way the research
design is established, through the building of relationships, and in the transparent communication
regarding the research to the subjects (Bang & Vougsini, 2016).
Through the design of this research any barriers that may exist between the researcher,
faculty and student were broken down to encourage the creation of space for knowledge to be
fostered (Bang & Vougsini, 2016). The position of power was disassembled and reassembled to
establish a place for knowledge gathering that is safe and accepting of all races and culture, and

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that in turn carries into patient-centered care delivery. Through this process the shifts in
individual identity that become possible include empowerment and confidence for the faculty in
cultivating culturally competent students, and the knowledge and confidence for the student to
provide excellent patient-centered care to diverse populations. The collective shift begins to
affect the achievement debt by closing the potential academic debt and disparity in culturally
competent patient-centered care (Ladson-Billings, 2006; Bang & Vougsini, 2016). Based on the
shift that takes place for the subjects and researcher the object can be more expansive through the
learning and social changes that begin to work together as a unit (Bang & Vougsini, 2016, p.
179; Engestrom and Sannino, 2010).
CHAPTER FOUR
Introduction
The purpose of this study was to understand the strategies used in one Athletic Training
Program (ATP) to prepare future athletic trainers for culturally relevant patient-centered care.
The following question and sub questions guided this study and were used to analyze the data:
1. What strategies are being used in one athletic training education program with the
intention to prepare students to provide culturally appropriate patient-centered care?
a. How does one athletic training program faculty member customize education to
meet the needs of students who will work with underrepresented populations?
b. Through what process do athletic training students learn cultural competence in
this AT program?
c. How does this process align with CRP?
d. How does this process support communal utility value?

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This qualitative problem-posing case study was completed at a university in an ATP
classroom. The participants included the faculty member leading the class and four of their
students. Due to the small and close community of athletic training, it was important to maintain
the confidentiality of the AT program, as well as the individual participants; therefore,
pseudonyms were used where needed, no identifying factors were discussed, and minimal
participant descriptions were included. At the conclusion of the document analysis, open-
dialogue conversations, interviews, and observations, the researcher coded the data and identified
the axial codes (Merriam & Tisdell, 2016). First, the background of the case study and the
participants are presented, followed by the findings in relation to the research questions.
ATP Course Case Study
The detailed descriptions of each of the measures broken down by context and measure
are described in Chapter Three. In Chapter Four, the measures and participants are discussed in a
descriptive format to holistically explain the process of the researcher’s involvement and the
participants’ experience. Additional details are provided below in Table 1 of the Measures
section and Table 2 of the Participants section. The following sections detail the case study
process that leads into the findings described through the overarching research question and four
sub questions that serve as the themes of the findings.
Measures
This problem-posing case study was completed in a first-year AT program classroom at a
coastal university. The AT program accepts cohort classes of incoming juniors every fall
semester and the program lasts two years throughout the students’ junior and senior years of their
bachelor’s degree. Access to the classroom was granted through the participating university’s
Institutional Review Board (IRB), the chair of the kinesiology department, and the program

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director of the AT program. An email with the description of the study was sent to three faculty
who teach within the ATP. Two faculty members volunteered to participate in the study and
provided their class syllabi. Based on the course content, one faculty member was selected as the
case study participant over the duration of the Fall 2018 semester. The researcher provided the
faculty member a summary of the case study along with six key articles to understand the
research. The researcher also had weekly email conversations with the faculty member to
understand where the class was in their studies, how they felt about their participation, and to
follow up on provided readings as well as research materials. As the classroom observations
were being scheduled, the documents were received and reviewed, including the program details,
the class syllabus, class reading, and assignments.
Through the document analysis portion of the data-collection process, the researcher was
able to determine the structure of the AT program and the specific class in which they
participated, understand the type of readings that were assigned and the authors’ backgrounds, as
well as review the assignments, both individual and group, for the first-year ATP clinical class.
The university website was used to review the AT program to understand the program duration,
the required units and class types, and the requirements to be accepted into the program. This
knowledge helped understand the process the students went through to pick an AT program and
apply to the program, and the preparation that was expected of them. Understanding the structure
of the program within the construct of the university system also helped form interview questions
for both types of participants in the case study. Next, the faculty participant provided the syllabus
for the course, which included the readings, assignments, and the rubrics for each assignment.
These documents provided the researcher with information on course activities, the backgrounds
of the authors for the assigned readings, and how the students were evaluated. The topics of these

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documents served as the problem-posing open dialogue conversations with the faculty member
and informed the interview questions for all participants. The data-collection process began with
using the document analysis to problem-pose over open-dialogue conversations with the faculty
participant.
The problem-posing discussions with the faculty participant were initiated via email and
at times continued after the class observations. Problem posing was provided in a discovery
format through the researcher’s review of the course documentation. The open dialogue included
samples of supplemental reading that can diversify the current assigned readings and whether the
faculty member would consider using them in class, as well as specific questions regarding
current class activities as they relate to race and culture. Three to five problem-posing questions
were emailed to the faculty participant before and after each observation in relation to the course
lesson for that session and based on the observation outcomes. The faculty participant replied to
the problem-posing emails by providing narratives in regard to their openness to include
supplemental materials, to discuss race and its nuances, as well as reflections on classroom
observation feedback. The researcher participated in two classroom observations to understand
how the lessons are discussed in the classroom and how cultural competence as part of the ATP
competencies is included in instruction.
Initially, three observation sessions were scheduled ranging from the beginning of the
Fall 2018 semester and a session in the middle of the semester to the last session at the end of the
semester to observe student presentations. The last observation of the semester was cancelled due
to a campus threat and all finals were collected alternately online. The first observation was held
one month into the Fall 2018 semester, which allowed the faculty participant to get to know their
students before introducing an observer. The class that was being observed was a first-year AT

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program clinical class, which was held once per week and covered topics such as medical
conditions, injury evaluations, and medical field trends. The classroom was located in the
kinesiology building and was designed to resemble a medical lab. The first observation started
two hours into the class session following a guest speaker on nutrition and lasted two hours. The
classroom consisted of 12 students—six females and six males—who sat at lab tables in no
particular organization. As the observer, the researcher sat in the back of the classroom to have a
full view of discussions and interactions. The second observation started at the beginning of the
class session and lasted four hours. During this session, 15 students were present—eight female
and seven male students. Both classes consisted of instruction that ranged from lectures to
student partner presentations, partner lab work, and group discussions. Table 1 summarizes the
measures included in the case study.

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Table 1
Data Collection by Measure
Measure Collected Data
Document
Analysis
AT program website
Syllabus
Class readings
Assignments
Rubrics
Problem-posing
Open Dialogue
Details: Email and in-person conversations with the faculty participant
to analyze curriculum/instruction styles and how race/culture are
included to meet the cultural competence competency required in AT
programs.
13 Email correspondences occurred over the course of the Fall 2018
Semester
3 in-person open-dialogue sessions occurred
Observations 2 Observations took place:
● First observation: two hours
● Second observation: four hours
Observation 3 was cancelled:
● In lieu of the third observation (student presentations on items
learned throughout the semester), student study participants
emailed their written presentation to the researcher for analysis.
Interviews 1 Faculty: The faculty member teaching the participating class was
interviewed.
4 Students: The student participants were first-year juniors in the
participating class.
Note. The measures were collected during the Fall 2018 semester for the ATP case study

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Participants
The faculty participant is a full-time tenured Assistant Professor within the ATP and
serves as the experiential education liaison. They currently teach two different classes for the
first-year students in the program and coordinates the clinical education experience. The faculty
participant has over 10 years of experience in the profession of athletic training and has been a
faculty member for the last two academic years. They are from a town in the Midwest and has
lived in different parts of the U.S. for work and education. The participant has also worked with
several different types of patient populations, ranging from rural to urban neighborhoods. They
identify as white culturally and express that they are open to learning and understanding other
races and cultures through professional development education, experience, as well as through
the experiences of their students. The researcher and the faculty participant had open-dialogue
conversations throughout the Fall 2018 semester in regard to the curriculum and course
instruction. The researcher also conducted a formal interview mid semester to understand the
participant’s identity and teaching philosophy as it relates to race and diverse cultures.
Throughout the interview, the faculty participant expressed many times that an important goal
for them is to develop their students into the best clinicians they can be after they leave the
academic environment.
This case study also followed the experience of four students in the AT program who
were enrolled in the participating first-year class. The students interviewed consisted of three
female students and one male student. They came from three different ethnic backgrounds; all
four were first-generation college students and community college transfers. These
demographics represented approximately 50% of the students in the class. Each student had
access to the researcher throughout the Fall 2018 semester during observed class sessions, via

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email, telephone, during the interview process, and ongoing. The student interviews depicted
their experience getting into the AT program, how they experience cultural competence
education and race conversations within the program and specifically the participating class, as
well as how they apply this knowledge to patient-centered care scenarios. The combination of
document analysis, problem-posing open dialogue, observations, and interviews provided a
glimpse into the participating ATP classroom and how cultural competence is addressed.

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Table 2
Participants
Participant Participant Demographics
Faculty Member Over 10 years’ experience in athletic training
second-year full-time faculty
White
Student Participant 1 - Matthew Male
Non-white ethnicity
Community college transfer
First-generation college student
Student Participant 2 - Ashley Female
Non-white ethnicity
Community college transfer
First-generation college student
Student Participant 3 - Amber Female
Non-white ethnicity
Community college transfer
First-generation college student
Student Participant 4 - Tanya Female
Non-white ethnicity
Community college transfer
First-generation college student
Note. Study participants during the Fall 2018 semester for the ATP case study

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Findings
The findings of this problem-posing case study address the overarching research question
by discussing the four themes based on the four sub questions that feed into the main research
question. These themes represent the experiences of the faculty participant and student
participants through a synergy of activities, as well as the relationship that is built through the
course of the AT program and specifically the participating class, as described through CHAT
(Foot, 2014). The activities that are explored in this study include classroom interactions,
program assignments and group projects. The a priori codes that were established through the
literature review and theoretical framework are racial and cultural identity between the faculty
and students as well as instructional methods that teach cultural “competence” in classroom
scenarios. Because the faculty participant is white, it is important to understand through the
findings how they approach cultural competence and whether they practice cultural humility
(Isaacson, 2014). The theoretical framework in this study explores relationships between the
faculty and students, as well as the intentional practice of bringing cultural competence to the
forefront. This theoretical framework assisted in determining what strategies within the ATP
classroom were intentional and provided examples for the identified a priori codes (Brown,
2017; Smith-Maddox & Solorzano, 2002).
Sub Question A: Customizing Education
The theme for sub question A pulls the findings from the document analysis, problem-
posing open dialogue, classroom observations, and the formal faculty interview. The findings
within this theme illustrate that the AT program and specifically the faculty participant are
making a consideration for cultural competence based on the educational competencies;
however, the strategies are planned at the general level as opposed to specifically highlighting

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race and/or cultural aspects in the forefront. The educational component as it relates to patient-
centered care in underrepresented communities was customized based on the course objectives,
planned classroom activities, and the faculty participant’s education identity, as well as their
teaching philosophy.
Course objectives and assigned reading. In this section, document analysis was utilized
to understand how the syllabus and class readings influence the racial and cultural experience of
the students in the AT program. The findings determined cultural competence being present in
the course objectives. However, it is not expressed through the assigned reading. The document
analysis looked through the ATP degree description and requirements on the university website,
as well as course documents, such as the syllabus, class readings, class assignments, and the
rubrics. The analysis indicated that the 2018 academic degree road map for the AT program
includes an upper-level comparative cultures class requirement that includes options such as
African-American, Chicano, and other racially specific studies, language studies, as well as
religious and gender-related courses. These courses are upper-level undergraduate courses from
other disciplines that are recommended in the spring semester of an ATP student’s senior year
and serve as further knowledge in understanding culture throughout the AT program studies.
Smith-Maddox and Solorzano (2002) listed transdisciplinary knowledge, such as comparative
culture studies, as tenet number five in their five tenets of critical race theory (CRT). While the
fifth tenet of Smith-Maddox and Solorzano’s (2002) study highlights the understanding of
various discriminations through transdisciplinary studies, the class selection in the offered
comparative culture studies vary in description and topics covered. Because most descriptions in
the comparative culture studies courses discuss oppression, social political, and economic
factors, this AT program customization meets the fifth tenet of CRT.

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The class syllabus displays the objectives based on the National Athletic Training
Association (NATA) Educational Competencies. One relevant competency is the Psychosocial
Strategies and Referral (PS) competency and specifically PS-4 (NATA, 2011): “Summarize and
demonstrate the basic processes of effective interpersonal and cross-cultural communication as it
relates to interactions with patients and others involved in the healthcare of the patient” (p. 27).
Although it is expected that students learn and practice cultural competence, the readings and
assignments do not reflect specific racial or cultural details.
During faculty personal communications ranging from August 17, 2018 thru December
21, 2018, the faculty participant was asked whether they would be comfortable with adding
supplemental articles to their reading list to further bring race to the forefront with this class.
They expressed being comfortable with this process and stated, “...(this year I) am adding the
Why Patient Values Matter in Clinical Decision Making as part of that, from the Oct 2017
NATA News article.” They also suggested that they are open to adding other articles as they
related to medical conditions. The document analysis did not indicate further customization of
curriculum and instruction for students to prepare to work with underrepresented communities.
The class readings include NATA position statements on topics, such as the sickle cell,
nutrition and performance enhancing drugs that touch on race and socioeconomic status. To
understand these position statements, the students discussed them through presentations and
group follow-up conversations or by getting into a circle to share their personal experiences. An
example of the readings included in instruction was displayed during the second observation in
November of 2018 during Fall 2018, which consisted of a class circle-up discussion and partner
presentations. During the circle-up discussion, the students and faculty participant made a circle
around the classroom to be able to look at each other as they discussed the NATA position

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statement on steroids. The position statement discussed steroids being more prevalent in
communities of color, which led to a class discussion about why the students thought that would
be a true depiction. The faculty curated conversation encouraging students to discuss personal
experiences from their cultural communities and how they have understood steroid outcomes
through their racial lens. While the course sessions were similar the faculty participant
customized the first observed session by skipping a NATA position statement discussion to
ensure the students were engaged and set them up with partners to work on clinical evaluations.
Currently, the supplemental readings used are from the NATA as opposed to external medical
sources. This is discussed by the faculty member when personal communication about reading
and instruction continued.
The faculty participant discussed using NATA resources on race, culture, and cultural
competence as supplements to assigned reading, although it is not part of the class curriculum, “I
do implement stuff that comes out in the NATA news, and distribute those handouts to the
classes.” They also discussed adding “on-the-go” assignments to understand cultural
competence.
This semester, I'm going to divide them into four groups, and they’re each going to take
either socioeconomic status, gender, race, or religion—I think those are the four kind of
main categories that they’re going to have to read through in the article and present to the
class. And we’ll have those conversations.
While students are expected to participate in transdisciplinary cultural education and the syllabus
covers a cultural competence course objective, the class readings and activities cover topics of
race and culture at a superficial level. The faculty participant is open to adding supplemental

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readings to the class and encourages open conversations during class instruction that leads to in-
depth discussions on race and culture.
Planned classroom activities. The findings in this section show how classroom activities
prepare ATP students to work with diverse populations in their clinical experience. The
classroom activities explored in this section were based on the observations and faculty feedback
regarding activities planned by the AT program, such as volunteering in the community. During
the first observation in October 2018 of the fall semester, the faculty participant led a discussion
regarding nutrition and how it can look different based on geographical location and access. The
students shared their experiences at their specific clinical education sites. Students who were at
affluent universities, high schools and clinics shared that their patients had healthy snack options,
such as sandwiches, healthy bars, juices, vegetables and fruit. On the opposite end of the
spectrum the students who were at clinical education sites with less resources either had no
available snacks for the patients or snacks that less nutritious such as chips. This discussion gave
the students perspective on how nutritional resources can affect the medical health of their
patients.
In the same observation throughout the partner and group work, the faculty participant
encouraged partnering with individuals with whom the students do not usually interact with to
ensure that they are able to work with different cultures and personalities. Specifically, the major
project of the Fall 2018 semester for both the first- and the second-year students consisted of
groups of two to three self-selected same-year partners and then were combined on a random
basis with similar groups from the second-year cohort. This type of group formation allowed for
the students to be both comfortable with the group members they selected as well as get to know
new members and understand how to work with different personalities. The class session closed

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with a partner presentation on sickle cell trait where the presenting students discussed racial
implications, testing, and treatment.
While the curricula, such as the reading assignments, are not customized to bring race
and culture to the forefront, during the formal interview the faculty participant stated that when
specific medical conditions are discussed during instruction, they make sure to include a
discussion about the communities in which these conditions may be prevalent.
I think identifying certain medical conditions that are more prevalent in certain races, we
absolutely talk about (that). There’s sickle cell in African American, skin cancer in
Caucasian, and a prevalence of those types of things. Socioeconomic status, what
does…(it have to do) about diabetes, and we talk about the position statement, how does
that play into health? But we don’t talk about what races that effects on a higher level
(medically) than other people, and why that may be.
They went on to say that while they ensure that the prevalence of medical conditions is discussed
they don't specifically plan discussions revolving around race and culture, "But it's not like I take
a class and just devote one class period to this topic and those types (race and culture) of
conversations."
When discussing class activities, the faculty participant described the partner and group
projects and asserted that group assignments are often based on random assignment to encourage
discourse with people with whom they would normally not interact. According to the faculty
participant, this random assignment can also prepare them when they are working with diverse
patient populations.

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I try to plan ahead and force them outside of their comfort zones a little bit, to force them
to get to talk to people that maybe they don’t like, or that they disagree with, or they
don’t typically talk to. Even in a class of 15, there are definitely groups and cliques.
Another way that the AT program as a whole adds cultural experiences to prepare the
students to work with underrepresented communities is by hosting or participating in community
events as volunteers. The faculty participant described these events as follows:
We had one (local) high school that contacted us that we did physicals at. So I think that
piece (is being visible in the community). We’ve had local middle school groups who are
starting sports medicine programs come to our class. We broke them all up into groups,
and they were just having conversations with the ATP students. We’ve also been
involved in two sports medicine days that are hosted by a different local high school.
Special Olympics is another one where we go and are medical volunteers. We worked
track and field at the spring games, and then this year we did the soccer competition.
Where we’re giving first aid providers for those individuals who are physically active in
wheelchairs and other areas.
Based on the first and second tenets of CRT, race should be on the foreground in
curriculum and instruction (Smith-Maddox & Solorzano, 2002). The AT program and
participating faculty member attempt to incorporate culturally competent content based on the
NATA competencies into the curriculum and instruction; however, it is not always intentional. In
the findings of this section, it is evident that classroom activities are not planned around race and
culture; however, they do touch on the subjects when discussing specific medical conditions, as
well as during community service activities. To ensure that race and culture is brought to the

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forefront in the AT program’s educational process, the class activities should include purposeful
racial and cultural content.
Faculty educational identity and teaching philosophy. The literature review illustrated
that faculty who have a strong educator identity are open to learning through professional
education and through their students’ experiences (Abu-Alruz & Khasawneh, 2013; Tisdell,
2006; Van Lankveld et al., 2017). Based on this research, it was important to understand the
faculty participant’s educational identity and teaching philosophy to explore how it relates to the
relationships they build with their students, as well as their ability to incorporate their students
experience into the classroom education. The faculty participant expressed their strong teaching
philosophy as being based on student engagement and the student’s comfort with the clinical
aspects of the AT program. This formal interview was conducted with the participating faculty
member through personal communication on October 26, 2018. Although it is important for the
faculty participant to customize their education to each student, they are aware of their
shortcomings and discuss utilizing resources if there is an aspect of a cultural discussion of
which they do not have knowledge. They expressed, “I’m not perfect; I know I have big deficits
in culture. I don’t have all the answers, but I think being able to …(use) resources to understand
what’s going on is important…” The faculty participant concluded by stating that part of how
they customize their instruction is by providing “real-life scenarios” that represent their
experience in the profession, as well as the experiences that the students bring to the classroom.
The faculty participant stated, "Kind of, providing them real life scenarios where we can talk
about two Jewish baseball players who are on a team and are very strict in their religion and how
the baseball team accommodates that."

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They continued by stating that they are aware that the class activities are not planned to
elicit race and culture conversations, but they believe that the discourse leads to those
discoveries.
So we do integrate kind of what they’re seeing and doing. Again, I don’t think it’s been
very specific. I’m not asking specifics that get down to race, gender, ethnicity, culture,
religion, and those types of conversations. Maybe I’m not asking initially, but I do think
some of that gets fleshed out in conversation.
As the faculty participant’s experience increases in teaching, they are adding additional sources
of assignments and conversation to their class based on the cultural competence educational
competency as it relates to customizing ATP education.
I saw the article that was printed last semester. I basically just handed it out as handout,
and we briefly talked about it. This semester, I’m taking that and expanding on it. I’m
going to put them into groups; each of them is going to be assigned a cultural competent
area. And then they’re going to present to the class, in the hopes that we have a little bit
more dialogue and dialogue between each other when we talk about these and address
them a little bit more specifically. As opposed to just, ‘Here’s your handout, I’m talking
about them,’ but really to have them (the students) talk more than I am talking in the
class.
The faculty participant stated that one of their major beliefs is to customize the class
discussions based on current events in the news, such as the mass shootings that occurred
nationwide during the Fall 2018 semester: “I feel that when the shooting at the Bar and Grill
happened, we did talk about it. We also had a professional come in and address the class as a
whole-because of the nature of the events of this horrific even.” They were then asked if they

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received training on cultural competence or how to make sense of tragic sociopolitical events and
they stated, "formal training (of how to teach this) I think is very limited in exposure, or none."
Based on the faculty participant’s teaching philosophy, the difficult conversations help the class
understand complex topics.
Overall, there are many methods used in the AT program at the coastal university to
customize students’ education as they prepare to enter their professional careers with diverse
populations, including transdisciplinary studies, class conversations, group assignments, and
clinical education experience. The aforementioned methods are important and already in place.
Therefore, it is imperative to capitalize on them to effectively implement the five tenets of CRT,
such as bringing race to the forefront and challenging the traditional paradigms of education
(Smith-Maddox & Solorzano, 2002). One of the tenets has been met through transdisciplinary
studies, while the other tenets are partially touched on throughout the AT program; however,
they are not met based on their general coverage through curriculum and classroom activities.
While cultural competence is only one part of the NATA educational competencies, it is an
important overarching theme that helps athletic trainers build relationships with their patients to
provide successful patient-centered care. In the next theme through sub question B, the findings
are represented through class observations and student feedback.
Sub Question B: How Do ATP Students Learn Cultural Competence?
For instruction and the overall student experience to meet the criteria of CRP, the
students must experience success, learn cultural competence, and grow their critical
consciousness (Ladson-Billings, 1992). This section explores classroom instruction and the
students’ experiences to understand how they learn cultural competence in the AT program. This
theme examines the findings through two classroom observations and four student interviews,

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focusing on the experience of the students during classroom instruction and their recollection of
activities throughout the AT program. The findings show that the most effective learning about
race and culture occurs through peer interactions, the class activities that focus on open
discussions, and the clinical education experience. By utilizing the concepts of CHAT, the theme
of how ATP students learn cultural competence will serve to provide the context for ATP faculty
surrounding the students’ experience within academic demands and program requirements, such
as the clinical education component, as well as from the activities of personal and cultural life,
such as family and financial situations (Foot, 2014). The students’ experience and how they
understand cultural competence can be used to drive curriculum and instruction creation.
To determine how ATP students learn cultural competence in the program, the class
observations were examined to understand their engagement and learning process when race and
culture are discussed. Discussions during the observation sessions attended by the researcher in
the Fall 2018 semester led to race and cultural discourse that was grounded in medical
conditions. Through these discussions, the students were able to share their experiences and learn
from both the faculty member and their peers based on experiences at different clinical sites.
Students partnered up to present NATA medical position statement reports to the class and
during the first observed session in October 2018, two groups presented on hydration and
nutrition. The peer-to-peer presentations created an interactive learning environment that allowed
for discussions on access to nutritional items in urban areas. During the second observation in
November 2018, student engagement was the highest in the circle-up group discussion about
steroids and race in which 10 out of 12 (83%) students shared their experience. One student
brought up that athletes from Latino and African-American backgrounds may use more steroids
due to the pressures of succeeding in athletics for scholarships and professional sport

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opportunities. This topic was then discussed at length with examples that students have
experienced in their community or at their clinical education sites. Throughout the observations,
the students spoke about their personal journeys and experience in the field; however, the
academic component of the discussion was generalized. Next, in the interviews the students
described additional class scenarios and activities that have helped them understand cultural
competence and discussed where it can be added.
After observing the class instruction, the participating students were asked how they learn
cultural competence and whether the class activities helped with their understanding. Two of the
four students interviewed asked what cultural competence was and were provided both the
NATA definition and the definition from the nursing profession used within the literature review
in this case study. During the interview process, the students shared how they have learned
cultural competence during class sessions, as well as what areas of cultural competence can be
added to the ATP curriculum.
All four students interviewed noted that the small cohort of 15 students and close
relationships help them understand each other’s race and cultures, as well as learn about cultural
competence through working with their peers. Matthew discussed being a part of a small cohort:
I feel like it’s more interactive in that we’re able to connect to our professors on a deeper
level. Not only that, but just the other classes that we take—we’re taking them with the
same cohort so every single class, we’re with the same people.
Matthew continued by stating that, "We have different backgrounds that I think just really
contribute to our whole learning environment. And not only that but just getting different
insights also is very interesting." Another student, Ashley, stated how getting to know her Jewish
classmate helped her understand a new religion:

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In the cohort, we have someone Jewish. Because I’m not completely familiar with the
Jewish religion or Jewish culture or being Israeli...I asked her and I tried to really get to
know the culture...just to be aware that she doesn’t do Christmas and why she doesn’t do
Christmas...It’s something that I didn’t know about and for her to just share about her
family life, that’s helped me see this culture...with a better view of it and a better
understanding of it that I can go up to her and be like, ‘Hey, can I ask you about this more
rather than just like turning a blind eye and really not caring that you’re Israeli or you’re
Jewish? Like I already know you, I already know this, and I value you more as a
classmate.
Tanya mentioned that because the small cohort was diverse it helped her prepare for her clinical
education experience, "I feel like having a variety and a multitude of races in a cohort helps with
clinical work." Lastly, Ashley discussed how the cohort’s perspective helps her understand
different medical scenarios, "Especially like in our cohort, you really get to understand where the
other students come from, and then their cultural experience and how it plays a role in the
medical part of the program."
Throughout the interviews, students reported general conversations taking place on the
“different” populations that the students interact with in their clinical experience, which was
presented during orientation and discussed as a topic of cultural competence. The students
reported that no specific details were covered regarding race and culture in their classroom
experience. Matthew stated:
During orientation, we talked about the different people we will work with...Aside from
just being the general overview of the different backgrounds, nothing too specific has

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been mentioned, aside from understanding that people do have differences ... are from
different races ... that we will be in contact with.
Matthew continued that thought by recalling that religions were also discussed in a general
manner, " Not so much religion has been talked about...but he has in the general scope of just
general backgrounds. From what I can remember, religion isn't touched on as much." As far as
textbooks and class reading assignments go Matthew mentioned that he did not see race being
covered, "I felt like none of the textbooks or any of the assignments have been specific to
different races. But I felt like in general, the textbooks were more general." Amber also shared
the thought that the cohort is diverse and therefore students learn from each other with the lead
of the faculty member. She stated, “It’s (cultural competence conversations) all been really
generalized because we have a lot of different cultures in our cohort, but nothing specifically.”
Three of the four students discussed the class discussions about the NATA position
statements and how those activities help them learn about cultural competence through science.
Matthew stated, “I feel like that’s (class discussions) really valuable. Just being able to see
different perspectives on different topics and then understanding how that perspective can
change your own beliefs.” Ashley noted how specific group projects helped her understand
cultural competence. Amber also mentioned the class discussions when she shared the following:
Like Circle Up, where we just discuss our clinical experience, and then we just talk about
like problems we see and how we address them and who our athletes are, injuries we’ve
seen, what kind of things they’re going through.
Amber discussed that while cultural competence conversations are good to have, they can still be
difficult to discuss with the entire group, "Having a position statement on the cultural

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competence issue does provide me some insight but at the same time, I feel like it's one of those
things that's still in its foundations that it's really hard to discuss."
Lastly, three of the four students discussed learning about cultural competence from their
clinical education, which are a part of the AT program education. Matthew discussed how certain
discussions from class have helped him interact better with patients at his clinical education site:
Understanding that (cultural competence) and using that in the clinical part has allowed
me to be more ... I guess, cater, to how different people react to different things. And then
also be more aware of how I’m reacting and trying to make it more comfortable for the
people I’m treating.
Ashley also mentioned that it makes her feel more competent when classroom discussions can be
utilized at her clinical site during her clinical education site; however, she recognizes that
cultural competence is a continuum and she still has more to learn:
Clinically, yes, it’s made me realize, ‘Oh wow, I’m actually learning something. I’m
learning this in the classroom and I can actually see that in the profession.’ But now
there’s just things that I feel I still lack like knowing all cultures.
Amber discussed that having a topic that was discussed in class being confirmed by an
experience at her clinical education site helps her understand cultural competence, "Having
other's opinions and point of view of culture essentially supported by something they've seen in
the clinical experience and then making it kind of my own really helps at my clinical site."
Because clinical education is solidified by academic knowledge, it is imperative to opening
discuss race and culture within the classroom.
It is evident from the student interviews that the three main ways they learn cultural
competence in the AT program is through the small-cohort peer interactions, through the open

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discussions and experience sharing during classroom learning, and through the experiences at
their clinical education sites. Although cultural competence education does occur in the program,
as the students’ discussed, many conversations are general and do not bring specific race or
cultures to the forefront. By practicing intentional education on race and culture, the AT program
can enrich the student’s cultural competence education (Brown, 2017). Now that the
customization of cultural education and how students learn cultural competence in the AT
program have been reviewed, the next theme covers the alignment of the prior themes with CRP.
Sub Question C: How Does This Process Align with CRP?
The following theme explores the curriculum and instruction as well as students’
experience and discusses the alignment with CRP as researched by Ladson-Billings’ (1992) in
her seminal work. The key tenets of CRP that informed this case study and were utilized in the
data analysis process are the following: (a) students must experience academic success; (b)
students must develop and/or maintain cultural competence; (c) students must develop a critical
consciousness through which they challenge the status quo of the current social order (Ladson-
Billings, 1992). While not all aspects in the measures collected aligned with CRP, the findings
below illustrate the measure that did align, which matches the tenet of academic success. The
findings are organized based on the three tenets of Ladson-Billings’ (1992) research.
Tenet A: Academic success. The first tenet in Ladson-Billings’ (1992) work discusses
that when students, especially students of color, experience academic success they are more
motivated to continue in their studies and persist through the world of academia. In this section,
the findings show how academic success has been structured by the AT program and faculty, as
well as how the student participants have experienced success.

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During the class observations, the researcher took note of lesson topics and discussions
that allowed the students to feel self-efficacious, communicate about race and culture, and
critically think about what they were learning. One of the class conversations during the first
observation in October 2018 covered access to healthy foods. Several students brought up that
there were more fast food restaurants than grocery stores in their neighborhoods. This class
conversation allowed the students who grew up in urban neighborhoods to bring their experience
into the discussion and feel confident in the value they brought to the class. Another conversation
surrounding a NATA position statement in the second observation during a meeting in
November 2018 allowed the students to discuss how body size is seen in their cultural
community. The participating students shared cultural outlooks from their home lives, as well as
what is traditional within their race, and one student specifically discussed the significance of
body size in the Asian culture. This student stated that because size was not of significance in the
Asian culture that there were smaller cases of steroid abuse. These class discussions gave the
students the opportunity to critically analyze information from their textbooks and articles, from
the faculty lectures, and align it with their personal experiences, as well as the experiences they
have had at their clinical education sites. The faculty participant and students also shared their
experience of ensuring that academic success is experienced and how it is experienced through
personal communications that took place during the Fall 2018 semester.
The formal interview with the faculty participant served as a process to understand how
the faculty member celebrates the success of their students (faculty participant, personal
communication, October 26, 2018). The faculty participant expressed many times during the
interview that they and the AT program as a whole are open to diverse students’ backgrounds

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and the students’ needs when it comes to time off from the program and special accommodations
for the academic rigor:
I think one big barrier we face is that our students work. So they not only have 20 to 25
clinical hours that they have to complete as part of this program, but because of their
backgrounds and their family situations, and they’re first-generation students; a lot of
them have one if not two jobs...it takes them away from their clinical experience, it takes
them away from their ability to practice, and it takes them away from studying. I know
one of our students does a graveyard shift. She comes to my class for five hours for a
class, and she’s had one, maybe two hours of sleep. We try to accommodate and try to
have an understanding of their backgrounds.
The faculty participant also stated that to help their students succeed, they allow them to
submit updated work, while still holding them accountable,
We have clinical standards, we have professional standards, and I’m not afraid to have
those conversations with my students that are honest that say, “Hey, your SOAP notes
were (not good); this is why they were (not great). This is the grade that you earned.
You’ll have two more opportunities to turn in a better draft, but this is your grade for now
because this has to get better.”
These two examples from the formal faculty participant interview show how this faculty member
and the program attempt to ensure the success of the students who have been accepted into the
program and aligns with the first tenet of CRP (Ladson-Billings, 1992).
The student interviews were collected as personal communication during the Fall 2018
semester and discussed the hands-on experience as opposed to the classroom experience

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mentioned by the faculty participant. Three of the four students stated that they felt the most
successful when they were able to get a clinical injury diagnosis correct. Matthew stated:
So there has actually been an assignment where we make a video that goes from the very
beginning to the very end of a SOAP note. And our professor and our classmates are able
to see that video, and we’re able to understand how you would present yourself to an
actual patient. And then, the professor gives us a grade of oh, you did this well, and these
areas that you could have done a little better on. So applying those simulated scenarios
and actually using that in clinical rotations has been very helpful and made me happy
when I am right.
Amber shared the same idea when she discussed being able to not only use what she learned
clinically but also the experiences of her peers, as well as her own experience while at the
clinical education, “...we all input our own opinion and our own experience and...it helps in my
clinical experience, which makes me more confident.” Lastly, Ashley discussed feeling like the
classroom learning was a success when she is correct in her injury assessments: “Clinically, it
feels very rewarding, personally, when you get that correct diagnosis, that differential
diagnosis—I feel like that just really makes me feel like I’m learning something and... I feel
confident as a clinician.” It is evident that the students are encouraged and experience success
through applying clinical education at their clinical education sites. Tenet A illustrates how the
students become efficacious through sharing academic success and tenet B demonstrates how
they develop cultural competence within the AT program.
Tenet B: Cultural competence development and maintenance. Cultural competence
development was discussed during the problem-posing open dialogue and faculty and student
interviews. Throughout the problem-posing open-dialogue process, which took place as a

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personal communication from August 2018 to December 2018, the researcher reviewed the class
curriculum and instruction observations to understand how they align with CRP. At this time in
the AT program, cultural competence-conscious NATA News articles are used as a resource in
the classroom along with conversations that touch on culture; however, the reading and
assignments do not reflect the cultural composition of the classroom. In discussing this with the
faculty participant, they were open to add supplemental articles and assignments that will
represent the class demographics, as well as the patient populations that the students serve. The
faculty participant made these statements in reference to adding culturally responsive curriculum
to future classes:
Based my reading through of the abstract I would be open to adding them (especially the
second one about socioeconomic status on diet in HANDLS). I have not seen these
infographics before (on diverse communities). I can definitely use the Diabetes one next
semester as we read the position statement on that and test our glucose. As for the BP and
HIV, it could probably be easily integrated into our gen medical course our second years
and enrolled in right now.
The faculty participant also mentioned, "It's been really interesting to be a part of this study. I
think it’s been good to focus some of my energy this semester on cultural competence. Also, I
would love resources to continue to integrate into my courses." During the review of reading
assignments through the document analysis it was noted that the main textbook used in the class
touched on culture once in the four chapters covered during the two observations the researcher
was a part of. While CRP is present in class discussions when medical conditions are studied, it
is evident that current curriculum should be infused with culturally responsive readings and

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assignments. The faculty participant is continuing to develop their personal cultural competence
and is open to adding CRP to their classes.
The students were also interviewed to understand how they learn about race and culture
in the classroom. When discussing the students’ experience of utilizing their own cultural
backgrounds within the classroom to build cultural competence, two of the four students stated
that they always felt comfortable; however, their specific races and cultures were not
represented. Matthew expressed this by stating:
So at (this university), I feel like they’re very accommodating for any background you
come from. Specifically talking about myself, I haven’t experienced anything that made
me feel uninclined to talk about my background or feel that I was excluded based on my
background. I do feel like if I needed or wanted to, there is no discrimination based off
the fact that I was from a specific background. But I personally haven’t felt any or had
any experiences that have dealt with this.
Amber also noted that race and culture are discussed, but that it is general due to the diverse
class and that her specific culture has not been represented in class:
There’s nothing that comes to the top of my head that has personally been addressed to
my culture. It’s all been really generalized because we have a lot of different cultures in
our cohort specifically, but nothing directly related to mine.
The other two students expressed that although they are non-white, they felt that they had similar
beliefs and values as the majority of the class and therefore did not feel like their culture was left
out.
Through this tenet, it is evident that although cultural competence is important to the AT
program, the concepts of CRP and how to bring it into the classroom are in the process of being

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developed. Beyond including cultural education in discussion this ATP classroom did not cover
specific cultural competence topics and through the student conversations it was not evident that
cultural competence was an ongoing education experience. The faculty is open to continue
learning about resources and ways to incorporate cultural education into their instruction.
Therefore, it is important for the ATP faculty to learn CRP methods and how resources from
other medical fields can influence cultural practices within the athletic training profession.
Tenet C: Developing a critical consciousness to challenge the status quo. Based on
work by Ladson-Billings (1992), critical consciousness is described as a moral character that
understands practical, as well as political activity and influences the quality of experience. While
the students and faculty in this AT program are developing cultural competence and critical
consciousness, they are not yet challenging the status quo of the educational system. As
discussed in the previous CRP tenets, although the faculty participant and the AT program as a
whole aim to include cultural competence into the education, it is done at a general level. The
faculty participant and students were asked about their personal cultural identity and how they
understand the racial as well as cultural differences of others, and the general answer was that
they were still learning to understand these concepts. Because the findings from the open-
dialogue conversations, observations, and interviews did not evoke discussions that pointed to
the full understanding of how political and societal activities influence the experiences of people
from different cultures, this tenet has not been met. Through cultural humility the faculty
participant can continue evolving in their knowledge and experience of working with students
from different backgrounds and will be able to use that experience to influence the positive
learning experiences of the students in the AT program.

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One aspect of the participating ATP class aligns with CRP, which is the academic
success of the students; however, key components that include cultural competence development
and building a critical consciousness have not been experienced by the students. To maximize
the cultural competence education within the AT program further alignment with the CRP
concept should be reached through deliberate practice (Brown, 2017). As discussed in the
previous themes, the students find their experience with cohort peers a valuable aspect of the
program, and the next theme explores how this value supports communal utility value.
Sub Questions D: How Does This Process Support Communal Utility Value?
Lastly, the AT program classroom and participants’ experiences illustrate how communal
utility value is supported through the curriculum activities. The process that is evaluated in this
theme explores how cultural competence education intersects with motivation. The key
principles of communal utility value that informed the analysis of the data from the faculty and
student interviews include goal setting (program goals), connecting educational material to their
(students) own lives, and the feeling of helping others (Brown, Smith, Thoman, & Allen, 2015).
The findings within these three principles are supported through CRP because they each lead to
the student experiencing success within the AT program, which is the first tenet of CRP and a
tenet that the participating ATP course has met.
Principle 1: Goal setting. Goal setting is a key principal in community utility value
because it allows the students to feel success once the goal is achieved (Brown, Smith, Thoman,
Allen & Muragishi, 2015). The goal-setting aspect of communal utility value was discussed
throughout the faculty participant and student interviews. The faculty interview is included in
this theme to analyze how the AT program brings aspects of goal making to ensure student
success (faculty participant, personal communication, October 26, 2018). Because the AT

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program is CAATE accredited and has education competencies to meet, measures and goals are
set for the program. The faculty participant stated, “...because again, at the end of this, they take
the BOC exam, and if they’re not passing the BOC exam, then we’re in trouble as a program. So,
there’s a very tangible outcome measure that we have.” Because goal setting is in place in the
AT program, communal utility value is supported through the first key principle and helps the
students have a clear path to graduation as well as career attainment.
When the students were asked about their goals after graduating from the AT program,
all four stated that the number one goal was to pass the BOC and attain jobs in their current
community. Each of the participants joined the program because of their affiliation with
athletics, personal injuries or the want to give back their community in the medical capacity. The
participating students goal setting process started through the application process to be accepted
into the AT program. Once they were accepted it is understood through their narratives that
learning the clinical aspects and becoming successful clinicians is the next goal. Lastly, after two
and half years of classes and four clinical education site rotations the students have a goal of
sitting for the BOC and passing in order to start their careers in the athletic training profession.
Through achieving each of the goals that are set by the NATA educational competencies,
the structure of the ATP and students’ personal goals, each student can feel success in their
accomplishments and be motivated to persist in the athletic training profession. This principle is
especially effective in students from underrepresented backgrounds who are represented in the
participating ATP. Students who come from diverse backgrounds and those who have faced
barriers strongly benefit from the communal utility value, and this can be seen through how their
personal experiences connect to their educational experience.

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Principle 2: Connecting educational experience to the students’ lives. According to
Brown, Smith, Thoman, Allen & Muragishi (2015) when science education was connected to
students lives in their study the students expressed more interest in the subject. The student
participant narratives help describe how the ATP education has connected to their personal lives.
These narratives express how the students’ lives intersect with the AT program and its relation to
their experiences getting into the program at this coastal university. Matthew shared his
experience by discussing how he found out about the career and his process of getting into the
program:
I was at a junior college when I got introduced to athletic training. We had a preceptor
who went to this program and he was talking about his experience here. And then, when
it came time for me to actually apply to different athletic training schools, this program
was on my list, but it wasn’t necessarily my top pick. After going through the application
process and getting an interview from them, I really felt like this program would be a
great choice for me. Personally, when I was applying to different schools, this was the
only school that had an in-person interview. And I felt like that was a very welcoming
experience and also just made me feel like I was prioritized and felt truly selected based
off not only what I was presenting in an application but also my personality.
Amber described how her process of getting into the program was stressful but also rewarding
because she got to select the program that she felt was the best fit for her.
It was pretty stressful, so I applied to the program, then I did my interview, and then I got
waitlisted. I picked this program not only because I really liked the fact that they did an
interview process, so they really got to know who they’re letting into the program. I
really liked the fact that this program was a little bit more diverse than the other schools,

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because of location and the applicants and the student body. I actually went to
community college out of high school. I had an athletic training student program in high
school and it was someone who was in this athletic training program. Then I suffered
from an ACL injury, so I did my rehab there. So I got more interested in the profession
because I saw all that the AT did and it really interested me. When I went to community
college, I also played soccer and so I got to meet the athletic trainers there, and they
really just encouraged me to be part of the program.
Ashley described her process as exciting and rewarding due to her not expecting to get into this
particular AT program. She also recounted her experience in a Military ROTC program and how
that shaped her attitude and goals.
In my last semester at my community college, I told the athletic trainer, ‘Hey, can I
follow you for my hours for the athletic training program?’ So, she was like, ‘Yeah,
register for my class.’ So, 60 hours come and go and that was during a natural disaster in
my area so I couldn't go to my clinical site. I was constantly in the clinic. I was working
from as soon as my classes were done until they close. I sent in my application the day it
was due. I wasn’t hoping for much, just because I didn’t think I was that impressive of a
student. I was more like well, maybe my experiences will be enough. This is something
that appeals to me because I came from the military background...and wanted to know
what made me push myself to do those things when I’m exhausted and just the amount of
stress and tension on my body and my fellow cadets. I was like, ‘Oh, what’s happening in
their body?’ At one point, we all had injuries, and no one could do PT because we were
just all broken.

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The fourth student, Tanya, described her experience as “pretty standard” and said that she was
skeptical about the AT program because of her employment schedule but is interested in the
subject and looks forward to learning more. All four students believe that their experience of
being first-generation college students and coming from a community college bring a lot of value
to the program and are glad that they have classmates who share similar experiences.
To connect the education to the students’ lives the faculty participant discussed how the
AT program works to collaborate with the students from each cohort to learn from each other.
The faculty participant expressed this when stating:
I think there’s definitely room for improvement. But I think we are doing okay with that
(connecting student experiences to the education), and at least we are trying to expose our
students to different cultures, different communities, (by) looking for ways to maybe
collaborate or come together or learn together I think it’s always on our minds.
When students experience the intersection of their personal lives with their academic
endeavors, they are more likely to persist and complete their education (Brown, Smith, Thoman,
& Allen, 2015). Having this utility value is important for the participating students because
among the academic aspect of the AT program they also have to spend 15-20 hours a week on
clinical education. The motivation to persist help the students succeed through both aspects of
the program. The combination of goal setting, student experience and the helping others key
principles will set the students in the AT program up for a successful degree-attainment process.
Principle 3: The feeling of helping others. The last key principle within communal
utility value explores how the students gain the feeling of helping others. This key principle
provides the students motivation because it gives them the opportunity to have a direct impact on
their communities. By giving back to the local community and volunteering in different clinical

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settings, the students get to experience helping others, which brings value to their own education.
This was evident when the faculty participant shared:
In the sports medicine competition that was held here, our students were grading the local
high school students on their ability to do skills. That was a great eye-opening experience
for them, just to be in that situation and help the local students.
While the students participate in volunteer and community events in their local areas that are
organized by the AT program, Ashley discussed how the knowledge she is acquiring in class will
help her give back to her military community:
When in the military...I wanted to know why someone had injuries, muscle strains, like
any muscular tendon injury. Mentally they were all still fighting, like we were all still
fighting mentally. We were all motivated and disciplined enough, but physically our
bodies just couldn’t do it anymore. So, it’s interesting to put that into the knowledge I’m
learning now and to be able to give back to other ROTC participants in the future.
Although the other student participants did not have direct stories about helping others,
throughout their interviews they each stated that they joined this profession because of their
experience of being helped by the athletic trainers in the past or because they wanted to be a part
of a helping medical profession that also had an orthopedic component to it. This was evident
when Amber stated, “I was always in the athletic training room because I played soccer and I
would always like sprain my ankle and was in there...to rehab...and I was like, ‘Oh, this is pretty
cool.’”
Both the faculty interview and the student interviews show that communal utility value is
supported by the ATP structure and enrollment process, as well as through the students’
experiences and motivations to succeed in the program (Brown, Smith, Thoman, & Allen, 2015).

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This supports the notion that the increase in communal utility value within a classroom
strengthens students’ motivation, especially those from underrepresented backgrounds, to
successfully complete their studies in STEM (Brown, Smith, Thoman, Allen, & Muragishi,
2015). Because one of the focuses of CRP is to ensure that students experience academic success
the process that is currently a part of the AT program supports communal utility value and uses
aspects of the research to enhance the students’ experience within the program. The strategies
found within curriculum customization, promoting cultural competence in education, aligning
curriculum with CRP, and supporting communal utility value provide insight to answer the
overarching research question in this case study.
Closing
The aim of this study is to identify what strategies are being used in an athletic training
education program to prepare students to provide culturally appropriate patient-centered care.
Four sub questions served as the themes that informed the data analysis. The findings for each
theme show the AT program’s strengths and the areas that need to be developed to ensure that
the cultural competence strategies prepare students to work with diverse populations. In the first
theme, the evidence shows that cultural competence is part of the AT program educational
strategies as seen through activities such as transdisciplinary studies, class conversations, group
assignments, and clinical experience; however, these strategies are discussed at the general level
rather than bringing race or culture to the forefront. The second theme elucidates that the three
main ways students learn cultural competence in the AT program are through small-cohort peer
interactions, class activities focusing on open discussions and experience sharing, and the
experiences at their clinical education sites. Similar to the findings in the first theme, the class
conversations are general and do not bring specific race or culture to the forefront. Based on the

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data collected in the third theme, academic success within the AT program aligns with one tenet
of CRP; however, other tenets, such as learning and maintaining cultural competence as well as
critical consciousness have not been experienced by the students. Lastly, the fourth theme shows
that communal utility value is supported by the AT program structure and through student
experiences, which leads to student motivation to succeed in the program. The strategies used to
prepare students for culturally appropriate patient-centered care are present in each of the
findings based on the four sub question themes; however, not all the tenets were met. Therefore,
it is important for the AT program to intentionally incorporate cultural competence into the
curriculum.
An important aspect to discuss is how a white faculty member can teach toward cultural
competence and ensure that their students understand the concepts. It is important for ATP
faculty members to practice cultural humility and be able to share their own process with the
students. By practicing and expanding on the strategies to teach toward cultural competence, the
students of color who are enrolled in the program can continue to succeed and not only persist
throughout the program, but also persist in the profession of athletic training. Overall, although
the findings are represented within the AT program strategies, adding key components of
bringing race and culture to the forefront as well as using the enrolled students’ cultural value are
recommended.
CHAPTER FIVE
Summary
The purpose of this study was to determine how cultural education is experienced in the
ATP and how CRP can be implemented to contribute to cultural-based competencies. Based on
research by the NATA, there is a disproportionately small number of athletic trainers of color

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that serve communities with high numbers of diverse patients (NATA, 2018). This problem-
posing case study reviewed how the AT program teaches cultural competence, how CRP was
utilized in the AT program, and how these items support communal utility value. The theoretical
framework of this study is based on CRT, with a pedagogical framework of CRP and communal
utility value, which helped examine the faculty and student relationships, as well as how cultural
competence is enacted. The study was conducted through CRT problem-posing principles with a
case study methodology. The case study focused on one ATP faculty participant and four of their
students. The following questions informed the case study and were utilized for data analysis:
1. What strategies are being used in one athletic training education program with the
intention to prepare students to provide culturally appropriate patient-centered care?
a. How does one athletic training program faculty member customize education to meet
the needs of students who will work with underrepresented populations?
b. Through what process do athletic training students learn cultural competence in the
AT program?
c. How does this process align with CRP?
d. How does this process support communal utility value?
Summary of Findings
To answer the overarching research question, the findings for this case study were
analyzed based on the four sub questions. The four sub questions form the strategies that have
been previously researched and proven to promote success in STEM fields through culturally
responsive approaches. The strategies of customizing educational curricula and understanding
how students learn cultural competence, cultural humility, CRP methods, and communal utility
value were researched and discussed throughout the literature review. Through the findings of

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this case study, the researcher was able to analyze what strategies align with previous research
and the strategies that require additional focus.
Curriculum Customization
The AT program is part of the STEM field that specifically focuses on the healthcare
profession of athletic training. The main focus of the program is to produce successful clinicians
who will pass the BOC exam to be nationally certified and prepare for licensure in most states.
Thus, less attention is devoted to ensuring cultural competence is an overarching theme of the
program. The participating ATP does incorporate cultural competence into its degree path and
throughout the required courses in a general manner. The current methods used in the AT
program to customize cultural education include activities such as transdisciplinary studies, class
conversations, group assignments, and clinical experience. To increase students’ cultural
understanding and knowledge, these activities should be presented overtly and relative to both
the student demographics as well as the demographics of the patients they serve. Gunn et al.
(2013), Jett (2013), and Larke (2013) recommend deliberately adding culturally relevant content
throughout the syllabus, assignments, and in instruction.
Cultural Competence Education in the AT Program
Because cultural competence is a part of the educational competencies used to evaluate
students and the educational program itself, the participating AT program includes cultural
objectives throughout the program course. Based on the findings, students learn cultural
competence through three main activities: small-cohort peer interactions, class activities focusing
on open discussions and experience sharing, and the experiences at their clinical education sites.
Through the students’ narratives, it was evident that they experienced cultural competence at a
general level in the AT program and are looking for a deeper understanding of their patients’

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racial and cultural diversity. Two of the four student participants requested clarification on
cultural competence and were provided with both the NATA definition and the definition used
throughout this study. The definition of cultural competence used in this study to analyze the
data is described by Garneau and Pepin (2015):
A complex know-act grounded in critical reflection and action, which the health care
professional draws upon to provide culturally safe, congruent, and effective care in
partnership with individuals, families, and communities living health experiences, and
which takes into account the social and political dimensions of care.
Although the participating AT program incorporates cultural competence into their educational
structure, the delivery of the education should allow for both faculty and student reflection, as
well as intentional discussions about the sociopolitical aspects of care to provide culturally
appropriate patient-centered care (Garneau & Pepin, 2015; Ladson-billings, 1992).
Alignment with CRP
While the first two themes served as ways to understand the current status of the
participating AT program, the next two themes went into depth to understand how the tenets of
CRP and communal utility value are being met. The main finding in this study that aligns with
CRP is the process of ensuring academic success for all students who are accepted to the AT
program. It is evident that the AT program is designed to ensure the success of its students by
acknowledging their cultural, as well as personal backgrounds and incorporating their experience
into classroom activities (Ladson ‐Billings, 1995; Ladson-Billings, 1992). However, as discussed
in the previous findings, the cultural curriculum has been presented in a general fashion and thus
the other key tenets of CRP, such as cultural competence and developing a critical consciousness
to challenge the status quo of education, have not been experienced by the students (Ladson-

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Billings, 1992; Ladson-Billings, 1995). To ensure all the tenets of CRP are enacted, Leonard,
Brooks, Barnes-Johnson, and Berry (2010) suggested adding culturally relevant content, such as
readings, as well as assignments that represent the students’ and communities served by this
university’s AT program.
Communal Utility Value
The communal utility value concept is supported through CRP as both topics intersect
through the academic success tenet (Ladson-Billings, 1992). In this finding, the researcher
explored how the current strategies of the AT program and specifically CRP support communal
utility value; it is evident that the program structure, enrollment process, and student experiences
provide a motivating environment. This finding meets all the requirements presented through the
research in the literature review and celebrates the experience of the student participants. The
key communal utility value requirements include: (a) setting goals, (b) connecting education to
student lives, and (c) the feeling of helping others (Brown, Smith, Thoman, & Allen, 2015). The
findings show that student goals are set both through the AT program and by the student to reach
the goal of national certification. The students are given opportunities during the clinical
classroom to share their personal narratives from the clinical setting and their cultural
backgrounds through which they also experience the act of helping others medically in their
communities. As identified in the literature, adding utility value to the educational system
increases students’ success in the classroom and translates to their chosen careers (Brown, Smith,
Thoman, & Allen, 2015; Harackiewicz et al., 2016;).
Recommendations for Practice
The recommendations for this study were derived from the findings and the researchers’
experience of working with the participants through the duration of the Fall 2018 semester. The

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following recommendations can be used for future research within athletic training and/or to
implement within the structure of ATPs:
1. Invite a third party from the NATA diversity committee or a campus diversity group to
review the curriculum and instruction and provide recommendations. It was evident from
the open-dialogue conversations and interviews that although cultural competence is part
of the educational requirements, having a researcher raise questions and provide
information through the problem-posing case study methodology assisted the faculty
participant to start thinking about more ways to include culture into the course. This
awareness creates a desire to bring race and culture to the forefront in curriculum as
opposed to providing generalized information.
2. Curriculum should be revamped as the ATP degree is becoming a m as t e r ’s level program
to include readings and assignments that represent the demographics of the students
enrolled in the program and the patients they serve. While the participating AT program
shows high success in supporting and motivating their students, future graduates will
benefit from seeing their cultures represented in the program curriculum through
readings, as well as assignments such as, standardized patients and practical exams.
Interprofessional Education (IPE) should also include cultural education to ensure the
collaboration with other healthcare professions is fluid. These efforts will prepare
students to serve diverse patient populations.
3. Invite guest speakers of different races and cultural backgrounds to address the class.
Currently, the participating AT program provides guest speakers from different settings.
However, based on student feedback, most are white. Three of the four students
interviewed recommended that the program bring in athletic trainers and healthcare

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professionals from other disciplines that reflect the demographics of the class and can
share their work, as well as how they obtained their current positions.
4. Hire and develop a diverse faculty. Based on the participating AT program and research
of similar programs, the faculty and staff are mostly white and need to be diversified to
represent the students, as well the population that the students will serve post program
completion. Intention to bring race and cultural to the forefront should not only be
present in the curriculum but also through the hiring process. Furthermore, training and
continuing education should be provided to faculty focused on cultural competence and
teaching toward culturally responsive pedagogy.
5. Discrimination and racism should be addressed in the forefront of the curriculum.
Although healthcare programs focus on clinical success, it is important to address the
disparities and sociopolitical activities of the current society. These aspects influence the
type of care, or the lack thereof that is provided in certain communities, and how it differs
from the affluent communities. Discussions and course assignments should discuss the
big picture of healthcare and specific medical conditions.
6. The participating AT program has a general structure that sets up enrolled students for
success and can offer other programs an outline for positive outcomes. During this study,
it was evident that the enrolled students were excited to be a part of the program and to
learn from the faculty. The first step that ensured the students were prepared for the
program was the interview process, which also fostered a sense of pride among the
students. The participating program also provides the opportunity for the small cohorts of
15 students each to participate in orientation, class discussions, peer interactions, and

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diverse clinical education opportunities which is an ideal environment for learning about
cultural competence.
7. Encourage the participation of faculty and students in various conferences, meet-up
groups, including alumni gathering, and to work as a unit utilizing campus resources.
Participation in professional conferences will allow both faculty and students to network
with AT professionals, diversity groups and to gain continuing education through
conference lectures. A network of alumni can also assist with career preparation and
discussions based on experience in the profession. Lastly, utilizing campus resources to
study and network with current classmates can foster a further environment of unity and
cultural understanding.
Implications
Implications for AT Programs
Based on the findings ATP education generalizes cultural competence and addresses it by
discussing general differences in populations and through experience at the student clinical sites.
It is important for AT programs to intentionally practice cultural competence and provide
culturally responsive instruction, as well as assignments that help the students explore race and
culture within the classroom. Based on faculty and student narratives an increase in cultural
education can help the students tackle diverse scenarios in their clinical education experiences
and careers. Discrimination and racism have to be addressed in the forefront of instruction as it
relates to the history and current sociopolitical activity within medical communities. While
topics like nutrition and sickle cell trait are discussed in a general manner, knowing the historical
aspects will help the students understand the nuances of race and culture as it relates to specific
medical conditions and patient care delivery. Lastly, AT programs should practice purposeful

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hiring and faculty development practices to ensure a racially and culturally diverse faculty.
Adding intentional practices surrounding faculty diversity will increase the cultural humility
within the ATP structure and instruction. These structural changes to the educational component
will help the students bring theory to practice when they experience providing patient-centered
care to diverse populations.
Implications for Research
This case study focused on one AT program in a coastal state with an urban setting.
Further research needs to be conducted with AT programs in other locations and states to
understand the demographics of different university populations. Because approximately 80% of
certified athletic trainers identify as white, the participating ATP had a differential representation
of races and cultures within the student population. While the students in the participating
program were diverse the faculty participant and other staff of the participating AT program
identify as white. Based on research by Isaacson (2014), it is imperative to practice an ethic of
cultural humility, where the emphasis is “attentive listening and openness to other cultures,” (p.
257). Due to the lack of racial diversity among educators in athletic training it is important for
ATP faculty, especially those who identify as white, to keep a practice of self-reflection and self-
critique in interactions with others, which will continue to improve their perspective and help
them prepare diverse students for patient-centered care (NATA, 2018; Isaacson, 2014). To
accomplish this, further research in ATP faculty preparation needs to be conducted to understand
the training and continuing education they receive as it relates to cultural competence and
specifically cultural humility.

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Conclusion
The profession of athletic training is young within the healthcare field and is maturing
through research, as well as expanding to additional settings. As discussed in the literature
review, only a few articles have focused on athletic training exploring the inclusion of cultural
competence, and each suggests that cultural competence is not being practiced clinically (Marra
et al., 2010; Nynas, 2015; Volberding, 2017). This case study adds to the profession of research
in athletic training as related to cultural competence education within AT program curriculum.
Being in the ATP classroom for a prolonged time over the course of the Fall 2018 semester gave
the researcher the opportunity to understand not only the AT program process, but also how
relationships are fostered through participant interactions. The findings in this study show that
race and culture have been discussed at the surface level and in order to bring these notions to the
forefront, faculty should build their cultural humility, enact all tenets of CRP and communal
utility value. It is important for faculty, especially white faculty working with diverse students to
understand power imbalances and strive to be self-aware in their interactions with diverse others,
which in turn will create an environment of partnership within the AT program. Further
alignment with CRP will assist the program in encouraging student persistence in the field of
athletic training, which will produce diverse athletic trainers and start changing the current
disparity. The detailed findings are important for other AT programs as well as general medical
professions to reference when considering how they incorporate cultural competence into their
education programs.

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Appendix A: Interview Protocol

Problem-posing case study methodology: The interview questions for the professor and their
students will be informed through documentation analysis (syllabus, assignments, and readings),
open-dialogue conversations, and observations throughout the duration of the fall 2018 semester.
Below are interview questions that reflect the research questions and can be expanded and/or
updated as informed through the documentation analysis, open-dialogue and the observations
that will take place.

Introduction: Professor:

Opening statement:
Thank you very much for taking the time to have discussions with me about cultural competence
within athletic training, how it is included in current ATP classes and what more can be done.
Your experience and insights will help me investigate the association between classroom
learning and the application in practice of patient care. I will be asking several questions related
to your classroom, lessons and curriculum, please answer in as much detail as you can. Feel free
to opt out at any time or from any specific question and/or the study. The discussions, interviews
and observations will be recorded with your permission. Please let me know if are not
comfortable with these protocols at anytime during the process. Thank you again for this
opportunity.

Overview of class/observations and set up:
This first interview will be about your instruction style, educator and personal identity, as well as
your goals as an educator. Would you like to start by telling me about the subject you teach and
the over goal of the class?

1. How would you describe your instruction style and/or theory?
Probe: How did you form this style?

2. What is your cultural identity?
Probe: How do you feel it affects your instruction?

3. What is your educator identity?
Probe: How do you see your role as a professor as it intersects with the education system,
colleagues, and the student experience?

4. What are your goals as an educator?
Probe: What do you expect to accomplish at the completion of this class?
5. What training have you received in regard to cultural competence?
Probe: Were they provided within your academic training or through continuing
education, and/or both?

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6. How do you approach race and cultural identity within the classroom?
Probe: Do you openly discuss race and cultural differences within the structure of the
class?
Probe: Does the class include student-controlled discourse based patient populations, race
and culture?

Classroom specific questions transition:
Now that we have discussed your classroom let’s take a deeper dive into your lesson planning
and students’ outcomes.

7. Based on the 2011 addition of cultural competence to the NATA educational
competencies, how do you add it to your current instruction?
Probe: How is it added overall to ATP curriculum?

8. In what ways do you adjust curriculum and/or instruction based on your class/patient
population demographics?
Probe: How is culturally responsive curriculum included in regard to textbooks,
supplemental articles, projects etc?

9. What instructional structures are in place for small group instruction, group work, and
partner projects?
Probe: How does the class structure promote interaction of students from different
backgrounds to work together?

10. In what ways is helping others through athletic training promoted?
Probe: What strategies are used to create motivation for students to persist in ATP and
the AT career?
Probe: How is the material in this ATP program connected to each student’s
life/background?

11. How do you feel barriers may affect the success of students within your classroom?
Probe: How do you handle these barriers?
Probe: What type of barriers do you see most often and how do you prepare for them?
Probe: How are student backgrounds taken into consideration throughout the program?
Probe: How does culture affect the selection process of ATP students?

12. Do you have additional information that you think will be important to include in this
study?

Closing: Thank you very much for your time and I look forward to working with you throughout
this study.

Introduction: Student’s:

Thank you very much for taking the time to talk with me today, I know how busy you are with
school and internships and other responsibilities. I will be asking several questions related to

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
your class and how the instruction relates to cultural competence, please answer in as much
detail as you can. You can opt out at any time from a question, the interview or the study in
general. This interview will be recorded with your permission. Thank you again for this
opportunity.

Student questions:
Please be aware that these interviews are confidential, and your name will not be used in the
report or with your professor. Feel free to be honest as this can.

1. How would you describe your cultural identity?
Probe: How do you feel your personal culture is addressed during class lessons?

2. How would you describe your process of getting into the ATP program?
Probe: Why did you select athletic training as a major?

3. Since being in the ATP program, how has your classroom experience differed from
previous college classes?

4. How has cultural competence been addressed in your class?
Probe: How has cultural competence been addressed throughout the ATP program?
Probe: What type of materials such as textbooks, articles and assignments have you
received that explores race and culture?
Probe: What type of discussions and activities take place to discuss race and culture?

5. Describe in what way groups and/or partner discussions/projects are set up during class?
Probe: How do these groups or partner projects reflect the classes diversity?

6. How have you applied what you have learned in class to patient care during your
internship?

7. What class activities would you describe as most helpful when translated to patient care?
Probe: What type of activities has the professor included in lessons?
Probe: How do you feel these activities help you feel comfortable working with diverse
populations?

8. What recommendations do you have the ATP program when implementing cultural
education?

9. Do you have additional information that you think will be important to this study?

Closing: Thank you very much for your time.

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
Protocol Table
Research Question Interview Question Type of Question
(e.g., Devil’s
advocate, opinion,
etc.)
Framework/Citation
What strategies are
being used in one
athletic training
education program
with the intention to
prepare students to
provide culturally
appropriate patient
care?
What training have
you received in regard
to cultural
competence?

Probe: Were they
provided within your
academic training or
through continuing
education, and/or
both?
Experience question CHAT (Foot, 2014;
NATA, 2011)

How do you feel
barriers may affect the
success of students
within your
classroom?

Probe: How do you
handle these barriers?
Opinions/Values
question

In what ways do you
adjust curriculum
and/or instruction
based on your class
population
demographics?
Experience and
behavior question
(CRT, Smith-Maddox
& Solorzano, 2002)
(CRP tenet, Ladson-
Billings, 1992)

How have you applied
what you have learned
in class to patient care
in your internship?
Behavior question
(Student Interviews)

Through what
process do athletic
training students
learn cultural
competence in the
ATP program?
Based on the 2011
addition of cultural
competence to the
NATA educational
competencies, how do
you add it to your
current instruction?
Background question (NATA, 2011)
(CRP tenets, Ladson-
Billings, 1992)

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM

Probe: How is it
added overall to ATP
curriculum?

How has cultural
competence been
addressed in your
class?

Probe: How has
cultural competence
been addressed
throughout the ATP
program?

Probe: What type of
materials such as
textbooks, articles and
assignments have you
received that explores
race and culture?

Probe: What type of
discussions and
activities take place to
discuss race and
culture?
Experience question
(Student Interview)
(CRT, Smith-Maddox
& Solorzano, 2002)
(CRP tenets, Ladson-
Billings, 1992)
How does this
process align with
CRP?
How do you approach
race and cultural
identity within the
classroom?

Probe: Do you openly
discuss race and
cultural differences
within the structure of
the class?

Probe: Does the class
include student-
Background question (CRT, Smith-Maddox
& Solorzano, 2002)
(CRP tenets, Ladson-
Billings, 1992)

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
controlled discourse
based on patient
populations, race and
culture?

What instructional
structures are in place
for small group
instruction, group
work, and partner
projects?

Probe: How does the
class structure
promote interaction of
students from
different backgrounds
to work together?
Experience/behavior
question
(CRT, Yosso, 2005)
(CRP tenets, Ladson-
Billings, 1992)

What class activities
would you describe as
most helpful when
translated to patient
care?

Probe: What type of
activities has the
professor included in
lessons?

Probe: How do you
feel these activities
help you feel
comfortable working
with diverse
populations?
Experience question (CRP tenets, Ladson-
Billings, 1992)
How does this
process support
community utility
value?
Describe in what way
groups and/or partner
discussions/projects
are set up during
class?

Experience question
(Student Interview)
(Communal Utility
Value - Brown, Smith,
Thoman, Allen, &
Muragishi, 2015)

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
Probe: How do these
groups or partner
projects reflect the
classes diversity?

In what ways is
helping others through
athletic training
promoted?

Probe: What strategies
are used to create
motivation for
students to persist in
ATP and the AT
career?

Probe: How is the
material in this ATP
program connected to
each student’s
life/background?
Experience question (Communal Utility
Value - Smith, Brown,
Thoman, &
Deemer, 2015)
How do athletic
training program
professors
customize education
to meet the needs of
students who will
work with
underrepresented
populations?
Probe: How is
culturally responsive
curriculum included in
regard to textbooks,
supplemental articles,
projects etc?
Behavior question (CRP tenets, Ladson-
Billings, 1992)

How would you
describe your
instruction style
and/or theory?

Probe: How did you
form this style?
Opinion/values
question

What is your cultural
identity?

Interpretive question (CRT - Smith-Maddox
& Solorzano, 2002)

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
Probe: How do you
feel it affects your
instruction?

What is your educator
identity?

Probe: How do you
see your role as a
professor as it
intersects with the
education system,
colleagues, and the
student experience?
Interpretive question

What are your goals
as an educator?

Probe: What do you
expect to accomplish
at the completion of
this class?
Values question

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
Appendix B: Problem-Posing Open-Dialogue Questions

Before Observation 1 (October 2018):
1. Based on my research I have found a couple of articles that discuss sex and racial
information/differences in reference to nutrition/health promotion. These articles are
attached and listed below. Would you consider including these (or similar articles that
you may come across) as supplemental readings for your current class or future classes
to discuss race and sex as they relate to the classroom discussion?
o NCAA D1 Female Student Athlete dietary reporting
o Quality in health for diverse communities

2. In reviewing Chapter 5 of the Arnheim text (16th edition). There is mention of culture
on 2 pages - Page 138 in the 5-1 Focus section when discussing shifts to healthier food
and beverage options and on Page 143 in the Vegetarianism section. When covering
this content in class are discussion held about cultural, religious and/or racial
differences? For example, kosher diets.

3. Do you feel like these discussions have a place in the ATP classroom? How do you
feel students are generally exposed to conversations about cultural differences in topics
that are general across disciplines such as prevention and health promotion?

Before Observation 2 (November 2018):
1. Comment/Question: As I mentioned during our interview, I heard a couple of students
in the classroom referring to each other as the "Asians." I think that this is an important
aspect in the sense that although we don't always have open discussions about culture,
it tends to be notices and brings individuals closer together. You mentioned an
assignment that will be based on the articles from NATA news, would you consider
encouraging the students to focus on their specific cultures or those they feel close to?
This relates to a theory used in my study (Utility Value), which brings awareness
through interactions.
2. Two attachments/info:
o I am attaching info graphics that EDAC has posted on the NATA website. Have
you seen or used these before? They describe medical conditions as they relate
to racial/ethnic minorities and were created by Karen Hostetter, PhD, ATC,
James W. Ball, PhD, Jennifer Deluna, EdD, Roger Clark, PhD, ATC through
the grant program
o I am also adding a link to a podcast about sickle cell. This is more of a pop culture
recommendation to understand the racial history but can be a suggestion as
opposed to an actual assignment: https://www.npr.org/podcasts/628529252/the-
realness
Before Observation 3 (December 2018):

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CULTURALLY RESPONSIVE PEDAGOGY IN THE ATP CLASSROOM
1. As race becomes more and more of a discussed topic on college campuses what are
your thoughts on preparation for such discussions.
o Would you be comfortable leading a conversation in the class that addressed
prejudice, racism, current events (such as the synagogue shooting)?
o How would you address stereotypes and other comments that may come up
inadvertently through these types of exchanges?
o I believe there was a recent protest on campus in regard to cultural competence
and instruction. Did you hear about it or see it? What are your feelings about
that?
2. In reviewing the interviews that were conducted with the students, there were several
mentions about increasing direct conversations about culture in the classroom. What
are your thoughts on that?
3. Lastly, what were some take aways that you got from participating in this study?
o How did you feel about the questions, conversations and feedback from class
observations if provided?
o What suggestions would you make for me moving forward with analyzing the
data?

Abstract (if available)

Abstract This study applies the theoretical framework of critical race theory (CRT) through the pedagogical lens of culturally responsive pedagogy (CRP) and communal utility value to understand how cultural education is implemented in an athletic training program (ATP) course. The purpose of this problem-posing case study is to understand how current instructional practices in an ATP course align with CRP and communal utility value. The study was conducted through the duration of the Fall 2018 semester and focused on document analysis, open-dialogue, observations, and interviews with one faculty member and four students from their classroom. CRT was used to analyze the data through a priori codes based on four themes guided by the research questions. The findings demonstrated that race and culture are included in the program’s instruction on the surface

Linked assets

University of Southern California Dissertations and Theses

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Asset Metadata

Creator Denmark, Natalya Drukarova (author)

Core Title Teaching towards culturally responsive pedagogy in the CAATE accredited athletic training classroom

School Rossier School of Education

Degree Doctor of Education

Degree Program Education (Leadership)

Publication Date 04/30/2019

Defense Date 03/06/2019

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag athletic training,athletic training program,ATP,communal utility value,critical race theory,CRP,CRT,cultural education,cultural humility,culturally responsive pedagogy,diverse patient-centered care,instructional practice,OAI-PMH Harvest,patient-centered care,problem-posing methodology,STEM

Format application/pdf (imt)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Hinga, Briana (committee chair), Hasan, Angela (committee member), Stecyk, Shane (committee member)

Creator Email drukarov@usc.edu,natalya.drukarova@gmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-161292

Unique identifier UC11660094

Identifier etd-DenmarkNat-7371.pdf (filename),usctheses-c89-161292 (legacy record id)

Legacy Identifier etd-DenmarkNat-7371.pdf

Dmrecord 161292

Document Type Dissertation

Format application/pdf (imt)

Rights Denmark, Natalya Drukarova

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA