Board of Certification Examination Achievement Gaps as a Barrier to Diversifying the Athletic Training Profession

Abstract

Context: Achievement gaps have been well documented in medical and health professions. Previous research indicates that underrepresented minorities consistently fall short of Caucasians in performance on standardized credentialing exams. Objective: To determine the relative risk of failure between ethnicity and first-time and retake pass rates on the Board of Certification, Inc. (BOC) examination. Design: Non-experimental, descriptive, retrospective analysis. Setting: Professional master's degree athletic training programs. Participants: 3742 unique candidates with 4425 attempts between exam window 1 of 2011–2012 (April) and exam window 5 of the 2019–2020 (February) cycle of the BOC examination were included in the analysis. Main Outcome Measures: The variables of interest included ethnicity as self-selected by the candidates, attempt number, result of each attempt, year, and testing window. Results: Examination candidates self-identified as Caucasian (60.4%, n = 2261/3742), Unknown (withholding an ethnicity selection) (10.6%, n = 395/3742), Hispanic (8.6%, n = 320/3742), and African American (8.4%, n = 313/3742). On the first attempt, Caucasian candidates pass at a rate of 93.2% (2107/2261), African American candidates at 74.8% (234/313), and Hispanic candidates at 86.9% (278/320) (overall first-time pass rate for this sub-sample = 90.5%, 2619/2894). The relative risk of first-attempt failure is higher for African Americans compared to both Caucasian (relative risk = 3.706, 95% CI = 2.903–4.730, p<0.001) and Hispanic candidates (relative risk = 1.923, 95% CI = 1.368–2.703, p>0.001). For Hispanic candidates, the relative risk of first-attempt failure was about 50% lower than Caucasian candidates (relative risk = 0.519, 95% CI = 0.377–0.715, p<0.001). Conclusions: Achievement gaps exist between Caucasian and ethnic minority groups in athletic training. Diversification of the athletic training workforce will require ensuring equity in preparation for and success on the BOC examination.