The Commission on Accreditation of Athletic Training Education (CAATE) officially formed in June 2006.1 Prior to this event, the CAATE existed as the Joint Review Committee on Educational Programs in Athletic Training (JRC-AT) within the Commission on Accreditation of Allied Health Educational Programs (CAAHEP). As a committee under the CAAHEP, the JRC-AT recommended the accreditation of professional athletic training programs, but it did not have the official authority to grant accreditation nor the distinction of being an independent association. The JRC-AT moved forward to become the independent accrediting agency for athletic training education when it evolved and became the CAATE. By doing so, the CAATE was tasked with creating all of the administrative functions that accompany the development of a new organization. Deeper than organizational policies and procedure, however, it also had to create its culture: the knowledge, beliefs, practices, and values defining who they are and how they will act.
The purpose of this article is to inform readers about the intent, development, composition, and implementation of the CAATE Code of Ethics. Parts of an organization's culture are implicit and take time to develop as the organization goes forward with its work; however, any new organization must develop and communicate the values it strives to achieve. These values can be expressed as a code of ethics. In addition to communicating what the organization values, a code of ethics may also guide decision making for the organization's members and evaluate the outcomes of their decisions.
Intent of the Code
As previously noted, the CAATE was the outcome of the JRC-AT leaving the CAAHEP and transitioning into an independent organization.1 Although the CAATE was independent of the CAAHEP, it still shared a similar purpose as the CAAHEP, which was the accreditation of health care programs. To fulfill this purpose, the CAATE needed to be recognized by certain authoritative bodies in the world of program accreditation. The two associations the CAATE identified during its inception2 were the Association of Specialized and Professional Accreditors3 (ASPA) and the Council on Higher Education Accreditation4 (CHEA).
Developing a code of ethics served a practical purpose for the CAATE with its goal to become a legitimate accrediting body. From an operational perspective, however, the CAATE Code of Ethics communicated the organization's values to itself, its associates (which includes CAATE Commissioners, committee members, site visitors, and CAATE paid staff), and the programs it accredits. Based on Schlabach and Peer's5 synthesis of the literature, a profession can be characterized as possessing a specific knowledge base, providing a unique service, managing this service, and accepting regulatory control. Individuals who pursue the respective profession also agree to abide by the norms, beliefs, and values of their chosen profession. Although creating a code of ethics does not make an association a profession, Meyers6 argues for any association to create a code of ethics to set the right tone for its members when conducting organizational activities. The CAATE is mainly an organization of volunteers who are trained health care professionals, not professional accreditors; consequently, it was imperative for the CAATE, its associates, and its constituents to be cognizant of the values and principles guiding its work and decision making as professional accreditors versus health care providers.
Development and Composition
Shortly after the CAATE was created, the organization's leaders formed the Ethics Ad-Hoc Committee. In time, this workgroup evolved into the standing Ethics and Professional Standards Committee. The original and current members of this committee were selected because of their expertise with professional ethics, program administration/leadership, program accreditation, organizational culture, and decision making. Today, the purpose of the Ethics and Professional Standards Committee is to oversee the CAATE Code of Ethics and investigate reported ethical violations.7 The charges for the original ad-hoc committee, however, were more developmental in nature: (1) examine the conflict of interest form and confidentiality statement; (2) develop the CAATE Code of Ethics; (3) develop a plan of action to address violations of the CAATE Code of Ethics; and (4) develop roles and responsibilities to more fully include the ethical practices of the commission and its committees, site visitors, and sponsoring institutions and their program official/administrators
The conflict of interest form and confidentiality statement—documents volunteers signed prior to beginning their service with CAATE—required little review; therefore, most of the adhoc committee's initial work focused on developing the CAATE Code of Ethics and related policies. At the time of this work, the ad-hoc committee was not aware of any validated instruments for identifying and ranking professional values; consequently, developing and drafting the CAATE Code of Ethics was a multi-staged process guided by the work of Raths et al.8 In short, the ad-hoc committee administered a survey it created from value-focused documents among health care organizations such as athletic training (eg, National Athletic Trainers' Association [NATA] Code of Ethics), physical therapy, and nursing.
The committee identified 14 health care values from these documents and asked the original CAATE Commissioners (8 of the 9 Commissioners completed the survey) to select from the list 5 values important to them and rank their top 3 values. Some of the values presented in the survey were integrity, altruism, loyalty, truth/honesty, respect, accountability, competence, and caring. Using the Commissioners' completed surveys, the ad-hoc committee performed the following tasks: (1) calculated the responses to identify the perceived important values and the highest ranking values, (2) compared these results with the original value-focused documents used to develop the survey, and (3) filtered the findings through the version of the ASPA Code of Good Practice9 that existed in 2007 (Figure 1). From this process, which has since been validated with other research,10 the ad-hoc committee drafted the CAATE Code of Ethics. This first version was approved by the CAATE Commissioners in 2007 and is still the current version of the CAATE Code of Ethics (Figure 2).
Developing the Commission on Accreditation of Athletic Training Education (CAATE) Code of Ethics. NATA = National Athletic Trainers' Association; ASPA = Association of Specialized Professional Accreditors
Definitions of the 5 principles of the Commission on Accreditation of Athletic Training Education (CAATE) Code of Ethics.
Identifying and communicating the values guiding the CAATE was an important accomplishment, but it did not complete this foundational work. Along with a code of ethics, it was imperative for the organization to write and implement policies and procedures for reporting and investigating complaints and, when required, administering sanctions for ethical violations.11,12 It is beyond the purpose of this article to describe the specific policies and procedures with reporting and investigating ethical complaints; however, it is important to highlight two key guiding principles for implementing the CAATE Code of Ethics.
First, the CAATE Code of Ethics guides the actions of only CAATE associates. Although this aspect of the process may seem self-explanatory, the issue is more complex when considering the vision of the CAATE is to ensure accrediting excellence across the continuum of athletic training education.13 As noted previously, one of the charges assigned to the Ethics Ad-Hoc Committee was to correlate ethical principles to the roles of commissioners, committee members, site visitors, and members of programs accredited by the CAATE. Each of these groups is part of the continuum of athletic training education; however, the individuals of each group fulfill different functions and report to different authorities as they perform their respective duties. CAATE associates (ie, Commissioners, committee members, site visitors, and paid staff of CAATE) are obliged to follow the policies and procedures needed to manage the organization; however, members of accredited programs (ie, administrators, faculty, preceptors, staff, and students) are compelled to follow the policies and procedures managing their college/university and the CAATE accreditation standards for their respective program (Figure 3). When an individual for one of these groups fails to fulfill obligations in an ethical manner, the consequences of that failure must come from the respective institution with authority over the individual and his or her actions in that situation.
Hierarchy of ethical responsibility. CAATE = Commission on Accrediation of Athletic Training Education
Paid staff for the CAATE and its volunteer associates (ie, site visitors, commissioners, and committee members) are responsible for following the policies and procedures to run the CAATE as guided by the CAATE Code of Ethics. If it is determined from the reporting and investigating procedures following a complaint that a CAATE associate violated the Code of Ethics, the sanction imposed on the individual would range from simple admonishment to full suspension from the CAATE for a designated period of time. Although the CAATE may also report the unethical behavior to another professional body (eg, Board of Certification, Inc), the primary jurisdiction the CAATE has over the individual is the person's continued role with the Commission. Any other sanction cannot be imposed by the CAATE.
Although members of CAATE-accredited programs are not subject to the CAATE Code of Ethics, they are expected to fulfill their ethical duty to the accredited program, and one aspect of this duty is to maintain the program's accreditation. After lengthy discussions and additional research, the CAATE added an ethics-focused standard to the accreditation standards for professional, post-professional degree, and post-professional residency programs. This new standard states these programs “must demonstrate honesty and integrity in all interactions that pertain to the athletic training program.”14 The purpose of adding this standard was to clarify for all involved parties that maintaining CAATE accreditation also means demonstrating honesty and integrity in all of their program-related activities. Failure to demonstrate this standard could negatively affect the program's accreditation. It is important to note that monitoring the ethical behaviors of program members is managed through the policies and procedures for earning and maintaining CAATE accreditation (ie, the Standards for the respective program); they are not monitored via the policies and procedures requiring CAATE associates to abide by the Code of Ethics. Also, programs are not required to submit narratives or evidence demonstrating compliance with this standard; however, site visitors may report the program as being non-compliant with the standard if site visitors identify unethical practices during a site visit.14
The second foundational principle for implementing the CAATE Code of Ethics was to identify what would satisfy a legitimate complaint. Defining the criteria required to submit a complaint was needed to differentiate rumors from actual complaints based on genuine evidence that could be investigated. Consequently, an actual complaint for violating the CAATE Code of Ethics must satisfy two overarching requirements: (1) the complaint must provide all required information (ie, name of the CAATE associate being accused; the accused's position in CAATE; the specific principle/conduct statement allegedly violated; detailed description of the incident; documentation supporting the complaint; and possible witnesses), and (2) the complaint must come from a person with direct knowledge of the incident. Satisfying these requirements is needed to conduct a fair and objective investigation of an alleged violation.
Seeking CAATE accreditation is a voluntary action, and at all possible times, the CAATE values the autonomy of its accredited programs. To be accredited, however, means accepting certain standards, such as complying with a higher level of accountability and demonstrating a greater level of professionalism. The CAATE's part in this relationship is to demonstrate honesty, respect, accountability/responsibility, integrity, and fairness as it makes decisions regarding the accreditation of athletic training professional, post-professional, and residency programs.
Since the inception of the CAATE, the Ethics and Professional Standards Committee has received three complaints. Two of these complaints solely addressed a program member's compliance with accreditation standards. The third complaint also focused on compliance with accreditation standards, but it also partially addressed issues with site visitor training. Consequently, these three complaints were managed via the policies and procedures for accrediting athletic training programs. There have been no reported violations of the CAATE Code of Ethics by CAATE associates, which is encouraging considering the CAATE has been independently accrediting athletic training programs for 13 years.
- Commission on Accreditation of Athletic Training Education. Historical overview. 2014; Author. https://caate.net/historical-overview/. Accessed September 1, 2014.
- Commission on Accreditation of Athletic Training Education. Overview of the Commission. Round Rock, TX: Author; 2006.
- Association of Specialized and Professional Accreditors. The Authoritative Voice of Specialized and Professional Accreditation. Chicago: Association of Specialized and Professional Accreditors; 2013:1–2.
- Council for Higher Education Accreditation. Council for Higher Education Accreditation. 2018; Author. https://www.chea.org/. Accessed December 1, 2018.
- Schlabach GA, Peer KS. Professional Ethics in Athletic Training. St. Louis: Mosby Elsevier; 2008.
- Meyers C. Codifying but not professionalizing bioethics. Am J Bioethics. 2005;5:68–69. doi:10.1080/15265160500245550 [CrossRef]
- Commission on Accreditation of Athletic Training Education. Committees. 2018; Author. https://caate.net/committees/. Accessed December 1, 2018.
- Raths LE, Harmon M, Simon SB. Values and teaching: working with values in the classroom. Columbus, OH: Charles E. Merrill Publishing Company; 1973.
- Association of Specialized and Professional Accreditors. Code of Good Practice. 2017; Author. https://www.aspa-usa.org/code-of-good-practice/. Accessed December 1, 2017.
- Schlabach GA. Professional values: cultivating the social contract with the seeds of professionalism. Int J Athl Ther Train. 2017;22:11–18. doi:10.1123/ijatt.2016-0061 [CrossRef]
- McNamara C. Complete guide to ethics management: an ethics toolkit for managers. 2015; Free Management Library. http://managementhelp.org/businessethics/ethics-guide.htm. Accessed October 8, 2015.
- Association of Corporate Counsel. Top Ten Tips for Developing an Effective Code of Conduct, vol 2015. Washington, DC: Author; 2010.
- Commission on Accreditation of Athletic Training Education. About. 2018; Author. https://caate.net/about/. Accessed December 1, 2018.
- Commission on Accreditation of Athletic Training Education. Updates to standards: ethics standard. 2016; Author. http://caate.net/updates-standards-ethics-standard/. Accessed July 1, 2017.