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International Arrangement: Impact on Athletic Training in Individual States

The International Arrangement (IA) for the profession of athletic training and therapy plays a key role in optimizing care, injury prevention, rehabilitation and supporting the rights of patients and the public to achieve their potential to live well. The IA ensures comparable best practices, quality education and professional standards. The IA provides an opportunity for Athletic Trainers (ATs), Athletic Therapists and Sport Rehabilitators to be mobile on a global scale by creating a pathway to challenge each other’s credentialing exam.

The current credentialing organizations included in the IA are Athletic Rehabilitation Therapy Ireland (ARTI), British Association of Sport Rehabilitators (BASRaT), BOC (USA) and Canadian Athletic Therapists Association (CATA).

Education and Credentialing

The IA organizations, in collaboration with International Consultants of Delaware (ICD), participated in an analysis of education and credentialing standards. The IA organizations, via cooperation and collaboration, established minimum educational standards for the IA. These standards serve as a benchmark during the process of credentials evaluation conducted by ICD to ensure that entry-to-practice skills and competencies as an athletic training and therapy professional have been acquired by the applicant. This is done through a detailed analysis of academic courses, syllabi, continuing professional education and other related activities that describe an applicant’s cumulative knowledge, abilities, behavior and expertise.

Anyone credentialed (certified or registered) by an IA organization qualifies and may submit an application to challenge the exam of any other IA organization.

Following is the process an AT or therapist in one of the included organizations goes through to become BOC certified through the IA:

  • Create a BOC profile and initiate the BOC exam application
  • Apply for an evaluation to be completed by ICD
    • Requires applicant to submit primary source documentation for identification, education or certification
  • ICD performs evaluation and submits report to the BOC
  • BOC reviews the evaluation and if gaps identified, directs the applicant how to bridge those gaps
  • All applicants have gaps relevant to health care delivery in the U.S. and are required to review pertinent materials and take a short assessment
  • Once all gaps have been bridged, the applicant is eligible to take the BOC exam
  • If the applicant passes the exam and is certified, the applicant must meet recertification requirements just as all other certified ATs are required to do

Impact at State Level

With the IA in force, the BOC recommends that state regulators assess the following potential impact this might have in individual states. The main question to ask is if a state practice act and/or rules allow ATs certified through the IA to obtain a license if the AT:

  • Does not have U.S. citizenship?
  • Has a degree outside of the U.S.?
  • Has a degree from a program that is not accredited by CAATE?
  • Does not speak English as their primary language?

With the IA being a fairly new opportunity, now is a beneficial time to pose these questions and determine any needed changes to accommodate international applicability. If you have questions regarding the IA, please contact the BOC at

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