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Keywords

Clinical Practice in Athletic Training

Abstract

Introduction: Engaging in difficult conversations is central to leadership growth and requires sustained effort to refine and strengthen these skills. Leaders not only need to navigate the complexities of their role within an organization, but also the intersectionality of interpersonal dynamics, emotional intelligence, structural hierarchies, and the nuanced environments that influence how communication occurs. Furthermore, leaders must adapt to role expectations that shift across clinical, academic, and administrative contexts, adjusting their approach to engaging in conversations based on these complexities. As part of a larger research project examining difficult conversations, this portion of the study explored how leaders in athletic training (AT) developed the relational and organizational awareness needed to navigate these complex interactions. Methods: In this grounded theory qualitative study, athletic trainers holding leadership positions within the Strategic Alliance were purposively recruited. Fifteen leaders participated (7 female, 8 male; age = 51.1 ±5.7 years), representing NATA (n=12), CAATE (n=2), and the NATA Research Foundation (n=1). Data saturation determined the final sample size. Participants completed Zoom-based, semi-structured interviews guided by a protocol validated by a panel of experts and piloted with three individuals. All interviews were audiorecorded and transcribed verbatim. Data were analyzed using grounded theory with open, axial, and selective coding to identify central themes and subthemes. Trustworthiness was ensured through member checking, peer review, and multi-analyst triangulation. Results: As part of a broader qualitative study of AT leaders’ perceptions of navigating difficult conversations, this portion of the analysis produced four themes: (1) building trust and collaboration, (2) emotional intelligence in relationship building, (3) impact of organizational politics and culture, and (4) interpersonal dynamics and role expectations. First, building trust and collaboration proved vital for successful engagement in high-stakes conversations. Strong interpersonal relationships grounded in trust influenced both the tone and content of conversations, thereby shaping the broader organizational culture. Participants described trust as a reciprocal process that develops over time, suggesting that these strengthened relationships positively affected how future conversations are approached and experienced. Second, leaders emphasized the importance of emotional intelligence in navigating challenging discussions, noting that self-awareness, empathy, and emotional regulation shaped how they framed and managed interactions and built relationships. Third, participants highlighted the influence of organizational politics and culture, explaining that norms and hierarchies within their professional environments often dictated how conversations unfolded and the strategies used. Finally, leaders described how interpersonal dynamics and role expectations, including distinctions between peers, supervisors, evaluators, and high-status stakeholders, required them to adjust their communication style to the relationship and context. They also noted clear differences between conversations occurring in formal employment roles and those taking place in leadership or committee settings, underscoring the distinction between management responsibilities, supervisory responsibilities, and broader leadership expectations. Translation to Practice: Findings from this analysis illustrate the complex interplay of relational and organizational factors that continually shape communication practices. This underscores the need for professional development initiatives that strengthen leaders’ capacity to engage effectively in difficult conversations. Such initiatives should emphasize practical strategies for building organizational and relational trust, regulating emotional responses, cultivating emotional intelligence, and tailoring communication styles based on relationship type and role expectations. Additionally, leaders may benefit from training focused on creating psychologically safe environments where honest, open dialogue is encouraged across hierarchical levels. Individuals who feel psychologically safe are more willing to participate in challenging discussions, reflect openly, and engage with greater intentionality. By enhancing understanding of how interpersonal and organizational factors shape communication, leaders can improve the quality and effectiveness of conversations that influence collaboration, evaluation, performance, and decision-making.

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