Background: The purpose of this cross-system and cross-cultural study was to investigate the current athletic training systems in the US and Japan, to assess US and Japanese athletic trainers' satisfaction with current athletic training ascension pathways in their respective country and to determine their interest in future transnational certification. Methods: Survey respondents included 1,060 Board of Certification (BOC)-certified athletic trainers who were National Athletic Trainers' Association members and practicing in the U.S. (344 males; 449 females; 267 abstained) and 110 BOC- and Japan Amateur Sports Association-certified athletic trainers currently practicing in Japan (45 males; 19 females; 46 abstained). A 108-question bilingual (back-translated), web-based, e-mail-distributed survey consisting of close-ended Likert-scale questions using a reverse-scale design and open-ended questions was used. Exploratory factor analysis was conducted to examine the reliability and validity of the Likert-type satisfaction scales. Repeated-measures analyses of variance (ANOVAs) (p.0.05) were conducted on scale-related data and one-way ANOVAs on individual question data to identify any within-group and between-group differences. Results: Ninety percent of the respondents (N = 1085) were at least somewhat satisfied with their athletic training (AT) "education" experience, including 63.4% who were very satisfied. Eighty two percent of the respondents (N = 896) were at least somewhat satisfied with their AT "certification" experience, including 49.6% who were very satisfied. Seventy six percent of the respondents (N = 856) indicated at least some interest in practicing AT abroad and 63.3% indicated at least some interest in obtaining a joint US-Japan certification if it became available. Three satisfaction scales with very high reliabilities were also validated in this study. Fifty three percent of respondents (N = 484) recommended reinstating a hands-on clinical assessment in the certification examination. Conclusions: Certified athletic trainers in the US and Japan were generally satisfied with the various ascension pathways they experienced but recommended reinstating a hands-on clinical assessment. The results of this study indicated a moderate to high functional equivalence between the US and Japanese athletic training systems, making the development of a joint curriculum and/or certification process a viable possibility. The majority of certified athletic trainers in Japan and the US were interested in the globalization of the athletic training profession. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://bibliotheek.ehb.be:2222/en-US/products/dissertations/individuals.shtml.]