Including Professionalism in the Undergraduate Curriculum Through the Use of Observation Hours and Recommended Readings
Jesse Pittsley, Ph.D.
Program Coordinator of Exercise Science
Winston-Salem State University
Winston-Salem, NC

Exercise physiologists who support the professionalization of the exercise physiology encounter numerous barriers when attempting to relay this message to others.  Exercise physiologists working in academia, like myself, are no different.  One of the most consistent dilemmas I’ve encountered is the identification of a proper, and politically savvy, section of the curriculum to broach the topics of accreditation, certification, and licensure.  Current exercise physiology (and more commonly, exercise science) curriculums are laden with science based courses that offer little room to address the issues surrounding the professionalization of the field.  Unlike Nursing and Physical Therapy programs, which have complete courses set aside for professionalism, exercise science programs appear more interested in shelling out numerous general knowledge courses that focus on historically related topics.  The purpose of this paper is to examine one way in which I plan to include the topics of professionalism in the curriculum where I currently teach.

 The Exercise Science curriculum at Winston-Salem State University recently evolved from a physical education curriculum that had been in place for several decades.  Like many Physical Education curriculums, the program required a one-credit course designed to send its majors into the community to observe professionals in the work setting.  This course offered an opportunity for students to see several different work settings before digging deep into the courses of the academic major and before the student teaching experience.  Along with the observations hours, this course required some journal writing and a final summary paper.  Those who designed the Exercise Science curriculum were wise not to remove this requirement from the program.  Not only are the observation hours a good introductory experience, the potential for thoughtful analysis significantly contributes to the overall curriculum. 

Observation hours are great opportunities for students to begin a reflective analysis of the field they are attempting to join.  It is often those hours where the student first learns what an exercise physiologist does in a “days work.”   They allow the student to investigate different employment sectors.  Furthermore, it is a great opportunity to interact with exercise physiologists and identify the advantages and disadvantages of working in the field.  And finally, observation hours may serve as a platform to discuss many of the concepts (such as code of ethics, scope of practice, certifications, licensure, and related issues) that are required by the different healthcare professions.

Course Design
Since this type of course may vary from program to program, I felt a brief description of the course would help orientate the reader.  To begin with, at Winston-Salem State, it is a one-credit course that is predominantly taken by sophomores and juniors in the program.  The course requires 30 observation hours that are preferably divided into two different settings.  As the instructor, I personally require the students to do half the hours in a “clinical setting” and the other half in a setting of their choice.  I chose to make this stipulation to prevent students regressing into an easy location placement and from spending all of the hours watching aerobics classes at a local health club. 

To begin the experience, students are required to make an initial phone call to the exercise physiologist explaining they would like to observe the person during a section of their work day.  I stipulate that the hours must be scheduled at specific times and days to discourage the “just show up when you want to” relationship.  I ask that the students arrive in appropriate attire and, if possible, avoid being a “wall-flower” during the experience.  Finally I ask the students to write a quick paragraph for every 2 hours they observe.

The Addition of Professionalism
The observation hours, in combination with the reflective writing, offers a satisfactory educational experience.  But, over the summer months, it occurred to me that I could make the experience more valuable.  I hypothesized that reflective statements regarding observation hours are likely to become repetitive and sterile beyond the first few entries.  Also, I recall from my own personal experience as a physical education student how little thought I placed into those perceived items of busy work.  Furthermore, exercise science students, who have even more of a sparse foundation in professionalism, would quickly run out of things to write about.  In the end it would receive a pile of journal entries containing little substance.  As a result, I felt I needed to make some changes to spur the students into a deeper analysis.

Traditionally, this type of course meets just a couple times per semester.  One meeting is scheduled to orientate the student and set ground rules.  The second meeting is used to bring closure to the experience.  Since I consider this too limited of interaction, the first change I implemented was to require to course to meet once every two weeks.  Although this does not sound like a significant change, raising the workload too high in a one-credit course could potentially create problems within the department.  My next change was to require an assigned reading regarding professionalism with 5 to 10 short-answer questions due each class period.  The questions are designed to encourage the students to investigate the readings and move beyond the usual “collegiate skimming.”  Finally, the actual class session is designed to merge talking about the observation hours with the topics surrounding professionalism. 

Recommeded Readings
If you are reading this brief paper you are most likely acquainted with a couple websites and journals dedicated to exercise physiology and professionalism.  The American Society of Exercise Physiologist has published a journal dedicated to the professional development of exercise physiology (Professionalization of Exercise Physiologyonline) since July of 1998.  In fact, the first few issues of this journal were published before ASEP ever had its first meeting.  For over six years, Dr. Tommy Boone has constructed essays and invited other authors to publish their analyses of this topic.  Since no other organization has approached exercise physiology in this manner, this journal is a rather novel publication containing several significant essays that will likely become cornerstone catalysts of the field's evolution.  Outside this journal, ASEP has published several significant position stands on accreditation, professional conduct, and licensure on its homepage that serve as important learning tools.  Over the past few days, in preparation of the course, I started to comb through the manuscripts posted on both the ASEP homepage and PEPonline in search for a handful of documents I would like to use in my course.  The following is a list and a short description of some I have identified.

Document #1
ACSM and Exercise Physiology: Past, Present, and Future
Roberts A. Robergs, Ph.D.
PEPonline,Vol 1 No 1 July 1998

Robert Robergs is the long-time editor of the Journal of Exercise Physiologyonline (ASEP’s research journal) and, therefore, has kept his contributions to PEPonline to a minimum.  But, as you will see when you read this article, when Robert Robergs focuses his energies to writing in essay format, he makes it count.  Although I’m young (still under that age of 30) and I still have a lot of people to meet, I am always willing to argue that Robert Robergs is the best critical thinker I have met.  If Dr. Robergs were to be given a cube, he would see the side almost all others fail to consider. As a result, his papers are edgy, controversial, and very interesting. One of the first articles written for PEPonline was a well-constructed and well-reference analysis of the evolution of exercise physiology under the rule of the American College of Sports Medicine. Throughout the paper, he points out that the relationship between ACSM and the field of exercise physiology was tragically flawed from the beginning.   From the failure to include the term “exercise physiology” in its flagship journal (which I would argue has worked to ASEP’s advantage) to the false acceptance as ACSM as the governing body of exercise physiology.  The article examines the history of this ACSM umbrella organization.  Although this article may be a bit politically risky for many of those in academia, it does require students to view the exercise physiology hierarchy from a different perspective. 

Document #2
The Dissection of Exercise Certifications 
Matthew G. Wattles, MS
PEPonline,Vol 5 No 3 March 2002

A very significant topic for exercise physiology students is certification.  There are over 200 certifications available for those looking to include exercise in their career.  In consequence, the business of exercise certification is a prime example of economic free market gone awry.  There are a lot of people interested in making money and academic certifications are no exception.  Unfortunately, combining this with how poorly professors address the issue certification in the classroom, there are many exercise students plagued with ignorance who are willing pay the cash for the wastes of paper.  Mr. Wattles (who incidently is now the ASEP President) addresses this issue by critically examining several popular certifications.  He doesn't pull too many punches in the process.  For instance, in response to the American Council on Exercise (ACE) exam he states:

“It is not necessary to spend a lot of time critiquing this exam. It is not worthy of a serious critique.  The American Council on Exercise has lobbied against any licensure of fitness professionals because the majority of their certifications are held by people who do not have college degrees. Furthermore, ACE’s cash cow comes from the money that they earn through their certifications.  The more people are able to sit for their exams, the more money earned by ACE.”

I plan to use this article in conjunction with certification information provided by ACSM and ASEP.  Certification is difficult to address with students.  Many employers consistently ask for some form of ACSM certification in their job postings.  I personally disagree with the ACSM certifications on the premises that they are not exclusionary of other healthcare professions.  This significant falter in logical thinking by ACSM has drastically hurt the professionalization of exercise physiology.  In contrast, ACSM does have monopoly in the certification market.  In short, it would be unethical not to broach that topic in class. 

Document #3
ASEP’s Standards of Professional Practice
ASEP Board of Accreditation
ASEP Board of Certification

Unlike the previous two items, The Standards of Professional Practice is not an article on PEPonline.  Instead, this is an official document of ASEP designed to orientate the reader to the responsibilities of an exercise physiologist.  In my opinion, this document separates ASEP from other “interest” organizations in the field of exercise physiology.  Fields such as nursing, physical therapy, and education pay ample attention to informing their students of proper conduct.  The "interest" organizations surrounding exercise physiology have failed in this objective.  Therefore, in addition to the other important documents that make up the professional infrastructure of the ASEP organization, the primary purpose of the "Standards" document was to correct this deficiency.  The document should serve as a cornerstone for every exercise physiology program. 

Document #4
The Exercise Physiology Code of Ethics: A Dilemma or a Standard of Conduct? 
Tommy Boone, Ph.D., MPH
PEPonline, Vol 5 No 11 November 2002 

Teaching the professionalization of exercise physiology without including an essay by Tommy Boone is like a chicken being a big fan of Colonel Sanders.  It just doesn’t make sense.  Dr. Boone has dedicated the most recent decade of his life to this plight.  One could probably use any one of his essays in such a course.  In this article, Dr. Boone examines each item of the ASEP Code of Ethics for exercise physiology.  Many students have an intuitive understanding of ethics, but this document has the potential to serve as a great teaching tool to help focus the students’ analysis.  I plan to use this essay in combination with the ASEP Standards of Professional Practice.  Both documents, as Dr. Boone has repeatedly stated should not be viewed as impenetrable documents that are not open to discussion.  Instead, such documents should be cross-examined much like the Constitution of the United States.  One could argue is that the purpose of professionalism is to question itself!  This essay is a good example of that.

Document #5
Guidelines for the Accreditation of Undergraduate Programs in Exercise Physiology
ASEP Board of Accreditation

Undergraduate study should always include an analysis of the academic coursework.  Students should understand the overall objectives of a program.  They should also understand where their specific program falls in the continuum of professional preparation.  To initialize this discussion, I plan to use selected aspects of the ASEP Accreditation document to draw the students' attention to specific issues and concerns about professionalism and credibility.  Do to the potentially dry nature of this document, it will be important to have well-constructed short-answer questions to help guide students through it. 

To accompany this document I will use an ACSM document describing the standards of its Registry of Undergraduate Programs.  Although I view this maneuver by ACSM as an emergency response to ASEP’s Accreditation standards and, therefore, do not support ACSM’s decision, the document does a good job of clearly outlining program objectives and the equipment exercise science programs should have.  Here, at Winston-Salem State, the laboratory equipment is very limited.  Therefore, it is strategic choice of mine to make the students aware of what our program does not have.  I’ve always found it amazing how a few unhappy students can influence the decisions of college administrators. 

Document #6
Questions Exercise Physiologists Should Ask Themselves
Tommy Boone, Ph.D., MPH

Finally, to teach the professionalization of Exercise Physiology, one must address licensure.  For students new to the idea of professionalism, licensure is an advanced topic that is constantly evolving.  Many exercise physiologists see licensure as the answer to all of their woes.  This is a logical conclusion since health care professions such as nursing, who have a solidified and important role in society, are licensed.  Unfortunately, this type of analysis is an over-emphasis of the “ends” without enough attention placed on the “means.”   Healthcare professions that have licensure have also established accreditation programs and exclusionary certification processes.  These programs have been in place for quite some time.  Exercise Physiology has not been as productive in its evolution.  Few states have accredited undergraduate programs and those possessing the exclusionary EPC certification are sparse.  As a result, the public has not been presented with a consistent definition of an Exercise Physiologist.  In this position stand, Dr. Boone takes a step back from the euphoric view of licensure and offers a much more poignant analysis of this final capstone of most healthcare professions.  This document is a quality teaching tool.  It is a fantastic question-by-question analysis of what licensure can and cannot do for exercise physiologists. 

Final Thoughts
I’ve pondered for several months how I would include the teaching of professionalism in the program I teach in.  Few programs have designated courses assigned to teach the topics of accreditation, certification, and licensure.   Therefore, most of us will have to be creative in how we include this material.  It my opinion, it is unethical not to teach about ASEP and about professionalism.  Students need to be aware of how exercise physiology has fallen behind the other healthcare fields, what can be done to prevent this from getting worse, and what the American Society of Exercise Physiologists is doing to help students throughout the United States.