MEXP Assessment of Learning

Final Reflection
Caitlin Benbow
4/29/2016

Introduction
The journey from an undergraduate student to a graduate student has been challenging,
frustrating, and overwhelming because the pace of learning is much faster than undergraduate.
Also, the expectations have increased two-fold and as a graduate student much more
responsibility is put upon the student than compared with undergraduate. However, the past 22
months have been well worth it because not only have I grown as a clinician, I have grown as
an individual and professional. I have shown immense growth in professional interactions,
interdisciplinary communication, and being confident in clinical decision making. Through the
transition of a year one graduate student to a graduate intern I have learned a lot about what it
will take to be a successful clinical exercise physiologist.
Overview of ACSM KSAs
The following ACSM KSAs have been continually addressed throughout my two years:
Core exercise physiology related anatomy and physiology, clinical exercise testing,
electrocardiography, medication, exercise prescription and programming, exercise safety, and
emergency procedures. The practical experiences in lab tied together the learning objectives of
exercise prescription and programming. In lab, I had to clinically apply the material I learned in
both 510 and 516 lectures. This was extremely beneficial because I learned how to individualize
exercise testing and prescription to the patients needs. In addition, I had to become comfortable
justifying the reason behind choosing protocols. EXP 503 and 510 have enhanced my
knowledge of cardiopulmonary anatomy and physiology. EXP 512 has prepared me to correctly
identify arrhythmias which helps during application based settings, such as, exercise testing and
telemetry reading in phase II cardiac rehab. Pharmacology helped me understand cardiac
medications. As much as pharmacology was helpful, I learned the most regarding
cardiopulmonary medications in 510 and 516. Having to classify medications and determine
exercise effects in both case studies and exercise testing settings greatly improved my ability to
understand medication effects. However, I felt like I lacked knowledge with diabetic medications.
I was told I have very proficient 12-lead ECG preparation skills and am very good with treadmill
protocols and making the patient feel comfortable. I attribute these proficient skills to my
rigorous academic preparation. The strategies I used in order to professionally grow include
professional reflections, utilizing extra practice time, collaboratively working with classmates,
and volunteering in mock scenarios.
During my second semester, the following ACSM KSAs were addressed:
Pathophysiology and risk factors (cardiovascular, pulmonary, metabolic, neuromuscular, and
orthopedic), continuation of exercise prescription and programming, nutrition and weight
management, human behavior, outcome assessment, and goal setting. Through lectures,
coursework, case studies, and my internships I have a wide variety of tools to utilize in terms of
exercise prescription and programming, weight management, and goal setting. I focused a lot
on goal setting with patients and setting SMART goals. I initially struggled creating SMART
goals when the goal was not exercise or nutrition related. However, through patient interactions
and reflections I learned that good follow up questions and reflective listening help create
tailored SMART goals for non-exercise related goals. Understanding lifting restrictions, heart
rate limitations, and FITT principles made creating exercise programs for phase II patients easy.
EXP 516 and 520 gave me the knowledge and confidence I needed to work successfully with
cardiac and pulmonary patients. EXP 515 taught me proper exercise modifications for a variety
of patient populations, including orthopedic and neurological conditions. There were a few
cardiac and pulmonary patients who had previous history for CVAs, orthopedic limitations, and
visual and auditory disturbances during my practicums that I attribute my success to EXP 515.
The first few times I worked with these patients I struggled with fast clinical decisions and did
not properly prescribe the safest modification. However, as time progressed working with these
patients, I improved my ability to adapt the original exercise prescription to best benefit them.

Most of the adaptations were equipment or range of motion changes. However, for the patients
with auditory disturbances, pictures and demonstrations were used to convey messages. I also
used a lot of tactile feedback to help the patients understand the correct movement. I found this
easier than adapting to patients with visual disturbances because it is harder to verbalize
directions. A lot of tactile feedback was used with these patients as well.
In EXP 510, I learned the most about the cardiopulmonary system. Especially in terms of
understanding responses in graded exercise tests between conditioned and unconditioned
patients. I learned about physiological adaptations that take place after a patient has committed
to an exercise program. Understanding the clinical aspects helped tremendously in my
internship experiences. EXP 503 expanded my knowledge of the musculoskeletal system and
how the systems are interrelated and work together. My proficiency in exercise testing, along
with my clinical decision making and justification, can be attributed to the rigorous and detailed
coursework of EXP 510. The clinical experiences provided in EXP 510 highlighted all of the
KSAs of health appraisal and fitness and clinical exercise testing. EXP 516 further improved
these skills and broadened my knowledge base to include chronic disease populations and
exercise testing. My transition from a second semester graduate student to my summer
graduate internship was seamless. My clinical and interpersonal skills shined in comparison to
the other summer intern. During my fall internship, the staff asked my opinion when it came to
decision making for patients exercise prescription because of my clinical skills and knowledge.
Throughout my internship experiences, I felt very confident in my ability to perform exercise
tests, prep the patient for a 12-lead ECG, analyze a rhythm strip, and understanding of cardiac
medications and their effects on exercise. Exercise testing is an area that I feel like I have
improved upon tremendously since entering graduate school. I have become more proficient at
providing cueing and tactile feedback, exercise blood pressures, ECG prep time, and overall
familiarity with various protocols. Being immersed in the exercise testing environment right
away, both in school and my clinical placements, has helped me overcome my nervousness and
showed me that I have learned best practice and possess the necessary skills to succeed in this
environment.
Reflection on Improvement Areas
Areas that I still need improvement in are speediness of assessing telemetry and
diabetic and pulmonary medications. I feel confident in my ability to accurately assess a rhythm
strip and decipher arrhythmias which we learned in EXP 512, such as: PACs, PVCs, A-fib, Vtach, and A-flutter within the six seconds it is on the screen. However, I am not proficient in
determining bundle branch blocks and heart blocks within the six seconds. In EXP 516 I was
able to apply rhythm identification when I performed GXTs. This practice lead to my ability to
determine the type of arrhythmia when analyzing an ECG strip from an exercise test at my
internships. Likewise, when I am monitoring a cardiac rehab session or performing a graded
exercise test I utilized the practice and feedback about how to quickly analyze a rhythm so I
would not take prolonged periods of time to figure out the arrhythmia. My goal for the spring is to
continue improving upon my ability to correctly identify rhythms and decrease the amount of
time it takes me to assess telemetry. I am seeing improvement from where I was during my
summer internship, but I know I need to keep working on this skill. The other aspect I want to
work on improving in the spring is understanding interactions and exercise effects of diabetic
and pulmonary medications. Through my internship experiences and case studies, I understand
cardiac medications and their effects. However, I want to learn more about pulmonary and
diabetic medications, especially their side effects and potential drug interactions. Through
patient experiences, I have gained understanding of potential side effects of different heart
medications and how this can affect their exercise capacity and daily energy levels.
Areas I want to improve upon during the spring semester are human behavior,
motivational coaching, and quality of outcome assessments. Assessing patient behavior is one

of the hardest concepts to grasp because in order to improve my ability I need repetitions of
patient intakes. I performed a few tobacco consultations during my summer internship, and
correctly identifying the patients behavior is key. Over the course of my summer and fall
internship, I have improved on my ability to assess patients overall demeanor. However, I want
to work on my ability to properly have a professional conversation with a patient, no matter how
they present in terms of personality and behavior. I observed the EPs during tobacco consults
and inpatient visits during my practicum experiences, and some of them change their approach
with defiant patients. I want to continue to improve my ability to know when I need to change my
approach with patients. I have worked with a diverse patient population and completed some
wellness coaching with overweight and obese patients. I have noticed improvement in my
motivational ability because of patients results and at home exercise adherence. However, this
is one very important aspect that I want to keep refining my skills in. My preceptor during the
summer was ACSM Wellness Coach certified; and two staff members at my fall site were CSCS
certified. I had the opportunity to look through those certification books and understand more
about the two certifications. This avenue is something that I want to pursue after graduation
because it will help me motivate and create tailored exercise prescriptions for diverse patient
populations and open up other career opportunities in various patient programs.
Final Clinical Experience Reflection
Mentoring and supervising the year one students for the first half of EXP 610 proved to
be more challenging than I first anticipated. The most challenging aspects of mentoring the year
one students were communication, providing clear instruction, utilizing constructive criticism
when appropriate, and providing clear and concise feedback. The challenging aspects of being
a supervisor were communication between my colleagues to convey the same message to the
year one students, evaluating performance, explaining my clinical decision making when
correcting the students, and teamwork within the wellness clinic department. However, with all
of the challenges came many positive experiences for me. I got to continually improve on my
clinical skills and decision making with providing the year one students with feedback and
corrections. My communication skills improved because I had to quickly adapt to communicating
with various professionals within our working clinic. Along with communication, was ensuring
that I carried out all of the tasks assigned by the department manager and delegating tasks
appropriate between my colleagues and year one students. The most important skill that I
learned through this experience was how to evaluate performances. When evaluating
performance I had to comment on areas of strengths and weaknesses. With the weaknesses, I
had to learn how to provide useful feedback, both tactile and verbal. Also, with performance
evaluations I found it helpful to allow the student to reflect on their performance prior to giving
my comments. Sometimes the students pushed back and became frustrated with the feedback
and comments. It was important for me to stand by my clinical decision and provide the student
with confidence that if they practiced the identified areas of performance that they would
improve their skills and grade. Overall, this seven week experience as a mentor and supervisor
benefited me greatly because I have discussed my clinical growth due to this experience in my
recent interviews.
Working with the stroke patients during our final practicum experience has been a great
learning experience. There are still obstacles that need to be addressed in order to make this
practicum the best experiencer it can be. Interdisciplinary communication is difficult through a
discussion board, the space is not functional when accommodating three or more patients, and
the experience needs more structure stemming from the instructors for exercise physiology and
physical therapy. With that being said, I learned a lot from this experience. Working with this
patient population challenged me when I created exercise prescriptions. There were a lot of
adaptations that were made in order to accommodate the needs of my patients. I also had a
very talkative patient, so staying on task was a challenge. However, I utilized the lessons I

learned from the EXP 520 experience and role playing with Dr. Kasimatis to keep the patient
focused and on task.
Professional Accomplishments
My first biggest accomplishment was during year one in EXP 520. I consider this a big
accomplishment because I saw a lot of improvement in myself from the initial client intake to the
discharge in terms of appropriateness of conversations. I learned through that experience that I
need to think twice before speaking with clients or putting them in a difficult situation. I also
learned during this experience that if patient education material is not meaningful it will do the
patient no good. During cardiac rehab, the patients did not receive educational materials
because they attended patient education classes. However, understanding patients helped with
having appropriate discussions with each patient which lead to the most beneficial educational
pieces for the patient. I will continue to refine my communication skills with patients because
everyone is different. I will also work on keeping conversations appropriate and focused on the
patients concerns. Along with this accomplishment, I would include the completion of two
tobacco consults. I was not required to complete tobacco consults, but I thought it would be a
great learning experience and help me understand areas that I still need further improvement in
when it comes to patient conversations and behavioral assessment.
My second biggest accomplishment was creating a balance assessment and program at
Gundersen. This stands out to me because it was a summer long project where I was able to
communicate with a physical therapist, work with Tiffany (an athletic trainer) on gait analysis,
present my proposal to the exercise physiology department, and create the necessary
documents for the assessment and program. The balance assessment was the Tinetti balance
assessment. This assessment is well recognized and is associated with many activities of daily
living which makes the fall risk assessment accurate for patients. Part of this project was gait
analysis. I was able to use CoachesEye and notes from the guest lecture of Dr. Bazzet-Jones to
present information on the gait section of the Tinetti protocol. The balance program incorporated
progression that I learned from lectures and recommended guidelines in terms of working on
agility, proprioception, and balance.
My third biggest accomplishment was creating patient education handouts at Watertown
over my fall practicum. I researched evidence based practices for education topics, altered the
layouts to make the handouts visually appealing, changed content to only include the most
important aspects, and provided user friendly links for patients to go for additional information.
Additionally, I instructed a variety of patient education classes. I have knowledge of how to
instruct classes based on: physical activity, stress, CVD risk factors, cholesterol, hypertension,
relaxation, nutrition, MyPlate, and sodium.
Throughout this program, what I am most proud of myself for is recovering from
adversity. The program presents many challenges along the way. There have been many times
where I felt like success was not possible. However, quitting is not in my nature. Overcoming
each challenging situation gave me more strength to keep pushing forward. Each challenge
presents its own learning opportunity. I have learned time management skills, interdisciplinary
communication, how to deal with confrontation, stress management, dictation, researching
skills, and proper patient interactions. The challenges have tested my ability to overcome
adversities; I can honestly say that because of the rigor of the program I have become a wellrounded clinician.
Professional Strengths
My current strengths include exercise testing and ECG prep, work ethic, patient
interactions, and teamwork. My weaknesses include reflective listening, tobacco consults,
exercise testing protocols other than treadmill, and motivational coaching. Goals that I will focus
on during the rest of my education are: performing cycle exercise test protocols, reflective
listening, improvement in utilizing behavioral strategies to help with behavioral changes dealing

with exercise and nutrition, and motivational coaching to help patients overcome barriers. I will
continue to work hard during the spring semester and improve in the areas that I need
proficiency in so I can become a RCEP and obtain a job in the clinical exercise physiology field.
Over the past two years, I have improved as an EP through better interdisciplinary
communication, dictation, listening, professional conversations, clinical decision making when it
comes to selecting exercise test protocols and exercise prescriptions, and patient education
instruction. Professional conversations, reflective listening, coaching, and patient demeanor
have all improved because of my experiences and constructive feedback in EXP 520 and guest
lectures with Dr. Kasimatis. Volunteering to role play during guest lectures significantly helped
during my internship experiences because most situations were never as difficult as they were
during class. Extensive exercise testing and ECG prep between EXP 510 and 516 made
performing tests during my internships a smooth transition. During lab and skill checks, more
aspects of clinical testing were performed than during my practicum experiences. It felt good to
be over prepared because I was able to perform exercise tests almost immediately after I
started. Working with a faculty member during EXP 520 informed me on areas where I needed
improvement before I entered my internship. During my internship, I was able to concentrate on
those areas by setting goals and challenges to help myself improve. And between EXP 520 and
my internships I feel like I have improved with my communication skills (verbal and written),
reflective listening, and professional conversations.
My clinical decisions and reasoning have evolved from taking the first idea to
considering multiple ideas and aspects. Through clinical reasoning, I can choose the best idea
that suits the individual patient. Patients will present with different attitudes, limitations,
circumstances, procedures, and beliefs; and sometimes it takes multiple ideas to come up with
the best plan for that patient. I also have learned to look back in text books and other resources
to help decide what might be best for a patient in terms of rehabilitation, home exercise,
psychological counseling, etc. Through my internships, I have improved upon staying within
boundaries of my scope of practice and referring patients to other professionals. I found that
patients are receptive when an explanation is given to them about various services and what
those services can offer them. Secondly, I found it very helpful to discuss with my fellow
colleagues ideas that I have for patients in terms of referrals and exercise prescriptions.
Sometimes I may not see everything about that patient or maybe a colleague has more
expertise in one area than I do. Collaborating with my colleagues during my internships has
helped me learn more about areas that I was not familiar with and improved the quality of care
my patients received.
Conclusion
When I look back on the course of my undergraduate and graduate education, the
moments that stand out to me I have experienced as a CEP graduate student. Those moments
stand out because I have had the most personal growth and gained an immense amount of
experience as a future clinical exercise physiologist through two incredible internships. As I
begin my career as an exercise physiologist, I want to continue making a difference in patients
lives. I will keep evolving as a clinician, but will always perform best practice as I was taught by
Dr. Reeves. As I move forward to graduation, I have set five year goals for myself. In five years,
I want to be a lead exercise physiologist within an organization that values patient centered care
and innovation, attaining my ACSM RCEP and certified cancer exercise trainer (CET), and
become involved in the WISCPHR leadership team. In closing, Maya Angelou once said they
may forget your name, but they will never forget how you made them feel.