Carroll University

Final
Reflection
EXP 620

Casey Wusterbarth

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My development of becoming a clinical exercise physiologist was challenging
due to the rigorous curriculum of the Carroll University program. The rigorous
curriculum required me to immediately get myself into a role of a professional
healthcare provider, an aspect that I believe has allowed me to progress more
efficiently. The development into a medical professional began in the first semester
of the MEXP program. The first semester curriculum provided a base of knowledge
that all clinical exercise physiologists need. These courses, the assignments
provided, and labs allowed myself to excel in the areas of different populations
including the apparently healthy.
Specifically, advanced exercise testing and prescription provided me with a
basis of how to classify an individual as being low, moderate, or high risk based on
the risk factors of cardiovascular disease. By knowing these risk factors a proper
exercise prescription and special accommodations or precautions can be made for
each patient. In addition to learning how to properly classify a patients risk through
the ACSMs guidelines, the learning of the AACVPR risk classifications provided me
with a knowledge of classifying patients prior to performing an intake within the
cardiac rehabilitation department at Aurora Sheboygan Memorial Hospital during my
internship. The lab for advanced testing and prescription also provided me an
understanding of the different protocols that may be used for a wide variety of
patient populations. This gave me increased insight on how to select a proper
modality for each patient. This skill was especially important during my fall
internship at St. Lukes Medical Center because of my time in inpatient cardiac
rehab. By knowing what modalities can be performed given a patients functional
ability I was able to prescribe appropriate exercise to all patients whether they were
right out of surgery in ICU or in the days after surgery. I was able to modify
exercises for patients that were unable to stand or ambulate in order to complete
their exercise for the session. This helped to prevent the patients from becoming
severely deconditioned, especially the ones that have suffered complications postsurgery. Also, the lab for advanced exercise testing and prescription allowed for me
to practice a wide variety of skills including holter tests, different aerobic fitness and
muscular fitness protocols, and performing a GXT test/stress test, which definitely
helped during both of my internships where I performed many stress and VO2 tests.
I now believe I have become proficient in performing and conducting stress tests on
apparently healthy and high risk individuals.
Although many assignments have helped me progress as an EP, I would have
to say the skill checks required for each lab may have been the most beneficial for
me in regards to becoming a professional. The skill checks required me to
continually practice my explanations of each test and allow the process to become
natural to me. The rigorous grading of these skill checks also provided me with an
awareness of my ticks/habits while speaking and conducting tests. By knowing
these ticks, I have improved my overall presence and professionalism when
speaking to both patients and cardiologists. However, I still sometimes find myself
correcting them during class. The last component of this class that improved my
skills as an EP and my clinical decision-making was the case studies. These allowed
me to think critically about the proper exercise prescription for these mock patients.
This specifically helped me in my fall internship, given the wide variety of admission
reasons and comprehensive medical histories of each of the patients.

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In regards to the experiences during the first semester, the greatest benefit
may have come from the Curative Care 6MWT with the patients. This specific
experience allowed me to refine my skills on one of the most widely used protocols.
Through performing this protocol numerous times during that experience I became
comfortable explaining the protocol to each pulmonary patient during my internship
at Aurora.
The second major course that provided me with a significant amount of
knowledge and gave me an advantage in securing an internship within cardiac
rehabilitation departments was the electrocardiography course. This course
provided me with a knowledge that most applicants have not become proficient in.
During my internship I was in charge of supervising up to four patients during each
cardiac rehab session. This made being knowledgeable of ECG rhythms very
important. I demonstrated this knowledge numerous times during my internship
identifying many abnormal rhythms including, bundle branch blocks, V-Tach, and Afib. By completing this course I was confident in my abilities to recognize when
there was a rhythm change for a patient during my internship. I also was able to
gain more practice in rhythm strips during my fall internship. During my time seeing
patients in inpatient cardiac rehab, I had to identify and document their rhythm pre,
during, and post-exercise. I do believe I gained more knowledge in rhythms during
my fall internship because I was exposed to a wide variety of patients, unlike my
time at my summer internship. Overall, the first semester definitely gave me a
significant amount of knowledge in relation to prescribing exercise to apparently
healthy individuals and the specific protocols used, however, the most beneficial
part of the curriculum at Carrolls MEXP program came from my second semester,
where I became proficient within the most crucial KSAs of the Registered Clinical
Exercise Physiologist. An additional aspect that gave me confidence in my ability to
provide safe and effective care was the completion of the advanced cardiac life
support course. This course was definitely challenging being that it was only three
days and required the memorization of many different scenarios. Although it was
difficult at the time, my confidence grew as a clinical decision maker knowing that I
could provide emergency cardiac care to my future patients.
During the second semester the most important class that gave me the
greatest benefit was the exercise in the prevention and rehab chronic diseases and
disabilities course. This course provided me with the base of prescribing exercise to
high risk cardiac, pulmonary patients, and comorbid patients. The case studies
specifically allowed me to practice my clinical decision-making skills in regards to
initial prescriptions and goal setting for comorbid patients with cardiac and
pulmonary diseases. This practice allowed me to excel in my internship and provide
patients with a proper exercise regimen that was appropriate given the patients
characteristics and functional ability. The second semester also helped me
throughout my fall internship at St. Lukes Medical Center. During my time there I
primarily worked in inpatient cardiac rehabilitation. This environment was
challenging and required a completely different set of skills that I learned from 516.
Although the class prepared me for the physical activity recommendations and
general guidelines when treating a patient, there was much more to learn. This
included the amount of equipment that most patients were attached to, which
included chest tubes, suctions, foleys, etc.

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In addition to the knowledge that I gained exercise in the prevention and
rehab of chronic diseases I was able to practice my initial skills in interviewing
during EXP 520. This class was very challenging for me because of my weaker
interviewing skills; however, over the course of meeting with my client I believe Ive
become more comfortable with interviewing patients and gaining more confidence
in my ability. During my summer internship I also was able to practice this skill in
order to become more proficient. I performed many intakes and reassessments of
rehabilitation patients during both my internships which helped me increase my
confidence in asking open-ended questions that will result in a greater amount of
feedback and information regarding their medical history. In addition to getting
confidence regarding intakes and assessments, EXP 520 increased my ability to
provide individualized patient education to inpatients. The tailoring of the patient
education that I did in 520, allowed me to be more proficient in my ability to
individualize each general patient education that was given to inpatients.
The specific KSAs that I believe I became proficient in over the course of the
fall, spring, summer internship, and fall internship include:
1.3.15: demonstrate the ability to provide testing procedures and protocol for
children and elderly with or without various clinical conditions
1.3.16: evaluate medical history and physical examination findings as they
relate to health appraisal and exercise testing
1.2.1-1.2.12: general knowledge of pathophysiology of CMP diseases and risk
factors
1.1.1-1.1.14: general knowledge of physiology and exercise science
1.4.4: identifying ECG patterns at rest and during exercise in patients with
pacemakers and
1.4.5: identify resting and exercise ECG changes
1.4.9: identifying potentially hazardous arrhythmias
1.4.12: administer and interpret basic resting spirometric tests and measures.
1.4.13: locate the appropriate sites for the limb and chest leads for resting,
standard, and exercise ECGs.
1.5.1: knowledge of common drugs from each class
1.5.2: knowledge of the effects of substances on the exercise response
1.7.4: knowledge of group exercise leadership techniques
1.8.1-1.8.18: general knowledge of nutrition and weight management
1.10.1-1.10.18: general knowledge of safety, injury prevention, and
emergency procedures
1.11.2: knowledge of and the ability to use the documentation required when
a client shows signs or symptoms during an exercise session and referred to a
physician
1.11.9: Ability to develop and administer educational programs and
educational materials
2.2.1-2.2.4: Cardiovascular pathophysiology and risk factors
3.2.1: pulmonary pathophysiology and risk factors
4.2.1: metabolic pathophysiology and risk factors

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The specific KSA that I believe I did not have the greatest proficiency in prior
to entering the fall semester of 2015 was the medications and classes. However,
over the course of my fall internship, I was exposed to more comprehensive
patients, specifically inpatient cardiac rehab. This allowed me to become more
familiar with an extensive list of medications that most patients were on
immediately post-surgery.
Ive had the chance to become more proficient in these KSAs throughout the
entire 1st year curriculum and especially both of my internships. These KSAs
specifically stand out to me because of the courses that Ive taken and the
experience that Ive gained through my summer and fall internship. Through my
internship I was able to supervise patients, develop exercise prescriptions, educate
patients on numerous different topics of CVD, and reassess most patients
throughout their time at cardiac and pulmonary rehab. By surrounding myself with a
diverse population of admission events I was able to gain knowledge and continue
to educate patients on their conditions. In regards to the knowledge of common
medications, I was able to see every patients snapshot of their medical history
which contained their medication list along with dosage. This information helped me
to recognize more medications and expand my knowledge on the different classes
of CVD drugs and the effects that they have during rest and exercise.
The proficiency of these KSAs has helped me identify my three biggest
accomplishments during my two years of the curriculum. I believe my first biggest
accomplishments during the first year curriculum was receiving my first A on the
case study portion of an exam. This grade helped me realize that I was becoming
more familiar with the material and enhancing my clinical decision-making skills.
This specific grade also stands out to me because I worked very hard to familiarize
myself with the material and it showed on my performance. This grade could not
have been achieved without the help of detailed PowerPoints and review days.
These review days solidified the information for me. My second biggest
accomplishment was during the summer internship. I was able to identify many
abnormal rhythms during supervision of my patients. I addressed the situation with
my supervisor in a calm manner and was able to stop the patient immediately to
prevent any further complications or emergencies. I was given praise by my
supervisor for the way I handled those certain situations. This event gave me a
considerable amount of confidence in my ability to remain calm during stressful
situations, an aspect of an EPs job that I was previously concerned about. A third
accomplishment, was performing and completing a thesis on the validity of physical
activity trackers. This accomplishment required a lot of patience and critical
thinking to complete the data collection and also the article. I do believe I may still
be lacking the ability to analyze data appropriately, but through my improved
problem solving and critical thinking skills has allowed to explore my options of
going on to complete a PhD, specifically in heart failure research. I do believe that I
have become a well-rounded student and am prepared for any position within a
cardiac rehab department. However, I do know that I have much more information
to learn so that I become proficient in every aspect of the identified KSAs for the
RCEP.
In order to continue gaining knowledge of all clinical populations, I sought out
different opportunities to work with pulmonary patients during my fall internship.

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These included many different procedures regarding patients with pulmonary
pathologies. During my last semester I continued to progress on my proficiencies
during EXP 610. I was able to take multiple roles that involved a significant amount
of responsibility. These included the graduate faculty assistance and adjunct
professor in exercise physiology for undergraduate students. I believe these
positions required me to use effective communication strategies to provide
constructive feedback to both improve the laboratory skills of both undergraduate
and graduate students. Additionally, these roles reiterated the importance of
working as a team to complete tasks. At times, the quality of the services suffered
due to a lack of communication within the team, but over time the operations of the
wellness clinic improved. In regards to gaining more knowledge in my final year as a
graduate student, I continued to read through exercise prescriptions for many
chronic diseased populations, specifically stroke patients.
I believe my greatest strength as a CEP is my knowledge of exercise
physiology aspects. These include the effects of exercise for patients with many
CPM diseases. During my internship I saw a wide variety of admission events, these
ranging from CABG, Stents, CHF, AVR, diabetes, pulmonary toxicity, COPD, and
restrictive lung disease. I believe I became proficient in heart anatomy by observing
procedures within the catheterization lab, observing echocardiograms, and also
completing the required assignments during my fall internship. Also, I was able to
take an advanced 12-lead ECG class, which went over how to identify where a
myocardial infarction is occurring or has occurred. This definitely helped me review
the aspects of electrophysiology and ECG aspects. The second strength that I
believe I am proficient in is prescribing exercise for a wide variety of populations.
During my internship I prescribed many exercises for cardiac and pulmonary
patients with many different comorbidities including prosthetic limbs, diabetes,
fibromyalgia, Parkinsons, arthritis, etc. A third strength that was identified by both
of my supervisors at Sheboygan and Milwaukee, was my personality. My supervisor
stated that I present myself with a calming demeanor and patients find it easy to
express their feelings about their complications without hesitation or judgement.
Additionally, I believe my versatility in teamwork is a great strength as a CEP
because of the multidisciplinary team that is needed to treat each patient.
My greatest weakness as a CEP, as identified by my supervisor is my
interviewing skills. I sometimes have difficulty asking detailed questions that allow
me to gain more information, however, my supervisor states that I have made great
strides in this very important KSA. A second weakness that I believe will come with
more experience is my confidence in clinical decision-making. I believe I am still in
the testing phase and I need to have more confidence in my decisions. I have taken
all the necessary courses regarding exercise prescription and I believe Ive become
proficient in my knowledge of exercise prescriptions for many populations. During
my time at St. Lukes Medical Center, my confidence again was questioned by my
supervisor in inpatient rehabilitation. I believe this was mainly due to my lack of
experience in inpatient rehabilitation, but over the course of the internship my
supervisor acknowledged that I did have the tools and made great strides in my
performance of providing inpatient rehabilitation. An additional weakness that my
fall supervisor identified was my dependability. This was primarily due to my limited
time availability due to my class schedule, thesis, and medical absences. I do

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believe that because of these absences I was not able to take advantage of all the
opportunities at St. Lukes Medical Center. However, this internship I believe still
provided me with the best experiences in inpatient cardiac rehab and also a more
demanding outpatient cardiac rehab. I will continue to improve on my identified
weaknesses during my career
Overall, I believe I have substantially increased my knowledge of all aspects
of cardiac, pulmonary, metabolic, and stroke rehabilitation. This includes all phases
of cardiac and pulmonary rehabilitation, specifically phase I and phase II rehab. I
still have a lot to become proficient in, but these past two years I believe has given
me a well-rounded basis of knowledge and professional practice in clinical exercise
physiology. Throughout my two years at Carroll Universitys Master of Science in
Exercise Physiology, Ive developed into a well-rounded clinician that provides
patient-centered care and utilizes best-practice. I believe Ive met all my goals as a
graduate student and now can focus on my career goals of receiving my RCEP and
becoming a lead exercise physiologist within a healthcare system that matches my
personal and professional values.