PEPonline Professionalization of Exercise Physiologyonline An international electronic journal for exercise physiologists ISSN 1099-5862 Vol 10 No 2 February 2007   The Heart of Professionalism Tommy Boone, PhD, MPH, FASEP, EPC Professor and Chair Director, Exercise Physiology Laboratories Department of Exercise Physiology The College of St. Scholastica Duluth, MN 55811  Believe in your future as an exercise physiologist.  Don’t let anyone say otherwise, regardless of talent, position, or training.  You are in absolute control.  Be courageous, take risks, and speak up.  Commit yourself to act. Recently, I read the 2005 article by Andrew Cole entitled, “Patients are at the Heart of New Medical Professionalism” [1].  It caused me to think about the professionalism of exercise physiology.  But, I should point out that this article, which summarizes a report by the Royal College of Physicians on medical professionalism, really hits home.  Imagine medical doctors talking about leadership and the need to create a single united voice; I found this point interesting since medicine has been around for a long time and is such a popular vocation.  One would think that physicians would have worked out all the bugs in their practice? As it turns out, that is not the case.  Medicine, law, engineering, and all other vocations have issues and concerns about what they are doing and how they can do it better.  Well, unfortunately, this is true for most professions.  It is less true for exercise physiology, but I’m getting ahead of myself.  The report I mentioned earlier also proposed a new definition of medical professionalism; one that increases the focus on partnership with patients and interdisciplinary relationships.  Both are especially important to exercise physiology and the use of exercise as medicine [2].  Implicit in this thinking is professional integrity demonstrated by exercise physiologists in the use of exercise as a medical treatment.  The title of the report is: “Doctors in Society: Medical Professionalism in a Changing World.”  Those involved in the development of the report need a big pat on the back for their insight and vision for emphasizing professionalism.  They concluded that medicine should create a single united voice that supports the idea that patients are at the heart of professionalism.  If this is something physicians should do, why isn’t it important for other healthcare professionals to do as well?  Why don’t exercise physiologists see the need to unite under a single voice?  Isn’t it time they realize that students are at the heart of the 21st century professionalism of exercise physiology? If only exercise physiologists did not feel the need to “keep their connection with sports medicine,” their future will be based less on the association, and more on who they are and how they feel as professionals.  Trying to hang on to the past has left little room for collaboration much less positive synergy within exercise physiology.  This has resulted in some degree of conflict among ourselves and a higher degree of stress for those who have chosen to empower and encourage others from within the ASEP infrastructure. Taking Action You might as well recognize that there will be exercise physiologists who will disagree with you, and they may actively work against your decision to join ASEP, but because they don’t understand your motives isn’t a sufficient reason not support the ASEP initiatives.  Remember there are exercise physiologists who believe as you do, you will find support and positive reinforcement to stick with the ASEP leadership.  So, why not begin now, as others are doing in their professions, to change attitudes and behaviors regarding exercise physiology. After all, it is just a matter of time, which reminds me of the following statement:  “Some exercise physiologists look at the ASEP organization.  Some even join it.  And some will lead it.  What role do you want to play?  Do you want to observe exercise physiology, follow other exercise physiologists, or be a leader in exercise physiology?  I think you can maximize your returns and those of students and colleagues if you work to be a leader in the profession.  This, I think, hits at the core of the problem in exercise physiology.  This is why I think exercise physiology is significantly behind other healthcare professionals when it comes to understanding, teaching, and practicing professionalism.  Where are the leaders?  Where are the exercise physiologists to guide and direct us towards a new definition of exercise physiology?    Leadership is about helping students live a better life by turning the ASEP vision into professional and financial results.  It is about getting out of debt, having more job alternatives, living with less fear and anxiety, and increasing hope and possibilities.  I believe part of this change process is the obvious necessity to develop accredited academic programs.  And, part of the change is to require a “professional development” course in every curriculum.  But, for now, the only such course that I’m aware of is the one I teach at St. Scholastica.  It is entitled “Professional Development of Exercise Physiology.”  This is but one problem among many that need evaluating and updating.    Another problem is the issue of the clients.  In other words, it seems reasonable to conclude that the heart of exercise physiology professionalism lies with the clients, who could be students, athletes, patients or others in need of a credible exercise program or prescription.  Isn't it obvious that today's research emphasis, which focuses on getting grants and publishing papers, puts professionalism at risk when that is all exercise physiologists think about!  In fact, as several PEPonline articles have pointed out [3-6], a set of values, beliefs, and relationships that underpin professionalism must be embraced to ensure that the public understands and turns to exercise physiologists for healthcare reasons.  The report by the Royal College of Physicians [7] concluded that "...serious failures in leadership means that the profession is undersellling itself.  While there are many leaders within medicine, there is little leadership of medicine as a whole."  The report calls for a common forum that "...would speak with authority on behalf of UK medicine on tissues of common interest without suppressing legitimate other voices."  This is "the" problem in exercise physiology.  There is a failure in leadership [8], which has left everything unchanged from what it was decades ago, which reminds me of the quote: "If you don't know where you are going, any road will get you there." [Anonymous] Becoming intentional about the professionalism of exercise physiology is the role of the ASEP organization.  There is nothing mysterious about the importance of being committed to professional development.  I might add that this view is not a direct function of the public having lost trust in exercise physiologists.  More disturbingly, the public has no reason even to look to exercise physiologists for prevention of healthcare problems.  It would be wrong, therefore, to think that this can go unnoticed and that, without correction, would definitely have a negative effect on future career opportunities.  Hence, there is clearly room for significant improvement in leadership and professional standards. The Emerging Paradigm The purpose of exercise physiology is multi-faceted.  From health, fitness, rehabilitation, and athletics, the primary purpose of exercise physiology is the use of exercise as therapy [9] in the prevention and/or postponement of diseases and disabilities.  Even if exercise physiologists don’t get it yet, this is the emerging paradigm that, along with other factors, defines exercise physiology as a profession.  As a way of seeing this point, note the Oxford English Dictionary [10] definition of a profession:   An occupation’s core element is work based upon the mastery of a complex body of knowledge and skills.  It is a vocation in which knowledge of some department of science or learning or the practice of an art founded upon it is used in the service of others.  Its members profess a commitment to competence, integrity, morality, altruism, and the promotion of public good in their domain.  These commitments form the basis of a social contract between a profession and society, which in turn grants the profession the right to autonomy in practice and the privilege of self-regulation.  Professions and their members are accountable to those served and to society.   It should be apparent that exercise physiology is a profession.  Perhaps not so obvious to other healthcare professionals, but true nonetheless.  Exercise physiology is a vocation in which the exercise physiologist’s knowledge, clinical skills, and judgment are used to protect (prevention) and restore (rehabilitation) the client’s mind-body well-being.  This purpose and commitment to the public is realized through a partnership based on mutual respect and appropriate accountability between the exercise physiologist and the client [11].  If exercise physiologists do not support this thinking, they are underselling who they are and what they do.  And, if they should keep fragmenting the collective body of exercise physiology by members supporting non-exercise physiology organizations, they will continue to hurt students, themselves and the emerging profession of exercise physiology.    Each one of us has the responsibility to be a leader and to move exercise physiology forward as others have done in their profession.  Note what a medical trainee said in the report [7, pp. 28-29]:  “I feel that our profession has been sold up the road by our superiors over the years for a few pieces of silver, for their own selfish interests.  That has eventually placed us, both present and future doctors, in very difficult positions, undermined our morale, confidence, and standing in society.  We lack leadership and foresight in our present-day peers and seniors.”  It shouldn’t come as a surprise that I think the same statement can is true for exercise physiology, and I think it is an entirely fair conclusion to make (however negative it may sound).  Exercise physiologists are not exempted from doing the right things for the right reasons.  Also, I think it is time to stop the fragmentation of membership between ASEP and other non-exercise physiology organizations.  For decades exercise physiologists have not had their own professional forum.  If exercise physiologists wished to take an active part in the shaping of their vocation, they are less likely to do so within a non-exercise physiology organization.  History is clear that several attempts to do so resulted in the idea being tabled [12].  I believe there is an important need for a professional forum, such as the new ASEP blogs and/or forums [13] so that exercise physiologists can debate, discuss, argue, study and, in general, think and write about existing policies or new policies, procedures, and/or standards of practice.  Open opportunity for input allows for new ideas and new thinking on all matters pertaining to what is exercise physiology and who is an exercise physiologist.    In that context, it would be foolish to think that there isn’t a need to clear the tension that exists between exercise physiologists who support ASEP and those who do not.  But, this article is not about these differences.  Rather, how can exercise physiologists come together to collectively benefit the professionalism of exercise physiology.  The truth is there has been too little time spent working together for a common purpose.  One such purpose is the ASEP vision [14].  Until more exercise physiologists come together in their collaborations and communications with each other, the students’ education and professionalism will not improve as fast as they should.  Accreditation is a very different vision of the student’s life after college.    ASEP is at the cutting edge of the new paradigm in exercise physiology.  Professionalism is not an option.  All other professions get this point.  It is no different for exercise physiology.  Professionalism identifies a set of values, behaviors, and relationships that underpin the science and practice of exercise physiology.  Imagine what might happen at your institution if exercise physiologists discussed pressing academic and ethical issues facing them and their students.  Further, imagine what might happen if they argued for task force meetings or professional development seminars to study the ethical and career implications of accreditation and professionalism.  Still further, an answer to the following question is critical:  “Can departments continue to teach students with outdated degree titles and academic courses?”  I don’t think so.  I believe that the outdated degrees will be updated once exercise physiologists take to heart their commitment to students.  It is just a matter of passion!  I believe that when you have a passion or a dream in your life, nothing can stop you or even slow you down.  It becomes the fuel of your life, the sunshine in your day.  It also makes you discover all the energy and the power that you have within yourself!!! It is without any doubt the best thing that can happen to someone in their life: discovering their PASSION. – Sylvie Frechette, Gold Medal Winner, 1992 Olympics Commitment to New Thinking The need for a deeper understanding of contemporary academic challenges is great.  And, yet there are only a few examples in higher education of deliberate efforts to change or even to think differently.  The department chair and faculty should be leaders in academia, especially since they have consciously and deliberately assumed responsibility for both the ethical and professional governance of their academic programs.  However, rather than being leaders, the majority of the academic programs and their faculty have not embraced the ASEP accreditation nor is it apparent that they understand the heart of professionalism.  This is an unsettling statement because it is evidence that the faculty and administration continues to embrace an outdated way of thinking that has for some time had negative effects on their students.  It also raises questions about the role of these departments.  Do they exist solely to benefit the faculty?  Or, do they have a responsibility to the students?    The accreditation effort is not about tenure and promotion.  It is about the commitment of a department and the support of the academic institution to a student’s education with a purpose.  This is important for many reasons, particularly since students are looking for a career and financial stability.  They are also concerned about professional connections and networking.  Leaders in many fields of higher education understand this point, especially the established professions in the healthcare industry, which raises the following questions:   What is our shared vision regarding exercise physiology?   What do others say about exercise physiology?   How do we frame what we think in a professional context? How do we account for our differences, if not conflicting ideologies? What can we do to move forward with the professional development of exercise physiology? Clearly, these questions and the lack of an agreed upon shared vision among the doctorate prepared exercise physiologists bear out that exercise physiology is a “work-in-progress.”  Over the course of the past decade, students have realized that their job opportunities fail to live up to their expectations.  This can get better with changes in the student’s academic setting, with changes in organizational thinking, and with changes in public thinking about exercise physiology.  Those who wish to influence the new way of thinking need to embrace the ASEP vision that academic programs should be defined by professionalism, integrity and accountability.  Hence, it is imperative that administrators and faculty focus the department’s internal decision-making to support ASEP accreditation.  Exercise physiologists need to understand that the best college and university departments are built on the foundation of “exercise physiology” thinking, professionalism, and respect.   To put this in a different light, exercise physiologists need to be willing to take risks, to teach that it is politically correct to distinguish sports medicine, exercise science, or other related degrees from exercise physiology, and to differentiate non-exercise physiologists (often referred to as fitness professionals) from exercise physiologists.  In other words, the bottom line is simply this:  Students must be willing to work on behalf of the professionalism of exercise physiology.  Since students are at the core of professionalism, it is only reasonable to expect their participation in their welfare, and if they act on the ASEP recommendation to honor accredited schools over non-accredited, professionalism will flourish and prosper to benefit all students and exercise physiologists alike.  The good news is:  You do not have to be perfect.  You will make mistakes.  You cannot possibly know the “right” way to do what you have never done.  What is important is that begin. – Peter Urs Bender, Leadership From Within Courage to Act Many people, including exercise physiologists, aren’t comfortable with taking risks.  Even presenting a paper before one’s peers can be simply too much for students and even teachers.  There are many other aspects of life that create too much tension and stress and, therefore, they are avoided as well.  For example, it is clear that many students do not like being called on in class.  Expressing how a person feels about an idea is often frustrating, particularly if that person feels others may react unfavorably to his/her comments.  Often, discussing new ideas and different ways of thinking or living (as in one’s lifestyle or relationships) create fear of rejection or failure.  No one is comfortable with criticism even in the form of a question, “Why did you ever think your own business idea would make it?”  But, at some point, avoidance stress inducing situations is not the answer, especially if a person wants to be successful and responsible as an individual for his/her own behavior.  This is exactly why we work at overcoming our fears, but to do so require courage and risk-taking to turn ideas into action and positive results.  Perhaps, Peter Urs Bender [15] said it best, “It means leaving the past behind and charting a course for the future.”  It seems to me that this idea is also at the “heart” of professionalism, especially when viewed from the context of what is essential to realizing a vision.  Make no mistake; to take action is essential to leaving past behind and creating the future.  Next time you are engaged in a conversation about ASEP you would rather postpone, do it anyway and see what comes from it.  Stepping outside your comfort zone is critical to the professionalism of exercise physiology.  Several things can encourage risk-taking.  For example, how about writing a paper about your feelings or ideas regarding exercise physiology or what you think exercise physiology ought to be?  Why not share your feelings regard the ASEP initiatives with others?  Make a commitment to a statement such as: “I am a board certified exercise physiologist, and I am proud of it even if you do not value or understand my professional credential?  Finally, why not conclude that it is okay to not have all the answers.  It is okay to say to others, “It is true, I’m not perfect, so what.  Who is perfect?”  Risking failure is the first step to being successful.     References Cole, A. (2005). Patients are at the Heart of New Medical Professionalism. British Medical Journal. 331:1355. [Online]. http://www.bmj.com/cgi/content/full/331/7529/1355 Boone, T. (2006). Exercise Physiology as Exercise as Medical Treatment. Professionalization of Exercise Physiologyonline. 9:12 [Online]. http://www.asep.org/asep/asep/ExerciseAsMedicalTreatment.html Boone, T. (2006). Seeing the Unobvious in Exercise Physiology. Professionalization of Exercise Physiologyonline. 9:9 [Online]. http://www.asep.org/asep/asep/SeeingTheUnobvious.html Boone, T. (2006). Thinking, Talking, and Writing as an Exercise Physiologist. Professionalization of Exercise Physiologyonline. 9:6 [Online]. http://www.asep.org/asep/asep/ExercisePhysiologyThinking.html Boone, T. (2006). The Exercise Physiology Mindset. Professionalization of Exercise Physiologyonline 9:4 [Online]. http://www.asep.org/asep/asep/TheExercisePhysiologyMindset.html Boone, T. (2003). Values Clarifications in Exercise Physiology. Professionalization of Exercise Physiologyonline. 6:6 [Online]. http://www.asep.org/asep/asep/ValuesClarificationANDExercisePhysiology.html Royal College of Physicians. (2005). Doctors in Society: Medical Professionalism in a Changing World. Report of a Working Party of the Royal College of Physicians of London. London: RCP Boone, T. (2006). Exercise Physiology: Professional Issues, Organizational Concerns, and Ethical Trends.  Lewiston, NY: The Edwin Mellen Press. Boone, T. (2002). Exercise is Therapy, Prevention, and Treatment: An Exercise Physiologist’s Perspective. Professionalization of Exercise Physiologyonline. 5:3 [Online]. http://www.asep.org/asep/asep/ExerciseIsTherapy.html Cruess, S. R., Johnston, S., and Cruess, R. L. (2002). Professionalism for Medicine: Opportunities and Obligations. MJA. 177:208-211. Boone, T. (2000). The Passionate Pursuit of Professionalism: A Critical Essay. Professionalization of Exercise Physioloygonline. 3:10 [Online]. http://www.asep.org/asep/asep/Passionate.html Boone, T. (2???). Professional Development of Exercise Physiology. Lewiston, NY: The Edwin Mellen Press. American Society of Exercise Physiologists. (2007). Professional Services: Blogs and Forums. [Online]. http://www.asep.org/ American Society of Exercise Physiologists. (2007). ASEP Vision. [Online]. http://www.asep.org/ Bender, P. U. (1977).  Leadership From Within. Toronto, Canada: Stoddart Publishing Company.   Copyright ©1997-2007 American Society of Exercise Physiologists   All Rights Reserved.