Clinical Student Team Experience in Practice (STEPs®) is a series of four courses that are embedded in the six didactic semesters of the DPT curriculum. Students will work in teams with a physical therapist clinical instructor to apply skills, demonstrate clinical problem-solving, and assume professional roles in various clinical patient care settings. Each semester students will be expected to demonstrate skills and knowledge gained from the current and previous coursework.
Structure and Function of the Human Body provides the anatomic and basic science foundation necessary for physical therapists' understanding of the human body. The course emphasis is on the gross anatomy of the body. We will explore the relationships between the musculoskeletal, neurological, and vascular systems of the human body, including a critical examination of the morphology and function of the axial skeleton, upper and lower limbs, and cardiac, pulmonary, gastrointestinal, urogenital, reproductive, and neuronal systems. This course covers the biomechanics of various organ tissues and the response of muscle, bone, joints, and soft tissue to disease and injury pertinent to the practice of physical therapy. This course will provide an introduction to the neuroanatomy of the central nervous system. Learners will gain knowledge regarding how the nervous system governs human movement and the impact of vascular structures on brain function. Through this course, learners will gain the foundational knowledge to understand how the anatomy of the human body, as well as introductory neuroanatomy, impact the care of patients/clients in the physical therapy profession.
This course is an introduction to the elements and principles fundamental to the study of human movement. Included are: a foundation of kinesiology and biomechanics, biomechanics of biological tissues, joint structure and function, typical and pathological joint movement, typical human development, motor learning, and observational gait analysis of typical and pathological gait patterns. Concepts of kinetics, kinematics, length-tension relationships, joint classification, and functional movement will be discussed. These concepts will be focused on the application to the patient population. The basic understanding of human movement provides a foundation for developing assessment and intervention strategies to improve and restore mobility and function.
Introduction to the Patient Examination will cover foundational concepts of the physical therapy patient examination. This course exposes students to the initial steps in the patient/client professional relationship. It will focus on the following skills: patient history, observation, obtaining consent, performing a systems review, vital signs, palpation, range of motion, goniometry, muscle performance testing, safe patient handling, and functional mobility. This course requires the student to integrate knowledge from pre-requisite courses and concurrent Duke DPT courses to apply to patient care scenarios. We will emphasize the integration of core values of the PT profession into practice. Our goal is that each student develops the necessary examination skills to assure both patient/client and student safety in the clinical environment. By the end of this course, the student will be able to perform a comprehensive, accurate, and appropriately prioritized patient examination on a standardized patient in a practical examination format. Students will also complete a summative, comprehensive written final examination.
Healthcare Systems will provide the student with an understanding of the components of the health system that the physical therapist must integrate and facilitate. Included in this course will be a focus on interpreting health systems research including the translation of findings into practice. Students in this course will be introduced to all aspects of the health care system and will be provided the foundations to serve as leaders in a collaborative health system model.
This course will introduce the practice management model for patients with pathology or impairments to their integumentary system. The histology of the skin and pathologies of the integument will be the foundation from which the assessment and management of pathological processes and wounds of various etiologies will be discussed. The continuum of impairment through functional limitation and disability will be presented as a result of primary and secondary pathologies of the integument. The students will look at secondary management of the integumentary system in many physical therapy settings and across the lifespan.
Exercise prescription is an integral part of the rehabilitation process and physical therapists are qualified to appropriately prescribe and dose exercise interventions for a variety of populations, including individuals with injuries, impairments, co-morbidities, and additional risk factors. Exercise prescription involves careful screening including history and physical examination to determine a patient's capacity for physical activity as well as their risk factors and goals. This course introduces the science and theory of exercise prescription in the continuum of care. An overall goal of the course is to provide the foundational basis for understanding the body's physiological responses to physical activity as well as understand the acute responses and chronic physiologic adaptations to physical activity, including some of the static and dynamic factors ('moderating variables') that influence such responses and adaptations. Students will be introduced to cardiorespiratory, strength, and mobility testing, exercise prescription, and special population considerations. Clinical correlations and case-study applications will be used throughout the course.
Physical therapists commonly encounter clients with cardiovascular and/or pulmonary systems dysfunction, either as a primary problem or co-morbidity. This course gives an overview of cardiovascular and pulmonary-related pathologies, examination procedures, diagnostic procedures, goal setting, and interventional strategies. Successful completion of the course requires the ability to synthesize and integrate information from this course with prerequisite and other related courses in a variety of cardiovascular and pulmonary case-based problem-solving experiences. The didactic portion of the course provides the background to make evidence-based clinical decisions in examination, evaluation, and treatment of patients with a wide variety of cardiovascular and pulmonary conditions. The practicum portion focuses on the integration of these decision-making capabilities with the necessary psychomotor skills required for the examination and treatment of patients with cardiovascular and pulmonary conditions.
Persistent pain affects 100 million Americans each year, and accounts for hundreds of billions of dollars in health care costs. Despite its profound impact, persistent pain is poorly understood and poorly managed across medical disciplines. In 2016, the U.S. Department of Health and Human Services released the National Pain Strategy, which exposed a key reason for poor understanding and management of persistent pain: 'Most health care professions' education programs devote little time to education and training about pain and pain care.' In this course, learners gain a robust theoretical foundation to understand pain through the lens of biological, physiological, psychological, cognitive, social, and cultural factors. At the completion of the course, learners will have the skills to not only comprehensively assess pain and its influences, but to initiate evidence-based pain modulatory interventions which future Duke DPT courses will build upon. Importantly, course content is annually revised to align with current guidelines from the International Association for the Study of Pain (IASP) and cutting-edge pain research.
The number of Americans 65 years and older is projected to double within the next 40 years which will result in more older adults seeking medical care. The goal of this course is to provide students with the foundational knowledge and skills for optimal physical therapy management of older adults. Students will learn key concepts related to aging, age-related diseases and disorders, multimorbidity, and frailty. Students will also learn about age-related stereotypes, the influence of the physical environment, and caregiver roles. Lastly, students will gain expertise in the measurement of physical performance and fall risk and gain competency in optimizing exercise and physical activity for common post-operative conditions, fall prevention, and overall health and wellness.
In this course, students will be introduced to the science of clinical reasoning in health care and physical therapy. The integration of clinical reasoning and evidence-based practice will be developed. Students will learn how to access knowledge for practice and learn the methods of scientific inquiry, including research theory, design, methods, and measurement. Students will learn how to: 1) determine the statistical conclusion of research evidence for practice, 2) provide the logic of hypothesis testing, and 3) utilize specific statistical tests used for the descriptive and inferential analysis of experimental research data. Epidemiological statistics that enhance the understanding of diagnostic tests and treatment options will also be covered and the analytical components of systematic reviews and meta-analyses. Students will read research literature weekly and participate in a critical appraisal of the selected research methods and the meaningfulness of the findings for clinical decisions.
This course covers foundational content related to assistive and adaptive technology used in improving the functional capabilities of patients/clients. Learners are introduced to orthoses and orthotic prescriptions based on clinical exam findings. Clinical skills in the management of individuals with limb loss and limb differences are learned with a focus on a biopsychosocial approach to care. Learners are exposed to prosthetic componentry and how to interact and collaborate with prosthetists and orthothists to best treat the needs of patients/clients. Basic wheelchair seating and mobility content will cover the patient/client evaluation and prescription of equipment to improve mobility and meet an individual's personal needs. Throughout this course, we interact with peer mentors, community volunteers, and assistive technology end-users to better understand the role of the physical therapist in using technology to improve the function of our patients/clients.
This course introduces the student to musculoskeletal examination, evaluation, diagnosis, prognosis, and intervention for impairments, functional limitations, and disability in clients with pathologies of the cervical, thoracic and lumbar spine, as well as the upper extremity. The course series will emphasize diagnosis-specific examination, evaluation, diagnosis, prognosis, referral, diagnosis, standard assessments, outcome measures & intervention. Diagnoses specific to the entire spine, shoulder, elbow, wrist and hand will be addressed. Students will demonstrate learning/understanding of course content via practical and written examinations.
This course includes the basic etiology, epidemiology, pathogenesis, clinical presentation of common neurological conditions and injuries, assessment procedures to define impairments and limitations in activity and participation, and development of the plan of care for persons with neurological dysfunction across the lifespan. The course will cover the management of central nervous system (CNS) dysfunction, peripheral nervous system dysfunction, vestibular pathologies, and motor unit diseases. Examination, evaluation, diagnosis, pharmacological management, clinical decision-making, prognosis, standardized assessments, outcome measures and interventions will be emphasized.
This course completes the two-session exploration of the human body and brain through a variety of learning experiences. This course provides the anatomic and basic science foundation necessary for physical therapists' understanding of the human nervous system. This course will provide a comprehensive survey of the neuroanatomy and neurophysiology of the central and peripheral nervous systems, which will provide a framework for understanding the form and function of the neuronal systems in the brain and spinal cord that motivate bodily actions and behaviors. Learners will command comprehensive knowledge concerning the form and function of the nervous system, and the means by which the nervous system governs human behavior. Through this course, learners will gain the foundational knowledge to understand how neuroanatomy and neurophysiology impact the care of patients/clients in the profession of physical therapy.
Cultural Determinants of Health and Health Disparities (CDHD) I is the first in a series of two courses embedded in the first year of the DPT curriculum. Students will be equipped with a deeper understanding of implicit and explicit bias, race, racism, sex, ability status, gender identity, and socioeconomic difference. Course facilitators and lecturers will guide students in provocative conversations around health disparities, structural competency, bias, and the impact of implicit associations on interactions with peers and patients. Through skills-building exercises and experiential opportunities, students will be challenged to explore individual, cultural, and social determinants of health and wellness. In addition, students will gain knowledge about the evidence and economics of health disparities, the Durham community, and the history of Duke Medicine's role in that community. Through the evaluation of peer-reviewed literature regarding health disparities, students will gather knowledge and skills to mitigate provider influences on disparities and ultimately improve the quality of healthcare.
Cultural Determinants of Health and Health Disparities (CDHD) II is the second in a series of two courses embedded in the first year of the DPT curriculum. Students will be equipped with a deeper understanding of implicit and explicit bias, race, racism, sex, ability status, gender identity, and socioeconomic difference. Course facilitators and lecturers will guide students in provocative conversations around health disparities, structural competency, bias, and the impact of implicit associations on interactions with peers and patients. Through skills-building exercises and experiential opportunities, students will be challenged to explore individual, cultural, and social determinants of health and wellness. In addition, students will gain knowledge about the evidence and economics of health disparities, the Durham community, and the history of Duke Medicine's role in that community. Through the evaluation of peer-reviewed literature regarding health disparities, students will gather knowledge and skills to mitigate provider influences on disparities and ultimately improve the quality of healthcare.
Foundational Pediatrics introduces the practice management model for pediatric patients. The theoretical basis of pediatric development, typical and atypical development, movement, and function, along with compassion and high standards of care will be the foundation from which the assessment and management of various pediatric diagnoses will be discussed. The students will be introduced to the wide range of pediatric diagnoses, within the context of an individual child's life and their family, in order to optimize the child's ability to thrive across their lifespan. The etiology, pathology, pathophysiology, pathokinesiology, and clinical presentation of common pediatric disorders will be covered as well as the typical alterations in motor development that can accompany neurological, neuromuscular, genetic, and orthopedic disorders in children. Examination, evaluation, diagnosis, clinical reasoning, clinical decision-making, prognosis, and the use of standardized assessments, outcome measures, and evidence-based interventions will be emphasized. Management across the lifespan across the ICF in various clinical settings will be addressed, including outpatient, school, early intervention, acute care, and home health settings. Students will participate in the Pediatric Movement Matters Program in which they will learn from children with neurological and neuromuscular impairments and disabilities.
Management of the Complex Patient will introduce the student to the assessment and management of complex patient cases across the lifespan and the continuum of care. An emphasis will be placed on clinical decision-making related to the physical therapy management of individuals with multimorbidity and polypharmacy. Furthermore, collaborative navigation of the complex patient through the health care system will be underscored.
The Comprehensive Assessment and Management of Practice (CAMP) I course will provide opportunities for students to deliver physical therapy services through a supervised team approach for the evaluation and treatment of adult musculoskeletal conditions. This course will build upon earlier foundational and STEPs experiences to further develop clinical reasoning. During CAMP, students will be mentored by DPT program faculty and physical therapists as they work in small groups to provide care to community members who have a variety of diagnoses causing movement dysfunction or pain. The students in this course will be involved in developing and documenting a plan of care based on the ICF model that includes goals, skilled intervention, and progression.
The Comprehensive Assessment and Management of Practice (CAMP) II course will provide opportunities for students to deliver physical therapy services through a supervised team approach for the evaluation and treatment of adult complex and neurological conditions. This course will build upon earlier foundational and STEPs experiences to further develop clinical reasoning. During CAMP II, students will be mentored by DPT program faculty and physical therapists as they work in small groups on applied skills pertinent to patient case management including examination and interventions including progressions. The students in this course will be involved in developing and documenting a plan of care based on the ICF model that includes goals, skilled intervention, and progression.
PT Professional Practice threads throughout the entire DPT curriculum. In this series of courses, learners will develop the professional behaviors, knowledge, and values crucial to be leaders in a dynamic health care environment. Through an understanding of the profession's history and governance, students will have experiences in professional and patient advocacy initiatives. Students will master the crucial skills of patient and professional communication in order to operate effectively in practice. Students will also be grounded in ethical frameworks that can be easily applied to practical situations encountered in clinical practice. This course series also seeks to develop leadership skills necessary to be change agents in healthcare practice, management, education, research, and advocacy.
To deepen their knowledge base in various practice content areas, students choose nine Advanced Practice Courses from the following topic tracks:
- PT 738 Complex Patient Management
- PT 739 Geriatrics
- PT 740 Leadership/Health Equity
- PT 741 Performing Arts
- PT 742 Neurorehabilitation
- PT 743 Orthopedic Sports
- PT 744 Pain Science
- PT 745 Pediatrics
- PT 747 Research
- PT 748 Teaching
- PT 749 Vestibular Rehabilitation
- PT 746 Pelvic Health
The CDHD III experience is offered to students in their second year to align with the professional practice course focus on advocacy and to contribute to meeting our divisional objective for our learners to 'be influential leaders, advocates, and change agents for their patients, community, and the profession.' Students will be provided opportunities to develop real-world skills to address disparities at the interpersonal and community levels. This content is offered during the DPT second year as a continuation of the first-year CDHD I and II courses to drive the clinical application of skills and offer opportunities for direct engagement. The course is offered in parallel with our integrated clinical experiences in CAMP to solidify our learners' abilities to grapple with these complex issues. The expectation is that learners will enter their summative third-year terminal clinical experiences competently prepared to identify and reduce healthcare disparities.
This course introduces the student to musculoskeletal examination, evaluation, diagnosis, prognosis, and intervention for impairments, functional limitations, and disability in clients with pathologies of the lower extremities. The course series will emphasize diagnosis-specific examination, evaluation, diagnosis, prognosis, referral, diagnosis, standard assessments, outcome measures & intervention. Diagnoses specific to the hip, knee, lower leg, ankle, and foot will be addressed. Students will demonstrate learning/understanding of course content via practical and written examinations.
This course series includes the basic etiology, epidemiology, pathogenesis, and clinical presentation of common focal and global neurological conditions and injuries. Learners will apply examination procedures to identify impairments, activity limitations, and participation restrictions and develop a plan of care for adults with neurological dysfunction. Learners will differentiate between central (CNS) and peripheral (PNS) nervous system dysfunction based on clinical characteristics, apply advanced skills in examination and task analysis to distinguish typical from pathological responses, and develop evidence-informed intervention strategies. The course series will emphasize diagnosis-specific examination and evaluation techniques, PT diagnoses, pharmacological management of neurological conditions, clinical decision-making, prognosis, standardized assessments, outcome measures, and interventions. Diagnoses highlighted in Foundational Neuro Practice II will include concussion, vestibular pathologies, cerebellar dysfunction, Parkinson's Disease (PD), Amyotrophic Lateral Sclerosis (ALS), Huntington's disease (HD), Neuromuscular disease (NMD), and Guillain-Barre Syndrome (GBS). Management across the lifespan and in various clinical settings will be addressed.