Medicine in Society Guide Malta 2021/22

6.9. Day 9: Mobility and Stroke

Preparatory work

In preparation students should have:

• Revised what they already know about the pathophysiology of stroke. 
• Looked at the NICE guideline for the diagnosis and initial management of stroke and transient ischaemic attack.
• Read the article “‘Me talk funny’: A stroke patient’s personal account”, which gives a personal account of stroke recovery from a linguist.
• Reviewed some of the information on the healthtalk.org website about both stroke and TIA, including lots of patient accounts.
• Looked at the Public Health England (PHE) Act-FAST campaign and considered what makes the posters effective.

 

Aims

To introduce students to the effects of stroke, particularly in relation to mobility and the part played by environmental factors, healthcare and other agencies in supporting the impaired person.

 

Learning outcomes

By the end of the day, students should be able to:

• Discuss the impact of stroke on an individual and their family and the role of voluntary agencies in providing support
• Demonstrate an understanding of the effect of poor mobility on the individual and the changes needed within the community to be more inclusive of them
• Identify important members of the MDT in assessment and care of patients with impaired mobility
• Describe a health promotion intervention that can reduce the risk of stroke in an individual at risk
• Practise pulse checks, blood pressure measurement, examination of central and peripheral pulses and communication skills

 

Example timetable

9.30 – 10.30	Tutorial on stroke
10.30 – 10.45	Tea break
10.45 – 11.45	Prepare for patient encounters Plan questions and observations   Patient encounters Interview a patient who has experienced a stroke or TIA Home visit to patient, and if appropriate their family/carer, with loss of mobility/function
11.45 – 12.45	Students feedback to group on their patient encounters and discuss the impact of stroke on an individual and their family/carers   Set up afternoon activity; In small groups visit or research local services/facilities providing support for stroke survivors and their families/carers or people with mobility problems or other disabilities and/or meet someone involved with delivering these services
12.45 – 13.45	Lunch
13.45 – 15.00	Small group research/visits/interviews as planned   1:1 formative feedback meeting with GP tutor (for 4-6 students)   Includes tea break
15.00 – 16.00	Feedback to group about visit/research/interview and discuss the role of voluntary agencies in providing support   Check in on small groups for health promotion posters Set homework for next session

  

Suggested Activities

• Tutorial on stroke – could cover stroke and TIA, risk factors, possible short and long term sequelae, stroke MDT members and roles, and health promotion interventions that can reduce a patient’s risk; students could work on these areas in breakout groups then present back to whole group.
• Meet with member of MDT to discuss role of team members  for stroke / disability care; or join an MDT meeting.
• Research into or visit to a local voluntary agency providing support to stroke patients, and/or interview person working for such an organisation.
• Prepare an interview schedule to use with a patient who has problems with mobility.  Include brief review of their home and work circumstances etc with respect to how well different environments are adapted to help overcome the patient’s disability
• Visit a patient with impaired mobility at home or conduct meet patient virtually, but make sure questions about home modifications, travel, work and accessibility are covered.
• Session teaching clinical skills e.g. pulse checks, blood pressure measurement, examination of central and peripheral pulses and practise these. Possibility for students to observe new patient checks and/or work alongside practice nurse/HCA to complete initial examinations, including pulse, BP, weight, height. Also, consider how these parameters are being carried out remotely using telemedicine.
• Have an individual formative feedback discussion with GP tutor on progress on the course so far, including first written assessment, plan for poster assignment and professional attitude and conduct.

 

Questions for students to consider

• How did you feel meeting a person that had suffered a stroke/had a mobility problem?  What aspects of the meeting were most difficult?  Did the patient seem comfortable with you?  Were you surprised at the impact it has had on their life?
• Did anything about the MDT surprise you? Were you aware that so many different professionals were involved in the care of patients with mobility problems?  What role did the GP play?  Was this what you had expected the GPs role to be?
• Consider the health promotion interventions you have heard about or observed today; what effect do you think that being told you are at high risk of stroke or heart disease has on an individual? 
• You may have a meeting today with your tutor.  How do you feel you are progressing? Have you set yourself any learning outcomes as a result of your experiences so far? Were you surprised at your tutor’s analysis of your progress?