Family Medicine Clerkship

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Stroke/Cerebrovascular disease

OVERVIEW

With the increasing number and percentage of Americans older than 65 years old, there is also an increasing number and percentage of people who are at risk for cerebrovascular disease, or who already have had a stroke.

TOPIC LEARNING GOALS AND OBJECTIVES
(Organized by ACGME Competencies)

Patient Care

GOAL: Students will accurately assess signs and symptoms of stroke.

OBJECTIVES: Students will be able to:

• Perform appropriate examination of the neurological and cardiovascular systems in the assessment of patients who present with concerns about possible stroke.
• Interpret laboratory data related to patients with new onset neurological symptoms, particularly numbness or weakness in an extremity with or without accompanying speech difficulty.

GOAL: Students will appropriately discuss reduction of risk factors for stroke with patients.

OBJECTIVES: Students will be able to:

• Explain indicators of risk and complications of stroke to their patients.
• Describe to patients the risks of stroke complications, including aspiration pneumonia, malnutrition/dehydration, and pressure sores, and the goals of management.
• Work with patients and their families to maximize independent living after a stroke, and prevent recurrence of stroke.

GOAL: Students will demonstrate sensitivity to individual and cultural differences in their development of treatment plans.

OBJECTIVES: Students will be able to:

• Discuss with patients and families the importance of lifestyle changes in the prevention and management of cerebrovascular disease.
• Develop treatment plans in the context of each patient's life and environment.

Medical Knowledge

GOAL: Students will understand the significance of hypertension screening and control and carotid artery screening in health promotion and disease prevention.

OBJECTIVES: Students will be able to:

• Discuss the epidemiology of cerebrovascular disease, including racial, ethnic, and socioeconomic differences.
• Describe the USPSTF recommendations for screening for cerebrovascular disease, including contributing factors such as hypertension, and also carotid artery screening.

GOAL: Students will understand the pathophysiology and risks of untreated carotid artery narrowing.

OBJECTIVES: The student will be able to:

• Describe the end organ complications of untreated carotid artery stenosis, alular abnormalities, and hypertension.
• Describe how to make the diagnosis of stroke.
• Discuss and defend the initial evaluation of a patient with a new diagnosis of stroke.

GOAL: Students will understand the rationale for treatment plans for cerebrovascular disease.

OBJECTIVES: The student will be able to:

• Describe the appropriate therapy for treatment of acute stroke and primary and secondary prevention of stroke.
• Discuss the evidence for the role of lifestyle changes in prevention of stroke.
• Discuss the side effects and costs of commonly used medications for stroke prevention and treatment.

Practice-Based Learning and Improvement

GOAL: Students will understand the role of screening for risk factors for stroke in practice and community settings.

OBJECTIVES: Students will be able to:

• Describe how screening for stroke and appropriate therapy for primary and secondary prevention of stroke is monitored in the assigned clerkship site.
• Consider the impact of environment and neighborhood on adherence to treatment plans and lifestyle changes.

GOAL: Students will understand the role of practice-based improvement.

OBJECTIVES: Students will be able to:

• Recognize the importance of practice analysis for a population at risk for stroke (e.g., hypertension and hyperlipidemia control, aspirin use).

GOAL: Students will bring up-to-date evidence to the point of clinical care.

OBJECTIVES: Students will be able to:

• Identify gaps in their own knowledge and frame appropriate clinical questions in regard to stroke prevention and management.
• Use best evidence to answer clinical questions about cerebrovascular disease risk, prevention, and treatment.

Interpersonal and Communication Skills

GOAL: Students will understand the importance of effective communication with patients and families in the management of stroke.

OBJECTIVES: Students will be able to:

• Describe the long-term treatment plans for stroke/cerebrovascular disease.
• Include patients and families in the development of treatment plans for a patient who has had a stroke.
• Demonstrate effective listening skills and empathy to improve patient adherence to lifestyle modifications, (i.e., diet, exercise and medications).

Professionalism

GOAL: Students will demonstrate the ability to care for patients with stroke from diverse patient backgrounds and with differing severity of the illness.

OBJECTIVES: Students will be able to:

• Demonstrate sensitivity and responsiveness with patients who are not adhering to treatment plans.
• Reflect on personal frustrations when patients are not adherent to plans.
• Demonstrate understanding of the relationship of to culture, age, gender, and disabilities.

Systems-Based Practice

GOAL: Students will understand the impact of health care systems and environment on the management of stroke.

OBJECTIVES: Students will be able to:

• Describe cost-effective strategies for treatment of stroke using different formularies.
• Analyze barriers to effective integrated treatment of stroke.
• Consider the role of other disciplines (e.g., pharmacy, nursing, social work, and allied health) in the treatment of stroke.

EDUCATIONAL METHODS AND RESOURCES

Web Sites

• StrokeStop
  StrokeSTOP: Stroke and Stroke Prevention Curriculum for Medical Students
  A pilot curriculum program has been developed to provide medical students with knowledge, skills, and attitude that will encourage them to take an activist approach to stroke and stroke prevention in their own future practice of medicine.

StrokeSTOP has been developed through a collaboration between the University of Massachusetts Medical School and the American Stroke Association. It is designed to be interwoven with first- and second-year neuroscience courses, and can be used for review purposes during clinical clerkships and electives.

Lead Author: Alexander Chessman, MD
Clerkship/Post-Clerkship Workgroup members: Ann O'Brien-Gonzales, PhD (Chair), Alexander Chessman, MD (EC Liaison), Caryl Heaton, DO, Janice Nevin, MD, MPH, Lauren Oshman, MD, Deborah McPherson, MD, Mark. E Quirk, EdD, David Schneider, MD, MSPH, William B. Shore, MD, Richard Usatine, MD

Family Medicine Curriculum Resource (FMCR) Project HRSA Contract 240-00-0107.

Revised November 23, 2003

For questions or comments, please contact Webmaster or Ardis Davis

This page last updated October 17, 2005