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Overcoming the monster! Perceptions of physiotherapy students regarding the use of stroke master plots for building therapeutic relationships; a vignette study – BMC Medical Education

Demographics of the respondents

A total of 90 students (39 MSc year 1; 32 BSc year 1; and 19 BSc final year 3 students) agreed to take part in this study. There were (25/90; 28%) male students with an average age of 25.0 years and (65/90, 72%) female students with a mean age of 20.1 years. Seventy-five (75/90, 83%) had not been on a neurological placement. Sixty students including all from BSc year 1 identified as having no placement experience. Table 1 provides a further break down of the group demographics.

Table 1 Demographics of the Respondents

Responses to each variation of the stories

A descriptive summary of student responses is given below and a summary of these responses is given within Table 2.

Table 2  A descriptive summary of student responses to individual questions

The findings from narrative content analysis of the various stories along with the descriptive statistics are presented below.

Summary of Story A

the monster is identified through the challenges created by the Stroke and references mental health difficulties. The monster is overcome through motivation, emotional support and relationship with her daughter.

Story A appeared more attractive to the first-year students (MSc 28%, BSc 19%) compared to the final year BSc students where only one student (5%) identified this story as most attractive. The majority of students identified story A as the most common story of all three. Year 1 BSc students identified this as most often (20/31, 65%) with smaller amounts identified by other groups (year 3 BSc 8/19, 42%; year 1 MSc 14/39;36%). A similar number of first year BSc (14/31, 45%) and first year MSc students (18/39,46%) selected story A as the story they would prefer to hear. The BSc year 3 students selected it slightly less (7/19, 37%). Story A was most often selected as a preferred story to tell themselves if in a similar situation by final year BSc students (8/19, 42%) and MSc year 1 students (14/36, 39%). BSc year 1 students selected it less often (10/31, 32%). Many students would tell story A because they feel it would be the one that they would relate to the most. Only 3 students thought Story A was unusual. All three students were from the year 1 cohorts.

Most MSc students and BSc year 1 and 3 students felt uplifted and touched by the story and by the way the daughter supported her mother. This reaction was identified by around a half of year 1 BSc student (BSc 14/32; 50%) and slightly less prevalent for year 1 MSc students (12/39;31%) and in final year 3 BSc students (6/19;42%). For instance, one student stated, “Story A. It is heartwarming, loving and touching” (BSc Female Year 1 Student, P62). A majority of students across all student groups (BSc Year 3, 16/19; 84%; BSc Year 1, 22/32;69%; MSc Year 1, 29/39;74%) identified the importance and value of family members supporting the mental and physical well-being of the individual. Students often identified that the family member was a needed source of motivation to recovery and manage the impact of suffering two stroke. This was recognized by around two thirds of third year BSc (12/19,63%) but only in around a third of the other groups (MSc 12/39,31%; 1st year BSc 10/32,31%).

More year 1 students in both the BSc (11/32, 34%) and MSc (7/39, 17.9%) cohorts felt sad compared to the final year 3 students (2/19, 11%). However, the year 3 students identified as feeling empathy towards the individual (4/19, 21%) which was slightly similar to the year 1 MSc (6/39,15.4%,) and slightly more than the BSc year 1 students (4/32, 12.5%).

More final year BSc students (7/19, 37%) were able to identify how common it was for patients who had a stroke to lose motivation due to the length of recovery and frustrating nature of the process. This was less evident in the first-year groups (MSc 4/39,10%; BSc 2/32, 6%). Further to this, year BSc 3 students highlighted the considerable healthcare challenges following stroke (12/19, 63%) which was higher than the year one students (MSc 9/39, 23%; BSc 4/32, 13%). For instance, a final year student stated: “The stroke was not fully treated and or she did not have the correct or personal recovery programme specifically for her case. The daughter family was the main rehab for her recovery not the untailored recovery [NHS] programme”(MSc-preg Female Year 1, P20).

Summary of Story B

The story identifies difficulties within the hospital experience as the monster; being able to recognize the difficulties and seeking to improve them was the way the monster was overcome.

Story B was the story that was identified as most attractive across all students. The third-year BSc students appear to be the most drawn to this story (12/19, 63%), followed by the two first year cohorts BSc (14/31, 45%) and MSc students (17/39, 44%). A large number of MSc students selected story B as the most common story (16/39,41%), with the around 20% (BSc year 1 6/31, 19%; BSc year 3 4/19, 21%) of students identifying it as most common. Many students highlighted faults with the NHS that contributed to this being a common story. This included overwhelming stress on the NHS, the healthcare professional’s ability to implement screening protocols/procedures and negative culture in the wards. For instance, one student stated: “Story B- I think there are a lot of people /patients that are seriously suffering in hospitals and finding it challenging to try and recover. The will to survive might be gone as well. That’s why it is essential to have a supportive environment to reignite their will to live” (MSc male year 1 student, P24).

Students also recognised that it was common to hear unpleasant stories because stroke was regarded as a difficult experience to live through. A relatively low number of students selected Story B as the preferred story to tell (MSc year 1 5/36, 14%; BSc year 1 4/31, 13%; BSc year 3, 3/19, 16%). Story B was most often selected by students across the cohorts because it considered motivated people to be independent, persistent and self-driven to accomplish all their goals. One student stated: “I would like to tell story B because this individual seems to have been extremely motivated by his stroke and they have achieved every goal set for them, which really inspires me and I hope by telling this story other people can be inspired too” (BSc female year 1 student, P57). Another student stated: “[story B] encourages people to do their own research and be persistent when asking doctors questions” (MSc male year 1 student, P3).

This story considered was most unusual for the BSc first year students (17/31, 55%), followed by the MSc students (13/39, 33%) then the BSc year 3 students (5/19, 26%). The majority of year 3 BSc students highlighted the shortcomings of the hospital environment (14/19, 74%). Less numbers of year 1 students highlighted this although numbers were still considerable (MSc 24/39, 62%; BSc 14/32, 44%). The shortcomings identified by students including the healthcare professional’s misdiagnosis, inadequate care, patient neglect, a lack of communication between the patient and a lack of patient-centered care. The students were also critical of the ward environment on the mental health of the individuals; similar numbers highlighted this across programs (BSc year 3 6/19, 32%; BSc year 1 7/32 22%; MSc year 1 10/39 26%). One student illustrated this; “[the story] highlights flaws in healthcare systems and shows how it affects patients and negatively impacts their recovery. Shows how patient centered care is sometimes not achieved and the needs and wishes of patients aren’t always taken into account” (BSc female year 3 student, P72).

Students consistently identified this story with words that demonstrated their shock, annoyance and frustration at seeing the narrative reported by the individual. This was most prevalent for the year 1 BSc students (11/32, 34%) and less prevalent for the BSc year 3 students (5/19, 26.3%) and the year 1 MSc students (7/39, 19%). Interestingly, some third-year BSc students (4/19, 21%) identified the story as realistic and were able to identify the mistakes as unfortunate but understood it from the perspective of broader challenges with the NHS and problems faced like short staffing and patient overload. One student stated; “The patient shed light to the unfortunate but realistic experiences that happens to stroke patients where their stroke might have been missed in the early stages” (BSc male year 3 student, P80). Students identified that they felt empathy towards the individuals this was most often in BSc cohorts (year 1 11/32, 34%; year 3 10/19, 53%) and less often in the MSc cohort (7/39, 19%).

Summary of Story C.The monster was identified as a loss of control following the stroke and the identification of negative or challenging experiences e.g., the inability to speak or express herself. A central way the monster was overcome was to view negative experiences as an adventure. Life and new experiences become an adventure.

Students were equally attracted to story C (BSc year 1 11/31, 35%; BSc year 3 6/19, 32%; MSc year 1 10/32, 25%). Around 10% of all students identified story C as the most common (MSc year 1 4/39, 10%; BSc year 1 3/31, 10%; BSc year 3 2/19, 11%). Those that identified the story as common did so by referencing the common physical and cognitive problems that many stroke patients experience such as losing ability to perform basic activities, speech, reduced memory and concentration. Story C was also identified as common due to the ability of people to adjust to one’s viewpoint and mindset after a stroke. The BSc year 3 students most often selected story C as their preferred story (12/19, 63%). This was similar to the year 1 BSc students who most often selected it (15/31, 48%). Slightly less students from the MSc cohort identified C as the preferred story (12/39, 31%). Students valued particular characteristics demonstrated in this story including persistence and determination to succeed. Also, students said that motivation would reassure respondents that their loved ones would be determined to progress and persist with their rehabilitation programme in order to achieve the best quality of life possible. BSc year 1 students stated that they would tell Story C if they were in a similar situation (14/31, 45.2%). This was slightly less from other cohorts (MSc year 1 12/36, 33%; BSc year 3 5/19, 26%). The value of the story for these students was the perceived ability to demonstrate the capacity to evolve and cope with a life-changing disease in a positive and novel way by viewing life as an adventure. For instance, one student stated: “… because it is a story of hope and is encouraging that things will end up good” (MSc-preg Female Year 1 Student, P14). Despite it being preferred, the majority of students across cohorts identified Story C as the most unusual for two cohorts (BSc year 3 13/19, 68%; MSc year 1 22/39, 56%), and perceived as unusual by less BSc year 1 students (12/31, 39%). Story C was assumed to be unusual due to the individual’s positive and hopeful outlook on life and seeing how life and recovery journey was an excitement and adventure.

High numbers of all year groups (year 1 BSc 18/32, 56%; year 1 MSc 16/38, 42%, n = 1 missing data; year 3 BSc 14/19, 74%) perceived that the story illustrated an amazingly rare positive attitude and mindset following the stroke. Several students found the story motivating and inspiring to read (BSc year 3 7/19, 37%; BSc year 1 7/32, 22%; MSc year 1 4/38, 11%). Interestingly this was identified as a surprising story for a number of final year students as it was unexpected and represented a unique ideology (8/19, 42%) whereas only one student in the year 1 cohorts identified it as surprising. At least half or more of all students identified the characteristics of the individual of this story most often. They highlighted the ability of someone to find strength, determination, and motivation intrinsically, enabling her to persevere with the rehabilitation program to move forwards in her recovery journey from stroke. This was illustrated by similar response levels across groups (BSc year 3, 12/19, 63%; MSc year 1 19/38, 50%; BSc Year 1 15/32, 47%).

Rizwan Ahmed
Rizwan Ahmed
AuditStudent.com, founded by Rizwan Ahmed, is an educational platform dedicated to empowering students and professionals in the all fields of life. Discover comprehensive resources and expert guidance to excel in the dynamic education industry.


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