As part of the ESO TF4UKR Department-to-Department Visiting Programme, I had the privilege of completing a ten-day internship at the Stroke Unit of the University Hospital de Santa Maria under the supervision of Professor Ana Catarina Gaspar Fonseca, a highly qualified neurologist with extensive expertise in cerebrovascular medicine. Hospital de Santa Maria is the largest university hospital in Portugal and the country’s leading medical center, closely affiliated with the University of Lisbon. The Department of Neurology and Stroke Unit plays a central role in providing specialised care while integrating clinical practice, scientific research, and teaching.

During the internship, I followed the full pathway of patients with acute stroke – from admission at the emergency department to clinical evaluation, neuroimaging, and decision-making regarding treatment (thrombolysis or mechanical thrombectomy). Particular attention was given to ensuring alignment between presenting symptoms and diagnostic findings, which enabled a highly personalised approach to each patient. The Stroke Unit can be highly estimated by its high level of organisation: efficient triage, standardised imaging protocols, and well-coordinated teamwork of a multidisciplinary staff (neurologists, interventional neuroradiologists, anesthesiologists, and nurses). A key feature was that physicians strictly adhered to acute ischemic stroke treatment protocols, and patients are sure to receive timely and effective care. The level of interventional stroke therapy meets the highest international standards.

The atmosphere at the Stroke Unit was exceptionally welcoming and hospitable. Doctors were eager to share their expertise, explain the organisational structure of stroke care in Portugal, and engage me in clinical discussions. I also had the opportunity to observe other departments of the hospital, which provided a broader perspective on how practical stroke care is integrated within a large university medical center.

I am deeply grateful to Professor Ana Catarina Gaspar Fonseca as well as the entire team of the Stroke Unit at Hospital de Santa Maria, and the ESO TF4UKR programme for this invaluable professional experience.

Learn more about the TF4UKR Programme: https://eso-stroke.org/resources/tf4ukr/

An incredible learning experience at Karolinska University Hospital through the D2D programme by the European Stroke Organisation (ESO)!

Together with a physician in physical and rehabilitation medicine (Dr. Guliaieva) we observed the highly skilled work of a multidisciplinary team: doctors, nurses, speech &language therapists, and other specialists.

During my clinical training at Karolinska University Hospital in Stockholm, I had the opportunity to observe and participate in the work of speech and language therapists (SLTs) in both acute and post-acute care settings. This was an extremely valuable and enriching experience that allowed me to broaden my professional knowledge and gain insight into interdisciplinary collaboration in a world-renowned medical facility.

Part of the SLT team works with patients in the acute phase of their condition, particularly those in intensive care units (ICUs). I had the opportunity to accompany the SLTs during the clinical assessment of such patients. Additionally, I was involved in two gold-standard instrumental swallowing assessments: Fiberoptic Endoscopic Evaluation of Swallowing (FEES) and Videofluoroscopic Swallow Study (VFSS). These procedures were followed by team discussions to determine appropriate therapeutic strategies and treatment plans based on the results.

I also participated in the diagnostic process for patients with head and neck cancer. These patients were evaluated both before and after tumor resection. It was insightful to observe how assessments and therapy planning are tailored to each patient’s condition and surgical outcomes.

Furthermore, I visited a rehabilitation center where patients stay after the acute phase of their illness. There, I observed the evaluation and treatment of patients with aphasia. I attended outpatient rehabilitation sessions and became familiar with the tools and scales used for aphasia diagnostics. Among these were standardised assessments such as:

• Western Aphasia Battery (WAB)
• Boston Diagnostic Aphasia Examination (BDAE)
• Aachen Aphasia Test (AAT)

This clinical experience deeply inspired me. I was particularly impressed by the professionalism, empathy, and scientific approach demonstrated by every member of the speech and language therapy team. The high level of interdisciplinary cooperation and the attention given to each individual patient were exemplary and serve as a model for clinical work.

I am sincerely grateful to the entire SLT team at Karolinska University Hospital for their openness, support, and willingness to share their experience and knowledge. Their mentorship made my stay not only educational but also personally meaningful. This training has strengthened my motivation to continue developing in the field of speech-language pathology and to implement the best international practices in my own work.

My name is Mariia Mykhailova, and I am a neurology resident at the Stroke Centre of Oberig Universal Clinic in Kyiv, Ukraine. With the support of the ESO TF4UKR Department to Department Visit Programme, I had the opportunity to complete a two-week clinical observership at the Stroke Unit of Mater Misericordiae University Hospital in Dublin. I was warmly welcomed by the team and had the opportunity to closely observe clinical practice under the supervision of consultant neurologists Professor Peter Kelly and Dr. Michael Marnane, who generously shared their expertise. Their guidance and openness were incredibly valuable, and I am excited to bring many of the insights I gained back to my work in Ukraine.

Throughout the observership, I was able to observe the full continuum of stroke care, including emergency assessments, inpatient rounds, and outpatient follow-ups. I was particularly impressed by how well-coordinated and fast the stroke team operated upon patient arrival. It was also remarkable to see how openly doctors consulted with one another – less experienced clinicians receiving real-time support and guidance from senior colleagues, including remotely when needed. This collaborative approach stood out to me as a strength and gave me ideas for enhancing shared decision-making in our own practice.

It was also valuable to observe the structure and operations of the Hyper Acute Stroke Unit (HASU), as such units are not yet common in Ukraine. The clearly defined workflows and systematic documentation offered a clear and efficient model that could be beneficial in our context.

I attended multidisciplinary meetings and joined one of the radiology case discussions, where consultants and radiologists reviewed selected imaging cases together. This kind of collaborative review was a helpful addition to clinical decision-making and could be a useful format to implement in our own practice.

At the outpatient clinic, I observed structured follow-up visits 3–6 months after discharge. I found the discharge booklet given to each patient particularly impressive – it includes a summary of their condition, relevant contacts, lifestyle recommendations, and diaries for tracking blood pressure and lab results. This kind of patient-centred resource could be very helpful if adapted for use in Ukrainian stroke services.

In addition, I learned several therapeutic approaches that were new to me, including aspects of blood pressure management in acute stroke. I was also inspired by how well the system supports rehabilitation after discharge – from social worker involvement to options for continued care at home or in rehabilitation centres. These practices could significantly improve stroke recovery outcomes if integrated into our own system.

This observership gave me the chance to compare stroke care in two different healthcare systems and reflect on what could be adapted locally. I also had the opportunity to build professional connections that I hope will lead to future collaboration and knowledge exchange.

Overall, this was a highly enriching and motivating experience. I am sincerely grateful to the European Stroke Organisation for supporting this opportunity, and I look forward to applying what I’ve learned to strengthen stroke care in Ukraine.