Issuu

JAARGANG 34 | NR 2 | JUNI 2021

PANESSAY

FACULTEITSBLAD DER M.F.V. PANACEA

Prof. progress test

Asclepius

Resume stress

Traumatology: The ABCs in ABCDE

Griekse god van de geneeskunde

Things students rarely talk about

28 Het nest verlaten

Practicing abroad

Review affiliatieziekenhuis II

What if clogs and cheese aren’t for me?

Uit de hokken

Coronacolumn

Commissiepagina

Resume stress

Professor progress test

Cheat map

Woonondersteuner

11 35ste f.t bestuur der M.F.V Panacea

Het nest verlaten

Past and present

Practicing abroad

Mastering the Master

Medicine on the move

Fotopagina

CoColumn

Asclepius

What medical instrument are you?

Help us choose!

Memes

Medical summaries

Activiteitenkalender

GRASP the future

wij bieden nachtrust

Groningen Oosterwolde Leek www.vandermeeracc.nl

VAN DER MEER

accountants & adviseurs

Uit de hokken

Uit het redactiehok Here we are, the last edition of the academic year, and thus also the last edition that I will play my role as main editor. When I first joined PanEssay, I was not sure whether this was the right committee for me, as I originally did not sign up for this one. But I soon realized that writing about the things you love most is something to be proud of, and most of all a lot of fun! From the weekly meetings, sitting down together to eat a masterfully prepared meal by one of the committee members to the committee trip in the middle of nowhere: I had an amazing time as a member of PanEssay. This year we unfortunately had to skip a lot of the fun things, and the new members did not get the chance to have the full PanEssay experience. But hopefully when things are back to normal, the next main editor can resume the activities that make this such a fun committee. But back to this edition; of course, we have once again prepared some high-quality stuff for you readers. I can remember that seeing the faculty for the first time was

very intimidating, and I found myself lost plenty of times. So, for you newcomers, Anne has made a great overview on where to find what in Antonius Deusinglaan. For seasoned PanEssay readers, Thomas has made a brand new column aimed for (pre)M1 students. Of course, these are just two of the amazing pieces of work that are written for this edition, so do not forget to explore the rest for yourself! This year must have been one of the most stressful years for most of you so be sure to sit down, have a drink, read the PanEssay and try to forget about medicine for the coming summer break.

Uit het bestuurshok Wanneer deze PanEssay op de mat valt, zal de zomervakantie (bijna) beginnen voor de bachelorstudenten. De masterstudenten zullen in de zonnige zomermaanden hard doorzwoegen in de kliniek of in de KTC lokalen. Op het moment van schrijven, begin mei, zijn de terrassen net open en hebben steeds meer mensen

hun vaccinatie(uitnodiging) ontvangen. Als bestuur en commissies hebben wij de eerste fysieke activiteiten kunnen organiseren in kleine groepjes. Zo hebben een aantal leden samen met de docenten op Koningsdag gewandeld in het natuurgebied bij Kardinge, hebben de eerstejaars studenten in duo’s door Groningen gewandeld met een lekkere stroopwafel van de MASH. Tenslotte hadden we het geweldige thuis-Galadiner en Silent Disco georganiseerd door de GalaCie en AkCie. Wij hopen natuurlijk in onze laatste maanden deze activiteiten steeds vaker te kunnen organiseren en jullie daarbij weer in het echt te kunnen spreken! Verder heeft tegen de tijd van verschijning de Mei ALV plaatsgevonden, waarin (hopelijk) onze lieve KaBoertjes goedgekeurd zijn. Zij zullen het 35ste f.t. bestuur der M.F.V. Panacea vormen en daarmee het zevende f.t. Lustrumbestuur! Onze laatste maanden als bestuur zijn daarmee ingegaan en de wissel in september komt steeds dichterbij. Vanaf september zal, naast het nieuwe collegejaar, ook het nieuwe bestuur starten!

Commissiepagina

Tropical Medicine Comittee Have you ever wanted to work abroad? Are you interested in the fields of war surgery or the mental health of war-affected populations? Do you see yourself working as a tropical doctor or for doctors without borders? As future doctors we have many open doors, we just need to decide which ones to walk through. We as the tropical medicine committee have organized an elective course for second years where we discuss the opportunities in tropical medicine and how multifaceted the field is.

During the sessions we organize, you learn everything about medicine in the tropics, as well as the influence of culture, communities and environmental factors on our profession. You learn about the prevalent but often neglected diseases in this region, which groups are particularly vulnerable and what is being done to combat their vulnerability. We also acknowledge the role of cognitive biases in our perception of tropical medicine, such as the white savior complex. Our course provides you with an overview of this very interesting field, you learn how the knowledge you obtain within your degree is translated into action in regions with less developed healthcare systems and how you yourself can become active in the field. We also ensure that after our course you are set up with plenty of resources and connections that you can utilize to further your interests.

MusicalCie We verkeren ons in duistere dagen, niks lijkt nog uit te maken. Een sociaal isolement dat zijn grenzen niet meer kent. Dagen thuis in de pyjama voor de persoonlijke computer. Geen enkel vooruitzicht, geen enkel puntje van licht.

theater, een talent voor een instrument of de benodigde skills voor de crew. Dus wanneer de tijd rijp is, geeft u op! Samen zullen wij twee onvergetelijke avonden voor heel Panacea, het gehele UMCG en het Hoge Noorden realiseren.

Herkent u dit, leest dan voort! In 2022 zal u er namelijk achter komen dat dit alles het waard was. Het jaar van de Musical, waar u allen naar uit kunt kijken, is dan immers aangebroken. Maar liefst veertien maal eerder hebben geneeskundestudenten laten zien dat ze meer kunnen dan leren of lezen, maar dat zij ook nog eens kunnen leven. Zo hebben zij passievol Grease opgevoerd, de sterren van de hemel gespeeld met Beauty and the Beast en al onze harten veroverd met Annie.

Wil je nu nog meer weten over de mensen achter deze sensationele organisatie, volg ons dan zeker op de gram: musicalcie_panacea. Zo kun je er onder andere achter komen wie onze stiekeme beroemdheid is of wie graag stoeprandjes consumeert. Én je vindt hier natuurlijk ook welke musical wij zullen opvoeren plus nog veel meer!

Als de MusicalCie hebben wij een schitterend doel om u één (of misschien zelfs twee) avonden lang te vermaken, te laten lachen of huilen, want alles kan op die ene avond. De avond van glorie en genot en gezelligheid. Hoewel deze commissie over verscheidene getalenteerde leden beschikt, kan zij, op haarzelf, niet de verwachtingen van deze ó zó enórme avond vervullen. Daar heeft zij u bij nodig! Iedereen met liefde voor

Lustrumcie This year the M.F.V. Panacea will celebrate their 35th birthday!!! That’s why we will organize an amazing week with a lot of fun activities, also called our 7th Lustrum. We hope that together we can celebrate this amazing milestone from our association extensively. It will be a week with a lot of parties, dancing, games and sometimes even educational activities. Are you already as enthusiastic as we are? Then invite all your friends to the activities and make it a week to remember. We hope to see you all during the Lustrum week. Kind regards, LustrumCie ‘20/‘21/’22 P.S. If you want to stay updated, go ahead and follow us on instagram @lustrumpanacea

Dit studiejaar bestaat M.F.V. Panacea 35 jaar!!! En daarom organiseren wij voor jullie een fantastische week met allemaal leuke activiteiten, namelijk het 7e lustrum. Wij hopen dat we de verjaardag van onze prachtige vereniging met jullie allemaal uitgebreid kunnen vieren. Het wordt een week waarin we met elkaar feesten, dansen, spelletjes doen en af en toe ook nog wat nieuws leren. Lijkt dit jou nou net zo geweldig als ons? Kom dan met al je vrienden en vriendinnen naar de activiteiten en maak er samen met ons een onvergetelijke week van. Hopelijk zien we jullie allemaal op het Lustrum. Groetjes de LustrumCie ‘20/‘21/’22 P.S. Volg voor updates instagram @lustrumpanacea

CepCie Are you feeling stressed about your studies? Not sure what to do with your future as a doctor? Chances are that you are not alone. Luckily we are here for you! We as the CepCie (Career Event Panacea), aim to provide you with the scientific as well as practical knowledge on how to get through your studies with the least amount of stress and help you with making decisions for your future career whilst at the same time having more than enough room for partying, drinking and following your social obligations! As the brand new committee of Panacea we are organizing a medical career day the likes of which you have never seen before! This year the day revolves entirely around stress. Especially for you medical students

we are organizing an amazing lineup, including experienced doctors, award winning speakers and even renowned celebrities in het medical field! Furthermore, for the first time in the history of Panacea this day will be given in english and in dutch! This way it will be a great opportunity for you and your fellow students to interact with the students from the different learning communities and form relationships (maybe even meet your soulmate) which might hold a lifetime! All these factors included are sure to lead to an exciting and unforgettable Career day in 2021. So don’t forget to buy your ticket and we will see you on the 10th of november!

Hendrik-Willem Pasterkamp

Professor Progress Test Traumatology: The ABCs in ABCDE For most of you it might be far away, but I know for a fact that for others they are glad it is finally over: trauma. Trauma is a recurring theme in G2020 and is often considered one of the most difficult themes of year 1 and 3. Trauma is also one of the topics that often recurs on the Progress Test. In this Professor Progress Test, I want to give you an overview of the basics in traumatology. After reading this I’m sure you’ll find that acute medicine might sound more traumatizing than it actually is.

I still remember having my first lecture by professor Nieboer. No laptops, no notebooks and no phones, that was the first rule. The second and third soon followed: don’t speak unless you’re spoken to, and you better not be late because you will be publicly shamed for it. And if that’s not intimidating enough, there is a chance you will be asked a random question about a life-threatening situation at any time during the lecture and if you don’t know the answer, you’ll actually feel like you just failed to save a patient’s life. Fortunately, although this sounds terrifying, these lectures have been some of the most, if not the most, fun and interesting lectures I have ever had during my Bachelor. And once you actually start to follow Dr. Nieboer’s advice, you’ll notice that the theory behind acute medicine is quite simple: treat first what kills first.

‘‘No laptops, no notebooks and no phones, that was the ﬁrst rule.’’ To make a proper assessment of what kills first, we start off by making a primary survey using the (C) ABCDE method. C-spine – the ABCDE method starts with a C, the C of the cervical spine. Before approaching a patient, try to find out what kind of accident or situation the patient has been in. High-energy accidents can cause spine injury and the patient should be handled with extra caution to prevent worsening of potential neurological injury. Always assume cervical spine fracture unless proven otherwise. Alarm symptoms: high-energy trauma, neck or back pain, loss of sensation

Airway – a proper oxygen supply is obviously the most important requirement of staying alive. No oxygen means no brain, no brain means no heart and no heart, well, game-over. It’s a common misconception that the heart is the central and most important organ of the body, and depending on your speciality it might be true. But in acute medicine, the brain is the organ you should be worried about. A proper intervention at this level to make sure the airway is secure and open by means of endotracheal intubation. Alarm symptoms: absence of breathing, inability to speak or cough, wheezing, cyanosis, use of accessory breathing muscles, foreign object or blood in the oral cavity or facial trauma Breathing – Alright, so now you know that the airways are open. But the question you should be asking now is: how well are the lungs functioning? You’ll be looking at breathing rate, breathing symmetry and overall movement of the chest and use of muscles. Shallow breathing can, for example, indicate abdominal trauma and pain. Asymmetric chest movement may indicate a (tension) pneumothorax. Proper intervention here consists of a non-rebreathing oxygen mask or a ventilator. Alarm symptoms: breathing rate below 12 breaths/pm, breathing rate above 20 breaths/pm, cyanosis, absence of breathing, increased work for breathing, swollen and immobile half of chest (tension pneumothorax or haemothorax), chest, upper back, or upper abdominal trauma. Circulation – Now that you know that your patient is getting enough oxygen, it is time to look at how well your oxygen transport is doing, aka the circulation. What is the heart rate? Is the heart rhythm regular?

Are there any major injuries internal or external that bleed extensively? In this phase it is important to determine if the patient is in shock, and how far the shock has progressed. More on shock later. Proper interventions at this stage: IV line insertion (although this is sometimes done earlier) and damage control surgery. Alarm symptoms: sweaty and clammy patient, paleness or blue skin, severe blood loss (>20%), slow capillary refill time, quick and shallow pulse. Disability – In this section of the primary survey, the inner neurologist in you should be woken up. You should look at the consciousness of the patient using the GCS/EMV score. Quick tests like looking at the pupils for anisocoria (one pupil larger than the other) or checking for leakage of liquor can already determine whether there has been neurological damage. High-energy accidents can also severely impact the spine, so testing the reflexes is also a good idea. Alarm symptoms: anisocoria, (progression to) loss of consciousness, headache, nausea, loss of control or sensation, long-lasting amnesia. Exposure – this last one might seem like the odd one out. Assessing exposure means, assessing for potential hypothermia. Proper action here is to use an emergency blanket to keep the patient warm. If the situation allows, and you don’t know it already, you should find out what happened to the patient and let him/her describe the situation. Alarm symptoms: blue skin colour, slurred speech, shivering, drowsiness. So now that you know or are reminded of what exactly the ABCDE method is, I want to talk a bit more about the principle of shock. When a patient is in shock, blood distribution is impaired. Organs are not getting enough oxygen, and this leads to organ failure and later death. Classic signs of shock include tachypnoea (20+ breaths/pm), tachycardia (100+ bpm), hypotension, reduced urine output (<15 ml/min) and low EMV/ GCS score. Shock can become irreversible. There are different types of shock, we differentiate between cardiogenic, distributive (neurogenic) and hypovolaemic shock. Cardiogenic shock – this type of shock is characterized by a sudden insufficient pump function of the heart. This is usually caused by a severe heart attack. Treatment is difficult, fluid replacement will not work as that will only increase the preload of the heart, potentially worsening the state of shock. Treatment involves vasopressors and anti-clotting medication.

Distributive (neurogenic) shock – Distributive shock happens when massive vasodilation causes blood to pool in areas whereas it lacks in others. This is usually caused by endotoxins released by bacteria in a bacterial infection. A different type of distributive shock is neurogenic shock. This happens when the (para)sympathetic innervation of the blood vessels is malfunctioning, causing vasodilation. Treatment involves fluid replacement and treatment of the cause, for example antibiotics in a bacterial infection. Vasopressors are also widely used.

‘‘When a patient is in shock, blood distribution is impaired. Organs are not getting enough oxygen, and this leads to organ failure and later death.’’ Hypovolaemic shock – Hypovolaemia happens due to haemorrhage and this is the most common type of shock. Injuries to certain organs (e.g. spleen) can cause hypovolaemic shock in less than 30 minutes. Treatment involves measures like surgery to stop the bleeding and volume replacement. Volume replacement in itself is already quite complicated, as you are replacing oxygen transporting blood with fluid. But that might be the subject of a different Professor Progress Test. Obstructive shock – Obstructive shock can happen due to several underlying mechanisms that cause obstructed blood flow. It is often grouped with cardiogenic shock but due to it’s unique pathophysiology, I want to add it here. Obstructive shock is usually caused by one of two complications: pulmonary embolism or cardiac tamponade. Massive pulmonary embolism causes the blood pressure in the lungs to increase, resulting in blood backing up to the heart. This increases afterload and reduces the pumping ability of the heart. Cardiac tamponade happens when fluid builds up in the pericardial space. This also increases the pressure to which the heart has to pump blood, and thus decreasing it’s efficiency. I hope you find that after reading this article, trauma is a little more clear to you, or it freshened up your memory. There is a lot more to acute medicine that are beyond the scope of this article like toxidromes, fractures, acute abdomen or emergency psychiatry. If you score badly in any of these subjects on the Progress Test and you want to change that once and for all, be sure to let us know, and maybe you’ll find everything you need to know in a future PanEssay!

Benedetta, Aoife and Svea

GRASP the future How toy play can make all the difference to a hospitalised child Hi there! We are Benedetta, Aoife and Svea, 5th and 6th year medical students at the Rijksuniversiteit Groningen and founders of the non-proﬁt organisation GRASP. Our story begins in 2018, when we got the opportunity to go to KwaZulu-Natal in South Africa for our bachelor project. Childhood malnutrition is a major problem in this particular region just like in many other parts all over the world. Sadly enough, 45% of deaths among children under the age of 5 are linked to undernutrition. Malnutrition can however not only lead to life-threatening problems: The World Health Organization states that poor nutrition can lead to “reduced immunity, increased susceptibility to disease, impaired physical and mental development, and reduced productivity”. In other words, childhood malnutrition results in delayed brain development leading to an increased risk of experiencing problems with cognitive, motor and socio-emotional skills throughout child- and adulthood. Our brains have unfathomable potential for plasticity and repair; in general whilst still under the age of 5 the brain is still capable of recovering from malnutrition. However, this recovery is dependent on several factors: appropriate dietary nutrients, psychosocial stimulation and emotional support of the child. The WHO therefore includes social-emotional stimulation by means of toy play as an important step in the treatment of malnourished children. However, the importance of playing with toys as a social-emotional stimulation is not always transposed in practice in hospitals or communities. One of the underlying reasons for this is usually a lack of information (from parents and health care professionals) and financial opportunities to purchase toys. Prior to the COVID-19 crisis 1 in 5 South African children did not have access to adequate early childhood development programmes (this includes structured play therapy), and amongst the hospitalised population this number was even higher. In 2018 we therefore travelled to KwaZulu-Natal in South Africa for our Bachelor Project, where we set-up toy making workshops in the General Justice Gizenga Mpanza Regional Hospital. During these workshops caregivers of hospitalised children learn about the fundamental importance of toy-play in their child’s early development, especially if a child is admitted due to malnutrition. Health care professionals also teach

caregivers how to make stimulating, ageappropriate toys for their children out of everydayaccessible recycled materials, empowering caregivers to interact more with their children. The toy making workshops have been a huge success and were continued by local health care professionals after our departure. These early successes motivated us to establish GRASP. As an organisation our goal is to promote interactive, stimulating caregiver-child toy play, so that all children have access to the best start in life and can grasp their full potential! In order to give more hospitals the opportunity to set-up the Toy Making Project, we are collaborating with local health care professionals. Through a training programme for health care professionals and an instruction booklet for caregivers, we aim to support doctors, nurses, occupational therapists and physiotherapists to set-up the Toy Making workshops in their own hospital. This is why we’ve started a Crowdfunding campaign together with the Nederlands Albert Schweitzer Fonds. With the money collected through this Crowdfunding campaign we want to improve our current training programme for health care professionals and instruction booklet for caregivers, and expand the toy making project to four new hospitals in KwaZulu-Natal. We would appreciate it immensely if you could donate to our Crowdfunding campaign, or share the website link via your social media channels and to your friends and family! By doing so you will be giving children in KwaZulu-Natal the chance to a better start in life, so that they can GRASP their future! For more information about the Crowdfunding campaign see: www.nasf.nl/grasp

M.F.V. Panacea

Introductie Futurum Tempore Lieve leden der M.F.V. Panacea, beste lezers, Met trots introduceren wij ons als futurum tempore! Met onze ervaren opper-KaBoer Nienke en de frisse blik van de andere vijf KaBoertjes, gaan we volgend jaar een prachtig Lustrumjaar tegemoet. Met Nienke’s kennis van de vereniging, Femke’s vlotte vingers, Lotte’s rekenmachine kunsten, Zita’s vlotte babbel, Wyke’s enthousiasme en Donna’s hart voor onderwijs gaan we een mooi jaar tegemoet met zijn zessen. Samen met jullie hopen wij veelbelovende ideeën te zaaien en te oogsten op de mooie grond der M.F.V. Panacea. We kijken er enorm naar uit om tijdens het zevende lustrum deze mooie vereniging te mogen besturen en er samen met jullie een onvergetelijk jaar van te maken. Wij hebben er heel veel zin in en hopen jullie allemaal te zien in de Lustrumweek en bij alle andere gezellige activiteiten in het verschiet. Liefs, Nienke, Femke, Lotte, Zita, Wyke en Donna Het 35ste f.t. Bestuur der M.F.V. Panacea

Seung-yae Yoon

Past and present Panessay: what has(n’t) changed? The quarterly PanEssay issues are a familiar sight on the doormat of many medical students in Groningen. But what a PanEssay issue looks like in 2021 is very different from when its ﬁrst issue was printed. After all, the PanEssay has been around for longer than most people that are reading the PanEssay today. With shifting times and changing writers, many features have come and gone – but certain elements have carried on through the passage of time. PanEssay’s Origins On August 20th, 1987, the three student bodies of the medical faculty at the University of Groningen (S.M.S., Placebo, and M.S.F.G.) merged to form M.F.V. Panacea. Under this newly organized association, a magazine – the PanEssay – was created for its members. The quarterly editions shed light on the affairs of Panacea and the faculty, as well as various medical topics. As we approach the 25th anniversary of Panacea in 2022, the total number of editions published nears 100. An Outline of the PanEssay For first-year students, who are busy with the tedious task of deciphering Nestor and reading abstract maps, trying to figure out how PanEssay issues are structured may seem like another task. Add to this the fact that many titles are in Dutch, and you get a confused international student. As the current issue will be the first that new students will receive, the structure of each issue has been broken down below. A PanEssay issue consists of a number of recurring columns and articles about a variety of topics. Leading every PanEssay edition is “Uit de hokken” (or “From the Lofts” in English): a section where the board of Panacea gives a short update on their activities in the past months, and the chair of the PanEssay gives you an idea of what to expect in the edition. The “Commissiepagina” (“Committee page”) is the second column you find, featuring short introductions from members of a few Panacea committees. If you’re wondering which of the 28 committees you would like to join, you can be sure to find an explanation of their functions here! On the last page, the “Activiteitenkalender” will keep you updated on upcoming Panacea events and exams.

Then come the education-oriented articles. One very useful column is “VGT-hulp” (“Prof. Progress Test”), where a topic frequently assessed in the Progress Tests is explained. We know how difficult it is to try to remember a subject you covered a year ago, so you can brush up your knowledge and test yourself with practice questions that we include. For those who haven’t learned about the topic yet, it is a chance to answer a few more questions on the Progress Test that you otherwise would not dare touch. Program organizers, educators, and student representatives can explain what they do in the “Onderwijscolumn” (“Education column”). An interview with a specialist in “Liedfe voor het vak” (“Passion for the field”) describes the specifics of the field. Lastly, the “Co-column” gives insights into life as an intern and useful tips on how to survive, while making the most of your time. Apart from these regular features, several articles cover all sorts of subjects. From personal experiences in medicine to medical history, ethics, and exciting developments, there’s always something you can take away. If you’re looking for lighter material, the articles about life in Groningen and our puzzles and memes will keep you entertained.

“From personal experiences in medicine to medical history, ethics, and exciting developments, there is always something you can take away.”

The Changes Throughout its history, however, the PanEssay has evolved. From the very first glance, one would notice that today’s covers look different from those published a decade ago. Current editions feature a photo related to the holiday or the mood and events of the month of publication. This hasn’t always been the case, however, with older issues having photos that give a preview to the articles, or not having any pictures at all. An even more noticeable difference is that all pictures in the older issues were printed in black and white. When printing in color became more affordable, PanEssay began incorporating more visual elements into its cover and articles. A “Fotopagina”, two pages purely dedicated to pictures of Panacea activities, was added later. Another visual difference is the PanEssay logo. It has been changed a few times since the original design was created, from the classic and elegant original design to the more modern and colorful design of today. The current issue marks another change as we look to decide upon a new look for PanEssay with your help. We’ve listed the candidates on the last page of the edition, and you can vote for your preference by scanning a QR code. It won’t take much time and your input would be much appreciated! What’s a faculty magazine if half of the students are unable to read it? Every issue was written 100% in Dutch until 2010, when the English program in Medicine was first introduced at the RUG. This could have been a problem for the newly-arriving international students, but PanEssay quickly included English articles and sought out English-speaking writers. From this point onwards, the PanEssay featured a mix of English and Dutch articles, keeping both internationals and Dutchies happy. Hence, you can read about interesting topics in your preferred language or practice your Dutch in a medical context.

magazines in their mail, but all other years will have to indicate their preference for a hard copy on our website.

The Unchanging Core Although it’s clear that the looks and execution of the PanEssay has changed throughout time, its content has largely remained the same. As a magazine created under Panacea, it shouldn’t come as a surprise that the voice of the members, board, and committees have always taken center stage in the magazine. A message from the board can be found in the earliest issues, and an activity calendar and committee page have been around for more than a decade. Extensive interviews with educators and organizations go way back, and individuals describing their experiences have always been welcomed. Similarly, education and career information have always formed integral parts of the PanEssay. Students could always turn to the PanEssay for insightful interviews with specialists and professors, and descriptions about the internships. And to spice things up with a little fun, every issue has included puzzles or memes on the last pages. I think it would be fair to say that while the magazine has adapted significantly to technological advances and a changing student body, a reader from 25 years ago would still be able to pick up modern issues and identify it as PanEssay. As for the future, I’m curious to see what it has in stock for our magazine, particularly what the effects of reducing the number of English-speaking learning communities to one will be. Additionally, will PanEssay follow the trend of digitization and environmental consciousness to go completely online? And how much danker will the memes get? All interesting questions, and one that a writer 25 years from now will perhaps reflect on.

“The current issue marks another change as we look to decide upon a new look for PanEssay with your help.” In the same year it first featured English articles, PanEssay made another important decision: to go online. In keeping with the growing access to personal electronic devices and the internet, all issues were also published on the official PanEssay website and on issuu.com/panessay. Taking a step further, an opt-in system for receiving a paper copy was put into place in 2018 to become more environmentally friendly. Today, first years will automatically receive our

Thomas van der Korst

Mastering the master Preparing better for the fresh intern Are you in the bachelor and do not have a clue how, based on what you are learning now, you can become a real doctor? Or maybe you are getting closer to your clinical internships and are panicking about how to prepare. The very first start in the clinic is intimidating and causes many people to spend every evening overpreparing just so they do not mess up. I am almost a doctor at this point, and through the past few years my way of preparing internships has changed significantly. I spend significantly less time preparing now than I did back in M1, some of which is up to acquired knowledge but a lot of which is up to the skill of case preparation. Through a case from my first year of internships, I will show you the differences in how I approached preparation then compared to now. Preparing for the internship You are a fresh M1 intern and your first internship will be at the department of paediatric gastroenterology. You are both excited and afraid about what is waiting for you. You want to make a great impression by being super well-prepared, but you also do not have a lot of time because of your job and social commitments. You ask your friend who is almost a doctor for some tips. Very early in your internships you should realise that the way you learned about diseases in the bachelor is not too useful in your internships. You have learned about diseases, about all possible symptoms it can cause, genetic predispositions, the molecular pathways, all possible treatments that exist, etc. This scientific and complete approach (which I would call the 20th/21st century approach) is great, and only possible through a body of quality research. However, most of this is not applicable to the clinical reality of a beginning medical intern. Before that knowledge is useful you first need to learn the 19th century approach, namely you have a symptom or a group of symptoms that occur often, what diagnostic steps are necessary and what are the tried and tested methods to treat them (even if you do not yet truly understand how). Only after mastering that can you work on the 20th/21st century approach. Before starting your internship the best book you can use for preparation is not the textbook from the bachelor because you will find a chapter for each (group of) disease(s). You really should buy or borrow a book in the “Probleemgeoriënteerd denken in de …-series” published by Tijdstroom publishers. These books contain cases which start with very common presenting symptoms in that specialism and then the

author takes you by the hand, showing how that case is solved. Relevant for paediatric gastroenterology are the ‘interne geneeskunde’ and ‘kindergeneeskunde’ editions. I cannot stress enough how much these helped in preparing for an internship, if you do any preparation make sure this is part of it. It helps to think like a clinician since you almost never start from a diagnosis, you almost always start from a symptom.

Preparing for the case Your first case is a 16 year old boy who developed diarrhoea for a few days during the summer vacation and thought nothing of it. Over the past few months it happened more often and he keeps losing weight even though he is not trying to lose it. He has now been referred by his general practitioner to the paediatric gastroenterology department to figure out what the cause is and for treatment. Before doing any preparation for any patient you should think about where you are seeing the patient. A patient who has been referred to a hospital has ALWAYS been seen by a general practitioner at least once with the same problem. And you always have to remember, general physicians are (generally) very good at their job. One very important job is to evaluate if a patient requires specialist intention and they have usually tried to exclude some things themselves. So most often you are seeing a patient who has a serious or complicated problem, or they need diagnostics or treatment only available in a hospital. Therefore the answer: “it’s probably nothing,” is probably wrong. Now on to the preparation. Which diseases do you need to prepare? All of them?! You could, but that would take an ungodly amount of work. You only need TWO resources to prepare (almost) any case in

(almost) any specialism well enough to get a compliment from your supervisor that you prepared well. This is not only based on my own experience but also on the experience of others who use this method based on my recommendation. The first source is ‘‘https://www.huisartsdd.nl/’’. This is a website which gives you a very good differential diagnosis based on a given presenting symptom. It categorises by how often a disease occurs in the categories vaak (often), soms (sometimes) and zelden (rare). In addition some diseases are in bold which means it is a disease which can cause serious harm or is deadly when not diagnosed and treated in a timely manner. You should always prepare the diseases which are in bold and are in the vaak category. “But,” you might ask, “how do I prepare all these diseases?” It might surprise you, but you should not use UptoDate as your first stop since it gives an overload of information which you do not need for your preparation. The best source for preparing for a patient is the BMJ’s Best Practice-website. You can only access it for free through the RUG-proxy by using the following link: bestpractice-bmj-com.proxy-ub.rug.nl (do not use https://www. Before it because sometimes it messes up the RUG-proxy). On the Best Practice website you type the disease you want to prepare; in our case it would be irritable bowel syndrome. You will be greeted by a summary of the disease and a lot of options to learn more about the disease in question. For preparing a case the most important options are History and exam and Differentials. On the History and exam page you will find a list of symptoms, risk factors, physical exam findings, etc. which help in differentiating if it is or is not in line with the disease. Through this you will find the questions which you should ask and which examinations you should do. Write this down. Then look at the differentials page, sometimes it is very close to the differential you got from Huisartsdd. When you click on the disease you see in which way it differs from the disease which you are preparing. This will give you extra questions which you should also write down. Then rinse and repeat for the important diseases fitting the presenting symptom. You end up realising that most questions are duplicate in your list and you end up with a few differentiating questions. From now on you can always use these preparations. This is especially good because within one specialism some presenting symptoms occur VERY often, for example blood in stool or abdominal pain in gastroenterology. Please note: do not use UpToDate for preparing questions, it is not suitable for the 19th century approach, you will use it for the next step.

Preparing for your proposal for the next step Through your preparation you manage to ask the right questions and the doctor praises you for doing so. He or she takes over and tells the patient what they can say on the basis of the questioning. The doctor tells the patient that he is not sure what the diagnosis is and orders a colonoscopy. You do not know why they decided to choose that path and you wonder why. In M1 (or M2 for that matter) you are usually not asked to come up with the next step in front of the patient because you cannot be expected to know that yet. Usually you can ask the doctor why they chose a certain investigation or a certain treatment if it is not super-obvious. A better way of going about it, is checking UpToDate after seeing the patient to see the logical next steps. If the doctor deviates from what you find there, ask why because they usually have a good reason and you can learn from that. You can also understand more about that specific disease and it will help to inform you for the next time you see a patient with that diagnosis. Why are you doing this after seeing the patient? Because it is unrealistic to remember every single possibility, especially if you want the time to relax after a tough day of internships. Also, you usually have the time to research while typing up your report of the patient. While typing the report in the file of the patient you find out that the specialist could also have started treatment or could have first investigated the stool of the patient. When discussing your report you get feedback about what is in there and you see what they change, apparently some things are not as important as you thought. You ask why they did not examine the stool first. The doctor explains that because of the likelihood of blood in the stool based on how it was described and the fact that they lost so much weight, an inflammatory bowel disease is very likely. This way treatment can be started faster instead of waiting for the stool examination first. Preparation is very important for your internships, but you should not give up all of your free time to do it. It is important to be smart about it, that way you can be well-prepared AND still have a lot of free time to relax and have fun.

Petra Feenstra

Asclepius De Griekse god van de geneeskunde Gemiddeld slaapt de mens een derde van zijn of haar leven. Allemaal hebben we deze slaap nodig om een gezond leven te kunnen leiden. Dit principe is bij niemand onbekend, de oude Grieken zijn geen uitzondering op deze regel. Er waren in het oude Griekenland zelfs tempels die een plaats boden voor helende slaap, Asclepions. Tijdens deze slaap kon de persoon bezocht worden door de god van de geneeskunde hemzelf, Asclepius. Asclepius was de zoon van Apollo en Koronis. Één van de bekendste varianten van de mythe vertelt over Koronis die een affaire begint met een andere sterveling, Ischys. Wanneer Apollo hierachter komt, stuurt hij zijn zuster Artemis op pad om Koronis van het leven te beroven. Terwijl Koronis levend verbrandt, voelt Apollo schuld opborrelen en besluit hij zijn ongeboren kind uit de buik van Koronis te snijden. Hiermee wordt de eerste keizersnee ooit een feit. Het kind wordt Asclepius genoemd, wat vertaald als ‘open te snijden’. Na de geboorte vertrouwt Apollo de zorg van zijn kind toe aan een centaur, Chiron genaamd. Centaurs zijn mythologische wezens die half mens en half paard zijn. Chiron is vaag, maar wijs en had veel medische kennis die hij overbrengt op de jonge Asclepius. Zo leert de halfgod over chirurgie, medicatie en bezweringen. Wat echt een verschil maakt in de helende kracht van Asclepius is een flesje met Gorgon bloed, geschonken aan hem door Athena. Gorgonen zijn wezens met slangen als haar en een blik die ieder die hen aankijkt in steen kan veranderen. Medusa is uiteraard een van de drie Gorgonen. Met dit Gorgon bloed kan een sterveling gedood worden of een gestorvene juist tot leven gewekt worden, afhankelijk van welke kant van de Gorgon het bloed was afgenomen. Asclepius wordt vaak afgebeeld op een manier die ieder bekend voorkomt, namelijk een slang die om een stok gekruld is: de staf van Asclepius. De slangenbeet is een van de meest gevaarlijke wonden die iemand kan oplopen, maar voor Asclepius en zijn flesje Gorgon bloed was dit geen uitdaging. Met dit flesje trok Asclepius er regelmatig op uit om mensen te genezen van ernstige kwalen en zelfs de gestorvene uit de dood te laten herrijzen.

Dit kon natuurlijk niet onopgemerkt blijven bij de goden. De god van de onderwereld, Hades, was overtuigd dat alle zielen van overledenen tot hem behoren en was niet gediend van het feit dat Asclepius deze zielen van hem ontnam. Daarnaast verstoorden de acties van de geneeskundige de normale gang van zaken gehandhaafd door Zeus. Normaal gesproken wordt het leven opgevolgd door de dood. Asclepius zou hiervoor boeten en zelfs sterven. Zeus stuurde een bliksemschicht op hem af die hij niet zou overleven. Ondanks zijn woede, kende Zeus de arts wel een sterrenstelsel toe (Ophiuchus), omdat Asclepius zoveel betekend heeft voor de stervelingen. Deze stervelingen zelf waren Asclepius zo dankbaar dat zij hem gingen aanbidden en beschouwen als een god. Er werden tempels ter ere van hem gebouwd, de eerder genoemde Asclepions. Hoewel het verhaal van de god van de geneeskunde een mythe is, zijn er werkelijk geschreven getuigenissen van mensen die genezen zijn door Asclepius, die hen een bezoekje bracht tijdens hun incubatio in een Asclepion. Voordat Asclepius stierf, kreeg hij een aantal kinderen die allemaal iets betekenen voor de medische wereld. Dit kon ook niet anders, aangezien hij trouwde met de godin van de gezondheid, Hygeia. De bekendste afstammeling van Asclepius is Hippocrates, de vader van de geneeskunde. Oorspronkelijk begon de eed van Hippocrates ook met ´Ik zweer bij Apollo de Genezer en bij Asclepius en bij Hygieia en Panacea en bij alle goden ...´. Voor ons, studenten van de RUG, is Panacea, de godin van de remedie, natuurlijk een bekende en ook zij is descendent van Asclepius. Al duurt het nog vele nachten slapen voordat wij dan toe zijn aan de eed van Hippocrates, en zijn we het verhaal van Asclepius allang weer vergeten, onthouden we misschien wel iets van helende slaap. Al blijkt dat in realiteit iets waar we alleen maar van kunnen dromen.

PanEssay @panessay

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Chandra Kooistra

Summary Companies The student behind the summary One of the most used items by a student are summaries - either ones they made themselves or purchased from what I call “Summary Companies”. These are companies that provide summaries on the entire theme for a price. But how popular is it to actually purchase these summaries? And while we students make use of these summaries to revise (or as a last ditch attempt to pass the exam), how is this experience for the other side: the students who create these summaries? To explore this, I interviewed a student who works for a summary company (SC) and also went online to see what students themselves think. For privacy reasons the name of the student nor the name of the company will be mentioned. The interviewee will be called Alex.

The Interview First let’s get some basics out of the way: what year are you in and how long have you been working for SC? “Right now I’m finishing year three and I’ve been working for SC officially since January 2019, when I made a summary for the medicine selection. From August onward I’ve been working on making summaries every month. So, officially two and a half years.”

What made you decide to continue working for SC? “At first it was because of the money. It is a nice job where you get paid a nice amount of money which is a great motivator. Another benefit was also that you are almost always up to date on the material and the job makes you start working on the theme early on.” Although Alex works with the study material, the job is really focussed on making sure everything is explained correctly, the sentences are written well and the grammar is right. You do not necessarily study while doing the job since you are busy with many other things. “I work from the comfort of my own home and I can work at any time during the day as long as it is finished before the deadlines.”

How did you discover this opportunity? “I purchased the summaries myself and at some point, I thought: “You know what? I’m gonna apply for the job”. However, I didn’t hear anything back. Later on, I got a call to help on the summary for the medicine selection and I started working on it.” After this summary, Alex didn’t receive any information from the manager, who also stopped responding to messages. At some point, they got another job and texted the new manager that they would stop working for SC. Surprisingly soon after, they suddenly got all kinds of information. After some consideration, they accepted this more permanent position. “At the start it was difficult to communicate since there is no physical workplace and the old manager did not respond to me. I discussed this with the new manager and she understood where I was coming from and tried to improve this issue”.

Quite a bit goes on in your job. Can you tell the readers a bit more about what you exactly do? “When checking the summary you have to make sure everything is included, so all the material and anything that has not been summarised yet. You check the layout, the grammar, the punctuation, if it has enough pictures, and also if the practice questions are relevant.” Alex explains that the job starts after the exam. First there is a preparation to know exactly what needs to be done for the summary. You check if the material matches up from last year and if there is something missing: whether it be articles or Youtube videos, you make sure to summarise that. The largest part of the job is correcting the summary itself and making sure everything is correct and put in the correct format.

Alex is also in charge of the people who create practice questions. At the end Alex makes sure everything is there and that the final product is complete and can be uploaded.

“At the end it kind of feels like your baby and it is your responsibility to make sure everything is in order.” The timeline to create this final product varies between one and a half weeks to two weeks. “Usually, you do not have a lot of time to go through a whole summary of 100+ pages, since you ideally want to read the material beforehand. This can be very stressful since during this period you are working pretty much nonstop on the summary.”

How did it go af first with combining this job with your studies? “In the beginning it was very tough. I remember having multiple mental breakdowns with my coworkers on the first summary, because you do not know where or how to start. The thing is, after your exam, you usually chill out and rest, but with this job you cannot take those chill days since you already have to start working on the next summary. Besides this, you still have your university tasks and it starts to feel like a constant cycle of surviving the workload.”

If you could go back in time, would you still take this job, knowing the hardships you will encounter? “That is a very good question. I think I still would have taken the opportunity since it allowed me to really work on my time and stress management. It was a wonderful opportunity to view medicine and studying from a different perspective. To be able to look at all the information and choose what is necessary to know and shorten it, is a good skill to develop.” Even though Alex encountered negative experiences, they also had positive experiences and learned and developed themselves a lot because of this job. “It really taught me how to manage my time and my stress. You learn to work with others who you might not want to work with. Furthermore, I can handle criticism better, since you really learn to handle this professionally and use the criticism constructively. You learn that not everything is perfect and that’s okay as long as you keep improving yourself.”

Lastly, what would you say to someone who is interested in working at SC?

“Really look at yourself and see if this is something you would be good at. Are you good at summarising? Are you good at grammar and spelling? Are you good with rules? Then this might be a job for you. Check if you can handle the pressure, it can seem intimidating, but i think this would be the case with a lot of jobs. Medicine in general requires a lot of effort and doing anything on the side could give some stress. It is a good opportunity, which looks good on your CV.”

The Students Besides interviewing someone on the inside, I wondered what the opinion of students is with regards to these summaries. On the Panessay instagram account, I posted some interactive questions. My first question was whether students purchased summaries, which 62% did from 152 votes. The reasons students gave for purchasing the summaries were quite similar to each other. The top recurring ones were: 1. As a back-up 2. As a recap 3. Difficulty creating their own summaries There was also a group of 38% which did not purchase summaries. The majority of them stated that they make their own summaries instead. Another popular reason for not purchasing summaries was because they did not trust them since they can contain mistakes. The fact that they cost money was something that came up as well, since there are plenty of free sources you can use. A very interesting point made by a student was that these summaries are made to help you pass and not to remember the material. From 108 students, 27% said that a job at a summary company seems like a pretty nice one compared to the 73% who would rather not work at one. This surprised me personally since I expected the group of people who would not want to work for a SC to be much bigger, but about one in four students would want to have such a job (in the small group that participated).

At the end of the day Whether you purchase summaries or not, hopefully this interview has given you some insight into the person behind the summary the majority of you use. And for those of you who might be interested, I hope that the reality of the job does not scare you off too much. As Alex said, despite all the hardships they would still have taken the job, because this really helped them develop their skills and learn more about themselves.

Marit Schulte

Code zwart?! Een ander soort coronamoe - deel II Sinds begin april werk ik niet meer op de longafdeling, maar ben ik volledig naar de Covid afdeling gegaan. Ik heb niet meer af en toe een dienst afgewisseld met het normale werk op de longafdeling. Er is duidelijk een verschil merkbaar tussen de incidentele keren dat ik er was tijdens een dienst in het weekend en nu ik er vast sta. Op Goede Vrijdag was mijn leidinggevende als enige afdelingshoofd in het ziekenhuis aan het werk. Dit was met goede reden, er was namelijk overleg over code zwart. Iets wat een helaas een realistische optie blijkt te zijn op dat moment. Er zijn tot dan nog maar iets meer dan tien beschikbare IC bedden in heel Noord-Nederland en er zal dus een moment komen dat er gekozen moet worden tussen patiënten. Op wat baseer je deze keuze? Dat is natuurlijk een vraagstuk wat al meer dan een jaar speelt en waar nog niet echt een passend antwoord op gevonden is. Ik vraag me af of daar ooit een goed antwoord op gevonden zal worden. Aan de andere kant was het op goede vrijdag wel ontzettend rustig op de afdeling. Er lagen maar 15 patiënten en ze waren er allemaal redelijk goed aan toe. Misschien ook omdat de gemiddelde leeftijd van wie er lag rond de 45 was. Het beeld dat er alleen oude mensen met Covid opgenomen worden in het ziekenhuis gaat allang niet meer op. Van die vijftien mensen, waren er misschien twee ouder dan 70 jaar, de rest was allemaal tussen de 30 en 55 jaar oud. Dan gaat het dus niet meer om je opa en oma, maar om je vader en moeder, of zelfs jezelf. Ook het beeld van alleen maar mannen met een dikke buik en een medische voorgeschiedenis gaat niet meer op. Patiënten die een week geleden nog vier keer in de week 10km gingen hardlopen, zie je ook op de afdeling terug. Dat er zo weinig patiënten op de Covidafdeling lagen, zou dat de stilte voor de storm zijn geweest? Zo voelde het voor ons in ieder geval wel. We hielden allemaal onze adem vast en keken ook met een oog naar wat op de spoed lag: in ieder geval acht verdenkingen op elk moment van de dag dat we kijken. Stel ze hebben allemaal covid en worden opgenomen, dan zijn we in één klap zo goed als vol. De IC heeft al geen plek meer over, dus wat ga je doen met de patiënten die dan nog binnenkomen? Er zijn al vaker dit soort momenten geweest. Dan had de spoedeisende hulp noodgedwongen een opnamestop en konden mensen dus niet meer op de spoedeisende hulp terecht. Of soms een opnamepauze.

Intussen zijn we bijna een maand verder en is het nieuws naar buiten gekomen dat belangrijke operaties niet door kunnen gaan en bijvoorbeeld kankerpatiënten niet meer geopereerd kunnen worden, maar ook dat de Covidafdeling afgeschaald wordt, omdat er niet genoeg personeel is. Het ziekteverzuim is ontzettend hoog. Het personeel kan het niet meer aan, maar de overheid denkt daar anders over. Iedereen is moe en is er klaar mee, maar opgeven kan niet. Met zijn allen komen we er doorheen. Nu ben ik maar een medische student die als bijbaantje parttime werkt op de covidafdeling, maar de verpleegkundigen die er al sinds de tweede golf onafgebroken staan en boven hun contracturen uit werken, die zie je langzaam echt behoorlijk uitgeput raken. Die grote klap qua patiënten lijkt vooralsnog niet te komen op de normale Covidafdeling, maar de ICs zijn wel al behoorlijk vol. Dat betekent niet dat het rustig is, zoals sommige buitenstaanders misschien beweren. Er liggen dagelijks nog ontzettend veel Covidverdachte patiënten op de spoedeisende hulp. Elke keer is het spannend of er nog patiënten naar ons toe komen of dat ze naar een verzorgingstehuis of terug naar huis gaan. Elke keer is het afwachten of we nog een overname krijgen vanuit elders in het land, omdat daar de ziekenhuizen al wel overstromen. In één keer kan het chaos worden. Opeens drie opnames en twee overlijdens op een avond met verpleegkundigen die al uitgeput zijn, dat is echt geen goede combinatie. En dan is dit alles nog maar beschreven vanuit het perspectief van een streekziekenhuis. Ik kan me niet voorstellen hoe dit zal zijn in de grote steden, waar veel meer mensen besmet zijn en opgenomen moeten worden. Gaan we ooit zo ver komen als in andere landen? Dat patiënten in stretchers op de gang komen te liggen? Ik hoop het niet, maar ik ben er wel bang voor als het zo door gaat.

Angelique Wortelboer

Resume-stress Things students rarely talk about Medicine is not an easy program: taking your suitcase full of books to the second ﬂoor almost every month is really intense. Not only that, but also the hours you had to put in studying, the internships, searching hours for the costs of DOACs in India (maybe this is something I still have not gotten over yet...) does not make it easy. However, in addition, we also tend to do a lot of extracurricular activities to stand out. This could lead to pressure and stress. But how present is this pressure/stress among medical students? Resume-stress among medical students We did an Instagram-poll to ask if other medical students experienced the pressure to build a good resume. The results were quite shocking: 125 of 150 students feel pressured to build a good resume (83%) and 9 8 students (75%) experience stress because of this pressure. If you look on the internet there are several articles on the subject of stress among students: it is a known problem that has been around for years. The poll gives a view of how students feel about the ‘’resume culture’’ in our program. It is a vicious circle where we see our peers doing a lot besides their studies, so we try to do just as well or even better than them and the cycle goes on. I just read a nice article talking about this issue and the author even gave this interesting yet kind of depressing phenomenon a name: ‘’resume inflation’’. A resume that once was good and outstanding, is average now since everyone is trying to stand out. My experience with resume-stress During my bachelor’s I was quite relaxed about my resume. Not that I did a lot of extracurricular activities, since I also wanted to have time for myself. That did not begin to change in the period that I had to ‘’wait’’ for my master’s to begin. I started that period by working and after that I did some volunteer work for a couple of months. But like all things, that ended and I was left with two and a half months of time to fill. I wanted to move on to another job. I was already busy with writing a motivational letter, when I began thinking: was this really what I wanted? I did not have a real summer vacation since I immediately started working after the bachelor project ended. So then I concluded that it might be a good idea to just have free time until I started with my masters. Nothing wrong with that right?

Well, in the beginning it was hard to let go of the idea of having to do something. The pressure of having to improve my resume did not leave my mind. Luckily, after a while I was able to completely relax. When I started my master’s I had all the energy I needed and I was ready to face the new challenges of becoming a coassistent (because yes, it can be hard sometimes). Nevertheless, I find it troubling that my resume got so in the way of just enjoying my free time. The upside So this pressure to stand out can have negative effects on our wellbeing, but are there only negative effects of this pressure to build a good resume? Luckily not. Experiencing pressure to build a good resume sometimes gives that extra push to do things you would otherwise not quickly do. Of course, you should not do things solely because you want to decorate your resume with experiences. Fortunately, there are so many things that can be good for your resume that is actually interesting to do. Plus, every experience is good for your personal development. Take home message Do I still think that this performance culture is unhealthy? Yes. However, this culture that we, ourselves created, is not going anywhere soon. You could use it as an advantage and broaden your horizon with new experiences. What you should not do is compare your (work) experience with that of others. Also, do not push your limits, while pursuing something that might not even be that relevant for the future. It is hard, but sometimes it is good to just sit down for a moment and be happy with what you have already achieved.

Anne van Casteren

Cheat map The faculty of medical sciences explained

First ﬂoor: bike storage, coffee, study places, and lecture halls 24

Second ﬂoor and up: tutor rooms, practicals, student desk

Building 3219: main lecture hall, break spaces

Building 3214/15: tutor rooms, study space Building 3211: tutor rooms

25 25

Marrit Bijlsma

Woonondersteuner Werken met ouderen saai? Ik dacht het niet! Werken in de zorg als eerstejaars geneeskundestudent, kan dat? Jazeker, dat kan! Ik werk namelijk als woonondersteuner in de ouderenzorg. Het werk is helaas nog onbekend bij de meesten, wat ontzettend jammer is. Het is een unieke kans om naast de studie geneeskunde al vroeg praktijkervaring op te doen. Er zijn altijd mensen nodig in de zorg! Voordat ik begon met het werken in de ouderenzorg had ik daar eerst, eerlijk gezegd, nog nooit over nagedacht. Het is wat anders dan de bijbaantjes die je om je heen ziet, zoals werken in de supermarkt, een kledingwinkel of de horeca. Dat ik wel wilde werken naast mijn studie, wist ik al zeker. Het leek me leuk om naast het studeren ook nog iets anders te doen en daarbij wat geld verdienen is mooi meegenomen. Uiteindelijk kwam ik per toeval bij een baantje in de zorg terecht en na enige twijfel besloot ik te solliciteren in de ouderenzorg. Nu ben ik er ontzettend blij mee dat ik deze beslissing genomen heb en ik had gewild dat ik van tevoren over het werk van de woonondersteuner had gehoord.

Een dag als woonondersteuner De dag begint vaak al vroeg, om 6 uur gaat de wekker. Ik wacht nog op het moment dat ik hieraan gewend raak, ik ben helaas niet zo’n ochtendmens. Om half 8 sta ik dan op het werk. De eerste bewoners komen dan al naar me toe lopen, helemaal klaar voor het ontbijt. Ik maak hier en daar een praatje en help mee met het klaarmaken van het ontbijt. Er is altijd wel een bewoner die hulp nodig heeft, of een bewoner die gewoon even zijn of haar hart wil luchten. Na het ontbijt kunnen we gaan wandelen, spelletjes doen of een taart bakken en ga zo maar door. Voor corona organiseerden we geregeld activiteiten, dit lukt op het moment helaas niet altijd door de strenge regels. Dan is het alweer tijd voor het middageten, met daarna een rustmomentje voor de bewoners. De middag- en avonddienst zien er ongeveer hetzelfde uit.

Werken in de zorg in combinatie met de opleiding geneeskunde Ingewikkeld is het werk op zichzelf niet, dit maakt het echter absoluut niet saai. Het contact met de bewoners is ontzettend leerzaam en vormt geregeld een uitdaging. Hier hebben we ook regelmatig vergaderingen over, met meer informatie over een ziektebeeld en

gesprekken over omgang. Hoe ga je om met een bewoner met dementie, die op zoek is naar haar man, maar die man woont hier niet of is al overleden? Of een bewoner met agressie? Of een bewoner met somatische problemen, die het hier ontzettend moeilijk mee heeft en eigenwijs, maar begrijpelijk, alles zelf wil blijven doen? Zo kan ik eindeloos doorgaan. Er zijn zoveel verschillende ervaringen die ik op het werk opgedaan heb, die mij geholpen hebben en nog steeds helpen bij de opleiding. Daarnaast kan ik kennis van de opleiding ook toepassen op het werk. De medische communicatievaardigheden komen bijvoorbeeld ontzettend goed van pas bij het voeren van emotionele gesprekken met bewoners. Ik kan niet wachten tot ik in mijn tweede jaar van geneeskunde als helpende aan de slag kan in de ouderenzorg, zodat ik nog meer over de bewoners en de zorg te weten kan komen.

Werken naast de studie Zoals sommigen van jullie zich nu misschien afvragen: is werken naast de studie geneeskunde niet te druk? Het is inderdaad druk. Voor mij is het het echter waard. Alle nieuwe ervaringen, alle nieuwe kennis over ziektebeelden uit de praktijk, en boven alles het contact met een bewoner, maken het ontzettend leerzaam en waardevol. De bewoner die eenzaam is als jij begint met werken, maar na een praatje en een wandeling een grote glimlach op het gezicht heeft staan. En nee, helaas is niet iedere dag leuk. Er zijn dagen dat het minder goed gaat. Misschien is er iemand overleden, gaat een bewoner achteruit, of is er weer de zoveelste lockdown afgekondigd door een coronabesmetting en lijkt het alsof er nooit een einde aan komt. Echter zijn dit de dagen dat we ontzettend veel voor de bewoners kunnen betekenen, en juist het lichtpuntje op de dag kunnen zijn dat de bewoners nodig hebben. En wie wil er nu niet een lichtpuntje zijn?

Angelique Wortelboer

Het nest verlaten Review afﬁliatieziekenhuis deel II Er komt een moment in je geneeskundestudie dat je niet meer in het UMCG of Martiniziekenhuis kan stagelopen. Op dat moment moet je toch echt je vleugels uitslaan en ergens buiten Groningen een stageplek kiezen. Om studenten wat meer inzicht te geven in hun keuze vragen we in deze nieuwe rubriek elke editie een student om iets te vertellen over zijn/haar stageplek in M2, dit keer in Emmen. Waarom heb je voor deze affiliatie gekozen? Ik kom zelf uit Drenthe en daarom was Emmen bij mij al goed bekend. Daarnaast wilde ik graag naar een ziekenhuis dat middelgroot is. Niet te groot, zodat de lijntjes kort zijn en je lekker veel zelf kan doen. Niet te klein, zodat alle acute en specialistische zorg er wel is. Emmen paste precies in dat straatje. Hoe was je ervaring in het ziekenhuis/de stad? Ik voelde me meteen welkom in Emmen, vooral omdat verreweg de meeste artsen waarmee je meeloopt het leuk vinden om je iets te leren. Bij de grotere specialismen, zoals interne geneeskunde of chirurgie kun je met vier coassistenten zijn, maar er zijn ook genoeg coschappen waar je alleen of met één andere co bent, zoals reumatologie of anesthesie. Je hebt genoeg vrijheid, zodat je een eigen draai aan de coschappen kan geven. Ik vond bij de gynaecologie bijvoorbeeld de fertiliteitspoli heel interessant en heb daar dan ook meer tijd aan besteed. Bij Treant kun je ook meer verwachten dan alleen basiszorg, zoals een hartinterventiecentrum en een gespecialiseerd mammacentrum. Verder zijn er ook leuke (delen van) coschappen te lopen in Hoogeveen of Stadskanaal. Als het vervoer lastig is, staan er co-auto’s klaar. Deze ziekenhuizen zijn een stuk kleinschaliger en zeker een leuke ervaring om eens mee te maken. Natuurlijk zijn er buiten het ziekenhuis ook leuke dingen te beleven, zoals naar de gevangenis gaan tijdens een dienst psychiatrie in Assen of huisbezoeken afleggen met de huisarts in Klazienaveen. Wat was het leukst aan het ziekenhuis/de stad? Natuurlijk is iedere afdeling anders. Persoonlijk vond ik de grote verschillen tussen de coschappen erg leuk. Van een rustige polistage neurologie in Hoogeveen tot een drukke spoed, Emmen heeft het allemaal. De stad Emmen zelf heeft, denk ik, geen geweldige reputatie. Zelf vond ik dat Emmen snel vertrouwd voelde. Emmen is ook heel groen, het bos “de Emmerdennen” ligt naast het ziekenhuis. Ik raad zeker aan om tijdens de lunch even een wandeling te maken om je hoofd leeg te maken of gezellig te kletsen.

Hoe was de werksfeer? En/of de sfeer onder studenten? De sfeer in Emmen heb ik altijd als heel goed ervaren. Natuurlijk ligt het aan de afdeling, maar over het algemeen is de sfeer goed en willen de meeste zorgverleners je iets leren. Het is onderling tussen de co’s hartstikke gezellig. Je leert snel iedereen kennen en je kan altijd gezellig tosti’s eten met je medeco’s bij de lunch. Als je ergens mee zit of gefrustreerd bent is er altijd iemand in de cokamer om even je hart bij te luchten. Verder hoef je nooit vertwijfeld te beginnen aan een coschap: er zijn veel medeco’s om je tips en tricks te geven. Hoe is het studentenleven naast de coschappen? Emmen zelf kun je helaas geen studentenstad noemen. Een deel van de coassistenten woont in Emmen en omgeving, maar veel blijven in ook Groningen wonen. Dat is goed te doen met het openbaar vervoer of met carpoolende medeco’s. Het was dan ook altijd gezellig in de bus of de auto. Bovendien is er een actieve coraad, die zeker voor corona regelmatig borrels, pubquizzen en een super leuke co-out dag organiseerde. Verder heb ik leuke verhalen gehoord over het cohuis, waar een aantal medeco’s verblijven. Voor wie is dit een goed ziekenhuis/stad? Dit is een goed ziekenhuis voor mensen die naar een middelgroot ziekenhuis willen. Emmen is ook een goede optie als je wil blijven wonen in Groningen. In mijn ervaring is iedereen die terugkijkt op zijn M2-jaar hartstikke blij met de ervaringen opgedaan bij Treant. Niet voor niets zijn veel semi-artsen en aniossen hier gebleven. Leukste afdeling(en)? Zelf vond ik mijn neurologiestage in Hoogeveen erg leuk. Ik heb verder goede verhalen gehoord over de plastische chirurgie en reumatologie. De afdeling cardiologie moet ik als semi-arts, en later anios, ook aanbevelen. Aantal plaatsen coassistenten voor Emmen? 11% van het totaal aantal plaatsen

Ivanka van Wijk

Practising Abroad What if the clogs and cheese just aren’t for me? The Netherlands is a unique country with so much to offer. Beautiful cities, tall people, endless wheels of cheese, bikers ready to hit you at any moment, the list goes on. Despite all these perks, for some students the idea of staying in NL to practice Medicine is less than appealing. You could be a native Dutchie looking for adventure and excitement, or an international student struggling to ﬁt in here and missing home. Luckily, there are plenty of options out there for every individual. The road might not be easy, and ﬁguring out the how, where, and what might feel like a steep mountain to climb. To help along the way, this is a starting guide to the options for practising abroad with a Dutch medical degree.

Europe UK If you are planning to stay in Europe to practice Medicine, then things luckily won’t be too complicated. If you have graduated with a Master degree and are BIG-registered, then you can work in principle in every EU country. There are agreements made within the EU to accept medical diplomas from other European countries. Sometimes there are additional requirements, like an exam or registration costs. However, it’s most likely the case that you won’t need to redo any part of your bachelor or master degree. As expected, you also need to demonstrate that you can fluently speak the language of the country you wish to practice in. This depends on your mother language, but a Dutch student who learned some German in high school won’t be able to practice in Germany without fluency. Therefore, It’s a good idea to brush up those language skills! After three years doing your internships in Dutch hospitals, it might take some effort to get even your Mother language up to par.

Maybe a hop over the North Sea is more appealing to you than staying in the EU, especially if you feel more comfortable in English than Dutch. Practising in the UK has become a bit more complicated since Brexit, but there are plenty of possibilities out there. The most important difference with the EU is that it is possible your diploma will not be recognized as equivalent to a UK medical degree. This judgement is made by the General Medical Council (GMC). Having a UK nationality does not play a role in this decision, only the location and university in which you obtained your degree. The Educational Commission for Foreign Medical Graduates will independently verify your qualifications. After this you must still prove English fluency. Unfortunately they cannot accept a bachelor in English (from English LC’s) as evidence, as all clinical experience is in Dutch in Groningen. You can take the IElTS or OET test to prove your English skills.

United States

‘‘As expected, you also need to demonstrate that you can ﬂuently speak the language of the country you wish to practice in.’’

Do you wish to live the American dream and move across the world? As appealing as it sounds, the United States is one of the most difficult countries in the world to practice in as a foreign doctor. Unfortunately, there are very strict requirements for practising in the States and many highly-qualified doctors end up having to repeat parts of their education for a chance to practice. If you want to set up your career quickly without having to go back to the books, then the US is not the country for you. One tricky requirement is that they expect your bachelor education to include the pure sciences, like Physics, Chemistry, Biology.

This is not included explicitly in the Bachelor here in Groningen, although you may come across it now and then in Physiology and Pharmacology. Most European students cover these topics already extensively in their secondary education, but this is not recognized by the US. Prepare to take these courses again at a university in the US if you plan to become registered there. Additionally, they require you to redo your internships and specialization in a US hospital. This can add a few extra years to your education before you can practice. Lastly, you will be expected to pass the Medical boards exam in the US, a difficult test that can take up to a year to study for even with six years of medical school behind your back. All in all, the American government purposefully makes it difficult for foreign doctors to practice in the US, so be prepared to spend a lot of extra time redoing aspects of your qualifications in order to work in the US as a doctor. This path is not the best choice for those ready to start their career and life in the near future.

Tropical Medicine/ Doctors without Borders If you are looking for an adventure but would enjoy setting down in the Netherlands after all, then maybe specializing in Tropical Medicine is the right choice for you. After your Master program you can follow a specialist training in the Netherlands that prepares you to work abroad, mainly in developing countries. This specialization, Tropenarts, takes about two years. This training is focused on surgery, paediatrics, and obstetrics/gynaecology. It’s divided into two clinical parts, one in the Netherlands and one abroad.

You also learn about public health, intercultural medicine and management. It prepares you to work in low-resource hospitals where women and children will be the main patient population. It’s the perfect specialization for those who aspire to join Doctors without Borders (Artsen Zonder Grenzen). After completing the training you can be placed in a wide array of countries who need support from European doctors. Overall, this is a great choice for those who seek an exciting job and want to see the world, but could see themselves returning to the Netherlands later in their life or career.

‘‘After your Master program you can follow a specialist training in the Netherlands that prepares you to work abroad.’’ This all might sound intimidating to a young doctor looking to experience the world, but with a little research and ambition you can probably figure out a route to practising in the country of your dreams. Even though you will be graduating with a Dutch diploma, this doesn’t mean you have to stay in this flat, below-sea-level paradise forever. Keep your mind open and be ready to encounter some challenges, but with enough determination you will find what works for you!

Angelique Wortelboer

Medicine on the Move Creating awareness on health and migration During our study we learn a lot about being a good doctor. However, even though migration has been greatly discussed in our society, it is not touched upon within our study. Because of this issue, Medicine on the Move was founded in June 2020 by Elena Soldati, Nienke Jensma and Macky Done. In only 6 months the committee grew from 3 members to 12. Their main objective is to create awareness within the future doctors on health and migration. They hope to inspire future doctors to learn and research more on this topic and create a more inclusive health care system in the future. Because of their good cause, we decided to interview them. Can you tell more about the foundation of Medicine on the Move? Migration and the refugee crisis was not included in our curriculum, not even within the community of Global Health. We decided to contact the Global Health unit of the UMCG to address this. They saw the issue and asked us to organise a webinar about these topics. We organized this and a few months later we did a symposium. Both were quite successful and right now we are planning on organizing two symposia every year related to the topics of migration. Finally, we were also invited to arrange an intracurricular class for the 1st year students of global health; we hope it will be a yearly opportunity. Why is it important for doctors and future doctors to know about topics like migration and the refugee crisis? Like I told earlier, migration and especially the refugee crisis are big phenomena that affect our society. Not only refugees, but doctors will also face patients with a migration background, with a different culture, sometimes a different language, and a different way of approaching health problems. And it is almost certain that this will increase. Because of these reasons, It is a topic of great importance. In order to have an inclusive health care system we need to be able to treat everyone adequately, especially the most underserved people. You told us before the interview that you have a Tolken Project and the NGO project. Could you tell the readers more about these projects? Yes, so the Tolken Project is a project to tackle one communication problem some patients face that do not speak fluent dutch. Because of this, there is a risk that the problem of the patient is not well understood. There is already a solution to tackle this problem: the Tolken telefoon. However, there are many doctors that do not know how to use this. So that is why we started this

project where we for example organise workshops for healthcare workers to make them aware of this tool and teach how to use this the most effectively. The NGO project aims to connect students from the University of Groningen with medical NGO(s) providing healthcare and support to refugees. We aspire to create internships as an integral part of the curriculum, where medical students will have the option of working for those NGO’s as medical students, or simply as volunteers. We want to create a network with NGOs in Italy, Greece and in the Netherlands.

How can our readers follow your activities? You can follow us on Facebook (Medicine on the Move), Instagram (@medicineonthemove), and Linkedin (Medicine on the Move (MOTM)). We post news related to migration and refugees to keep people updated. Additionally, we also give updates on our upcoming events, like symposia and workshops. Wanna join us? Are you interested in health and migration? Do you want to improve medical education by bringing your own idea? Do you want to help organize classes with doctors and experts from all over the world? (Nigeria, Yemen, Afghanistan, Iraq, Koerdistan, Suriname and sometimes also The Netherlands!) Do you want to be in direct contact with the Global Health professors and doctors of the UMCG? We have 4 positions opening in August / September 2021: - 2 students for social media - 1 student who wants to join the NGO team - 1 student who is interested in becoming the new chair (with mentoring by the current chair!) Contact us on instagram or here: educationonhealthandmigration@gmail.com

Chris Lenselink

Cocolumn De stage wetenschap In tijden van corona was het eeuwige wachten tussen de bachelor en de master plots weer terug: waar er eindelijk weer een goede doorstroom was, heeft Corrie dat weer even tenietgedaan. Mensen die voor oktober hadden geloot konden als vanouds pas in mei starten. Gelukkig was daar ook weer die oude vriend om dat gapende gat op te vullen: de alom geliefde stage wetenschap. Het woord ‘wetenschap’ is onlosmakelijk verbonden met het woord ‘statistiek’, wat bij menig student toch nog altijd een pavloviaanse respons uitlokt. Met een flashback naar de werkcolleges van een sympathieke en goed uitleggende docent, denk je waarschijnlijk alleen aan dat eerste college waar je aanwezig bent geweest. Voor die vijf openboekvragen hoef je daar immers niet heen, toch? Hoewel statistiek zeker een groot deel van de stage wetenschap is, is dat niet allesbepalend. Zoals mijn voorganger Suzanne in deze column schreef, kan je ook een kwalitatief onderzoek doen. Toch vond ik dat niks, en dook ik lekker in de wondere wereld van p-waardes om mijn hoofdvraag te beantwoorden. Het vinden van een onderwerp dat je leuk lijkt is mijns inziens het belangrijkste deel van de hele stage wetenschap. Voor mij was het gauw duidelijk dat ik iets binnen de cardiologie wilde doen: ik had hier al twee pilot projects gedaan en wil ook wel verder binnen dit vakgebied. Treur niet als je dit nog niet weet: er zijn diverse databases met beschikbare onderzoeksprojecten.

“Toch vond ik dat niks, en dook ik lekker in de wondere wereld van p-waardes om mijn hoofdvraag te beantwoorden.” Toch kwam Corrie zelfs hier roet in het eten gooien: voor een stage wetenschap was het niet toegestaan om in het UMCG te komen. Voor mijn onderzoek zelf was dat niet eens zo’n ramp, maar ik vond het vooral vervelend om weer een halfjaar zielig thuis achter de computer te zitten. Maar goed, dat is het nieuwe normaal.

preventie kunnen dienen voor bijvoorbeeld een myocardinfarct of plotse hartdood. De concentraties van 92 eiwitten werden bepaald in een patiëntcontroleonderzoek. De ideale kans om alles te laten zien wat ik (niet) weet van t-toetsen, regressieanalyse en sensitiviteit. Natuurlijk gaat het nooit zoals je gepland hebt. Het duurde liefst drie maanden voordat de eiwitconcentraties bepaald waren – na veel over-en-weergemail. Heb je net een prachtige introductie geschreven, wil je begeleider toch een andere insteek. Niet per se kenmerken voor specifiek een stage wetenschap, misschien wel voor wetenschap in het algemeen, of zelfs voor het leven (ja, filosofisch). Het allerleukste was echter wel dat er, twee weken voor de deadline, bleek dat ik een zogenaamde bonferronicorrectie moest toepassen op mijn p-waarde. Voor de geïnteresseerden: omdat ik 92 keer dezelfde analyses heb gedaan, moest ik de beoogde p-waarde van 0,05 delen door 92 (=0,0005), omdat de kans op een toevalstreffer anders heel groot is. Allemaal leuk en aardig, maar dat had wel als gevolg dat al mijn resultaten niet significant waren, terwijl ik wel mijn resultaten en discussie met significante resultaten geschreven had. Ik besloot om dit toch aan te passen, maar het kostte het me wel flink veel tijd terwijl het eigenlijk al klaar had moeten zijn. Uiteindelijk is het allemaal wel gelukt, maar voelde het alleen een beetje afgeraffeld. De beoordelaars waren toch redelijk positief en het verslag is beloond met een 8. Dat is geen verkeerde manier om de eerste masterpuntjes binnen te harken. Echt klagen over de stage wetenschap kan ik dan ook niet, want het was zeker geen voltijdwerk en alles is naar behoren afgerond. Ondertussen lonken daar die spiksplinternieuwe gegraveerde stethoscoop, reflexhamer en stemvork, over wiens avonturen ik graag in de volgende cocolumn verhaal.

Het doel van mijn stage wetenschap was om te kijken of er biomarkers zijn die asymptomatische ischemische hartziekte kunnen voorspellen en daarmee als primaire

Chandra Kooistra Marrit Bijlsma

Memes

Colofon De PanEssay is het faculteitsblad van de M.F.V. Panacea. Zij verschijnt vier keer per jaar. Ook zijn wij online te vinden op panacea.nl/panessay. De redactie opereert onafhankelijk van het bestuur der M.F.V. Panacea, volgens artikel 20 lid 6 van het Huishoudelijk Reglement der M.F.V. Panacea. Kopij kan via e-mail worden aangeleverd. De redactie behoudt zich het recht voor taalkundige wijzigingen aan te brengen of stukken niet te plaatsen. Plaatsing van een stuk houdt niet in dat de redactie de daarin weergegeven zienswijze onderschrijft. Hoofdredactie Hendrik-Willem Pasterkamp Redactie Thomas van der Korst Chris Lenselink Marit Schulte Angelique Wortelboer Suzanne Schuurman Ivanka van Wijk Anne van Casteren Marit Bijlsma Chandra Kooistra Petra Feenstra Seung-yae Yoon

Redactieadres M.F.V. Panacea, t.a.v. PanEssay Antonius Deusinglaan 1 9713AV Groningen E-mail panessay@panacea.nl Online www.panacea.nl/panessay Facebook PanEssay Instagram @panessay Oplage 2000 stuks Drukker Donkel & Donkel, te Drachten Coverfoto Chris Lenselink Marit Schulte Sluitingsdatum eerstvolgende editie 7 november 2019

Activiteitenkalender Juni 1 Tentamen 2.2.4 1 JV3 Into the Coschappen 3 Carrière-avond 7 Thema inloopuur 7-10 ISCOMS 10-11 Binnenlandse reis 11 Opleidingsmiddag UMCG 14 EHBDD workshop 14 CSO webinar Persoonlijke effectiviteit 18 Academic Theather 18 Hechtcursus masterraad 21 PanEssay verschijning 21 CSO webinar Datavisualisatie 21-22 Bachelordiner 23 Tentamen 1.2.4 24 Tentamen 2.2.5 24 AkCie Eindactiviteit Spoco Snowworld 25 Co-Outdag M1 PMG-activiteit

@PanEssay