Timo comes to class: ‘This operating room specialisation is so incredibly relevant’

The windows are ajar in the classroom on the fourth floor of the Edith Stein building letting a mild spring breeze flow into the room on this Thursday afternoon. An ambulance siren can be heard in the distance, probably on its way to Medisch Spectrum Twente (MST). This however, does not distract any of the 15 students of the Nursing OR specialisation. Their attention is firmly focused on the ‘artificial respiration’ lesson, which is part of their training as assistant anaesthetists. Guest lecturer Corné Hogenkamp, who used to work as an assistant anaesthetist himself, goes through the material with the class, and asks lots of questions. “Why should you never intubate someone who suffers from asthma?” The class ponders the question. You can hear fingers busily typing on the many laptops. These are clearly 15 incredibly motivated aspiring assistant anaesthetists. All the professional jargon holds no secrets anymore, not even ‘hypoxic respiratory insufficiency with diffuse bilateral abnormalities’.

Prone position during artificial respiration

Lung X-rays appear on the board. The white spots show where things are not as they should be in the lungs. Various lung diseases pass the review, including Covid-19, and the benefits of a prone position when performing artificial respiration. Corné: “It makes it possible to ventilate other lung fields, and the blood flow changes because of gravity. The idea is that by turning someone onto their stomach, you can improve the ventilation-perfusion ratio.” Timo also listens and contributes to the interactive conversation with the class. As we get up to leave, he says: “I was fascinated by everything I heard. I personally experienced a very complex medical situation with my father as well as my father-in-law in recent months. This field is so important, and this OR specialisation is so incredibly relevant. I am even more aware of that now.”

An extra study route, an extra degree

As we walk from Saxion to MST, we discuss the OR specialisation within the study programme in Nursing. The students we just saw are in the third year of the Nursing programme, and the second year of the OR specialisation. Like students in the study programme in Technology Health & Care (G&T), they can complement their study programme with this additional specialisation to become a surgery assistant or assistant anaesthetist. Tycho Hanrats explains how it works, as he takes us to MST, his internship location. Tycho is a third-year student in G&T and is currently enrolled in the second year of the OR specialisation, studying for surgery assistant. The OR specialisation not only offers students like Tycho a very specific stepping stone into professional practice, it also provides them with a second degree, in addition to their Nursing or G&T degree. Halfway through their second year of study, students must apply for a training place at one of the region's hospitals. This is a prerequisite to enrolling in the OR specialisation. On average, students attend classes at Saxion one day a week, and ‘learn on the job’ at the OR on the other four days. This combination allows them to very quickly link their theoretical knowledge to professional practice.

White lockers, blue overalls

We soon find ourselves at the heart of that professional practice environment: at MST, in a changing room with white lockers and benches, among arriving and departing OR staff, putting on blue OR overalls. The overall covers our shoes and clothes. There are blue and purple scrub caps to cover our hair. Tycho shows us around behind the scenes of the OR complex. Along the sinks, there is a rack of X-ray aprons containing a protective lead layer. As we walk into the corridor next to a row of automatic doors leading into operating rooms, we run into Charlotte Baan and Cagla Ilkay, who are both training as assistant anaesthetists in the OR specialisation, and have become quite familiar with this corridor in the past eighteen months. They are almost done with their training and find the guidance they receive at MST to be helpful and warm: “People really treat us as colleagues, while also creating room for us to learn. This specialisation gives us the opportunity to delve into other technical-medical aspects of our work as nurses,” they say. Charlotte has also been hired to work at MST starting from September.

Scope towers and lasers

Timo is impressed: “We are happy and honoured to be invited to take a look here, and to bring even more attention to these incredible study programmes and essential specialisations like the OR specialisation.” Meanwhile, we peek around the corner at the sterile stockroom, where all the instruments are kept by speciality. Right next to it are the operating rooms where thoracic operations are performed, one of MST's specialities. Plastic surgery usually takes place in OR 11. Tycho takes us further through the corridor and points out the operating rooms for robotic surgery and urology. As a trainee surgery assistant, he is currently assisting in the latter. “We do internships and change speciality every four weeks,” he explains. “Next week I am moving to general surgery.” An adjacent room is used to store stand-alone equipment that can be used in the OR, from a scope tower to a laser. “Do you recognise all the different devices by now?”, Timo asks. “Yes, by now almost everything,” says Tycho. “When I prepare to go into the OR, I know exactly what I need.” He has a lot of affinity with technology, Tycho says. He was previously enrolled in a study programme in automotive engineering at the Regional Training and Education Centre (ROC) of Twente. This was apparently an additional reason for Niels ten Hoope (surgery practice manager) to choose Tycho for the sought-after training spot at MST. Tycho's technical knowledge and skills certainly come in handy. All in all, he took an extraordinary step, from an MBO programme in automotive engineering to an HBO programme in nursing.

Practising intubation

And then, suddenly, we find ourselves in one of the operating rooms. Soft beeps sound from the equipment and here too, the plenum system blows a gentle stream of air across the instruments. Charlotte and Cagla have prepared two patient simulators: “We now want to show you some practical applications from the artificial respiration class you attended at Saxion. Following an explanation of different anaesthesia techniques (epidural, nerve block, and general anaesthesia), Timo gets to work on one of the two patient simulators, using different forms of artificial respiration. He is handed a mask and asked to move the simulator's jaw into the right position to put on the mask. It takes strength, notes Timo. “It requires a special technique where you have to place your fingers just right,” he concludes. Even more complex is the act of intubating, which Timo gets to practise next. Charlotte demonstrates it for him. Via a GlideScope, with a built-in camera, video images on a monitor show whether everything is in the right position. Timo is instructed to make an upward movement, without tilting the simulator's head, and look for the epiglottis. It is a complex movement that requires a lot of practice and concentration. “Does anyone else want to try?” he asks. It is one of the last things we get to do during this impressive visit. Then it's back to the changing room, where we take off our overalls and scrub caps. Tycho then takes Timo to his urological surgery class, taught by Dr Erik Bastiaan Cornel, on incontinence surgery in men, to conclude this medical afternoon.

Photography: Nadi Egbers
Vlog: Timo Kos & Nadi Egbers