Professor Bob Zietse has been in the lecture theatre for fifteen minutes by the time his students arrive. In addition to the thirty students who are attending the lecture in person, he will also teach students who are attending the lecture remotely, by means of an iPad installed on his desk. A pile of paper sits on the long table next to the door.

Lecture: Skill-based learning seminar (Wednesdays, 1pm, in Erasmus MC lecture room 39).

Lecturer: Bob Zietse, also a well-known Youtuber amongst medical students because of his Bob’s Brain Breaker videos.

Subject: How kidneys behave and how they are communicating with us through the urine.

Audience: First-year medical students. Some students are attending remotely, but the majority come to the in-person seminar because they find it important and enjoyable.

Reason to follow: It gives students in-depth knowledge, teaches them how to work with others and how best to treat patients. It’s a small taste of what the students will be doing once they are doctors.

“Welcome, all of you!” shouts Zietse at exactly 11am. The chatter in the lecture theatre falls silent. The lecturer then positions himself in front of his iPad and waves. “Hello, viewers at home!” This is not the kind of lecture where a lecturer explains everything to listening students. Today, the students work in small groups and try to solve cases together. The subjects discussed range from impaired kidney function to diarrhoea, loss of strength and cardiac arrhythmia. The lecturer puts the students to work at once. “You’ve received the questions digitally, but if you’d rather work on paper, there are printed versions over there.” He points at the sheets of paper on the long table.

Serum and plasma

Students Jeremy, Fabienne and Willemijn, who are seated at the back of the lecture theatre, decide to collaborate. Their first case study focuses on a 34-year-old man who has been taken to the emergency room due to impaired kidney function. He has no history of kidney disease, but he’s had a fever for several days now. He sweats a lot and is not drinking much. “OK, let’s look at the first question,” says Jeremy after the three students have read the case details thoroughly and have discussed the patient’s condition at length. “What is the difference between serum and plasma?”

“There’s no protein in plasma, right?” says Willemijn. Fabienne tries to find a note on her laptop. “Yes, that’s right. Serum and plasma are in your blood, but serum is plasma plus coagulation factors, which means serum contains proteins, while plasma doesn’t.”

Don’t guess

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Image credit: Pauline Wiersema

The three struggle a bit to answer the second question: What is the patient’s GFR? ‘GFR’ stands for ‘Glomerular Filtration Rate’ and indicates how much blood the kidneys can filter each minute, which is to say it indicates how well the kidneys function. You can use the rate to determine the stage of the patient’s kidney disease. “I honestly have no idea,” says Jeremy. Fabienne writes down a formula in her notebook. “Maybe we can use this formula. We can calculate his creatinine clearance, right?” Only for Willemijn to say: “But we don’t know his urine volume.”

The three are joined by the lecturer, who listens to their discussion. “So we have all the information we need to answer the question, except volume,” he says when the students get stuck. “You’re not allowed to guess the patient’s urine volume. So in this situation the correct answer is: ‘We don’t know.’” “Oh, so we’re allowed to say, ‘We have no idea’?” asks Jeremy.

The lecturer then explains what students must focus on in these kinds of situations and which substances must be measured in the patient’s body. “My advice for the upcoming exam is to read the question very attentively. However, my advice for the rest of your life is to listen well to your patients.”

‘My advice for the upcoming exam is to read the question very attentively.’

Bob Zietse
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Image credit: Pauline Wiersema

Nice work environment

Zietse walks around the lecture theatre, visiting one group, then another. His students seem to like the seminar. “It’s a lot of fun, and at the same time it’s quite difficult. The questions are complicated, but once the lecturer has explained how it’s done, it all makes complete sense,” says student Zoe. “I think it’s good that we’re given enough time to think it over, rather than being presented with the answer straight away. When the lecturer explains the whole process, you understand the rationale behind it.”

‘The lecturer is approachable. We’re always allowed to ask him questions, whenever we get stuck.’

Student Gelno

Student Linda says, “We’re really given a chance to apply the subject matter. When you attend a lecture, you listen to what the lecturer says, but here we actually work. You’re less likely to be presented with case studies in a lecture.” Her fellow student Veerle agrees. “We dig deeper into the subject matter and it’s a nice work environment. It’s very easy to collaborate with your fellow students.” A third student, Gelno, adds: “The lecturer is approachable. We’re always allowed to ask him questions, whenever we get stuck.”

Clear explanations

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Image credit: Pauline Wiersema

The groups go on discussing the questions, while Zietse walks to his iPad. He puts in his ear buds and asks how the students who are attending the seminar remotely are doing. One student asks a question. “Funnily enough, that’s the question I’ve been asked the most,” says the lecturer. “I’m about to discuss the two case studies with the entire group. If I don’t answer your question while doing that, shall we discuss it in Teams afterwards?” The remote student nods. “OK, I’ll take you all back to the theatre now.”

Zietse interrupts the discussions the students are having and explains things to the entire group, making a few jokes along the way. “So let’s look at the abnormal acid-base values here. First, let’s look at the bicarbonate, because bicarbonate means…?” No one in the theatre answers. “Perhaps I should first explain the concept of interactive teaching to you once more?” Zietse asks jokingly. The students laugh and answer his question, in unison: “Metabolic acidosis.” The lecturer nods with satisfaction and continues explaining things. Ten minutes later he concludes his explanation by stating: “So the only question you should really be asking, time and again, is: what would you do if you were a kidney?”

‘So the only question you should really be asking, time and again, is: what would you do if you were a kidney?’

Bob Zietse

“He’s very enthusiastic when he tells his stories,” says student Marley. Another student, Wenjia, thinks he’s funny, too. “He makes puns and has certain catchphrases that he’ll use over and over during all the seminars.”

But the main thing is that his explanations are clear and easy to understand. As student Marc says: “For instance, he’ll tell us not only that sodium levels depend on what you eat, but he’ll illustrate that by saying that he went to an Italian restaurant last night because it was his wife’s birthday, and so he consumed more sodium than usual, and then he’ll explain the consequences this will have for his kidney function. I’m not sure if it actually was his wife’s birthday [it was – ed.], but thanks to stories like that, you’ll remember his explanations.”

Editor Feba Sukmana and illustrator Pauline Wiersema follow a lecture every month. Together they describe and depict how education is given, what happens in the lecture hall and what students think of the lecture.

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