High life in the lowlands

The Netherlands is a great place for an elective or even a medical career. Erlangga Yusuf tells you all you need to know

The Netherlands is a small European country, of no more than 42 000 km2, in which about 16 million people live. It is by far the most densely populated country in the European Union.¹ Just like the United Kingdom, it is a constitutional monarchy. The capital is Amsterdam, but the government resides in the Hague.

The Netherlands was home to the painter Rembrandt, one of the Dutch masters, who celebrates his 400th birthday this year, and the country is also famous for tulips, which bloom each spring.

PHOTOS.COM Medical schools

The Netherlands has eight medical faculties, two in Amsterdam and one in each of Rotterdam, Utrecht, Groningen, Maastricht, Nijmegen, and Leiden (table 1). Seven of these are part of the world's top 200 universities.² To enter a medical school, you need to do well at secondary school. A minimum score of 8 out of 10 is needed to enter medical school directly. If your grade is less than 8, you must count on your luck: you need to participate in a national lottery weighted by score. A higher average mark means a better chance, and this game requires a score of at least 6. So, you also need to be lucky to become a doctor in the Netherlands. Because this system is unfair, the government is trying a system to let the universities select their students by their own criteria, but this new system is not yet widely accepted and used.³ Curriculums differ. Some, as at Maastricht University, teach using problem based learning,⁴ and in Amsterdam they are using a mixture of problem based and traditional teaching. Four years of preclinical education is followed by two years' undergraduate rotation in the main clinical disciplines.⁵ Ward rotations are about eight weeks for fundamental disciplines, such as internal medicine, paediatrics, and surgery, and about six weeks for other disciplines, such as neurology, psychiatry, and obstetrics and gynaecology. All these disciplines also have outpatient rotations.

Biomedical research

International studies show that Dutch medical research is considered among the best in the world. And the Netherlands is one of the world's most prolific countries in terms of absolute numbers of scientific publications.⁶ In contrast to the United Kingdom, where most medical research is financed via organisations such as the Medical Research Council, most money for medical research in the Netherlands comes directly from government.⁷ This means that industries' involvement in medical research is less important, and the scope for fundamental research, which may not be so interesting to industry, is bigger.

The government has cut its spending on scientific research in recent years, but Dutch research remains at a high level. This is possible because spending cuts lead to closure of only the research groups that deliver the least publications with the lowest citation rates. Groups that publish research articles in journals with high impact factors have good findings and remain competitive.

Medical...

While doing clinical electives or working in the Netherlands, you will see many diseases. The Netherlands has strong ties to Indonesia, in Asia, which it occupied for almost 350 years. Workers were invited from Morocco, in Africa, and Turkey, in Europe and Asia, in the '60s. Suriname, in South America, was a colony, which gained independence in the '70s. This diversity of people's origin will bring you into contact with diverse diseases such as Behçet disease, sickle cell anaemia, other tropical diseases, and psychiatric illnesses such as post-traumatic stress disorder due to war trauma, as well as diseases typical of rich countries.⁸

In the Netherlands you can also experience a liberal way of life and see how that influences medicine. You can see the effect of a liberal policy on soft drugs in clinics and on the street. Don't be surprised if you hear drug addicts on the street offering their wares to tourists: "I have cocaine, marijuana, ecstasy, and everything you want." You can also learn about euthanasia in the first country to legalise it.⁹

PHOTOS.COM
Dont fret about USMLE/PLAB - just relax

... or non-medical?

There are also non-medical reasons to come to the Netherlands, such as the scenery, culture, football, and language (table 2). White beaches, such as Scheveningen (near Leiden), Bloemendaal aan Zee (near Amsterdam) are beautiful in summer. If you like culture, the museums that hold the works of the Dutch masters are waiting for you. And if you're a football fan, almost every city that has a medical school also has a Dutch premiership league team. Only Maastricht and Leiden don't.

The Dutch language will not be a barrier to a social life here because 87% of Dutch people speak good English. Apart from the United Kingdom, this is a higher percentage than in any other European country.¹⁰

Start your visit

No official requirements are stipulated to do your clinical elective in the Netherlands. Commonly, you need to have done most of your clinical rotation at your home institution. A good command of English is mandatory, and knowing Dutch is an advantage. Firstly, check the international department at your medical school as to whether they have an exchange agreement with their Dutch counterparts for clinical electives. Many medical schools do, especially in Europe.

If they don't have an agreement, you can try to arrange one yourself. Try to contact the Dutch medical faculties and ask them about the possibilities of clinical electives, or you can also ask them for the contact address of the departments at which you want to do your clinical electives. Not all faculties have an official clinical elective programme, but most will be eager to help you to do your clinical rotation at their university. Mostly, you won't need to pay a fee.

For a research elective, contact the scientists who are doing research in the area of your interest. Look in medical journals or see if researchers at your institution have contacts in the Netherlands. Research electives, like clinical electives, have no official programme, but if you are a medical student in an advanced phase of your medical studies, most Dutch scientists will allow you to help them in their lab, and there is also no fee to pay. If you wish to stay longer and do a PhD in research in the Netherlands, the scientists will be able to inform you whether they can act as your promoter. If they can and you are accepted, you can apply for a residence permit. Many research departments have experience with foreign PhD students, and they will be able to tell you about this and to arrange the next steps (like visas and housing). You will earn a salary as a PhD student (more than enough to pay your monthly costs). To be accepted as a PhD student you must have a masters degree in medical or related sciences, and you don't need to master Dutch. English will be sufficient most of the time. If you want to work as a doctor in the Netherlands, you need to master the Dutch language. Doctors' certificate from the countries of the European Union plus Switzerland, Iceland, Liechtenstein, and Norway are recognised in the Netherlands. If you are from further afield, make contact with the special referral office (see box), which will direct you to the right office at the right institution.¹¹ And if you are worrying about exams such as the Professional and Linguistic Assessment Board (PLAB) test or the United States medical licensure examination (USMLE), I have good news - the Netherlands doesn't have them!