Interview with Professor Martine van Zandvoort
Martine van Zandvoort has been professor of Translational Neuropsychology since 1 July 2021. Her chair, which was established within the strategic theme Brain, creates a bridge between the Faculty of Social Sciences at Utrecht University and the Faculty of Medicine at UMC Utrecht. Van Zandvoort has been successfully combining research, education and healthcare in her work right from the start of her career. She emphasizes the importance of that approach at every opportunity. “I do have a touch of missionary zeal.”
Was there a need for a chair to serve as a bridge-builder?
“Absolutely! Improved imaging technologies, experimental set-ups and ways of cataloguing behavior are advancing our knowledge about the brain in leaps and bounds. In order to make sure that science remains in step with education and healthcare, I believe there needs to be a constant exchange between those three disciplines. A PhD thesis should not end up in a desk drawer, and what doctors see in practice should not remain in the consulting room but must be used as input to refine hypotheses in science, for example. And emerging talent should be included in all clinical and scientific developments through education. I try to get people excited about this way of thinking.”
What does that combination of healthcare, research and education look like in practice?
“I supervise a number of PhD students who are working on all kinds of different research lines. Plus, I have always found the time to see patients at least one day a week. At the moment, I work in an outpatient clinic for two days a week. That yields good examples of patients, which I can then pass on to bachelor students in the lectures I give. I am responsible for graduation research projects and subjects for the master’s neuropsychology major. I am also the chief trainer of the central Netherlands post-master training program in Mental Health Care psychology, the ‘GZ-opleiding’, for RINO Groep Utrecht. And I am responsible for the diagnostics curriculum of the specialist program for clinical neuropsychology. In short, I get to preach everywhere!”
Because that’s what you enjoy doing?
“I do have a touch of missionary zeal, yes. Especially when it comes to the combination of healthcare, research and education. Focusing is very important, but I believe we also need people who can zoom out and look at the field at the meta level. For example: I edit the new handbook for clinical neuropsychology that is used throughout the Netherlands. However, it is almost impossible to find people to write on important cognitive domains, such as memory or attention, because there is no-one who is conversant with the state of the art of the field as a whole and can also translate this to the patient level.”
Do you find that surprising?
“Not really, because the funding of research is organized in such a way that you need to find a niche to be innovative in. As a result, you find yourself in a huge funnel. Don’t get me wrong: the people within that funnel are incredibly good at what they do. But zooming out from time to time and linking your knowledge with other domains is also essential. If you don’t, you end up with lots of individual beads. And the patients sitting opposite you in the consulting room never suffer from just one rare disorder, it’s always more complex than that. As such, every patient contact is a kind of mini-research project for me.”
What kind of patients do you generally see yourself?
“One of the reasons I became a professor is my expertise in the field of neuro-oncology. Some of the patients I work with have awake brain surgery. This involves removing a tumor, but not at all costs. Wherever possible, you want to preserve cognitive functioning so that a patient can cope with the rest of their treatment while remaining themselves. You do that by stimulating people during awake surgery and seeing where there is function so you can try to preserve it. Previously, there were no good task descriptions for this kind of surgery at UMC Utrecht, except for language. Professor of neurosurgery Pierre Robe has led the way in awake surgery on the neurosurgical side, and he asked me whether I felt up to devising tasks for it. I seized that challenge with both hands and together we really did pioneering work.”
What kind of tasks are you talking about?
“Perhaps you are familiar with the Stroop task, where, for instance, the word ‘red’ is written in blue and you have to say the color the word is printed in. Since your reading conflicts with what you are being asked to do, that causes a delay, because you need to suppress the automated, dominant reading process top-down. If that delay becomes disproportionate and a person gets stuck, or if they go right ahead and start making mistakes, you know something is going on with their inhibition. And inhibition is a very important component of what makes us human, so you don’t want to compromise that. We have a whole battery of such tasks, such as for the inner representation of the body. You don’t need to look at your feet to know where you are. That’s because inside your head there is a mini-me of yourself that continually updates where you are. Losing that causes a huge amount of insecurity.”
But doesn’t a tumor need to be removed completely?
“You can never completely remove brain tumors, and they virtually always come back. Which is why it is very important to discuss in advance how far you can go with the patient. If I say to you: we can keep you alive, but we will have to amputate your arm, your first reaction might be: I couldn’t care less. But having to carry on living without your arm can make you deeply unhappy. It is very important that you reach agreement beforehand about the functions that must be preserved. That means you can leave a piece of brain tissue in place if it is important for those functions.”
Sounds like a huge responsibility
“It is, but for a neuropsychologist like me everything comes together in these kinds of treatments. Patients are awake all the way, even when you are opening their skull. Preparing people for that, guiding them through it and reducing their fears is the ultimate challenge. During the surgery, I have to give instructions on whether to remove a piece of the brain or leave it in place. So I need to be quite sure it’s OK to do so. The decisions we take are literally on a knife-edge.”
Do you enjoy performing under pressure?
“I think so. I do feel pressure because the faculty of Social Sciences and the Faculty of Medicine are both backing this chair. But above all it is a huge honor, and the fact that there is room for my chair indicates that people see the value in combining different paths. I think that’s great.”