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Surgery students 'losing dexterity to stitch patients'

183 points by rb808 8y ago

rb808 8y ago
They didn't mention losing stamina to be able to write with a pen for more than 15 minutes either.
- RandallBrown 8y ago
  Every time I write something longer than my signature I realize how weird it is that my hands are out of shape. And it's not even really my hands, but the muscles for writing. My typing muscles are fine and can go almost all day.
  - PhasmaFelis 8y ago
    I think how you were (or weren't) taught to write has a lot to do with that. I wasn't really taught the proper way for a left-hander to write, and my handwriting has always been slow, cramped, and painful.
    - RandallBrown 8y ago
      That's possible, but when I was in elementary school and high school (and even into college) I could take pages of notes without my hand getting tired. I can't even remember the last time I wrote more than a few words down at once.
  - rootusrootus 8y ago
    You can mitigate that somewhat with a really good pen. A lot of the fatigue comes from pushing down the pen to make it write. Something like a fountain pen that just glides across the paper with very little pressure is much easier to write with for an extended time.
    - toomanybeersies 8y ago
      You don't even need a fountain pen, which even as a fountain pen user I will admit can be fiddly sometimes (doesn't write on certain paper, can be messy, requires constant refilling). A half decent gel pen will work almost as well, combining the best parts of a fountain pen with the best parts of a ballpoint. I can write for hours with a fountain pen or a gel pen, but I really struggle with those $1 Biro pens.
    - RandallBrown 8y ago
      Unfortunately, as a left-hander, fountain pens just don't really work for me.
jplayer01 8y ago
Ah, no biggie. We'll just replace them with robuts.
moioci 8y ago
I'm sorry, but is the surgery professor's name really Kneebone?
- nathancahill 8y ago
  https://en.wikipedia.org/wiki/Nominative_determinism https://en.wikipedia.org/wiki/Nominative_determinism
  - leoc 8y ago
    I was deeply disappointed to find out that Tom Burr is actually an artist.
- bitwize 8y ago
  If you check his LinkedIn profile, you'll see he's connected to Drs. Thighbone and Anklebone.
  - dplavery92 8y ago
    If your ankles connect to your knees, you might be in trouble, friend. :^)
    - gpm 8y ago
      There's a reason he became a doctor.
  - warent 8y ago
    Sometimes you just have to make the sacrifice and accept the obligatory downvotes for an amazing post like this.
booleandilemma 8y ago
Let them play video games.
- RandallBrown 8y ago
  This isn't even about having poor dexterity, it's about having poor sewing skills. I would guess that most people's fine motor skills are actually better now than in the "old" days just because of how much people type on phones and computers.
  - gpm 8y ago
    I would guess that our "motor" skills are as good or better, but that our "tactile feedback sensing and response" is far worse. Not only are we not training it at all, we are abusing it with weird signals all the time in the form of vibration motors. I would separately guess that "tactile feedback and response" is harder to find and more important for a surgeon than "fine motor control", though obviously they do need both.
  - kazinator 8y ago
    Typing on real keyboards with all ten fingers is quite a different engagement of dexterity than dabbing at a screen with two thumbs, or just an index finger.
  - iaw 8y ago
    To me, typing on a phone is a lot easier to learn in terms of dexterity than threading a needle.
    - mrguyorama 8y ago
      I'm not convinced. My mother can thread a needle just fine, but the keyboard on an iPhone is very tiny, and she often produces incorrect keystrokes. Next time I am intoxicated, I should (unscientifically) test this by comparing the difficulty of threading a needle with that of sending an accurate and correct text message
jorblumesea 8y ago
Well given the main criteria for med school is study, study, study...is it that surprising that this is the case? Most med schools select for test scores as their primary criteria and that is the single largest factor by far.
- loceng 8y ago
  This is a major problem with the education system. Doctors/professionals are being selected for their memorization skills, not for critical thinking or for their mind-body connection/self-awareness. The best humans for memorization aren't humans at all, it is AI - and so schools are selecting people who's positions will become most obsolete in the near future. This will be a problem for society as the status quo, doctors et al trained for positions their education and loans went towards, will no longer be the best option for people - and there will be resistance by the status quo, by these doctors et al.
  - jorblumesea 8y ago
    They are selecting for people who are book smart, because most professionals engage in a system where memorization is a key component of the field. Engineering, law and other professions work similarly, to some extent. It's not necessarily wrong, I want my doctor to have a thorough knowledge of their subject area and be able to have the mental capacity in the right places. But surely, we can be selecting for people who are better rounded as opposed to human robots. You actually see the same thing in engineering interviews. Regurgitating leetcode answers etc but ask them a question that's not exactly what they studied for and it all falls apart. As you said: > being selected for their memorization skills, not for critical thinking
    - loceng 8y ago
      The argument is that memorization is the leading metric to learning. If critical thinking - which is what counters indoctrination - is the leading metric, then things are learned much more deeply than merely remembering information in contextual silos, devoid of interconnectivity that critical thinking allows and builds for. A physician's "subject area" is "all" areas, and they too will refer to Google or other resources to confirm to themselves - similarly with medical advertising rampant in the US, it's often the patients who put ideas into the doctors' minds. Do they need 12 years of schooling to "know" everything - which will likely be outdated knowledge by the time they learn it? Or should we be training people to become experts at navigating systems of learning and specifics protocols to follow, so they are efficient and fluid? Specialization is valuable for many reasons, though we don't seem to leverage or engage with that properly, yet.
moioci 8y ago
On a serious note, here in the US, to get into med school these days, you have to be pretty much the perfect blend of Albert Einstein and Albert Schweitzer (or Alberta), which doesn't leave lots of time for needlecraft and the like.
- edwardhusarcik 8y ago
  I'm at a US MD school and we have plenty of time to do needlecraft and the like. Most of us aren't Albet Einstein, at least I know I'm not. My favorite thing to do is volunteer for Habitat for Humanity (we do roofing, wood work, dry wall, etc), and I have plenty of classmates that are involved in the arts. Not trying to discredit how hard we've all worked to have the opportunity to be in a US MD school. Tens of thousands of people would give up everything to have our spots. In relation to the article, we have plenty of opportunities to do suture clinics as a second year and even practice with box trainers. Perhaps training is different outside the United States.
- trimbo 8y ago
  You know what they call the worst medical student in their graduating class? "Doctor"
cwbrandsma 8y ago
Apparently those students skipped Arts and Crafts in school.
- deleted 8y ago
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- SketchySeaBeast 8y ago
  Possibly in the hopes that they could focus more on the classes and grades required to get them into med school.
- mrguyorama 8y ago
  Our school did not have that kind of arts and crafts. A year or two before I gained access, they removed cooking and "Home Economics" from the middle school curriculum. I missed out on basic "how to live life" education which, while I was able to access that knowledge at home, I'm sure other children were less fortunate, and in fact I still have never taken it upon myself to learn to sew, though I plan to soon. Taking those classes in high school instead would have required me to give up AP classes, or my independent study of Computer Networking class.
- InclinedPlane 8y ago
  How old are you? Arts and crafts got cut from most schools years and years ago. If you're very lucky your school has a band and foreign language classes.
RcouF1uZ4gsC 8y ago
I don't see any objective measure of this assertion, such as students taking longer to stitch with practice materials. This whole thing seems like a "kids these days" lamentation.
- fipple 8y ago
  I know that I can easily guess the age of a person calling my business based on whether they can actually talk properly on the phone. Above about 35 they can all do it. Below about 25 they use the phone so little that they cannot place a professional phone call or leave a professional voicemail.
  - function_seven 8y ago
    What do the younger callers do (or not do) that sticks out? Are they awkward in their greeting? Do they act like someone who's giving a speech for the first time?
    - freehunter 8y ago
      I've noticed something similar, it's mainly a lack of confidence. Being on the phone is being put on the spot, and your voice is the only stalling technique you have. In text or email or IM, you can pause and respond without anyone noticing you're stalling. In person you can fidget or walk across the room or make motions with your hands or make a face instead of saying something. On a phone call, all you have is your voice. So if you get uncomfortable and start stuttering or stumbling and you don't have the confidence to recover, you're not going to recover. You've also only got your voice to give impressions of your attitude and emotions, as well. People who are good on the phone tend to be animated, tend to use body language even if the other person can't see it, smile when they're happy, and furrow their brow when they're not. All of this impacts your speech, and a bit of over-acting goes a long way. They also know how to break into someone else's conversation to get a chance to speak. These are all things learned over time, and someone who just started using a phone isn't going to have the skills or the confidence to pull it off.
ronilan 8y ago
This sounds like a valid concern until you realize that it is just transfer of responsibility. What the surgeon wants is for lower level schools to provide him with students that are pre-trained for his specific needs. If the Imperial College of London needs people who can cut-and-sew, then the Imperial College of London should teach them to cut-and-sew. Or even better, the Imperial College of London can just institute a “cut-and-sew” entrance exam. Given the status and pay of a surgeon, it is likely that the exam prep industry will do the training job for them. If they don’t, then some Youtubers surely will. Problem solved, no robots harmed and everyone got some extra plushies.
- classichasclass 8y ago
  And yet, when I graduated med school, I could do basic stitches and things like a low-level excisional biopsy. I got better at this in residency (I'm a family doc by training, and we have some surgical training), but we had to have those skills before we graduated. Every single student did, from radiologists to psychiatrists, and I even had a little sign off book for that purpose. If you're in a surgical residency and you can't do the basic tasks like suture a wound before you become a surgical intern, you're in trouble, because your first night on call you're going to be doing one. This guy isn't really exaggerating that this is a problem. Residency hones your skills; it doesn't build them.
- joe_the_user 8y ago
  Sure, as far as this being a problem for Imperial College of London, you're stop-on. But the fact that they're complaining and they should be introducing remedial courses (or something) is something of a "canary in a coal mine", an indication that these skills aren't being learned, with implications beyond medicine.
- rpedela 8y ago
  That's like saying a pro soccer team should just teach you how to play. Surgeons need pro-sport level dexterity and it is extremely difficult, if not impossible, to achieve that if you start training in your 20s.
  - 8y ago
fipple 8y ago
The same forces that are causing these students to lose the dexterity to stitch are bringing the advent of surgical robots that will do this for them.
- kazinator 8y ago
  The small number of people who still have dexterity will build a small number of robots, which then build a larger number of robots ...
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etrautmann 8y ago
It's almost certainly the case that learning precision dexterity early in life is far easier than later. There are neurophysiological reasons why it's easier to learn certain skills earlier in life. That being said, this is just one guy's opinion, not a true motor behavioral study. The impulse to blame the "kids these days" seems like an ever-present force, so I wouldn't place too much emphasis on this without a proper study of precision dextrous manipulation across age cohorts.
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- vanderZwan 8y ago
  > The impulse to blame the "kids these days" seems like an ever-present force Lamenting a lack of experience with arts and crafts and similar sounds more like an "education these days"-complaint to me. If children do suffer from a lack of trained motor skills it is not their fault, but it is something to take seriously, for their sake more than anyone else. Also, I dunno waiting for a proper study is worth the risk. It would take quite long, which means that if it is a problem we already screwed over a generation. Plus, people complaining about a lack of physical education these days is not something limited to surgery. Taking physical education more seriously as being important for general development, and not something just for the people who want to continue in sports is probably beneficial for everyone in the long term anyway. (tangent: I wonder if these students would perform better when handling robot arms with a control stick than previous generations)
  - barry-cotter 8y ago
    > Taking physical education more seriously as being important for general development, and not something just for the people who want to continue in sports is probably beneficial for everyone in the long term anyway. Physical education is awful and it is not capable of not being awful. Even if it was not almost uniformly focused on team sports which some people hate to the point of faking illness and others love to the point of obsession, leading to massive capability gaps, it would still be irrelevant. Two or three hours a week of teacher directed exercise is nothing in the scheme of developing real skill. If people were serious about this problem they could allow children ample time to play, learning about the world and their bodies as small animals are meant to, or if they insist on making everything into a subject, treat physical education as a core part of the curriculum, English public school style, where everyone plays team sports almost every day.
StreamBright 8y ago
Or we need robots to take this task?
- eiaoa 8y ago
  Robots have terrible dexterity. Also, it's pretty depressing to hear the response to deskilling be more deskilling.
- preordained 8y ago
  Yes, and the robots will be programmed with the world's premier language--JavaScript! We're a little undermanned right now, so we'll outsource it to some of those top flight offshore programmers. What a time to be alive
skadamat 8y ago
This post is SUPER relevant - http://worrydream.com/ABriefRantOnTheFutureOfInteractionDesign/ http://worrydream.com/ABriefRantOnTheFutureOfInteractionDesi... The rant is about interaction design in computer screens, but the points made here are easily transferred if we treat the tools & the environment surgeons work in as a user interface.
Animats 8y ago
30 years ago, I heard a mechanical engineering professor at Stanford complaining about Indian engineering students never having used a screwdriver. That was something the lower classes did. Now the US has that problem.
- gpvos 8y ago
  In the west, the lower classes are more likely to use screens too much when young, while the higher classes are restricting their kids' screen time (which hopefully leads to them doing more with their hands).
  - walshemj 8y ago
    What my little prince "Josh" get his hands dirty with those shudders working class shop kids. I suspect those higher classes would have a fit if one of their kids got their ands dirty - quite keen on it for the lesser classes though.
    - mywittyname 8y ago
      Craft-based activities are bourgeois af these days. There are so many places to take you kids and have them learn woodworking, knitting, etc, and the classes are filled with little Aiden, Cayden, and Braedons whose mom's drove them to class in luxury SUVs and post their little projects on insta.
      - walshemj 8y ago
        Ah you mean handicrafts chiz ( mrs joyful prize for rafia work) I was talking about taking real engineering classes.
- purplezooey 8y ago
  If we keep voting up all these hard right people we'll all be using screwdrivers to maintain Gilead soon enough.
rdlecler1 8y ago
I read an article somewhere that manual dexterity was one of the most important factors in a successful surgery (more than education). Seems like something we should be screening and should be something that favors gamers?
- thrower123 8y ago
  A friend of mine took up being an orthopedic surgical PA late in life after being a mechanic for a couple decades. From what he says, there's a lot more brute strength and ignorance involved than one might envision, and the skills of handling power tools transferred surprisingly well.
  - classichasclass 8y ago
    My fondest orthopedic memory as a naive third year medical student was walking by the operating suite and seeing the resident and the attending on a total knee replacement suit up in full body suits with ventilation. "Oh," I thought in wonderment, "what commitment to a sterile environment!" Then a couple months later I was the student on service suiting up and I understood the truth: they're aerosolizing bone dust with those shrieking saws when they're implanting the new joint. The room was actually foggy with the stuff. The suits were to protect us! It's a gritty specialty.
- the_cat_kittles 8y ago
  i think it favors musicians more than gamers. gamers operate digitally in many cases, with buttons that are on or off. not true of the thumbsticks ill conceded. but musicians often execute much more nuanced movements as far as pressure and placement are concerned. i am biased as a guitarist.
- pen2l 8y ago
  > Seems like something we should be screening and should be something that favors gamers? Ehhh, not so sure about that. I was really good at FPS games (played counter strike for some 10 years), and I can't stitch for the life of me. My mother who is in her late 60s however, oh boy can she stitch and stitch fast. She can thread things well too - Last thanksgiving, we were doing some threading with the turkey, and I was amazed at her threading skills. I tried to imitate her but just couldn't.
jfk13 8y ago
While I can imagine there might be something to this, it seems like it's far from being generally agreed: https://www.bbc.co.uk/news/uk-46036095 https://www.bbc.co.uk/news/uk-46036095.
purplezooey 8y ago
Wouldn't it be nice to be in a profession that values people over 35 more.
stevew20 8y ago
Doctors were very worried about becoming obsolete from new technology, which is why they shunned the thermometer for quite a while.
massysett 8y ago
He is blaming “screens” but he needs to consider whether the admissions process causes this, not “screens”. Maybe they are admitting students with no practical knowledge, and maybe this has changed in the past ten years. For instance maybe in prior years applicants were more likely to have practical job experience: a summer job in retail, fast food, etc. Now maybe they only select students who have programmed existences. Just seems odd to me that he would make this observation then suddenly jump to blaming it on “screens”.
- kopo 8y ago
  I see handwriting has gone to the dogs these days so maybe he is onto something...
  - vanderZwan 8y ago
    When I was a kid, in the year before we started learning cursive writing, we spent a long time[0] practicing drawing neat swirls and lines a few times a day in class. It was fun! And it definitely made a difference in preparing our fine motor skills for learning how to write. I know this for certain because for whatever reason[1] our recent government decided to drop that preparation part of children's education, and teachers have noted that handwriting has gone to crap within the span of a few years. [0] Hard to say if it was weeks, months or a full year, because everything more than a day away is long when you're five. [1] The answer, as always, is budget cuts: trying to spend less money on teachers and material and time. I find this especially infuriating because our centrist/right-wing politicians always claim that the progressive ones don't have a clue about economics, yet somehow are blind to the fact that good, accessible education as early as possible is one of the best long term ROIs a country can make.
aaron695 8y ago
Video games improve surgeon dexterity https://www.upi.com/Video-games-improve-surgeon-dexterity/51631219092333/ https://www.upi.com/Video-games-improve-surgeon-dexterity/51... Study VS the articles reporting on an old fogies opinion on the evils of technology.
p1mrx 8y ago
Learning to play the guitar is a good way to improve dexterity. I'm very gradually upgrading my left hand from dialup to broadband.
- nicetryguy 8y ago
  Right handed guitar player of 20 years here. I'm currently learning the piano, and was very surprised how quickly my Left hand fingers pick up on notes, chords and rhythms, and how unrhythmic and clumsy my Right hand fingers are in comparison!
th3o6a1d 8y ago
Fake news
gadders 8y ago
Funnily enough, my 12 year old daughter recently did a surgery taster day at Imperial College. By the end of the day she was suturing sponges and putting canulas in a fake arm. Highly recommended if you you're UK based and have a child interested in medicine: http://www.tastemedicine.com http://www.tastemedicine.com
oedmarap 8y ago
I'll say this from personal experience; having children play a musical instrument such as the piano when they are young helps massively with finger dexterity, speed, and muscle development. Having children also tinker with electronics (and anything else modular for that matter) is also a great way to gain accuracy needed for minute and subtle movements. These have added benefits over simple handwriting -- in that writing is a prolonged contraction of the muscle whereas playing an instrument and doing small scale work involves contraction-release and learning of pressure sensitivity.
- Nr7 8y ago
  I can't help but to wonder how much difference there actually is when playing the piano or typing on a keyboard as a child.
  - exDM69 8y ago
    There is a big difference. When typing on a keyboard, you can make mistakes and take your time. When playing a musical instrument, you need to hit the right note on the first attempt and at the right time or it'll sound obviously wrong. Neither playing the piano or typing on a keyboard will alone build good manual dexterity. Precision and strength are also needed. Just writing or drawing with a pen would be a great help.
cimmanom 8y ago
How long until this work can be automated and such dexterity will become unnecessary?
ryanmercer 8y ago
Teach them to knit or embroider in their downtime, problem solved.

183 points by rb808 8y ago

rb808 8y ago

They didn't mention losing stamina to be able to write with a pen for more than 15 minutes either.

RandallBrown 8y ago
Every time I write something longer than my signature I realize how weird it is that my hands are out of shape. And it's not even really my hands, but the muscles for writing. My typing muscles are fine and can go almost all day.
- PhasmaFelis 8y ago
  I think how you were (or weren't) taught to write has a lot to do with that. I wasn't really taught the proper way for a left-hander to write, and my handwriting has always been slow, cramped, and painful.
  - RandallBrown 8y ago
    That's possible, but when I was in elementary school and high school (and even into college) I could take pages of notes without my hand getting tired. I can't even remember the last time I wrote more than a few words down at once.
- rootusrootus 8y ago
  You can mitigate that somewhat with a really good pen. A lot of the fatigue comes from pushing down the pen to make it write. Something like a fountain pen that just glides across the paper with very little pressure is much easier to write with for an extended time.
  - toomanybeersies 8y ago
    You don't even need a fountain pen, which even as a fountain pen user I will admit can be fiddly sometimes (doesn't write on certain paper, can be messy, requires constant refilling). A half decent gel pen will work almost as well, combining the best parts of a fountain pen with the best parts of a ballpoint. I can write for hours with a fountain pen or a gel pen, but I really struggle with those $1 Biro pens.
  - RandallBrown 8y ago
    Unfortunately, as a left-hander, fountain pens just don't really work for me.

jplayer01 8y ago

Ah, no biggie. We'll just replace them with robuts.

moioci 8y ago

I'm sorry, but is the surgery professor's name really Kneebone?

nathancahill 8y ago
https://en.wikipedia.org/wiki/Nominative_determinism https://en.wikipedia.org/wiki/Nominative_determinism
- leoc 8y ago
  I was deeply disappointed to find out that Tom Burr is actually an artist.
bitwize 8y ago
If you check his LinkedIn profile, you'll see he's connected to Drs. Thighbone and Anklebone.
- dplavery92 8y ago
  If your ankles connect to your knees, you might be in trouble, friend. :^)
  - gpm 8y ago
    There's a reason he became a doctor.
- warent 8y ago
  Sometimes you just have to make the sacrifice and accept the obligatory downvotes for an amazing post like this.

booleandilemma 8y ago

Let them play video games.

RandallBrown 8y ago
This isn't even about having poor dexterity, it's about having poor sewing skills. I would guess that most people's fine motor skills are actually better now than in the "old" days just because of how much people type on phones and computers.
- gpm 8y ago
  I would guess that our "motor" skills are as good or better, but that our "tactile feedback sensing and response" is far worse. Not only are we not training it at all, we are abusing it with weird signals all the time in the form of vibration motors. I would separately guess that "tactile feedback and response" is harder to find and more important for a surgeon than "fine motor control", though obviously they do need both.
- kazinator 8y ago
  Typing on real keyboards with all ten fingers is quite a different engagement of dexterity than dabbing at a screen with two thumbs, or just an index finger.
- iaw 8y ago
  To me, typing on a phone is a lot easier to learn in terms of dexterity than threading a needle.
  - mrguyorama 8y ago
    I'm not convinced. My mother can thread a needle just fine, but the keyboard on an iPhone is very tiny, and she often produces incorrect keystrokes. Next time I am intoxicated, I should (unscientifically) test this by comparing the difficulty of threading a needle with that of sending an accurate and correct text message

jorblumesea 8y ago

Well given the main criteria for med school is study, study, study...is it that surprising that this is the case? Most med schools select for test scores as their primary criteria and that is the single largest factor by far.

loceng 8y ago
This is a major problem with the education system. Doctors/professionals are being selected for their memorization skills, not for critical thinking or for their mind-body connection/self-awareness. The best humans for memorization aren't humans at all, it is AI - and so schools are selecting people who's positions will become most obsolete in the near future. This will be a problem for society as the status quo, doctors et al trained for positions their education and loans went towards, will no longer be the best option for people - and there will be resistance by the status quo, by these doctors et al.
- jorblumesea 8y ago
  They are selecting for people who are book smart, because most professionals engage in a system where memorization is a key component of the field. Engineering, law and other professions work similarly, to some extent. It's not necessarily wrong, I want my doctor to have a thorough knowledge of their subject area and be able to have the mental capacity in the right places. But surely, we can be selecting for people who are better rounded as opposed to human robots. You actually see the same thing in engineering interviews. Regurgitating leetcode answers etc but ask them a question that's not exactly what they studied for and it all falls apart. As you said: > being selected for their memorization skills, not for critical thinking
  - loceng 8y ago
    The argument is that memorization is the leading metric to learning. If critical thinking - which is what counters indoctrination - is the leading metric, then things are learned much more deeply than merely remembering information in contextual silos, devoid of interconnectivity that critical thinking allows and builds for. A physician's "subject area" is "all" areas, and they too will refer to Google or other resources to confirm to themselves - similarly with medical advertising rampant in the US, it's often the patients who put ideas into the doctors' minds. Do they need 12 years of schooling to "know" everything - which will likely be outdated knowledge by the time they learn it? Or should we be training people to become experts at navigating systems of learning and specifics protocols to follow, so they are efficient and fluid? Specialization is valuable for many reasons, though we don't seem to leverage or engage with that properly, yet.

moioci 8y ago

On a serious note, here in the US, to get into med school these days, you have to be pretty much the perfect blend of Albert Einstein and Albert Schweitzer (or Alberta), which doesn't leave lots of time for needlecraft and the like.

edwardhusarcik 8y ago
I'm at a US MD school and we have plenty of time to do needlecraft and the like. Most of us aren't Albet Einstein, at least I know I'm not. My favorite thing to do is volunteer for Habitat for Humanity (we do roofing, wood work, dry wall, etc), and I have plenty of classmates that are involved in the arts. Not trying to discredit how hard we've all worked to have the opportunity to be in a US MD school. Tens of thousands of people would give up everything to have our spots. In relation to the article, we have plenty of opportunities to do suture clinics as a second year and even practice with box trainers. Perhaps training is different outside the United States.
trimbo 8y ago
You know what they call the worst medical student in their graduating class? "Doctor"

cwbrandsma 8y ago

Apparently those students skipped Arts and Crafts in school.

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SketchySeaBeast 8y ago
Possibly in the hopes that they could focus more on the classes and grades required to get them into med school.
mrguyorama 8y ago
Our school did not have that kind of arts and crafts. A year or two before I gained access, they removed cooking and "Home Economics" from the middle school curriculum. I missed out on basic "how to live life" education which, while I was able to access that knowledge at home, I'm sure other children were less fortunate, and in fact I still have never taken it upon myself to learn to sew, though I plan to soon. Taking those classes in high school instead would have required me to give up AP classes, or my independent study of Computer Networking class.
InclinedPlane 8y ago
How old are you? Arts and crafts got cut from most schools years and years ago. If you're very lucky your school has a band and foreign language classes.

RcouF1uZ4gsC 8y ago

I don't see any objective measure of this assertion, such as students taking longer to stitch with practice materials. This whole thing seems like a "kids these days" lamentation.

fipple 8y ago
I know that I can easily guess the age of a person calling my business based on whether they can actually talk properly on the phone. Above about 35 they can all do it. Below about 25 they use the phone so little that they cannot place a professional phone call or leave a professional voicemail.
- function_seven 8y ago
  What do the younger callers do (or not do) that sticks out? Are they awkward in their greeting? Do they act like someone who's giving a speech for the first time?
  - freehunter 8y ago
    I've noticed something similar, it's mainly a lack of confidence. Being on the phone is being put on the spot, and your voice is the only stalling technique you have. In text or email or IM, you can pause and respond without anyone noticing you're stalling. In person you can fidget or walk across the room or make motions with your hands or make a face instead of saying something. On a phone call, all you have is your voice. So if you get uncomfortable and start stuttering or stumbling and you don't have the confidence to recover, you're not going to recover. You've also only got your voice to give impressions of your attitude and emotions, as well. People who are good on the phone tend to be animated, tend to use body language even if the other person can't see it, smile when they're happy, and furrow their brow when they're not. All of this impacts your speech, and a bit of over-acting goes a long way. They also know how to break into someone else's conversation to get a chance to speak. These are all things learned over time, and someone who just started using a phone isn't going to have the skills or the confidence to pull it off.

ronilan 8y ago

This sounds like a valid concern until you realize that it is just transfer of responsibility. What the surgeon wants is for lower level schools to provide him with students that are pre-trained for his specific needs. If the Imperial College of London needs people who can cut-and-sew, then the Imperial College of London should teach them to cut-and-sew. Or even better, the Imperial College of London can just institute a “cut-and-sew” entrance exam. Given the status and pay of a surgeon, it is likely that the exam prep industry will do the training job for them. If they don’t, then some Youtubers surely will. Problem solved, no robots harmed and everyone got some extra plushies.

classichasclass 8y ago
And yet, when I graduated med school, I could do basic stitches and things like a low-level excisional biopsy. I got better at this in residency (I'm a family doc by training, and we have some surgical training), but we had to have those skills before we graduated. Every single student did, from radiologists to psychiatrists, and I even had a little sign off book for that purpose. If you're in a surgical residency and you can't do the basic tasks like suture a wound before you become a surgical intern, you're in trouble, because your first night on call you're going to be doing one. This guy isn't really exaggerating that this is a problem. Residency hones your skills; it doesn't build them.
joe_the_user 8y ago
Sure, as far as this being a problem for Imperial College of London, you're stop-on. But the fact that they're complaining and they should be introducing remedial courses (or something) is something of a "canary in a coal mine", an indication that these skills aren't being learned, with implications beyond medicine.
rpedela 8y ago
That's like saying a pro soccer team should just teach you how to play. Surgeons need pro-sport level dexterity and it is extremely difficult, if not impossible, to achieve that if you start training in your 20s.
- 8y ago

fipple 8y ago

The same forces that are causing these students to lose the dexterity to stitch are bringing the advent of surgical robots that will do this for them.

kazinator 8y ago
The small number of people who still have dexterity will build a small number of robots, which then build a larger number of robots ...

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etrautmann 8y ago

It's almost certainly the case that learning precision dexterity early in life is far easier than later. There are neurophysiological reasons why it's easier to learn certain skills earlier in life. That being said, this is just one guy's opinion, not a true motor behavioral study. The impulse to blame the "kids these days" seems like an ever-present force, so I wouldn't place too much emphasis on this without a proper study of precision dextrous manipulation across age cohorts.

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vanderZwan 8y ago
> The impulse to blame the "kids these days" seems like an ever-present force Lamenting a lack of experience with arts and crafts and similar sounds more like an "education these days"-complaint to me. If children do suffer from a lack of trained motor skills it is not their fault, but it is something to take seriously, for their sake more than anyone else. Also, I dunno waiting for a proper study is worth the risk. It would take quite long, which means that if it is a problem we already screwed over a generation. Plus, people complaining about a lack of physical education these days is not something limited to surgery. Taking physical education more seriously as being important for general development, and not something just for the people who want to continue in sports is probably beneficial for everyone in the long term anyway. (tangent: I wonder if these students would perform better when handling robot arms with a control stick than previous generations)
- barry-cotter 8y ago
  > Taking physical education more seriously as being important for general development, and not something just for the people who want to continue in sports is probably beneficial for everyone in the long term anyway. Physical education is awful and it is not capable of not being awful. Even if it was not almost uniformly focused on team sports which some people hate to the point of faking illness and others love to the point of obsession, leading to massive capability gaps, it would still be irrelevant. Two or three hours a week of teacher directed exercise is nothing in the scheme of developing real skill. If people were serious about this problem they could allow children ample time to play, learning about the world and their bodies as small animals are meant to, or if they insist on making everything into a subject, treat physical education as a core part of the curriculum, English public school style, where everyone plays team sports almost every day.

StreamBright 8y ago

Or we need robots to take this task?

eiaoa 8y ago
Robots have terrible dexterity. Also, it's pretty depressing to hear the response to deskilling be more deskilling.
preordained 8y ago
Yes, and the robots will be programmed with the world's premier language--JavaScript! We're a little undermanned right now, so we'll outsource it to some of those top flight offshore programmers. What a time to be alive

skadamat 8y ago

This post is SUPER relevant - http://worrydream.com/ABriefRantOnTheFutureOfInteractionDesign/ http://worrydream.com/ABriefRantOnTheFutureOfInteractionDesi... The rant is about interaction design in computer screens, but the points made here are easily transferred if we treat the tools & the environment surgeons work in as a user interface.

Animats 8y ago

30 years ago, I heard a mechanical engineering professor at Stanford complaining about Indian engineering students never having used a screwdriver. That was something the lower classes did. Now the US has that problem.

gpvos 8y ago
In the west, the lower classes are more likely to use screens too much when young, while the higher classes are restricting their kids' screen time (which hopefully leads to them doing more with their hands).
- walshemj 8y ago
  What my little prince "Josh" get his hands dirty with those shudders working class shop kids. I suspect those higher classes would have a fit if one of their kids got their ands dirty - quite keen on it for the lesser classes though.
  - mywittyname 8y ago
    Craft-based activities are bourgeois af these days. There are so many places to take you kids and have them learn woodworking, knitting, etc, and the classes are filled with little Aiden, Cayden, and Braedons whose mom's drove them to class in luxury SUVs and post their little projects on insta.
    - walshemj 8y ago
      Ah you mean handicrafts chiz ( mrs joyful prize for rafia work) I was talking about taking real engineering classes.
purplezooey 8y ago
If we keep voting up all these hard right people we'll all be using screwdrivers to maintain Gilead soon enough.

rdlecler1 8y ago

I read an article somewhere that manual dexterity was one of the most important factors in a successful surgery (more than education). Seems like something we should be screening and should be something that favors gamers?

thrower123 8y ago
A friend of mine took up being an orthopedic surgical PA late in life after being a mechanic for a couple decades. From what he says, there's a lot more brute strength and ignorance involved than one might envision, and the skills of handling power tools transferred surprisingly well.
- classichasclass 8y ago
  My fondest orthopedic memory as a naive third year medical student was walking by the operating suite and seeing the resident and the attending on a total knee replacement suit up in full body suits with ventilation. "Oh," I thought in wonderment, "what commitment to a sterile environment!" Then a couple months later I was the student on service suiting up and I understood the truth: they're aerosolizing bone dust with those shrieking saws when they're implanting the new joint. The room was actually foggy with the stuff. The suits were to protect us! It's a gritty specialty.
the_cat_kittles 8y ago
i think it favors musicians more than gamers. gamers operate digitally in many cases, with buttons that are on or off. not true of the thumbsticks ill conceded. but musicians often execute much more nuanced movements as far as pressure and placement are concerned. i am biased as a guitarist.
pen2l 8y ago
> Seems like something we should be screening and should be something that favors gamers? Ehhh, not so sure about that. I was really good at FPS games (played counter strike for some 10 years), and I can't stitch for the life of me. My mother who is in her late 60s however, oh boy can she stitch and stitch fast. She can thread things well too - Last thanksgiving, we were doing some threading with the turkey, and I was amazed at her threading skills. I tried to imitate her but just couldn't.

jfk13 8y ago

While I can imagine there might be something to this, it seems like it's far from being generally agreed: https://www.bbc.co.uk/news/uk-46036095 https://www.bbc.co.uk/news/uk-46036095.

purplezooey 8y ago

Wouldn't it be nice to be in a profession that values people over 35 more.

stevew20 8y ago

Doctors were very worried about becoming obsolete from new technology, which is why they shunned the thermometer for quite a while.

massysett 8y ago

He is blaming “screens” but he needs to consider whether the admissions process causes this, not “screens”. Maybe they are admitting students with no practical knowledge, and maybe this has changed in the past ten years. For instance maybe in prior years applicants were more likely to have practical job experience: a summer job in retail, fast food, etc. Now maybe they only select students who have programmed existences. Just seems odd to me that he would make this observation then suddenly jump to blaming it on “screens”.

kopo 8y ago
I see handwriting has gone to the dogs these days so maybe he is onto something...
- vanderZwan 8y ago
  When I was a kid, in the year before we started learning cursive writing, we spent a long time[0] practicing drawing neat swirls and lines a few times a day in class. It was fun! And it definitely made a difference in preparing our fine motor skills for learning how to write. I know this for certain because for whatever reason[1] our recent government decided to drop that preparation part of children's education, and teachers have noted that handwriting has gone to crap within the span of a few years. [0] Hard to say if it was weeks, months or a full year, because everything more than a day away is long when you're five. [1] The answer, as always, is budget cuts: trying to spend less money on teachers and material and time. I find this especially infuriating because our centrist/right-wing politicians always claim that the progressive ones don't have a clue about economics, yet somehow are blind to the fact that good, accessible education as early as possible is one of the best long term ROIs a country can make.

aaron695 8y ago

Video games improve surgeon dexterity https://www.upi.com/Video-games-improve-surgeon-dexterity/51631219092333/ https://www.upi.com/Video-games-improve-surgeon-dexterity/51... Study VS the articles reporting on an old fogies opinion on the evils of technology.

p1mrx 8y ago

Learning to play the guitar is a good way to improve dexterity. I'm very gradually upgrading my left hand from dialup to broadband.

nicetryguy 8y ago
Right handed guitar player of 20 years here. I'm currently learning the piano, and was very surprised how quickly my Left hand fingers pick up on notes, chords and rhythms, and how unrhythmic and clumsy my Right hand fingers are in comparison!

th3o6a1d 8y ago

Fake news

gadders 8y ago

Funnily enough, my 12 year old daughter recently did a surgery taster day at Imperial College. By the end of the day she was suturing sponges and putting canulas in a fake arm. Highly recommended if you you're UK based and have a child interested in medicine: http://www.tastemedicine.com http://www.tastemedicine.com

oedmarap 8y ago

I'll say this from personal experience; having children play a musical instrument such as the piano when they are young helps massively with finger dexterity, speed, and muscle development. Having children also tinker with electronics (and anything else modular for that matter) is also a great way to gain accuracy needed for minute and subtle movements. These have added benefits over simple handwriting -- in that writing is a prolonged contraction of the muscle whereas playing an instrument and doing small scale work involves contraction-release and learning of pressure sensitivity.

Nr7 8y ago
I can't help but to wonder how much difference there actually is when playing the piano or typing on a keyboard as a child.
- exDM69 8y ago
  There is a big difference. When typing on a keyboard, you can make mistakes and take your time. When playing a musical instrument, you need to hit the right note on the first attempt and at the right time or it'll sound obviously wrong. Neither playing the piano or typing on a keyboard will alone build good manual dexterity. Precision and strength are also needed. Just writing or drawing with a pen would be a great help.

cimmanom 8y ago

How long until this work can be automated and such dexterity will become unnecessary?

ryanmercer 8y ago

Teach them to knit or embroider in their downtime, problem solved.