8 ms·

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

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.
- pmart123 8y ago
  Is the lack of training the case, or not simply not testing med school applicants for dexterity? i.e. Wouldn't this be more like the NFL only using the Wonderlic test to assess quarterbacks?
  - rpedela 8y ago
    Yes, maybe med schools should also do physical tests as part of an entrance exam for surgeons. That would likely solve the problem, and it would also signal to kids interested in becoming surgeons to get good at hand/eye coordination, hand dexterity, and anything else that is important physically.
    - deleted 8y ago
      [deleted]
    - classichasclass 8y ago
      This assumes students have a good idea what specialty they plan to enter when they start medical school, which I assure you is not the case. Even then, there are "non-surgical" specialties where some surgical skills are needed, so it's not as simple as saying "surgeon or not." Family medicine and ob/gyn would be the classic ones, but also emergency physicians, for example.
      - pnw_hazor 8y ago
        That's what parents are for. I foresee a whole line of toddler dexterity toys.
        jacobolus 8y ago
        For toddlers, most toys are dexterity toys. We could do with more emphasis on knife use, carpentry, sewing/knitting, soldering, etc. among primary school students though.
        ordu 8y ago
toss1 8y ago
No, it does not work that way. Tactile dexterity depends greatly on developing a 'feel' for what you are doing. It means developing: 1) heightened sensitivity to the inputs of all the nerves, joints, and muscles, 2) delicate and highly tuned muscle activation, coordination among muscles, and hand-eye-object coordination, 3) refined expectations about the behavior of your materials, 4) deep and subtle integration of all those skills. Neuroscience studies show that experts in a field can develop 10x the sensitivity of ordinary healthy people in relevant perceptual disciplines. E.g., if the ordinary person can distinguish a pressure difference of 1g on his fingertip, a pianist or surgeon would be able to distinguish 0.1g pressure. This kind of tuned neuromuscular system does not develop from simply taking a set of courses. It takes years or decades of training. It may even be the case that if not developed during the more plastic stages of brain/neuromuscular development, it will be close to impossible, or at least substantially more difficult. To obtain real professional-level dexterity takes decades of learning, understanding, & integrating many subtleties and sub-skills before fluency is achieved. A closer analogy would be literacy. The professors certainly have a specific need that their students be literate. Yet I wouldn't expect anyone, even a highly intelligent person, who had not learned to read and developed extensive and solid note-taking skills to arrive at Med school and expect that the professors teach him/her to read, write, and take notes. This is because it takes decades of learning, understanding, & integrating many subtleties and sub-skills before fluency is achieved. edit:clarity & #4
- tsumnia 8y ago
  I will agree with you as well as the OP. One thing my comment history shows is that I believe a mixture of technical and conceptual literacy is needed for learning. My current research is that students rely on copying and pasting and don't write out code enough to experience syntax errors (the first issue many CS students face). I am currently researching the use of retyping worked example code to help low-performing students. The article very much reads as an editorial "the next generation isn't ready" piece. It blames the lack of dexterity on smartphones, yet there is no research on this, just anecdotal accounts. I'm sure there is merit to the professor's claims, but the article does not back up the claims. That being said and tying to OP's comment, expertise does take time; however, when improve skills that an individual is bad/inadequate at, then deliberate practice [1] can be used. This is what motivates my current research. Someone that is not technically literate is unable to write/debug problem-solving solutions, despite being competent in problem-solving. Therefore, require deliberate practice on where they struggle, in writing syntax. All technical skills need to be ingrains to the point of having a "feeling". Whether total immersion or specific practice is better has not be really researched, though I'm sure it is a combination of the two (with specific practice being deliberate in nature). [1] https://en.wikipedia.org/wiki/Practice_(learning_method)#Deliberate_practice https://en.wikipedia.org/wiki/Practice_(learning_method)#Del...
avip 8y ago
This is very naive (to the point of detached from reality). Kids who do not develop motoric skills become grownups without said skills. There's a gap there almost unbridgeable. It sounds like you take stiching to be "easy", something that can be taught in a few days like let's say basics of JS. But teaching the body to do things is a serious task. Have you ever watched a grown up learning to swim, bike, or ice-skate?
- ronilan 8y ago
  > Have you ever watched a grown up learning to swim, bike or ice-skate? I’m a Level 2 CASI certified snowboard instructor. I taught hundreds of adult beginners over the years. I myself started as a never-ever when I was 35. Season starting soon, come up (I’m at Vancouver/Grouse) it’s awesome!
  - avip 8y ago
    Actually we've met once, but it wasn't on Grouse. I'll keep the open invitation 'till it's relevant.
  - 2muchcoffeeman 8y ago
    Meaningless without knowing your history. If you were a skateboarder and tranfered to snow boarding, you have transferable skills. Snow boarding is also done upright, so your spatial awareness is the same. Try teaching adults with no gymnastics background how to handstand. Kids can pick this up in weeks. I know very few examples of adults managing it. And even then their skill level is not very high.
  - dagw 8y ago
    They can be taught to be competent enough to get down your average black slope without hurting themselves, but they almost never develop the fluidity and effortlessness across all kinds of conditions that comes with having done something since they where kids.
- Marsymars 8y ago
  I taught myself how to swim as an adult. The main challenge I found wasn't "new muscle memory things are hard", but "as an adult, I'm not used to committing serious time to things that I'm terrible at".
aj7 8y ago
No no no. 25 years or older is too late to learn manual dexterity skills, or worse, to find out you don’t have them. A few years ago, the NYTimes published adjoining videos of an expert, and not-so-expert surgeon working on very similar tasks. The expert, it was almost like watching ballet. I could not finish the video of the non-expert: the cringe factor from the fumbling, the inability to grip tissue, inability to string together surgical moves, it was too much to watch and imagine it happening to you. Ed: I found the link to the less skilled surgeon video. Could not find the more skilled one. https://www.nytimes.com/video/health/100000002513726/the-bad-surgeon.html https://www.nytimes.com/video/health/100000002513726/the-bad...
- jochakovsky 8y ago
  The two videos are here, https://well.blogs.nytimes.com/2013/10/31/a-vital-measure-your-surgeons-skill/ https://well.blogs.nytimes.com/2013/10/31/a-vital-measure-yo...
winningcontinue 8y ago
They just need to overhual the entire profession altogether. Surgeons should just supervise a live surgery, while attending physicians and assistants will do the actual operation. The person with the knowledge and information will oversee and manage the entire procedure, the lower level people will do the actual cutting and sewing. People with more specialized skills doing what they're each better out. Better outcomes.
deleted 8y ago
[deleted]
YeGoblynQueenne 8y ago
>> 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. If I may, it's "Imperial College London" - not "The Imperial College of London". It's one of the top rated reasearch institutions, worldwide, for science and technology. That an Imperial professor is concerned about students' skills is cause for alarm.
calcifer 8y ago
> If they don’t, then some Youtubers surely will Only on HN you can find such hubris that a comment arguing surgical skills can be provided by Youtubers is sitting at the top of a thread.
- village-idiot 8y ago
  Youtubers can’t seem to make it through basic social interactions without causing a social firestorm half of the time, I’m going to take a hard pass on them teaching surgical skills.
zaroth 8y ago
That wasn’t my take-away from the article at all. TFA is not at all asking lower level schools to provide students pre-trained for any specific need. Quite the opposite. Anecdotally, this Professor believes that increased focus on exams and computer use is leading to a generalize dulling of dexterity and specifically tactile sense / fine motor skills. This isn’t something that you can prep for like an exam. It’s specifically the exam focused mentality and the idea you can cram or prep for this that is the root of the problem. The untested theory behind the article is that children and adolescents need long term and broad exposure to all sorts of varied tasks which challenge their fine motor skills to develop the pathways that will shift the bell curve back to where it was, and lead to a greater number of students who are ultimately capable of achieving an ‘elite’ level of surgical skill. In the absence of these programs and with the arduous focus on exams/testing, that the nervous system development and motor pathways for an increasing number of otherwise perfectly qualified students are simply stunted. Those students will have a much harder time developing the necessary dexterity and fine motor skill required for even basic tasks like stitching and suturing. But more likely it’s not that they won’t get the basics, but an increasing percentage will never even be capable of approaching the skill level of an elite surgeon. Now, the whole things smacks a bit of generational prejudice and seems totally anecdotal. It certainly seems like it is something quantifiable that could and should be more rigorously studied.

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.

pmart123 8y ago
Is the lack of training the case, or not simply not testing med school applicants for dexterity? i.e. Wouldn't this be more like the NFL only using the Wonderlic test to assess quarterbacks?
- rpedela 8y ago
  Yes, maybe med schools should also do physical tests as part of an entrance exam for surgeons. That would likely solve the problem, and it would also signal to kids interested in becoming surgeons to get good at hand/eye coordination, hand dexterity, and anything else that is important physically.
  - deleted 8y ago
    [deleted]
  - classichasclass 8y ago
    This assumes students have a good idea what specialty they plan to enter when they start medical school, which I assure you is not the case. Even then, there are "non-surgical" specialties where some surgical skills are needed, so it's not as simple as saying "surgeon or not." Family medicine and ob/gyn would be the classic ones, but also emergency physicians, for example.
    - pnw_hazor 8y ago
      That's what parents are for. I foresee a whole line of toddler dexterity toys.
      - jacobolus 8y ago
        For toddlers, most toys are dexterity toys. We could do with more emphasis on knife use, carpentry, sewing/knitting, soldering, etc. among primary school students though.
      - ordu 8y ago

toss1 8y ago

No, it does not work that way. Tactile dexterity depends greatly on developing a 'feel' for what you are doing. It means developing: 1) heightened sensitivity to the inputs of all the nerves, joints, and muscles, 2) delicate and highly tuned muscle activation, coordination among muscles, and hand-eye-object coordination, 3) refined expectations about the behavior of your materials, 4) deep and subtle integration of all those skills. Neuroscience studies show that experts in a field can develop 10x the sensitivity of ordinary healthy people in relevant perceptual disciplines. E.g., if the ordinary person can distinguish a pressure difference of 1g on his fingertip, a pianist or surgeon would be able to distinguish 0.1g pressure. This kind of tuned neuromuscular system does not develop from simply taking a set of courses. It takes years or decades of training. It may even be the case that if not developed during the more plastic stages of brain/neuromuscular development, it will be close to impossible, or at least substantially more difficult. To obtain real professional-level dexterity takes decades of learning, understanding, & integrating many subtleties and sub-skills before fluency is achieved. A closer analogy would be literacy. The professors certainly have a specific need that their students be literate. Yet I wouldn't expect anyone, even a highly intelligent person, who had not learned to read and developed extensive and solid note-taking skills to arrive at Med school and expect that the professors teach him/her to read, write, and take notes. This is because it takes decades of learning, understanding, & integrating many subtleties and sub-skills before fluency is achieved. edit:clarity & #4

tsumnia 8y ago
I will agree with you as well as the OP. One thing my comment history shows is that I believe a mixture of technical and conceptual literacy is needed for learning. My current research is that students rely on copying and pasting and don't write out code enough to experience syntax errors (the first issue many CS students face). I am currently researching the use of retyping worked example code to help low-performing students. The article very much reads as an editorial "the next generation isn't ready" piece. It blames the lack of dexterity on smartphones, yet there is no research on this, just anecdotal accounts. I'm sure there is merit to the professor's claims, but the article does not back up the claims. That being said and tying to OP's comment, expertise does take time; however, when improve skills that an individual is bad/inadequate at, then deliberate practice [1] can be used. This is what motivates my current research. Someone that is not technically literate is unable to write/debug problem-solving solutions, despite being competent in problem-solving. Therefore, require deliberate practice on where they struggle, in writing syntax. All technical skills need to be ingrains to the point of having a "feeling". Whether total immersion or specific practice is better has not be really researched, though I'm sure it is a combination of the two (with specific practice being deliberate in nature). [1] https://en.wikipedia.org/wiki/Practice_(learning_method)#Deliberate_practice https://en.wikipedia.org/wiki/Practice_(learning_method)#Del...

avip 8y ago

This is very naive (to the point of detached from reality). Kids who do not develop motoric skills become grownups without said skills. There's a gap there almost unbridgeable. It sounds like you take stiching to be "easy", something that can be taught in a few days like let's say basics of JS. But teaching the body to do things is a serious task. Have you ever watched a grown up learning to swim, bike, or ice-skate?

ronilan 8y ago
> Have you ever watched a grown up learning to swim, bike or ice-skate? I’m a Level 2 CASI certified snowboard instructor. I taught hundreds of adult beginners over the years. I myself started as a never-ever when I was 35. Season starting soon, come up (I’m at Vancouver/Grouse) it’s awesome!
- avip 8y ago
  Actually we've met once, but it wasn't on Grouse. I'll keep the open invitation 'till it's relevant.
- 2muchcoffeeman 8y ago
  Meaningless without knowing your history. If you were a skateboarder and tranfered to snow boarding, you have transferable skills. Snow boarding is also done upright, so your spatial awareness is the same. Try teaching adults with no gymnastics background how to handstand. Kids can pick this up in weeks. I know very few examples of adults managing it. And even then their skill level is not very high.
- dagw 8y ago
  They can be taught to be competent enough to get down your average black slope without hurting themselves, but they almost never develop the fluidity and effortlessness across all kinds of conditions that comes with having done something since they where kids.
Marsymars 8y ago
I taught myself how to swim as an adult. The main challenge I found wasn't "new muscle memory things are hard", but "as an adult, I'm not used to committing serious time to things that I'm terrible at".

aj7 8y ago

No no no. 25 years or older is too late to learn manual dexterity skills, or worse, to find out you don’t have them. A few years ago, the NYTimes published adjoining videos of an expert, and not-so-expert surgeon working on very similar tasks. The expert, it was almost like watching ballet. I could not finish the video of the non-expert: the cringe factor from the fumbling, the inability to grip tissue, inability to string together surgical moves, it was too much to watch and imagine it happening to you. Ed: I found the link to the less skilled surgeon video. Could not find the more skilled one. https://www.nytimes.com/video/health/100000002513726/the-bad-surgeon.html https://www.nytimes.com/video/health/100000002513726/the-bad...

jochakovsky 8y ago
The two videos are here, https://well.blogs.nytimes.com/2013/10/31/a-vital-measure-your-surgeons-skill/ https://well.blogs.nytimes.com/2013/10/31/a-vital-measure-yo...

winningcontinue 8y ago

They just need to overhual the entire profession altogether. Surgeons should just supervise a live surgery, while attending physicians and assistants will do the actual operation. The person with the knowledge and information will oversee and manage the entire procedure, the lower level people will do the actual cutting and sewing. People with more specialized skills doing what they're each better out. Better outcomes.

deleted 8y ago

[deleted]

YeGoblynQueenne 8y ago

>> 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. If I may, it's "Imperial College London" - not "The Imperial College of London". It's one of the top rated reasearch institutions, worldwide, for science and technology. That an Imperial professor is concerned about students' skills is cause for alarm.

calcifer 8y ago

> If they don’t, then some Youtubers surely will Only on HN you can find such hubris that a comment arguing surgical skills can be provided by Youtubers is sitting at the top of a thread.

village-idiot 8y ago
Youtubers can’t seem to make it through basic social interactions without causing a social firestorm half of the time, I’m going to take a hard pass on them teaching surgical skills.

zaroth 8y ago

That wasn’t my take-away from the article at all. TFA is not at all asking lower level schools to provide students pre-trained for any specific need. Quite the opposite. Anecdotally, this Professor believes that increased focus on exams and computer use is leading to a generalize dulling of dexterity and specifically tactile sense / fine motor skills. This isn’t something that you can prep for like an exam. It’s specifically the exam focused mentality and the idea you can cram or prep for this that is the root of the problem. The untested theory behind the article is that children and adolescents need long term and broad exposure to all sorts of varied tasks which challenge their fine motor skills to develop the pathways that will shift the bell curve back to where it was, and lead to a greater number of students who are ultimately capable of achieving an ‘elite’ level of surgical skill. In the absence of these programs and with the arduous focus on exams/testing, that the nervous system development and motor pathways for an increasing number of otherwise perfectly qualified students are simply stunted. Those students will have a much harder time developing the necessary dexterity and fine motor skill required for even basic tasks like stitching and suturing. But more likely it’s not that they won’t get the basics, but an increasing percentage will never even be capable of approaching the skill level of an elite surgeon. Now, the whole things smacks a bit of generational prejudice and seems totally anecdotal. It certainly seems like it is something quantifiable that could and should be more rigorously studied.