Surgery students 'losing dexterity to stitch patients'(bbc.com)
bbc.com
Surgery students 'losing dexterity to stitch patients'
https://www.bbc.com/news/education-46019429
186 comments
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
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
And that’s assuming that the only consequence of losing dexterity is in highly specialized skills like piano or surgery, which is a bet I wouldn’t make.
The human body and mind are highly dynamic system where minor changes make big differences. A good example is that learning a second language makes you better at learning, it doesn’t just teach you how to use different words. I would bet that lowered dexterity due to less hand usage would result in all kinds of weird developmental changes.
The human body and mind are highly dynamic system where minor changes make big differences. A good example is that learning a second language makes you better at learning, it doesn’t just teach you how to use different words. I would bet that lowered dexterity due to less hand usage would result in all kinds of weird developmental changes.
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)#Del...
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)#Del...
For sure, both immersion and deliberate practice work -- eventually. The issue is the scale and scope of the remedial project.
OP casually shunts off the severely deficient students as an 'invalid concern' and "just [a] transfer of responsibility", as if the schools merely "should teach them". Or, perhaps add an exam that would be solved by some 3rd party exam-cram courses or YouTube videos.
OP is wrong in this by orders of magnitude.
The training that you propose with immersion and deliberate practice is more, but likely still drastically inadequate.
There's little doubt that the surgery professors are observing a new and serious deficiency, even though the article doesn't mention quantifying the observations or research that nails down the exact cause.
Moreover, the skill deficit is deceptively simple, and may require years to fix, or even be unfixable in those subjects. Several examples:
* A group of monkeys being raised in an indoor arboretum had some injuries, and the scientists installed much more stout sticks and secured the vegetation. No more injuries due to broken branches, but when the monkeys were introduced to the wild, instead of swinging & leaping through the leafy canopies like their wild brothers, they cowered at the trunks. They'd completely failed to learn while young the skills required, and so the release failed for that generation.
* Personal experience, in learning a physical skill to an internationally competitive level, starting from being already well-coordinated, it took close to a decade of full immersion & dedication to get to the national team level. Moreover, even having achieved this skill level in certain sports, I've tried to get good at things like juggling and piano, and I have no illusions that even making a similar level of dedication, I'd never get anywhere near a professional level in either -- I didn't build that kind of wiring earlier.
* I've made arguments like yours to concert-level musicians, i.e., that simply being dedicated enough and training hard enough would get one to a professional level. Instant response of "NOoooo..." -- they've each seen multiple people pour years of their lives into hard work with top teachers and never get to a professional level, and these weren't people starting with a deficit.
* In neuroscience there is observed a period of plasticity for some skills. While it is not absolute, it is phase in brain development where the brain is particularly suited to absorb & learn certain skills. With some skills and animals, it is absolute -- if not exposed during that time, the organism or person will have an unsurmountable lifetime deficit. Languages are like this, where picking up a language between the ages of 4-8yo is almost effortless, but after that... Even if it is a skill that can be overcome in a different period of life, it's much more difficult.
Serious professional level manual dexterity and physical skills are not something that can be picked up even with multiple dedicated courses.
I'd venture that putting in the courses of immersion & deliberate training you suggest, and at a level of intensity equal to med school itself, might recover 30% of the deficient students in several years, delaying their Med School by the same period. Seems out of scope to me.
But the OP's idea of a pre-screening exam is good, not because prep courses would solve it, but because the pre-med students could wash themselves out of contention if they lacked the skills to begin with.
OP casually shunts off the severely deficient students as an 'invalid concern' and "just [a] transfer of responsibility", as if the schools merely "should teach them". Or, perhaps add an exam that would be solved by some 3rd party exam-cram courses or YouTube videos.
OP is wrong in this by orders of magnitude.
The training that you propose with immersion and deliberate practice is more, but likely still drastically inadequate.
There's little doubt that the surgery professors are observing a new and serious deficiency, even though the article doesn't mention quantifying the observations or research that nails down the exact cause.
Moreover, the skill deficit is deceptively simple, and may require years to fix, or even be unfixable in those subjects. Several examples:
* A group of monkeys being raised in an indoor arboretum had some injuries, and the scientists installed much more stout sticks and secured the vegetation. No more injuries due to broken branches, but when the monkeys were introduced to the wild, instead of swinging & leaping through the leafy canopies like their wild brothers, they cowered at the trunks. They'd completely failed to learn while young the skills required, and so the release failed for that generation.
* Personal experience, in learning a physical skill to an internationally competitive level, starting from being already well-coordinated, it took close to a decade of full immersion & dedication to get to the national team level. Moreover, even having achieved this skill level in certain sports, I've tried to get good at things like juggling and piano, and I have no illusions that even making a similar level of dedication, I'd never get anywhere near a professional level in either -- I didn't build that kind of wiring earlier.
* I've made arguments like yours to concert-level musicians, i.e., that simply being dedicated enough and training hard enough would get one to a professional level. Instant response of "NOoooo..." -- they've each seen multiple people pour years of their lives into hard work with top teachers and never get to a professional level, and these weren't people starting with a deficit.
* In neuroscience there is observed a period of plasticity for some skills. While it is not absolute, it is phase in brain development where the brain is particularly suited to absorb & learn certain skills. With some skills and animals, it is absolute -- if not exposed during that time, the organism or person will have an unsurmountable lifetime deficit. Languages are like this, where picking up a language between the ages of 4-8yo is almost effortless, but after that... Even if it is a skill that can be overcome in a different period of life, it's much more difficult.
Serious professional level manual dexterity and physical skills are not something that can be picked up even with multiple dedicated courses.
I'd venture that putting in the courses of immersion & deliberate training you suggest, and at a level of intensity equal to med school itself, might recover 30% of the deficient students in several years, delaying their Med School by the same period. Seems out of scope to me.
But the OP's idea of a pre-screening exam is good, not because prep courses would solve it, but because the pre-med students could wash themselves out of contention if they lacked the skills to begin with.
> A group of monkeys being raised in an indoor arboretum had some injuries, and the scientists installed much more stout sticks and secured the vegetation. No more injuries due to broken branches, but when the monkeys were introduced to the wild, instead of swinging & leaping through the leafy canopies like their wild brothers, they cowered at the trunks. They'd completely failed to learn while young the skills required, and so the release failed for that generation.
Do you have a link about this one? Sounds interesting.
Do you have a link about this one? Sounds interesting.
I wish I had a link, sorry. Read it probably over 10 years ago
It's a delicate balance for sure, but I do think time on task lends itself toward mastery. KA Ericsson's deliberate practice has been met with criticism [1], someone born with good genes and having a tailored upbringing will flourish while another person cannot. I've trained someone with functional, but severe mental disabilities and while he'll never be regarded as a 'master', his overall coordination and quality of life have improved. I personally hold the "lifetime learner" mentality, and so I look at it less of becoming a mastery and just getting better.
That's a longer term approach. I agree that if I'd started some of my current hobbies at a younger, more malleable age, I would have improved at a faster rate. But I also can't time travel, so should I simply give up my aspirations of learning? Hitting 35 soon, the skills I have are all I can have? If we assume the article is referring to young med students, they are still in their early twenties - is that too late to 'start'? What about any non-traditional student that goes to a community college for a vocational trade, are they SOL? As you mention, it is more difficult, but I'd argue not impossible through specialized training.
Pre-screening is a suggestion I'd be very careful towards. The reason being is that Computer Science saw a rapid spike in popularity in the 80s [2]. Unfortunately, academia could not match the demand and so they were faced with an issue of "whom to teach". One approach was to increase the difficulty of entrance exams. I'm sure this eliminated a lot of poor students just going where the money was; however as Roberts puts it, some students took this as a sign that they were "unwanted", causing a sharp decline in enrollment in the field. Interestingly enough, this drop is around the time women in CS took a nosedive [3] that we are only now recovering from. In addition, many underrepresented groups do not pursue CS at a young age, contrary to Caucasian males. Walking into their first CS courses, it's intimidating to be met with peers that have been modding Minecraft since they were 12. We're seeing a similar 'peak interest' in CS due to the dot-com/social media era and many of the same suggestions are getting thrown around. Coupled with the demand for future software developers [4], there is a need to figure out how to teach individuals starting out with an inadequate skill level.
Instead of pre-screening, I'd lean more towards placement tests, faded assistance, and teaching discipline (which I've called perseverance/'grit' in other posts). Not everyone enters the classroom at the same ability and so those that need additional work should be given time to hone those skills. Faded assistance (scaffolding) removes the crutches as a student's 'Zone of Proximal Development' increases [5]. The mistake learned from your monkey example is they failed to be properly integrate into real world scenarios where those crutches are nonexistent. Finally, discipline teaches students to continue, even after becoming skilled. Doctors that continued to practice after their time in school were better performers than those that did not [6]. In the martial arts I train, you typically have earned your blue belt after 2 years. By that time, you KNOW every technique; however, many students also quit around this time because they become frustrated they aren't as good as the people nearing 10-20 years of training.
Others have mentioned it, but in addition to their neuroplasticity, children are forced to learn because a) they have an empty cup (neuroplasticity), and b) they are forced to (early specialization by parent). It's harder for an adult to learn because of both age and they don't have the same time to devote to becoming skilled like they did as a child. This is why I like the idea of specialized courses and why I prefer academia to something like a MOOC. There is an implicit "forced learning" where the novice is devoting time toward progression.
If a student "can't learn CS", I'd say it is because they are ill equipped to learn it at that time. As such, the next step is to identify why they struggle (technical literacy, problem-solving, reasoning, or some combination of those) and seek to improve that skill before moving into CS. Similar to surgery, by identifying what basic skill a student struggles with and then improving it should be the first course of action. WHERE that basic skill should be taught is more political than I'd like to get into, since I've written enough.
[1] http://www.chrest.info/fg/Articles-2011-2015/Hambrick-2014-I... [2] https://cs.stanford.edu/people/eroberts/CSCapacity/ [3] https://www.npr.org/sections/money/2014/10/21/357629765/when... [4] https://fas.org/sgp/crs/misc/R43061.pdf [5] https://en.wikipedia.org/wiki/Zone_of_proximal_development [6] https://www.ncbi.nlm.nih.gov/pubmed/22141427
That's a longer term approach. I agree that if I'd started some of my current hobbies at a younger, more malleable age, I would have improved at a faster rate. But I also can't time travel, so should I simply give up my aspirations of learning? Hitting 35 soon, the skills I have are all I can have? If we assume the article is referring to young med students, they are still in their early twenties - is that too late to 'start'? What about any non-traditional student that goes to a community college for a vocational trade, are they SOL? As you mention, it is more difficult, but I'd argue not impossible through specialized training.
Pre-screening is a suggestion I'd be very careful towards. The reason being is that Computer Science saw a rapid spike in popularity in the 80s [2]. Unfortunately, academia could not match the demand and so they were faced with an issue of "whom to teach". One approach was to increase the difficulty of entrance exams. I'm sure this eliminated a lot of poor students just going where the money was; however as Roberts puts it, some students took this as a sign that they were "unwanted", causing a sharp decline in enrollment in the field. Interestingly enough, this drop is around the time women in CS took a nosedive [3] that we are only now recovering from. In addition, many underrepresented groups do not pursue CS at a young age, contrary to Caucasian males. Walking into their first CS courses, it's intimidating to be met with peers that have been modding Minecraft since they were 12. We're seeing a similar 'peak interest' in CS due to the dot-com/social media era and many of the same suggestions are getting thrown around. Coupled with the demand for future software developers [4], there is a need to figure out how to teach individuals starting out with an inadequate skill level.
Instead of pre-screening, I'd lean more towards placement tests, faded assistance, and teaching discipline (which I've called perseverance/'grit' in other posts). Not everyone enters the classroom at the same ability and so those that need additional work should be given time to hone those skills. Faded assistance (scaffolding) removes the crutches as a student's 'Zone of Proximal Development' increases [5]. The mistake learned from your monkey example is they failed to be properly integrate into real world scenarios where those crutches are nonexistent. Finally, discipline teaches students to continue, even after becoming skilled. Doctors that continued to practice after their time in school were better performers than those that did not [6]. In the martial arts I train, you typically have earned your blue belt after 2 years. By that time, you KNOW every technique; however, many students also quit around this time because they become frustrated they aren't as good as the people nearing 10-20 years of training.
Others have mentioned it, but in addition to their neuroplasticity, children are forced to learn because a) they have an empty cup (neuroplasticity), and b) they are forced to (early specialization by parent). It's harder for an adult to learn because of both age and they don't have the same time to devote to becoming skilled like they did as a child. This is why I like the idea of specialized courses and why I prefer academia to something like a MOOC. There is an implicit "forced learning" where the novice is devoting time toward progression.
If a student "can't learn CS", I'd say it is because they are ill equipped to learn it at that time. As such, the next step is to identify why they struggle (technical literacy, problem-solving, reasoning, or some combination of those) and seek to improve that skill before moving into CS. Similar to surgery, by identifying what basic skill a student struggles with and then improving it should be the first course of action. WHERE that basic skill should be taught is more political than I'd like to get into, since I've written enough.
[1] http://www.chrest.info/fg/Articles-2011-2015/Hambrick-2014-I... [2] https://cs.stanford.edu/people/eroberts/CSCapacity/ [3] https://www.npr.org/sections/money/2014/10/21/357629765/when... [4] https://fas.org/sgp/crs/misc/R43061.pdf [5] https://en.wikipedia.org/wiki/Zone_of_proximal_development [6] https://www.ncbi.nlm.nih.gov/pubmed/22141427
Then, like the poster above says, the med schools should test for dexterity as a part of the admissions requirement. Instead they focus on taking only the people who have 4.0 GPAs and perfect test scores, so they get applicants who, guess what, spent their youth focusing on getting a 4.0 GPA and perfect test scores. It's not like that leaves you a lot of time for sewing.
>perfect test scores, 4.0 GPA, spending youth striving towards
While this generally increases acceptance odds, by no means do medical schools require this. I always recommend fact-checking tidbits of K-12 daycare lore. Once upon a time, I believed the 'impossible to enter unless perfect stats' rumors too until I looked at the actual data. Apply early in the cycle and broadly to many schools and the numbers quickly turn in your favor.
>t. 30-something who got into a US medical school with closer to a 3.0 (although a 4.0 in the prereqs), a ~50 percentile MCAT, and a soft science bachelors, focusing less than 2 years in late twenties to do so.
While this generally increases acceptance odds, by no means do medical schools require this. I always recommend fact-checking tidbits of K-12 daycare lore. Once upon a time, I believed the 'impossible to enter unless perfect stats' rumors too until I looked at the actual data. Apply early in the cycle and broadly to many schools and the numbers quickly turn in your favor.
>t. 30-something who got into a US medical school with closer to a 3.0 (although a 4.0 in the prereqs), a ~50 percentile MCAT, and a soft science bachelors, focusing less than 2 years in late twenties to do so.
> Then, like the poster above says, the med schools should test for dexterity as a part of the admissions requirement.
They do - my friends who were applying to medical school all had to bring some example of manual dexterity. My housemate brought some needlework she'd done.
They do - my friends who were applying to medical school all had to bring some example of manual dexterity. My housemate brought some needlework she'd done.
Many medical specialties don't require high dexterity. Most medical students don't decide whether to go into surgery until they've been in school for a while and assisted on some procedures.
>> Then, like the poster above says, the med schools should test for dexterity as a part of the admissions requirement.
> Many medical specialties don't require high dexterity. Most medical students don't decide whether to go into surgery until they've been in school for a while and assisted on some procedures.
The easy and obvious solution is to test everyone on entrance and only let people choose specialities if they have the necessary dexterity.
> Many medical specialties don't require high dexterity. Most medical students don't decide whether to go into surgery until they've been in school for a while and assisted on some procedures.
The easy and obvious solution is to test everyone on entrance and only let people choose specialities if they have the necessary dexterity.
Why not have the test when people choose their specialty?
I don't understand that either. You might screen out the smart Dr House who is good at diagnosing, but doesn't have the dexterity he would need to be a surgeon.
You're not screening them out from being doctors, but from specializing in surgery. The people who don't want to be surgeons won't need to take the test and those that fail can select a different specialty.
> Why not have the test when people choose their specialty?
That's certainly an option.
On balance, I think the increased cost is worth giving people years of advanced notice about what their career options are. If someone really has their heart set on surgeon or nothing, they can go do something else rather than find out they won't make it 2 years into med school (with the associated debt).
That's certainly an option.
On balance, I think the increased cost is worth giving people years of advanced notice about what their career options are. If someone really has their heart set on surgeon or nothing, they can go do something else rather than find out they won't make it 2 years into med school (with the associated debt).
I'm sure the testing industry would love this proposal, but I disagree. Let people know general dexterity scores needed, give them an option to test themselves, but don't require it until it is time for admission. You'd be way, way, way overtesting for a skill the majority won't need. Most med students are ultimately not at all interested in surgery due to how long the post-graduate residencies are (5 years, minimum), to say nothing of potential fellowships. And there's only about ~1,300 total residency spots per year anyway, so testing all med students would just be a unnecessary revenue stream.
glibgil(1)
You are right, and I have speculated that surgery might be subdivided into virtuosos with superb operating skills, and scientist-coach-types, who plan, monitor, and are expert at contingent strategies.
The Johnson O’Connor Research Foundation (see <http://www.jocrf.org/home>) has found that there are several different “aptitudes”, and you need to be really, really good in at least three of them before you are likely to be successful and happy as a surgeon.
They’ve got longitudinal studies over several decades with strong statistical methods.
If you are ever between jobs, or wondering what things you could be really good at or what careers might be a good choice for you, I highly recommend signing to take their extensive testing procedures, and then following up with them over the decades.
They’ve got longitudinal studies over several decades with strong statistical methods.
If you are ever between jobs, or wondering what things you could be really good at or what careers might be a good choice for you, I highly recommend signing to take their extensive testing procedures, and then following up with them over the decades.
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.
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.
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?
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.
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.
And there are people who know exactly what they want to be at age 10. The goal isn't to graduate everyone who wants to be a surgeon. The goal is to graduate only the best people. If someone gets to med school, decides they want to do surgery, and fails dexterity, then guess what? They don't get to be a surgeon. I think that is okay and most likely produces better patient outcomes in the long-term.
Couldn’t you make the same argument regarding whether testing physics or organic chemistry aptitude is necessary for every specialty? The admissions office could at least nudge students to not pursue surgery if they have poor dexterity.
Well, that sort of already happens, but some schools are admittedly better at this form of "career counseling" than others, and usually well after they have matriculated. At my own school we were required to have such an interview before we started clerkships and faculty members would try to develop this sort of self-insight about where one's skills and aptitudes are best, but years later the students who rotate with me now tell me this is optional, which seems like a step backwards.
That's what parents are for. I foresee a whole line of toddler dexterity toys.
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.
We could do with more emphasis on knife use, carpentry, sewing/knitting, soldering, etc. among primary school students though.
There are lots of it, but it is not enough. Fine motor skills are aquired for decades.
https://en.wikipedia.org/wiki/Fine_motor_skill
I'd add that writing with a pen, playing musical instrument are important activities to develop fine motor skills. Just to buy toddles more toys would not work, without constant development later.
https://en.wikipedia.org/wiki/Fine_motor_skill
I'd add that writing with a pen, playing musical instrument are important activities to develop fine motor skills. Just to buy toddles more toys would not work, without constant development later.
> 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.
No, it assumes that if you make surgery and related specialties areas that one has to plan to enter when one starts medical school, the surgeons that result will have better manual dexterity.
Saying that if you change things, things will change, that is never a good argument against changing things. The real question is what the possible negatives would be of the change.
No, it assumes that if you make surgery and related specialties areas that one has to plan to enter when one starts medical school, the surgeons that result will have better manual dexterity.
Saying that if you change things, things will change, that is never a good argument against changing things. The real question is what the possible negatives would be of the change.
[deleted]
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?
> 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!
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!
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.
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.
Actually we've met once, but it wasn't on Grouse. I'll keep the open invitation 'till it's relevant.
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.
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".
Learning how to swim in adulthood vs learning how to swim and becoming good enough at a competitive level are very different things.... Im not trying to downplay your achievement, but that's the level of distinction here with regards to surgeons.
I've always wondered if it's basically impossible or just not something people have time for, but many of my friends in college were completely uncoordinated and I find it difficult to imagine them being able to become surgeons. They also grew up before smartphones though, they just never played any sports or did anything physical.
I don't think this is true. Other reasons that it's difficult for adults to learn things are:
1) A fear of embarrassment while learning - because as an adult learner you're at the bottom of a far wider range of skill levels of people your own age than a child is when they're learning. When you've been working on your French for two years, and a five year-old French child speaks with a facility you don't have in your wildest dreams, well, remember that that five year-old has been working on their French for five years; and while they were learning, they never had to feel like they were too far behind every other under-five in the world.
2) The constant encouragement of adults to concentrate on improving the things that they're already good at, and not to waste too much time on the things they're not good at that aren't necessary for their jobs. I think part of this comes in the form of theories that it's impossible to learn things after you're the customary age for people to learn that thing. Or worse, that everybody who is good at a thing was anointed by god or genes to be good at it, therefore if you aren't good at it already you probably weren't chosen.
1) A fear of embarrassment while learning - because as an adult learner you're at the bottom of a far wider range of skill levels of people your own age than a child is when they're learning. When you've been working on your French for two years, and a five year-old French child speaks with a facility you don't have in your wildest dreams, well, remember that that five year-old has been working on their French for five years; and while they were learning, they never had to feel like they were too far behind every other under-five in the world.
2) The constant encouragement of adults to concentrate on improving the things that they're already good at, and not to waste too much time on the things they're not good at that aren't necessary for their jobs. I think part of this comes in the form of theories that it's impossible to learn things after you're the customary age for people to learn that thing. Or worse, that everybody who is good at a thing was anointed by god or genes to be good at it, therefore if you aren't good at it already you probably weren't chosen.
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.
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.
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.
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.
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...
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...
The two videos are here, https://well.blogs.nytimes.com/2013/10/31/a-vital-measure-yo...
>> 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.
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.
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> 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.
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.
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.
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.
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.
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.
> 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)
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)
> 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.
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.
> Physical education is awful
For some, yes. And it is certainly taught in an inadequate way in most cases.
> and it is not capable of not being awful.
And this is where you basically close the door on any further discussion. I think the issue is more that you are too fixated on what Physical Education is than on what it could and should be.
For some, yes. And it is certainly taught in an inadequate way in most cases.
> and it is not capable of not being awful.
And this is where you basically close the door on any further discussion. I think the issue is more that you are too fixated on what Physical Education is than on what it could and should be.
Two hours a week of coaching is better than none. Unstructured play is great, but it's no substitute for targeting coaching when it comes to developing useful skills.
> Two hours a week of coaching is better than none.
No one gets good at anything on two hours a week of practice. Absolutely nothing. Two hours a week will barely get you past novice in a year. It’s so little, so seldom that a substantial amount of each lesson has to be revision too but even if learning was instant and perfect 100 hours a year rounds to nothing.
> Unstructured play is great, but it's no substitute for targeting coaching when it comes to developing useful skills.
Tell it to the Chinese football team. Then tell it to the Brazilian football team.
No one gets good at anything on two hours a week of practice. Absolutely nothing. Two hours a week will barely get you past novice in a year. It’s so little, so seldom that a substantial amount of each lesson has to be revision too but even if learning was instant and perfect 100 hours a year rounds to nothing.
> Unstructured play is great, but it's no substitute for targeting coaching when it comes to developing useful skills.
Tell it to the Chinese football team. Then tell it to the Brazilian football team.
> No one gets good at anything on two hours a week of practice. Absolutely nothing.
You have never done any sports, have you?
> Tell it to the Chinese football team. Then tell it to the Brazilian football team.
Are you seriously going to use two professional teams with extensive professional coaching as an argument against the use of coaching?
Nobody is arguing against unstructured play, you are just trying to steer the conversation into a direction where it's an either/or situation where it is not.
You have never done any sports, have you?
> Tell it to the Chinese football team. Then tell it to the Brazilian football team.
Are you seriously going to use two professional teams with extensive professional coaching as an argument against the use of coaching?
Nobody is arguing against unstructured play, you are just trying to steer the conversation into a direction where it's an either/or situation where it is not.
Bullshit. I've seen my own children and their peers make significant improvements in several sports with only 2-3 hours a week of coached practice. For example it's not that hard to learn a decent swimming crawl stroke, but almost no one can figure out the right technique on their own. That takes an experienced instructor and focused, disciplined practice. You might have had a bad experience in PE class but don't project your own failings on others.
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There was a similar theme in the military where the trigger finger was loosing dexterity and being surpassed by the thumb for controls. Most people didn't grow up shooting on farms but they do get access to a phone early on.
As an example the Javelin anti Armour missile have playstation-esq aiming controls on them for this reason and most remote weapons systems have a thumb driven joystick config.
As an example the Javelin anti Armour missile have playstation-esq aiming controls on them for this reason and most remote weapons systems have a thumb driven joystick config.
What proportion of enlistees in the military post ww2 have ever a lot of shooting experience.
Sounds like presumably "USA" is not expending enough time and money on target practice - I would hope that UK still understand s the lesson taught by the Napoleonic wars that well trained and practiced troops are key to winning a firefight.
And crew served weapons is quite different to traditional marksmanship and that's where most of the killing is done these days.
Sounds like presumably "USA" is not expending enough time and money on target practice - I would hope that UK still understand s the lesson taught by the Napoleonic wars that well trained and practiced troops are key to winning a firefight.
And crew served weapons is quite different to traditional marksmanship and that's where most of the killing is done these days.
The US Federal Government sponsors the Civilian Marksmanship Program specifically because of that concern.
http://thecmp.org
You wouldn’t know it to listen to them talk these days, but this was actually one of the original goals of the NRA.
https://en.wikipedia.org/wiki/National_Rifle_Association
You’d be surprised. Gun fetishism often starts at a pretty young age in America.
I would also like to point out that this guy's name is "Kneebone". Sounds fake, but okay.
It’s called nominative determinism
... That would explain why I have a degree in German actually.
With a name like "derReineke", I should think so.
I love it. The first thing I thought was "Kneebone? Huh... I wonder if he comes from a lineage of doctors."
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This post is SUPER relevant - 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.
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.
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.
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).
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.
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.
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.
Ah you mean handicrafts chiz ( mrs joyful prize for rafia work) I was talking about taking real engineering classes.
Tangentially related, I heard on a Tim Kennedy (MMA champion/Army Special forces) podcast that they have people enlist in the army or police force that have never even been in a fight in real life.
If we keep voting up all these hard right people we'll all be using screwdrivers to maintain Gilead soon enough.
If you keep posting unsubstantive comments, especially off-topic political flamebait, we're going to end up banning your account. We've had to ask you multiple times already.
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”.
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”.
I see handwriting has gone to the dogs these days so maybe he is onto something...
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.
[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.
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.
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.
I am a medical student, and I have taken the MCAT. It is not just a memorization test. Each section is made up of a series of excerpts from scientific papers and questions that relate to that article. It requires you to synthesize the new information from an article with your knowledge of chemistry, biology, etc. to come to the correct answer. From what I understand, the USMLE exams are similar. It is important to score well on the MCAT because medical schools want student who are able to read scientific papers and apply their findings. Medical schools also look beyond just MCAT score and grades when selecting students.
I can relate to this experience (US medical student). Medical school is not only about being able to memorize literally everything possible, but also applying that knowledge in situations that may not fit the "perfect" picture. It's the ultimate test of memory, application, and communication (because when you find the right answer, you also have to be able to explain it to your patient).
My childhood dentist is the best craftsman that I know. Can carve stuff in wood, make jewelry, any part of fixing up a house.
If we or his kids ever got any wounds that needed stitching he would do it instead of the hospital as we knew he would do a better job.
If we or his kids ever got any wounds that needed stitching he would do it instead of the hospital as we knew he would do a better job.
Steven Zeitels is one of the best vocal surgeons in the world -- he's operated on Adele, Roger Daltrey and others. Prior to becoming a physician, he did leather work, selling his creations on the street and that appears to have allowed him to develop unrivaled manual skills [0]:
Zeitels succeeded in part because of his leatherwork in college: It made him ambidextrous, a necessary skill for a procedure in which a cut a millimeter too deep would damage the vocal cords, but where one too shallow would leave some of the lesion intact, and therefore able to grow back. The problem with Zeitels’s surgery, however, was that no one else could repeat it. No one else in the field could be as precise. As he looked to publish his findings in an atlas on the larynx, one editor told him, “You can’t write that! People can’t do that!” His findings were published anyway, but the editor was right.
[0] https://www.bostonmagazine.com/2008/09/22/voicebox-hero/
Zeitels succeeded in part because of his leatherwork in college: It made him ambidextrous, a necessary skill for a procedure in which a cut a millimeter too deep would damage the vocal cords, but where one too shallow would leave some of the lesion intact, and therefore able to grow back. The problem with Zeitels’s surgery, however, was that no one else could repeat it. No one else in the field could be as precise. As he looked to publish his findings in an atlas on the larynx, one editor told him, “You can’t write that! People can’t do that!” His findings were published anyway, but the editor was right.
[0] https://www.bostonmagazine.com/2008/09/22/voicebox-hero/
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
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
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.
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.
This is specifically about surgeons which actually make up a relatively small proportions of Doctors.
I would expect that selection for surgeons is above and beyond the test scores.
I would expect that selection for surgeons is above and beyond the test scores.
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?
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.
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.
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.
> 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.
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.
> should be something that favors gamers
Not sure. Don't game use only 2 of 5 fingers on each hand excessively ? ( Thumb and Index)
Not sure. Don't game use only 2 of 5 fingers on each hand excessively ? ( Thumb and Index)
For controllers, yeah, more or less.
But given the way games also tend to be addicting, I wonder if it hurts people's drive/motivation (on aggregate, not per individual) as much as it helps people's finger dexterity.
I often wonder if certain sports actually do a better job training dexterity, short of focused practice on specific tasks. Or knitting, or juggling, or... heck, even cooking.
But given the way games also tend to be addicting, I wonder if it hurts people's drive/motivation (on aggregate, not per individual) as much as it helps people's finger dexterity.
I often wonder if certain sports actually do a better job training dexterity, short of focused practice on specific tasks. Or knitting, or juggling, or... heck, even cooking.
To play devil's advocate: how many/which fingers do you use to hold a needle? I'd guess it's roughly the same ;)
You hold a needle with fingers, but you also need to handle it up, down, left, right and rotate it pitch, roll, yaw. Lot more analog than pressing fixed buttons.
Well if there's a game controller that works on surgery motions may be a lot more parents would encourage their kids to play this game.
> how many/which fingers do you use to hold a needle ?
Suturing is not the only thing a Surgeon does...
Suturing is not the only thing a Surgeon does...
Building on what another poster said, gamers who play on computer utilize pretty much all of the fingers on their keyboard hand (likely left hand for most people, non-dominant for most). The mouse hand is usually just index, middle, and thumb.
Well, do you practice stitching? If not, then how would you possibly be good at it?
Yeah, I don't.
To think of it now: I think boy scouts really are a great organization, to be teaching kids how to tie knots and survive in the outdoors.
I wish such a thing existed for me to attend as an adult!
To think of it now: I think boy scouts really are a great organization, to be teaching kids how to tie knots and survive in the outdoors.
I wish such a thing existed for me to attend as an adult!
In Germany it would be "Technisches Hilfswerk" (technical disaster assistance). I am sure something similar exists in the US or elsewhere.
10 years ago or more, I read an article saying that telepresence surgery was the wave of the future and doctors who grew up playing video games were much better at it.
But you'd expect that to be increasing on average, given how video games keep getting more popular. It seems like, perhaps, operating buttons and joysticks doesn't train the same sort of dexterity as sewing does.
But you'd expect that to be increasing on average, given how video games keep getting more popular. It seems like, perhaps, operating buttons and joysticks doesn't train the same sort of dexterity as sewing does.
Only tangentially related, but still relevant: I had a very positive experience with a telepresence neurologist this year - not in surgery, but in consultation.
My mom had what we thought might be a stroke, but without the typical symptoms of a stroke. We wound up in the ER on a Saturday in a medium-sized metropolitan area (maybe 250k people). They wheeled her back for a head CT, and at the same time wheeled in a telepresence cart, with a computer screen and a video camera. Within a minute or so, a remote neurologist was on the screen talking to me. Before my mom was even wheeled back to the exam room, he had viewed the images and identified the bleed in her brain that was causing her vision problems.
I was fascinated by all of this, so I asked the ER doctor and nurse about it, and they told me that with specialties like neurology, on a weekend they’d have to page someone to come in. It would likely be 30 minutes before they even walked in the door of the hospital. With the telepresence neurologist, the SLA was something like 5 minutes. That’s a huge difference when dealing with serious medical problems, and it’s not hyperbole to say that it will save lives.
Another thing I learned that day: Not all strokes look like strokes, and any sudden-onset vision problem is a stroke until it’s been ruled out.
My mom had what we thought might be a stroke, but without the typical symptoms of a stroke. We wound up in the ER on a Saturday in a medium-sized metropolitan area (maybe 250k people). They wheeled her back for a head CT, and at the same time wheeled in a telepresence cart, with a computer screen and a video camera. Within a minute or so, a remote neurologist was on the screen talking to me. Before my mom was even wheeled back to the exam room, he had viewed the images and identified the bleed in her brain that was causing her vision problems.
I was fascinated by all of this, so I asked the ER doctor and nurse about it, and they told me that with specialties like neurology, on a weekend they’d have to page someone to come in. It would likely be 30 minutes before they even walked in the door of the hospital. With the telepresence neurologist, the SLA was something like 5 minutes. That’s a huge difference when dealing with serious medical problems, and it’s not hyperbole to say that it will save lives.
Another thing I learned that day: Not all strokes look like strokes, and any sudden-onset vision problem is a stroke until it’s been ruled out.
I was just looking it up -- here's the original paper, from 2007:
https://www.ncbi.nlm.nih.gov/pubmed/17309970
And, if you don't want to read the paper, here's a piece about it and some related studies (2013):
https://www.medicalbag.com/lifestyle/gamers-make-good-surgeo...
https://www.ncbi.nlm.nih.gov/pubmed/17309970
And, if you don't want to read the paper, here's a piece about it and some related studies (2013):
https://www.medicalbag.com/lifestyle/gamers-make-good-surgeo...
I wonder how much of the telepresence thing has to deal with adjusting for lag. Accounting for lag and high pings was definitely something a lot of early gamers grew up with (and is still an issue).
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.
I'm a gamer and I really liked surgery. I've always been kind of clumsy so I put in a lot of time practicing in the labs before I started doing simple operations. My surgery rotation was a great experience because of that.
The problem with these rotations is you do them and then move on to the other ones. More than one year passed before I got the chance to stitch something up again. The results were not as good...
I believe that if you want to be a surgeon you need to be constantly practicing and honing your manual skills. It's probably much easier to do this in residency where you're 100% focused on surgery and won't have to switch to a pediatrics or gynecology rotation after some time.
The problem with these rotations is you do them and then move on to the other ones. More than one year passed before I got the chance to stitch something up again. The results were not as good...
I believe that if you want to be a surgeon you need to be constantly practicing and honing your manual skills. It's probably much easier to do this in residency where you're 100% focused on surgery and won't have to switch to a pediatrics or gynecology rotation after some time.
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.
This is definitely true. This surgeon looks a bit foolish, he is seemingly unaware that there is a long history of medical educators complaining that the current generation are worse at X because of Y. Often it biased by a couple of outlier cases you saw last week.
Show some scientific integrity Kneebone, it would be easy to do an actual unbiased study instead of ranting to the BBC.
Show some scientific integrity Kneebone, it would be easy to do an actual unbiased study instead of ranting to the BBC.
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.
The current cell phone infrastructure and the phones themselves really suck for talking to people. This is why, I think, kids don't talk over the phone. Not because they really prefer texting over voice but that live voice sucks. The smart phone is a bad shape for catching and producing sounds and the cell phone network has high and variable lag, dropped calls, many "Can you hear me now" moments, the "I can hear you clearly and think all is well but you can't hear me" problem, etc. So people don't do most of there communications with voice and eventually you see people texting each other in the same room. It really is a problem that has not gotten enough attention. I recently brought back my landline so a least 1/2 the communication is on a good system for talking when I actually want to have a conversation with someone over the phone. Its great but why does it cost $30 a month for just unlimited local calls? Only someone with quite a bit of extra resources would have one.
Business have landlines and/or low latency internet to handle quality voice communication. Most families these days don't.
Business have landlines and/or low latency internet to handle quality voice communication. Most families these days don't.
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?
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.
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.
This is funny. I just realized that I never talk to anyone under 30 on the phone. The few kids I do talk to (my nieces) use FaceTime exclusively. Your explanation makes sense.
Meanwhile, all the phones at my office have attached cameras and displays. We can see each other on the phone. Except most of use keep the camera turned off because we want to retain our private eye rolling.
Meanwhile, all the phones at my office have attached cameras and displays. We can see each other on the phone. Except most of use keep the camera turned off because we want to retain our private eye rolling.
What model of phones do you have and what software do you use them with?
It's a skill - I did some helpdesk work which certainly helped a lot, but I don't think you should be measuring someone based on the way they talk on the phone. There are lots of factors that could impact the way someone comes across on a phone call.
They didn't mention losing stamina to be able to write with a pen for more than 15 minutes either.
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.
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.
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.
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.
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.
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.
Unfortunately, as a left-hander, fountain pens just don't really work for me.
Apparently those students skipped Arts and Crafts in school.
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.
Taking those classes in high school instead would have required me to give up AP classes, or my independent study of Computer Networking class.
Possibly in the hopes that they could focus more on the classes and grades required to get them into med school.
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.
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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.
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.
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.
You know what they call the worst medical student in their graduating class?
"Doctor"
"Doctor"
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.
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.
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.
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.
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.
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.
The small number of people who still have dexterity will build a small number of robots, which then build a larger number of robots ...
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
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.
Wouldn't it be nice to be in a profession that values people over 35 more.
Learning to play the guitar is a good way to improve dexterity. I'm very gradually upgrading my left hand from dialup to broadband.
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!
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!
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Teach them to knit or embroider in their downtime, problem solved.
Ah, no biggie. We'll just replace them with robuts.
Or we need robots to take this task?
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
Robots have terrible dexterity.
Also, it's pretty depressing to hear the response to deskilling be more deskilling.
Also, it's pretty depressing to hear the response to deskilling be more deskilling.
Let them play video games.
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.
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.
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.
By that logic, we're all far better piano players too.
Skills and neural pathways have training and use specificity. Even (or especially) slightly different practices can have surprisingly little transfer, or even interference.
Skills and neural pathways have training and use specificity. Even (or especially) slightly different practices can have surprisingly little transfer, or even interference.
That's not the logic I was using. Using your piano example, I was saying that people would be better at learning to play the piano today, because our fingers are already used to pressing keys.
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.
To me, typing on a phone is a lot easier to learn in terms of dexterity than threading a needle.
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
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
I have found the position of my finger in relation to a touchscreen has a substantially weaker correlation with successfully pressing the button I want than the position of the thread in relation to a needle's eye has with successfully threading the needle.
How long until this work can be automated and such dexterity will become unnecessary?
I'm sorry, but is the surgery professor's name really Kneebone?
I was deeply disappointed to find out that Tom Burr is actually an artist.
If you check his LinkedIn profile, you'll see he's connected to Drs. Thighbone and Anklebone.
Sometimes you just have to make the sacrifice and accept the obligatory downvotes for an amazing post like this.
If your ankles connect to your knees, you might be in trouble, friend. :^)
There's a reason he became a doctor.
Fake news
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.