
Surgery students 'losing dexterity to stitch patients' - rb808
https://www.bbc.com/news/education-46019429
======
ronilan
This sounds like a valid concern until you realize that it is just transfer of
responsibility.

What the surgeon wants is for lower level schools to provide him with students
that are pre-trained for his specific needs.

If the Imperial College of London needs people who can cut-and-sew, then the
Imperial College of London should teach them to cut-and-sew.

Or even better, the Imperial College of London can just institute a “cut-and-
sew” entrance exam. Given the status and pay of a surgeon, it is likely that
the exam prep industry will do the training job for them.

If they don’t, then some Youtubers surely will. Problem solved, no robots
harmed and everyone got some extra plushies.

~~~
toss1
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

~~~
imgabe
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.

~~~
nradov
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.

~~~
nordsieck
>> 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.

~~~
dagw
Why not have the test when people choose their specialty?

~~~
carlmr
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.

~~~
dagw
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.

------
etrautmann
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.

~~~
derReineke
I would also like to point out that this guy's name is "Kneebone". Sounds
fake, but okay.

~~~
gaius
It’s called nominative determinism

~~~
derReineke
... That would explain why I have a degree in German actually.

~~~
Filligree
With a name like "derReineke", I should think so.

------
skadamat
This post is SUPER relevant -
[http://worrydream.com/ABriefRantOnTheFutureOfInteractionDesi...](http://worrydream.com/ABriefRantOnTheFutureOfInteractionDesign/)

The rant is about interaction design in computer screens, but the points made
here are easily transferred if we treat the tools & the environment surgeons
work in as a user interface.

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

~~~
gpvos
In the west, the lower classes are more likely to use screens too much when
young, while the higher classes are restricting their kids' screen time (which
hopefully leads to them doing more with their hands).

~~~
walshemj
What my little prince "Josh" get his hands dirty with those _shudders_ working
class shop kids.

I suspect those higher classes would have a fit if one of their kids got their
ands dirty - quite keen on it for the lesser classes though.

~~~
mywittyname
Craft-based activities are bourgeois af these days. There are so many places
to take you kids and have them learn woodworking, knitting, etc, and the
classes are filled with little Aiden, Cayden, and Braedons whose mom's drove
them to class in luxury SUVs and post their little projects on insta.

~~~
walshemj
Ah you mean handicrafts chiz ( mrs joyful prize for rafia work) I was talking
about taking real engineering classes.

------
massysett
He is blaming “screens” but he needs to consider whether the admissions
process causes this, not “screens”. Maybe they are admitting students with no
practical knowledge, and maybe this has changed in the past ten years.

For instance maybe in prior years applicants were more likely to have
practical job experience: a summer job in retail, fast food, etc. Now maybe
they only select students who have programmed existences.

Just seems odd to me that he would make this observation then suddenly jump to
blaming it on “screens”.

~~~
kopo
I see handwriting has gone to the dogs these days so maybe he is onto
something...

~~~
vanderZwan
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.

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

~~~
loceng
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.

~~~
jac241
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.

~~~
edwardhusarcik
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).

------
rdlecler1
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?

~~~
PhasmaFelis
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.

~~~
larrywright
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.

------
RcouF1uZ4gsC
I don't see any objective measure of this assertion, such as students taking
longer to stitch with practice materials. This whole thing seems like a "kids
these days" lamentation.

~~~
fipple
I know that I can easily guess the age of a person calling my business based
on whether they can actually talk properly on the phone. Above about 35 they
can all do it. Below about 25 they use the phone so little that they cannot
place a professional phone call or leave a professional voicemail.

~~~
function_seven
What do the younger callers do (or not do) that sticks out? Are they awkward
in their greeting? Do they act like someone who's giving a speech for the
first time?

~~~
freehunter
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.

~~~
function_seven
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.

~~~
fipple
What model of phones do you have and what software do you use them with?

------
rb808
They didn't mention losing stamina to be able to write with a pen for more
than 15 minutes either.

~~~
RandallBrown
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.

~~~
rootusrootus
You can mitigate that somewhat with a really good pen. A lot of the fatigue
comes from pushing down the pen to make it write. Something like a fountain
pen that just glides across the paper with very little pressure is much easier
to write with for an extended time.

~~~
toomanybeersies
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.

------
cwbrandsma
Apparently those students skipped Arts and Crafts in school.

~~~
mrguyorama
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.

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

~~~
edwardhusarcik
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.

------
oedmarap
I'll say this from personal experience; having children play a musical
instrument such as the piano when they are young helps massively with finger
dexterity, speed, and muscle development.

Having children also tinker with electronics (and anything else modular for
that matter) is also a great way to gain accuracy needed for minute and subtle
movements.

These have added benefits over simple handwriting -- in that writing is a
prolonged contraction of the muscle whereas playing an instrument and doing
small scale work involves contraction-release and learning of pressure
sensitivity.

~~~
Nr7
I can't help but to wonder how much difference there actually is when playing
the piano or typing on a keyboard as a child.

~~~
exDM69
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.

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

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

------
gadders
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)

------
jfk13
While I can imagine there might be something to this, it seems like it's far
from being generally agreed:
[https://www.bbc.co.uk/news/uk-46036095](https://www.bbc.co.uk/news/uk-46036095).

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

------
p1mrx
Learning to play the guitar is a good way to improve dexterity. I'm very
gradually upgrading my left hand from dialup to broadband.

~~~
nicetryguy
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!

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

------
jplayer01
Ah, no biggie. We'll just replace them with robuts.

------
StreamBright
Or we need robots to take this task?

~~~
preordained
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

------
booleandilemma
Let them play video games.

~~~
RandallBrown
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.

~~~
dredmorbius
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.

~~~
RandallBrown
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.

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

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

~~~
bitwize
If you check his LinkedIn profile, you'll see he's connected to Drs. Thighbone
and Anklebone.

~~~
dplavery92
If your ankles connect to your knees, you might be in trouble, friend. :^)

~~~
gpm
There's a reason he became a doctor.

------
th3o6a1d
Fake news

