Could you tie a series of square knots around the neck of a teaspoon without, even slightly, moving the teaspoon? How about using tweezers to extract a grape from inside a roll of toilet paper, without piercing the grape’s skin or touching the roll? Aspiring surgeons should have the dexterity to accomplish such tasks. But increasingly, they don’t.
Faculty members at medical schools in the United States and Britain have noticed a marked decline in the manual dexterity of students and residents. Some say it’s because of fewer hands-on courses in primary and secondary schools — shop class, home economics, drawing, painting and music. Others blame too much time spent tapping and swiping screens rather than doing things that develop fine motor control like woodworking, model building and needlework.
“You know if someone has learned French because it’s very obvious, but the language of touch is harder to recognize,”said Dr Roger Kneebone, professor of surgical education at Imperial College London . And just like verbal language, he thinks it’s easier to acquire when you’re young: “It’s much more difficult to get it when you’re 24, 25 or 26 than when you’re 4, 5 or 6.”
Scientific literature is replete with studies that show the more procedures a surgeon performs, the more likely their patients will have shorter hospital stays, suffer fewer complications and, most important, survive.
That creates a problem for today’s medical students, particularly those lacking dexterity, because of rules on how much they can work. The introduction of the maximum 80-hour workweek in 2003 had the unintended consequence of limiting surgical residents’ availability to participate in operations and refine their skills.
It’s also true that while surgery used to require cutting the patient open, advances in technology have created more minimally invasive procedures using scopes and programmable instruments like the Gamma Knife, which uses focused radiation to destroy tumors rather than having to remove them.
Some of the newer technologies demand less manual dexterity and more of the kinds of skills and reflexes one acquires playing video games. But nevertheless, they require repetition and experience to do well. But even if the procedure is not one that requires exceptionally fine motor skills, some still worry that medical students who are “all thumbs” — meaning their primary experience working with their hands is thumb-typing on their phones — may be deficient in ways other than just dexterity.
Dr Maria Siemionow , a transplant surgeon at the University of Illinois College of Medicine, recalls spending hours in her youth crocheting sweaters and also cutting out pictures and words in magazines and gluing them into elaborate collages. Such creative endeavors not only develop dexterity, she said, but also require a three-dimensional imagination, planning, patience and precision.