Comments On Manual Dexterity-NYT

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Gordon commented May 31, 2019
G
Gordon
New Hope, PAMay 31, 2019
Times Pick
It's funny, this article talks about the reduction in motor skills but fails to mention THE
most rudimentary skill no longer being taught in schools: cursive writing. Learning
how to do all those loops and curls, while working on self-expression, is a key motor
skill combination. Educators seem okay with the disappearance of the practice, yet, I
feel we are losing touch with our past in a deeply troubling way.
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Mario commented May 30, 2019
Mario
New Paltz, NYMay 30, 2019
@Gordon
I had a conversation about this about 10 years ago with a shop teacher. He said that kids in
his class, given a sentence to write out and, let's say, 8 inches of line to fit it into, could not
accurately judge how to space their writing. They lacked that kind of spatial awareness.

The problem with what goes on with a lot of (new fangled) education is that it tries to put
the cart before the horse and ignores the benefits in cognitive development that comes
with perfecting these "outdated" skills. The truth is there is very little meaningful things that
a little kid can do. So what if they're going to be "employing keyboarding skills" when
they're older. Something like cursive writing builds hand-eye coordination and develops
spatial judgment, attention to detail, patience, and so forth.

For God's sake, we use the term "grasp" to mean "understand"—but heaven
forbid a kid should pick up a pencil.
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Steve commented May 31, 2019
S
Steve
New YorkMay 31, 2019
@Gordon

Considering that physicians have traditionally been cited for their poor
handwriting I doubt anybody would have surgery by any of them based on their
handwriting.
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Kristen Rigney commented May 31, 2019
K
Kristen Rigney
Beacon, NYMay 31, 2019
Times Pick
I’m a retired preschool Special Ed teacher, and I’ve been seeing this for a long time. Ever
since this country handed the responsibility of overseeing preschool curriculum over to the
public school systems, that curriculum has been increasingly oriented towards reading and
math exclusively, neglecting “hands on” traditional preschool activities, especially arts and
crafts. I’ve always thought this was a big mistake. I also work in a summer library program
with kids in middle school, and in the past ten years, I see kids who are great readers, but
can’t use a pair of scissors and have difficulty printing legibly.
When I was teaching, I came to realize that the more involved and active kids were
when learning, the more body (and brain) parts they used, the better they learned
and the more it was retained. Anyone who has studied the brain at all knows what a
large area that control and sensation of our hands takes up in there relative to other
body parts. Should we let that real estate lie fallow, now that we have machines to do
many things that were once done by hand? Are our hands just vestigial appendages
now, like toes? If not, I think we need to encourage hand skills to enhance learning in
all areas, especially in preschool and primary education.
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LA commented May 31, 2019
L
LA
BostonMay 31, 2019
@Kristen Rigney as a PNP that was my first thought as well. This isn’t an issue of
school-age hobbies; it’s very early gross and fine motor development. I’d love to
see some Pedi OTs chime in. Putting mittens on infants’ hands, not allowing
enough tummy time, discouraging crawling in favor of using walkers or stand-up
centers — all affect early motor development and learning. These kids grow up
individually “just fine,” but lacking the dexterity they could have had with freer
motor development. All of which adds up over large populations. It’s time for
early childhood education and care to correspond more to what the research
tells us kids need and less to parents’ academic aspirations for the under-7 set.
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Allen commented May 31, 2019
A
Allen
GainesvilleMay 31, 2019
Surgery will soon be unnecessary so psychomotor skills will me not be an issue. Electronic
medical records has the potential to cure all medical problems.

You see a provider, they sit with their back to you. They enter some information into the
electronic medical record and also download as much useless information as possible (so
as to justify the visit charge). There is not an examination worthy of being called an
examination (they listen to your heart with your shirt on, examine your abdomen when
you are sitting upright, and if diabetic check your feet without needing to take off your
shoes).

An examination template is downloaded into your record, followed by another
assessment and recommendations template and amazingly, magically, miraculously
the electronic medical record has resolved your medical problems. The blind can see
and the lame walk.
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hey nineteen commented May 31, 2019
H
hey nineteen
chicagoMay 31, 2019
Hey, naysayers, consider that the authors see something about medical education that you
don’t see. Might be hard to directly compare the data on the manual dexterity of today’s
class of entering surgical residents with the Class of ‘70 because no one was gathering data
on manual dexterity back then, or even now, for that matter. Most doctors outside of
medical school will never do anything under a microscope, let alone perform or teach
others to perform surgery microscopically. (Do you even own a microscope?) As such, Dr.
Siemionow’s experience and assessment outweighs your own - and that especially includes
those of you who are still so obviously chapped over all you endured in your surgical
residencies that your hubris shines like your own private sun.

But it’s not just surgeons who are all thumbs: If you haven’t been to see your primary
care doctor recently, I recommend you go before she or he retires. Either we’re
collectively not teaching (or not requiring) basic physical examination skills. I wouldn’t
shake my head if I were working only with 3rd year medical students but when senior
residents do not perform a proper, thorough physical exam, something is amiss.
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Sarah commented May 31, 2019
S
Sarah
North CarolinaMay 31, 2019
Older surgeons are always bemoaning the new generation's comparative lack of
dedication AKA unwillingness to tolerate their abuse. They have been berating the
clumsiness of young students and surgeons for decades; it's the kind of fodder for
verbal abuse they live for. These complaints are suspiciously lacking in evidence of
genuinely poorer skill among medical students and interns.
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Diane commented May 31, 2019
D
Diane
Washington StateMay 31, 2019
I had a Mohs procedure to remove a basal cell cancer on my nose. The surgeon gave
me the option of having a "divot" or he could make a short incision along the length
of my nose and stitch it together. I opted for the latter and he did such a fine job that
there is barely a scar. The nurse later told me that his mother had been a Home
Economics teacher and had taught him to sew when he was a boy.
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AB commented May 31, 2019
A
AB
Sewing skills don't get you into surgical residencies - boards scores do. We are now
seeing the same with OBGYN. All the gunners are going for specialties that screen for
them. Maybe that is the problem.
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Randeep Chauhan commented May 31, 2019
R
Randeep Chauhan
Bellingham, WashingtonMay 31, 2019
This makes me nostalgic for the good ol' days of 100 hour work weeks. I think a less
talented surgeon is preferable to a chronically sleep deprived one. The fact that
residents "only" work 80 hours now--compared to the 40-50 the average American
does--exemplifies this problem. To ameliorate this, can the education process be
expedited? Or can "dexterity building" exercises be incorporated earlier? Can the
training begin earlier in the 4 years of medical school? Is a Bachelor's degree really
necessary to matriculate? Why can't aspiring surgeons complete the pre-requisite
courses, and begin training earlier? After completing Organic Chemistry, General
Chemistry, General Biology, Physics, Biochemistry I was ready to start training. I am a
sycophant when it comes to surgeons; the workload, stress, responsibility and
sacrifices are unrivaled by any other profession. I was humbled by how ambitious,
productive, erudite, and willing to teach surgeons were that I encountered in
Orthopedic and Neurosurgery. Let's make their lives easier. Coming from a failed
Pre-med.
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Leslie commented May 31, 2019
L
Leslie
VirginiaMay 31, 2019
Although I got good care during a recent cholycystectomy, my surgeon certainly did
not learn to sew as a child. At 74, I can no longer pursue bikini modeling....
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Agarre commented May 31, 2019
A
Agarre
UndefinedMay 31, 2019
I’m suspect of any standard that attempts to weed people out that may have little or
no basis in science. You know who gets to take piano and art and build model planes?
Rich kids. Proving manual dexterity in order to enter a surgical program would seem
just another obstacle kids from disadvantaged backgrounds would face.
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Hannah Aron commented May 31, 2019
H
Hannah Aron
NycMay 31, 2019
Funny to read this. I grew up sewing and doing lots of crafts and always felt it made
me “handy” even for unrelated tasks. Maybe they should test for “handiness” too.
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Bjh commented May 31, 2019
B
Bjh
BerkeleyMay 31, 2019
This is quaint. But more and more surgeries are being done by robots.
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Steven C. Simon, MD, FACS commented May 31, 2019
S
Steven C. Simon, MD, FACS
Chandler, AZMay 31, 2019
I have been a surgeon for nearly 30 years and a musician/composer for over 50. It is not
simply coincidence that there is a common terminology to both disciplines. Both are
activities using specific instrumentation for a performance. Both entail elements of
pre-planned composition and elements of improvisation. The is a common experience of
the phenomenon of ‘flow’ when all is proceeding well. There are fundamental principles of
technique and organization in both fields.
Both are, in my experience, performing arts.
The value of music education in childhood is well established.
The commonalities of experience in the two disciplines has, and remains to this day,
a defining feature of my, and many other surgeons’ life.
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Matt commented May 31, 2019
M
Matt
HoustonMay 31, 2019
AI assisted Robots will be there to save the day as humans spend more time playing
games on their phones
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Bob DeFoor, Jr., MD, MPH commented May 31, 2019
B
Bob DeFoor, Jr., MD, MPH
Cincinnati, OhioMay 31, 2019
I've been interviewing, selecting, and training surgical residents and fellows for over 15
years now and haven't noticed any trends in worsening manual dexterity, despite the
ubiquity of smart phones. The lack of anything more than anecdotes in this article is
troublesome. Where is your data to support this?

I do agree that we have no real way to upfront assess hand eye coordination in a student
applying for a surgical residency. In particular, how do we gauge their ability to to perform
fine motor procedures in the operating room under stressful conditions when a child is
under the drapes?

That said, even if they have hands of stone, I feel my job as an educator is to work
diligently with them to become competent, safe, and thoughtful surgeons.
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Robin F commented May 31, 2019
R
Robin F
Los AngelesMay 31, 2019
Not very comforting, but it won’t even matter soon. Isn’t AI-assisted surgery going to
solve all that? Robots are perfect in every way.

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Think Before You Speak commented May 31, 2019
T
Think Before You Speak
CaliforniaMay 31, 2019
Surgery is a profession that requires many skills, only one of which is that of
eye-hand coordination and manual dexterity. It is unfortunate that this article has
completely overlooked basic tenets of mathematics and statistics - that the majority
of surgeons are merely average. As in every other discipline and profession, only a
few excel and rise to the top of the field.
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David B. commented May 31, 2019
D
David B.
SFMay 31, 2019
My life was “salvaged“ by an astonishingly good orthopedist: down to earth and well
mannered to boot.

It is in no way clear to me how he or I would’ve benefited substantially from his having a
firmer grasp of the topics you list above.

Would you elaborate?
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Ed commented May 31, 2019
E
Ed
CAMay 31, 2019
This article is garbage. It does not cite a single study that has investigated the value of
prior activities and hobbies on performance as a resident. Participation in team
sports (which does not necessarily hone fine motor skills) has been associated with
better resident performance. Isolating the opinion of a single egomanic
neurosurgeon who happened to play piano should not sway the lay public or meeical
schools into choosing candidates based on hobbies that do no affect your ability to
make decisions, work in a team, communicate with patients, respond to feedback, or
persevere through failure - all of these qualities are far more important than innate
dexterity.
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Badger commented May 31, 2019
B
Badger
TXMay 31, 2019
@Ed i appreciate your observations, but I have a question.

First, I am not a surgeon or even an MD but I have practiced my fair share of
micromanipulation. Instinctively, at the end of the day someone needs to hold
the scalpel. Wouldn't their dexterity have a significant bearing on the outcome
of a surgery?
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Ed commented May 31, 2019
E
Ed
CAMay 31, 2019
@Badger

Excellent question. Yes, dexterity does matter, but the minimum standards for being a
good, safe, surgeon who takes excellent care of patients doing common surgical
procedures within one's technical abilities is not as high as one thinks. Surgical trainees are
far more likely to drop out due to professionalism and decision-making issues - not
dexterity. I.e. they are 100% capable of keeping their hands steady and making their hands
do what they want, but having the knowledge, judgment, and insight to tell one's hands
what to do and when to do it is far more important.

There are select surgical procedures that are so complex and challenging that only a few
surgeons in the world can do them, but the population at large needs more than a handful
of savants to do their procedures - we need many, well-trained, safe surgeons to
adequately serve public need. Sports example: Should the NBA only draft players who can
make more than 50% of their 3 pointers?

The article interviewed some prominent surgeons but only Dr. Kneebone is an authority on
resident training, and I believe a group at his institution published a systematic review of
the literature showing that tests of visuospatial reasoning and psychomotor skills may
predict learning rate during residency, but not overall quality of surgeon performance.

It is easy for someone who is good at something to attribute their success to
some experience in their past. Anecdotes, however, should not drive policy or
practice.
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Kevin Chin commented May 31, 2019
K
Kevin Chin
MarylandMay 31, 2019
This article is full of anectodal reports from older doctors lamenting about “back in
my day” and “kids these days” quotes. The article does cite scientific literature about
the number of procedures a surgeon has done correlating with the likelihood of
success (fewer complications). This is true. However the literature states that a
surgery’s success is correlated with the number of that type of surgeries the surgeon
has done. In other words if a surgeon has performed 1000 appendectomies, she will
be very successful at future appendectomies, but if she performs gastric bypass
surgery and has never performed gastric bypass, her experience performing all those
appendectomies has no correlation with her gastric bypass surgery success. If the
medical literature proves that there’s no cross over success between surgeries,
making an argument that woodshop and crochet will equal success is laughable.
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Local Physician commented May 31, 2019
L
Local Physician
New York, NYMay 31, 2019
This is an idiotic article. There is a mountain of data to discuss and explore regarding what
innate and trainable skills are best for professions of manual dexterity, or medical
procedures. This article refers to none of them, in favor of repeating folksy anecdotes from
various old MDs of how having churned their own butter makes them better surgeons than
the now ubiquitous straw man stereotype of screen addicted millennials.

I’ve spent my entire medical training at the country’s premier institutions being
poorly trained (or not trained at all) by those you quoted. I excelled as soon as they
were no longer in my way, and remain held back only by the same misperception in
medicine that older is better. My patients have all benefitted greatly since I stopped
taking their instruction and let my PlayStation skills free.
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S
Steve
As a physician myself, I would consider it wonderful if only those with excellent dexterity
became surgeons. However, this isn't true now or for a long time. Most medical students
who become surgeons do so not because they have better dexterity than other students
but because the surgical specialties are the highest paying.
I realize surgeons have a reason to perpetuate the myth of their superior dexterity
but it just isn't so.
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sggibak commented May 31, 2019
S
sggibak
TxMay 31, 2019
@Steve
With all due respect, sounds like n overgeneralization and misguided assessment of what
drives people to pursue a career in medicine of any specialty, surgical or otherwise.
Lots of money to be made by intelligent, driven people in finance and tech industries if
that’s the end goal.
Certainly not what motivated me to become a surgeon.
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S
Steve
@sggibak

I know that money never motivated anybody to enter any specialty. Except that
there is almost a perfect match between the most desired specialties and
income. And it isn't that the most desired ones happen to be the ones that draw
the most income as the match between the two has varied over time depending
on which ones were the highest paid.
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S
sggibak
TxMay 31, 2019
@Steve
Hmm, your initial post implied very acutely that students chose surgical fields for the
compensation. Perhaps I misinterpreted.

Plus, I always heard medical students interested in money followed the ROAD to
wealth. Radiology, ophthalmology, anesthesia and derm. None of these are
surgical specialties.
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One Surgeon commented May 31, 2019
O
One Surgeon
This article provides little to back up its claims and simplifies a complex topic as what
makes a good surgeon to the point that it's not worth the paper it was written on.
As a surgeon in academic medicine for 13 years, who has trained countless surgeons,
I can tell you that whether my trainee built model trains or if she was an artist or a
piano player is meaningless. It's not about manual dexterity. Its about knowing when
surgery is indicated, knowing the anatomy and it's variations, preparing for the case
ahead of time, knowing the steps of the procedure, knowing what can go wrong and
where, how to manage things if they go wrong to minimize injury, knowing your
limits, having humility, having the willingness to acknowledge and learn from
mistakes, seeing the patient as a human being, and lastly having good 3 dimensional
spatial awareness.
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bringindafunk commented May 31, 2019
B
bringindafunk
hallowedhallsMay 31, 2019
@One Surgeon
as a fellow surgeon, thank you for your excellent comment. I wanted to , but
you nailed it. anyone who is dedicated can be taught HOW to operate, the key is
finding people who have the intelligence, and are able to connect with patients
to know WHEN to operate. if programs can't train a surgeon in an 80 hour work
week...which works out to 20,000 hours in a 5 year residency (assuming 2 weeks
off a year)...then that is the programs failing. this article basically makes the
argument that a pure technician is desirable...but ask any patient about their
favorite surgeon and I would suspect most would talk about the one the held
their hand and listened and stuck with them...and I would suspect outcomes
data would support than too.
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Bob commented May 30, 2019

Bob
PlymouthMay 30, 2019
From an orthopaedic surgeon with 36 yrs cutting experience:
-you need hand skills
-you can learn them
-best to start as early as possible( childhood, building things, piano, lego, mechano sets,
hang out at hardware store, knitting...)
-I learnt practical skills from my father a farmer
-women have much better hand skills
-dentists start earlier using their hands in training.
-as a surgeon also have some practical hobbies
-stuck to a computer screen is not a good idea
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Millenial commented May 30, 2019
M
Millenial
NY, NYMay 30, 2019
I am part of the millenial generation who grew up playing video games and also
happen to be a current neurosurgery resident. What happened to the quote about
being able to teach a monkey to operate, and that the good surgeons are the ones
who make the right decisions (like when and more importantly when not to operate).
Technique trumps "hands." The debate regarding duty hours is important, but the
basis of this article does not hold water.
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phil commented May 31, 2019
P
phil
alamedaMay 31, 2019
@Millenial You have an obvious "axe to grind." I don't believe you. I believe
the surgeons quoted in the article.

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S
sggibak
TxMay 31, 2019
@phil
Didn’t get that sense at all.
In complete agreement with Millenial.
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Kathryn commented May 30, 2019
K
Kathryn
GeorgiaMay 30, 2019
Several surgeons who trained with Dr. Jim Curico told me that he could perform
surgical procedures unlike anyone else. There was no 80 hour work week at Parkland!
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Jim commented May 30, 2019
J
Jim
There is no reason for this lack of dexterity to be surprising. Many young persons
today believe they can learn by only observing.
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1
B
bringindafunk
@Jim - the other thing to consider is that, in this day and age, patients expect a
seasoned veteran to perform their surgery....with no complications...and a
perfect recovery every single time...and they object to residents or med
students "practicing on them". just a thought
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Eileen Hays commented May 30, 2019
E
Eileen Hays
WA stateMay 30, 2019
Prospective dentists are evaluated for dexterity -- why not surgeons?
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2
S
Steve
@Eileen Hays

In fact dentists used to be more evaluated for their dexterity. At one time part
of the dental school entrance exam required demonstrating dexterity by carving
pieces of chalk.
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B
bringindafunk
@Eileen Hays - many times, they are. I had to tie knots behind my back, and
with my eyes closed during my residency interview....and then I worked very
hard 80 hours a week, 50 weeks a year for 5 years.
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Nana2roaw commented May 30, 2019
N
Nana2roaw
Albany NYMay 30, 2019
I usually rail about the endless hours I spent practicing cursive writing when I could
have been studying science or history. Perhaps cursive writing is not such a waste
after all.
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mutabilis commented May 30, 2019
M
mutabilis
HaywardMay 30, 2019
It appears that this article is the culmination in a series of medical myths that warn us
to never have surgery in the late afternoon during the month of July by a surgeon
who never did needlepoint.
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MD/PhD commented May 30, 2019
M
MD/PhD
I played piano and violin as a child and did all sorts of crafts. I still sucked at tying surgical
knots on my surgical rotation. I needed to practice but since I didn't want to become a
surgeon, I didn't.

It's not the phone swiping. Before phones there were TVs which plenty of kids plunked
down in front of instead of cultivating other skills.

I will say that piano and violin helped me develop my brain in many other ways, and
also taught me discipline. I encourage everyone to support these skills in their
children.
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B
bringindafunk
@MD/PhD - great points! encouraging your kids to play piano and sports and
violin etc. has its own benefits. it is a great idea, and fruitful...even if they don't
become a surgeon.
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Texan commented May 31, 2019

Texan
USAMay 31, 2019
@MD/PhD

Good points.

My son is in residency- finishing his Transitional Year.

He did particularly well in his surgery rotation and was commended for his work sewing up
the face of a three year old girl in his ER rotation.

As a child my wife and I through the kitchen sink at him. music, art, sports and
even auto mechanics
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Texan commented May 31, 2019

Texan
USAMay 31, 2019
@Texan

threw not through

Accidentally hit enter, but wanted to add that he is a very compassionate
person. I believe that helps one drive towards perfection in these situations.
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Cheryl commented May 30, 2019
C
Cheryl
HoustonMay 30, 2019
So, why was a high-schooler performing surgery on gerbils?
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Marie commented May 30, 2019
M
Marie
Grand RapidsMay 30, 2019
@Cheryl Same thought here.
I would seriously worry if my kids started operating on small animals. And
what about anesthesia? Also, isn’t it against the law?
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Can commented May 30, 2019
C
Can
NCMay 30, 2019
My 16 year-old son is highly gifted and can spends hours repairing things around the
house. He still wants more LEGO sets for Christmas and can knock out the 1000 piece
rocket in about an hour.
He has been the go-to guy for everything computer related in middle and high school. One
of his teachers told me that he was dismantling his old Chrome book during class the other
day. He put it back together before the bell rang.
He aces his exams without studying.
Problem is he has 0 interest in going to college. Kills me!!
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Reno commented May 30, 2019
R
Reno
STLMay 30, 2019
@Can For a kid like that you have to show him how college would be
fun/interesting/beneficial not just tell him. Sign him up for a college engineering
summer program where he gets to build something challenging like an engine
or a rocket. Not a fluff class - something advanced.
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Greenie commented May 31, 2019
G
Greenie
VermontMay 31, 2019
@Can

He sounds smart to me. Why go to college unless you're going to study
something there you plan on using? Sounds like he'll figure out for himself what
he wants to do. College is highly overrated.
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itsmildeyes commented May 31, 2019
I
itsmildeyes
philadelphiaMay 31, 2019
Watch the movie The Boy Who Harnessed the Wind. Some kids just think like engineers.

Your son will be fine.
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WE commented May 30, 2019
W
WE
DCMay 30, 2019
Med school Interviewer : Did you play “Operation” as a kid?
Applicant: yes!! I crushed it!
Interviewer: you’re in!
That was a great game...
Our dad used to get us these wonderful kits, made by SkilLab or something similar.
One kit was “biology” and it came with a worm, a grasshopper, fish and a frog -each in
formaldehyde. Scapels, probes, forceps, too!! Can you even imagine such a kit being
for sale anymore? We had it good back then.
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Ramon Reiser commented May 30, 2019
R
Ramon Reiser
Seattle And NE SCMay 30, 2019
In 1966 at least 4 hr/day of the first year were spent dissecting the cadaver. The third
quarter it was the brain and physiology lab which typically took ~4 hours to set up and
operate.

During that time most of us used our scalpel with care, practicing for when we would be
doing it on alive patients. In a corner were always several residents practicing surgical
procedures.

I wonder if something has been lost with dissection becoming so limited. I can still
picture the inner body by visualizing dissecting. Motor memory and three
dimensional feel.
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B
bringindafunk
@Ramon Reiser - I agree with you...but remember, that in 1966 there was a lot
less to learn about biochemistry, physiology, pharmacology etc. Things are
different and the education system needs to change too.
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Julie D. Cantor commented May 30, 2019
J
Julie D. Cantor
UCLA School of LawMay 30, 2019
I’d like to hear from those who are in or completed a general surgery residency in the
United States about the number of hours they spent per week, on average, during
their five years of training doing scut work that could have been delegated to one or
two physician assistants, leaving them ample time in the OR to work on their surgical
skills or do other activities to improve manual dexterity. I’d also like to hear how
much they were paid and the salary of a physician assistant. My guess is that they did
2-3 years of scut for $45k and that the two PAs needed to do that work so they could
do more surgical things would cost around $180k. Then everyone can do the math.
It’s not the 80-hour workweek — which probably saves lives because
surgeons-in-training notoriously fell asleep in their cars, to say nothing of the quality
of care they could provide in their various states of delirium. Follow the money.
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Y commented May 31, 2019
Y
Y
SMay 31, 2019
@Julie D. Cantor yes, yes, yes
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Alex commented May 31, 2019
A
Alex
Houston, TXMay 31, 2019
@Julie D. Cantor-I am in another surgical residency (not general surgery) and am
currently paid $45000 a year, which is one of the lowest salaries for residency in
my speciality. I do about ~10 hours of work per week that could be given to an
Administrative Assistant (not even a medical professional). This includes tasks
such as our hour logs, calling facilities asking what surgeon has what surgery
where the next day, etc. When I am on call, about ~30-40 hours a week of 'scut'
work could be done by PAs or even the nurses on the floor. You are spot on,
follow the money; it is shocking what people will find.
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LM commented May 31, 2019
L
LM
USAMay 31, 2019
@Julie D. Cantor Recent residency graduate here. Started as an intern years ago with 50k
salary doing more clerical tasks than our PA getting more than double my salary and
working half as many hours.

It's a great deal for the PAs. But it's no wonder residents don't want to work > 80
hours as interns doing mindless tasks for less than minimum wage after 20+
years of schooling and 200k+ in student debt. Some might call that "lazy,
entitled millenial" and some might call that only fair.
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kat commented May 30, 2019
K
kat
PAMay 30, 2019
I'm surprised that this article didn't end with "Get off of my Lawn!"
This issue that you're bringing up is a non issue. Many surgeries today are done minimally
invasively-a childhood of playing video games may give you a headstart in developing the
hand-eye coordination needed to do these surgeries, but it isn't required. So why aren't
these old head surgeons pointing out how the younger surgeons might be better than they
are at this?

It's a time honored tradition for older people to complain about the younger
generation, that is all this is.
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Matt commented May 30, 2019
M
Matt
CAMay 30, 2019
The most skilled technician in my experimental semiconductor lab are women from the
Philippines.

As finicky a work as you can find

Perhaps US Medical Schools ought to simply admit more students from foreign
countries were people still do delicate manual work when young.
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1
Forest commented May 30, 2019
F
Forest
ORMay 30, 2019
@Matt
Great idea. Instead of finding qualified, interested applicants here in the US, where I’m sure
there are plenty, let’s yet again buy into the myth that young people here in the US don’t
have the right stuff. Not every kid in the US grows up glued to a screen.

The suggestion at the end of the article makes lots more sense. Select people
for surgical residencies who actually have the skills most important for being a
good surgeon.
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LM commented May 30, 2019
L
LM
USAMay 30, 2019
Surgical skills are hard to objectively evaluate. How much does nature versus nurture factor
into surgical outcomes? I’ve seen bad outcomes from elegant surgeries and amazing
outcomes from not-so-elegant surgeries. Ideally you’d want a surgeon with innate skills
who has also had ample practicing opportunities.

In the past, people without this “innate skill” in med school went off to endure 120
workweeks in surgical residency, when they were actively taking care of patients on the
floor and operating. If they didn’t know how to operate before, well now they do. Can you
survive 120 hours per week in the OR for 5-7 years and not be able to operate? You would
eventually screen yourself out.

Nowadays, the opportunities for residents to engage in open surgeries have
decreased and this lack of “innate skill” has risen to the surface. There is a rise in
lap/robotic surgery and ever-increasing clerical duties to appease hospital
administration. My surgical residency experience was 20% sitting at a computer,
checking off boxes for utilization management, reordering the same set of orders lost
in cyberspace, changing a diet to specify “Kosher” after the patient had already had
Kosher meals for days, time on hold with Medicare, etc. Do I have the same innate
skill as I did before residency? Yes. Can I do open surgery as well as someone who
trained 20 years ago could at my stage? I’m not sure.
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4
A
Alex
@LM-As a current surgical resident, I agree. I would like to add another limiting
factor in surgical resident education is the loss of resident autonomy in the OR.
I routinely hear of my older attendings talking about how they had full reign in
the OR as residents with their attendings hardly in the building. Due to what I
believe is a fear of lawsuits, I feel like my education is limited by much less 'skin
to skin' operations than the training of my attending's age. Attendings are more
often in surgery, breathing down the neck of the resident, to make sure there is
a perfect outcome. This robs the resident of responsibility in the case, learning
from mistakes, and being engaged.
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Cheryl commented May 31, 2019
C
Cheryl
HoustonMay 31, 2019
@Alex But if I'm the patient, I'm gonna want that perfect outcome and not being
the victim of the mistake the resident learns from.
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A
Alex
@Cheryl-Therein lays the catch 22: you can't have good surgeons giving good
results to patients without first training good residents who have learned from
residency. I understand your concern, but the reality is that residency
education has been neutered. There has to be an acceptance from patients
that medical care (due to the long training involved) may involve trainees. As an
aside, you would be surprised at the number of surgeries going on where the
resident is actually a far better surgeon than the attending himself. One
attending I work with is the doctor for several famous athletes... His lack of
clinical and surgical skills is notorious, unbeknownst to patients. He needs a
resident to function.
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Mary commented May 30, 2019
M
Mary
PennsylvaniaMay 30, 2019
I was glad to see they included sewing and art as examples of dexterity training. The best
surgeon I know is a woman, and not only is she brilliant, she loves to do art projects that
are extremely detailed and require great patience and dexterity.

From her and other doctors who are women, I am very aware that the medical
profession has not historically been inclusive of women. So, I am very glad to see the
article making an effort to pretend that inclusion exists. It will, someday.
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C Snyder commented May 30, 2019
C
C Snyder
Kansas CityMay 30, 2019
Some points after ~30 y of training surgical fellows.
1) There is a general correlation between volume of specific types of cases and outcome.
2) The 'average' pilot/professional athlete/internist/surgeon is very very good (HS -> college
-> medical school -> 5 years of closely supervised residency -> 1-2 years of research (often)
-> 1-2 years of supervised fellowship, with dropout/culling at every level).
3) Hobbies (sewing, woodworking, building a model of London out of toothpicks) are
unlikely to have the slightest influence on how good the surgeon is.
4) There have been mild declines in case volume in some specialities with residency hour
restrictions.
5) Good judgement/knowledge is exponentially more important than 'good hands',
particularly since 90+ % of people can learn to due the rudiments of surgery, and 90+ % of
operations do not require virtuoso skill.
6) There are outliers in everything, including surgery - 'naturals' with remarkable
efficiency or dexterity. Does it matter for your appendectomy? Probably not.
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1
A
Alex
@C Snyder-On point number six, I completely agree. As a current surgical
resident at a well known program in my field, several of the most well known &
senior attendings from my programs have... Tremors, so much for dexterity! Yet,
their clinical outcomes appear to be just as good as those without this issue,
which I believe is due to applying their knowledge base. That being said, there
are those with extremely remarkable hands; there is one remarkably gifted
surgeon in particular, out of the 70 attendings I cover, that I think of. Without a
doubt, I would have him do my surgery if I needed it.
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Treetop commented May 30, 2019
T
Treetop
UsMay 30, 2019
Well, my youngster is a good student and great at building models and drawing, but
terrified of blood! Sometimes not all the stars align.
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Scott SolowayMD commented May 30, 2019
S
Scott SolowayMD
New Haven CtMay 30, 2019
When I interviewed applicants for our eye residency at Yale in the late 1970s and
early 1980s the first question asked was what are your hobbies. Applicants who we
accepted who did not have visual, dexterity oriented or mechanical hobbies usually
were the poorest surgeons which showed up early in their residency. Often the most
book learned with the best medical school grades did not have the dexterity for eye
surgery.
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Mike commented May 30, 2019

Mike
Urbana, ILMay 30, 2019
Among model railroaders, who build models in scales all the way from ride-on size down to
Z scale (really tiny, think locomotives about the size of a pinky-finger), it's often said that
doctors can afford the hobby more easily so that's why there are so many in it relative to
the general population.

Looks like many may have been practicing other skills. And that's a good thing.

That's probably why some call Model Railroading the World's Greatest Hobby.
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Frank Brown commented May 30, 2019
F
Frank Brown
AustraliaMay 30, 2019
loss of dexterity ?

I'm heartened to observe - in the childcare that I volunteer with - that the kids are offered a
large number of small hand tasks - e.g. beading, drawing, lego, making slime - often
handling tiny pieces that are difficult for my older hands to grip

so for those kids I'm hopeful !
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susan kinsey commented May 30, 2019
S
susan kinsey
long island,nyMay 30, 2019
Any activity that uses both hands uses both sides of the brain. I have been teaching
elementary art for 27 years. There has been a decline in the amount of kindergarten
students who can color inside a line or cut on a line. Think about it -years ago when
children were in restaurants with their parents they would be coloring, now they are
plugged into an electronic device.

I try my best to have them working with clay or doing weaving etc. The strength in their
hands is weak and its takes concentration to weave or sew, something everyone needs to
develop. Drawing from real life develops eye-hand coordination.

Unfortunately art classes are viewed as fluff, even though people don't understand
that artists designed the clothes they wear, the houses they live in ,the cars they
drive, the furniture they sit on, the websites they view, the ads in magazines they
read, the list goes on and on, but art isn't important right?
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S.L. commented May 30, 2019
S
S.L.
Briarcliff Manor, NYMay 30, 2019
They don't have good dexterity so surgeons push their patients into robotic surgery
because they played video games when they were younger. This is not a good thing
because a skilled surgeon can do the surgery better in less time which keeps the
patient under anesthesia for a shorter time. It is scary to think that surgeons are not
good with fine motor skills. This does not bode well for the future.
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Imohf commented May 30, 2019
I
Imohf
AlbuquerqueMay 30, 2019
My son played piano for years! He played with Liberty Falls houses, and when one
broke repaired them so not a crack would show! My Laundry table was a dolly
hospital, where he repaired all kinds of injured dolls, even sewed them. After he
played a Mendelssohn piano concerto in a competition, I told him he needed to have
his hands insured! I am sure he makes an excellent neurosurgeon! He also showed
the dolls a lot of compassion and care and was unnecessarily bullied incessantly for
this in school! I am certain he shows his patients great compassion and care,
especially pediatric ones!
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mom of 4 commented May 30, 2019
M
mom of 4
chelseaMay 30, 2019
My youngest did just a ton of origami, executes skillful meal prep and played all kinds
of instruments, though none stuck. She'll start college in August, premed & public
health concentrations late this August. Something tells me there are many paths to
manual dexterity. Other articles have specified some first person action games help
ER surgery students. Doesn't the mix of activities children enjoy play a role in which
fields attract them in college?
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1
EF commented May 30, 2019
E
EF
LouisianaMay 30, 2019
I think the problem is more related to decreased training hours. I finished
training in Cardiac Surgery 28 years ago, and have had 2 post Libby Zion
residents who had half as much training experience than I at the end of training.
Both of these young heart surgeons, had to do an additional year of “Super
Fellowships,” which are unofficial fellowships at academic centers where they
made much less money and filled holes in the on call schedules at institutions
who needed to solve man power issues in order to allow official trainees to have
mandated time off. I trained with no limit on my work hours, but never had to
make clinical judgements unsupervised. Your NYT was off on that story... which
put us where we are today. Interesting to contemplate how this article may
change the system 20 years from now. It would be an interesting self evaluation
if your NYT would critically chronical the unintended consequences of the Libby
Zion article. I think the issues in that unfortunate event was more about poor
supervision than lack of sleep!
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DDD commented May 30, 2019
D
DDD
Rochester, NYMay 30, 2019
Having good hands is overrated in my view. Knowing what to do in the OR is far more
important. Even without perfect dexterity, as long as the surgeon is patient, persistent and
has an excellent understanding of the anatomy and proper use of instruments he or she
can get excellent outcomes. Having good dexterity primarily allows you to be a faster
surgeon. And that is a skill that improves with time.
Most mistakes I see trainees make are not a matter of dexterity (although that
happens too) but misunderstanding of the anatomy, improper use of instruments or
not understanding the purpose of each step in a surgical procedure.
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1
A
Alex
@DDD-Exactly this. At my residency program, we hold monthly cadaver
dissection workshops for each residency class. As a resident in my last year of
training, I've watched successive groups of residents progress in their skills.
Some come to our program with great coordination and dexterity, but that
means nothing if one doesn't practice. I have observed some residents that
were just "average" at the beginning, now have excellent surgical skills. Why?
They spent countless hours on a suture board practicing, hours reading about
the anatomy/ landmarks/ procedure steps, took every opportunity available to
them to be in the OR and experience what separates a good surgeon from a
bad one. I agree that persistence is key.
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Sara commented May 30, 2019
S
Sara
San FranciscoMay 30, 2019
You have got to be kidding me. The ability to glue intricate collages is what gave
someone the dexterity to be a successful surgeon? And I don't think the decline of
crocheting was due to the smartphone, so this doesn't sound like a recent problem.
Also, we're back to the limitation on resident's hours again - why would you want
someone operating on you if they've been working 120 hours per week, meaning less
than 7 hours sleep per night, if they're sleeping all of those hours? This sounds like a
promotion of the very few who are very successful on limited sleep and can point
their success to childhood activities that the average doctor-in-training did not
participate in.
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Linda Vega commented May 30, 2019
L
Linda Vega
New York CityMay 30, 2019
Several of the art majors I advised over the course of my career as a college advisor
went on to medical and dental school. Not only their dexterity but also their visual
acuity were highly prized factors in their applications. There’s no reason to major in
biology if one is interested in entering the medical field.
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4
A
Alex
@Linda Vega-As a current surgical resident, I would actually highly disagree with you.
Though in Medical School admissions it may be in vogue to push for more liberal arts
majors to be accepted, in my experience this is completely ill advised. Throughout Medical
School as well as residency, I observed a strong pattern. Those without a firm
science-based Bachelor's degree struggled with the scientific method (as well as critical
reasoning), analysis of scientific literature, as well as grasping the flood of medical (i.e.
science) information thrown at you. This wasn't everyone, but again there was a strong
correlation. Additionally, though there is value in art degrees, dexterity and visual acuity is
already cultivated by other methods for most people. In my surgical residency, nearly all
the residents have either a previous Biology, Chemistry, or Engineering degree before
residency. I and a few other routinely play the guitar, another used to work on cars,
another worked repairing cell phones, etc. Non-surgical hand skills were cultivated in many
other venues that did not require an art degree.

As an aside, a better predictive tool of success in medicine, namely patient
interactions and caring, is previous work experience before Medical School.
Those that I observe had a service type job before medicine are much better at
working with the medical team as well as serving patients.
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Forest commented May 30, 2019
F
Forest
ORMay 30, 2019
@Linda Vega
It’s possible to major in both art and a science, one doesn’t have to choose. If
medical or dental school doesn’t happen, a student with both majors is
probably better off than one with only an art degree. I know many professionals
in numerous fields who do serious art as a hobby and can afford to do so
because of their non-art majors.
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Reader commented May 30, 2019
R
Reader
USMay 30, 2019
But how were they as surgeons?
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LFelber commented May 30, 2019
L
LFelber
New JerseyMay 30, 2019
As an art teacher, I see the lack of dexterity among my young students. So I often give
projects of cutting,pasting and working in clay to strengthen those little fingers.
Also awhile ago, when I was talking to an industrial arts teacher, who was lamenting the
loss of auto shop classes. He related the story of a former student who came in and
thanked him for teaching auto repair. If the student hadn't taken it, then he would not
have been able to do his current job which was being a cardiologist.
Enough said.
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Pala Chinta commented May 30, 2019
P
Pala Chinta
NJMay 30, 2019
So much room for improvement in how students are accepted into med school and
residency programs. Absolutely I’d rather be operated on by someone who has great
manual dexterity and brains, not just brains. That means a childhood and
adolescence and adulthood in which hands ate used for art, music, penmanship,
woodworking, baking, gardening, pottery, sculpture, plumbing, carpentry, knitting,
collage, and much more, not just social media and online textbooks. Hey, I enjoy
fooling around with digital photo ending from time to time, but is no substitute for
learning how to develop film and figure how out how to use a camera the old
fashioned way. Same goes for any activity that requires brains and hands. Both need
practice.
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Andy commented May 30, 2019
A
Andy
FloridaMay 30, 2019
I am a relatively young pulmonary and critical care specialist who works with both medical
and surgical residents.
I would never call myself particularly dexterous, but I oftentimes need to perform minor
procedures in my practice (central lines, bronchoscopy, chest tubes, etc).
While there are obviously some people with natural gifts with their hands, most of us need
to put in the time and effort to learn these skills. I don’t think the surgical residents I see
are born any better than the medical ones but were made to put in much more work.
I regularly cringe when supervising the medicine residents, and even simple knot tying that
every medical student must learn in their surgery rotation, is many times forgotten.
If my own example is any guide I believe almost anyone can be taught the basics with
enough practice, even later in life. However when it comes to surgical specialists
performing delicate procedures, residency programs should be seeking out
individuals with both the intelligence and dexterity that is required. I know I would
want my family going to those with such skills when the time comes.
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BS Spotter commented May 30, 2019
B
BS Spotter
NYCMay 30, 2019
On the other hand more procedures are done with scopes and robots favoring video
game players...
1
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John Mardinly commented May 30, 2019
J
John Mardinly
Chandler, AZMay 30, 2019
50 years ago I was a guitar teacher in Ann Arbor Michigan, and I had a student ~40
years old who had such poor fine motor control that he could not do anything as
simple as just pluck a string. I don't know how he even got dressed. After a month of
lessons, I told him that there was no chance he would ever be able to play even the
simplest thing on a guitar, that I should not be wasting his money, and that perhaps
he should consult a doctor to see if he had some sort of neuro-motor disease. I
learned later that he actually WAS a doctor at the University of Michigan hospital!
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Still Waiting for a NBA Title commented May 30, 2019
S
Still Waiting for a NBA Title
SL, UTMay 30, 2019
Okay so they may be swiping a screen instead of sewing or woodworking, but I bet
they are know how to type on a keyboard and use a video game controller.
1
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1
A
Alex
@Still Waiting for a NBA Title-Thanks for pointing this out. As a surgical resident,
a few of my attendings point out to me that my generation is a lot better at
arthroscopy than they were at our point for precisely this reason. I don't know
if it is true, but it certainly is interesting.
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CAV commented May 30, 2019
C
CAV
PhillyMay 30, 2019
News flash:

Older surgeons disparaging their trainees, and pining for days of old.

A story as old as the profession, what’s the news here?
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37Rubydog commented May 30, 2019
3
37Rubydog
NYCMay 30, 2019
I had a dental implant to replace a broken crown...the dental surgeon’s focus on
precision was wildly apparent...seemed he would check the images after each
millimeter...turns out he made plastic airplane models as a kid.
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cosmicaug commented May 30, 2019
C
cosmicaug
USAMay 30, 2019
«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.

[...]

“There is a language of touch that is easy to overlook or ignore,” said Dr. Roger Kneebone,
professor of surgical education at Imperial College London. “You know if someone has
learned French or Chinese because it’s very obvious, but the language of touch is harder to
recognize.” 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.”»

These must be very interesting medical residency programs if they have residents
who were 4, 5 or 6 when smartphones became ubiquitous.
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Laura commented May 30, 2019
L
Laura
As an intellectual, I’m appalled by the complete lack of data supporting this article.
Observations don’t make truths.

There is, in fact, evidence to suggest playing video games improves surgical technical
skill, which many millennials play regularly. Show me some real data NYT.
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Kirk Schlafer commented May 30, 2019
K
Kirk Schlafer
Osan Air Base, Korea (U.S. Air Force)May 30, 2019
Thoughts from a surgeon of 22 yrs experience who’s currently chief of the medical staff 40
miles from the North Korean border. Dexterity is important, sure. But this article largely
misses what’s actually required of a good surgeon:

1. WHAT is the actual diagnosis of this patient (includes not only an anatomical and
physiological, but also a psychological assessment)

2. WHICH interventions (medical, surgical, social) would offer this patient relief, provide
greater function, or otherwise yield a higher level of baseline happiness?

3. IS surgery even necessary, and/or might it do more harm than good?

4. IF so; WHICH surgery... and WHEN... and HOW can we lower the risks that might occur
from this intervention?

5. Is my TEAM’s composition and composure adequate... and is closed loop
communication fully intact?

6. Does the patient understand the risks and benefits, and are they and their families
aware of their own key role in the short and long term recovery process?

7. Does the patient trust us and feel safe under our care?... if not, WHY not??

8. Does the surgeon adequately understand the pertinent pathophysiology and anatomy...
and are they able to recognize and resolve anatomical variants when they are
encountered?

9. Double check everything... was there something I missed? This patient is trusting me
with their life; was there something I MISSED??

10. “Knife!” (gosh we sure hope he knows how to use the knife... did he play with
legos when he was a kid)?
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1
R
Reader
USMay 31, 2019
How about a follow up with stories of medical practice 40 miles from the North
Korean border?!

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David Krigbaum,DDS commented May 30, 2019
D
David Krigbaum,DDS
Wausau, WisconsinMay 30, 2019
Dentistry is a tactical profession. Dentists make great surgeons due to their dexterity
requirements.

Of course I'm a little biased----I'm an oral & maxillofacial surgeon, the surgical
specialty of dentistry.
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2
Sneeral commented May 30, 2019
S
Sneeral
NJMay 30, 2019
Do you mean a tactile profession?
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CML commented May 31, 2019
C
CML
Brooklyn, NYMay 31, 2019
@David Krigbaum,DDS
My own dentist is also an accomplished amateur magician, or perhaps I should
say, a prestidigitator!

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michaeltide commented May 30, 2019
M
michaeltide
Bothell, WAMay 30, 2019
No problem. Soon surgery will be all done by robots. What could go wrong?
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1
Judy Harmon Smith commented May 30, 2019
J
Judy Harmon Smith
Washington stateMay 30, 2019
@michaeltide. What could go wrong? Robots aren't developed, operated or
maintained in a vacuum. Sheer chance and the usual human failings
unfortunately can still apply. See the recent Boeing airliner debacle.

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Jonathan commented May 30, 2019
J
Jonathan
New York CityMay 30, 2019
Your timing is off. No one who is in medical school today was swiping screens as a
child.
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summary commented May 30, 2019
S
summary
NYCMay 30, 2019
Manual dexterity,perspective, knowledge and touch are all necessary attributes of the
classic healing arts. It always amazed me that dentists do what they do so expertly
while working upside down and backwards in a mirror-reflected field of vision!
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Taz commented May 30, 2019
T
Taz
NYCMay 30, 2019
Years ago, an x-ray revealed a mass in my thoracic region. It was diagnosed as benign; but
it was large, and needed to be removed by surgery.

I vividly recall my GP saying, "Now all we have to do is find you the best pair of hands
in New York."
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KC commented May 30, 2019
K
KC
Every time I read about a surgeon boasting about working 120 hours a week back in the
Stone Age, it makes me angry. No, we are not going back to that--not now, not ever. Smart
college graduates don't want to work that many hours a week, and the tech industry (which
pays just as well as medicine, without all the years of slave labor to get there) is continually
catering to work-life balance. Nor is it necessary, frankly; a surgical resident with poor
hand-eye-coordination being forced to work more hours is not going to outperform
someone with natural talent.

I do think medical schools would do well to emphasize or at least evaluate technical
skill, and to guide those students into (or away from) certain specialities. I do some
minor surgical procedures in my practice, but I also refer elsewhere when necessary,
and I do not send my patients to surgeons with poor surgical skills (sorry, but there
are some).
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Zack commented May 30, 2019
Z
Zack
USAMay 30, 2019
I'm currently enrolled as a medical student in the USA (applying to a surgical specialty) and I
have some thoughts on this. Firstly, there's no surgery school aspect of medical school.
Much of what you learn (technical skills) for surgery are done on your own time.

I learned sewing, tying, and scalpel technique mostly outside of medical school on top of
my studies, research, and leadership positions. In the operating room we are last to be
considered to help with procedures and often sit and watch instead of actively
participating. The residents, interns, and sometimes even PA's get priority.

When my parents were medical students they were placing chest tubes, actively
participated as primary assist for many surgeries and got a lot more experience than I
have. Much of the medical student and intern responsibilities has been relegated to note
writing, discharge paperwork, and other administrative tasks. The insane work hours of
past do not seem relevant to how much we miss out on the day to day.

I'm not sure what to do about this or how we can change it.
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4
Lauryn commented May 30, 2019
L
Lauryn
@Zack I second this. I graduated from medical school last week and am entering a surgical
field for residency. With the exception of a few surgical simulation sessions, these skills are
not taught in medical school. When they are, you're often given one surgeon's personal
preferences on how to cut/tie, which will almost certainly get you yelled at by another
surgeon with different preferences.

Also NYT, maybe it's a good think to mention physician burnout and suicide
when allowing older surgeons to wax poetic about 120 hour weeks. That was
inhumane and unsafe and we will not be treated that way any longer. If the
compromise is that residencies need to be longer, so be it, but I don't think it's
necessary. But what do I know, maybe on the other side of residency I'll have a
different opinion.
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DDD commented May 30, 2019
D
DDD
Rochester, NYMay 30, 2019
@Zack
True. This is a reality of the medicolegal environment we live in. Med students
get less and less surgical and patient care exposure and show up for residency
knowing how to do almost no procedures and are very unaccustomed to
making any patient care decisions. This bleeds into delaying graduated
autonomy of residents in procedures. One could argue that medical care has
become safer because med students and residents are doing less
independently. But how will this affect our graduates 5-10 years from now who
are still 'in training' when they start practice?
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Frank Brown commented May 30, 2019
F
Frank Brown
AustraliaMay 30, 2019
@Lauryn - physician burnout ?

my father was a small country town GP, surgeon and coroner - he worked long hours six
days a week and then tended to be woken up in the middle of the night to attend road
accidents or visit on-call chronic patients. I grew up seeing the stress that he was under.

he died of a stroke at 49 when I was 15 - but then again he had high blood
pressure since he was 10 - and became the man of the family with 4 younger
siblings when his father died of cancer and his mother was left with the farm.
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Kathy commented May 30, 2019
K
Kathy
FloridaMay 30, 2019
Frightening. But never mind the arts and crafts — few 20-somethings nowadays were ever
trained in the use of pens and pencils for writing. As children in the ‘50s and ‘60s we were
drilled on the perfect formation of every letter, filling entire pages with one letter at a time.
Handwriting was a school subject on a par with spelling and math. Excellent hand-eye and
fine muscle training. Hard to believe I went through high school and college writing by
hand, not just my notes, but reports and term papers for submission. That’s a whole lot of
practice.
It looks like the loss of handwriting education has had mental and physical effects no
one could foresee.
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Curiouser commented May 30, 2019
C
Curiouser
Some time ago the brighter college students went into finance not medicine. Now we
can evaluate the dexterity of those who struck to screens. If one day we have
Medicare for all it will be hard to find a decent surgeon or internist. Hey, bleak is
bleak. Per Verghese any day, "...above ground is a good one."
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RC commented May 30, 2019
R
RC
MNMay 30, 2019
A question for the future is, does society have a mechanism to regulate the uncritical
and potentially harmful insertion of technology into as many aspects of human life as
can be imagined?
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asdf commented May 30, 2019
A
asdf
nyMay 30, 2019
Seems that all these science people here have forgotten the difference between correlation
and cause and effect.

There may be a strong correlation between manual dexterity and model building, but
there is no evidence here of cause and effect. Maybe people who build models do so
because they have greater manual dexterity and are good at model building.
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Rachel commented May 30, 2019
R
Rachel
NycMay 30, 2019
I shared this article with my 11yo daughter, an aspiring surgeon. Although she
doesn’t build anything she is a dedicated and accomplished pianist. Interestingly,
although her fingers fly on those keys, she is often klutzy in other areas. I wonder
why. (I think she may just not care about dropping a plate or a pencil but does care
greatly about her music.)
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SW commented May 30, 2019
S
SW
BostonMay 30, 2019
Not sure that manual dexterity is a "learn while young or never" skill.

One of my good friends loved to play Jenga because he could beat everyone. He was a
dental student, used to working deftly in tight spaces.

The only person who could beat him was me--an electrician, also used to manual dexterity.

Both skills learned in adulthood. (Plus, I would get shocked if I was careless AND
power was unexpectedly on).
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normanlippman commented May 30, 2019
N
normanlippman
Rehoboth,deMay 30, 2019
The director of my oral surgery residency told us a good surgeon measures twice and cuts
once.
Obviously, one needs to combine the intellectual and clinical skills with the
necessary experience. Not so easy to accomplish.
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1
Judy Harmon Smith commented May 30, 2019
J
Judy Harmon Smith
Washington stateMay 30, 2019
@normanlippman. My mother said the same thing about sewing, and my
husband said the same thing about carpentry.
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tom harrison commented May 30, 2019
T
tom harrison
seattleMay 30, 2019
I would be less interested in how many models my surgeon made as a kid and more
interested in how many quilts they have made.

I have done both. Models were easy. They came with instructions and could only go
together one way. Quilts? I was presented with a bunch of scraps to put together
and make it durable enough for my little daughters to use on a daily basis. They
would have trashed my models in a week or so.
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Henry commented May 30, 2019

Henry
My father was an OB/GYN surgeon for many years. During he Korean War he was
stationed in Denver in an orthopedic ward helping wounded servicemen recover
from hand and arm injuries. One tool was a crochet loom, lap size, which many found
very helpful in regaining dexterity. He never stopped using one himself. The result
was scarves and blankets for everyone he knew and hands that retained their skill
well into his 60s.
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Sam commented May 30, 2019
S
Sam
HoustonMay 30, 2019
I am a surgeon and have trained >100 residents and fellows who ultimately went on
to independent practice. The decline in surgical dexterity is evident in the last 6-7
years and ten lack of “grit” and ability to process problems using tactile and hands on
solutions is evident. The lack of using hands to actually build things coupled with a
sense of using the internet for every solution is destroying our tactile abilities. Case in
point... with the decline of “scouts” many medical students actually don’t know how to
tie a surgical knot.. the most fundamental of all skills in surgery. I often have to teach
a 27 year old how to do this correctly for the first time. It’s quite sad.
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danarlington commented May 30, 2019
D
danarlington
massMay 30, 2019
So many ways to react:

1. I recognized my child's need for this and had a very hard time finding model kits that
required even minimal dexterity. Most were what we used to call (when I was young)
"shake the box and it will fall together" models.

2. Dexterity is indeed a learned skill but it is under-appreciated. People in the manual
trades are looked down upon but they are in most cases very good with their hands. In the
knowledge economy their skill is under-valued.

3. There are many opportunities: playing the violin, sewing (as mentioned, this also
develops 3D visualization and reasoning), painting...

4. In the Communist bloc there were fewer consumer goods and technical hardware
generally, so people improvised to a degree we in the West do not appreciate. In
particular they developed mathematical pencil-paper ways of doing things that we
did with expensive computers or elaborate experiments.
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Sara commented May 30, 2019

Sara
OaklandMay 30, 2019
Screen life also reduces peripheral vision, interpersonal coherence and the quality of
attention.
It is also undermining medical care to rely so much on the electronic health record
which requires MD screen time that reduces 1:1 engagement.
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Roberta PA-C commented May 30, 2019
R
Roberta PA-C
Portland ORMay 30, 2019
Writing long hand with pen or pencil embeds the thought/ idea written in the brain.
Taking notes with pen or pencil allows one to scribble notes in margins, consolidate
lecture with text book observations and generally personalize the absorption of
important material...it allows for prioritization of material. All of this process goes
missing with merely keyboarding info in to a computer as the fingering of a keyboard
does not provide the same neurological connections as the motions necessary to
form written letters. I could remember entire pages of chemical reactions from my
notes by "feeling" the and remembering the movement of my hands when writing
them ..this is all being lost...along with intuition.
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Mat commented May 30, 2019
M
Mat
KerberosMay 30, 2019
Performed surgery on gerbils as a teenager?!

Good Lord. He shares something in common with another teenager who liked
dissecting animals, but that guy went on to become a serial killer...
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2
C's Daughter commented May 30, 2019
C
C's Daughter
NYCMay 30, 2019
@Mat

Maybe we should assume that the surgeries were performed in a lab setting
with the appropriate tools, controls and supervision rather than, say, on the
sidewalk with an Exacto-knife with his mother yelling at him to come in for
dinner??
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C.A. commented May 31, 2019
C
C.A.
OregonMay 31, 2019
@Concerned Citizen-cosmetics, obviously. Didn’t like the shape of his nose.

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jim commented May 30, 2019
J
jim
bostonMay 30, 2019
One simple step to instill manual dexterity in young people would be to bring back
handwriting instruction including cursive.
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Larsen E. Pettifogger commented May 30, 2019

Larsen E. Pettifogger
GraftvilleMay 30, 2019
There’s a lot to be said for childhood tinkering with stuff by hand.

It’s my understanding (from an article I read a few years ago, but cannot find online),
that CalTech’s Jet Propulsion lab found that the new generation of Ph.D. engineers
were great in their written work, but were lacking the knowledge and skills derived
from building and tinkering with things (cars, radios, TVs, etc.) that previous
generations of engineers had done when they were young. I’m still blown away by the
fact that the guitar Queen’s Brian May (Ph.D. astrophysicist) plays was built by May
and his father when May was a kid. Apparently his dad built their TV, too. Tinkering,
indeed.
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b fagan commented May 30, 2019
B
b fagan
chicagoMay 30, 2019
@Larsen E. Pettifogger - and Brian May's now an astrophysicist.

Another area where tinkering has become more difficult is general electronics - the
integrated circuit has taken away the fun of being able to solder together a bunch of
discrete components, add a battery, and get results.

Cars are heading in a similar direction - the electric car is essentially a complex
interior sitting on top of a simplified collection of batteries, motors and a few
more computers. The change in the number of parts making up the power train
is collapsing from back when a carburetor could be adjusted.
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D
danarlington
massMay 30, 2019
@Larsen E. Pettifogger When I taught engineering I told the students to buy
something for class and take it apart. They had never taken anything apart in
their lives. I told them to buy two in case they were afraid they would spoil one. I
reimbursed them just to make sure they did it.
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b fagan commented May 30, 2019
B
b fagan
chicagoMay 30, 2019
I built an awful lot of models as a kid, Revell and Testors soaked up a lot of my allowance
and then my high-school grocery store money. (people who know those names also built
models) I fished as a boy, and since monofilament line wasn't free, I was pretty good at
undoing tangled knotted clumps of line. Then drafting class in high school.

Now you tell me I should have been a surgeon. Oh, well.
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1
D
danarlington
massMay 30, 2019
@b fagan Not only do I recognize those names but it never occurred to me to
sniff the glue. I was amazed to learn about this later.
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BT commented May 30, 2019
B
BT
Leuven, BelgiumMay 30, 2019
Surgery is much more than just dexterity. Surgery is about combining professional
perfection -skills- with empathetic communication -patients- and creativity -surgeon-,
leading to novel treatment techniques and strategies in order to provide people the
best possible healthcare, today and tomorrow.
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Pb commented May 30, 2019
P
Pb
USAMay 30, 2019
As a gastroenterologist who trains fellows to do endoscopy, I have noticed that
trainees who played XBoX and video games as kids do better and learn endoscopy
faster.
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Mary commented May 30, 2019
M
Mary
Cape Elizabeth, MaineMay 30, 2019
And a lack of focus on penmanship. My three adult children (ages27-33) all have
deplorable handwriting, a subject matter barely touched on when they were in
elementary school.
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mediapizza commented May 30, 2019
M
mediapizza
I went to school with an MD who was not into surgery and she got faint during a procedure
in her hospital time. She is reputable in her medical practice, she's just not a surgeon.

Any school has to weed out candidates who just don't have what it takes, however
medicine is one of the few professions where someone cannot specialize without taking
years of general postgrad studies to be followed by residency or fellowship. Doctors learn
many skills that will come to be completely unnecessary throughout their specialized
career because the way the system is set up, and potentially damaging in lost time and
learning potential.

Back to that doctor. Once she left the operating room, the surgeon said "Maybe medicine
isn't for her" in a snarky tone. Totally wrong! Surgery was not for her, medicine
absolutely was.

I may have been a great surgeon, but didn't want to spend four years and a quarter
million dollars to possibly find out I was wrong.
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Counter Measures commented May 30, 2019
C
Counter Measures
Old Borough Park, NYMay 30, 2019
An accompanying article in the New York Times today speaks of the heart wrenching
tragedy occurring in North Carolina hospitals regarding surgery on infants! Face it
folks, unless we take good care of our own healths, we are doomed when entering
the current American healthcare system!!!
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vcb commented May 30, 2019
V
vcb
new yorkMay 30, 2019
Back in the 70s I was a student in the Faculty of Science at McGill. Applicants to the
dental program were required to show manual dexterity by carving a prescribed
shape out of a block of chalk. You could ID the wannabe dentists by the chalky
residue from practicing. I hear they got rid of that test, perhaps they should bring it
back for dentistry and certain medical specialties!
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Paul from Oakland commented May 30, 2019
P
Paul from Oakland
SF Bay AreaMay 30, 2019
Regarding whether surgical residents should go back to working 120 hours per week:
Newer research on sleep and memory retention confirm that sleep deprivation
drastically reduces memory retention. But I've not read of studies that examined
sleep deprivation impact on "physical memory" retention. It's likely that we would see
a similar drop. So the answer to improving surgeons physical skills isn't further
overworking them. Frankly, I wouldn't want a surgical resident coming near me with
a scalpel if they averaged 4 hours of sleep.
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tom commented May 30, 2019
T
tom
long island, N.Y. usaMay 30, 2019
Dental Students. I have been going to the Stony Brook Dental School for a number of
years, for a variety of procedures. Most of my experiences have been positive. For the
last few months a new student had been doing a molar repair with mixed results. I
noticed that her hand coordination was mediocre, resulting in several mistakes that
required that the work had to be redone. There may be many reasons why a person
does not have optimum dexterity, certainly in some cultures working with your hands
at any age is looked down upon.
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the passionate reader commented May 30, 2019
T
the passionate reader
North CarolinaMay 30, 2019
As someone married to a craniofacial surgeon who grew up in the 50s and 60s building slot
cars and taking shop, this article resonates with me.

I'd add that many of today's young people were never exposed to tools in the way
earlier generations were. We taught all our children how to build stuff and, routinely,
when they went over to other kids' homes, those parents would tell me, with concern
in their voices, that my children had asked if they could use dangerous tools--saw and
nails--when asked what they wanted to do. We've raised a generation of kids who can
hook up an X-Box, stream Game of Thrones, and master social media but who have
no idea how to repair a chair, hang a door, or build a box.
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Frank Baudino commented May 30, 2019
F
Frank Baudino
Aptos, CAMay 30, 2019
I had the opportunity to teach in a middle school classroom on STEM day--guest teachers
came in and gave a presentation on their particular field of knowledge.

What I noticed was that "wet lab" physics and chemistry experiments were replaced by
screen simulations. Of course, screen simulations required no dexterity and always
produced the "expected" outcome. Real science requires dexterity and is
messy--educationally so.

The same thing could be applied to music taught in schools (or, now, the lack of it). It
used to be the case that recorders (small flute-like instruments) were supplied for
music lessons in middle school. Learning to play required dexterity and persistence.
No longer. Try to get the iPods out of kids' ears!
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Oriole commented May 30, 2019
O
Oriole
TorontoMay 30, 2019
When I taught art to elementary and middle school students visiting art galleries in
the 2000s, their fine motor skills were noticeably weaker than those of the same age
group 20 years earlier. Worse, they had a mental block about making their own
drawings/sculptures/whatever 'from scratch'. They were so used to downloading
readymade images from computers, that they seemed afraid that their own work
wouldn't be as 'perfect'. I had to help them think of drawing etc. as 'experimenting' in
order to get their courage up to risk creating something 'inferior'. The only fine motor
skill they all possessed was the ability to type quickly with their thumbs. Repetitive
strain injuries, here we come !
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chris l commented May 30, 2019
C
chris l
los angelesMay 30, 2019
There may have been a dip in kids growing up doing things requiring fine motor skills, but
there are plenty and increasing opportunities for them today. Disassembling and
reassembling a smartphone to replace a screen or an antenna (it's not hard and can save a
ton of money) or assembling small parts built from your own 3D printer both require the
sorts of hand/eye/fine motor coordination of surgery. I'm an experimental physicist and
spent much of my career working with very tiny things similar to surgery, and while I've
noticed a shift towards students having programming experience rather than hands on
experience, there are still many, many kids out there growing up developing the manual
dexterity required for fine motor work.
Like many other commenters - I'm also skeptical of the idea that limiting surgeons to
80 hrs is a bad thing. I work with non-living things and we limit our hands-on
technicians to much less than that for hardware safety. Repetition of tasks is more
important than practice doing them without sleep - having many more repetitions
while awake and alert still trains the motor skills (and probably better trains them) so
that if you do have to do them under adverse conditions they deteriorate less. This
effect is also very visible in athletic training, which has many parallels to surgical
training, and I've never known any coaches who deliberately sleep-deprived their
athletes.
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Michael Feely commented May 30, 2019
M
Michael Feely
San DiegoMay 30, 2019
I was a surgeon for many years; I have always tried to observe what does and does not
make a good surgeon. Given that very clumsy people don't go into surgery often, I place
manual dexterity down the list of desirable characteristics. The good surgeon? They see
their patients as people not "cases"- result, sometimes they advise against surgery that
might help because of other health problems. Next, planning, planning, planning-good
surgeons run the operation forward in their heads, identify what can go wrong and that
apparently easy operations can go wrong. Having planned, they operate carefully. What
they do is not a chance to show their brilliance but a series of small careful steps each of
which must be accomplished before the next is started. Despite the confident exterior
great surgeons have a small voice inside constantly reminding them that things can go
disastrously wrong and they listen to it.
Good surgeons realize they are part of a team and surround themselves with good
team-mates. Many times good nursing has saved a patient of mine when I didn't delivery
my best.
Bad surgeons tend to have one characteristic in common-they think mistakes are
made by others.
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1
Bob commented May 31, 2019

Bob
PlymouthMay 31, 2019
@Michael Feely
You are so right ( from another surgeon)

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Tony S commented May 30, 2019
T
Tony S
ConnecticutMay 30, 2019
Using keyboards (real or onscreen) almost exclusively is a factor too. A lot of kids are not
able to write by hand very long. It’s like the hand muscles are not developed properly.

Get your surgeries now, folks!
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A Goldstein commented May 30, 2019

A Goldstein
PortlandMay 30, 2019
I wonder how the issues raised in this article relate to surgeons who excel at robotic
surgery where they stare at monitors and manipulate devices that are more like
joysticks than forceps.
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Total Socialist commented May 30, 2019
T
Total Socialist
USAMay 30, 2019
The game, Operation, should be required in all elementary school curricula.
6
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1
eenie commented May 30, 2019
E
eenie
earthMay 30, 2019
@Total Socialist I loved that game. Thanks for the memories.
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stan continople commented May 30, 2019

stan continople
brooklynMay 30, 2019
At the other end of the spectrum, look at Ben Carson. As a brain surgeon, he
apparently had outstanding dexterity. but in all other aspects of life he is a (barely)
functional somnambulist.
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1
S
Steve
@stan continople

there is a widespread myth that neurosurgeons are the most intelligent of all
doctors. In fact, they don't need much intelligence because all the diagnoses
they treat are made by testing so they don't really have to think very much.
They do need dexterity but so do carpenters and car mechanics but we don't
claim they are as a group especially intelligent.
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Postette commented May 30, 2019
P
Postette
I get so depressed when I see 2, 3, 4 year olds tapping on screens.

What are their parents thinking?

Are they crazy?
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1
Nick commented May 30, 2019
N
Nick
MAMay 30, 2019
@Postette

I get so depressed when I see the youth absorbed with books.

I get so depressed when I see the youth absorbed with ipods.

I get so depressed when I see the youth absorbed with computers.

I get so depressed when I see the youth absorbed with smart phones.


Are they crazy?

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David commented May 30, 2019
D
David
CAMay 30, 2019
Wow, the penultimate paragraph is a withering critique of the foundation of the
surgical profession.
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Aaron commented May 30, 2019
A
Aaron
Wow, congrats on getting “millennials are lazy” and “millennials are too addicted to
screens” in one article with no empirical basis!
2
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1
T
Tony S
@Aaron
I agree that articles looking down on millennials and Gen Zers are way too common and
often lack evidence.

However, there is data here. Surgeons training surgical residents are reporting
that manual dexterity has significantly decreased in younger trainees. This is a
problem we shouldn’t ignore. Hopefully new parents and schools will listen and
will start emphasizing manual skills.
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Irene Cantu commented May 30, 2019
I
Irene Cantu
This problem is not limited to physicians. It extends to wet lab scientists. People don't
want to use their hands anymore.
They prefer to use a computer screen. Lets hope this trend doesn't plague the
restaurant business.
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R
Reader
USMay 30, 2019
Another possible factor: much less time spent handwriting.
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1
B commented May 30, 2019
B
B
SoutheastMay 30, 2019
@Reader Yes. Handwriting is becoming a lost art. Students love to try it--the
hush that comes over the classroom is amazing!--but very few of them really
work at it or learn to do it well. I now teach in middle school, and students here
either keyboard or use a weird, blocky print. Some students cannot sign their
own names in cursive. You'd be amazed how many "signatures" I see that
clearly imitate their parents' scrawl--but all the letters are illegible.
4
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Brett commented May 30, 2019
B
Brett
Ah yes, 2006 when before the iPhone came out, everyone was woodworking and
sewing all the time.
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2
MJ commented May 30, 2019
M
MJ
DCMay 30, 2019
@Brett

To be fair, in the late 90s it was still routine to take 'shop' and 'home ec' classes
every year. And I learned basic woodworking and sewing skills through those
classes. I'm not going to building any houses or anything, but it certainly
benefited my needlepoint skills.
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N
Nick
MAMay 30, 2019
@Brett

Every generation sees the worst aspects in the next one.
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B. commented May 30, 2019
B
B.
BrooklynMay 30, 2019
My father-in-law was delighted when one day he was accosted by a well-dressed man who
said, "Taking your shop class in high school was the best thing that ever happened to me."

Asked what he was doing nowadays, the man replied, "I'm a dental surgeon."
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asdfj commented May 30, 2019
A
asdfj
NYMay 30, 2019
Weren't video games supposed to help develop fine motor skills? That was the
excuse to our parents when I was a kid anyway, has that view fallen out of favor?
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1
Lissa commented May 30, 2019
L
Lissa
@asdfj

I think it went the way of 'but the articles are so well-written!'
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APS commented May 30, 2019
A
APS
Olympia WAMay 30, 2019
I know with robot-assisted surgery that the joystick greatly compensates for dexterity
problems (to the point where tipsy non-surgeons at trade shows can manipulate stuff
with great facility). Still, don't really want to hang your hat on that.
1
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not my ancestors commented May 30, 2019
N
not my ancestors
CanadaMay 30, 2019
Just last night I started an embroidery project to see if I could still remember how to
do the stitches and if I still had the manual dexterity to execute. I was pretty
shocked--it' been almost 50 years since I had spent any real time doing this and it was
almost as if I had never stopped. It was slightly harder to thread the needles! I
remembered most of the stitches and my fingers could still execute them. The point
about these skills being developed while young rings true to me. I spent thousands of
hours as a child stitching, drawing, painting and playing music--as I stitched last night
I thought about why my children had never spent much time with this type of thing
--they had many more choices including athletics and music--but also the ever
present screens. I feel lucky that I may now spend time again with these
pastimes--with joy and without frustration. It's not just surgeons who benefit.
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1
Maria commented May 30, 2019
M
Maria
@not my ancestors
Learning to stitch or to surf or ride a bike or speak Chinese or play the piano is child's play
when you are young, but it is possible to do these things very well when you learn later. It
takes time (which children have a lot of) and willingness to fail.

I'm a gynecologist in an medical school. I have noticed a decline in resident manual
dexterity, but I do not believe that work hours restrictions are a major contributor. When I
was a resident at Baylor in the 1980s, we considered forming a union like the residents at
UCSF. We logged hours and we were working 132 hours a week. We had calls in the OB
intensive care unit that lasted as long as we had a patient in the unit. When you have been
awake for 60 hours, you can't write your name, you can't form coherent sentences, you
can't walk straight or maintain normal body temperature. It was not safe for patients or for
doctors. After graduation, two colleagues died in single-car accidents.

Now that we have work hours restrictions, I find that residents are still
exhausted, maybe because so many have children. But some residents take
pottery class, or take up knitting. When I see a resident who can find a breast
lump after they have been kneading dough or working with clay, or a resident
who knows that a running locking stitch is a buttonhole stitch or a blanket stitch,
I smile.
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William commented May 30, 2019

William
MinnesotaMay 30, 2019
The trend in many schools is to provide less support for music and art programs and
more for sports programs. This trend will not help solve the problem described in
this article.
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1
B
B.
Much easier to use the body than to use brain and fingers. That's why. Another
kind of dumbing down in our schools.
5
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David Bartlett commented May 30, 2019

David Bartlett
Keweenaw Bay, MIMay 30, 2019
In addition to fine surgical skills, we should also be wondering about the entire spectrum of
medical practice and how our internet/smartphone/gaming culture has influenced learning
and behaviors. For example, instead of focused study, something which used to occur with
books, solitude and lots of quiet time, how many students---in any discipline---are
distracted by their devices? Not to mention the deleterious effects of 'screen learning' on
the brain, which we are hearing more and more about?

How many doctors-to-be figure they'll just be able to basically 'google-it' when the time
comes, thus never learning to be good seat-of-the-pants diagnosticians (something I've
personally encountered several times over recent years with young M.D.'s)? How many
engineers, architects, scientists and other STEM-rooted careerists are we unleashing into
society, whom will one day design the bridge that will fail, the building that will fall, the
medicine that will harm?

For a start, I would like to hear from the present 'old school' practitioners----what are
their opinions of the new crop coming up now? What I am hearing here and there is
not good.
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SteveRR commented May 30, 2019

SteveRR
CAMay 30, 2019
Anecdote absent actual empirical evidence is a nice 'story'.

I am confident that current surgeons like every demanding profession since Plato has
denigrated their up and coming replacements as soft, under-trained and lacking some
traditional toughness.

Robotic surgery is a real and growing specialty and rewards those who have grown up with
video games - just like flying a modern jet. There are currently robots in over a third of US
hospitals.

I would expect that if these medical schools were concerned then there would be
actual research embedded in this nice story.
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2
V
vcb
How about some empirical evidence showing that robotic surgery is better than
or at least equivalent to standard laparoscopic surgery? All the studies I've seen
show no advantage. But the surgeons all love their high tech toys. As do the
companies who build and sell them to the new generation of tech obsessed
MDs and administrators.
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SteveRR
CAMay 30, 2019
@vcb

You are correct that robotic surgery has had mixed results.
However, having worked with robots in manufacturing for three decades I have no doubt
they will keep getting better until they can take over the majority of routine surgery.
And it does address the purported claims in the article just as welding robots
addressed the shortage of welders in the 90's
1
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basahoramismo commented May 30, 2019
B
basahoramismo
chicagoMay 30, 2019
I am a surgical nurse and have participated in hundreds of surgeries. I noted that
one particular surgeon had an amazing use of his hands. He handled tissue as if it
were that of a neonatal infant. His instruments he held like they were of bone china
from the Tang dynasty. I asked him once if he always knew he wanted to be a
surgeon and practiced dexterity when he was young. "Not concsiously", he said but
he did love building model airplanes and ships in bottles from an early age. There
you go. Although he was a general surgeon, I would have chosen him do to the most
delicate plastic surgery if given the choice.
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2
S
Steve
@basahoramismo

Do you really believe surgeons are more likely to build model airplanes and
ships in bottles than are internists, family physicians, or psychiatrists? I'm a
physician myself and have never heard anybody claim that when they were
younger surgeons were more likely to do these things than physicians in any
other specialties.

Flag
L
Leslie
@Steve That's saying surgeons are more likely to have made models than physicians.

Basahoramismo is saying that surgeons who made models are better than surgeons who
don't.

Big difference. Sorry you didn't see that.
2
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A
asdfj
NYMay 30, 2019
Friendly reminder to never get procedures done at teaching hospitals. They will
invariably have inexperienced students doing the procedure on you, even if they
claim "a senior surgeon will be present (or do it)." The price discount at teaching
hospitals is never worth the risk of having an inexperienced student operating on
you.
4
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15
Gordon Miller commented May 30, 2019
G
Gordon Miller
I completely disagree! While you do have students involved in your treatment, the care at a
teaching hospital will be leading edge. The doctors at teaching hospitals are really
up-to-date on the research literature because they are teaching new doctors.

Doctors not in teaching hospitals also aren’t in the most competitive
environments. In a teaching hospital, you are challenged to stay on top of your
game.
18
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A
asdfj
NYMay 30, 2019
@Gordon Miller
I'm curious, do you work in healthcare, what's your experience? I'm basing my
view on the advice given to me by my brother-in-law and his father, who have
approx 7 decades of cardiovascular surgery experience between the two of
them. I've heard some pretty bad horror stories about students messing up
procedures and the admin trying to cover up that it wasn't an experienced
senior doing the op.
3
Flag
Catherine commented May 30, 2019
C
Catherine
That might be true for more routine procedures, but if you are facing a truly
difficult surgery the teaching hospital could be the best choice since a master
surgeon will be the one doing the work. I had what teuned out to be very
challenging spinal surgery by a world-class surgeon at a teaching hospital more
than 30 years ago, and I credit that choice for my not being a quadriplegic.
8
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VIEW ALL
FilmFan commented May 30, 2019
F
FilmFan
Y'allywoodMay 30, 2019
A college friend majored in Studio Art at our highly ranked liberal arts college and is
now one of the top reconstructive breast cancer surgeons in the country. She still
paints and is a gifted artist. Back in our college days, I was somewhat perplexed by
her not having a more traditional pre-med major like many of our peers, but clearly
she understood that Art provided excellent training for her eyes and hands as a
future surgeon.
92
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Orbis Deo commented May 30, 2019
O
Orbis Deo
The dexterity is definitely different or certainly is lacking, but still more apparent is
the difference in seeing. So much is done robotically or laparoscopically that sight is
in a way taken for granted. Looking for and seeing something in two dimensions is
rather different in two dimensions than three, regardless of the imagery program
used.
4
Flag
CA commented May 30, 2019
C
CA
DelhiMay 30, 2019
I can very well relate with the findings of the study. An acquaintance of mine has an
enviable motor skills. She has been extremely good at embroidery, stitching, mending
electric appliances since her teens. She picked up surgery by herself while practising
and held out as an only dependable surgeon in the region. Without formal training,
she was given the responsibility of conducting full day surgical camps in remote parts
of India, which she did with zero failure rate. Her immense patience and
perseverance are inspiration to me.
27
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Rob D commented May 30, 2019
R
Rob D
Rob D NJMay 30, 2019
My daughter in law is a young dentist. Upon application to her dental school it was a
requirement that the applicant have fine motor skills experience. In her case, having
played violin and piano sufficed. I would hope that medical school surgical programs
would have high minimum requirements at least and then build upon them.
50
Flag
MIMA commented May 30, 2019
M
MIMA
HeartsnyMay 30, 2019
It’s interesting. Here in Wisconsin we have an annual fundraising event called “The Doctor’s
Recital” which sells out immediately - hundreds of tickets.

Doctors and healthcare providers give us a spectacular talent show. So many have studied
plyaying instruments and perhaps could easily have been professional musicians.

My mind goes to the pianists, sometimes two pianos on stage, duets of classical music -
their fingers flying on those keys faster than the speed of lightening it seems.

And other musicians, the guitars, horns, whatever. Their expertise lets us know this talent
did not happen automatically or just overnight. It makes us think of them practicing in
childhood and all the way through - taking all their music seriously as well as having fun
with it.

Brings me to this point - you want successful potential someday surgeons? Give them an
instrument and sign them up for lessons when they’re young! Drag them away from their
electronics and lead them to something they will enjoy lifelong an something they will
accomplish besides a swish on a screen. Music and instruments.

Wonder if it truly makes a difference. My guess would be yes, definitely. In mind and
dexterity.
38
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1
C
C.A.
OregonMay 31, 2019
@MIMA-my local neurosurgeon still plays in a band.

Flag
ALB commented May 30, 2019
A
ALB
Dutchess County NYMay 30, 2019
These are some of the reasons art should be a requirement in every student curriculum
from K-12. Art teaches you to think differently and figure out multiple ways to solve
problems. With art, you make things with your hands. Making things is good for the brain,
hands and soul; it creates something tangible and can be experienced with all the senses.
All these skills are transferrable to every career, and yet many schools cut art as
superfluous.

A person can be born with "good hands" but they still need to be honed, and just like
an athlete practices over many years, surgeons need to practice dexterity. If they
haven't developed their hand skills before med school they have a lot of catching up
to do. Maybe knitting/ crocheting/needlework should be a required course in med
school. :)
40
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2
Betsy B commented May 30, 2019
B
Betsy B
DallasMay 30, 2019
@ALB
Artist and educator here. So many contemporary students want to design "games" but get
frustrated by having to conceptually comprehend perspective; how can you possibly design
an imaginary world unless you understand how to spatially represent the one you are in?
As for dexterity, the easily frustrated never succeed at art, nor do those who have trouble
concentrating.
I spent hours as a child drawing, sewing and making things.
I taught a non-majors' painting class at a state university for years, and some of
the best students were pre-med and engineers who had childhood art
ambitions.
6
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A
ALB
@Betsy B, and you know there are many kinds of "art". Maybe the easily
frustrated don't stick with art, but they probably aren't going to med school
either!
1
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Danielle commented May 30, 2019
D
Danielle
CincinnatiMay 30, 2019
I am a traditional illustrator, relying on nib pens, my inkwell, deep breathing and a lot
of steadiness and calm in order to create my work. I’m self taught, but realize that my
earlier skills in hand sewing likely helped along the way. Both practices bring an
almost stunned response from people who ask me how I do what I do, with the
typical remark being, “I had no idea that anyone was still working with these tools and
techniques.” My instinctive thought always leads to surgeons, and my gratitude for
their work. Their tools have advanced, but their dexterity and focus will always play a
profoundly important role.
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A Goldstein commented May 30, 2019

A Goldstein
PortlandMay 30, 2019
I wonder how the issues raised in this article relate to surgeons who excel at robotic
surgery where they stare at monitors and manipulate devices that are more like
joysticks than forceps.
5
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Total Socialist commented May 30, 2019
T
Total Socialist
USAMay 30, 2019
The game, Operation, should be required in all elementary school curricula.
6
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1
eenie commented May 30, 2019
E
eenie
earthMay 30, 2019
@Total Socialist I loved that game. Thanks for the memories.
4
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stan continople commented May 30, 2019

stan continople
brooklynMay 30, 2019
At the other end of the spectrum, look at Ben Carson. As a brain surgeon, he
apparently had outstanding dexterity. but in all other aspects of life he is a (barely)
functional somnambulist.
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1
S
Steve
@stan continople

there is a widespread myth that neurosurgeons are the most intelligent of all
doctors. In fact, they don't need much intelligence because all the diagnoses
they treat are made by testing so they don't really have to think very much.
They do need dexterity but so do carpenters and car mechanics but we don't
claim they are as a group especially intelligent.
5
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Postette commented May 30, 2019
P
Postette
I get so depressed when I see 2, 3, 4 year olds tapping on screens.


Are they crazy?
23
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1
N
Nick
MAMay 30, 2019
@Postette

I get so depressed when I see the youth absorbed with books.

I get so depressed when I see the youth absorbed with ipods.

I get so depressed when I see the youth absorbed with computers.

I get so depressed when I see the youth absorbed with smart phones.


Are they crazy?

Flag
David commented May 30, 2019
D
David
CAMay 30, 2019
Wow, the penultimate paragraph is a withering critique of the foundation of the
surgical profession.
2
Flag
Aaron commented May 30, 2019
A
Aaron
Wow, congrats on getting “millennials are lazy” and “millennials are too addicted to
screens” in one article with no empirical basis!
2
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1
T
Tony S
@Aaron
I agree that articles looking down on millennials and Gen Zers are way too common and
often lack evidence.

However, there is data here. Surgeons training surgical residents are reporting
that manual dexterity has significantly decreased in younger trainees. This is a
problem we shouldn’t ignore. Hopefully new parents and schools will listen and
will start emphasizing manual skills.
4
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Irene Cantu commented May 30, 2019
I
Irene Cantu
This problem is not limited to physicians. It extends to wet lab scientists. People don't
want to use their hands anymore.
They prefer to use a computer screen. Lets hope this trend doesn't plague the
restaurant business.
6
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R
Reader
USMay 30, 2019
Another possible factor: much less time spent handwriting.
11
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1
B commented May 30, 2019
B
B
SoutheastMay 30, 2019
@Reader Yes. Handwriting is becoming a lost art. Students love to try it--the
hush that comes over the classroom is amazing!--but very few of them really
work at it or learn to do it well. I now teach in middle school, and students here
either keyboard or use a weird, blocky print. Some students cannot sign their
own names in cursive. You'd be amazed how many "signatures" I see that
clearly imitate their parents' scrawl--but all the letters are illegible.
4
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Brett commented May 30, 2019
B
Brett
Ah yes, 2006 when before the iPhone came out, everyone was woodworking and
sewing all the time.
11
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2
MJ commented May 30, 2019
M
MJ
DCMay 30, 2019
@Brett

To be fair, in the late 90s it was still routine to take 'shop' and 'home ec' classes
every year. And I learned basic woodworking and sewing skills through those
classes. I'm not going to building any houses or anything, but it certainly
benefited my needlepoint skills.
6
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N
Nick
MAMay 30, 2019
@Brett

Every generation sees the worst aspects in the next one.
1
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B
B.
My father-in-law was delighted when one day he was accosted by a well-dressed man who
said, "Taking your shop class in high school was the best thing that ever happened to me."

Asked what he was doing nowadays, the man replied, "I'm a dental surgeon."
29
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A
asdfj
NYMay 30, 2019
Weren't video games supposed to help develop fine motor skills? That was the
excuse to our parents when I was a kid anyway, has that view fallen out of favor?
3
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1
Lissa commented May 30, 2019
L
Lissa
@asdfj

I think it went the way of 'but the articles are so well-written!'
2
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APS commented May 30, 2019
A
APS
Olympia WAMay 30, 2019
I know with robot-assisted surgery that the joystick greatly compensates for dexterity
problems (to the point where tipsy non-surgeons at trade shows can manipulate stuff
with great facility). Still, don't really want to hang your hat on that.
1
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not my ancestors commented May 30, 2019
N
not my ancestors
CanadaMay 30, 2019
Just last night I started an embroidery project to see if I could still remember how to
do the stitches and if I still had the manual dexterity to execute. I was pretty
shocked--it' been almost 50 years since I had spent any real time doing this and it was
almost as if I had never stopped. It was slightly harder to thread the needles! I
remembered most of the stitches and my fingers could still execute them. The point
about these skills being developed while young rings true to me. I spent thousands of
hours as a child stitching, drawing, painting and playing music--as I stitched last night
I thought about why my children had never spent much time with this type of thing
--they had many more choices including athletics and music--but also the ever
present screens. I feel lucky that I may now spend time again with these
pastimes--with joy and without frustration. It's not just surgeons who benefit.
23
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1
Maria commented May 30, 2019
M
Maria
@not my ancestors
Learning to stitch or to surf or ride a bike or speak Chinese or play the piano is child's play
when you are young, but it is possible to do these things very well when you learn later. It
takes time (which children have a lot of) and willingness to fail.

I'm a gynecologist in an medical school. I have noticed a decline in resident manual
dexterity, but I do not believe that work hours restrictions are a major contributor. When I
was a resident at Baylor in the 1980s, we considered forming a union like the residents at
UCSF. We logged hours and we were working 132 hours a week. We had calls in the OB
intensive care unit that lasted as long as we had a patient in the unit. When you have been
awake for 60 hours, you can't write your name, you can't form coherent sentences, you
can't walk straight or maintain normal body temperature. It was not safe for patients or for
doctors. After graduation, two colleagues died in single-car accidents.

Now that we have work hours restrictions, I find that residents are still
exhausted, maybe because so many have children. But some residents take
pottery class, or take up knitting. When I see a resident who can find a breast
lump after they have been kneading dough or working with clay, or a resident
who knows that a running locking stitch is a buttonhole stitch or a blanket stitch,
I smile.
12
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William commented May 30, 2019

William
MinnesotaMay 30, 2019
The trend in many schools is to provide less support for music and art programs and
more for sports programs. This trend will not help solve the problem described in
this article.
35
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1
B
B.
Much easier to use the body than to use brain and fingers. That's why. Another
kind of dumbing down in our schools.
5
Flag
David Bartlett commented May 30, 2019

David Bartlett
Keweenaw Bay, MIMay 30, 2019
In addition to fine surgical skills, we should also be wondering about the entire spectrum of
medical practice and how our internet/smartphone/gaming culture has influenced learning
and behaviors. For example, instead of focused study, something which used to occur with
books, solitude and lots of quiet time, how many students---in any discipline---are
distracted by their devices? Not to mention the deleterious effects of 'screen learning' on
the brain, which we are hearing more and more about?

How many doctors-to-be figure they'll just be able to basically 'google-it' when the time
comes, thus never learning to be good seat-of-the-pants diagnosticians (something I've
personally encountered several times over recent years with young M.D.'s)? How many
engineers, architects, scientists and other STEM-rooted careerists are we unleashing into
society, whom will one day design the bridge that will fail, the building that will fall, the
medicine that will harm?

For a start, I would like to hear from the present 'old school' practitioners----what are
their opinions of the new crop coming up now? What I am hearing here and there is
not good.
24
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SteveRR
CAMay 30, 2019
Anecdote absent actual empirical evidence is a nice 'story'.

I am confident that current surgeons like every demanding profession since Plato has
denigrated their up and coming replacements as soft, under-trained and lacking some
traditional toughness.

Robotic surgery is a real and growing specialty and rewards those who have grown up with
video games - just like flying a modern jet. There are currently robots in over a third of US
hospitals.

I would expect that if these medical schools were concerned then there would be
actual research embedded in this nice story.
10
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2
V
vcb
How about some empirical evidence showing that robotic surgery is better than
or at least equivalent to standard laparoscopic surgery? All the studies I've seen
show no advantage. But the surgeons all love their high tech toys. As do the
companies who build and sell them to the new generation of tech obsessed
MDs and administrators.
5
Flag

SteveRR
CAMay 30, 2019
@vcb

You are correct that robotic surgery has had mixed results.
However, having worked with robots in manufacturing for three decades I have no doubt
they will keep getting better until they can take over the majority of routine surgery.
And it does address the purported claims in the article just as welding robots
addressed the shortage of welders in the 90's
1
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basahoramismo commented May 30, 2019
B
basahoramismo
chicagoMay 30, 2019
I am a surgical nurse and have participated in hundreds of surgeries. I noted that
one particular surgeon had an amazing use of his hands. He handled tissue as if it
were that of a neonatal infant. His instruments he held like they were of bone china
from the Tang dynasty. I asked him once if he always knew he wanted to be a
surgeon and practiced dexterity when he was young. "Not concsiously", he said but
he did love building model airplanes and ships in bottles from an early age. There
you go. Although he was a general surgeon, I would have chosen him do to the most
delicate plastic surgery if given the choice.
127
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2
S
Steve
@basahoramismo

Do you really believe surgeons are more likely to build model airplanes and
ships in bottles than are internists, family physicians, or psychiatrists? I'm a
physician myself and have never heard anybody claim that when they were
younger surgeons were more likely to do these things than physicians in any
other specialties.

Flag
L
Leslie
@Steve That's saying surgeons are more likely to have made models than physicians.

Basahoramismo is saying that surgeons who made models are better than surgeons who
don't.

Big difference. Sorry you didn't see that.
2
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A
asdfj
NYMay 30, 2019
Friendly reminder to never get procedures done at teaching hospitals. They will
invariably have inexperienced students doing the procedure on you, even if they
claim "a senior surgeon will be present (or do it)." The price discount at teaching
hospitals is never worth the risk of having an inexperienced student operating on
you.
4
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15
Gordon Miller commented May 30, 2019
G
Gordon Miller
I completely disagree! While you do have students involved in your treatment, the care at a
teaching hospital will be leading edge. The doctors at teaching hospitals are really
up-to-date on the research literature because they are teaching new doctors.

Doctors not in teaching hospitals also aren’t in the most competitive
environments. In a teaching hospital, you are challenged to stay on top of your
game.
18
Flag
A
asdfj
NYMay 30, 2019
@Gordon Miller
I'm curious, do you work in healthcare, what's your experience? I'm basing my
view on the advice given to me by my brother-in-law and his father, who have
approx 7 decades of cardiovascular surgery experience between the two of
them. I've heard some pretty bad horror stories about students messing up
procedures and the admin trying to cover up that it wasn't an experienced
senior doing the op.
3
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Catherine commented May 30, 2019
C
Catherine
That might be true for more routine procedures, but if you are facing a truly
difficult surgery the teaching hospital could be the best choice since a master
surgeon will be the one doing the work. I had what teuned out to be very
challenging spinal surgery by a world-class surgeon at a teaching hospital more
than 30 years ago, and I credit that choice for my not being a quadriplegic.
8
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VIEW ALL
FilmFan commented May 30, 2019
F
FilmFan
Y'allywoodMay 30, 2019
A college friend majored in Studio Art at our highly ranked liberal arts college and is
now one of the top reconstructive breast cancer surgeons in the country. She still
paints and is a gifted artist. Back in our college days, I was somewhat perplexed by
her not having a more traditional pre-med major like many of our peers, but clearly
she understood that Art provided excellent training for her eyes and hands as a
future surgeon.
92
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Orbis Deo commented May 30, 2019
O
Orbis Deo
The dexterity is definitely different or certainly is lacking, but still more apparent is
the difference in seeing. So much is done robotically or laparoscopically that sight is
in a way taken for granted. Looking for and seeing something in two dimensions is
rather different in two dimensions than three, regardless of the imagery program
used.
4
Flag
CA commented May 30, 2019
C
CA
DelhiMay 30, 2019
I can very well relate with the findings of the study. An acquaintance of mine has an
enviable motor skills. She has been extremely good at embroidery, stitching, mending
electric appliances since her teens. She picked up surgery by herself while practising
and held out as an only dependable surgeon in the region. Without formal training,
she was given the responsibility of conducting full day surgical camps in remote parts
of India, which she did with zero failure rate. Her immense patience and
perseverance are inspiration to me.
27
Flag
Rob D commented May 30, 2019
R
Rob D
Rob D NJMay 30, 2019
My daughter in law is a young dentist. Upon application to her dental school it was a
requirement that the applicant have fine motor skills experience. In her case, having
played violin and piano sufficed. I would hope that medical school surgical programs
would have high minimum requirements at least and then build upon them.
50
Flag
MIMA commented May 30, 2019
M
MIMA
HeartsnyMay 30, 2019
It’s interesting. Here in Wisconsin we have an annual fundraising event called “The Doctor’s
Recital” which sells out immediately - hundreds of tickets.

Doctors and healthcare providers give us a spectacular talent show. So many have studied
plyaying instruments and perhaps could easily have been professional musicians.

My mind goes to the pianists, sometimes two pianos on stage, duets of classical music -
their fingers flying on those keys faster than the speed of lightening it seems.

And other musicians, the guitars, horns, whatever. Their expertise lets us know this talent
did not happen automatically or just overnight. It makes us think of them practicing in
childhood and all the way through - taking all their music seriously as well as having fun
with it.

Brings me to this point - you want successful potential someday surgeons? Give them an
instrument and sign them up for lessons when they’re young! Drag them away from their
electronics and lead them to something they will enjoy lifelong an something they will
accomplish besides a swish on a screen. Music and instruments.

Wonder if it truly makes a difference. My guess would be yes, definitely. In mind and
dexterity.
38
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1
C
C.A.
OregonMay 31, 2019
@MIMA-my local neurosurgeon still plays in a band.

Flag
A
ALB
These are some of the reasons art should be a requirement in every student curriculum
from K-12. Art teaches you to think differently and figure out multiple ways to solve
problems. With art, you make things with your hands. Making things is good for the brain,
hands and soul; it creates something tangible and can be experienced with all the senses.
All these skills are transferrable to every career, and yet many schools cut art as
superfluous.

A person can be born with "good hands" but they still need to be honed, and just like
an athlete practices over many years, surgeons need to practice dexterity. If they
haven't developed their hand skills before med school they have a lot of catching up
to do. Maybe knitting/ crocheting/needlework should be a required course in med
school. :)
40
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2
Betsy B commented May 30, 2019
B
Betsy B
DallasMay 30, 2019
@ALB
Artist and educator here. So many contemporary students want to design "games" but get
frustrated by having to conceptually comprehend perspective; how can you possibly design
an imaginary world unless you understand how to spatially represent the one you are in?
As for dexterity, the easily frustrated never succeed at art, nor do those who have trouble
concentrating.
I spent hours as a child drawing, sewing and making things.
I taught a non-majors' painting class at a state university for years, and some of
the best students were pre-med and engineers who had childhood art
ambitions.
6
Flag
A
ALB
@Betsy B, and you know there are many kinds of "art". Maybe the easily
frustrated don't stick with art, but they probably aren't going to med school
either!
1
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Danielle commented May 30, 2019
D
Danielle
CincinnatiMay 30, 2019
I am a traditional illustrator, relying on nib pens, my inkwell, deep breathing and a lot
of steadiness and calm in order to create my work. I’m self taught, but realize that my
earlier skills in hand sewing likely helped along the way. Both practices bring an
almost stunned response from people who ask me how I do what I do, with the
typical remark being, “I had no idea that anyone was still working with these tools and
techniques.” My instinctive thought always leads to surgeons, and my gratitude for
their work. Their tools have advanced, but their dexterity and focus will always play a
profoundly important role.
28
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Mike L commented May 30, 2019
M
Mike L
NYMay 30, 2019
This is absolutely true. I grew up building models and it has definitely made my finger
dexterity much better. To say nothing of that it also taught me critical thinking and
problem solving. I never thought about this but it is fascinatingly true.
16
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Bello commented May 30, 2019
B
Bello
Western MassMay 30, 2019
Especially applies to dentistry, where good craftsmanship makes all the difference.
15
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BRUCE commented May 30, 2019
B
BRUCE
PALO ALTOMay 30, 2019
Certainly, the decline in model building among the youth contributes, but why isn't
the lack of instruction in handwriting and penmanship also considered a cause in the
decline in manual dexterity? Isn't learning to legibly communicate with a writing
instrument an issue of developing manual manipulative skill?.
66
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Lupi Robinson commented May 30, 2019
L
Lupi Robinson
North Haven CTMay 30, 2019
Most schools have eliminated the teaching of “cursive” — a mistake in my mind.
Learning cursive definirely helps with manual dexterity. Boys, particularly, who find it
difficult should be required to do it.
69
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tencato commented May 30, 2019
T
tencato
Los angelesMay 30, 2019
Count me as sceptical on the conclusions drawn here based on speculation of what
happened two and one-half decades before surgical training. There's simply no proof for
these conclusions.
If motor skills were declining, this would be evident in dentistry, and dental residencies,
with the exception of oral surgery, have always had less intense hours than general surgery
residencies.
And while there have always been people for whom tasks involving motor skills are
more difficult, nearly all of them could be trained to the level required to be
competent practitioners.
4
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2
Roger C. commented May 30, 2019
R
Roger C.
Fairfield, CTMay 30, 2019
@tencato
1. many dental procedures usually take an hour or two, rarely many hours or a whole day.
2. Learning curves have been shown to be logarithmic functions (e.g., to achieve the same
improvement one sees going from 100 to 200 repetitions one will have to go from 200 to
400 and then from 400 to 800, etc).
3. Therefore most dental students/residents can accumulate a lot of repetition
doing relatively short duration procedures in a much shorter time than a
surgeon doing complex surgeries that last many hours each
4
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Julie Tea commented May 30, 2019
J
Julie Tea
vancouverMay 30, 2019
@tencato
Dental schools screen for fine motor skills in applicants while potential surgeons
currently aren’t screened for this. It does make you wonder why not.
8
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Karen Chung commented May 30, 2019
K
Karen Chung
Chicago, ILMay 30, 2019
Babies having to start out in life mainly in supine (on their back), due to “back to
sleep” campaign in mid 90’s might be a factor in this. This does NOT mean sleep
position should change because supine sleeping is still imperative for infants. But it
does play a role in how human bodies develop now. Limited prone or tummy
positioning during infancy directly affects weight bearing on upper extremities and in
turn hand development and fine motor skills into childhood. In addition, babies are
now in carriers and devices more vs being able to just play on floor, etc. This has an
affect on all body systems, sensory, visual, perception...Couple this with what the
article is stating about more time on video games, computers, etc vs higher level
dexterity activities, the upper extremity skills of someone born in older generations
are different. Go back to your basic infant development milestones 101 and if you
look very closely at what building blocks are required to develop high level gross
motor and fine motor coordination skills, babies are not experiencing the same
opportunities today. Ask an older pediatric physical therapist who has been treating
infants before back sleeping and is still treating today. There’s a clear difference.
Again, “back to sleep” should never change for safety reasons nor is this the only
reason for what this article is presenting. But it should be considered as a
contributing factor.
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HArriet Katz commented May 30, 2019
H
HArriet Katz
Albany NyMay 30, 2019
Maybe the older generation wasn’t so much better than the talent of today, but prior
culture Was less forthcoming in acknowledging mistakes.
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MLChadwick commented May 30, 2019
M
MLChadwick
Portland, MaineMay 30, 2019
The notion that forcing docs-in-training to work more than 80 ours a week would improve
their manual dexterity is perplexing.

One's skill at tying those knots would magically improve while one is staggering
around far beyond the point of exhaustion?
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Ashley commented May 30, 2019
A
Ashley
Fort Collins, COMay 30, 2019
@MLChadwick Exactly! I thought this article was great, until that was mentioned.

Limiting work hours of residents and other medical professionals is an
important step forward for safety, and I hope no one is suggesting we backslide.
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ST commented May 30, 2019
S
ST
NYCMay 30, 2019
@MLChadwick I think you are making the wrong assumption. I'm not sure that anyone is
recommending increasing the hours per week. What is being talked about is increasing the
weeks. Meaning, add an extra year on to training.

You can't decrease hours per week of training with the same number of weeks
and expect a similarly trained resident. So these 5 year residencies need to be 6
now. Hours problem solved.
4
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interested observer commented May 30, 2019
I
interested observer
SF Bay AreaMay 30, 2019
@MLChadwick Unless it is an elective operation under optimal condition, you
cannot plan for it. Disease processes progress or regress at their own clock and
if you happen to be off, you will never witness the event and learn to handle it.
Hospitals have reduced staffing at night for obvious reasons and if you happen
to be on call, you will get greater exposure and opportunities to do the
procedures. The harder one works, the better one gets.
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JohnR commented May 30, 2019
J
JohnR
PrincetonMay 30, 2019
Someone should do a longitudinal study of passionate Lego builders and correlation
to surgical dexterity. My 11yo still drops everything (yes, even video games) when a
new Lego set enters the house.
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1
ncvvet commented May 30, 2019
N
ncvvet
nyMay 30, 2019
@JohnR

I'm sending this to my S-I-L who for years has built Lego projects with our 6 YO!
6
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poslug commented May 30, 2019
P
poslug
CambridgeMay 30, 2019
Different sized pencils, some very large at an early age used to be one approach. I
vaguely remember having to reassemble old watch innards as a play thing and
always being called upon to thread needles. Mom was into dexterity as an aspect of
engineering, drawing, and detail in general. A different era but one with some skills
that can be re introduced.
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docgrose commented May 30, 2019
D
docgrose
Sleepy Hollow, NYMay 30, 2019
This is a common and baseless claim, though you you will find many, many people willing
to swear by it.
First: the reason residents are doing fewer cases has far more to do with two other factors
than the 80 hour rule. The first issue is that in fields like Acute Care Surgery, which is what
Dr. Scalea practices, there are fewer and fewer operative cases because of advancements
in interventional radiology, as well as the realization that many injuries previously operated
on could be managed just as well without surgery. The second issue is related to the
involvement of the attending in current training. I trained in a residency and then practiced
in a program where there was almost never a time in the operating room whithout the
attending present and actively involved in the operating room. This was a paradigm shift
from even what I saw in medical school. On my rotation as a medical student I spent a
month doing cases (2-3 a day) with senior residents during which on only two cases the
entire involved attendings. These two factors contribute far more to residents decrease
operating time than the 80 hour rule.
Furthermore, working 120 hours a week simply meant you functionally weren't present for
most of it, and it couldn't be consigned to memory - not exactly what we should be asking
of our future doctors.
Finally: we don't educate for imagination and creativity, but for memorization & good
guessing. Get rid of standardized tests, and surgical skills will blossom.
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1
S
ST
NYCMay 30, 2019
@docgrose While I agree that the 120 hours a week we put in were not all productive, I
think your other point isn't as valid. The problem with many residency programs is that
students choose based in part on name, and then get terrible training where they watch
the whole time. This can sometimes be chalked up to picking the wrong training program.
In my program the PGY-2s were operating like crazy.

As well, attendings will stay with the residents they feel they need to stay with in
order to have the case go well. Maybe your senior residents had done more
cases (because of the longer hours) or were just great surgeons...
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Zaffar K Haque commented May 30, 2019
Z
Zaffar K Haque
Monroeville, PAMay 30, 2019
I have read that a physician knows his/her destined career by the age of 14. For a future
Surgeon in the USA, that means there are 12 years of wasted opportunity [assuming they
will first enter the operating room at the age of 26]. The American Surgical Association
may want to intervene by setting up simulation centers for high school students, college
students, and medical students. Instead of half-heartedly performing checklists that
future physicians feel compelled to do [volunteering, doing research on fruit flies, etc], they
should zone in more productive activities that will eventually benefit society to a far greater
extent than these resume-building activities. Performance in simulation centers can then
be used as a criteria for admission into the specialty.

Tom Brady had been a quarterback for around 13-14 years [starting with flag football after
recess] before he threw his first pass in the NFL. We all know how invested the NFL is in
college football.

The professional surgical societies should take a cue from other professions that
demand manual dexterity.
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1
HArriet Katz commented May 30, 2019
H
HArriet Katz
Albany NyMay 30, 2019
I remember my roommate wants mentioning how well her dexterity was
received. She attributed it to all of the sewing her mother had Taught her as a
child.
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S
ST
NYCMay 30, 2019
While training in residency as an orthopaedic surgeon we saw this all the time. And I still
say to this day: You can't read about how to ride a bike. Sure you can read about the
physics, read about the momentum, but at the end of the day you just need to ride the
bike. And as we've all see anecdotally, the earlier you learn the better you are.

Many training program pride themselves on super high test scores and in-training
exam scores. These numbers have almost zero to do with the technical skills of
surgeons. There's a big difference between knowing what to do and being able to
make your hands do it. The question is, How do you find the surgeon who operates
really well? Many many times she isn't on the billboard, in the magazine, or at the big
academic center...
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1
Sam commented May 30, 2019
S
Sam
HoustonMay 30, 2019
As a fellow surgeon I could not agree more.
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Shahbaby commented May 30, 2019
S
Shahbaby
NYMay 30, 2019
During my medical school training, my Ob/Gyn mom made it clear that she wanted me to
be a surgeon eventually. I was very handy even as a child and used to puttering around the
house fixing broken things.

However, I realized how easy it is to actually damage an object further in the very process
of trying to 'fix' it, and then I had to repair the damage I had unintentionally caused, in
addition to the original damage.

This fact gave me pause and I had nightmares of doing the same inside a human body that
I would be trying to repair as a surgeon. Much to the enduring disappointment of my mom,
I decided to train as a non-surgical internist instead.

Besides, as medical students, we had all seen the various surgeons operate and we
ALL knew the surgeons to avoid if ever we personally needed surgery. Manual
dexterity and precision is key in the surgical field; and in my opinion some
standardized measurement of this ability should be incorporated into testing before
anyone is allowed inside a patient's body with a super sharp scalpel...
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RP commented May 30, 2019
R
RP
As an attending surgeon in an academic medical center, I have very clearly found that
some people have instinctually good hands, and others are challenged throughout
residency. Whether it is a generational shift is harder to say, but I think there has long
been a debate in medical education around the need to assess dexterity in surgical
resident selection. More importantly, we still have yet to standardize a way to
effectively educate trainees, simply encouraging them to practice when technical
errors are noted.
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4
Zaffar K Haque commented May 30, 2019
Z
Zaffar K Haque
Monroeville, PAMay 30, 2019
@RP. I agree with your skepticism about whether the problem is generational
(or that the problem can be blamed on cell phones). Neither the NFL, the NHL,
or the Boston Symphony Orchestra is complaining that the current generation
has fallen behind with regard to manual dexterity. The Musician has been
practicing since the age of 4. The quarterback has been the quarterback since
the age of 10 (recess). I think we start too late with regard to the medical sub
specialties that demand manual dexterity.
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treefrog commented May 30, 2019
T
treefrog
Morgantown WVMay 30, 2019
@RP
At the state university I attended many years ago, the applicants for admission
to the dental school spent hours and hours practicing carving blocks of chalk.
This was preparation for a timed carving test that was a key element in the
admissions process. I have been told that this is still the case. At medical
schools in that era, a less formal but thorough screening would occur. A 4th
year med student headed towards a surgical residency would typically have
performed [under close supervision and evaluation] simple procedures,
procedures that nonetheless required the student to demonstrate
brain<=>eye<=>hand coordination. My impression is that this is no longer the
situation, that such performance is now delayed until after the beginning of
residency training.
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treefrog commented May 30, 2019
T
treefrog
Morgantown WVMay 30, 2019
@RP
As an academic surgeon, RP, how do you currently "...assess dexterity in surgical
resident selection..." Do you directly supervise 3rd and 4th year students, or are
you just signing off on the evaluations given by their residents? My classmates,
med students in the mid 1970's, had the opportunity to work under the direct
vision of senior surgical faculty. An alumna credited her distinguished academic
career to the encouragement and guidance she received from senior faculty as
a 3rd year student. I remember a very senior surgeon demonstrating, then
directing me through an urgent procedure under less-than-optimal conditions.
When we were done, he said "That's how we did it on Omaha Beach, June 6th,
1944."
7
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VIEW ALL
Jane commented May 30, 2019
J
Jane
Where is the evidence to support the claim that today’s medical students are less
dextrous? This is anecdotal and unfounded millennial bashing. As a recent medical
graduate and current resident, I can say that many of my peers excel in creative
pursuits, including playing instruments and making art. What’s more, they’re devoted
to becoming excellent doctors. Why make a difficult road even harder with
condescension?
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3
Gary Gelbfish commented May 30, 2019
G
Gary Gelbfish
NYMay 30, 2019
As an active vascular surgeon who has done well over 10,000 open-surgical cases since
1983, I beg to strongly differ with your characterization and conclusion. This article is not
about condescension or bashing. It describes a valid concern that warrants discussion and
not trivialization. It may yet lead to the harder evidence that we would all like, if/when a
formal study is ultimately undertaken.

The opinions described in the article match my personal observation that my childhood
hands-on experience gave me a significant edge in the operating room while training. My
initial "good-hands" gave me a running start and compounded my acquisition of skills,
since I was able to do more at every stage of my training. "Endless" training hours further
honed my skills.

It has also been extensively documented that surgical outcomes are correlated with
experience in a given procedure. Additionally, "flying time," is a well accepted concept in so
many other professions. Why should surgical training be different?

I find this article spot-on, describing the challenges that surgical training and practice face
today. While I do believe there are ways to "catch-up" via specific focus on manual
dexterity, this can only happen if one agrees to its importance.

When I trained, the mantra was "Any monkey can learn to operate;" so formal
training focused mostly on the intellectual parts of surgery. I have always found
this approach to be patently ludicrous.
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Craig in Orygun commented May 30, 2019
C
Craig in Orygun
OregonMay 30, 2019
I looked at orthopedic surgery residency as a 5 year period when I wouldn’t have
hobbies but instead concentrate all my efforts into learning everything I could
about orthopedics. Some of the late night encounters with patient problems
were grueling but it’s how you learn medicine. You can’t learn everything from a
book or video clip.

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