Surgery students 'losing dexterity to stitch patients'

[Derek Cohen]

https://www.bbc.com/news/education-46019429

Regards from Perth

Derek

[Phil Mueller]

Interesting insight, Derek. Thanks for posting. When you consider many young folks can’t even change a light switch, it says a lot for the future of skilled trades.

[Malcolm Schweizer]

Professor Kneebone? I had to look and be sure it was a real news site when I saw that name.

[Howard Pollack]

I find it astounding how difficult it is to translate what I can figure out in my head to my hands. Without actually doing things, and often getting them wrong, it is impossible to really develop the neurology that allows hand skills.
-Howard

[Bill Houghton]

This may accelerate the development of the surgery "robots," which, up to now, have been focused on the most delicate operations.

[James Waldron]

Who needs to stitch patients when today we have staples. It takes little dexterity to handle a stapler.

[James Waldron]

And, of course, we have butterfly bandages, cyanoacrylate adhesives (Dermabond, etc.) and safety pins.

[James Waldron]

Then, too, it's rarely a surgeon who stitches/staples/glues the patient. It's more likely either some Physician's Assistant or Nurse Practitioner finishing up and closing up the patient so the surgeon can make it for his tee time.

[Dave Anderson NH]

Similarly the use of CAD systems for mechanical drawing instead of old fashioned drafting on paper, vellum, or Mylar has its own issues. I constantly receive customer drawings from yung engineer done on CAD systems which are elegant but unmanufacturable due to inadequate space to install all of the features. When a part 1" x 1" shows up on a screen filling almost the full screen it is easy for the engineer to pack 10 pounds in the proverbial 5 pound bag. Unfortunately at times technology doesn't substitute for common sense.

[Mike King]

Similarly the use of CAD systems for mechanical drawing instead of old fashioned drafting on paper, vellum, or Mylar has its own issues. I constantly receive customer drawings from yung engineer done on CAD systems which are elegant but unmanufacturable due to inadequate space to install all of the features. When a part 1" x 1" shows up on a screen filling almost the full screen it is easy for the engineer to pack 10 pounds in the proverbial 5 pound bag. Unfortunately at times technology doesn't substitute for common sense.

What's interesting is that the furniture artisans I've had the privilege to learn from reject CAD as a design tool emphasizing the importance of drawing as the initial stage of design. While some acknowledge that CAD may have a role, they believe there's no substitute for the ability to draw and sketch.

[Jim Koepke]

What's interesting is that the furniture artisans I've had the privilege to learn from reject CAD as a design tool emphasizing the importance of drawing as the initial stage of design. While some acknowledge that CAD may have a role, they believe there's no substitute for the ability to draw and sketch.

This recalls the laments of an engineer who worked along side me and a few other drafters and engineers at a breathing air compressor company. One of his tirades was how the contractor would read the drawings wrong since they had mostly eastern European machinist who were familiar with different standards to drawings. He said, "in the old days the engineer would design it, draw it, go down to the shop and make it and then return to the drawing board to make any corrections."

This was before CAD was established in most engineering/drafting applications.

The only thing that is certain is change.

jtk

[Jim Koepke]

I prefer humans, thank you.

Likely how long we will have humans to do this depends on how long it takes for medical robotics to find inroads into rural areas?

jtk

[William Fretwell]

I blame their grandmother’s, if they had been taught to darn socks before the age of ten by their grandmother (like me) we wouldn’t be having this trouble. Bout the same time I took up woodwork......
My nurse wife works for a surgeon who can cut and sew but has no time for the keyboard!

[Vincent Tai]

When I first read this a few days ago I immediately sent it to a friend and texted "They should all learn how to sharpen and cut." Spending some time in the kitchen might actually help my Gen X peers' tactile knowledge. For years I've been bemused when looking at my siblings and watching them struggle with a kitchen knife and point it and dropping it on onions as if they're waving a wand like Hermoine in Harry Potter doing "Wingardium Leviosa." Though recently after a few months and a piqued interest in cooking my youngest sibling can handle a kitchen knife proficiently.

I think home sense sort classes and wood shop/ music will be well missed far too late as they shrink and shrink. Finger dexterity and confidence in your tactile senses are go only as far as you maintain them. I quit violin a decade ago and rarely pick it up except a short period where I taught a friend who attempted to learn the instrument. I could remember much of the movements and what not but boy that was real hard on the fingers wrists arms shoulders and ego. I was doing some organizing in my room and opened up my violin case and messed around with the fiddle and realized I might've gotten much stronger compared to when I was 10 but now without the technique honed and maintained daily a decade ago I would easily injure myself doing vibrato with the wrong sort of approach.

[bill howes]

Sounds a bit like the lament of an elderly surgeon. I well remember the distress of an administrator when we began to staple wounds. He asked how the residents would learn to sew. We replied that they probably wouldn't have to, but if they did being young they would learn far more quickly than he could learn how to staple. Don't give up on youth.

[Jim Koepke]

Talking to my dentist about this today, he said he had read an article with an opposing opinion. It seems with all the video games kids play today they have excellent dexterity. At least when it comes to the skills needed to direct robotic medical devices.

jtk

[Bill Orbine]

This thread is somewhat like a hammer and nail gun topic! A lot of people don't know how to use a hammer.

[Dave Richards]

The robots currently being used in surgery aren't autonomous. The surgeon and/or PA or surgical resident are operating the manipulators of the robot to do the surgery including putting in stitches. They are sitting at the control station looking through a stereo optical system at the site where they are working. Surgery with the robot is a good thing for the patient because it only take a few very tiny incisions to get the manipulators inside. Those small incisions are less disruptive to intervening tissue like muscle and they heal faster with less chance of infection. If the surgeon couldn't use the robot, much larger, more disruptive incisions would be required and there'd be a better chance for complications after surgery.

A few years ago I had an opportunity to use one of the surgical robots that was being used for training. In that case I was only working on silicone blobs and not a real patient. I was able to make incisions and then put in stitches with a curved suture needle. Pretty cool stuff.

[John K Jordan]

https://www.bbc.com/news/education-46019429
Regards from Perth
Derek

We can do our part to help correct this - provide opportunities for young people to develop manual skills: woodworking, carving, welding, machining, painting, fiber arts, ceramics, target shooting, music lessons. (Well, for ceramics we go down the road to my potter friend's studio.)

Some are ahead of the curve. Two of my woodturning students are in veterinarian school - both have proven to be exceptional at the lathe with minimal instruction. However, they are both the kind of people who are interested and want experience in everything. I suspect in every medical school there are similar people - perhaps lacking a natural drive for such things will eventually divert the unexceptional to non-surgical or even non-medical careers. (Some people are in medical school because daddy is a doctor.)

JKJ

[Julie Moriarty]

Similarly the use of CAD systems for mechanical drawing instead of old fashioned drafting on paper, vellum, or Mylar has its own issues. I constantly receive customer drawings from yung engineer done on CAD systems which are elegant but unmanufacturable due to inadequate space to install all of the features.
On one job I ran we had to call in the engineer for every change. One wall was filled with electrical gear but the wall wasn't long enough to install everything shown on the print. I asked the engineer if we could move a disconnect to the adjacent wall. He looked at the print, then at the wall and the disconnect and the spacing of all the other gear (it was tight) and back at the print. Then angrily he points to the print and says to me, "It all fits here!"

[Bill Carey]

On ... "It all fits here!"

LOL. Been there. Ran a job to install new escalators in the middle of an open department store in NY, and the conc was 2' off. The engineer cam out and said, Well, that's supposed to say 23'. Like we should have known that the 21' on the drawing was wrong. I mean, you just erase it and draw it again in the right place, right? What's the big deal?

[Bert Kemp]

Similarly the use of CAD systems for mechanical drawing instead of old fashioned drafting on paper, vellum, or Mylar has its own issues. I constantly receive customer drawings from yung engineer done on CAD systems which are elegant but unmanufacturable due to inadequate space to install all of the features. When a part 1" x 1" shows up on a screen filling almost the full screen it is easy for the engineer to pack 10 pounds in the proverbial 5 pound bag. Unfortunately at times technology doesn't substitute for common sense.

I think engineers should be required to build and use what they design that way we might get some usable , fixable products LOL

[John K Jordan]

I think engineers should be required to build and use what they design that way we might get some usable , fixable products LOL

Automobile (and truck and even lawnmower) designers should be required to service every part they put in the vehicle. I can't count the number of times I've encountered parts that were extremely difficult to access, places no normal human could reach, sometimes requiring me to build or buy and expensive tool.

When my architect son started school an architect friend told him there are four things an architect needs to know.
1. how to get the work
2. how to design the project
3. how to get it built
4. how to get paid

All are important but #3 is the kicker. When doing inspections on construction sites I can't tell you how many stories I heard from contractors and workers about something the architect designed that was difficult or even impossible to build. Some arbitrary things were possible but grossly inefficient and overly expensive - for example the architect who specified 16'2" dimensions when he should have known that a 16' board is cheaper than a 14'. With some feedback, one firm actually started thinking about this.

JKJ

[Julie Moriarty]

LOL. Been there. Ran a job to install new escalators in the middle of an open department store in NY, and the conc was 2' off. The engineer cam out and said, Well, that's supposed to say 23'. Like we should have known that the 21' on the drawing was wrong. I mean, you just erase it and draw it again in the right place, right? What's the big deal?

And that points to the hands off environment CAD has given us. When you make a mistake, hit Ctrl-Z and it's erased. When drawing with pencil and paper, there's a lot of erasing and redrawing to do so you naturally put in more thought before proceeding.

Our electronic world may have made things easier but it has also taken us away from living in the real world with the human element at its foundation. Kinda like what's happening with the smartphone generations. Every human interaction is done through an electronic device. Makes me wonder how these new generations are at reading facial expressions and vocal inflections.

[Vincent Tai]

Our electronic world may have made things easier but it has also taken us away from living in the real world with the human element at its foundation. Kinda like what's happening with the smartphone generations. Every human interaction is done through an electronic device. Makes me wonder how these new generations are at reading facial expressions and vocal inflections.

We watch Netflix and gauge human interaction as unfolds before our eyes.

I'm only half kidding. Plenty of people still get a good amount of proper human interaction. I think. Hope. Yikes I need to stop making tools for day and see another human.

[Thomas L Carpenter]

For the last several years before I retired I interviewed entry level chemists for lab positions. I always said that undergraduate chemists should have taken shop in high school so they would know how to do basic repairs on instruments. Word must have gotten out because one of them answered my favorite question (what do you do for fun?) with "I like to do roofing for Habitat for Humanity". Hired her immediately.

[Rod Sheridan]

As a society we don't like to pay for things, whether they be taxes for infrastructure such as a good education, or for a piece of furniture, art, sculpture etc produced by a crafts person.

We are simultaneously rejecting craft, as well as education in our society.

It kind of makes you wonder where we want to head, as a society........Rod.

[Lee DeRaud]

This thread is somewhat like a hammer and nail gun topic! A lot of people don't know how to use a hammer.And some of us who know how, simply can't.

Between my lack of depth perception (congenital) and my impact-intolerant elbow and shoulder (age-related), I think the guy who invented the nail gun ranks right up there with Isaac Newton.

[Julie Moriarty]

It kind of makes you wonder where we want to head, as a society........Rod.
Talk to your smartphone and let it do all the work. That's where we're headed.

[Roger Feeley]

Professor Kneebone? I had to look and be sure it was a real news site when I saw that name.

The surgeon that replaced my knee is named Bohn. Great surgeon and a really nice guy.

I mentioned it to my GP and he said, "That's nothing, we have a liver specialist in town named Boozer."

You have to wonder about the day when the med students choose their specialties. They get to Dr Bohn and everyone just sort of expects them to specialize in orthopedics.

[Jim Koepke]

When my architect son started school an architect friend told him there are four things an architect needs to know.
1. how to get the work
2. how to design the project
3. how to get it built
4. how to get paid

Sadly one thing architects seldom know is how to move furniture or appliances. My family was in furniture and appliance retail. We often felt homes and apartments would be designed very differently if every architect was required to move furniture and appliances for a couple of years.

jtk

[Lee DeRaud]

Sadly one thing architects seldom know is how to move furniture or appliances. My family was in furniture and appliance retail. We often felt homes and apartments would be designed very differently if every architect was required to move furniture and appliances for a couple of years.My favorite was a friend's two-bedroom apartment: living room, kitchen, and half-bath downstairs, bedrooms upstairs.

With a small wrought iron spiral staircase connecting the two. Most of the bedroom furniture had to be hoisted up to the balcony, and of course that meant everything had to be humped the long way around the building from the parking lot. When he moved out, he also had to pay to have the two trees outside trimmed to make room for the extraction.

[Rick Potter]

We need an Ap so the kids can stitch with their thumbs. :p