Dexterity and Fine Motor Skills needed for Psychiatry?

[asdfat]

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[MacDonaldTriad]

as a psychiatrist how often if ever do you need to utilize fine movements?

Never. If you can type on a key board, your good to go.

 

[heyjack70]

Not fine motor skills, but I've had to use gross motor skills to get away from a violent patient with psychosis.

 

[whopper]

You don't need it IMHO unless you're going to duck when a patient is about to punch you. Such skills aren't needed in outpatient, but in ER and involuntary inpatient yes. You don't necessarily need them if you're smart, savvy and the hospital has good security.

I sometimes tell medstudents that I think psychiatrists will have the longest shelf-life among physicians because we don't have to stand 12 hours a day in a surgery, if we lose fine motor skills we can still practice, and we don't have to do long-extended shifts where we're on our feet all day in a chaotic situation where a dangerous patient could punch us at any moment.

My dad is a surgeon and his mind is all there but he can't keep up with the younger surgeons in terms of running to a code and staying up all night for calls.

 

[WingedOx]

You don't need it IMHO unless you're going to duck when a patient is about to punch you. Such skills aren't needed in outpatient, but in ER and involuntary inpatient yes. You don't necessarily need them if you're smart, savvy and the hospital has good security.

I sometimes tell medstudents that I think psychiatrists will have the longest shelf-life among physicians because we don't have to stand 12 hours a day in a surgery, if we lose fine motor skills we can still practice, and we don't have to do long-extended shifts where we're on our feet all day in a chaotic situation where a dangerous patient could punch us at any moment.

My dad is a surgeon and his mind is all there but he can't keep up with the younger surgeons in terms of running to a code and staying up all night for calls.

This also makes our disability insurance rather inexpensive... though not all that likely to pay out of course.

Still, on the "shelf-life" comment, I was always amused in my training at the number of guys in their 70s who could still drop in and do the job a couple times a month as a teaching experience for the students and residents, particularly on the therapy side.

 

[nitemagi]

You need fine interpersonal skills in therapy.

It's its own procedure.

 

[shan564]

The only time I've used fine motor skills is in med school and internship, but you could always avoid doing procedures (your senior will probably agree to do it for you) if you have a valid reason.

The only time I've used any real motor skills in actual psychiatric practice is when doing ECT, but that wasn't "fine" motor skills by any stretch of the imagination. In fact, my wrist was in a cast for a good chunk of my ECT rotation, and it didn't impair my ability to do it.

I shattered my wrist in a motorcycle accident and went back to work two days later (the only reason why I didn't go straight back to work the next day was because I also had a mild concussion, and the post-concussive symptoms would have impaired my ability way more than the wrist fracture). The only problem was that it was hard to type. I felt lucky to have chosen psychiatry at that time - in most other specialties, I probably would have had to take 1-2 months off work. I also had to take a day or two off after the subsequent surgery, but that was because I was high on opiates, not because of the wrist itself.

 

[Bartelby]

Agreed, no fine motor skills needed. Also re: safety I am a PGY-IV and have never been struck by any patient (and I have done a lot of ER psych!), nor have any of the residents in my program in any of the four years during my time here. I think if I recall correctly ER physicians are at higher risk of assault than we are. Just use common sense if you see warning signs (jaw clenching, fist clenching, angry/intimidating actions, voice raising, violating personal space, etc) and de-escalate, get security, or give the person space to cool off and come back later.

 

[masterofmonkeys]

No need. I've got nerve damage and haven't been sued yet! seriously though. I'll have one arm or another in a sling for the next 6 months and I'm taking a grand total of 4 days off for that (2 for each surgery).

 

[Shikima]

No need. I've got nerve damage and haven't been sued yet! seriously though. I'll have one arm or another in a sling for the next 6 months and I'm taking a grand total of 4 days off for that (2 for each surgery).

Wouldn't it be easier if you just cut them off?

 

[splik]

The only time I've used fine motor skills is in med school and internship, but you could always avoid doing procedures (your senior will probably agree to do it for you) if you have a valid reason.

are there not any required procedures of med students? I actually don't know, maybe this depends on where you went to school? We had to do venipuncture, insert IVs, do ABGs, insert an NG tube, foley catheterization for men and women, give IM and IV injections, deliver a baby etc in order to graduate

most of these arent things that interns and residents do in this country so maybe none of this is required?

 

[clausewitz2]

Great, I figured considering the national shortage for psychiatrists that some medical schools wouldn't mind making a few accommodations if necessary.

Apart from the schools that have rural leadership tracks and a few with accelerated family med tracks, most medical schools aren't going to treat you any differently based on what specialty you go into. Do not expect any slack because you want to go into something underserved outside one of those special programs. Almost every medical student says they want to work with underserved populations in their applications, even the ones who wind up in integrated cosmetic radiation neuroderm.

What might be useful to address your concerns is look at the schools you are interested in, and find their "technical standards." These will include the motor skills you have to matriculate. If you have a problem meeting these, they are within their ADA-given rights to say "sorry, no, can't accommodate you reasonably."

 

[clausewitz2]

are there not any required procedures of med students? I actually don't know, maybe this depends on where you went to school? We had to do venipuncture, insert IVs, do ABGs, insert an NG tube, foley catheterization for men and women, give IM and IV injections, deliver a baby etc in order to graduate

most of these arent things that interns and residents do in this country so maybe none of this is required?

I was required to do a few things on surgery and obgyn. But on surgery we were allowed to count doing these things to simulators, so the requirement had approximately zero teeth.

 

[J ROD]

are there not any required procedures of med students? I actually don't know, maybe this depends on where you went to school? We had to do venipuncture, insert IVs, do ABGs, insert an NG tube, foley catheterization for men and women, give IM and IV injections, deliver a baby etc in order to graduate

most of these arent things that interns and residents do in this country so maybe none of this is required?

I had most of these requirements and a few more.

 

[hamstergang]

are there not any required procedures of med students? I actually don't know, maybe this depends on where you went to school? We had to do venipuncture, insert IVs, do ABGs, insert an NG tube, foley catheterization for men and women, give IM and IV injections, deliver a baby etc in order to graduate

most of these arent things that interns and residents do in this country so maybe none of this is required?

I never inserted an IV, an NG tube, or a foley (I once did pull a foley out, and got urine on the resident...). I never gave an IM or IV injection. I never delivered a baby (I was there, gloved up and all, but the resident did the work).

I did do some venipuncture, one ABG, and sutured once. I attempted an LP once but the patient was difficult so I failed (neurosurgery resident took a loooooong time to make it work).

I don't know what's required and what's not but I did graduate 4 years ago.

 

[WalterDonnie]

my school doesn't have any procedure requirements. Even if the school you goto does, I'm sure the ADA would cover you. I wouldn't worry much. You will probably have to write with a pen quite a bit though.

 

[clausewitz2]

So here's a representative sample of technical standards from the first result in a Google search (happens to be from Cornell):

"Motor: A candidate must have sufficient motor function to carry out the basic laboratory techniques and to elicit information from patients by palpation, auscultation, percussion, and other diagnostic maneuvers, perform a dissection of a human cadaver, and have sufficient motor ability to use a microscope. A candidate should be able to perform a complete physical examination (including pelvic examination); diagnostic procedures (e.g., venipuncture and basic laboratory tests (e.g., urinalysis)) A candidate must be able to execute motor movements reasonably required to provide general care and emergency treatment to patients. Examples of treatment reasonably required of physicians are cardiopulmonary resuscitation, the administration of intravenous medication, the application of pressure to stop bleeding, the suturing of simple wounds, assisting in surgical operations, and the performance of simple, general obstetrical and gynecological procedures. Such actions require coordination of both gross and fine muscular movements, equilibrium and functional use of the senses of touch, vision, and hearing. "

 

[Shikima]

Float like a butterfly, sting like a bee.

Words to remember when doing ER psychiatry.

 

[milesed]

There was a trainee 3 years behind me who I also had as a med student with CP. It impaired her gait, fine motor and speech a bit, but she made it through fine. It took her a bit longer to complete things, but she did it. Her tenacity and work ethic were very impressive and she never asked for any type of accommodations.

 

[shan564]

are there not any required procedures of med students? I actually don't know, maybe this depends on where you went to school? We had to do venipuncture, insert IVs, do ABGs, insert an NG tube, foley catheterization for men and women, give IM and IV injections, deliver a baby etc in order to graduate

most of these arent things that interns and residents do in this country so maybe none of this is required?

I went to med school in Australia, where interns/residents do a lot of these procedures, but you could get away with not doing any of those things during med school and just learning them as an intern. I didn't go out of my way to seek those opportunities, and also didn't go out of my way to avoid them... but it wouldn't have been too hard to avoid them if needed.

I've noticed the same thing when teaching med students here in the US. Many of them have never done most of those procedures, although some may be required (since I've never been an intern on surgery or Ob/gyn, so I'm not sure what they require).