Am I cut out to be an ENT doc?

[jsong812]

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So here's my dilemma. I'm currently a m4 doing my sub-i at an away institution. I fell in love with otolaryngology during my m1 year and since then, I've never looked back. I've got the grades and test scores to put myself in pretty good shape for matching but after doing 5 weeks of otolaryngology, I sometimes second guess my physical abilities to be a head and neck surgeon. As fascinating as some of the procedures are, I always wonder whether I'll have the fine motor skills to be successful. You see, I've never been the type to be good with their hands. And even when I'm trying to close a wound, I have this nervous tremor that's hard to shake; or when i try to pick up something with my non-dominant hand, I have a hard time keeping it steady. I tell myself it's just the nerves and that I'll get over it but I'm starting to get a little self-conscious and wonder whether I even belong in this field. So my question is, how much of being a good surgeon is naturally being gifted with you hands? and how much of it is just learning? I keep telling myself that's why residency is 5 years long but I just can't hep but to feel otherwise...and it's kind of depressing now because I worked so hard to get here and now I'm having second thoughts. Any input, especially from attending/residents would be greatly appreciated. Thanks

 

[Pir8DeacDoc]

My thought is of every ten folks that you see, one of them is extremely gifted with their hands, i.e. a natural. One of ten is horrible with their hands and probably won't make a good surgeon. The other 8/10 are somewhere in the middle, having to work hard (to varying degrees) at being a good surgeon. There are ways to learn to steady the hands and I imagine you'll find as you get more comfortable things will get easier. Being a student evokes a lot of nerves and it can be tough. Don't let this stand in the way of things if you really are set on being an ENT otherwise. If you love the field my guess is things will work out.

Good luck!

 

[robosurgeon]

My thought is of every ten folks that you see, one of them is extremely gifted with their hands, i.e. a natural. One of ten is horrible with their hands and probably won't make a good surgeon. The other 8/10 are somewhere in the middle, having to work hard (to varying degrees) at being a good surgeon. There are ways to learn to steady the hands and I imagine you'll find as you get more comfortable things will get easier. Being a student evokes a lot of nerves and it can be tough. Don't let this stand in the way of things if you really are set on being an ENT otherwise. If you love the field my guess is things will work out.

Good luck!

haha that's a cool observation. definitely helps. i also doubt myself but i have no idea yet of where i stand with my hands

 

[resxn]

I believe that "natural" surgeons don't have "good hands" because they are steady. I think the natural surgeons are those that innately understand tissue.

I can tell you that it is indeed about 10% of med students that I see who understand, innately it seems, tissue planes, how to handle tissues, when to move your hands (not how well they do it), where to move their hands, how to move tissue, how to retract and how not to.

I'd 10x rather have someone who understood tissue that a robot who had steady hands that just did what I said.

Of the 90% who don't have this innate ability, most can learn it, some exceptionally well, others not so much.

There's always an ability to help with a tremor or something like that. It's much harder to teach someone anticipation. It takes a lot of observation and a desire to learn if it's not natural, but it can be done. If you love it, you'll be successful.

 

[ZagDoc]

I believe that "natural" surgeons don't have "good hands" because they are steady. I think the natural surgeons are those that innately understand tissue.

I can tell you that it is indeed about 10% of med students that I see who understand, innately it seems, tissue planes, how to handle tissues, when to move your hands (not how well they do it), where to move their hands, how to move tissue, how to retract and how not to.

I'd 10x rather have someone who understood tissue that a robot who had steady hands that just did what I said.

Of the 90% who don't have this innate ability, most can learn it, some exceptionally well, others not so much.

There's always an ability to help with a tremor or something like that. It's much harder to teach someone anticipation. It takes a lot of observation and a desire to learn if it's not natural, but it can be done. If you love it, you'll be successful.

With my experience as a MS4, most definitely agree with this. Next time you're in the OR, take a few minutes to watch what everyone does with their arms and hands instead of their instruments. There's lots of little tricks to help steady your hands. You'll see people resting their hand on the army navy, on the patient, on the hand of the person holding the suction. You'll see people extend their pinkie to brace their hand against something or fulcrom their wrist if they have to retract at a more right angle. You'll see people tuck their elbows in close or lean closer into the operative field. You'll also find a part of it is simply nerves and things, especially sewing, become easier as you gain comfort and confidence.

That being said, learning the art of the dissection and being able to predict how to best assist the lead surgeon has a much steeper learning curve. After scrubbing over 100 cases, there's some days I get it, and other days I still suck at it.

 

[Pir8DeacDoc]

Thanks for clarifying resxn. When I put "great hands" I really meant more than just steady hands. That really doesn't mean much, as you mentioned. Ability to understand tissues, proper countertraction, and economy of motion are things that few people have innately. Some folks seem to have that and it makes learning the operation much easier, IMHO. For the record I fall into the has to work at it crowd.

 

[neutropeniaboy]

Don't worry about a "nervous tremor." No one is perfectly steady. I have a tremor if I've had too much coffee that morning. After doing a trauma case with a lot of retracting, drilling, and screwing, it's very obvious.

Under the microscope, you'd think it would be magnified. But, I agree with everyone else. You find ways to rest your hands to stabilize them as you do your work. If you can steady your hands on the patient, a retractor, an assistant's hand, or whatever, then you are golden.

Surgery can be learned. Skills can be acquired. Don't worry about this. There's never been any correlation between your surgical skills as a medical student and how good of a surgeon you will be when you finish. (However, I do think that if you didn't play video games as a child [adult??? especially FPS], you'll never be good!)

 

[OtoHNS]

Surgical skill can definitely be learned (I'm living proof).

If I were you, I'd steal some suture from the OR and practice knot tying and suturing/instrument tying at home. Pigs feet was the classic thing to practice suturing where I trained.

Start by learning good technique and doing it very slowly and once you get that down, you can gradually speed up until you're a badass. Make sure you get attendings and/or senior residents to critique you so you don't practice bad habits.

 

[Bigpwn]

How do you do when you are practicing knot tying at home? I'm PGY3 now, and I can tell you that key of doing well intraop is be confident and be comfortable. Doesn't matter how "talented" you are, you are not going to do well in a mastoidectomy if you don't support your hand during drilling.

You should also pick up a game console if you don't have one already. I actually think it helps with hand eye coordination. That was my excuse for buying a PS3