Surgery without great technical skill

[eliteeli]

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Hi all!

So I'm starting Med school in August and obviously this is extremely early on but I figured I would ask this anyway. Among a bunch of other potential specialties, I think that I would be interested in potentially going into surgery. I happen to not be too great with my hands and don't have the best technical/fine motor skills. Would this be prohibitive? Or is it the type of thing that if you practice working on it for a while you don't need to be naturally skilled beforehand?

Input from an actual surgeon would be great if possible!

Thanks

 

[woltej1]

there are specific exercises you can do to tune your fine motor skills, but obviously with anything there are those who are born naturally better at it and those who can't do it if their life depended on it. If you fall somewhere in the middle of the bell curve then you should be able to learn just about any skill with enough focus and practice.

 

[SouthernSurgeon]

This is a question that comes up quite frequently. If you do a search function there are lots of helpful threads.

The quick summary:
(A) Traditional teaching is that learning how to operate is actually the easiest part of learning to be a surgeon. Learning the clinical judgment is harder. There is an old saying among programs directors that you can teach a monkey how to operate, but not how to be a surgeon.

(B) On the other hand, technical skill clearly matters, and is going to be a point of increasing emphasis in the future. There was an article last year in the NEJM correlating technical skill with patient outcomes - and more and more research on this subject is coming down the pipeline.

(C) There really are some people who cannot operate. We had someone drop out of our program after essentially realizing this during their residency. This commonly happens after the 2nd or 3rd year as you get more and more experience doing big and challenging operations. These are outliers though. For some it is just poor motor skills, for others it is poor spatial and cognitive processing skills (e.g. cannot picture in their head how a vascular anastomosis should look and where to place the sutures - this resident could place a stitch just fine if you literally pointed where to put it in and where it should come out). There are also practicing surgeons on the very low end of the technical spectrum - the jokes about 007 ("licensed to kill") or HO-DADs ("Hands of doom and destruction") came from somewhere - and residents & OR nurses all know who these people are. In my mind some of them truly should not be allowed to practice, but the system and culture insulate these individuals (at least at the present, though hopefully that changes in a positive way in the future).

So what to do to put this all together? There are truly some people who can't do it - they are in the minority. There are others who can do it, but probably shouldn't. Still the minority but a greater number. There are definitely students who self-select themselves out of surgery when they realize they have low aptitude. But students are becoming so marginalized in the clinical wards and OR that they often don't even get the technical experience they need to figure that out. My advice for you would be to try it out and try to get as much hands-on experience as you can so that you can make an informed choice.

 

[gyngyn]

Hi all!

So I'm starting Med school in August and obviously this is extremely early on but I figured I would ask this anyway. Among a bunch of other potential specialties, I think that I would be interested in potentially going into surgery. I happen to not be too great with my hands and don't have the best technical/fine motor skills. Would this be prohibitive? Or is it the type of thing that if you practice working on it for a while you don't need to be naturally skilled beforehand?

Input from an actual surgeon would be great if possible!

Thanks

Almost anyone can be brought up to a minimally acceptable level of competence. In a denominator of hundreds of residents I can only recall 2 whose best efforts were inadequate to meet minimal standards.

Those with fewer gifts do have to work much harder and longer, though. It's like dancing. Some are just a delight from the first step, others will be able to do a serviceable job if they work hard at it (but it won't be pretty).

 

[ventulus18]

"I would like to see the day when somebody would be appointed surgeon somewhere who had no hands, for the operative part is the least part of the work."
Harvey Cushing

 

[SouthernSurgeon]

"I would like to see the day when somebody would be appointed surgeon somewhere who had no hands, for the operative part is the least part of the work."
Harvey Cushing

As you can probably tell from my post, I think this truism overstates things, although the underlying sentiment (that the cognitive side is more important than the physical part) is true.

 

[Mr Interesting]

Speaking of surgery guys, has that "Ask a general surgery resident" thread from Prowler been deleted? I can't seem to find it. I also haven't seen him in awhile on here.

 

[SouthernSurgeon]

Speaking of surgery guys, has that "Ask a general surgery resident" thread from Prowler been deleted? I can seem to find it. I also haven't seen him in awhile on here.

His account looks to have been deactivated to me? It comes up as a number rather than a name which is what happens when someone deactivated their own account (ie not banned)

 

[Mr Interesting]

His account looks to have been deactivated to me? It comes up as a number rather than a name which is what happens when someone deactivated their own account (ie not banned)

Ah that sucks... I sure would love if a surgery resident would start one of those again 🙄😛

 

[mimelim]

I'm on Trauma call all the rest of this week, but I'll make one later if SouthernIM (or someone else) doesn't want to.

 

[Mr Interesting]

I'm on Trauma call all the rest of this week, but I'll make one later if SouthernIM (or someone else) doesn't want to.

Thanks, loved your previous Vascular intern thread. Would love to hear how things have been since your intern year.

 

[mmmcdowe]

You can always use to ask a neurosurgeon thread too to get another opinion.

 

[Mr Interesting]

Oh... guess I could have done that lol thanks for the suggestion.

 

[ventulus18]

As you can probably tell from my post, I think this truism overstates things, although the underlying sentiment (that the cognitive side is more important than the physical part) is true.

There is a range of fine motor control needed in (neuro)surgery. Everybody gets better with practice, the learning curve can be steep, and there is always room to get better.

Aneurysm clipping = technical


Decompressive craniectomy = not as technical

 

[Wasted Energy]

I asked a surgeon I was shadowing this question a while back. His response was that "We could teach a monkey to do it." n=1

 

[La Presse]

Isn't @Winged Scapula a surgeon?

 

[Winged Scapula]

Isn't @Winged Scapula a surgeon?

Yes...

 

[La Presse]

Yes...

Was kind of hoping for some deep insight on the quality of surgical skill you've observed from surgical residents and beyond. 😛

 

[mrh125]

If you're a great standardized taking robot you can probably at least match into surgical residencies because of how much scores count. That counts.

 

[Winged Scapula]

Was kind of hoping for some deep insight on the quality of surgical skill you've observed from surgical residents and beyond. 😛

I am not capable of deep insight on a sunny Sunday afternoon while shopping for new pretty shoes and clothes to wear to conference next week. 😛

Suffice it to say that most are average; a very technically gifted resident comes along rarely. One of the best I ever saw in residency was one of my senior residents: he's a surgical oncologist at Hopkins now. I have seen some below average residents as well; mostly what bothered me about them was the lack of thoughtfulness and purpose in their movements.

 

[Optimus-Prime]

how do you guys feel about the da vinci??

 

[gyngyn]

I have seen some below average residents as well; mostly what bothered me about them was the lack of thoughtfulness and purpose in their movements.

I can't bear "please" and "thank you" every time they ask for an instrument, like I'm at some kind of tea party...

 

[chillaxbro]

Impress adcoms by purchasing a Da Vinci robot and practicing

 

[Optimus-Prime]

Impress adcoms by purchasing a Da Vinci robot and practicing

I've heard it corrects any sort of tremor, gives greater dexterity, etc. However patient outcomes aren't drastically different.

Got a family member in gen surg residency who feels it has potential though

 

[gyngyn]

I've heard it corrects any sort of tremor, gives greater dexterity, etc. However patient outcomes aren't drastically different.

Got a family member in gen surg residency who feels it has potential though

No one will ever let a "robot" deliver their baby!
Paradoxically, you can teach a monkey to do a section...

 

[SouthernSurgeon]

how do you guys feel about the da vinci??

I suggest checking out a blogger named skeptical scalpel. His posts on the robot pretty much sum up how a great many people are starting to feel about it.

Da Vinci also just pissed a ton of people off by going back on their word about backwards compatibility and their newer model that just got released.

 

[caffeinemia]

I love doing skin tag excisions and condyloma fulgurations with my davinci. It really reduces the recovery time!

 

[ventulus18]

For those interested, great essay on the learning curve as it applies to the technical aspects of surgery:

http://www.aansneurosurgeon.org/210613/6/3008

 

[Leoz M Jiliums]

For those interested, great essay on the learning curve as it applies to the technical aspects of surgery:

http://www.aansneurosurgeon.org/210613/6/3008

Brilliant, thanks for sharing!

 

[tiedyeddog]

Hi all!

So I'm starting Med school in August and obviously this is extremely early on but I figured I would ask this anyway. Among a bunch of other potential specialties, I think that I would be interested in potentially going into surgery. I happen to not be too great with my hands and don't have the best technical/fine motor skills. Would this be prohibitive? Or is it the type of thing that if you practice working on it for a while you don't need to be naturally skilled beforehand?

Input from an actual surgeon would be great if possible!

Thanks

You will learn it during your training.

 

[tiedyeddog]

His account looks to have been deactivated to me? It comes up as a number rather than a name which is what happens when someone deactivated their own account (ie not banned)

Oh wow, that is incredibly disappointing to me...

I remember talking to him in these forums as he started medical school... He must be either a chief or attending by now. Sad to see he is no longer posting, always contributed in a positive way. 🙁

 

[487806]

Oh wow, that is incredibly disappointing to me...

I remember talking to him in these forums as he started medical school... He must be either a chief or attending by now. Sad to see he is no longer posting, always contributed in a positive way. 🙁

Yeah definitely agree. Prowler was an awesome resident, but now that he's gone, I'll have to sadly replace him with his counterpart @southernIM 😍

 

[repititionition]

http://www.nejm.org/doi/full/10.1056/NEJMsa1300625

 

[DermViser]

This is a question that comes up quite frequently. If you do a search function there are lots of helpful threads.

The quick summary:
(A) Traditional teaching is that learning how to operate is actually the easiest part of learning to be a surgeon. Learning the clinical judgment is harder. There is an old saying among programs directors that you can teach a monkey how to operate, but not how to be a surgeon.

(B) On the other hand, technical skill clearly matters, and is going to be a point of increasing emphasis in the future. There was an article last year in the NEJM correlating technical skill with patient outcomes - and more and more research on this subject is coming down the pipeline.

(C) There really are some people who cannot operate. We had someone drop out of our program after essentially realizing this during their residency. This commonly happens after the 2nd or 3rd year as you get more and more experience doing big and challenging operations. These are outliers though. For some it is just poor motor skills, for others it is poor spatial and cognitive processing skills (e.g. cannot picture in their head how a vascular anastomosis should look and where to place the sutures - this resident could place a stitch just fine if you literally pointed where to put it in and where it should come out). There are also practicing surgeons on the very low end of the technical spectrum - the jokes about 007 ("licensed to kill") or HO-DADs ("Hands of doom and destruction") came from somewhere - and residents & OR nurses all know who these people are. In my mind some of them truly should not be allowed to practice, but the system and culture insulate these individuals (at least at the present, though hopefully that changes in a positive way in the future).

So what to do to put this all together? There are truly some people who can't do it - they are in the minority. There are others who can do it, but probably shouldn't. Still the minority but a greater number. There are definitely students who self-select themselves out of surgery when they realize they have low aptitude. But students are becoming so marginalized in the clinical wards and OR that they often don't even get the technical experience they need to figure that out. My advice for you would be to try it out and try to get as much hands-on experience as you can so that you can make an informed choice.

I think that's the worst part IMHO. General Surgery rotations have become to where one can go the entire rotation without actually showing any surgical/knot-tying skills. Even the NBME shelf exam is nearly all medicine. So students that get an "Honors" on the rotation truly believe they're cut out for surgery, when they may have the knowledge but not the technical skill.

 

[487806]

I'm on Trauma call all the rest of this week, but I'll make one later if SouthernIM (or someone else) doesn't want to.

Hip hip hooray!

 

[SicEmBears]

For those interested, great essay on the learning curve as it applies to the technical aspects of surgery:

http://www.aansneurosurgeon.org/210613/6/3008

Amazing read!

If anyone is interested in reading a book that deals with the idea of learning technical skill, the question of the "gut-feeling," and theory of surgical training, read Complications by Atul Gawande. He has fascinating thoughts about the "imperfect science" of medicine and surgery, and compellingly illustrates it with his own cases.

 

[QuinnTheEskimo]

I can't imagine why you would want to do surgery if manual dexterity is your weakness.

 

[eliteeli]

Thanks for all of the insight guys!

 

[Perzt]

http://www.nejm.org/doi/full/10.1056/NEJMsa1300625

The top-rated surgeon would likely score low on a tremor test for residency screening.. Lol

 

[Xenoblade]

I have seen some below average residents as well; mostly what bothered me about them was the lack of thoughtfulness and purpose in their movements.

I know exactly what you mean here. I have problems with this at times but I try to think about my movements, especially if I don't want to fish out some nut that I dropped in the engine of my car due to my carelessness.

 

[ridethecliche]

When I'm in the OR, watching some of the attendings operate is mesmerizing.

 

[TheRobin]

play more video games, seriously

Dat Fifa skill.