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Surgery students 'losing dexterity to stitch patients' 
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A professor of surgery says students have spent so much time in front of screens and so little time using their hands that they have lost the dexterity for stitching or sewing up patients.

Roger Kneebone, professor of surgical education at Imperial College, London, says young people have so little experience of craft skills that they struggle with anything practical.

https://www.bbc.co.uk/news/education-46019429

Never though of surgery and craft skills in that way before.

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Tue Oct 30, 2018 9:12 am
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I'm sure I've read about how kids today have less manual dexterity due to "modern tech" - use of tablets at home as well at school. IIRC the normal milestones that indicate development were being re-evaluated (eg make a tower out of 9 blocks by age 3 years) as kids couldn't achieve it by this age. This had a knock on effect on "penmanship" where kids couldn't write properly with a pencil in primary school compared to the previous generation.

When I was a kid, I played with Lego, then Meccano and then Airfix models. The fun bit was in the time spent building. But I was always crap at bigger things - consequently, I can do soldering, wiring and "small things" but struggle with sawing wood in a straight line.

EDIT: Forgot to add - historically, a junior doctor would spend a decent amount of time in surgical fields (even if they wanted to be a cardiologist). A junior doc a couple of years out of medical school would have had experience from:
- dissection classes at medical school (an entire cadaver would be allocated to a team of students who would learn as they dissected and explored)
- as a final year medical student, they were allowed to perform appendectomies, drain abscesses - simple stuff
- would have spent six months minimum in the first year out of medical school on a surgical rotation where they would have spent time in theatre on a daily basis, typically assisting the operating surgeon

Now, you have teaching via prosection (prepared cadaver specimens with pins in denoting organs, nerves etc). Final year students are not allowed to operate. Even after training for a couple of years, you might be allowed to suture wounds closed. "Theatre time" was important - it counted a lot for experience. Now, how many audits you've done, or how many papers you've published appear to be more important than how much experience you've had in surgery.

I remember friends who had applied to dentistry had to take along some evidence of their hand-eye coordination (one friend took along a model they had built, another took a painting).

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Tue Oct 30, 2018 11:00 am
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cloaked_wolf wrote:
I'm sure I've read about how kids today have less manual dexterity due to "modern tech" - use of tablets at home as well at school. IIRC the normal milestones that indicate development were being re-evaluated (eg make a tower out of 9 blocks by age 3 years) as kids couldn't achieve it by this age. This had a knock on effect on "penmanship" where kids couldn't write properly with a pencil in primary school compared to the previous generation.


My wife being a primary school teacher is very keen that children learn skills like sewing and making things. She’s just done a sewing project with them, and she’ll have others planned.

A couple of years ago, I was asked to supervise year 5 children doing a Christmas sewing project. They had pre-made kits of tree decorations to sew up and stuff. The pieces were pre-punched for stitching. You could not, in a month of Sundays, get this wrong. Most of them could not do this simple thing. It was sewing, but you could see where to put the needle, but the majority of them just could not do this.

cloaked_wolf wrote:
When I was a kid, I played with Lego, then Meccano and then Airfix models. The fun bit was in the time spent building. But I was always crap at bigger things - consequently, I can do soldering, wiring and "small things" but struggle with sawing wood in a straight line.


I did too. I’ve just mended a clock. There was a bit missing, and I made a temporary bit (out of a piece of milk bottle plastic and some fuse wire) which will do until such time as I can get to a clock menders and ask for a proper piece. I also got the chime working, by tightening up a screw. Ha! Meccano, I thought. I had a massive box of the stuff as a child - both my parents had sets, so combined gave me masses of the stuff. My wife says I’m good at seeing how things work. I guess that’s Meccano and Lego.

So, a story for you. These are not new problems. In the late 1980s and 1990s, the need to teach practical stuff in secondary schools was being taken away. My dad taught metal work, wood work and technical drawing, and he saw the practical sides of his subjects reducing. He said he could get kids through GCSE exams without going into the workshop. He and his colleagues fought to keep them, and they were allowed to keep some workshop space. My dad was of the opinion that if you are going to work with materials, you might actually need to know how they feel in the hand, how they behave, how to work with it. He was also very, very keen on machine safety. If he taught you to use a lathe, you knew how to use it safely.

Spool forward to 1996, my final year at the Uni art school, and there were workshops for the industrial designers and model makers. The lecturer in charge of all of this found out what my last name was, and asked if my dad taught woodwork and metal work. I told him he did, and he asked me what school. I told him.

Everyone who went near their workshop needed a health and safety session. He said that everyone from that school knew how to use the equipment safely already. He also said that their abilities on the machines were beyond the standards they were running the remedial classes on. People were coming into those model making classes unable to use machines safely or competently, apart from, it seems, my dad’s school. He said if that school was on a student’s application, then he was confident that they knew what they were doing in the workshop with materials.

So, you know, there are people who are trying to push these skills forward, but the education system is very much stacked against practical stuff these days.

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Tue Oct 30, 2018 1:52 pm
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Completely agree about being able to pass exams without going into a workshop. Similarly, you can get quite far as a surgical trainee before you ever hold a scalpel. I'm on a doctors forum and they're discussing how overseas graduates are better skilled at surgery purely because they've had training and exposure to surgery earlier in their training. This is comparison to British doctors. The other issue they've mentioned is that, historically, if someone was crap at surgery, you could tell them so and stop them trying to progress further. Nowadays, it's down to failure of initial teaching and remedial training etc rather than just not having the knack for it. As a comparison, one of my best friends is training to be an orthopaedic surgeon. Ten years ago, he was doing work on a student house he'd bought with his parents. Stuff that I'd have no clue about. He was also hands-on in doing an oil change, brake fluid change, replacing the brakes, fitting a new clutch on his car etc. There's me at most able to change sparkplugs and light bulbs, and change a wheel at that stage. I've gone on to be a GP and the closest I get to surgery is joint injections and draining abscesses.

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Tue Oct 30, 2018 2:52 pm
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paulzolo wrote:
Roger Kneebone, professor of surgical education at Imperial College, London.

One really wonders if he got that job through merit, or is he well connected?


Tue Oct 30, 2018 9:05 pm
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ShockWaffle wrote:
paulzolo wrote:
Roger Kneebone, professor of surgical education at Imperial College, London.

One really wonders if he got that job through merit, or is he well connected?

:lol:

ISWYDT

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Tue Oct 30, 2018 10:26 pm
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