Have Medical Students Lost Their Dexterity? The Video Game Surgery Debate

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Thursday 1st November 2018

A debate has been sparked by a professor of surgical education claiming that surgery students have lost the dexterity to stitch and sew up patients because they spend so much time looking at screens and less time engaging in tactile activities. This argument has been counted by a number of doctors, surgeons and health professionals who claim that counter to this, spending time in front of a screen engaging in dextrous tasks has actually helped their skills.

Professor Roger Kneebone, who oversees Imperial College London’s surgical education, argued that young people struggle with any practical activity because they have very little experience of craft skills, and so cannot cut or sew accurately despite being highly skilled academically. Professor Kneebone has recommended a more rounded creative education to offset this issue, something that has been supported by the Edge Foundation, and former MP and current Director of the Victoria and Albert Museum, Tristam Hunt.

All three will speak on the subject at the V&A Museum of Childhood, where a report is to be launched highlighting the need for a more creative curriculum.

Professor Kneebone has said that many physical skills have been replaced with “swiping” on a flat screen and that removes the experience of handling materials and developing a prospective surgeon’s physical abilities.

By contrast, a number of professionals, from physiotherapists to junior surgeons to consultant surgeons to Professor Steve Wigmore from the University of Edinburgh’s surgery department, have not only argued that screen activities do not cause any issues to dexterity, but in fact could aid in dexterity or be good to warm up before performing certain kinds of surgery.

Paul Cowling, a consultant surgeon based in Leeds, recounted the story of a young junior doctor helping to retrieve a loose object from within a patient using keyhole surgical equipment. The doctor then cited his “Nintendo skills” as the reason he could do it so quickly.

Trainee surgeon Saied Froghi noted that his practice playing fast-paced games such as first-person shooter Halo or real-time strategy game Age of Empires helped when working with keyhole surgical equipment, as you are focused on a screen, using the system’s controls to move the instruments without looking. Intensive care registrar at Sheffield Teaching Hospital, Rajin Chowdhury, said gaming had made him more dextrous, as they improve hand-eye coordination and allow for better adaptation to unintuitive surgical situations, such as appendectomies, a keyhole surgery where due to the nature of how the camera is entered into the stomach, the controls are inverted.

Furthermore, Ashley James, a physiotherapist, noted that there is very little evidence that smartphone use by students has any effect on their dexterity. He cited a small study that showed frequent texters have slightly improved reaction times compared to people who text less frequently, with little difference in dexterity between the two. He goes on to say that he believes Professor Kneebone should not be quite as forthright with his claim.

The debate will likely continue, but it appears that the claim by Professor Kneebone is currently only backed by his own anecdotal evidence, and other medical professionals have a very different experience with technology, even arguing it has positive effects. In the end, the training and teaching of a given medical student will be the main key as to their quality.