No, Smartphones Aren't Making Med Students Less Dexterous

Arghavan Salles, MD, PhD


July 09, 2019

In late May, a colleague asked me what I thought of an article about surgical trainees published in the New York Times. The (faulty) premise of the piece is that medical student dexterity is in steep decline because trainees are growing up with smartphones, rather than playing piano or woodworking. My initial response to the article was surprise. I had not heard or participated in any such conversations about declining dexterity in today's students, despite my being heavily involved in medical education—surgical education in particular.

As I reflected on the article, I evolved from thinking it was controversial to being appalled that it was published, especially on such a large stage. I shared my thoughts in a thread on Twitter and wrote a letter to the editor of the New York Times, which has gone unpublished. I want to share with you what I believe are the flaws inherent in that article, and I also wish to suggest a different approach to medical education, one that doesn't blame learners.

A Lack of Data

The main supposition of the article is that faculty at medical schools in the United States and the United Kingdom have observed a substantial decline in manual dexterity among medical trainees. However, no academic study or research is cited; only anecdotal opinions and accounts are provided.

A quick search for "manual dexterity surgeons" pulls up multiple articles, most of which are irrelevant to the claims made in the New York Times article. One study from 1989 compared manual dexterity of medical and surgical residents and found no difference. Another study compared surgeons' dominant and nondominant hands; the results were mixed. A third study compared manual dexterity (as measured by carving soap) with surgical skills in terms of residency rank, cognitive skills, and decision making. No correlation was found. Strikingly, I could not find any data to support the suggestion that manual dexterity among students is decreasing.

In lieu of such data, I only have my own experiences. For 3 years, I was surgical director of the Washington University Institute for Surgical Education, where we trained medical students, residents, fellows, and others in surgical skills. I also am the co-chair of the Surgical Education Research Group within the Association for Surgical Education. I have been attending the Association for Surgical Education annual meeting for over 10 years now. I can say, unequivocally, that before this article, I had never had a single conversation with any of my colleagues about a decline in student dexterity and had encountered no studies on the subject.

'A Direct Insult'

The concern about swiping and tapping on phones decreasing dexterity seems misplaced. Smartphones did not exist before 2007. Anyone who was 4 or 5 years old at that time would only be 16 or 17 years old today. Even someone who was 10 years old at the advent of smartphones would be only 22 years old now. None of these folks are old enough to be current surgical trainees. If a negative impact is to be perceived owing to "tapping and swiping," it is too soon to identify it among surgical trainees.

Another confusing aspect of the article is its focus on open surgery, despite the growing popularity of less invasive approaches. The author briefly acknowledges that minimally invasive procedures are more common today, and that manual dexterity may be less important for these types of procedures. She then cites one of the many articles written about the association of video games and laparoscopic skill acquisition.

In this study, those who played video games made fewer errors, performed faster, and had higher performance scores than those who did not. Despite these promising data, the author says that today's medical students—who "are 'all thumbs'—may be deficient in ways other than just dexterity." It's hard to read that as anything other than a direct insult to students' cognitive abilities, despite a complete lack of evidence documenting any such deficiencies.


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