Surgical Skills/Procedures Question

I have what may be an odd question for Natalie, or Dave, or anyone else who has worked with med students/interns learning new procedures.
When learning new procedures, I have trouble with the “handedness” of the procedures. (I am a right-handed person who does many things left handed). I never know which hand to use to hold which piece of equipment, and so I get a little flustered while starting. For example it took me until my EM rotation to discover that I suture better left-handed. Once I learn the procedure, I can then usually do it with either hand, and do it as well or better than my peers, but… I know that it takes me longer to get those skills down initially while I work out what hand to use for what. During internship a busy resident probably won’t have the time or the patience required to give me that time, and I’ve found that attendings generally aren’t too patient with my “experimenting” to try to figure out if this is a right handed or left handed procedure for me. (It would be much easier if I was just fully left handed. Then at least people would expect me to do things backwards.) Obviously I’m not going into surgery, so this is not a HUGE issue, but I like procedures and I don’t want to be known as the slow intern. Anyway, my question is, have you encountered other students/interns with this problem, and do you have any suggestions, or know what worked for them? I always try to get a chance to get familiar with kits beforehand, if there are spare ones, or already opened kits, and I take every opportunity to practice procedures, but this isn’t always possible. I have my senior surgery rotation coming up. Any thoughts or suggestions? Thanks for any suggestions.
Epidoc (soon to be IMDoc, clearly not surgdoc).

Hi there,
I write with both hands, tie with both hands, suture with both hands and cut with both hands. It is imperative for a surgeon to use both hands and practice with both hands. The bottom line is that you can grab some extra suture from the OR, a needle driver and go home to practice suturing with both hands and figure out which one you are more comfortable using.
For the non-surgeon, I would not expect you to have any great rate of speed in terms of suturing or tieing as long as the ties hold. Again, since you will not be doing surgery and ligating vessels, most of your ties will be for tieing down lines which is rarely done these days (Stat-Locs are so much better than sutures for central lines and introducers).
Use any hand that you feel comfortable with and keep making those ties and sutures. If you have problems obtaining equipment, PM me and I will send you some (I have loads of needle drivers and sutures around my house).
The more you do a procedure, the more efficient you will become so I would not worry about speed at your level. By the end of next year, you should have more of an idea of where you will be putting your hands and how you will do lines. For example, I arrange things in my line insertion kits in the order that I will use them so I can just grab what I need and keep moving. My arrangement scheme is a personal one and you will develop your personal arrangements for these things.

Hi epidoc,
I write and eat and do other fine motor skills with my left hand… and tend to do major motor skills (throwing, batting, kicking) with my right side. I often have no idea when I start a skill which hand it’ll end up being and I often try both for a while before settling in to one side or another. If I was going to be a surgeon like Nat I would definitely practice with both sides.
I think if you did a lot of suturing in the ED that should be helpful for most of what you’ll do in surgery anyway, right? and I also found that practicing with pig’s feet (and, since I took an advanced anatomy course, cadavers) was very helpful in just getting a little more comfortable with skills like suturing. Not that I’m fast by any means–in fact, still kind of painfully slow–but not 100% incompetent at least.
Lately I’ve been tutoring 2nd years and I’ve learned something very interesting. The ones who are good at the physical exam are the ones who very diligently practice the physical exam. That should not be a surprise but sometimes I deceive myself into thinking that this kind of thing boils down to some kind of talent or inborn dexterity. It has become very clear as I watch people learn that although i’m sure there is variation in dexterity, the variation in skills is mostly due to the amount of practice. I find this both encouraging (it’s possible to get good at it) and discouraging (it’s only possible if you practice a lot!).
Good luck! and don’t let them start calling you a “meddie”!
–joe wright
PS: actual exchange heard btwn members of the surg team in the ED:
“Hey, where did the meddies go?”
“Shh, they’re here, don’t let them hear you call them meddies.”
“I wonder what they call us?”
“Jackasses, probably.”
“Yeah, probably.”
“You want to go get some soda?”

Thanks Nat and Joe,
Joe, you’re right, practice makes all the difference. It was a LOT of practice on the suture board and in the ER that made me pretty darn good at suturing (and helped me figure out which hand to use-- now I can do both). I guess it’s just with the whole handnesses issue I get nervous when learning the new procedures since I’m never sure which way I’m going to need to do it and it may take a little while to figure it out. And of course any new procedure is awkward at first. (The upside is once I do learn it I can usually do it with either hand pretty quickly). I’ll just have to take every opportunity to practice stuff.
So far no one has called me a “meddie”-- just a “flea to be”! The conversation overheard in the ED-- classic!