Dexterity assessment of hospital workers: prospective comparative study

Key findings

The Tremor study found that surgeons on average were quicker and more successful at completing the buzz wire game within five minutes compared with other hospital staff roles; although, they were more likely to swear while completing the task. This difference remained evident even after accounting for baseline differences in age and gender between groups and when analysed over two minutes.

Findings in relation to the available evidence

The buzz wire game might be a reasonable tool for assessing manual dexterity because the tool evaluates fine motor skills, hand and eye coordination, steadiness, handling stress, and provides objective data within an inexpensive and simple solution. Although not formally validated as a measure of manual dexterity, previous studies have found the buzz wire game performs comparably to other validated tools of dexterity.5 Moreover, it counts any haptic feedback as an error, preventing participants feeling their way through the task and provides a true assessment of manual dexterity.5Similar style wire loop games have been used in earlier studies assessing dexterity, fine motor skills, and hand-eye coordination.6

Previous research has suggested that surgeons’ propensity for swearing might be a coping mechanism for high pressure situations to help them maintain skill despite stress.78 Nurses and non-clinical staff showed relatively good game completion rates and were most likely to express noises of frustration. Physicians swore less and had the lowest level use of noises of frustration. Our findings both align with and diverge from previous studies. Squire and colleagues found no dexterity differences between medical and surgical residents, contrasting our results.1 Constansia and colleagues reported no correlation between surgical subspecialisation and dexterity, with dexterity negatively correlating with age.2 Our study, however, showed surgeons outperforming other groups of healthcare workers, maintaining superior dexterity across age groups. These contrasts highlight the complexity of assessing manual dexterity in healthcare settings. Our use of the buzz wire game and broader participant range might offer new insights into dexterity distribution across hospital roles.

Nature versus nurture

Although tremor was observational in nature, and hence not designed to determine reasons for the observed differences, a possible explanation for the better performance of surgeons compared with other hospital staff roles might be due to either a training effect or innate ability. Surgeons undergo extensive training and continue to use their hands daily while operating. Over time, frequent operating might enhance hand and eye coordination and their ability to complete tasks such as the buzz wire game. Conversely, surgeons might be a self-selected group for whom tasks requiring hand and eye coordination is appealing, or individuals with poor manual dexterity might not progress through surgical training. Doctors who find manual tasks challenging might also be attracted to other specialties; although, this explanation might in part be refuted by the observation that some medical specialties include interventional procedures. Additionally, these hypotheses do not explain the observed difference between surgeons and nursing staff, suggesting some degree of a training effect. To definitively answer this question, twin studies comparing surgeons and non-medical siblings are required, although feasibility might be challenging.

Implications

These data provide surgeons at Leeds Teaching Hospitals with boasting rights regarding their dexterity skills, in both the operating theatre and the coffee room. In the future, assessments such as the buzz wire game could be included in the training programme for surgical trainees to develop fine motor skills. Another potential use of the buzz wire game might be as a tool to streamline cumbersome interviews for specialty training programmes. Future studies should examine the clinical and cost effectiveness of such approaches for the wider NHS and how these may seamlessly integrate into practice. Staff members in specialties with lower performance might consider adding the buzz wire game to their Christmas wish lists for use as a training tool.

Although surgeons performed better than other groups, their use of swearing was higher. Surgeons, and those working with surgeons, might wish to consider investing in a swear jar or similar intervention aimed at reducing swearing and optimising composure during challenging tasks; although, such interventions must be tested in prospective studies to ensure their effectiveness.

Limitations

Our study has important limitations that should be noted. Firstly, the use of a family game as an assessment tool may have introduced bias by potentially favouring people with young children or with other previous experience. People considering themselves to be more dexterous may also have been more likely to take part and the reasons for non-participation were not recorded. Secondly, confounding factors, such as prevailing stress, fatigue, and caffeine consumption at the time of the assessment might have affected performance because none of these factors was controlled. We attempted to mitigate this risk by recruiting participants away from direct patient contact, but the pattern of secondary care work is difficult to predict. Thirdly, although we recruited a diverse cohort of hospital staff from various roles, our study was conducted at a single NHS trust, which limits the generalisability. On one hand, some generalisability is met through the standardisation of healthcare training in the UK, meaning that healthcare staff have similar opportunities to develop their skills of dexterity. On the other hand, the study does not account for regional, national, or international differences in working patterns, activities, or resources, which might lead some professionals to develop their skills more than others. Fourthly, the Tremor study was observational in nature, and hence not designed to determine the reason for the observed differences between hospital staff groups. Fifthly, being observed might have resulted in a lower frequency of swearing (Hawthorne effect), or conversely that surgeons curtailed their foul language less than other hospital staff groups. Finally, our findings are not applicable to children younger than 4 years for whom the buzz wire game’s small parts may represent a choking hazard, although these individuals are unlikely to be currently employed in secondary care.

Conclusions

This study shows that surgeons at Leeds Teaching Hospitals have greater dexterity but higher levels of swearing when assessed using a buzz wire game compared with other hospital staff roles. Nurses and non-clinical staff showed commendable dexterity and expressed noises of frustration more openly, showing the diverse skill sets across hospital staff roles. Future training might benefit from incorporating family games to enhance both dexterity and stress management across all specialties. Implementation of a surgical swear jar initiative should be considered for future fundraising events.