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Updated: Jan 10, 2026
Step By Step: Microsurgical training method combining two nonliving animal models
Published on: May 9, 2015
Challenges Experienced by Surgical Trainees With Small Hand Size: A Multi-Institutional Mixed Methods Study
Rebecca Tang1, Michael Kochis1, Dandan Chen1
1Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
Objectives:
Surgeons with smaller hand size experience ergonomic mismatch related to instrument design. We aim to describe the impact of these ergonomic disadvantages on the educational experiences of surgical trainees and identify strategies for mitigating such challenges.
Design:
A survey queried demographics, hand size, and perceived impact of hand size on completing operative tasks. Results were summarized with descriptive statistics, and perceived impact of hand size compared between residents with and without small hand size (SHS, defined as glove ≤6.5) via t-test. A subset of respondents including trainees with SHS and their educators completed semi-structured interviews further investigating their perspectives. Interview transcripts were analyzed using an inductive thematic approach.
Setting:
Three large academic medical centers.
Participants:
One hundred residents (51.0% response rate) and 123 attendings (49.6%) completed the survey. Eleven residents and 8 attendings were interviewed.
Results:
Residents with SHS noticed an impact of hand size on completing operative tasks 50.0% of the time, compared to 15.5% in residents without SHS (p < 0.001). Main themes surrounding the challenges facing surgical trainees with SHS included: (1) Technical challenges related to instrument handling, (2) Slower skill acquisition particularly in early years of training, (3) Negative psychological consequences for trainees including self-doubt and fear of judgment, (4) Negative impact on resident evaluations and operative autonomy, (5) Inadequate support from educators, and (6) Overcoming challenges through technical workarounds, deliberate practice, self-advocacy, and role-modeling.
Conclusions:
Surgical trainees with SHS face challenges that significantly impact their learning environment. Developing and practicing technical workarounds, self-advocating, and identifying role models allows trainees with SHS to overcome these challenges and become excellent surgeons. This study highlights the ongoing need for faculty development to increase awareness of this issue and improved instrument design for this growing sector of the surgical workforce.
