The O'Connor Tweezer Dexterity Test as a Screening Tool for Hiring Surgical Hair Restoration Assistants

The transplantation of very large quantities of small hair-grafts has become the norm in hair transplantation; therefore, the surgical assistant who cuts and places the hair grafts into the recipient sites has become a key figure in the operation. Since this activity requires tremendous dexterity and patience, hiring the right individuals to perform this work can be a formidable task. Recently, the author has researched the topic of dexterity tests and discovered an invaluable hand-eye coordination test called The O'Connor Tweezer Dexterity Test, which accurately determines whether an individual will be able to perform the task of hair graft placement with speed and precision. Since utilizing this test during the interview process, it has been found to be an invaluable screening tool.

When researching the origin of hair transplantation in the United States, one invariably discovers the landmark article written by Orentreich in 1959. Originally, Orentreich's technique was performed with large punch-graphs ranging from 4mm to 5mm that eliminated alopecia, but left behind its well-known hallmark - the infamous "baby doll" appearance. Amazingly, these large hair grafts remained the sine qua non of hair transplantation until the late 1980s, at which time the ideas of Nordstrom, Bradshaw, Brandy, Marritt, Stough, Lucas, and Swinehart and Griffin began to take effect. This preaching conveyed the realization that large clumps of hair surrounded by large areas of bald skin are unsightly. Conversely, smaller bundles of hair separated by smaller areas of bald skin are much more aesthetically pleasing.

As smaller and smaller hair-grafts (ranging from 1 hair to 8 hairs per graft) were becoming more and more the norm, another problem began to develop for the hair restoration surgeon. With these smaller grafts came the reality that hundreds of these needed to be transplanted per session in order to transfer enough hair to make a significant impact on baldness. This, of course, equated to an increased amount of time to perform the surgery and a large medical staff of highly skilled individuals to complete the task.

THE SURGICAL ASSISTANT

As the number of grafts being transplanted skyrocketed, the role of the surgical assistant became even more crucial to the hair restoration surgeon. In order for a hair practice to sustain a quality result while making efficient use of the surgeon's time, it became necessary to hire and subsequently train several assistants to cut and place the multitude of hair-grafts being transplanted.

Individuals who are interviewed for the surgical assistant position often possess the necessary personal characteristics (i.e., compassion, friendliness, knowledge), but not the incredibly fine dexterity needed to perform this work, several of these individuals end up being released from employment once the surgeon discovers that he/she cannot perform the tasks of hair-graft cutting and placement effectively and quickly. Others who are not proficient at this work quit secondary to frustration.

Before utilizing the test discussed in this article, the author would usually ask the interviewee if he/she found fine work, like needlepoint, relaxing or frustrating. If this kind of work was considered enjoyable, the interviewee was given strong consideration -if it was considered frustrating, the candidate was felt not to be a good candidate for the job.

THE O'CONNOR TWEEZER DEXTERITY TEST

In an attempt to find a more effective way to screen these employees, the author researched various dexterity tests. Of these tests, the O'Connor Tweezer Dexterity Test (Lafayette Instrument Company, Lafayette, Indiana) was found to most effectively fulfill the needs of the author.

The vehicle for performing this examination is a 5 7/8 x 11 5/8 -inch board, which contains 100 holes 1/16 inch in diameter arranged in 10 rows of 10 holes, each spaced ½ inch apart. Into each of these holes, the individual inserts a pin that is one inch long and 1/16 in diameter. The pins that are to be placed are located in the upper half of the board in a pin well measuring 4 ¾ inches in diameter and ½ inch deep.

O'Connor Tweezer Dexterity Test board

The test measures the speed with which an individual can pick up pins or similar small items (i.e. hair-grafts) with tweezers one at a time and place them into the holes. It resembles the Finger Dexterity Test (also manufactured by Lafayette Instrument Company), but requires finer hand-eye coordination than the Finger Dexterity Test. It has been noted that some interviewees can score high on the finger Dexterity test and poorly on the Tweezer Test. The Tweezer Test is therefore the test of choice in the author's practice.

The package insert of this test states, "A high score on the tweezer test indicates manual aptitude for work involving precision and steadiness in the use of small hand tools, such as forceps in the hands of an anatomist, or surgeon, or biological laboratory worker, or the tweezers in the hands of a watch repairer or stamp collector." This statement obviously relates to hair restoration assistants who utilize very fine jeweler's type forceps to insert tiny hair-grafts into a large number of extremely small incisions or holes.

ADMINISTERING THE TEST

The subject should be seated comfortably at a table about 30 inches in height. The Tweezer Dexterity Test is placed in front of him/her about one foot from the edge of the table with the tray at the right if the interviewee is right-handed, or vice versa. It should be at an angle of about 90 degrees with the subject's working hand, but may be changed if so desired.

The examiner should read the instructions as stated in the package insert. The interviewee should be told that the board consists of 100 holes, each large enough to hold one pin; they are to pick up one pin at a time with the tweezers and fill the holes, placing one in each as fast as he/she can; and "They are to pick up the pins by the end opposite or farthest away from them and only use the hand in which they hold the Tweezers."

The examiner should show by gesturing that the holes are filled from left to right for a right-handed individual and each row is to be completed before the next is started. It is to be further explained that the elbow may rest on the table, but no other hints are to be given. The interviewee should then be allowed to place 10 pins (and no more) in the top line for practice. After the allowance of a moments' rest, the test is begun with a stopwatch. The number of seconds that it takes to place all 100 pins is then recorded as the score and it is analyzed.

INTERPRETATION OF PERFORMANCE

The early norms for this test were based for the most part on the performance of factory employees and applicants. According to these figures, men scored higher in these early tests and women scored distinctly lower. Claims have been made that the higher degree of dexterity may belong to persons who are successfully engaged in doing intricate work requiring assembling, such as watchmaking, making precision instruments, cutting small dies, making fine glass work, setting jewels, microscopic laboratory work, wood engraving, and/or any type of employment requiring very delicate and skillful manipulation of small tools at a fast rate. With the exception of workers engaged in fine instrument assembling, no norms have been published that relate success or failure in given occupations.

It is known that the majority of manual occupations do not require a high degree of dexterity because semi-skilled workers, and even skilled manual operators as a whole, achieve an average standard score of about 360 seconds, thus equaling the average of the general population.

DISCUSSION

After having utilized the O'Connor Tweezer Dexterity Test for approximately 2 years, it has been found to be very successful at screening out those individuals who do not have the necessary fine dexterity to perform the work of hair-graft placement.

But before beginning to use this test routinely as a screening tool, it was necessary to find a range of scores that was acceptable to the author. To find this range, the author performed the test on his current staff of 122 surgical assistants. The scores for all 12 assistants were recorded and both the mean and median scores of the cumulative scores were derived. The mean score was found to be 252 seconds and the median score 240 seconds. The best score was 189 seconds and the worst 309 seconds.

From this data, the author decided that a candidate for the job should not score below 320 seconds. Ideally, the closer to 200 seconds the more attractive the interviewee was for the job. The author also evaluates the other important characteristics of a potential employee (i.e. intelligence, compassion, social skill) in relationship to the O'Connor Tweezer Dexterity test. If the score is near 400, other characteristics are required to be extraordinary. If the score is near 200, attributes other than dexterity may not be weighed as heavily.

SUMMARY

The O'Connor Tweezer Dexterity Test has been found to be an extremely useful tool for screening out unqualified individual seeking a job as a surgical assistant in a hair surgery practice. Because hair-grafts have become "more and more" and "smaller and smaller," the surgical assistant has become a key figure for achieving a good result. By using the O'Connor Tweezer Dexterity Test as a screening tool, the hair restoration surgeon will reduce the incidence of mishiring individuals who are not able to perform this very fine and tedious work. He/she will also reduce the incidence of assistants quitting secondary to frustration. Because this work requires such a high level of dexterity, it is the surgeon's responsibility to find individuals with the highest level of skill possible.