Maxillofacial Surgery Training Research Articles

Simulation-based training in maxillofacial surgery: are we going to be left behind?

Simulation is an important way both to optimise a trainee’s learning time and reduce morbidity and operating time for patients. We have reviewed the current use of simulation in training for maxillofacial surgery, and provide an overview of areas of practice where it may be useful. A web-based survey of trainees’ opinions of it was made in February 2018, and disseminated using the Junior and Fellows in Training group mailing lists. We also reviewed popular current simulation courses that are available. A total of 45 of the 57 trainees who replied agreed that simulation-based training would be beneficial in maxillofacial surgery, particularly with regard to maxillofacial surgical emergencies. A total of 54 of the 57 also agreed that simulation-based training would be a useful adjunct to their clinical training. However, most of the simulation-based courses available were priced beyond the budgets available to UK-based trainees for study, although funding changed in April 2018. While other surgical disciplines have adopted simulated clinical teaching and its benefits, maxillofacial surgery has limited the use of all types of formal simulation. Surgical simulation training is increasingly being used to complement the traditional surgical apprenticeship in other specialties, and ours needs to consider ways in which we can use it, given that trainees within the specialty think that it would be useful. Other specialties have shown that there is good transfer of skills from simulation to the actual clinical operating environment, and this increases satisfaction, decreases morbidity, and reduces the time required for intraoperative teaching.

Oral & Maxillofacial Surgery (OMFS) trainees and consultants resume the trend of letting their dental registration lapse

Oral & Maxillofacial Surgery (OMFS) trainees and consultants resume the trend of letting their dental registration lapse

Teaching in Oral and Maxillofacial Surgery Training Programs: A Resident Perspective

Teaching in Oral and Maxillofacial Surgery Training Programs: A Resident Perspective

A nationwide survey of undergraduate training in oral and maxillofacial surgery.

To investigate the current status of undergraduate training in oral and maxillofacial (OMF) surgery in Germany using a nationwide survey and hence contribute to an educational improvement in the field. A 39-item questionnaire was sent to all university clinics with an OMF surgery chair in Germany (n = 34). Ninety-two percent of OMF clinics are involved in the curricular training in medicine and 100% in dentistry. Eighty-one percent of OMF clinics perform curricular examinations and, respectively, 86% in dentistry. Examinations are mainly performed written with multiple-choice tests (62% medicine, 76% dentistry) and using non-structured oral examinations (57% medicine, 86% dentistry). Objective structured clinical examinations (OSCEs) are only used in 19% of all faculties. OMF surgery with its involvement both in medical and dental education has a special position as a surgical discipline. Our results show that OMF as a specialty is underrepresented in dental and especially in medical education considering the numerical and health economic importance of OMF consultations. Enhancing curricular integration and developing more structured examination forms is necessary to guarantee a high quality of OMF education.

“Flipped classrooms” in training in maxillofacial surgery: preparation before the traditional didactic lecture?

While virtual learning environments (VLE) can be used in medical education as stand-alone educational interventions, they can also be used in preparation for traditional “face-to-face” training sessions as part of a “flipped classroom” model. We sought to evaluate the introduction of this model in a single module on maxillofacial radiology from a course on trauma skills. Course delegates were randomised into two groups: one was given access to an e-learning resource (test group) and the other attended a traditional didactic lecture (control group). Knowledge and confidence were assessed before and after the course with a 20-question single-best-answer paper and a 10-situation 100mm visual analogue scale (VAS) paper, respectively. All participants were then given free access to the VLE for 30days and were invited to take part in an e-survey. Neither group showed improvements in the single-best-answer scores, but both groups showed comparable improvements in VAS (control: median (range) values improved from 40.8 (17.7–82.5) mm to 62.8 (35.3–88.7) mm, p=0.001; test group: from 47.7 (10.9–58.1) mm to 60.5 (32.4–75.6) mm, p=0.005). Half of the respondents stated that they preferred the “flipped classroom” approach, and 22/22 stated that they would be “likely” or “very likely” to use an e-learning resource with expanded content. The “flipped classroom” approach was well received and there were comparable improvements in confidence. As maxillofacial radiology lends itself to online instruction with its reliance on the recognition of patterns, and problem-based approach to learning, a piloted e-learning resource could be developed in this area.

“Run-through” training at specialist training year 1 and uncoupled core surgical training for oral and maxillofacial surgery in the United Kingdom: a snapshot survey

Training in oral and maxillofacial surgery (OMFS) in the UK has undergone considerable changes during the last 10years, and “core” surgical training has replaced “basic” surgical training. In 2014 a pilot “run-through” training programme from specialist training year one (ST1)-ST7 was introduced to facilitate early entry into the speciality. Run-through training guarantees that a trainee, after a single competitive selection process and satisfactory progress, will be given training that covers the entire curriculum of the speciality, whereas uncoupled training requires a second stage of competitive recruitment after the first one (for OMFS only) or two years of “core” training to progress to higher specialty training.The first two years of run-through training (ST1-ST2) are the same as for core surgical training. Dual-qualified maxillofacial aspirants and those in their second degree course are curious to know whether they should go for the uncoupled core surgical training or the run-through programme in OMFS. The General Medical Council (GMC) has now agreed that run-through training can be rolled out nationally in OMFS. To assess the two pathways we used an online questionnaire to gain feedback about the experience from all OMFS ST3 and run-through trainees (ST3/ST4) in 2016–2017. We identified and contacted 21 trainees, and 17 responded, including seven run-through trainees. Eleven, including five of the run-through trainees, recommended the run-through training programme in OMFS. Six of the seven run-through trainees had studied dentistry first. The overall mean quality of training was rated as 5.5 on a scale 0–10 by the 17 respondents. This survey gives valuable feedback from the current higher surgical trainees in OMFS, which will be useful to the GMC, Health Education England, OMFS Specialist Advisory Committee, and those seeking to enter higher surgical training in OMFS.

Surgical Simulation Training in Patient Specific Mandibular Reconstruction: A pilot training model for Oral and Maxillofacial Surgery Trainees

Surgical Simulation Training in Patient Specific Mandibular Reconstruction: A pilot training model for Oral and Maxillofacial Surgery Trainees

Oral and Maxillofacial Surgery (OMFS) Trainees – Their Training Rotations and Their Consultant Appointments – Do they stay or do they go?

Oral and Maxillofacial Surgery (OMFS) Trainees – Their Training Rotations and Their Consultant Appointments – Do they stay or do they go?

In 2017 Oral & Maxillofacial Surgery (OMFS) trainees and consultants reverse the previous trend of letting their dental registration lapse

Introduction: OMFS in the UK requires both medical registration and a registerable dental degree to enter training and to join the General Medical Council (GMC) specialist list. The GMC is the primary regulator for OMFS. For hospital practice, except where a consultant's contract states otherwise, OMFS surgeons are not required to register with the General Dental Council (GDC).

Outcomes with Ambulatory Anesthesia Delivered in an Oral and Maxillofacial Surgery Training Program

Oral and maxillofacial surgeons in the United States have the ability to provide anesthesia, including conscious to deep sedation, while simultaneously performing the surgical procedure in a clinic setting. These skill sets are taught during residency, where residents learn a variety of sedation techniques by performing sedation.

Educational philosophies within medical graduates undertaking a dental degree when compared with other non-medical graduates

Background: Kings College offers the only three-year dental programme for medical graduates within Europe. Dual qualification in medicine and dentistry is a requirement for training in maxillofacial surgery. On the tenth year running, we conducted a study looking at the differences in various parameters relating to educational philosophy. Objective: The aims of this study were to identify the variance in the ways specific student groups approached their undergraduate training. The areas included: learning methodology, attendance, self-directed techniques, career motivation, stress levels and coping strategies, time management and time spent in paid employment. Methods: Questionnaires were used to evaluate how medical graduates on the three-year dental programme compared with university graduates on the four-year programme and school leavers on the five-year programme. Findings: Medical graduates came across as highly motivated self-directed learners with excellent time management skills. Attendance at lectures was poor owing to time spent in paid employment and the basis of previous studies. School leavers on the five-year programme demonstrated grossly contrasting study methodology where the majority attended lectures regularly. Their stress levels were higher when compared to medical graduates despite spending a longer duration on the programme. Graduates on the four-year programme demonstrated a mixture of attributes. Conclusion: Students on different dental programmes within Kings College exhibit an array of different study techniques. Career motivation, past learning experiences, extracurricular commitments and differences in stress coping mechanisms were all thought to be key factors in explaining these differences.

Surgical vision: enhancing training in oral and maxillofacial surgery

Surgical vision: enhancing training in oral and maxillofacial surgery

Outcomes with ambulatory anaesthesia delivered in an oral and maxillofacial surgery training program

Outcomes with ambulatory anaesthesia delivered in an oral and maxillofacial surgery training program

Non technical skills and simulation training in oral and maxillofacial surgery

Non technical skills and simulation training in oral and maxillofacial surgery

‘Double indemnity’ or ‘half your fees’? Oral & Maxillofacial Surgery (OMFS) trainees and consultants continue to let their dental registration lapse

‘Double indemnity’ or ‘half your fees’? Oral & Maxillofacial Surgery (OMFS) trainees and consultants continue to let their dental registration lapse

Cost of training in oral and maxillofacial surgery: beyond the second degree

Training in oral and maxillofacial surgery (OMFS) involves considerable personal expense, a long period of training and the need for two degrees. Other costs have also increased, with little change in pay and poor access to funding. After a Freedom of Information request and having reviewed available data, we have established the cost of training in OMFS. There is considerable regional variation in access to funding, with escalating fees for conferences and courses. Recent changes have failed to address these.

Prevalence of Substance Abuse Among Oral and Maxillofacial Surgery Residents From 2006 to 2015

Substance abuse in oral and maxillofacial surgery (OMS) training programs is an important and under-represented topic in the literature. This study's purpose was to assess the prevalence of substance abuse in OMS training programs in the United States during a 10-year period and to determine the substances most abused by OMS residents. A cross-sectional survey study was conducted by sending an online questionnaire to program directors and chairpersons of all OMS graduate training programs accredited by the Commission on Dental Accreditation. The content- and validity-tested survey asked respondents to report on substance abuse cases at their program from 2006 to 2015. Auxiliary questions asked opinions on substance abuse. To analyze the data, percentages were calculated, including the estimated prevalence of abuse; results were presented as bar charts. Forty-six of the 101 OMS training programs (45.5%) responded. Sixteen of the responding 46 programs (34.8%) reported at least 1 suspected or encountered incident of substance abuse. The 2 most abused substances were alcohol and narcotics. During the decade studied, the prevalence of resident substance abuse was estimated to be 1.2%. The estimated prevalence of resident substance abuse has gone unchanged since Rosenberg's initial study in 1986 (J Oral Maxillofac Surg 44:458, 1986). With the introduction of new drugs and despite more stringent protocols, substance abuse continues to be a germane issue for OMS requiring ongoing attention clinically and in the literature.

How Many Temporomandibular Joint Total Joint Alloplastic Implants Will Be Placed in the United States in 2030?

The purpose of this study is to provide a statistical projection of the number of alloplastic temporomandibular joint (TMJ) total joint replacements (TJRs) that will be performed in the United States through the year2030. The program directors of all 101 Commission on Dental Accreditation-accredited oral and maxillofacial surgery training programs in the United States were surveyed online by use of a questionnaire developed using Redcap (Chicago, IL) over a 6-week period (February 2015-March 2015). The questionnaire included 19 questions related to each program's TMJ disorder and TMJ TJR curricula, as well as clinical experience. In addition, members of the American Society of Temporomandibular Joint Surgeons were surveyed online using Redcap and via direct survey forms. Moreover, requests for the total number of TMJ TJR devices produced and implanted during the same period were made to the 3 manufacturers of Food and Drug Administration-approved TMJ TJR devices in the United States. The response rate among program directors was 52.5%, and the total number of TMJ TJR devices implanted in oral and maxillofacial surgery programs in 2005 was 412. This total increased by 38% to 572 in 2014. Statistically, this projects an increase of 58% over the next 16years to 902 TMJ TJR operations by 2030 (95% prediction limits, 768 and 1,037). The total number of TMJ TJR devices distributed by one manufacturer increased from 430 in the year 2000 to 1,004 in 2014 (133%). By use of these data, statistically over the next 16years, the number of TMJ TJR devices distributed by this company is projected to be 1,658 (95% prediction limits, 1,380 and 1,935). The data presented in this study show an increasing demand for the use of TMJ TJR devices in the management of end-stage TMJ disorders to the year2030.

Editor’s Choice: Making a long journey shorter

Training in oral and maxillofacial surgery involves a time and financial commitment above and beyond that required in other specialties. But the attraction of working across two fields of healthcare has meant that the specialty has, until now, not had to worry about filling its training posts. Last year there were more than …

Quality assurance review of training in oral and maxillofacial surgery by the General Medical Council: areas of good practice, requirements, and recommendations

The purpose of this paper is to disseminate the outcome of the 2012/13 UK-wide quality assurance review of postgraduate training in oral and maxillofacial surgery (OMFS) by the General Medical Council (GMC), as part of its review of small specialties. OMF surgeons need to be aware of the evidence on which the conclusions are based, and to know about the strengths of the specialty and the areas for future development so that postgraduate training, and ultimately the outcomes for patients, can be improved. This paper, by the authors involved in the review, summarises the salient points and is not a verbatim report.