Oral And Maxillofacial Surgery Training Research Articles

To what extent do oral and maxillofacial surgery residents suffer from imposter syndrome?

ObjectivesThis study aims to evaluate frequency and severity of Imposter Syndrome (IS) in oral and maxillofacial surgery (OMS) residents and identify factors associated with higher Clance Imposter Phenomenon Survey (CIPS) scores. Study DesignA cross-sectional study was performed with a survey including CIPS, demographic, and training program structure questions distributed to all OMS training programs and residents in the United States. Primary predictor variable was gender and main outcome variable was CIPS score. Statistical analyses were performed using linear regression in R v4.3.1; statistical significance was set to p-value < .05. Results175 OMS residents responded. The average CIPS score was 59.8 (IQR 52, 70). Statistically significant differences were found between average male and female resident scores (56.5 vs. 66.9; p<.001) and male and female single-degree residents (54.3 vs. 73.1; p<.001), but not for dual-degree residents (58.8 vs. 63.9; p=.35). ConclusionsThe average male resident experiences moderate IS, while the average female resident experiences frequent IS. Loss of significance between male and female dual-degree resident scores may be due to the completion of a doctoral degree, an internship, and/or dental board exams upon entering medical school, leading to more favorable accomplishment comparisons among medical school peers.

Barriers to research among residents in oral and maxillofacial surgery.

Research is an integral part of oral and maxillofacial surgery (OMS) residency training. This study aimed to identify the current barriers perceived by OMS residents toward conducting research during training. A cross-sectional, questionnaire-based study was conducted. The survey was distributed to 670 OMS residents across the United States in 2021 and consisted of questions regarding demographics, residency program requirements and resources, and perceived barriers to research. Data were analyzed using descriptive statistics, Fisher's exact tests, Kruskal-Wallis tests, and post hoc Dunn's test with a statistical significance of P<0.05. The response rate was 24.2%. Most participants' programs had a minimum research requirement to complete a residency (80%). The top three reported barriers to completing research were lack of time (84%), limited access to research mentors or supervisors (37%), and lack of access to biostatistical support (31%). Factors associated with these barriers included the lack of a research director, supervisor, mentor, assistant, or statistician. There was no significant difference between residents in programs with protected research time versus those without. OMS residents generally viewed research experience during residency as beneficial but reported important barriers, most notably: insufficient time. Although most OMS training programs in the US require research for completion, many do not provide adequate time to facilitate this process. Compared with literature from over a decade ago, it appears little progress has been made to remedy similar barriers to research. Addressing this deficiency may increase the quantity and quality of research, furthering the profession.

Survey of United Kingdom oral and maxillofacial surgery (OMFS) specialists and trainees about the reasons that they retain or drop their registration with the General Dental Council (GDC) including a summary of changes in the numbers registered with the GDC 2014-2023

When dual degree OMFS training was mandated in the UK in 1995, OMFS specialists were required to be registered with both the General Dental Council (GDC) and General Medical Council (GMC). In 2005 this legal requirement for dual registration with both regulators was removed. During 2021 the authors surveyed UK OMFS specialists and trainees asking them why they chose to remain on or leave the Dental Register to give context to the changing numbers of OMFS specialists and trainees holding Dental Registration between 2014 and 2023. In 2014 of 539 OMFS specialists and trainees only 62 (12%) were solely GMC registered, that is, they had let their Dental Registration lapse. In 2023, of 709 OMFS specialists and trainees, 320 (45%) were solely GMC registered. Those whose first qualification was medicine were less likely to be dually registered. Of those who replied to the survey and remained dually registered, most (40%) based this decision on ‘worries about the consequences’ of dropping their dental registration. Some other reasons were not based on fact at that time. Cost was the most common reason (49%) given for dropping their GDC registration by respondents who were only registered with the GMC. On the positive side, the January 2023 GDC position statement about OMFS who are not on the Dental Register removed the GDC’s previous restriction on location of practice and teaching dental students. However the statement does not unambiguously allow OMFS surgeons to practice across the full OMFS curriculum. Will the 2023 GDC position statement alter the trend of OMFS specialists and trainees towards single medical registration?

Can we support second degree students by incorporating non-surgical facial aesthetics into undergraduate dentistry during the first degree?

Non-surgical facial aesthetics (NSFA) are cosmetic procedures intended to reduce signs of ageing and provide facial rejuvenation. There is currently no recommendation for NSFA to be included in the undergraduate dental curriculum globally. This study aims to gain the views of final year dental students about pursuing a career in NSFA. An online survey was completed by 114 final year dental students across two English Universities. A total of 67% (77/114) of students would pursue a career in NSFA. A total of 76% (87/114) and 75% (86/114) of students were not aware of the complications associated with the administration of dermal fillers and Botox injections, respectively. Most students considered NSFA upon graduation. NSFA provides a transferable skillset and useful anatomical knowledge. Incorporation of NSFA in undergraduate education could financially support oral and maxillofacial surgery (OMFS) trainees within their second degree. This may in turn promote retention within the speciality with high financial costs associated with OMFS training.

Exploring the concerns of second-degree dental students on entering specialist OMFS training and their attitudes towards the second-degree curriculum

Within the UK, oral and maxillofacial surgery (OMFS) is a competitive specialty with a rigorous training programme that currently requires dual degrees in both medicine and dentistry. Training in OMFS can present various challenges in terms of finances, length of training, and work-life balance. The current study explores the concerns of second-degree dental students in trying to obtain an OMFS specialty training post, as well as their views on the second-degree curriculum. An online survey was distributed via social media to second-degree dental students across the UK and 51 responses were received. Respondents cited a lack of publications (29%), specialty interviews (29%), and the OMFS logbook (29%) as the primary concerns about securing a higher training post. Eighty-eight per cent felt there were elements of repetition within the second degree for which competencies had already been achieved, and 88% agreed with streamlining the curriculum within the second degree. We propose that the second degree should incorporate ways to build the OMFS ST1/ST3 portfolio as part of a tailored curriculum, removing or condensing the repetitive elements, and instead emphasising areas of concern for trainees such as research, operative experience, and interview guidance. Second-degree students should be provided with mentors with an interest in research and academia to provide guidance and promote early interest in academia.

#OMFSurgery: analyzing the use of social media applications in oral and maxillofacial surgery resident training

BackgroundDespite its increasing popularity, to our knowledge the use of social media applications (SM) for residents’ training in Oral and Maxillofacial Surgery (OMFS) has not been investigated yet. The aim of this study was to evaluate the use of SM applications by OMFS residents for post-graduate training in Germany.MethodsFor explorative assessment, an online questionnaire containing 27 questions about the current use of SM for resident training was sent to OMFS residents in Germany.ResultsSixty-four colleagues participated to the study. Thirty-four participants (54%) responded to regularly use those platforms mainly for OMFS-related content. YouTube (65%, n = 37), Instagram (48%, n = 27), ResearchGate (25%, n = 14) and WhatsApp (16%, n = 9) were the most popular platforms. (Surgical) videos (97%, n = 59), pictures and graphics (82%, n = 50) were the mainly accessed contents. Forty-four participants (69%) stated that SM substantially contributed to their OMFS training. Dentoalveolar surgery and implantology (66%, n = 35) and aesthetic facial surgery (55%, n = 29) content contributed most to OMFS resident training. Fifty-one participants (80%) recommended an official SM account of the DGMKG.ConclusionsSM is frequently used by OMFS residents for the consumption of training-related content. There is an imbalance toward dentoalveolar and facial aesthetic surgery regarding the presented content. Academic institutions and societies should complement their educational activities to not miss this emerging educational innovation. Official SM content by academic institutions and societies could contribute to the existing educational activities.

The specialty of oral and maxillofacial surgery (OMFS) in Europe – Part 2: training environment including the new Union of European Medical Specialists (UEMS) Oral and Maxillofacial Surgery European Training Requirement (OMFS ETR)

OMFS training in Europe has incrementally improved over the last 50 years. However, not all European nations have a formal written curriculum/syllabus, quality indicators, exit examinations, or guidelines for training programmes or trainers. In 2021 the OMFS Section of the Union of European Medical Specialists (UEMS) created an OMFS European Training Requirement (OMFS ETR) to help address these gaps and raise training standards in Europe. This paper includes key lessons from OMFS training programmes across Europe. It also summarises the new OMFS ETR as a comprehensive curriculum and syllabus. The ETR is a resource for nations with dual degree or single medical degree versions of the specialty. More importantly, it can act as a template for the handful of European Economic Area (EEA) nations that do not currently have a recognised OMFS specialty in Directive 2005/36 EU or the European Free Trade Association Treaty. By outlining the breadth and depth of the specialty, the ETR will be useful for competent regulatory authorities as well as OMFS trainees and trainers, patients, and politicians. The OMFS ETR includes key competencies and capabilities alongside training structures and documentation. A free unrestricted Access© database can be downloaded from www.omfsuesm.eu so OMFS experience can be recorded in a similar way across international borders. The OMFS ETR will be a living document. As it is unlikely that OMFS will remain frozen in time, this training document will also evolve. Its true value will become clear as it is used by current and future OMFS surgeons.

To What Extent is Each Area of Oral-Maxillofacial Surgery Practiced in the United States Today?

To What Extent is Each Area of Oral-Maxillofacial Surgery Practiced in the United States Today?

Oral and Maxillofacial Surgery (OMFS) Consultant Workforce in the UK: Pension pressures, changing job-plans, changing demographics, recruitment issues and the COVID backlog in elective surgery mean that urgent action and strategic planning are needed

Introduction: UK OMFS training means that the time between completing training and reaching retirement age is short. Mean retirement age is 59.6 years for UK doctors giving the average OMFS consultant approximately 20 years of practice. Current pension tax regulations, new consultant posts having 10 session job plans, increasing proportion of female specialists and backlog of elective care created by COVID-19 may create a significant gap between workforce and work needed. Methods: The age of current OMFS consultants was estimated using the date of their primary medical/dental qualification, changes in job plans using data from the BAOMS Workforce Census and from job-plans of recently advertised posts and unfilled posts from Regional Specialty Professional Advisors (RSPAs). Results: First degree dates were identified for 476 OMFS substantive consultant posts. Estimated average age was 52.7 years (minimum 35.9, maximum 72.1), 75th centile age 59.0 with 23% of the current workforce above the average retirement age for doctors. New consultant posts were all 10 sessions (40 hours), whereas existing consultants average 12.1 sessions. Current vacancies are summarised here: Conclusions: A significant number of the OMFS consultant workforce is above the average retirement age. Loss of senior colleagues from the workforce if added to differences between existing and new job plans and a higher proportion of female specialists may require both increasing number of specialty training posts and more effective recruitment. Introduction: UK OMFS training means that the time between completing training and reaching retirement age is short. Mean retirement age is 59.6 years for UK doctors giving the average OMFS consultant approximately 20 years of practice. Current pension tax regulations, new consultant posts having 10 session job plans, increasing proportion of female specialists and backlog of elective care created by COVID-19 may create a significant gap between workforce and work needed. Methods: The age of current OMFS consultants was estimated using the date of their primary medical/dental qualification, changes in job plans using data from the BAOMS Workforce Census and from job-plans of recently advertised posts and unfilled posts from Regional Specialty Professional Advisors (RSPAs). Results: First degree dates were identified for 476 OMFS substantive consultant posts. Estimated average age was 52.7 years (minimum 35.9, maximum 72.1), 75th centile age 59.0 with 23% of the current workforce above the average retirement age for doctors. New consultant posts were all 10 sessions (40 hours), whereas existing consultants average 12.1 sessions. Current vacancies are summarised here: Conclusions: A significant number of the OMFS consultant workforce is above the average retirement age. Loss of senior colleagues from the workforce if added to differences between existing and new job plans and a higher proportion of female specialists may require both increasing number of specialty training posts and more effective recruitment.

1633 Developing Confidence in Dental Core Trainees; A National Review of The Trainee Experience

Abstract Aim In the U.K, Dental Core Training (DCT) is an elective postgraduate training programme. There are over 700 DCT jobs with the majority in Oral and Maxillofacial Surgery (OMFS). Our focus was to measure the confidence and skills of 103 DCTs, as they mature during a year in OMFS. Method OMFS DCTs answered questionnaires in month 1, 3 and 6 of their training post, regarding confidence and proficiency in assessment of dental infections, facial fractures, swellings, pathology, airway risk, imaging and performing suturing. Results In month 1, 55% of DCTs were ‘somewhat confident’ in performing intra-oral suturing and assessing dento-facial infection out of the skills assessed. Only 22% of DCTs were ‘extremely confident’ in any competencies. Specifically, DCTs felt ‘not at all confident’ with interpretation of scans (78%) and assessment of facial fractures (35%). Between month 1 and month 6 there has been an increase in confidence across all competencies. Notably, a 42% confidence increase in extra-oral suturing and 61% increase in assessing mandibular fractures. Conclusions We demonstrate that an OMFS training year improves confidence in clinical skills and that an adequate time in a post is required to attain that. Our results highlight areas where DCTs lack confidence early in their posts. These could be targeted at dental school, during the hospital induction process or through guided support and training in the initial phase of their jobs. This study adds clarity to both dentists and doctors contemplating a training year in OMFS and gives insight into how to support and train them.

Perspectives of Dental Students in Oral Surgery Education and Training

Graduating dental students are expected to be competent in performing minor oral surgical procedures, but this depends on their education and training while in dental school. Students’ self-perceptions in performing surgical procedures offer valuable insights and highlight shortcomings in the current oral and maxillofacial surgery (OMS) education and training. The surgical skills of dental students have been found deficient in certain aspects in previous surveys conducted in Europe (Macluskey, et al, 2012; Cabbar, et al, 2019), but none have been conducted/published in the United States. The aim of this study is to evaluate dental students’ self-perception of their competency in surgical skills to perform oral surgical procedures and practice "independently" at a dental school in the United States.A cross-sectional survey of dental students in class of 2021 (D4) and 2022 (D3) was conducted at Virginia Commonwealth University (VCU) School of Dentistry February-March 2021. The Association of British Academic Oral Maxillofacial Surgeons (ABAOMS) questionnaire was utilized and adapted, with permission, in accordance with the OMS curriculum in U.S. dental schools. The questionnaire (Figure 1) involves 17 items covering 5 domains (information, experience, skills, knowledge, and interest, in addition to feedback section for comments). The responses were scaled on a 5-point Likert-type scale. The anonymous data were collected and entered into the REDCap database, and the responses were summarized using descriptive statistics and compared using Fisher's Exact test. A P-value of < .05 was considered statistically significant. All narrative feedbacks were tabulated and analyzed qualitatively. Ethical approval was obtained from the Institutional Review Board (IRB # HM20020893).Sixty-four students (46 D3, 18 D4) participated (32 M, 32 F). Most D3 students performed fewer than 25 extractions (91%), while most D4 performed more than 25 extractions (89%). Analysis of the responses per question is detailed in Figure 2. Comparative analysis between the classes showed that the D4 were significantly more confident than D3 in performing surgical extractions while the D3 were significantly more confident in understanding head and neck anatomy. Comparative analysis between the genders showed that the females were significantly more confident than males in various aspects of OMS practice. Overall, the majority of D3 and D4 students felt more confident performing simple dental extractions than surgical extractions. Most students felt the OMS specialty is an enjoyable and rewarding discipline and consider practicing OMS procedures after graduation despite feeling unconfident in certain aspects. Qualitative analysis revealed that the main recurrent themes were the limited time allowed and devoted to practice dental extractions and the need for more hands-on supervised training.The students’ responses highlight the importance of teaching and supervised training by oral surgery faculty and the need to allocate more time to practice surgical procedures to enhance students’ self-confidence. The questionnaire is a useful survey tool to evaluate, and subsequently improve, the OMS curriculum, teaching, and training among the U.S. dental schools. The plan is to conduct a national survey via future collaboration with the ADA and AAOMS.

Parental Policy in OMS Residency Programs is Necessary but Unavailable: Cross-sectional Survey of OMS Resident Attitudes toward Parental Leave

Guidelines regarding parental leave in oral and maxillofacial surgery (OMS) do not exist. This inconsistency may contribute to gender disparities and an increase in resident burnout. The purpose of this study was to examine perceptions and attitudes of OMS residents toward parental leave.This was a cross-sectional study in which an anonymous 28-item questionnaire was electronically mailed to all current residents in OMS residency programs in the United States during August 2020. The survey consisted of 5 sections: 1) resident demographics (age, gender, parental status), 2) residency program information (geographic location, MD/non-MD status), 3) parental policy information (presence of formal parental leave policy, time allowed for parental leave, requirements associated with time off, on-call duties for parental leave), 4) attitudes regarding parental leave (regarding additional on-call time, performance, emotions toward parental time off, program support during pregnancy), 5) resident well-being (lactation facilities, availability of childcare).Statistical analysis was completed using R statistical software (Version 4.0.3). Descriptive statistics were completed. Univariate analyses were performed using the Wilcoxon Rank Sum test for ordinal outcome and categorical exposure. Fisher exact test for categorical outcome and categorical exposure and the Spearman test to analyze correlation between an ordinal outcome and an ordinal exposure were conducted. Statistical significance was 2-sided P-values < .05.Surveys were sent to 860 OMS residents; 220 completed the questionnaire (25.6%). The majority of respondents were male (n = 156, 70.9%) between the ages of 26-30 (n = 114, 51.8%). Respondents had no children (n = 135, 61.4%), had at least 1 child during residency (n = 60, 27.3%), were currently expecting (n = 14, 6.4%), or had a child prior to residency (n = 11, 5%). Half of the respondents did not know whether their OMS program had a formal parental leave policy (n = 110, 50%). Almost one-third of OMS residents reported that their program did not have a policy regarding parental leave (n = 60, 27.3%). Some programs had a policy regarding parental leave (n = 38, 17.3%) or only regarding maternity leave (12, 5.5%). Most programs allotted 2-6 days (n = 26, 11.8%) or 1-2 weeks (n = 16, 7.3%) off.Residents felt that their co-residents usually gave enough notice for parental leave (n = 74, 33.6%). Pregnancy was reported to the program director in the first trimester (n = 25, 11.4%) or second trimester (34, 15.5%). Some residents reported no negative emotions from the program (n = 43, 19.6%) and co-residents regarding parental leave (n = 51, 23.2%). Most respondents felt that parental leave is fair in their program (n = 170, 77.3%). During parental leave, residents found support in family (n = 45, 20.5%), co-residents (n = 20, 9.1%), and/or attendings (n = 3, 1.4%).Some residents believed that becoming a parent positively impacted their performance (n = 28, 12.7%). Some residents believed that residency had a negative impact on their performance as a parent (n = 41, 18.6%). Parenthood did not prevent pursuit of fellowship training (n = 44, 20%). The majority of co-residents indicated that parenthood had a neutral (n = 64, 29.1%), negative (n = 18, 8.2%), or positive (n = 16, 7.3%) impact on the performance of their colleagues. Respondents indicated that their program/hospital has lactation facilities (n = 57, 25.9%) and/or childcare services (n = 47, 21.4%).The researchers found that most residents are supportive of parental leave despite the lack of a formal policy in their programs. For those residents who conceived during residency, the time allowed for parental leave was on average 1-2 weeks in length, considerably less than what is allowed in the Family and Medical Leave Act of 1993 (FMLA). Additionally, parental status did not have an effect on a resident's decision to pursue fellowship training. In conclusion, parental leave guidelines within the OMS specialty are needed to support the integration of family with postgraduate OMS training and to encourage the pursue of the specialty.

Feedback in Oral and Maxillofacial Surgery Education

<h3>Purpose</h3> The practice of giving feedback has never been evaluated in OMS (oral and maxillofacial surgery) education. The aim of this study was to characterize variations in feedback-giving strategies utilized in resident education and compare this to their preferred ways of receiving feedback. As a secondary aim, we wish to gauge residents' satisfaction with the feedback they receive. As a tertiary aim, we wish to compare residents' and attendings' perception of said feedback. <h3>Methods</h3> We sent surveys to all OMS residency program directors nationwide for completion by their residents and faculty (Figures 1, 2). All responses were recorded via a 5-point Likert scale. Responses were grouped into categories of <i>agreee</i> + <i>strongly agree, neutral</i>, and <i>disagree</i> + <i>strongly disagree</i> for statements of preference or agreement and <i>almost never</i> + <i>seldom, sometimes, most of the time</i> + <i>nearly all of the time</i> for statements of setting and time. Wilcoxon-Mann-Whitney <i>U</i> tests were used to compare responses between 2 groups, with <i>P</i> < .05 for statistical significance. <h3>Results</h3> Our results show significant differences between how feedback is given, based on the residents' perspectives, and how they prefer it be given. Most notable, 79% would like feedback to occur during a postoperative debrief immediately after the case; however, only 27% report that this is the usual setting (<i>P</i> < .0001). Additionally, 92.95% prefer verbal, face-to-face feedback, whereas they agree that it occurs this way 59% of the time (<i>P</i> < .0001). In terms of resident satisfaction, only 47% were satisfied with the current feedback practices. The biggest deficiencies appear to be in the quality and specificity of said feedback, with only 43% agreeing that each of these are adequate. Additionally, only 49% felt that the amount was adequate. In regards to faculty vs resident perceptions, significant differences were found in nearly all responses. The groups only agreed on the seldom use of rating tools and the importance of feedback in OMS education, which was nearly unanimous (94% vs 96%). The largest difference was in the use of postoperative debriefing, which faculty reported to occur often 65% of the time, while residents reported only 27% (<i>P</i> < .0001). Ninety-four percent of faculty responded that feedback is most often delivered verbally, face-to-face, while only 59% of residents agreed (<i>P</i> < .0001). Additionally, 76% of faculty believed the quality of their feedback to be adequate, versus only 43% of residents who felt that this was the case (<i>P</i> < .0001). <h3>Conclusion</h3> Our results indicate several issues regarding the current practices of feedback in OMS training. Residents most prefer feedback given verbally, face-to-face, in a postoperative debriefing, while they indicate that this is often not the case. Interestingly, faculty believe that both of these occur significantly more frequently than the residents report. Faculty also believe that the quality of their feedback given is adequate, while residents disagree. Overall, it appears that resident satisfaction with current practices is low, and our study identifies multiple opportunities for improvement.

The UK Mentoring and Support Programme (MSP) for those considering a career in Oral and Maxillofacial Surgery (OMFS). A review of a ‘Register Interest in OMFS’ website and the MSP as two key resources created by the British Association of Oral and Maxillofacial Surgeons to promote recruitment and retention (2008–2020)

In 2008, to create a rapid route for information transfer in relation training and recruitment for OMFS trainees, the British Association of Oral and Maxillofacial Surgeons (BAOMS) created a website to "Register Your Interest in OMFS" (RYIO). From 2011 a Mentoring and Support Programme (MSP) was created to provide focussed guidance for trainees aiming for specialty training. This paper reviews the effectiveness and cost of these programmes.Between 2008 and 2020, 1744 individuals used RYIO on 2715 occasions. Of these registrations, 1772 were by dentists, 193 dental students, 589 doctors and 161 medical students. 2354 were from UK and Ireland and 351 from the rest of the world. 188 registrants subsequently became UK OMFS trainees or specialists. All registrants valued the information provided. In response to RYIO trainee feedback the new ‘Taste of OMFS 2020’ programme was created.The MSP was originally called the Junior Trainee Programme (JTP). The MSP scheme provides a layer of mentorship/support which runs parallel to the medical/dental training post or period of study. Of 180 members of MSP, 72 have obtained specialty training posts in OMFS. There are 88 current members. Full information is available on the BAOMS website www.baoms.org.uk. Reviewing both programmes, participant feedback is excellent with tangible results whilst cost effectiveness is high.

Duration of specialty training in the UK for oral and maxillofacial surgery (OMFS) for trainees completing training between 2000 and 2019

Introduction: Specialty training in OMFS in the UK lasts 5 years. In 2007 a pilot of ‘run-through’ training started with core training (ST1) posts linked to specialty training which should be completed in 6 years.

Number of UK OMFS trainees joining the UK Oral and Maxillofacial Surgery (OMFS) specialist list 1999–2018 is increasing with time

Introduction: If “There are three kinds of lies: lies, damned lies, and statistics” then there are three types of statistics, facts, guesses and workforce planning. Accurate data on the UK OMFS workforce are difficult to assemble even by ‘official’ groups such as the Department of Health.

Should we recruit trainees into the Oral and Maxillofacial Surgery pathway at the beginning of the second degree to ensure the long term viability of the specialty?

There has been a sustained decline in the number of trainees applying for entry into the Oral and Maxillofacial Surgery (OMFS) training program, which has sparked further debate on the issue of OMFS training and the future of the specialty in the United Kingdom. Here I discuss the option of recruiting the trainees into the program at the beginning of their second degree to streamline the training, and to improve the recruitment drive to ensure long term viability of the specialty.

Feedback in the Education of Oral and Maxillofacial Surgery Residents

In surgical residencies, formative feedback on both operative technique and judgment is needed to build adept surgeons. The general surgery literature indicates deficiencies thereof, and disparities between resident and faculty perceptions of feedback.1,2 In oral and maxillofacial surgery (OMS), there is a dearth of research on this crucial aspect of education. In this survey-based descriptive study, we aim to characterize variations in feedback-giving strategies utilized in resident education and compare this to their preferred ways of receiving feedback. As a secondary aim, we wish to gauge residents’ satisfaction with the feedback they receive. As a tertiary aim, we wish to compare residents’ and attendings’ perception of said feedback. We hypothesize that residents and faculty will value feedback but may have differing ideas on the content and delivery. To these means, we sent surveys to all OMS residency program directors nationwide, for completion by their residents and faculty (Figures 1, 2). All responses were recorded via a 5-point Likert scale. Responses were grouped into categories of “agree” + “strongly agree,” “neutral,” and “disagree” + “strongly disagree” for statements of preference or agreement, and “almost never” + “seldom,” “sometimes,” “most of the time” + “nearly all of the time” for statements of setting and time. Wilcoxon-Mann-Whitney U tests were used to compare responses between 2 groups, with P < .05 for statistical significance. Our results show significant differences between how feedback is given, based on the residents’ perspective, and how they prefer it be given. Most notably, 79% would like feedback to occur during a postoperative debrief immediately after the case. However, only 27% report that this is the usual setting (P < .0001). Additionally, 92.95% prefer verbal, face-to-face feedback, whereas they agree that it occurs this way 59% of the time (P < .0001). In terms of resident satisfaction, only 47% were satisfied with the current feedback practices. The biggest deficiencies appear to be in the quality and specificity of said feedback, with only 43% agreeing that each of these are adequate. Additionally, only 49% felt the amount was adequate. In regards to faculty vs resident perceptions, significant differences were found in nearly all responses. The groups only agreed on the seldom use of rating tools and the importance of feedback in OMS education, which was nearly unanimous (94% vs 96%). The largest difference was in the use of postoperative debriefing, which faculty reported to occur often (65% of the time), while residents reported only 27% (P < .0001); 94% of faculty responded that feedback is most often delivered verbally, face-to-face, while only 59% of residents agreed (P < .0001). Additionally, 76% of faculty believed the quality of their feedback to be adequate vs only 43% of residents felt this was the case (P < .0001). Our results indicate several issues regarding the current practices of feedback in OMS training. Residents most prefer feedback given verbally, face-to-face, in a postoperative debriefing, while they indicate that this is often not the case. Interestingly, faculty believe that both of these occur significantly more frequently than the residents report. Faculty also believe that the quality of their feedback given is adequate, while residents disagree. Overall, it appears that resident satisfaction with current practices is low, and our study identifies multiple opportunities for improvement. Figure 2Faculty RedCap Survey View Large Image Figure Viewer Download Hi-res image

United Kingdom immigration and emigration of oral and maxillofacial Surgery (OMFS) specialists 2000-2020: how might Brexit impact on OMFS?

The United Kingdom left the European Union (EU) in January 2020. As it is unclear how many of the rights of OMFS surgeons to travel and work will remain after the transition period, we have reviewed how these rights have been used in the past. The OMFS specialist list from the GMC was compared with a database of current OMFS colleagues. Data were analysed using WinStat® (R. Fitch Software). Of 494 active surgeons on the OMFS specialist list, 23 (5%) completed their OMFS training outside the UK. Of these, 22 were specialists from Europe of whom 12 were substantive NHS consultants with others working as Fellows or visiting the UK occasionally. Two per cent of UK OMFS consultants are -specialists from Europe, the majority from Greece. Of the OMFS specialists who completed training in the UK since 1995, 24 are currently working outside the UK, and of them, 16 left the UK to return to their nation of origin (all 11 of those working in the European Economic Area [EEA] were born there). Of the seven UK-born specialists working overseas, none was working in the EEA. Twenty per cent of UK trainees whose primary degree was known (n = 117) received their primary qualification outside the UK, 38 in from the EU, and 79 from further afield. The majority of these UK trained specialists with non-UK first degrees (n = 101) stayed in the UK to work after training. The most significant impact of Brexit on OMFS could be a restriction on the opportunity for non-UK doctors and dentists to come to the UK to train and stay to work.

Legislation for Oral and Maxillofacial Surgery (OMFS) in the UK lags behind the patient care we provide: an illustrative timeline and recommendations for the future.

OMFS is the surgical specialty which bridges dentistry and medicine. As the specialty of OMFS emerged from the dental specialty of Oral Surgery during the 1980s the Dentists Act 1984, whose purpose included preventing medical practitioners providing unregulated general dental care, was published. In 2008 the Postgraduate Medical Education and Training Board (PMETB) review of training in OMFS concluded that dual qualification was essential and recommended that OMFS specialists should only be required to register with one regulator, the General Medical Council. For OMFS to continue to provide high quality patient care, and to help the GDC and GMC in their roles regulating our specialty, BAOMS has identified 5 areas for regulatory change: (1) All OMFS specialists should be able to practice the full curriculum of OMFS with only GMC registration if they wish to - this was recommendation 4 of the PMTEB Review of OMFS in 2008. (2) If an OMFS specialist or trainee is registered with both the GMC and GDC. (3) A Memorandum of Understanding between the GMC and GDC should prevent any fitness to practice concerns being processed by both regulators. (4) Dually registered OMFS specialists should be able to indicate that they have had "appraisal of the full scope of practice" to comply with GDC Continuing Professional Development (CPD) regulations. (5) Oral Surgery specialist list should retain Route 11 for OMFS specialists as the Oral Surgery Curriculum is entirely within the OMFS curriculum. Legislative changes may be the best route to deliver these recommendations. Until these changes happen, the GMC, GDC and BAOMS should work together in the best interests of patients.