Using this handbook 2
OMFS:the specialty 3
UK legal aspects of OMFS 4
Duties of an OMFS junior 6
The future of OMFS 7
Career pathways in OMFS 8

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1 Chapter1OverviewUsing this handbook 2OMFS:the specialty 3UK legal aspects of OMFS 4Duties of an OMFS junior 6The future of OMFS 7Career pathways in OMFS 8 2CHAPTER1 Overview2Using this handbook• This handbook has been written primarily for junior trainees working in oral and maxillofacial surgery (OMFS).• We have deliberately tried to avoid writing a condensed surgical textbook and have attempted to provide a practical ‘hands- on hospital travel guide’ for use during your time as an OMFS junior.• The ‘clinical areas’ chapters make up the backbone of this handbook. This concept is the result of our desire to give you what you really need to know when you really need it. For example, consider fractured mandibles— the information you need to know about patient management is dierent depending on whether you are seeing a patient in the accident and emergency department (A&E), in theatre, on the ward, or as an outpatient.• There is a chapter on subjects that we consider essential for getting the most out of a job in OMFS, so we have called this chapter ‘basic knowledge’.• There is a chapter on essential skills which is no substitute for practical teaching but should get you out of a corner, as will the emergencies chapter. We hope that you will have read these in advance of being called upon to enactthem!• Oral medicine is a vast subject and no attempt has been made to condense it into this handbook. Instead, we have tried to provide a mixture of basic knowledge and practical tips on how to manage the oral medicine patient.• We encourage you to spend some time looking at oral and maxillofacial radiographs and images whenever possible with a senior colleague. The radiology chapter cannot teach you how to recognize pathology on images and is only intended to provide some broad general radiological knowledge to support your learning.• We hope that this handbook will be more of a knowledgeable friend and guide than just a list of facts. After all, you can access facts on the Internet.• Finally, we hope that you enjoy your time in our specialty and wish you the very best of luck in your future chosen career. OMFS:THE SPECIALTY3 OMFS:the specialty• OMFS is one of the ten surgical specialties recognized by the surgical colleges and is regulated by the General Medical Council(GMC).• It is a unique specialty. In the UK, to be appointed as a consultant in OMFS you must not only be on the GMC specialist list but also possess a registerable dental degree. It is now not necessary to be on the General Dental Council (GDC) register, and many consultants choose nottobe.• The same requirements are stipulated throughout the EuropeanUnion.• The specialty has evolved greatly in the last 30years.• In times past, oral surgery was a popular dental specialty which dealt with diseases of the jaws and mouth. But during both World Wars, oral surgeons were called upon to manage some of the vast amounts of oral and maxillofacial trauma. Probably because of this, the oral surgeons saw that there was a need for oral and maxillofacial specialists and the specialty grew. Our forefathers realized the need to have a proper medical education and surgical training, and so medical degrees became mandatory. Eventually the specialty ceased to be regulated by theGDC.• This move left dentistry without an oral surgery specialist list and that void was lled. There is now a dental specialty, oral surgery, which is mainly conned to dental schools. Training pathways in oral surgery are now also starting to appear in district general hospitals in theUK.• Some OMFS surgeons have become super- specialized and dropped the oral surgery component completely, and are dedicated craniofacial or head and neck cancer surgeons, but most OMFS units manage the full remit of oral and maxillofacial surgery.• OMFS surgeons have the same basic surgical training as any other surgeon and are additionally trained in dentistry, which is what makes this surgical specialty so unique. 4CHAPTER1 Overview4UK legal aspects ofOMFSIf you have either GMC or GDC registration, you can work as a junior trainee in OMFS. To progress into higher surgical training in OMFS, dual qualication, core surgical training, and success in the Membership of the Royal Colleges of Surgeons of Great Britain and Ireland (MRCS) examina-tion is required. The specialty is ultimately regulated by theGMC.Although the specialty is now recognized as a medical one, much of the clinical day- to- day workload in OMFS relates to the surgical aspects of den-tistry, and procedures that involve the teeth. For example, the extraction, manipulation, or implantation of teeth could all be seen to fall within ‘the practice of dentistry’. However, these are all relevant duties for an OMFS junior to undertake. Juniors in OMFS who are not registered with the GDC must be careful to know their legal limitations with respect to ‘the practice of dentistry’, which is dened and protected bylaw.The practice ofdentistryPrior to 2005, it was acceptable for both registered dentists and doctors to practise dentistry. However, in 2005, following a judgment of the European Court of Justice,1 the Dentists Act 1984 was amended, restricting the prac-tice of dentistry to those with GDC registration.Since the 2005 amendment, there has been some contention over what denes ‘the practice of dentistry’ with respect to OMFS, especially as the number of singly medically qualied doctors working in the specialty has steadilygrown.In 2008, a position statement on this issue was made by the GDC, and subsequently reiterated by the British Association of Oral and Maxillofacial Surgeons (BAOMS).GDC statement(2008)• ‘The GDC considers that suitably qualied and registered healthcare professionals may take whatever action is necessary to deal with dental emergencies.’• ‘The GDC would expect any non- emergency dental treatment to be carried out by a GDC registrant.’• ‘Council would have no diculty with suitably qualied and registered medical practitioners performing certain tasks, which would in a dierent context be restricted to GDC registrants (for example the extraction of teeth) if they are an essential part of a necessary medical or surgical procedure and are performed in that context.’• ‘This applies equally to oral and maxillofacial trainees and specialists.’1 Landeszahnärztekammer Hessen v Markus Vogel (2003). Case C- 35/ 02. UK LEGAL ASPECTS OFOMFS5 BAOMS statement(2008)• ‘Medical (non- GDC) registrants should be entitled to practice the full scope of OMFS, including the surgical removal of teeth and dental extractions, provided:• it is undertaken under the auspices of a hospital department ofOMFS• it is performed under appropriate supervision of and delegation from a consultant OMFS surgeon• the practitioner only undertakes treatments where they are compe-tent to doso’.• ‘Council would not support a non- GDC registrant undertaking dental extractions or other dental procedures as an independent High Street practitioner.’More recently, a further statement has been issued with regard to registra-tion with theGDC.BAOMS statement(2013)‘From January 1st 2014, all applicants for specialty training in OMFS must be fully registered with the UK General Dental Council (GDC), or have a contemporaneous letter from the GDC stating that their dental qualica-tion would entitle them to be fully registered if they were to apply. Those unable to demonstrate this will not be shortlisted for interview. Temporary registration will not be acceptable.’ 6CHAPTER1 Overview6Duties ofan OMFSjunior• These, by nature of the specialty, can be extremely diverse.• The GMC and GDC documents:‘Duties of a doctor’ (2014)2 and ‘Standards for the dental team’ (2013),3 are worth being awareof.• In most OMFS units you will work with all age groups of patients in the main clinicalareas.• You will use a mixture of general medical knowledge and surgical skills, with many clinical problems requiring a dental perspective.• You will manage a wide range of diseases from congenital oral anomalies in neonates to advanced disseminated cancer. You may be called upon to be an oral physician advising paediatricians on geographic tongue and following this nd yourself in A&E reducing a dislocated mandible or repairing a complex facial laceration.• You should equip yourself with a good pen torch and some tongue spatulas. Aminiature Snellen chart may also be useful and is found inside the back cover of this handbook.• You will be expected to acquire some skills quite quickly and we advise you to read this handbook at least once before you start your new job and use it to direct your learning of new skills.• You will nd it advantageous to work as a team, utilizing individuals’ previous training— the singly qualied doctor’s medical knowledge will help the singly qualied dentist and their dental knowledge will help the doctor.2 M http:// www.gmc- uk.org/ guidance/ good_ medical_ practice/ duties_ of_ a_ doctor.asp3 M https:// www.gdc- uk.org/ professionals/ standards/ team THE FUTURE OFOMFS7 The future ofOMFS• OMFS has changed hugely in the last 10years and has become the dominant specialty in head and neck oncology, and craniofacial trauma and deformity, in addition to oral surgery.• At the time of writing, most juniors in OMFS units are singly qualied dentists and this will be the most likely and important change in the future.• The change has been slow but is inevitable; units will employ more medically qualied doctors to work in their departments. This will have some impact on the type of work juniors do unsupervised, but in reality, the days of leaving an OMFS senior house ocer to ‘just get on with’ a list of dental extractions areover.• In the past, most OMFS consultants took dentistry as their rst degree and had a fair amount of oral surgery experience before furthering their OMFS skills. However, in recent years an increasing number of medically qualied doctors are embarking on dentistry as a second degree. Perhaps this handbook will encourage this— we sincerely hopeso!• More recent national recruitment rounds for higher surgical training have shown a 50:50 applicant split in terms of dental to medical primary qualication (previously it was90:10)• No one knows how this trend will change the specialty, if at all, but the doctors choosing to take dentistry as a second degree seem to be some of the most highly motivated and talented trainees. This can only be good for the specialty and encourage its future evolution.• Similarly, the dentally qualied trainees who (encouragingly) chose to return to medical school and complete core surgical training often select themselves as high iers.• The mix of these two introductory trainee pathways is fantastic for the future of OMFS and will ensure that the specialty continues to evolve and develop in the years tocome. 8CHAPTER1 Overview8Career pathways inOMFS• The requirements for a higher surgical training post (a registrar training number) include:• Aregisterable dental degree.• Aregisterable medical degree.• Aminimum of 6months of training inOMFS.• Completed core surgical training.• MRCS examination.• Those who have a dental degree can often obtain a medical degree on a shortened course, and similarly some dental schools are now oering shortened courses for doctors.• Dental graduates who wish to work in the National Health Service (NHS) must have a provider number which is given on completion of a vocational training post in the UK. This is not a requirement for those who wish to train in OMFS. However, those who are about to embark on a medical degree as a second degree may nd employment more easily if they have an NHS provider number.• Some experience in other head and neck specialties, such as ear, nose, and throat (ENT), plastic surgery, neurosurgery, and ophthalmology, may be advantageous.• Applicants for specialist training posts in OMFS will have spent longer in undergraduate training than other specialties, and it is usually expected that they will have maximized the benet of this extra time and have a CV to reectthis.• Most OMFS surgeons are enthusiastic about their specialty and tend to be very supportive of trainees. If you are considering a career in OMFS, it is a good idea to approach a consultant in OMFS and get some adviceearly.• The BAOMS has trainee groups who can help you make the right career choice and we recommend you contact them through the BAOMS website (M http:// www.baoms.org.uk).

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