Oral and Maxillofacial Surgery Curriculum

2 Purpose

The purpose of the curriculum for OMFS is to develop, by certification, competent doctors, able to deliver excellent outcomes for patients as consultant surgeons in the UK. The curriculum will provide consultant surgeons with the generic professional and specialty-specific capabilities needed to manage patients presenting with the full range of acute OMFS conditions up to, including and beyond the point of operation, and to manage the full range of acute and elective conditions in the generality of the specialty. OMFS surgeons tend to focus their training and subsequent practice in one or more areas allowing flexibility to meet patient and service demands. Trainees will be entrusted to undertake the role of the general OMFS Specialty Registrar (StR) during training and will be qualified at certification to apply for consultant posts in OMFS in the UK or Republic of Ireland.

Patient safety and competent practice are both essential and the curriculum has been designed so that the learning experience itself should not affect patient safety. Patient safety is the first priority of training demonstrated through safety-critical content, expected levels of performance, critical progression points, required breadth of experience and levels of trainer supervision needed for safe and professional practice. Upon satisfactory completion of training programmes, we expect trainees to be able to work safely and competently in the defined area of practice and to be able to manage or mitigate relevant risks effectively. A feature of the curriculum is that it promotes and encourages excellence through the setting of high-level outcomes, supervision levels for excellence, and tailored assessment and feedback, allowing trainees to progress at their own rate.

This purpose statement has been endorsed by the GMC’s Curriculum Oversight Group and confirmed as meeting the needs of the health services of the countries of the UK.

The Shape of Training (SoT) review1 and Excellence by Design: standards for postgraduate curricula2 provided opportunities to reform postgraduate training. The OMFS curriculum will produce a workforce fit for the needs of patients, producing doctors who are more patient-focused, more general and who have more flexibility in their career structure. The GMC’s introduction of updated standards for curricula and assessment processes laid out in Excellence by Design requires all medical curricula to be based on high-level outcomes. The high-level outcomes in this curriculum are called Capabilities in Practice (CiPs) and integrate parts of the syllabus to describe the professional tasks within the scope of specialty practice. At the centre of each of these groups of tasks are Generic Professional Capabilities3 (GPCs), interdependent essential capabilities that underpin professional medical practice and are common to all who practise medicine. The GPCs are in keeping with Good Medical Practice (GMP)4. Equipping all trainees with these transferable capabilities should result in a more flexible, adaptable workforce.

The curriculum has been developed in consultation with stakeholders, including trainees, trainers, employers, lay representatives and other groups, ensuring the development of a curriculum that is fair, flexible, non-discriminatory, fit for purpose today with the capacity to evolve in future iterations in response to changing needs of patients. There was agreement that the curriculum will develop surgeons who possess the broad-based knowledge and skills to manage unselected emergency and elective patients referred to secondary care, providing general treatment plans and recognising the need for referral to sub-specialist care where appropriate. OMFS consultants on completion of training will be able to demonstrate competence across the breadth of the specialty to the levels defined in the specialty-specific curriculum. At certification, an OMFS surgeon will be able to demonstrate the capability to manage an unselected acute emergency adult and paediatric take. The necessary applied clinical knowledge and skills are described in the OMFS specialty-specific syllabus modules.

The curriculum specifically develops OMFS surgeons who are able to lead and work in multi-disciplinary teams (MDTs) and with colleagues from a wide range of professional groups in a variety of hospital and primary care settings. The management of some clinical conditions requires interactions across certain surgical specialties e.g. Otolaryngology, Neurosurgery, Plastic Surgery and the OMFS curriculum aims to improve patient care by enhancing understanding and skills across traditional specialty boundaries.

The curriculum will allow trainees to train in a variety of community settings where the necessary facilities and governance arrangements are in place and, after certification, specialists in OMFS will have the necessary capability to work in community settings subject to the availability of equipment and safe governance. However, the need for specialised equipment and x-ray facilities limits the ability to undertake work in individual primary care facilities and smaller community hospitals. The curriculum will develop OMFS surgeons that can work in a hub and spoke model, where patients are treated centrally for complex elements of their care but managed more locally to their communities for initial assessment and follow up.

The need to work with colleagues in all settings, including primary care, is embedded within the OMFS curriculum. The OMFS curriculum will develop surgeons who work with and value the wider MDT including general practitioners, general dental practitioners, physiotherapists, specialist nurses, social workers and psychologists. This, together with advances in telemedicine and digital imaging, will facilitate and enhance the quality of care for patients in the community setting.

Although much of the syllabus is specific to the treatment of conditions within the scope of an OMFS surgeon, generic technical skills and knowledge and skills in the management of specific conditions treated by other specialities, such as airway management, are transferable. Trainees who choose a different career route may be able to have a shorter than usual training pathway in their new training programme, in recognition of learning already gained. As training in OMFS requires a dental qualification, transfer into OMFS from other medical specialties is less likely. This flexible approach with acquisition of transferable capabilities, will allow training in OMFS to adapt to current and future patient and workforce needs as well as to changes in surgery with the advent of new treatments and technologies.

Trainees will enter OMFS training via a national selection process at either ST3, or through the ST1 run-through programme. Trainees will learn in a variety of settings using a range of methods, including workplace-based experiential learning in a variety of environments, formal postgraduate teaching, simulation-based education and through self-directed learning. OMFS training is outcome-based rather than time-based. However, it will normally be completed in an indicative time of five years for uncoupled trainees entering at ST3 and six years for those entering run-through programmes at ST1.

Figure 1 – Training Pathway in Oral and Maxillofacial Surgery

In run-through programmes, it is expected that most trainees will undertake posts in specialties other than OMFS in the first year of training which offer the most beneficial experience for sitting the Intercollegiate Membership examination of the Royal Colleges of Surgeons (MRCS). It is desirable that trainees are supported to sit and pass the MRCS examination in this first year (phase 1). Success at MRCS, attainment of core curriculum competence by the end of ST1 and an ARCP outcome 1 enable the trainee to progress directly to phase 2 of training. Run-through trainees who do not achieve these outcomes by the end of ST1 will not progress to phase 2 of training and will have training extended through the ARCP process as defined in A Reference Guide for Postgraduate Foundation and Specialty Training in the UK (the Gold Guide5).

There will be options for those trainees who demonstrate exceptionally rapid development and acquisition of capabilities to complete training more rapidly than the current indicative time of five (uncoupled) or six (run-through) years. There may also be a small number of trainees who develop more slowly and will require an extension of training in line with the Gold Guide. Trainees who choose less than full time training (LTFT) will have the indicative training time extended pro-rata in accordance with the Gold Guide.

The programme will be divided into 3 phases:

Phase 1 will be completed by those entering run-through training via national selection at ST1. It will take an indicative year to complete and will involve placement in surgical specialties to provide optimal training for the MRCS examination, taken towards the end of ST1. It is most likely that trainees will be exposed to General Surgery, Trauma and Orthopaedic Surgery, Otolaryngology and Plastic Surgery through this year. There will be a critical progression point at the end of phase 1, requiring achievement of the GPCs and the development of the CiPs to a level equivalent to the end of core surgical training, a pass in the MRCS examination and an outcome 1 at ST1 Annual Review of Competence Progression (ARCP) in order to progress to phase 2.

Phase 2 will take an indicative time of three years, during which trainees will achieve the GPCs and the OMFS specialty-specific applied knowledge and clinical skills as defined in the CiPs and syllabus across the generality of the specialty dealing with both elective and unselected emergency presentations. At the end of phase 2 there is a critical progression point for entry into phase 3. At this point trainees will be required to demonstrate the professional conduct, judgement and values to be able to assess, investigate, diagnose and manage patients in the out-patient, multi-disciplinary, emergency and operating theatre settings commensurate with the CiPs and defined syllabus. This will be assessed at ARCP and the trainee considered to have met the criteria to sit the Intercollegiate Specialty Board (ISB) examination.

Phase 3 will take an indicative time of two years and trainees will continue to develop and achieve the GPCs and technical skills in the generality of elective presentations and to operatively manage an unselected take to the level described for certification. On completion of phase 3 trainees will be eligible for certification and for recommendation to enter the specialist register.

Areas of special interest

Trainees tend to develop an area of special interest during their training. Demonstration of excellence in this area of special interest can be demonstrated by the CiPs and the levels of competence outlined in the specialty-specific modules.

1 Shape of training: Securing the future of excellent patient care

2 Excellence by design: standards for postgraduate curricula

3 Generic professional capabilities framework

4 Good Medical Practice

5 Gold Guide 8th edition