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INTRODUCTION
Oral & Maxillo-Facial Surgery is a medical specialty
which has developed by different means and with different results in the
various countries of Europe.
In order to adjust the objectives on training of OMFS it
will be to the advantage of all European countries to rely on guidelines which
guarantee quality assurance of training and provide optimum patient
care.
The UEMS-section of Stomatology and Oro-Maxillo-Facial
Surgery and the European Association of Cranio Maxillofacial Surgery in their
capacity of representing the specialty of Oral & Maxillo-Facial-Surgery on
scientific and professional level in Europe feel obliged to serve as advisor
regarding education and training of OMFS and to assist all European countries
in their work to record the fundamental requirements for specialty training
in
Oral & Maxillo-Facial-Surgery.
EU legislation, national rules and the International
Guidelines of Oral & Maxillo-Facial Surgery are important components which
must be taken in consideration when setting up training programmes and
standards for the specialty.
DEFINITION and SCOPE of the
SPECIALTY
Oral & Maxillo-Facial Surgery is that Specialty
concerned with the history – taking, prevention, examination, treatment
and rehabilitation of the congenital and acquired pathologic conditions of the
cranium, the face, the mouth, the jaws and the neck. Acquired conditions can
result from disease, malformation, tumour, trauma, degeneration and
ageing.
The scope includes but is not limited to :
- management of pain and anxiety
- dento-alveolar surgery including
periodontology
- treatment of infections involving bone soft tissues in
the head and neck area
- management of the cranio-maxillo-facial trauma ( bone,
teeth, and soft tissues ), both acute injuries and sequellae
- oral pathology / oral medicine
- preprosthetic surgery including
implantology
- surgical and non surgical management of the
temporomandibular joint disease and disorders
- oncological surgery and treatment in the head and neck
area, including benign and malignant salivary gland tumours, and management
of regional lymph node stations
- regional reconstructive surgery including harvesting
of hard and soft tissue grafts and free tissue transfer including
microsurgery
- orthognathic/facial orthopaedic surgery and
treatment
- aesthetic/cosmetic/plastic facial surgery
- surgery and treatment of congenital abnormalities
including clefts of the lips and palate.
- craniofacial surgery
Standards of Training
In order to practice the full scope of the specialty oral
and maxillo-facial surgeons are unique in that they require education and
training in both medicine, dentistry and a training in surgery in general and
in the relevant surgery of the specialty which should be formally recognised
based on national requirements.
The specialty training in oral & maxillo-facial
surgery may be accomplished in a number of ways. The entry point may be either
a medical degree or a dental degree.
The duration of core training for Oral and Maxillo-Facial
Surgery should be 6 years.
National programmes may include up to 2 years of either
relevant surgical training or may include up to 2 years of the relevant
2nd degree. ( medicine, dentistry or stomatology as they are
recognised in the Directives of the EU ).
Faculty
The advanced training programme in oral and maxillofacial
surgery must be directed by an oral and maxillofacial surgeon. The head of
training should have been practicing the specialty of Oral and Maxillo-Facial
Surgery for at least 5 years after qualification. There should be additional
teaching staff in a sufficient number to ensure that all trainees receive
sufficient teaching and close personal monitoring during the training. Both
teacher and staff should be practicing the full range of Oral and
Maxillo-Facial Surgery. All faculty members should have undergone training in
education techniques and are requested to show evidence of CME/CPD. The teacher
must provide a training programme for the trainee in accordance with the
trainee’s own qualities and facilities of the institution which also
comply with national rules and EU - legislation.
It is the director’s responsibility to assure that
individuals completing training meet the performance standards for the
programme and for the practice of the specialty. All training programmes should
be directed by a single responsible individual. The programme director should
devote adequate time to the training program to ensure:
- the development and implementation of a planned
curriculum.
- ongoing evaluation of the programme content, faculty
teaching and resident performance
- proper administration of the programme
- maintenance of records related to the educational
programme
The size and time commitment of the teaching staff should
be sufficient to ensure:
- continuity of instruction
- exposure of trainees to a broad range of diagnostic
and treatment modalities
- faculty participation in teaching activities,
including conferences and seminars
- quality assurance and audit through the evaluation of
complications and outcomes of all relevant cases.
Faculty should be available for supervision and
consultation for procedures completed in the operating room and outpatient
departments.
5. Requirements for Training Institutions. Facilities and
Resources.
Training institutions for the specialty of Oral and
Maxillo-Facial Surgery must be recognised by the national authority of the
country. The size and diversity of the training institutions and programmes
have to consider both quality and quantity of training activities. Specialty
training in oral and maxillo-facial surgery requires both outpatient clinic and
operating room experience. Clinical facilities should be properlyn equipped for
performance of all ambulatory and inpatient oral and maxillo – facial
surgery procedures. In addition to patient care facilities and resources should
be adequate to provide the educational experience and opportunities for
research required to fulfil the needs of an programme which will lead to the
registrable qualification of an Oral and Maxillo-Facial Surgeon.
Quality assurance must be an integral part of the
training programme of all training institutions. A national register of
approved hospital institutions should be available.
Regulations of Access to
Training
Regulations of access to training in the specialty should
be implemented by the National Authority in accordance with national manpower
planning projections in each EU member state. Teachers and training
institutions or other responsible bodies select and appoint in accordance with
national rules trainees who are suitable for oral and maxillofacial surgery.
The selection should be transparent and application should be open to all
persons who preferably hold both medical and dental qualifications at the time
the training is completed.
Curriculum
Medicine
The trainee must have the medical degree which will
provide the ability to evaluate the total patient and to assess the patient for
surgical and anaesthetic risks. The trainee must be familiar with patient
evaluation, including additional experience in the art of history taking and
comprehensive physical examination and further more with therapeutics including
sufficient knowledge of all the relevant accepted therapeutic agents e.g. :
chemotherapy, radiotherapy.
Fundamental to the training of an oral and maxillo-facial
surgeon is extensive experience in the areas of critical care of the seriously
ill surgical patient and the team management of the severely injured
patient.
Dentistry
The trainee must have also extensive training in
dentistry which is not only an integral part of the specialty but also
differentiates oral and maxillofacial surgery from other medical specialties.
The trainee must be familiar with the full scope of dentistry including
prosthetics, orthodontics, dental surgery and dental restoration.
Specialty
The oral and maxillo-facial trainee must be exposed to
the full scope of the specialty. Clinical training in oral and maxillofacial
surgery should provide a complete, progressively graduated sequence of
outpatient, inpatient and emergency room experience. The trainee’s
exposure to major and minor surgical procedures must be integrated throughout
the duration of the training programme. The trainee should receive a broad
surgical experience by being primary surgeon in procedures involving the full
scope of oral and maxillofacial surgery (see table with recommendations of
operation numbers which are to be performed by the trainee during his / her
training period as minimum requirements).
The trainee should receive extensive experience
throughout the programme in all aspects of pain and anxiety control.
The trainee should be exposed to sufficient numbers of
patients with a wide variety of problems to develop competence in the full
scope of oral and maxillofacial surgery as it is recorded in section 2, page
2.
Regularly scheduled seminars and conferences should be
conducted to augment the clinical programme. The trainee should have the
opportunity of discussing treatment plans with members of other specialties
.
Faculty and trainees should be encouraged to attend
national, regional and international scientific meetings.
The trainee should be encouraged to participate in
research and to publish.
Fellowships , following specialty training are one method
of providing surgeons with additional surgical experience and for expansion of
their scope of practice.
The central monitoring authority for careful review of
the curriculum and of quality assurance shall be the National Board of Oral and
maxillofacial surgery in accordance with national rules and EU legislation as
well as considering recommendations of UEMS and EACMFS.
Trainee Evaluation
There should be documentation of ongoing evaluation of
the progress of each trainee . The trainee should receive formal periodic
evaluation and should only be advanced to a position of higher responsibility
on the basis of this evaluation and readiness for advancement. Performance
should be formally evaluated and documented in all the components of training.
The trainee must keep his / her personal inventory of performance ( log book )
up to date.
European and International Training
Opportunities
Exchanging of trainees between National, European and
International recognised training centres is recommended and is to be
encouraged. National and International training opportunities for oral and
maxillofacial surgeons and trainees expands educational options and improves
international understanding within the specialty and is an important aspect of
professional education in oral and maxillofacial surgery.
Quality Assurance in Oral and
Maxillofacial Surgery
Quality assurance must be an integral part of the
programme of all training institutions. The National Medical Authority or
National Board of each EU member country together with teachers and training
institutions should implement a system of quality assurance of training. to
assure that the goals and objectives of the training are met and recognised by
the national authorities. This could be done by visitations or inspections of
training institutions, assessment of training and monitoring logbooks. A
national register of approved training institutions should be
available.
Recommendation
Recommendation of operation numbers which a trainee should perform during
his / her training period as minimum requirement
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