Oral and Maxillofacial Pathology Training in the UK

Oral and Maxillofacial Pathology Training in the UK Professor Chris Franklin Regional Postgraduate Dean and National Lead Dean for OMFP June 2006

General Professional Training • 2 years General Professional Training (GPT) • Currently one year in Vocational Training (VT) in GDP and one year in SHO hospital and/or CDS post • UK curriculum development (Autumn 2006) • At present those wishing to enter specialist training need to pass MFDS • Satisfactory completion of GPT ? assessed by new exam or by continuous assessments using OSCEs, DOPs, CBDs etc

Entry to higher training • From 2006 GDC entry to specialist training :- On the GDC register Fit to practice Broad experience • National Specialty Advisory Committees (SACs) will set specific entry requirements for each specialty • Satisfactory completion of GPT (MCDRCS?)

Training programme in OMFP • 5 years post GPT based in the health service (NHS) • Can be centrally or locally NHS funded • Longer programme for those in clinical academic posts ie PhD or research / teaching commitments • Jointly managed by Specialist Advisory Committee (SAC) in Additional Dental Specialties (SACADS) and RCPath

Recruitment to the specialty • Process follows RCPath guidelines • Educational job description completed by hospital unit • JD approved by RCS Faculty Specialty Adviser • Lead dean confirms training number available providing SAC have approved post, and funds available • SAC may need to prioritise units seeking posts • Units are approved for training and capacity by SAC • Ensures units are not over committed

Managing the workforce 1 • Lead PG Deans with Chairs of SACs monitor number of trainees in registrar* posts alongside retirements • Work with DH National Workforce Review Team to review current position and request central funding for new posts in order to arrive at steady state!!! • Attempt to match those in training to upcoming retirements over training period • Set number of National Training Numbers (NTNs) in each specialty * Specialist Registrars (SpRs)

Managing the workforce 2 • Additional Dental Specialties comprise :- • Oral Medicine • Oral and Maxillofacial Pathology • Oral and Maxillofacial Microbiology • Dental and Maxillofacial Radiology • Approximately 25 NTNs shared by the 4 groups • Lead Dean holds numbers and allocates across England working in conjunction with SAC • Information shared with N Ireland, Scotland & Wales

Competitive entry to training posts • National advert • Process managed by Human Resources locally • National recruitment and allocation of posts possible in future

Types of training posts • Specialist Registrar posts (SpR) in NHS • Clinical academic (lecturer) posts (Hon SpR) • Numbers of trainees nationally monitored by national lead dean • Postgraduate Dental Deans (PGDDs) work in conjunction with SAC and DH national workforce team to try and balance new posts to retirements • Can increase numbers in line with government policy

Annual monitoring of trainees • Each trainee allocated educational supervisor • Formal appraisal twice each year • Annual assessment using Record of In –Training Assessment (RITA) • Completion and validation of logbook • Completion of personal development or learning portfolio (PDP) • CPD complies with GDC requirements for re-certification (revalidation in due course)

Record of In –Training Assessment (RITA) • 5 annual assessments • Panel comprises PG Dean, Training Programme Director (TPD), College Advisor and external assessor • Five levels of RITA – most trainees are satisfactory • Trainee can be referred for targeted training in year or for ‘remedial’ training that requires extension to programme. Last resort is ‘counselling out’ • Problems should have been identified before RITA day so as to have potential action plan

Training programme 1 • Deanery appointed Training Programme Director (TPD) manages programme and rotation • Acts as mentor for trainees and works with trainers to ensure programme works • TPD co-ordinates rotation, RITAs and Specialty Training Committee (STC) • STC comprises all trainers and Dean and meets 2-3 times/year. Reviews training issues and trainee performance • Other courses funded according to PDP requirements including management training

Training programme 2 • Five year programme includes at least 1 year in general pathology • Training provided in ‘cut up’, interpretation of histology, histopathology. • Trainees attend ug and pg lectures in pathology including those for general MRCPath trainees • Trainees attend EQA and regional slide seminars

Competency expected for the award of a CCST* in Oral and Maxillofacial Pathology Pathologist capable of providing an independent diagnostic service at the level required for the award of a CCST in the specialty and … be able to offer a specialist opinion on referred cases and be able to provide specialist advice to clinicians with direct responsibility for the treatment of patients *Certificate of Completion of Specialist Training

Levels of competency 1 to be able to diagnosematerial for which accurate and complete reports are expected, taking account of all relevant specialist reporting guidelines to be able to offer at least a working diagnosison material with which trainee will be familiar and will have had experience of reporting but for which further investigations and/or discussion with a specialist are required before issuing a definitive report (eg neoplasms of bone and soft tissue; rare types of odontogenic tumours)

Levels of competency 2 to be able to offer at least a differential diagnosis on material that the trainee will be aware of but may have had only limited or no experience of directly reporting. This group will include some rare/uncommon lesions diagnosable after further investigations and/or research, and lesions for which a specialist opinion will be required (eg aspects of ENT pathology, neoplasia of the lymphoreticular system)

Scope of Oral and Maxillofacial Pathology 1 Oral cavity Disorders of the teeth, supporting structures and lesions derived from odontogenic tissues Major/minor salivary glands & other mucosal glands Inflammatory / neoplastic / cystic disorders of major / minor salivary glands and sino-nasal, pharyngeal, laryngeal minor glands

Scope of Oral and Maxillofacial Pathology 2 Jaws, craniofacial bones and temporomandibular joint Inflammatory, developmental, neoplastic and reactive lesions involving bone, bone marrow or periosteum and cartilage (in association with appropriate radiographic and biochemical data) Diagnose or working diagnosis of non-neoplastic disorders of TMJ and working / differential diagnosis of benign and malignant neoplasms

Scope of Oral and Maxillofacial Pathology 3 Ear, sinonasal tract and nasopharynx Experience in ENT pathology will vary from centre to centre, particularly for trainees from academic departments of oral pathology, reflecting patterns of referral of specimens and local reporting practices Pharynx and larynx Diagnose / working / differential diagnosis of inflammatory, reactive and neoplastic disorders arising from the pharyngeal mucosa and underlying lymphoid tissue and glands. Similar awareness of laryngeal pathology

Scope of Oral and Maxillofacial Pathology 4 Neck and thyroid gland Diagnose non-neoplastic disorders of lymph nodes, (or working / differential diagnosis in appropriate cases such as in granulomatous inflammation), and working / differential diagnosis of malignant lymphomas and of metastatic malignant disease Diagnose developmental cysts in the neck and to offer at least a working / differential diagnosis of paraganglioma and of soft tissue tumours Aware of disorders of thyroid gland and be able to offer at least a differential diagnosis of main types of thyroid carcinomas presenting as metastatic deposits in the neck

Scope of Oral and Maxillofacial Pathology 5 Facial and neck skin Diagnose squamous cell carcinoma, basal cell carcinoma, actinic keratosis and epidermal dysplasia (or working/ differential diagnosis in difficult cases) And to offer at least a working/differential diagnosis for melanocytic nevi and common benign adnexal tumours such as pilomatricoma

Scope of Oral and Maxillofacial Pathology 6 Cytology, fine-needle aspiration (FNA), true-cut biopsies and frozen sections Familiar with these techniques and of their applications and limitations in relation to diseases in the head and neck region Able to interpret such material from salivary tumours and cervical masses as a triage to identify the presence of carcinoma

Joint NHS/clinical academic pathway • Funding arrangements different ie University not NHS • Trainee needs PhD (not required for entry to specialist training but for academic progression) • Therefore extended programme needed. Five year programme allows one year towards this. • Extended programme 2-3 years more (ie 7-8 years)

MRCPath exam format Part 1 – may be taken after 2.5 years training 2 written papers (essay& short notes) testing core knowledge Paper 1 general pathology and principles relevant to oral pathology Paper 2 is slanted to Oral Pathology Requires one year of experience in general pathology in addition to oral pathology training Part 2 – may be taken after 4.5 years training Comprises practical and oral components over two days and is a test of competence in histopathology diagnosis and report writing

Out of Programme Experience (OoPE) • Trainees can request OoPE in order to visit other units in order to gain experience not available in own unit. • Can simply be short term visit (days/weeks) or • Longer periods ie 3 months up to one year • Must show same training cannot be provided locally • Funding must be found by trainee for 6 months or more so that local post can be back-filled

Completion of training • Satisfactory completion of five RITAs • Passed Parts 1 and 2 of MRCPath • Postgraduate Dean signs off completion of training • Dean sends recommendation to GDC for award of Certificate of Completion of Specialist Training (CCST) • CCST permits trainee to go on OMFP Specialist List • Eligible for consultant appointments

Oral and Maxillofacial Pathology Training in the UK