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 Oral and Maxillofacial Surgery in the United Kingdom for trainees joining the OMFS specialist list between 2002 and 2019

IntroductionOMFS Specialty Training in the UK is usually 5 years and ‘starts’ at Specialty Training Year 3 (ST3). In 2007 a pilot of ‘run-through’ training started with Core Training (CT) posts linked to specialty training (ST1 posts). ST1 posts are usually 12 months but may be up to 24 months.MethodUK OMFS consultants joining the OMFS specialist list between 2002 and 2019 were contacted regarding their training. If their training was extended beyond the expected date of completion, they were asked to give a primary and secondary reason from a simplified list. Results were analysed with Winstat©.ResultsA total of 382 consultants were contacted, 325 responding (86%) and of these 290 were appointed at ST3 and their mean extension of training time was 0.63 years. For those 35 who were appointed to ST1, their training was on average 0.77 years longer than planned.Undertaking a Fellowship (33%) was the commonest reason for extension, followed by administrative delay (24%), unsuccessful attempts at the FRCS exam (12%) and training reasons (10%).Female trainees (n=37) spent on average 1.28 years longer than planned in training compared to male trainees (288 - 0.67 years). Gender differences were also present in the main reasons for extension with 12% of female respondents giving family reasons as the main cause, whereas only 2% of males gave this reason. Problems with training was the main cause for extension for 19% of females compared to 8% of males.ConclusionsUnderstanding factors which extend training and the length of these extensions could have the twin benefits of openness for new trainees and directing support to existing trainees. Differential attainment and Equality Diversity & Inclusion (EDI) are domains whose monitoring is required by the General Medical Council and undertaken by training authorities. The small numbers of trainees in OMFS programmes may not always allow training variance to be recognised.     

The Benefit of the Smartphone in Oral and Maxillofacial Surgery: Smartphone Use Among Maxillofacial Surgery Trainees and iPhone Apps for the Maxillofacial Surgeon

The use of smartphones has soared among healthcare professionals in recent years, with estimated figures reporting that the majority of clinicians own and use smartphones in the workplace. Smartphones allow the clinician to carry textbooks in their pocket, write documents on the move and use email and internet to enhance productivity and clinical decision making. These advances in smartphone technology have enabled access to healthcare information for the clinician and transfer of data between team members, giving rise to the phenomenon of telemedicine. With the ability to instantly transfer clinical data to the off-site surgeon, combined with purpose-built medical apps, the smartphone is rapidly becoming an invaluable tool for the modern surgeon. Many studies have linked the benefits of smartphones and apps in other surgical specialities, but no article to date has highlighted the merits and full scope of this technology to the Oral and Maxillofacial Surgeon. We report that 94 % of British maxillofacial surgery trainees own a smartphone, with 61 % owning an iPhone. 89 % of trainees questioned had downloaded medical apps and used them regularly during clinical activities. We discuss the clinical application of the smartphone in the field of oral and maxillofacial surgery and review a list of useful and relevant apps for the modern maxillofacial surgeon using the iPhone as an example platform.     

FRCSEd (Oral and Maxillofacial Surgery): a milestone in the history of Oral and Maxillofacial Surgery in the United Kingdom

The British Association of Oral and Maxillofacial Surgeons (BAOMS) and the Royal College of Surgeons of Edinburgh (RCSEd) have had leading roles in organisation, assessment and improvement of surgical training in the United Kingdom. This was particularly well illustrated by the establishment of the fellowship examination in Oral and Maxillofacial Surgery (FRCSEd, OMFS).     

Factors predicting success in the Intercollegiate Membership of the Royal College of Surgeons (MRCS) examination: a summary for OMFS

The Intercollegiate Membership of the Royal College of Surgeons (MRCS, parts A and B) is a mandatory examination for entry into higher surgical training in the UK. We investigated which factors predict success in both the written (Part A) and clinical (Part B) parts of the examination, and provide a summary for oral and maxillofacial surgeons (OMFS). All UK graduates who attempted both parts between 2007 and 2016 were included. There was a positive correlation between the scores in parts A and B (r = 0.41, p < 0.01). For Part A, men (odds ratio (OR) 2.78; 95% CI 1.83 to 4.19), white candidates (OR 1.70; 95% CI 1.52 to 1.89), and younger graduates (under 29 years of age), were more likely to pass (OR 2.60; 95% CI 1.81 to 3.63). Foundation year one (FY1) doctors had higher pass rates than all other grades (e.g. core surgical trainee 2 compared with FY1 OR 0.50; 95% CI 0.32 to 0.77). The number of attempts at Part A and the final score, as well as ethnicity and stage of training, were independent predictors of success in Part B. Candidates who did well in Part A were more likely to do well in Part B. Several independent predictors of success were identified, but only the stage of training and ethnicity were common predictors in both parts. Higher scores obtained by younger candidates might be relevant to OMFS trainees who take Part A after studying medicine as a second degree.     

Oral and Maxillofacial Surgery (OMFS) Consultant Workforce in the UK: reducing consultant numbers resulting from recruitment issues,pension pressures,changing job-plans,and demographics when combined with the COVID backlog in elective surgery,requires urgent action

Mean retirement age for UK doctors is 59.6 years, giving the average OMFS consultant approximately 20 years of practice. Current pension tax regulations, new consultant posts typically restricted to a maximum of 10 sessions (40 hours), increasing proportions of consultants working less than full time (LTFT), all combined with the backlog of elective care created by COVID-19 will create a significant gap between workforce capacity and clinical demand. The age of current OMFS consultants was estimated using the date of their primary medical/dental qualification. Changes in job plans were estimated using data from the BAOMS Workforce Census and from recently advertised posts. Reports of unfilled posts were collated by OMFS Regional Specialty Professional Advisors (RSPAs). First degree dates were identified for 476 OMFS substantive consultant posts. Estimated current average age of OMFS consultants was 52.7 years (minimum 35.9, maximum 72.1), 75th centile age 59.0 and 23% of the current consultant workforce above the average retirement age for doctors. The 10 sessions of new OMFS consultants posts is significantly less than existing consultants' average of 12.1 sessions (48.4 hours). Unfilled consultant posts in Great Britain are 13% of the total compared to 20% in Northern Ireland and Ireland. Many (23%) of the OMFS consultant workforce are above average retirement age. Forty-hour contracts; new consultants working LTFT; and early loss of senior colleagues because of pension pressure will reduce NHS’ capacity to treat OMFS disorders and injuries. This paper suggests increasing consultant posts, increasing trainee numbers, and actively retaining senior surgeons to maintain capacity.     

Predictors and risk factors for admission to critical care in cervicofacial infections: a Maxillofacial Trainee Research Collaborative (MTReC) study

Cervicofacial infections carry significant morbidity. Patients present on a broad spectrum of severity, with some requiring outpatient management and others admission to higher level care. Recognition of risk factors is helpful in decision making regarding the need for admission to higher level care. Prospective data were captured on 1002 patients in 25 centres across 17 regions of the United Kingdom (UK) by the Maxillofacial Trainee Research Collaborative (MTReC). Patients admitted to critical care were compared with those who received ward-level care. Multivariate and receiver operating characteristic curve analyses were used to identify predictors for critical care admission. Our results show that the best predictor for critical care admission is the presence of three or more features of airway compromise (AUC 0.779), followed by C-reactive protein (CRP) >100 mg/L (OR 2.70; 95% CI 1.59 to 4.58; p < 0.005), submandibular space involvement (OR 3.82; 95% CI 1.870 to 7.81; p = 0.003), white cell count (WCC) >12 × 10⁹/ dl (1.05; 95% CI 1.01 to 1.10; p = 0.03), and positive systemic inflammatory response syndrome criteria (OR 2.78; CI 1.35 to 5.80; p = 0.006). Admission to critical care is multifactorial, however, the presence of three or more features of airway compromise is the best predictor. Awareness of this alongside other key clinical findings in cervicofacial infections may allow for the early recognition of patients who may require escalation to critical care.     

The prognostic implications of comorbidity and risk factors for (post)operative complications,days spent in the intensive care unit (ICU), and length of hospitalization in patients with oral squamous cell carcinoma: A prospective study

BackgroundThis study aimed to investigate the prognostic implications of comorbidity/risk factors in a cohort of patients with OSCC.MethodsThe prospective study included patients with biopsy-proven primary OSCC. The impact of potential predictors on (post)operative complications, days spent in the ICU, and length of hospitalization was analyzed using both univariate and multivariate analysis.ResultsUsing a microvascular free flap (p = 0.009) and tobacco abuse (p = 0.005) had statistically significant impacts on postoperative complications in univariate, but not in multivariate, analysis. The duration of anesthesia (p < 0.001), type of neck dissection (p = 0.014), reconstruction type (p < 0.001), and red blood cell transfusion during operation (p = 0.007) had statistically significant impacts on spending ≥ 3 days in ICU in univariate analysis, with reconstruction type (p = 0.022) and red blood cell transfusion during operation (p = 0.034) having similar impacts in multivariate analysis. The duration of anesthesia (p < 0.001), pT (p = 0.009), type of neck dissection (p = 0.046), reconstruction type (p < 0.001), and microvascular free flap (p < 0.001) had a statistically significant impacts on length of hospitalization in univariate analysis, with reconstruction type (p < 0.001) also having a significant impact in multivariate analysis.ConclusionNone of the investigated variables showed a significant effect on the prediction of (post)operative complications according to the Clavien-Dindo classification. The type of reconstruction proved to be a valid predictor for the time spent in ICU as well as for the overall length of hospitalization. Red blood cell transfusion during operation further predicted the time spent in ICU after operation. Both variables should be taken into account when performing a comprehensive planning of the patients’ hospitalization.