Massachusetts General Hospital/Harvard Medical School MD oral and maxillofacial surgery program: a 30-year review

Oral and Maxillofacial Surgery Training in the United States: Influences of Dental and Medical Education, Wartime Experiences, and Other External Factors

Here, we trace the history of oral and maxillofacial surgery (OMS) education from the mid-19th century to the present. We consider the effects of separation of dentistry and medicine, discovery of anesthesia, antisepsis, antibiotics, and wars on surgical progress and training. In the 19th century, apprenticeships with well-known surgeons were the norm. In the 20th century, training evolved from nonintegrated dental school and hospital experiences to 3- and then 4-year integrated hospital programs. After World War II individual oral surgeons pursued the MD degree after residency. The formal dual degree OMS paradigm began in the 1970s.

Changes in United Kingdom oral and maxillofacial surgical specialty trainees since 1995 - numbers, gender, first degrees, and nations of origin

Training in UK surgery has changed dramatically since 1995, from a relative lack of structure to time-limited and highly documented programmes. Training in oral and maxillofacial surgery (OMFS) has shared these changes and included some significant changes of its own. Minutes from the OMFS Specialty Advisory Committee (SAC) were reviewed over the last 25 years to record the number and location of newly approved posts. The General Medicine Council's (GMC) OMFS specialist list in 2019 was combined with the records of OMFS specialists' dental qualifications held by the General Dental Council (GDC) and augmented from a database of OMFS trainees and consultants in the UK. Data on demographics, location, and nature of the first medical or dental degree were noted for analysis. A total of 691 OMFS specialists and trainees were identified from GMC, OMFS SAC and consultant databases. Of these, 12 consultants held only dental qualification/registration. First degree data could not be obtained for 12 specialists (all male). A further 20 OMFS specialists, whose training was outside the UK, were also excluded from further analysis. In 1995 there were 95 national training posts, by 2013 there were 150. Over the last quarter of a century, there has been an increase in medicine first trainees, an increase in female trainees and specialists, and a relative decrease in OMFS trainees from the Indian subcontinent. The varied origins of the OMFS workforce has contributed to greater diversity and inclusion within the specialty. In the UK, OMFS appears to have produced the correct number of specialists whilst maintaining a high standard of training. The next change in OMFS training programmes is to deliver The Postgraduate Medical Education and Training Board's (PMETB) recommendations. As we move to achieve this it is imperative that as new doors open, we do not close others.

Dual-degree Oral and Maxillofacial Surgery Training in the United States: "Back to the Future"

In the present report, we trace the history of education and training of oral and maxillofacial surgeons as it has evolved from the mid-19th century to the present. We consider the effects of the discovery of ether anesthesia, the separation of medicine and dentistry, and other milestones such as antisepsis (Lister), antibiotics (Fleming) and surgical progress during wartime. The main emphasis, however, is on the background, development, and implementation of current dual-degree oral and maxillofacial surgery training programs, the first 5 programs, the pioneer advocates for this training, and progress and challenges for the future.

The Effect of Oral and Maxillofacial Surgery Curriculum on United States Medical Licensing Examination Step 1 Performance

PURPOSE

Over the years, a few types of combined oral and maxillofacial surgery (OMS)-MD residency curricula have evolved that differ in how the MD is integrated. The purpose of this study was to look for a difference in United States Medical Licensure Examination (USMLE) Step 1 pass rates among these different curricula.

MATERIALS AND METHODS

An anonymous electronic survey was e-mailed to the directors of all 46 United States-based OMS-MD-integrated programs, querying OMS curriculum type and USMLE Step 1 results over the years 2007-2017. Programs were then characterized by the curriculum sequence, whether USMLE Step 1 was taken before or after starting medical school, and the amount of dedicated test preparation time.

RESULTS

Of 46 OMS-MD program directors, 32 (70%) responded. No statistically significant difference in the USMLE Step 1 pass rate was found among the 4 main types of OMS-MD curricula (range, 89 to 95%; P = .06). Completing some part of medical school before taking USMLE Step 1 also had no effect on OMS residents' pass rates (94% vs 92%, P = .23). However, an increasing number of weeks of dedicated test preparation time was significantly correlated with increasing USMLE Step 1 pass rates (87% with no dedicated test preparation time, increasing to 96% with ≥6 weeks of dedicated test preparation time; P = .05). Finally, only 7 of 806 total residents (0.9%) dropped out of a program because of the inability to pass USMLE Step 1.

CONCLUSIONS

The data show a high overall USMLE Step 1 pass rate with a direct correlation between the duration of dedicated test preparation time and pass rate. No difference in USMLE Step 1 pass rates was observed based on the sequence of OMS-MD-integrated curricula or the completion of some pre-USMLE medical school before USMLE Step 1 among OMS residents.

The Development of Dual-Degree Programs in Oral and Maxillofacial Surgery: Celebrating the 75th Anniversary of the Journal of Oral and Maxillofacial Surgery and the 100th Anniversary of Our Specialty

The concept and history of dual-degree residency education and training are reviewed.

Who are we? A qualitative evaluation of trainees' perspectives on professional identity in oral and maxillofacial surgery

INTRODUCTION

Professional identity is becoming increasingly important in medical education in terms of developing appropriately trained and safely practising doctors. Oral and maxillofacial surgery (OMFS) is a unique surgical speciality that requires dual qualification in medicine and dentistry. Its junior trainees move between the various roles of student, doctor and dentist, and at certain times these roles may overlap. This heterogeneous early training may raise significant barriers for them in terms of understanding their professional identity and developing their own sustainable sense of belonging. This study looks to understand current trainees' perceptions of the professional identity of an oral and maxillofacial surgeon.

METHOD

A qualitative research methodology based on a grounded theory approach was used in this study. Data were collected using in-depth, semi-structured interviews with OMFS specialist trainees. Subsequent theories were constructed after thematic analysis.

RESULTS

A model of the professional identity of an oral and maxillofacial surgeon is proposed.

DISCUSSION

This study represents the first attempt to understand professional identity in OMFS trainees. It will provide insight into what trainees understand by the term in this speciality, as well as outlining what trainees feel are important elements to develop a sense of belonging within the speciality.

Knowledge, attitude and awareness of speciality of oral and maxillofacial surgery amongst medical consultants of vadodara district in gujarat state

BACKGROUND AND AIM

Aim of this study was to survey the knowledge, attitude and awareness of the subject of oral and maxillofacial surgery speciality amongst the consultants and practitioners of medicine in district of Vadodara.

MATERIALS AND METHODS

List of members of various specialities in medical faculty were obtained from Indian Medical Association, Baroda branch and staff members of medical colleges of Vadodara district. A questionnaire survey was made which was distributed and their options were noted.

RESULTS

Surgical removal of third molar, oral submucous fibrosis and implants were the problems where oral surgeons were preferred. For maxillofacial trauma plastic surgeons and orthopaedic surgeons were preferred than oral surgeons. For maxillofacial pathology E.N.T surgeons were mostly preferred. There is low awareness regarding oral and maxillofacial surgery amongst the general practitioners and medical consultants in Vadodara district.

CONCLUSION

Survey shows that our training needs to be upgraded and revamped so that our trainees (post graduates in oral surgery) and have a greater "hands-on" exposure during their postgraduate training. They will then be able to handle increasingly complex cases in a multispecialty setup when they graduate and earn the mutual respect of the medical and dental fraternity and also the general public. MBBS students during their dental postings should be made aware of the depth and scope of oral surgery branch.

RNA therapeutics targeting osteoclast-mediated excessive bone resorption

RNA interference (RNAi) is a sequence-specific post-transcriptional gene silencing technique developed with dramatically increasing utility for both scientific and therapeutic purposes. Short interfering RNA (siRNA) is currently exploited to regulate protein expression relevant to many therapeutic applications, and commonly used as a tool for elucidating disease-associated genes. Osteoporosis and their associated osteoporotic fragility fractures in both men and women are rapidly becoming a global healthcare crisis as average life expectancy increases worldwide. New therapeutics are needed for this increasing patient population. This review describes the diversity of molecular targets suitable for RNAi-based gene knock down in osteoclasts to control osteoclast-mediated excessive bone resorption. We identify strategies for developing targeted siRNA delivery and efficient gene silencing, and describe opportunities and challenges of introducing siRNA as a therapeutic approach to hard and connective tissue disorders.

Small interfering RNA knocks down the molecular target of alendronate, farnesyl pyrophosphate synthase, in osteoclast and osteoblast cultures

Farnesyl pyrophosphate synthase (FPPS), an enzyme in the mevalonate pathway, is the inhibition target of alendronate, a potent FDA-approved nitrogen-containing bisphosphonate (N-BP) drug, at the molecular level. Alendronate not only inhibits osteoclasts but also has been reported to positively affect osteoblasts. This study assesses the knockdown effects of siRNA targeting FPPS compared with alendronate in both osteoclast and osteoblast cultures. Primary murine bone marrow cell-induced osteoclasts and the preosteoblast MC3T3-E1 cell line were used to assess effects of anti-FPPS siRNA compared with alendronate. Results show that both FPPS mRNA message and protein knockdown in serum-based culture is correlated with reduced osteoclast viability. FPPS siRNA is more potent than 10 μM alendronate, but less potent than 50 μM alendronate on reducing osteoclast viability. Despite FPPS knockdown, no significant changes were observed in osteoblast proliferation. FPPS knockdown promotes osteoblast differentiation significantly but not cell mineral deposition. However, compared with 50 μM alendronate dosing, FPPS siRNA does not exhibit cytotoxic effects on osteoblasts while producing significant effects on ostoblast differentiation. Both siRNA and alendronate at tested concentrations do not have significant effects on cultured osteoblast mineralization. Overall, results indicate that siRNA against FPPS could be useful for selectively inhibiting osteoclast-mediated bone resorption and improving bone mass maintenance by influencing both osteoclasts and osteoblasts in distinct ways.

Perception of oral maxillofacial surgery by health-care professionals

Oral and Maxillofacial Surgery (OMFS), a dentistry specialty recognized by the Federal Dentistry Board in the mid-1960s, is responsible for the diagnosis, and clinical and surgical treatment of traumatic, congenital, developmental and iatrogenic lesions in the maxillofacial complex. Even today, difficulties are experienced owing to the lack of knowledge of the general public and health professionals concerning the scope of OMFS. To investigate recognition of the scope of OMFS, 400 questionnaires were sent to dentistry students, medical students, dentists and doctors, in 4 equal groups. The questionnaire covered 26 clinical situations in four different specialties (OMFS, Plastic Surgery, Ear Nose and Throat Surgery, Head and Neck Surgery) and an option with no specialty specified. Each interviewee had to correlate the clinical situation with the respective specialist. For facial trauma, dento-facial deformities, mandibular reconstruction and temporomandibular joint surgery, most respondents would consult the OMF surgeon for treatment (mean, 90%). In cases of oral biopsy and treatment of benign mandibular tumours the mean referral rate to OMFS was low (48%). On the basis of the questionnaire responses, a good level of knowledge of the scope of OMFS was found. In order to ensure the correct referral of all patients, the specialty needs to broaden its horizons.

USMLE Step 1 Scores as a Significant Predictor of Future Board Passage in Pediatrics

PURPOSE

To explore the relationship(s) between USMLE, In-Training Exam, and American Board of Pediatrics (ABP) board-certifying exam scores within a Pediatric residency-training program.

METHODS

Data were abstracted from records of graduating residents from the Pediatric residency program at the University of Florida College of Medicine Jacksonville from 1999 to 2005. Seventy (70) residents were identified and their files reviewed for the following information: USMLE Step 1 and 2 scores, in-training exam results and eventual board scores as reported by the ABP. Correlation and regression analyses were performed and compared across all tests.

RESULTS

The correlation coefficients between the three types of tests were all statistically significant. Using logistic regression, however, only USMLE Step 1 scores (compared to Step 2) had a statistically significant association with board performance. Interestingly, none of the three in-training exam scores had any additional impact on predicting board performance given one's USMLE Step 1 score. USMLE Step 1 scores greater than 220 were associated with nearly a 95 per cent passage rate on the board-certifying exam.

CONCLUSIONS

The data suggests that performance on USMLE Step 1 is an important predictor of a resident's chances of passing the pediatric boards. This information, which is available when a resident initiates training, can be used to identify those at risk of not passing the boards. While Step 1 scores should not be used as a sole determinant in the recruiting process, individual learning plans can be developed and implemented early in training to maximize one's ability to pass the certifying exam.