oral and maxillofacial pathology training in the uk professor chris franklin regional postgraduate...
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Oral and Maxillofacial Pathology Training in the UK
Oral and Maxillofacial Pathology Training in the UK
Professor Chris FranklinRegional Postgraduate Dean and
National Lead Dean for OMFP
June 2006
General Professional TrainingGeneral 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 trainingEntry 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 OMFPTraining 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 specialtyRecruitment 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 1Managing 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 2Managing 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 postsCompetitive entry to training posts
National advert
Process managed by Human Resources locally
National recruitment and allocation of posts possible in future
Types of training postsTypes 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 traineesAnnual 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) 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 1Training 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 2Training 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
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 1Levels of competency 1
to be able to diagnose material 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 diagnosis on 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 2Levels 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 1Scope of Oral and Maxillofacial Pathology 1
Disorders of the teeth, supporting structures and lesions derived from odontogenic tissues
Oral cavity
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 2Scope of Oral and Maxillofacial Pathology 2
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
Jaws, craniofacial bones and temporomandibular joint
Scope of Oral and Maxillofacial Pathology 3Scope of Oral and Maxillofacial Pathology 3
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
Ear, sinonasal tract and nasopharynx
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 4Scope of Oral and Maxillofacial Pathology 4
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
Neck and thyroid gland
Scope of Oral and Maxillofacial Pathology 5Scope of Oral and Maxillofacial Pathology 5
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
Facial and neck skin
Scope of Oral and Maxillofacial Pathology 6Scope 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 pathwayJoint 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 formatMRCPath 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)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 trainingCompletion 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