Oral and Maxillofacial Pathology Training in the UK

1
Oral and Maxillofacial Pathology Training in the
UK

• Professor Chris Franklin
• Regional Postgraduate Dean and
• National Lead Dean for OMFP

June 2006
2
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

3
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?)

4
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

5
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

6
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)
7
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

8
Competitive entry to training posts

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

9
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

10
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)

11
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

12
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

13
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

14
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
15
Levels 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)
16
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)
17
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
18
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
19
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
20
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
21
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
22
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
23
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)

24
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
25
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

26
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

27
(No Transcript)