Association of British Academic Oral and Maxillofacial Surgeons
1. Response to the GDC Specialist Lists Review Group on the “Consultation on
amendments/additions to the existing Specialist List”
The Association of British Academic Oral and Maxillofacial Surgeons (ABAOMS) is pleased
to have been asked to take part in this consultation process. In preparation for this response,
our association has developed a policy statement on the dental surgical specialist lists and this
has been approved as a consensus view of our group. The document gives particular
emphasis to the future of academic training programmes in oral surgery, and is attached to
this document. Our responses to the specific questions posed in the consultation will
therefore refer substantially to our policy statement.
Questions
1.
Do you have any comments about the criteria which the Working Group has adopted?
We are happy with the criteria of the Working Group.
2.
Do you think that each of the current specialist lists meets the above criteria?
With regard to the current specialist list in Oral Surgery, the programme in academic
oral surgery is now the only training pathway that leads to entry onto the list. The
sphere of work is clearly defined as a distinctive branch of dentistry and is
encompassed within the EU directives III/D/114/4/82 and III/D/1374/84. It has an
approved curriculum and training programme, and establishment of this list is in the
interests of patients for the following reasons:
1.
2.
3.
Provision of an important sphere of clinical service.
Training of a group of clinical academics who assume responsibility for the
training of undergraduates and postgraduates.
Creation of a group of clinical academics with specific expertise in research
work, as required by our Universities and for the furtherance of the specialty.
ABAOMS has reservations concerning the current specialist list in surgical dentistry.
There is an approved curriculum and training programme but the specialty is not
recognised in other parts of the EU. Furthermore, we recognise that there is a need to
develop NHS (non-academic) training programmes in oral surgery, leading to
consultant status in hospital practice.
3.
If you have suggested that any of the existing lists should be abolished, please state
what consequences (if any) you consider this would have for public protection.
We do not think it would be appropriate to simply abolish the existing surgical
dentistry list and/or fuse the current surgical dentistry and oral surgery lists. It would
seem more appropriate to freeze the current surgical dentistry list and initiate
appropriate ‘grandfathering’ arrangements for the new oral surgery list. Nevertheless,
this would still be likely to result in a single list that would include specialists with a
wide range of skills and training backgrounds. Providing that the specialists worked
within their sphere of competence and that appropriate clinical governance procedures
were in place, there should be no problems with public protection. Most importantly,
it would not be appropriate to “devalue” the sphere of activity of existing consultants
or specialists that would share the combined list. In other words, as emphasised in
our policy statement, the specialist list should not be used to limit activity artificially.
4.
If you have suggested that any of the existing lists should be adjusted or divided,
please outline, if possible, the proposed new curriculum and possible alternative
training pathways, and identify who should be involved in the development of the new
curriculum and possible training pathways.
As outlined in our attached policy statement, ABAOMS has carefully considered the
curriculum for a new specialist list in oral surgery. This has been based on the EU
directives III/D/114/4/82 and III/D/1374/84 and would permit flexibility within the
level of competencies achieved. Following the principles enshrined within the EU
directives, we have defined a list of “essential competencies” which must be achieved
by all trainees, in order to be considered a specialist in oral surgery. In addition, the
series of competencies marked by an asterisk in the EU directives (to denote that they
are not included in the training programmes in some member states) would be
included as “extended competencies”. Inclusion of these latter competencies would
be dependent upon training opportunities. Academic trainees have always had the
opportunity to become competent in the full breadth of oral surgical work and we feel
strongly that this must be allowed to continue. Equally we see no reason why some
NHS trainees should not also pursue this sphere of activity, providing that they have
appropriate training opportunities and a competency based assessment of
achievements.
We believe that ABAOMS should be involved in the development of this new
curriculum and training pathway, together with representatives of the Academic
Advisory Committee for Oral & Maxillofacial Surgery (AACOMS) and the British
Association of Oral Surgeons (BAOS). We would like the programme to be
supervised and monitored by the establishment of a new dental SAC in oral surgery,
reporting directly to JCSTD. Our reasons for this proposal are outlined in our policy
statement. We believe that after a reconfigured list has been established and any
grandfathering arrangements completed, entry would only be achieved via a training
programme in oral surgery. We do not consider it appropriate to gift entry onto this
list to trainees in oral and maxillofacial surgery, as occurs at present.
ABAOMS considers that this development would enhance current patient care. Oral
surgery is currently neglected in some parts of the UK because our busy maxillofacial
colleagues need to devote a substantial proportion of their time to the care of major
oncological cases. There is also currently a recruitment problem in the specialty of
Oral and Maxillofacial Surgery. We believe that oral surgery requires a consultant-led
service within the NHS.
5.
Should any new dental specialties be introduced?
Creation of a new oral surgery list is merely a refinement of the existing lists. It is
clearly defined as a distinctive branch of dentistry under the EU directives and, as
outlined above, would be of benefit to patients. Other benefits include the retention of
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an extremely successful academic training programme that has helped to overcome
the generalised shortages of clinical academic staff in dentistry. Markers of the
success of our programme are listed in our policy statement, and include the creation
of 18 clinical academic staff via the programme since 1991, inclusion of academic
consultants trained on this programme in most UK dental schools, and promotion of
four of our trainees to Chairs in the specialty.
In the preparation of this response, it will be apparent that we have made particular efforts to
retain the special characteristics of our academic training programme. We have also ensured
that our programme fulfils the criteria listed in the draft report of the Academic Careers SubCommittee of Modernising Medical Careers and the UK Clinical Research Collaboration
(published January 2005), and “Clinical Academic Medicine – The Way Forward”, a report
from the Forum on Academic Medicine (published November 2004).
2. Response to the GDC Specialist Lists Review Group on the “Consultation on greater
flexibility for specialist training programmes”
1.
Do you think that the current entry requirements (generally 2 years general
professional training (GPT) and Membership of the Faculty of Dental Surgery
(MFDS) or equivalent) for dental specialist training are adequate and relevant?
ABAOMS believes that these entry requirements are adequate and relevant. However,
we are also aware of the development of Foundation Programmes as part of
“Modernising Medical Careers” and the subsequent recommendations of the
Academic Careers Sub-Committee that suggested a limited programme of integrated
Foundation Programmes for potential academic trainees. This would require the
creation of SHO equivalent posts linked to academic units, providing an introduction
to a potential academic career. Such programmes would need to be associated with
dental schools and would incorporate a short attachment to an academic unit, a
research project and involvement in undergraduate and/or postgraduate teaching.
2.
Do you think there should be changes to the current entry requirements?
The current AACOMS training pathway has an entry requirement of MFDS and a
PhD or equivalent doctorate. We believe that both requirements are extremely
important and have ensured the success of our programme.
3.
Should entry requirements vary according to individual specialties or be identical
across all disciplines? Please be specific.
ABAOMS believes that the entry requirements for an academic programme are
specific, due to the need for a research doctorate. The clinical requirements can be
identical across all disciplines.
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Length of training programmes
4.
Do you think that the current minimum lengths of training programmes are
appropriate?
As outlined in our responses above, ABAOMS considers that training programmes in
oral surgery should be flexible, depending upon the competencies included within the
programme. If only the ‘essential competencies’ are included, a training programme
of 3 years would be adequate. If the ‘extended competencies’ are undertaken (thereby
including, for example, management of maxillofacial trauma and facial deformity), a
training period of 4 years would be required.
5.
What do you think will be achieved by changing the length of the training
programme?
ABAOMS considers that there are advantages to tailoring the training period on an ad
personam basis to individual needs and training opportunities. This permits the
minimum period of training needed to achieve the relevant clinical competencies.
6.
There have been suggestions that previous postgraduate training should be
recognised for the specialist training programme. If you agree with such a proposal
please comment on:
a)
What kind of training should be recognised towards the specialist training
programme and for which specialties?
It follows from our comments above, that training should be tailored to
individual needs on a flexible basis. For example, a current specialist on the
surgical dentistry list would certainly need a shortened period of training prior
to entry onto the oral surgery list, depending upon the additional competencies
they aimed to achieve.
In contrast, some clinical competencies require an extended period of training
to be achieved satisfactorily. For example, the management of facial
deformity or maxillofacial injuries would need to be achieved over a period of
at least 3 years, in order to allow the trainee to encounter the breadth of work
and potential complications.
ABAOMS also considers that training in ‘extended competencies’ should be
made available to those who have already completed specialist training on a
more restricted curriculum. This allows career development and
enhancement, as part of the ‘skills escalator’.
b)
What do you think should be the maximum length of time for which
exemption from the overall training programme could be granted?
This is difficult to answer for the reasons outlined above and would depend
upon the individual and the competencies to be achieved.
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c)
Are there instances where a reduction in the length of the overall specialist
training programme is not appropriate?
As above.
d)
Are there other issues to bear in mind?
Other relevant issues are discussed in our Policy statement.
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