This specification describes the requirements for advanced training in oral and maxillofacial surgery. It is based on the Royal Australasian College of Dental Surgeons “Guidelines for the Accreditation of Training Programmes and Positions in Oral and Maxillofacial Surgery”.
This training is the final years of the pathway to fellowship in oral and maxillofacial surgery of the Royal Australasian College of Dental Surgeons. It is usually preceded by attainment of the Master of Dental Surgery (MDS), the Bachelor of Medicine and Bachelor of Surgery (MBChB) and a minimum of three years relevant clinical experience.
Terms are defined in the HWNZ Head Agreement and/or Service Agreement.
2.0 DESCRIPTION OF SERVICES
The programme is a clinically-based training programme extending over two or more years, designed to provide progressive experience and responsibility. Training must include delegated operating responsibility commensurate with developing skills and experience. Advanced surgical training involves the application of surgical science appropriate to the specialty as well as to the practice of surgery.
2.1 LEARNING ENVIRONMENT
Training occurs in an approved post in a programme approved by the RACDS. Learning takes place in clinical settings (operating theatres, wards, departments and outpatient clinics), and includes access to formal teaching sessions. It is recognised that, for a given registrar, several training posts are usually required to obtain adequately wide experience. Registrars shall be released from service to attend theoretical training, and receive supervision and training.
2.1.1 Clinical Placements
General Requirements Training is on an apprenticeship basis, and much learning is by example. The example set by senior surgical staff and other staff strongly influences the quality of the learning experience. This requires both good role modelling by the supervisor and active participation by the registrar, with constructive feedback given to the registrar.
Supervision will ensure that registrars’ learning is objectives-based, targeted to registrars’ learning needs, and that there is application of cultural appropriateness to the practice of surgery.
A good knowledge of, and good practice, in medico-legal and ethical aspects of professional practice is also a requirement of training.
Workplace safety issues are the responsibility of providers and will apply to all registrars.
Registrars’ rotations will be selected to ensure a full range of relevant experience and different supervisors, as specified for the specialty.
Each clinical placement must provide a reasonable period of continuity (at least six months) under the supervision of a particular surgeon or surgeons.
Specific Requirements A formal teaching programme, delivered by appropriately skilled and experienced staff, will be provided. A minimum of one half day, or its equivalent, per week will be devoted to activities which would include regular tutorial sessions specifically designed for advanced registrars, and regular surgical meetings such as grand rounds, clinico-pathological conferences, surgical audit, morbidity/mortality reviews, and surgical forums. This programme will meet the syllabus requirements of the RACDS and include Early Management of Severe Trauma (EMST) course (if this has not previously been achieved by the trainee) and specific preparation for examinations.
2.1.2 Formal Teaching Programme
General Requirements The objectives of the programme are the acquiring of:
Knowledge in depth of the areas belonging to the specialty.
Knowledge of relevant areas of other surgical specialties.
Knowledge of the practical aspects of rehabilitation for surgical patients.
Knowledge of the practical aspects of palliative care in the specialty.
Expertise in research and audit.
Understanding of medico-legal and ethical issues relating to surgery.
The programme will include preparation for health leadership and management. It is likely to include effective service delivery and resource management, the management and policy environment in the New Zealand health system (including some understanding of the concept of health economics), models of health service delivery, understanding of cultural appropriateness and medico-legal ethics, and some exploration of how multidisciplinary teams function.
Specific Requirements Learning is facilitated through the creation of a planned and managed learning environment achieved through interactions between the registrar and patients, interactions with other health professionals in a variety of clinical settings (operating theatres, wards, and departments) and includes access to formal teaching sessions, meetings and discussions, direct supervision of the clinical service provided, and support and guidance to ensure that learning occurs and progress towards qualification is made.
2.1.3 Access to Resources
To meet the objectives of the training programme, the registrar requires access to:
An approved formal teaching programme.
Adequate library facilities, with a relevant range of journals and recognised texts appropriate to the practice of surgery.
Clinical support services, including qualified anaesthetic staff and a comprehensive laboratory service.
Clinical meetings and conferences, seminars, and surgical educational meetings.
Necessary variety of clinical material for training.
Adequate personal operative experience for the registrar, under adequate supervision.
A surgical audit system.
Input from a range of clinical staff.
Understanding of the application of evidence based guidelines, including technology assessment.
Supervision and assessment of registrars by surgical mentors and Specialty Supervisors is necessary to ensure the quality of training, general progress, suitability to continue training, suitability to sit the Special Stream Fellowship in oral and maxillofacial surgery examinations, and the completeness of training.
2.2.1 Clinical Supervision
Mentors will possess appropriate qualifications and be recognised by the RACDS as suitable for mentorship.
There will be at least two qualified consultants on any unit to which the registrar is assigned.
Suitable mentors will be provided who have responsibility for the registrars’ patients and will:
Supervise not more than two registrars at any one time.
Supervise clinical work, including observation of patient examinations and surgical procedures.
Provide guidance on the development of attitudes, knowledge and skill objectives.
Ensure that principles of culturally appropriate care are applied to the practice of surgery.
The level of supervision of the registrar is dependent on ability, and will vary as the registrar progresses through the programme. Opportunities for directly supervised, indirectly supervised and monitored, but relatively independent clinical practice will be provided according to the ability of the registrar.
During the time registrars are on duty or on call, there must be a clear line of responsibility from the patient to the registrar to a designated surgical consultant.
2.2.2 Educational Supervision
The Specialty Supervisor will:
Approve the outline of the formal teaching programme.
Provide coaching of registrars, as necessary, in their preparation for exams.
Advise advanced surgical registrars on all aspects of surgical training.
Ensure the structured programmes and clinical attachments organised as preparation for the examinations will be linked to the examination timetable.
Each registrar shall keep a log book throughout advanced surgical training which provides information on operation statistics and educational activities, such as research, publications, presentations at meetings and attendance at courses and seminars. This will be reviewed three monthly by mentors, and six monthly by Hospital and Speciality Supervisors.
2.3 PROGRAMME COORDINATION
A Specialty Supervisor, approved by the Board of Studies for Oral and Maxillofacial Surgery of the RACDS, at that training centre will:
Be familiar with the RACDS regulations on training, examination and registration of registrars.
Advise potential and current registrars on their training and registration requirements.
Monitor supervision, experience, and allocation of duties for registrars and facilitate such changes as may be necessary.
Regularly evaluate registrars’ training, both clinical and academic experiences, including inspecting log books (at least six monthly) and report on their progress in terms of attitudes, clinical skills, teaching ability, and educational activities at the end of every rotation.
Arrange regular meetings with surgeons to discuss programmes and the progress of individuals.
Provide confidential reports to the Regional Surgical Committee through which the Board of Studies for oral and maxillofacial surgery of the RACDS will be able to make recommendations regarding eligibility to sit the Special Stream Fellowship examination, and regarding progress and completeness of training.
Be a member of the Regional Surgical Committee in oral and maxillofacial surgery of the RACDS.
Participate in the selection of advanced surgical registrars.
2.4 EXPECTED OUTCOMES
All educational objectives to be met, as demonstrated by a pass in the written and clinical parts of the Special Stream Fellowship examination which will cover the areas of surgery laid down in the syllabus.
To be eligible to sit Special Stream Fellowship examination, registrars must have completed:
A period of advanced training as approved by the Board of Studies.
An investigative project, approved by the Board of Studies.
An Early Management of Severe Trauma course (this may be completed prior to entering into advanced training).
Evidence of adequate experience and satisfactory reports from Specialty Supervisors of surgical training. Application to present for the Special Stream Fellowship examination will be accompanied by a summary of the training received, based on progressive reports and inspection of the log-book.
Any other prerequisites as prescribed by the Board of Studies.
The Special Stream Fellowship examination consists of:
Written section: at least two papers which may include a section on surgical and developmental anatomy.
Clinical examination: two separate parts with separate marks.
Oral section: including surgical pathology, operative surgery, surgical and developmental anatomy, and additional material as determined by the Board.
Completion of advanced surgical training, and passing of Part I and Part II examinations qualify the registrar for the award of Fellowship in Oral and Maxillofacial Surgery of the Royal Australasian College of Dental Surgeons – FRACDS (OMS).
Be accepted by the RACDS into the training programme; and
Be a graduate in dental surgery of a dental school recognised by the Dental Council of New Zealand; and
Have Dental Council of New Zealand registration as a dentist; and
Be a graduate in Medicine and Surgery of a Medical School recognised by the Medical Council of New Zealand; and
Have general registration as a medical practitioner from the Medical Council of New Zealand
Be a New Zealand citizen or hold a New Zealand residency permit as conferred by the New Zealand Immigration Service.
Trainees who do not meet the above criteria may be considered on a case by case basis.
3.2 PROVIDER ELIGIBILITY
Training occurs in an approved post in a programme approved by the RACDS and HWNZ.
4.0 LOCATION AND SETTING
The training primarily takes place within a DHB Oral and Maxillofacial Surgery unit approved by the RACDS.
Any secondment of a registrar to another location for further training experience must comply with Part 9 of the HWNZ Head Agreement.
5.0 ASSOCIATED LINKAGES
Links will be established with:
Royal Australasian College of Dental Surgeons
6.0 PURCHASE UNIT AND REPORTING UNIT
A training unit trainee formally enrolled in the training programme. Part time trainees will be purchased on a pro rata training unit basis.
7.0 QUALITY STANDARDS: PROGRAMME SPECIFIC
This section should be read in conjunction with Schedule 1 Part 3 of the HWNZ Head Agreement, which specifies generic quality standards for all programmes provided under the contract. Placements will be provided appropriate to the registrars’ knowledge and experience so that clinical training can be graduated and ongoing.
A log of experience is completed for each registrar and evaluated periodically to ensure completeness of training.
Registrars will be invited to give feedback on their experience annually.
Providers will demonstrate their commitment to training by:
Having policies in place, which detail the roles, responsibilities and limitations for the trainees in the organisation.
Having written and implemented policies on cultural safety
Assessing and monitoring of the standards of supervisors
Provide placement appropriate to the trainees’ knowledge and experience, so that the training can be graduated and ongoing.
Invite trainees to give feedback on their experiences annually
Regularly reviewing care to ensure it is in line with currently accepted practice including knowledge of multi-culturalism, ethics, informed consent, complaints and disciplinary procedures
Monitor that access to clinical resources are adequate and initiate action when appropriate.
In accrediting or reviewing a programme, the RACDS will assess whether the programme meets the objectives set by its professional needs as judged by:
The number and relevant experience of the clinical staff.
Rigour, breadth and depth of instructional offerings.
Adequacy of facilities and supporting personnel.
8.0 REPORTING REQUIREMENTS: PROGRAMME SPECIFIC
This section should be read in conjunction with Schedule 1 Part 1 of the HWNZ Head Agreement, which specifies generic reporting requirements for all programmes provided under the contract.
8.1 PROGRESS REPORTING
Section 2.4 of the specification details the expected outcomes of the education and training programme
8.2 QUALITY REPORTING
Reports as described in Section 1 Part 1 of the HWNZ Head Agreement require a summary of the programme. Section 1 Part 3 of the HWNZ Head Agreement requires that there is a quality plan in place for the ongoing monitoring of the training provided. The summary will refer to the outcomes of this internal quality management and make reference to the programme specific quality standards in 7.0 above, particularly supervision.
1/B43: Specification in Oral & Maxillofacial Surgery