Review of General Dental Council and General Medical Council "fitness to practise" hearings related to maxillofacial surgery.

Dually-registered specialists in oral and maxillofacial surgery (OMFS) may be subject to disciplinary hearings by the General Medical Council (GMC) and the General Dental Council (GDC) for the same allegations, a phenomenon referred to as "double jeopardy" within the specialty. Previous efforts by both councils to simplify regulatory arrangements have made little progress. We have therefore reviewed the range and scope of fitness to practise (FTP) proceedings relevant to OMFS. We searched the online GMC register to find registered OMFS specialists and obtained FTP proceedings from 2004-2016 through a Freedom of Information request from the GDC. We then searched for cases relevant to OMFS, and cross-checked GMC and GDC registers for dual registration before reviewing relevant cases and identifying and discussing themes. Seven OMFS specialists are currently subject to GMC sanctions. A total of 22 GDC hearings related to OMFS, all of which began after 2011. Six involved the practice of OMFS, work within an OMFS department, or work by a dually-registered doctor. While "double jeopardy" is uncommon, it does happen. The cases reviewed raise issues about the remit of the GDC and their understanding of clinical practice in OMFS. We found no evidence of progress in attempts to simplify FTP proceedings. The number of GDC hearings relevant to OMFS is increasing.

Scheduling terminology for oral and maxillofacial surgery. Are we speaking a universal language?

Use of a universal vocabulary to assist with the scheduling of operations has been shown to considerably reduce delays and improve the use of theatre resources. Within the UK the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) has established a classification to assist with the triage of both emergency and non-emergency operating lists. We completed a survey to assess the uptake and understanding of this classification when scheduling maxillofacial operations. From a list of eight scheduling terms, respondents had to choose one each for 20 different clinical situations (that represented equally) immediate, urgent, expedited, and elective operations as defined by them. A total of 50 surveys were collated. Only 65% of answers selected represented NCPOD terms. 25% of answers represented a term higher and 18% a term lower, on the scale of intervention for the same category of situation. Current NCEPOD terms do not seem to be used universally and are poorly understood. Considerable variation in terminology exists when scheduling maxillofacial operations.

Errors in interpretation of neck levels in postoperative pathological specimens.

Accurate orientation of pathological specimens is of fundamental importance, and specimens that are divided postoperatively may be misinterpreted. We asked surgeons and pathologists to identify boundaries between nodal levels on a clinical photograph of a neck dissection specimen. Few participants were able to identify the boundaries between levels accurately, with several important errors where a marked level contained none of the relevant anatomical tissue. Most errors were in level I, and the number decreased towards level IV. Errors were made by both pathologists and surgeons. The boundaries of level IIA were consistently overestimated, which may have implications for previous studies that evaluated patterns of nodal spread.

Pinning out pathological specimens--are we risking an unnecessary escalation of treatment?

The importance of surgical resection margins is paramount, and it is vital that they are accurately delineated so that clinicians' decisions about adjuvant treatment can be validated. Pathological specimens therefore are often pinned to aid orientation and maintain mucosal margins. However, in cadaveric resections of bovine tongues, pinning of the specimens significantly reduced the depth of tissue. In clinical practice, if results are affected by the fixation method and not based on the true margins, it could profoundly influence the use of adjuvant treatment in patients with cancer. Pinning the specimens with the mucosal surface against the board will maintain any theoretical benefit for the mucosa and does not compress the specimens.

Qualitative comparison of curricula in oral and maxillofacial surgery training. Part 2: oral surgery.

A comparison between the curricula for specialist training in oral surgery (OS), and oral and maxillofacial surgery (OMFS) illustrates the overlap between the two specialties. We identified and compared relevant curricula for OMFS with competencies in the OS specialist-training curriculum using a qualitative assessment to establish the degree of overlap. All competencies within the OS curriculum are covered by OMFS curricula, and 21 of 96 OMFS clinical competencies are covered by OS core competencies. The majority of OMFS competencies are unique and are not directly comparable with those in the OS curriculum. Knowledge of this overlap may help to avoid unnecessary duplication in the training of those who wish to transfer specialty.

Qualitative comparison of curricula in oral and maxillofacial surgery training. Part 1: dental foundation training.

Dental foundation training (DFT) is a two-year programme being introduced for new dental graduates. It is not currently compulsory but there are plans to make it so. Those studying oral and maxillofacial surgery (OMFS) must complete both medical and dental degrees, and training, and if DFT becomes a requirement for dental registration, the process could be lengthened. We aimed to examine the overlap between DFT and medical foundation and core surgical training, to highlight areas of potential duplication for those who completed their surgical training before graduating from dental school. Relevant curricula for OMFS trainees were identified and compared with the DFT curriculum, and a qualitative assessment tool was developed to measure overlap between non-analogous curricula. Depending on previous experience, an OMFS trainee who completed core training in surgery before studying dentistry may already have covered 76% of the DFT curriculum. Areas with the least duplication in clinical skills (53%) were notably those related to restorative dentistry, prosthodontics, and periodontology, but there was considerable overlap in non-clinical areas such as communication skills (100%) and professionalism (90%). A method of standardised assessment of previous experience may allow for DFT to be shortened for OMFS trainees.