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Oral and Maxillofacial Surgery
Introduction
Purpose of the Program
Masters Degree Program
Period of Training
Training Supervision
Scope of Training
Emergency Duty Roster
Program Changes

Introduction

The Oral and Maxillofacial Sugery (OMS) Residency Training Program, offered by the US Army Dental Activity (DENTAC), Fort Gordon, Georgia, is a four-year advanced education program leading to specialty certification in OMS for selected US Army Dental Corps officers. Research training is fully integrated into the program and leads to a Master of Science awarded by the Medical College of Georgia (MCG).

Upon successful completion of training, a resident will be awarded a certificate of completion and the skill identifier 63N9C by the Office of The Surgeon General of the US Army. The program is fully accredited by the Council on Accreditation of the American Dental Association and its graduates are recognized as qualified to take the examination of the American Board of Oral and Maxillofacial Surgery.

Purpose of the Program

The purpose of this program is to train selected dental officers in all aspects of OMS. The resident will learn the background sciences and develop the clinical experience necessary to select those techniques which meet the biological, physiological, and mechanical requirements for oral rehabilitation. The clinical aspect will require attention to detail, precision, and perfection of various techniques. The interrelation of other clinical specialties with OMS is also emphasized. The didactic phase will be presented through formal courses, staff lectures, consultant visits, hospital conferences, library research, literature reviews and seminars.

Masters Degree Program

In cooperation with MCG, a Masters Degree Program in Oral Biology is possible on a voluntary basis and on the conditions that the applicant is:

  1. academically accepted by MCG; and
  2. approved by the Program Director.

The resident may start the program only after completion of the first year of the OMS Residency Program. The decision to approve applying for a Masters Program will be made by the Program Director. The costs for the Masters Program may be met by incurring a six year obligation of service or paying for the program on an individual basis.

PERIOD OF TRAINING

The period of training is four years and will consist of a minimum of 48 weeks each year.

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TRAINING SUPERVISION

The program will be supervised by the Dental Education Committee. The committee is composed of the Director of Dental Services, the chiefs of the specialty services, the continuing education officer, and the chief of biometrics. The OMS Residents will be under the direct supervision and guidance of the Program Director and the Assistant Program Directors. Resident progress is reported monthly to the Dental Education Committee. A formal written report is submitted quarterly to US Army Dental Command. Close communication between resident and mentor will ensure training progress. A weekly resident/mentor conference is scheduled for this purpose.

SCOPE OF TRAINING

The formal biomedical science program of instruction is supplemented by other less formal means of instruction during the four year program. This serves to broaden the OMS resident's knowledge and to provide a practical end or clinical approach to much of the fundamental knowledge which has already or will be acquired. The resident attends and participates in regularly scheduled staff teaching conferences, lectures, seminars, specialty teaching conferences, literature reviews and other formal teaching sessions specified in the training schedule. Instruction periods are conducted in anesthesiology, surgical anatomy, general and oral pathology, pharmacology, biochemistry, physiology, microbiology, physical diagnosis, diagnostic clinical laboratory procedures, and the conduction of research. Portions of this training are conducted by or in close cooperation with the medical staff. Supplemental instruction afforded by professional training in other departments of the hospital is scheduled with planned programs or resident duties.- responsibilities and time, designed to reach a well-defined objective. The logical coordination of the oral and maxillofacial surgical treatment with other dental and medical treatment programs, consistent with optimum treatment and care to the patient, is emphasized. The clinical application of basic sciences is included in the format of lectures, seminars, discussion periods, clinical conferences and teaching sessions conducted by the OMS staff and by other members of the hospital staff. Maximum resident participation in the presentation of formalized discussion and lectures is emphasized.

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Course Content

The OMS Residency Training Program conducted is composed of combined clinical and hospital experiences, closely integrated with an intensive study of the biomedical sciences. Instruction, training and experience provided include:

  1. Orientation and Introduction of Graduate Oral Surgery
  2. Biomedical Sciences
    1. Anatomy
    2. Physiology
    3. Pharmacology and Biochemistry
    4. Physical Diagnosis and Examination
    5. Pathology
  3. Clinical OMS
  4. Hospital OMS
  5. Intramural Services
    1. Clinical Medicine
      1. Internal Medicine
      2. Cardiology
      3. Pulmonary Medicine
      4. Medicine
    2. Pathology
      1. Oral Pathology
      2. Clinical Laboratory Procedures
    3. Radiology
    4. General Surgery
    5. Plastic Surgery
    6. Otolaryngology/Head and Neck Surgery
    7. Anesthesia
    8. Neurosurgery
    9. Trauma Rotation/Puerto Rico
  6. Emergency Room Services
  7. Diagnosis and Treatment Planning
  8. Library
  9. Research and Independent Study
  10. Teaching Lectures, Conferences and Seminars

First Year

Eighteen of the 48 months of training are devoted to off-service rotations. The first year resident begins with an introduction and initiation to the OMS inpatient and outpatient services. Skills in exodontia, local anesthesia and IV sedation techniques are monitored and expanded. The resident is introduced to exodontia techniques under outpatient general anesthesia, as well as, major operating room procedures. Surgical assisting and performance of individual procedures are emphasized according to the resident's skill level and past experiences. Hospital admissions and charting procedures are introduced and the resident works closely with the chief resident as he or she prepares to rotate off-service. Physical findings and examination procedures are emphasized through lectures and conferences, as well as with direct patient demonstrations. The principles of trauma assessment and care are reviewed and, during July and August, the resident gains primary experience in OMS trauma treatment. The resident begins to function on call with the chief resident and alone with the chief resident as his immediate backup.

A one month Radiology rotation is scheduled for September where the resident gains familiarity with interpretation of skull, cervical spine, and chest films as well as CT and radioisotope scans. One month rotations in Cardiology and Pulmonary Medicine are scheduled in November and October. It is here, while interacting with real in- and out-patients, that the primary skills in physical diagnosis and the essentials of disease treatment and management are gained through one on one interaction with staff and the OMS resident. In December, all residents return to the OMS Service.

In March a four month rotation on the Anesthesia Service is begun. During the rotation necessary skills are gained to evaluate preoperative patients and, while under direct supervision, numerous general anesthesia techniques are performed. Physiology, pharmacology and physical diagnosis are reviewed and the resident is prepared to safely deliver general anesthesia.

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Second Year

In July, all residents are on the OMS services. Vacation time is encouraged during July for the second through fourth year residents and December for all residents

The second year resident is devoted primarily to surgical rotations beginning in August. This rotation includes a two months on the General Surgery Service and two months in Plastic Surgery Service. Here the resident is expected to gain experience with pre and post operative care, fluid and nutritional requirements, insertion of central lines, chest tubes, etc., and basic surgical techniques. As in the medicine and anesthesia rotations, strong emphasis is placed on physical diagnosis and recognition of acute surgical indications.

The resident returns to OMS for four months in the middle of the second year where he or she begins to apply the medical and surgical knowledge to OMS. Patients are admitted to the OMS Service, physical exams performed, sedation and general anesthetics techniques are used for minor and major surgical procedures. An intense anatomy review is completed and the didactic schedule is weighted toward general pathophysiology, microbiology, pharmacology and oral pathology.

In October and November the resident goes to Neurosurgery to further enhance surgical and neurological diagnostic skills. In April and May, the resident goes to the Plastic Surgery Service for experience in soft tissue management.

Third Year

A month in Otolaryngology (ENT) is provided to further sharpen diagnostic abilities and gain additional knowledge in treatment of head and neck disorders. The third year resident then spends two months on the OMS Service at University of Puerto Rico, San Juan, Puerto Rico. This rotation has proven to be an outstanding experience in the management of maxillofacial trauma.

The resident then returns to the OMS Service, DDEAMC, in April for the remainder of his or her training. In spring the didactic schedule is geared toward a review of physiology, pharmacology, and a continuation of oral pathology. In June the third year resident assumes the duties and responsibilities of "Chief Resident."

Fourth Year

The new Chief Resident assumes responsibility for the inpatient OMS Service, answers consultations from other services, is the primary surgeon of record for the majority of operating room cases, and actively participates in the training and teaching of the first, second, and third year residents. The fourth year resident must submit a scientific paper for publication based on clinical research or case reports and literature review. Diagnostic abilities, treatment planning, and surgical skills are honed during the last year.

Lectures and Conferences

Teaching conferences, seminars and literature reviews and guest speakers are programmed on a weekly basis and are made through the contribution of the OMS teaching staff and guest medical specialists. Resident participation is emphasized. Conferences are used to reinforce the physical diagnosis, physiology and pharmacology arms of the program. Oral pathology is integrated on an every day basis through interaction with the staff associated oral pathologist and the presentation of conferences on clinicopathological by the staff. In the winter of each year, head and neck regional anatomy is studied through participation in a formalized dissection course taught by an MCG anatomist. Additional experience is gained through operating table during rotations with the OMS Service, General Surgery, Neurosurgery, Anesthesia and Head and Neck/ENT rotations.

Consultants

The use of guest civilian consultants to reinforce teaching philosophies and introduce different concepts is an integral part of the program’s teaching plan. Currently, six consultants per year are invited to the program, as well as those available to other programs locally at the MCG. The use of consultants within the DENTAC and DDEAMC is also emphasized.

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Research

The resident must prepare a paper suitable for publication as part of the requirements for graduation from the OMS Residency Training Program. The paper may be the result of a research project, clinical investigation or case presentation. As the resident enters his second year, a topic must be formally submitted for approval and necessary protocols are submitted through the Clinical Investigation Service, when appropriate. Due to re-writes and possible submission for publication, the project must be completed three months prior to residency completion. Deadlines for submission of a topic, a bibliography and first and second drafts will be delineated on a yearly basis. The Approving authority for the paper is the Program Director. If the project involves human use, the DDEAMC Clinical Investigation committee approval and assistance must be obtained. The goal of the paper is to develop an objective view of published scientific literature and develop knowledge and experience in submitting a paper for publication.

Library

Use of the Medical Library comprises an extremely important background segment of the four year OMS residency program. The resident is introduced to the library in the first month of training and regular assignments are made to aid in developing the resident's ability to critically read and evaluate professional literature. Literature reviews (Journal Club) are conducted throughout the four year program. The objectives of the literature review are to provide a means for group study of current professional literature, to amplify the knowledge of current concepts and practices of oral surgery and related medical fields, to stimulate interest in the study of scientific literature and to provide experience in critically evaluating the material read. The club regularly reviews multiple medical and dental publications.

Conferences

As part of their training, residents in the OMS program will attend routine and period Medical and Dental Staff Conferences. These include, but are not limited to, a weekly (or as pertinent cases present) Head and Nock Tumor Conferences, monthly literature reviews, weekly conferences on oral pathology, visiting consultant lectures, dental staff continuing education lectures, OMS resident conferences, weekly grand rounds for OMS patients, and other special conferences, lectures and quarterly professional dental meetings as arranged.

Resident Teaching Responsibilities

Graduated degrees of teaching responsibility are assigned to the second, third and fourth year OMS residents. The fourth year resident directly participates in the orientation and teaching of the first year resident during the initial two month OMS Service orientation. The first year resident responds to emergency calls with the fourth year resident for an established period of time prior to being allowed to respond independently. The fourth year resident is then responsible to act as a backup to the first year resident to insure proper patient management. The fourth year resident also participates in the supervision and teaching of the second and third year residents when they are on the oral surgery call roster. Teaching responsibilities are assigned in a balanced relationship with other activities and are maintained within the sphere of the fourth year resident's capabilities and surgical experience.

Under the guidance of the OMS Service Chief, residents are expected to conduct conferences and teaching ward rounds, as well as clinical teaching sessions for other services of the hospital. All residents are assigned to prepare and deliver individual topics of concern throughout the program. Additional objectives in this phase are to develop the residents' organized thinking and give additional experience in public speaking. Residents are assigned presentations at the local yearly meeting at MCG of the residents from OMS Service Programs throughout the Southeast United.

EMERGENCY ROSTER DUTY

Assignment to the emergency duty roster is integrated into all four years of the program. The on-call resident may be called for emergency consultation by the Dental Officer of the Day or by Emergency Room personnel. The on-call resident is called by the Emergency Room in all appropriate cases of head, neck, face and oral trauma and participates in the initial diagnosis, treatment and management of the traumatized patient. Experience is gained in a team concept of head and neck trauma and the resident works closely with representatives of the ENT Service. A trauma team concept agreement is enforced within this institution and guarantees primary experience in all phases of facial trauma.

PROGRAM CHANGES

Changes in the teaching schedule and program course of rotation will be made with the approval of the Dental Education Committee, as per those mandates of the Essentials of Training for Advanced Programs in OMS provided by the Council on Dental Education of the American Dental Association. Questions relating to this program may be addressed to: Commander, USA DENTAC, ATTN: Director, OMS Residency Program, Fort Gordon, Georgia 30905-5660.

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