- Email: [email protected]
A review of oral and maxillofacial surgery journals’ contribution to undergraduate surgical education
Available online at www.sciencedirect.com
British Journal of Oral and Maxillofacial Surgery 52 (2014) 894–900
Review
A review of oral and maxillofacial surgery journals’ contribution to undergraduate surgical education Rele Ologunde ∗ , Mark Sykes Imperial College London, London, UK Received 19 March 2014; accepted 18 August 2014 Available online 22 September 2014
Abstract We searched the Medline database of 4 leading international journals of oral and maxillofacial surgery (OMFS) for all articles containing the terms “undergraduate”, “medical student”, or “dental student” in the abstract, title, or keywords, from the earliest paper to 2013, to identify and review publications that related to the education of undergraduate medical and dental students. We found 130 articles, of which 22 (17%) met the inclusion criteria. Most were published by teams based in the United States, followed by those from the United Kingdom and Germany. The earliest was published in 1986. Since then, most have been published in the Journal of Oral and Maxillofacial Surgery (0.33/year) and the least in the International Journal of Oral and Maxillofacial Surgery (0.11/year). Eleven original research articles concerned dental students and 4 concerned medical students. Three studies looked at both groups and compared them with their qualified counterparts. There is a relative paucity of articles relating to the education of undergraduates, particularly medical students, in OMFS journals, although the number has increased over the last decade. There is a need for more educational papers to be aimed at students interested in pursuing OMFS as a career. © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Keywords: Surgical education; Medical education; Undergraduate; Training
Introduction The limited exposure of undergraduates to oral and maxillofacial surgery (OMFS) has been well documented. In 1994, a survey that explored the public and professional perception of the specialty identified the need for better education about its scope among undergraduate students, doctors and dentists.1 However, awareness of OMFS as a specialty remains limited among medical2 and dental3 undergraduates in the United Kingdom (UK), although evidence suggests that understanding is greater among dental undergraduates than among their medical colleagues.4 If undergraduates are to make informed
∗ Corresponding author. Imperial College School of Medicine, Faculty of Medicine, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK. E-mail addresses: [email protected] (R. Ologunde), [email protected] (M. Sykes).
choices about their careers and about surgical specialties such as OMFS, they need a better understanding of their scope and the opportunities that are available, particularly as career choices are increasingly being made earlier on in undergraduate or postgraduate education.5 Knowledge and awareness among undergraduate medical and dental students could be improved if more surgically orientated educational articles were published within the field of OMFS and its allied specialties. We therefore aimed to identify and review publications relating to the education of medical and dental students in 4 leading international OMFS journals: the British Journal of Oral and Maxillofacial Surgery (BJOMS), Journal of Cranio-Maxillo-Facial Surgery (JCMFS), Journal of Oral and Maxillofacial Surgery (JOMS) and the International Journal of Oral and Maxillofacial Surgery (IJOMS). These were chosen as they represented the journals of national (UK and US) and transnational (Europe) associations, and an international association.
http://dx.doi.org/10.1016/j.bjoms.2014.08.014 0266-4356/© 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
R. Ologunde, M. Sykes / British Journal of Oral and Maxillofacial Surgery 52 (2014) 894–900
895
Fig. 1. Algorithm to show selection of articles (BJOMS = British Journal of Oral and Maxillofacial Surgery, JCMFS = Journal of Cranio-Maxillo-Facial Surgery, JOMS = Journal of Oral and Maxillofacial Surgery, IJOMS = International Journal of Oral and Maxillofacial Surgery).
Methods We searched the Medline database in February 2014 for all publications containing the terms “undergraduate”, “medical student”, or “dental student” in the abstract, title, or keywords in BJOMS, JCMFS, JOMS, and IJOMS, from the earliest paper to 2013. We analysed the title and abstracts of each one for a focus on undergraduates. Articles were included if they explored the education of dental or medical students, or both. They were excluded if they examined postgraduate education (dental and medical) or if they examined only the awareness or perception of OMFS among undergraduate students.
technical note, and one letter. Table 2 shows the types of articles published in each journal. All the papers were published after 1985. Only 4 were published between 1986 and 2005 and none was published in 2006. From 2007 to 2013, 18 were published. In the 27 years since 1986, JOMS had the highest rate of publication (0.33 articles/year) and IJOMS the lowest (0.11/year) (Table 2). The trend in the rate of publication in all 4 journals combined is shown in Figure 2. A total of 11 original research articles concerned dental students and 4 concerned medical students. Three studies looked at medical and dental undergraduates and compared them with their qualified counterparts. Most were published by teams based in the US (n = 6). Those based in the UK and Germany published 5 each.
Results Discussion We found 130 publications, of which 22 (17%) met the inclusion criteria (Fig. 1). Table 1 gives a summary of each paper. There were 18 original research articles, two editorials, one
Most of the publications were original research articles, and a common theme was the exploration of students’ knowledge
896
R. Ologunde, M. Sykes / British Journal of Oral and Maxillofacial Surgery 52 (2014) 894–900
Table 1 Summary of publications relating to the education of medical and dental students in 4 leading international journals of oral and maxillofacial surgery. First author and reference
Year
Type of publication
Study design
Study participants
Country
Summary
Lehtinen6
1986
Original research
Observational
Dental students (n = 30)
Finland
Assessment of moments occurring during simulated tooth extractions by students. The moments were significantly lower than the forces needed for real extractions. The authors concluded that students should be supervised by a teacher able to demonstrate the correct grip and style of extraction
Humphris7
1993
Original research
Prospective cohort
Dental students (n = 55), sixth-formers (n = 50) and relatives of patients attending a dental hospital (n = 51)
UK
Hunter24
1996
Original research
Crosssectional survey
Dental students, dental practitioners, medical students, medical practitioners, and the general public (n = 100 in each group)
US
Evaluation of how effectively the information in a leaflet about operations to remove impacted third molars improved knowledge. It helped to improve the knowledge of sixth form students and patients more than dental students. However, dental students knew significantly more than sixth form students and patients (p<0.01) Survey to find out how much is known about the management and treatment of specific conditions in OMFS and its allied specialties. The authors concluded that some students and professionals were not aware of the wide surgical scope of the specialty
McCann20
2005
Original research
Crosssectional survey
21 UK medical schools
UK
Questionnaire survey to find out whether medical undergraduates have adequate training and qualified doctors have the ability to diagnose, investigate, manage, and refer patients with common oral disorders. Only 11 of the 21 medical schools that responded incorporated teaching on oral diseases in their curricula. 28% of medical staff diagnosed cases correctly, compared with 88.7% of dentists. The authors concluded that the education of doctors and medical students about oral diseases is inadequate
Lazarski8
2007
Original research
Prospective cohort
Dental students (n = 61)
US
Subhashraj4
2008
Original research
Crosssectional survey
Dental students, medical India students, dental practitioners, medical practitioners, and paramedics (n = 100 in each group)
Study to evaluate the effect of feedback and instruction on the acquisition and performance of surgical psychomotor skills using a model system for the repair of mandibular fractures. The authors concluded that written instructions and feedback can enhance the acquisition of these skills Questionnaire survey to ascertain the level of knowledge regarding the role of OMFS in health care. The authors concluded that dental students and professionals are more aware of the scope of the specialty (including the treatment of specific conditions) than medical students and professionals.
Rocha23
2008
Original research
Crosssectional survey
Dental students, medical students, dentists, and doctors (n = 100 in each group)
Brazil
Magliocca9
2009
Original research
Prospective cohort study
Dental students (n = 108)
US
Questionnaire survey to investigate the ability to correlate clinical situations with respective specialists for management of the condition. The authors concluded that knowledge of the scope of OMFS was good Evaluation of the effect of a new teaching curriculum that consists of clinical and didactic material reinforced using interactive techniques compared with an old curriculum that did not use this approach, on National Dental Examining Board II (NDEB-II) examination results. Students’ perceptions of the new curriculum were also evaluated. Survey results showed a positive response to the new teaching techniques. A significant improvement was noted in only 2 of the 11 sections of the NDEB-II examination. The authors concluded that the new curriculum may have had a positive influence on examination scores
R. Ologunde, M. Sykes / British Journal of Oral and Maxillofacial Surgery 52 (2014) 894–900
897
Table 1 (Continued) First author and reference
Year
Type of publication
Study design
Study participants
Country
Summary
Lambrecht25
2010
Technical note
Review
N/A
Switzerland
Walker26
2010
Editorial
Review
N/A
UK
Description of the use of 3-dimensional cone beam computed tomographic-based haptic models of patients integrated into teaching models for use in undergraduate and postgraduate education. The authors concluded that the models enabled students to simulate routine standard oral operations with supervision under “dry conditions” An overview of the opportunities for research in OMFS that are available to trainees and undergraduates
Qin19
2010
Original research
Questionnaire survey
Medical students (n = 236)
China
Evaluation of the benefit of PBL in large classes on stomatology among medical students who have had or have not had experience of PBL. The authors concluded that it is feasible to implement PBL in large classes, and that it is enjoyable and functional for students with or without experience of this style of learning
Pohlenz10
2010
Original research
Observational
Dental students (n = 53)
Germany
Casap11
2011
Original research
Observational
Final year dental students (n = 40)
US
Dennis27
2011
Editorial
Review
N/A
US
Shanks17
2011
Original research
Crosssectional survey
Medical students (n = 458)
UK
Dunleavy18
2012
Letter
N/A
N/A
UK
Pilot study to assess a modified virtual environment (Voxel-Man simulator, Hamburg, Germany) as an educational tool for apicectomies. 96% of students recommended the virtual simulation as an additional tool in dental education and indicated that the force feedback, 3-dimensional spatial perception, and image resolution, are sufficient for virtual training in dental operations Study comparing the benefits of a virtual reality navigation system with a freehand protocol for teaching the surgical stage of dental implantation. The authors concluded that virtual reality navigation added minimal value to the training. An overview of current dental education in the US and its limitations, particularly for those wishing to pursue OMFS as a career. The article also explored how the contribution of oral and maxillofacial surgeons can improve the education of dental students Questionnaire survey assessing the education and experience of medical students in examining the oral cavity. 458 (76%) students responded. 73% had not been taught how to examine the oral cavity, 81% had had no experience of doing so in patients, and 89% felt that the tuition had not been adequate Reply to Shanks et al agreeing that the teaching of medical students on how to examine the oral cavity is poor. The author proposed adoption of the US National Institute of Dental and Craniofacial Research screening exam.
Meckfessel12
2011
Original research
Prospective cohort
Dental students (n = 228)
Germany
Study evaluating students’ perceptions of an e-learning package in dental radiology, and assessment of its effect on subsequent examination results (n = 138) compared with those who had attended traditional lectures (n = 90). 72% of respondents reported a positive attitude towards e-learning. After the package was introduced, the failure rate fell from 40% to less than 2% over 2 years (p < 0.001)
898
R. Ologunde, M. Sykes / British Journal of Oral and Maxillofacial Surgery 52 (2014) 894–900
Table 1 (Continued) First author and reference
Year
Type of publication
Study design
Study participants
Country
Summary
Zhang13
2012
Original research
Prospective cohort study
Dental students (n = 87)
China
Jarosz3
2013
Original research
Crosssectional survey
Dental students (n = 286)
US
Höfer14
2013
Original research
Observational
Dental students (n = 26)
Germany
Mücke16
2013
Original research
Prospective cohort
Medical students (n = 59), surgeons (n = 19)
Germany
Landes15
2014
Original research
Crosssectional survey
Dental students (n = 197)
Germany
An evaluation of a hybrid course consisting of a PBL and a 1-year clinical rotation under supervision (n = 43) compared with a traditional lecture-based course (n = 44). The PBL group had better results overall than the traditional group. The authors concluded that PBL courses combined with supervised clinical rotation improve students’ operative skills, their ability to analyse cases, and their self-confidence Questionnaire survey assessing knowledge of common procedures, management, and referral patterns in OMFS. Significant associations were found between the year of dental education and students’ perceptions of conditions managed in OMFS. The authors concluded that it is vital to recognise and address the changes during undergraduate training to increase educated referrals Pilot study to evaluate practical knowledge using an OSCE. The mean (SD) overall score was 63.2% (8.89%). The authors concluded that the examination successfully evaluated clinical competencies in a broad spectrum of cranial and maxillofacial surgical skills Assessment of microsurgical skills of students and surgeons after completion of a comprehensive 14-day microsurgical course. Students achieved higher scores in both the practical (p < 0.0001) and theoretical (p = 0.009) components of the examination. The authors concluded that training in microsurgical skills should begin in undergraduate medical education, as students are more malleable and able to learn the correct techniques A cross-sectional and longitudinal study of improvement in knowledge before (n = 26) and after (n = 171) the introduction of a weekly practical skills training (PST) day for dental students as assessed by an OSCE. Results increased from a mean (SD) 63.3 (9.7%) before, to 75.5 (10%) after its introduction (p < 0.05). The authors concluded that PST effectively optimised clinical skills
OMFS = Oral and maxillofacial surgery; ENT = Ear, nose and throat; OSCE = Objective structured clinical examination; PBL = Problem-based learning
about the management and treatment of specific conditions in OMFS. Most of them explored the education of undergraduate dental students,3,6–15 and few explored the education of undergraduate medics.16–20 These findings suggest that surgical papers in leading OMFS journals are skewed towards the educational requirements of dental students. This is not
surprising given that traditionally, the primary qualification for OMFS has been a degree in dentistry, with medicine as a second degree,21 so dental students have been the target audience in the past. However, as an increasing proportion of applicants to OMFS specialist training hold a primary qualification in medicine,22 there is a growing need to engage with,
Table 2 Comparison of educational articles for medical and dental students between leading international journals of oral and maxillofacial surgery. Journal
BJOMS JCMFS JOMS IJOMS
Type of publication Original research
Technical note
Letter
Editorial
3 5 8 2
0 0 0 1
1 0 0 0
1 0 1 0
Total
Articles/year
5 5 9 3
0.19 0.19 0.33 0.11
BJOMS = British Journal of Oral and Maxillofacial Surgery; JCMFS = Journal of Cranio-Maxillo-Facial Surgery; JOMS = Journal of Oral and Maxillofacial Surgery; IJOMS = International Journal of Oral and Maxillofacial Surgery.
R. Ologunde, M. Sykes / British Journal of Oral and Maxillofacial Surgery 52 (2014) 894–900
899
Fig. 2. Combined rate of publication in all 4 journals between 1986 and 2013.
and address, the unique educational challenges faced by this group. The conclusions of studies that assessed both medical and dental students varied. A study in Brazil found a good level of knowledge among both groups,23 while a study in India suggested that dental students had a better understanding of the scope of the specialty and the treatment and management of conditions.4 However, a study from the US found that some medical and dental students had a limited knowledge and understanding of the specialty.24 These findings may reflect genuine differences in the sample groups as each study came from a different country, and the students concerned were at different stages in their undergraduate course. The diverse findings may also reflect differences in the content of the dental or medical curricula between countries. Several articles did not report original research. Lambrecht et al25 described an innovative technique using 3-dimensional cone beam CT to develop haptic models of patients for use in teaching. This technique could be a valuable contribution to undergraduate education in bedside clinical examination as it enables students to develop and hone their examination skills on simulated models with conditions seen in real patients. To highlight opportunities within OMFS for research, Walker et al26 explored the various options available to students and trainees in OMFS. Students in particular may find it challenging to fit research around their academic commitments, and given the length of training, may be discouraged from taking time out to complete a formal research degree. This article explored the benefits in doing so. Dennis27 gave an overview of current dental education in the US and described some of the limitations in the current system for students aspiring to a career in OMFS. The article shows the importance of developing dental education to prepare for a career in the specialty. Interested medical students may have to seek out experience in OMFS, which suggests that they need help from personal tutors. Undergraduates could be encouraged to consider specialist training if surgeons were affiliated to medical schools, and importantly, if the number of educational articles on
OMFS was increased. It is vital that students interested in a career in the specialty have a thorough understanding of the challenges involved and are given guidance early in their courses to enable them to pursue suitable extra-curricular activities and educational experiences. Organisations associated with OMFS journals should promote the specialty among undergraduates and instigate educational initiatives. At present only the British Association of Oral and Maxillofacial Surgeons (BAOMS) has a trainee interest group that is open to all trainees, including undergraduates.28 The International Association of Oral and Maxillofacial Surgeons (IAOMS) is currently in the process of establishing a similar group.29 In the UK, specialties such as plastic surgery and ophthalmology have long invested in undergraduate education which has proved extremely beneficial for students through the establishment of elective prizes, courses on practical skills, taster days, essay competitions, and conferences.30,31 National, transnational, and international organisations could adopt similar practices and expand their educational output and presence among interested students. Given the limited exposure of undergraduates to OMFS, particularly within the medical curriculum, journal articles that analyse the profession historically and give an overview of the training pathway, those that are educational, or give advice on careers in OMFS, will be of interest to students and may help to ensure that the best candidates continue to be attracted. We found that most of the papers on undergraduate education were published in the last decade. This may indicate an increased interest in OMFS among recent medical and dental graduates, and is a promising sign. The main limitation of the present review is that we restricted our inclusion criteria to only 4 journals and therefore excluded a number of publications that comment on the education of undergraduate medical and dental students in both OMFS and non-OMFS journals. There is still a paucity of articles relating to the education of undergraduates, particularly medical students, in OMFS journals. We present this review to highlight the historical
900
R. Ologunde, M. Sykes / British Journal of Oral and Maxillofacial Surgery 52 (2014) 894–900
and current trends in educational research and publication in OMFS journals, and to call for investment and prioritisation in both areas. Conflict of interest The authors have no conflict of interest to declare. Funding No funding was received to support this work.
References 1. Ameerally P, Fordyce AM, Martin IC. So you think they know what we do? The public and professional perception of oral and maxillofacial surgery. Br J Oral Maxillofac Surg 1994;32:142–5. 2. Goodson AM, Payne KF, Tahim A, et al. Awareness of oral and maxillofacial surgery as a specialty and potential career pathway amongst UK medical undergraduates. Surgeon 2013;11:92–5. 3. Jarosz KF, Ziccardi VB, Aziz SR, et al. Dental student perceptions of oral and maxillofacial surgery as a specialty. J Oral Maxillofac Surg 2013;71:965–73. 4. Subhashraj K, Subramaniam B. Awareness of the specialty of oral and maxillofacial surgery among health care professionals in Pondicherry, India. J Oral Maxillofac Surg 2008;66:2330–4. 5. Rees-Lee JE, Lee S. Reaching our successors: the trend for early specialisation and the potential effect on recruitment to our speciality. J Plast Reconstr Aesthet Surg 2008;61:1135–8. 6. Lehtinen R, Ojala T. Apparatus for simulating extraction forces. Int J Oral Maxillofac Surg 1986;15:444–5. 7. Humphris GM, O’Neill P, Field EA. Knowledge of wisdom tooth removal: influence of an information leaflet and validation of a questionnaire. Br J Oral Maxillofac Surg 1993;31:355–9. 8. Lazarski MP, Susarla SM, Bennett NL, et al. How do feedback and instructions affect the performance of a simulated surgical task? J Oral Maxillofac Surg 2007;65:1155–61. 9. Magliocca KR, Diamante M, Salamen OJ, et al. Use of an interactive teaching modality in predoctoral oral and maxillofacial surgery. J Oral Maxillofac Surg 2009;67:362–8. 10. Pohlenz P, Gröbe A, Petersik A, et al. Virtual dental surgery as a new educational tool in dental school. J Craniomaxillofac Surg 2010;38:560–4. 11. Casap N, Nadel S, Tarazi E, et al. Evaluation of a navigation system for dental implantation as a tool to train novice dental practitioners. J Oral Maxillofac Surg 2011;69:2548–56. 12. Meckfessel S, Stühmer C, Bormann KH, et al. Introduction of e-learning in dental radiology reveals significantly improved results in final examination. J Craniomaxillofac Surg 2011;39:40–8. 13. Zhang Y, Chen G, Fang X, et al. Problem-based learning in oral and maxillofacial surgery education: the Shanghai hybrid. J Oral Maxillofac Surg 2012;70:e7–11.
14. Höfer SH, Schuebel F, Sader R, et al. Development and implementation of an objective structured clinical examination (OSCE) in CMF-surgery for dental students. J Craniomaxillofac Surg 2013;41:412–6. 15. Landes CA, Hoefer S, Schuebel F, et al. Long-term prospective teaching effectivity of practical skills training and a first OSCE in cranio maxillofacial surgery for dental students. J Craniomaxillofac Surg 2014;42:e97–104. 16. Mücke T, Borgmann A, Ritschl LM, et al. Microvascular training of medical students and surgeons - a comparative prospective study. J Craniomaxillofac Surg 2013;41:e187–90. 17. Shanks LA, Walker TW, McCann PJ, et al. Oral cavity examination: beyond the core curriculum? Br J Oral Maxillofac Surg 2011;49: 640–2. 18. Dunleavy D. Re: L.A. Shanks, T.W. Walker, P.J. McCann, M.J. Kerin, Oral cavity examination: beyond the core curriculum? [Br J Oral Maxillofac Surg 2011] Br J Oral Maxillofac Surg 2012;50:279. 19. Qin XJ, Kong J, Lu L, et al. Application of problem-based learning in a large class in stomatology course. J Oral Maxillofac Surg 2010;68:739–43. 20. McCann PJ, Sweeney MP, Gibson J, et al. Training in oral disease, diagnosis and treatment for medical students and doctors in the United Kingdom. Br J Oral Maxillofac Surg 2005;43:61–4. 21. Langdon JD. Training for oral and maxillofacial surgery, academic oral surgery, and surgical dentistry in the United Kingdom. J Oral Maxillofac Surg 2006;64:1803–6. 22. Magennis P. Oral and maxillofacial surgery (OMFS). Information for CT applicants 2014 recruitment round 2014 [Accessed on 7 March 2014]. Available from URL: http://www.surgeryrecruitment.nhs.uk/ sites/surgeryrecruitment/files/OMFS for CT Applicants 2013-14.pdf 23. Rocha NS, Laureano Filho JR, Silva ED, et al. Perception of oral maxillofacial surgery by health-care professionals. Int J Oral Maxillofac Surg 2008;37:41–6. 24. Hunter MJ, Rubeiz T, Rose L. Recognition of the scope of oral and maxillofacial surgery by the public and health care professionals. J Oral Maxillofac Surg 1996;54:1227–33. 25. Lambrecht JT, Berndt D, Christensen AM, et al. Haptic model fabrication for undergraduate and postgraduate teaching. Int J Oral Maxillofac Surg 2010;39:1226–9. 26. Walker TW, Cascarini L, Brennan PA. Educational paper: research in oral and maxillofacial surgery. Br J Oral Maxillofac Surg 2010;48:629–32. 27. Dennis MJ. Predoctoral dental education and the future of oral and maxillofacial surgery. J Oral Maxillofac Surg 2011;69:248–51. 28. Junior Trainees Group of the British Association of Oral and Maxillfoacial Surgeons [Accessed on 9 March 2014]. Available from URL: http://jtgonline.org.uk/ 29. International Association of Oral and Maxillofacial Surgeons: Trainee Interest Group [Accessed on 9 March 2014]. Available from URL: http://www.iaoms.org/trainees/ 30. Royal College of Ophthalmologists. Undergraduate Ophthalmology. [Accessed on 9 March 2014]. Available from URL: http://www.rcophth. ac.uk/page.asp?section=321§ionTitle=Undergraduate+ Ophthalmology 31. Davis CR, O’Donoghue JM, McPhail J, et al. How to improve plastic surgery knowledge, skills and career interest in undergraduates in one day. J Plast Reconstr Aesthet Surg 2010;63:1677–81.
British Journal of Oral and Maxillofacial Surgery 52 (2014) 894–900
Review
A review of oral and maxillofacial surgery journals’ contribution to undergraduate surgical education Rele Ologunde ∗ , Mark Sykes Imperial College London, London, UK Received 19 March 2014; accepted 18 August 2014 Available online 22 September 2014
Abstract We searched the Medline database of 4 leading international journals of oral and maxillofacial surgery (OMFS) for all articles containing the terms “undergraduate”, “medical student”, or “dental student” in the abstract, title, or keywords, from the earliest paper to 2013, to identify and review publications that related to the education of undergraduate medical and dental students. We found 130 articles, of which 22 (17%) met the inclusion criteria. Most were published by teams based in the United States, followed by those from the United Kingdom and Germany. The earliest was published in 1986. Since then, most have been published in the Journal of Oral and Maxillofacial Surgery (0.33/year) and the least in the International Journal of Oral and Maxillofacial Surgery (0.11/year). Eleven original research articles concerned dental students and 4 concerned medical students. Three studies looked at both groups and compared them with their qualified counterparts. There is a relative paucity of articles relating to the education of undergraduates, particularly medical students, in OMFS journals, although the number has increased over the last decade. There is a need for more educational papers to be aimed at students interested in pursuing OMFS as a career. © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Keywords: Surgical education; Medical education; Undergraduate; Training
Introduction The limited exposure of undergraduates to oral and maxillofacial surgery (OMFS) has been well documented. In 1994, a survey that explored the public and professional perception of the specialty identified the need for better education about its scope among undergraduate students, doctors and dentists.1 However, awareness of OMFS as a specialty remains limited among medical2 and dental3 undergraduates in the United Kingdom (UK), although evidence suggests that understanding is greater among dental undergraduates than among their medical colleagues.4 If undergraduates are to make informed
∗ Corresponding author. Imperial College School of Medicine, Faculty of Medicine, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK. E-mail addresses: [email protected] (R. Ologunde), [email protected] (M. Sykes).
choices about their careers and about surgical specialties such as OMFS, they need a better understanding of their scope and the opportunities that are available, particularly as career choices are increasingly being made earlier on in undergraduate or postgraduate education.5 Knowledge and awareness among undergraduate medical and dental students could be improved if more surgically orientated educational articles were published within the field of OMFS and its allied specialties. We therefore aimed to identify and review publications relating to the education of medical and dental students in 4 leading international OMFS journals: the British Journal of Oral and Maxillofacial Surgery (BJOMS), Journal of Cranio-Maxillo-Facial Surgery (JCMFS), Journal of Oral and Maxillofacial Surgery (JOMS) and the International Journal of Oral and Maxillofacial Surgery (IJOMS). These were chosen as they represented the journals of national (UK and US) and transnational (Europe) associations, and an international association.
http://dx.doi.org/10.1016/j.bjoms.2014.08.014 0266-4356/© 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
R. Ologunde, M. Sykes / British Journal of Oral and Maxillofacial Surgery 52 (2014) 894–900
895
Fig. 1. Algorithm to show selection of articles (BJOMS = British Journal of Oral and Maxillofacial Surgery, JCMFS = Journal of Cranio-Maxillo-Facial Surgery, JOMS = Journal of Oral and Maxillofacial Surgery, IJOMS = International Journal of Oral and Maxillofacial Surgery).
Methods We searched the Medline database in February 2014 for all publications containing the terms “undergraduate”, “medical student”, or “dental student” in the abstract, title, or keywords in BJOMS, JCMFS, JOMS, and IJOMS, from the earliest paper to 2013. We analysed the title and abstracts of each one for a focus on undergraduates. Articles were included if they explored the education of dental or medical students, or both. They were excluded if they examined postgraduate education (dental and medical) or if they examined only the awareness or perception of OMFS among undergraduate students.
technical note, and one letter. Table 2 shows the types of articles published in each journal. All the papers were published after 1985. Only 4 were published between 1986 and 2005 and none was published in 2006. From 2007 to 2013, 18 were published. In the 27 years since 1986, JOMS had the highest rate of publication (0.33 articles/year) and IJOMS the lowest (0.11/year) (Table 2). The trend in the rate of publication in all 4 journals combined is shown in Figure 2. A total of 11 original research articles concerned dental students and 4 concerned medical students. Three studies looked at medical and dental undergraduates and compared them with their qualified counterparts. Most were published by teams based in the US (n = 6). Those based in the UK and Germany published 5 each.
Results Discussion We found 130 publications, of which 22 (17%) met the inclusion criteria (Fig. 1). Table 1 gives a summary of each paper. There were 18 original research articles, two editorials, one
Most of the publications were original research articles, and a common theme was the exploration of students’ knowledge
896
R. Ologunde, M. Sykes / British Journal of Oral and Maxillofacial Surgery 52 (2014) 894–900
Table 1 Summary of publications relating to the education of medical and dental students in 4 leading international journals of oral and maxillofacial surgery. First author and reference
Year
Type of publication
Study design
Study participants
Country
Summary
Lehtinen6
1986
Original research
Observational
Dental students (n = 30)
Finland
Assessment of moments occurring during simulated tooth extractions by students. The moments were significantly lower than the forces needed for real extractions. The authors concluded that students should be supervised by a teacher able to demonstrate the correct grip and style of extraction
Humphris7
1993
Original research
Prospective cohort
Dental students (n = 55), sixth-formers (n = 50) and relatives of patients attending a dental hospital (n = 51)
UK
Hunter24
1996
Original research
Crosssectional survey
Dental students, dental practitioners, medical students, medical practitioners, and the general public (n = 100 in each group)
US
Evaluation of how effectively the information in a leaflet about operations to remove impacted third molars improved knowledge. It helped to improve the knowledge of sixth form students and patients more than dental students. However, dental students knew significantly more than sixth form students and patients (p<0.01) Survey to find out how much is known about the management and treatment of specific conditions in OMFS and its allied specialties. The authors concluded that some students and professionals were not aware of the wide surgical scope of the specialty
McCann20
2005
Original research
Crosssectional survey
21 UK medical schools
UK
Questionnaire survey to find out whether medical undergraduates have adequate training and qualified doctors have the ability to diagnose, investigate, manage, and refer patients with common oral disorders. Only 11 of the 21 medical schools that responded incorporated teaching on oral diseases in their curricula. 28% of medical staff diagnosed cases correctly, compared with 88.7% of dentists. The authors concluded that the education of doctors and medical students about oral diseases is inadequate
Lazarski8
2007
Original research
Prospective cohort
Dental students (n = 61)
US
Subhashraj4
2008
Original research
Crosssectional survey
Dental students, medical India students, dental practitioners, medical practitioners, and paramedics (n = 100 in each group)
Study to evaluate the effect of feedback and instruction on the acquisition and performance of surgical psychomotor skills using a model system for the repair of mandibular fractures. The authors concluded that written instructions and feedback can enhance the acquisition of these skills Questionnaire survey to ascertain the level of knowledge regarding the role of OMFS in health care. The authors concluded that dental students and professionals are more aware of the scope of the specialty (including the treatment of specific conditions) than medical students and professionals.
Rocha23
2008
Original research
Crosssectional survey
Dental students, medical students, dentists, and doctors (n = 100 in each group)
Brazil
Magliocca9
2009
Original research
Prospective cohort study
Dental students (n = 108)
US
Questionnaire survey to investigate the ability to correlate clinical situations with respective specialists for management of the condition. The authors concluded that knowledge of the scope of OMFS was good Evaluation of the effect of a new teaching curriculum that consists of clinical and didactic material reinforced using interactive techniques compared with an old curriculum that did not use this approach, on National Dental Examining Board II (NDEB-II) examination results. Students’ perceptions of the new curriculum were also evaluated. Survey results showed a positive response to the new teaching techniques. A significant improvement was noted in only 2 of the 11 sections of the NDEB-II examination. The authors concluded that the new curriculum may have had a positive influence on examination scores
R. Ologunde, M. Sykes / British Journal of Oral and Maxillofacial Surgery 52 (2014) 894–900
897
Table 1 (Continued) First author and reference
Year
Type of publication
Study design
Study participants
Country
Summary
Lambrecht25
2010
Technical note
Review
N/A
Switzerland
Walker26
2010
Editorial
Review
N/A
UK
Description of the use of 3-dimensional cone beam computed tomographic-based haptic models of patients integrated into teaching models for use in undergraduate and postgraduate education. The authors concluded that the models enabled students to simulate routine standard oral operations with supervision under “dry conditions” An overview of the opportunities for research in OMFS that are available to trainees and undergraduates
Qin19
2010
Original research
Questionnaire survey
Medical students (n = 236)
China
Evaluation of the benefit of PBL in large classes on stomatology among medical students who have had or have not had experience of PBL. The authors concluded that it is feasible to implement PBL in large classes, and that it is enjoyable and functional for students with or without experience of this style of learning
Pohlenz10
2010
Original research
Observational
Dental students (n = 53)
Germany
Casap11
2011
Original research
Observational
Final year dental students (n = 40)
US
Dennis27
2011
Editorial
Review
N/A
US
Shanks17
2011
Original research
Crosssectional survey
Medical students (n = 458)
UK
Dunleavy18
2012
Letter
N/A
N/A
UK
Pilot study to assess a modified virtual environment (Voxel-Man simulator, Hamburg, Germany) as an educational tool for apicectomies. 96% of students recommended the virtual simulation as an additional tool in dental education and indicated that the force feedback, 3-dimensional spatial perception, and image resolution, are sufficient for virtual training in dental operations Study comparing the benefits of a virtual reality navigation system with a freehand protocol for teaching the surgical stage of dental implantation. The authors concluded that virtual reality navigation added minimal value to the training. An overview of current dental education in the US and its limitations, particularly for those wishing to pursue OMFS as a career. The article also explored how the contribution of oral and maxillofacial surgeons can improve the education of dental students Questionnaire survey assessing the education and experience of medical students in examining the oral cavity. 458 (76%) students responded. 73% had not been taught how to examine the oral cavity, 81% had had no experience of doing so in patients, and 89% felt that the tuition had not been adequate Reply to Shanks et al agreeing that the teaching of medical students on how to examine the oral cavity is poor. The author proposed adoption of the US National Institute of Dental and Craniofacial Research screening exam.
Meckfessel12
2011
Original research
Prospective cohort
Dental students (n = 228)
Germany
Study evaluating students’ perceptions of an e-learning package in dental radiology, and assessment of its effect on subsequent examination results (n = 138) compared with those who had attended traditional lectures (n = 90). 72% of respondents reported a positive attitude towards e-learning. After the package was introduced, the failure rate fell from 40% to less than 2% over 2 years (p < 0.001)
898
R. Ologunde, M. Sykes / British Journal of Oral and Maxillofacial Surgery 52 (2014) 894–900
Table 1 (Continued) First author and reference
Year
Type of publication
Study design
Study participants
Country
Summary
Zhang13
2012
Original research
Prospective cohort study
Dental students (n = 87)
China
Jarosz3
2013
Original research
Crosssectional survey
Dental students (n = 286)
US
Höfer14
2013
Original research
Observational
Dental students (n = 26)
Germany
Mücke16
2013
Original research
Prospective cohort
Medical students (n = 59), surgeons (n = 19)
Germany
Landes15
2014
Original research
Crosssectional survey
Dental students (n = 197)
Germany
An evaluation of a hybrid course consisting of a PBL and a 1-year clinical rotation under supervision (n = 43) compared with a traditional lecture-based course (n = 44). The PBL group had better results overall than the traditional group. The authors concluded that PBL courses combined with supervised clinical rotation improve students’ operative skills, their ability to analyse cases, and their self-confidence Questionnaire survey assessing knowledge of common procedures, management, and referral patterns in OMFS. Significant associations were found between the year of dental education and students’ perceptions of conditions managed in OMFS. The authors concluded that it is vital to recognise and address the changes during undergraduate training to increase educated referrals Pilot study to evaluate practical knowledge using an OSCE. The mean (SD) overall score was 63.2% (8.89%). The authors concluded that the examination successfully evaluated clinical competencies in a broad spectrum of cranial and maxillofacial surgical skills Assessment of microsurgical skills of students and surgeons after completion of a comprehensive 14-day microsurgical course. Students achieved higher scores in both the practical (p < 0.0001) and theoretical (p = 0.009) components of the examination. The authors concluded that training in microsurgical skills should begin in undergraduate medical education, as students are more malleable and able to learn the correct techniques A cross-sectional and longitudinal study of improvement in knowledge before (n = 26) and after (n = 171) the introduction of a weekly practical skills training (PST) day for dental students as assessed by an OSCE. Results increased from a mean (SD) 63.3 (9.7%) before, to 75.5 (10%) after its introduction (p < 0.05). The authors concluded that PST effectively optimised clinical skills
OMFS = Oral and maxillofacial surgery; ENT = Ear, nose and throat; OSCE = Objective structured clinical examination; PBL = Problem-based learning
about the management and treatment of specific conditions in OMFS. Most of them explored the education of undergraduate dental students,3,6–15 and few explored the education of undergraduate medics.16–20 These findings suggest that surgical papers in leading OMFS journals are skewed towards the educational requirements of dental students. This is not
surprising given that traditionally, the primary qualification for OMFS has been a degree in dentistry, with medicine as a second degree,21 so dental students have been the target audience in the past. However, as an increasing proportion of applicants to OMFS specialist training hold a primary qualification in medicine,22 there is a growing need to engage with,
Table 2 Comparison of educational articles for medical and dental students between leading international journals of oral and maxillofacial surgery. Journal
BJOMS JCMFS JOMS IJOMS
Type of publication Original research
Technical note
Letter
Editorial
3 5 8 2
0 0 0 1
1 0 0 0
1 0 1 0
Total
Articles/year
5 5 9 3
0.19 0.19 0.33 0.11
BJOMS = British Journal of Oral and Maxillofacial Surgery; JCMFS = Journal of Cranio-Maxillo-Facial Surgery; JOMS = Journal of Oral and Maxillofacial Surgery; IJOMS = International Journal of Oral and Maxillofacial Surgery.
R. Ologunde, M. Sykes / British Journal of Oral and Maxillofacial Surgery 52 (2014) 894–900
899
Fig. 2. Combined rate of publication in all 4 journals between 1986 and 2013.
and address, the unique educational challenges faced by this group. The conclusions of studies that assessed both medical and dental students varied. A study in Brazil found a good level of knowledge among both groups,23 while a study in India suggested that dental students had a better understanding of the scope of the specialty and the treatment and management of conditions.4 However, a study from the US found that some medical and dental students had a limited knowledge and understanding of the specialty.24 These findings may reflect genuine differences in the sample groups as each study came from a different country, and the students concerned were at different stages in their undergraduate course. The diverse findings may also reflect differences in the content of the dental or medical curricula between countries. Several articles did not report original research. Lambrecht et al25 described an innovative technique using 3-dimensional cone beam CT to develop haptic models of patients for use in teaching. This technique could be a valuable contribution to undergraduate education in bedside clinical examination as it enables students to develop and hone their examination skills on simulated models with conditions seen in real patients. To highlight opportunities within OMFS for research, Walker et al26 explored the various options available to students and trainees in OMFS. Students in particular may find it challenging to fit research around their academic commitments, and given the length of training, may be discouraged from taking time out to complete a formal research degree. This article explored the benefits in doing so. Dennis27 gave an overview of current dental education in the US and described some of the limitations in the current system for students aspiring to a career in OMFS. The article shows the importance of developing dental education to prepare for a career in the specialty. Interested medical students may have to seek out experience in OMFS, which suggests that they need help from personal tutors. Undergraduates could be encouraged to consider specialist training if surgeons were affiliated to medical schools, and importantly, if the number of educational articles on
OMFS was increased. It is vital that students interested in a career in the specialty have a thorough understanding of the challenges involved and are given guidance early in their courses to enable them to pursue suitable extra-curricular activities and educational experiences. Organisations associated with OMFS journals should promote the specialty among undergraduates and instigate educational initiatives. At present only the British Association of Oral and Maxillofacial Surgeons (BAOMS) has a trainee interest group that is open to all trainees, including undergraduates.28 The International Association of Oral and Maxillofacial Surgeons (IAOMS) is currently in the process of establishing a similar group.29 In the UK, specialties such as plastic surgery and ophthalmology have long invested in undergraduate education which has proved extremely beneficial for students through the establishment of elective prizes, courses on practical skills, taster days, essay competitions, and conferences.30,31 National, transnational, and international organisations could adopt similar practices and expand their educational output and presence among interested students. Given the limited exposure of undergraduates to OMFS, particularly within the medical curriculum, journal articles that analyse the profession historically and give an overview of the training pathway, those that are educational, or give advice on careers in OMFS, will be of interest to students and may help to ensure that the best candidates continue to be attracted. We found that most of the papers on undergraduate education were published in the last decade. This may indicate an increased interest in OMFS among recent medical and dental graduates, and is a promising sign. The main limitation of the present review is that we restricted our inclusion criteria to only 4 journals and therefore excluded a number of publications that comment on the education of undergraduate medical and dental students in both OMFS and non-OMFS journals. There is still a paucity of articles relating to the education of undergraduates, particularly medical students, in OMFS journals. We present this review to highlight the historical
900
R. Ologunde, M. Sykes / British Journal of Oral and Maxillofacial Surgery 52 (2014) 894–900
and current trends in educational research and publication in OMFS journals, and to call for investment and prioritisation in both areas. Conflict of interest The authors have no conflict of interest to declare. Funding No funding was received to support this work.
References 1. Ameerally P, Fordyce AM, Martin IC. So you think they know what we do? The public and professional perception of oral and maxillofacial surgery. Br J Oral Maxillofac Surg 1994;32:142–5. 2. Goodson AM, Payne KF, Tahim A, et al. Awareness of oral and maxillofacial surgery as a specialty and potential career pathway amongst UK medical undergraduates. Surgeon 2013;11:92–5. 3. Jarosz KF, Ziccardi VB, Aziz SR, et al. Dental student perceptions of oral and maxillofacial surgery as a specialty. J Oral Maxillofac Surg 2013;71:965–73. 4. Subhashraj K, Subramaniam B. Awareness of the specialty of oral and maxillofacial surgery among health care professionals in Pondicherry, India. J Oral Maxillofac Surg 2008;66:2330–4. 5. Rees-Lee JE, Lee S. Reaching our successors: the trend for early specialisation and the potential effect on recruitment to our speciality. J Plast Reconstr Aesthet Surg 2008;61:1135–8. 6. Lehtinen R, Ojala T. Apparatus for simulating extraction forces. Int J Oral Maxillofac Surg 1986;15:444–5. 7. Humphris GM, O’Neill P, Field EA. Knowledge of wisdom tooth removal: influence of an information leaflet and validation of a questionnaire. Br J Oral Maxillofac Surg 1993;31:355–9. 8. Lazarski MP, Susarla SM, Bennett NL, et al. How do feedback and instructions affect the performance of a simulated surgical task? J Oral Maxillofac Surg 2007;65:1155–61. 9. Magliocca KR, Diamante M, Salamen OJ, et al. Use of an interactive teaching modality in predoctoral oral and maxillofacial surgery. J Oral Maxillofac Surg 2009;67:362–8. 10. Pohlenz P, Gröbe A, Petersik A, et al. Virtual dental surgery as a new educational tool in dental school. J Craniomaxillofac Surg 2010;38:560–4. 11. Casap N, Nadel S, Tarazi E, et al. Evaluation of a navigation system for dental implantation as a tool to train novice dental practitioners. J Oral Maxillofac Surg 2011;69:2548–56. 12. Meckfessel S, Stühmer C, Bormann KH, et al. Introduction of e-learning in dental radiology reveals significantly improved results in final examination. J Craniomaxillofac Surg 2011;39:40–8. 13. Zhang Y, Chen G, Fang X, et al. Problem-based learning in oral and maxillofacial surgery education: the Shanghai hybrid. J Oral Maxillofac Surg 2012;70:e7–11.
14. Höfer SH, Schuebel F, Sader R, et al. Development and implementation of an objective structured clinical examination (OSCE) in CMF-surgery for dental students. J Craniomaxillofac Surg 2013;41:412–6. 15. Landes CA, Hoefer S, Schuebel F, et al. Long-term prospective teaching effectivity of practical skills training and a first OSCE in cranio maxillofacial surgery for dental students. J Craniomaxillofac Surg 2014;42:e97–104. 16. Mücke T, Borgmann A, Ritschl LM, et al. Microvascular training of medical students and surgeons - a comparative prospective study. J Craniomaxillofac Surg 2013;41:e187–90. 17. Shanks LA, Walker TW, McCann PJ, et al. Oral cavity examination: beyond the core curriculum? Br J Oral Maxillofac Surg 2011;49: 640–2. 18. Dunleavy D. Re: L.A. Shanks, T.W. Walker, P.J. McCann, M.J. Kerin, Oral cavity examination: beyond the core curriculum? [Br J Oral Maxillofac Surg 2011] Br J Oral Maxillofac Surg 2012;50:279. 19. Qin XJ, Kong J, Lu L, et al. Application of problem-based learning in a large class in stomatology course. J Oral Maxillofac Surg 2010;68:739–43. 20. McCann PJ, Sweeney MP, Gibson J, et al. Training in oral disease, diagnosis and treatment for medical students and doctors in the United Kingdom. Br J Oral Maxillofac Surg 2005;43:61–4. 21. Langdon JD. Training for oral and maxillofacial surgery, academic oral surgery, and surgical dentistry in the United Kingdom. J Oral Maxillofac Surg 2006;64:1803–6. 22. Magennis P. Oral and maxillofacial surgery (OMFS). Information for CT applicants 2014 recruitment round 2014 [Accessed on 7 March 2014]. Available from URL: http://www.surgeryrecruitment.nhs.uk/ sites/surgeryrecruitment/files/OMFS for CT Applicants 2013-14.pdf 23. Rocha NS, Laureano Filho JR, Silva ED, et al. Perception of oral maxillofacial surgery by health-care professionals. Int J Oral Maxillofac Surg 2008;37:41–6. 24. Hunter MJ, Rubeiz T, Rose L. Recognition of the scope of oral and maxillofacial surgery by the public and health care professionals. J Oral Maxillofac Surg 1996;54:1227–33. 25. Lambrecht JT, Berndt D, Christensen AM, et al. Haptic model fabrication for undergraduate and postgraduate teaching. Int J Oral Maxillofac Surg 2010;39:1226–9. 26. Walker TW, Cascarini L, Brennan PA. Educational paper: research in oral and maxillofacial surgery. Br J Oral Maxillofac Surg 2010;48:629–32. 27. Dennis MJ. Predoctoral dental education and the future of oral and maxillofacial surgery. J Oral Maxillofac Surg 2011;69:248–51. 28. Junior Trainees Group of the British Association of Oral and Maxillfoacial Surgeons [Accessed on 9 March 2014]. Available from URL: http://jtgonline.org.uk/ 29. International Association of Oral and Maxillofacial Surgeons: Trainee Interest Group [Accessed on 9 March 2014]. Available from URL: http://www.iaoms.org/trainees/ 30. Royal College of Ophthalmologists. Undergraduate Ophthalmology. [Accessed on 9 March 2014]. Available from URL: http://www.rcophth. ac.uk/page.asp?section=321§ionTitle=Undergraduate+ Ophthalmology 31. Davis CR, O’Donoghue JM, McPhail J, et al. How to improve plastic surgery knowledge, skills and career interest in undergraduates in one day. J Plast Reconstr Aesthet Surg 2010;63:1677–81.