- Email: [email protected]
A single standard in double degree
LETTERS TO THE EDITOR J Oral Maxillofac Surg 59:714-715, 2001
A SINGLE STANDARD IN DOUBLE DEGREE
dependent on licensure or ranking. It is only when the MD degree is bogus, as previously described, that a double standard is indeed a fact. Thus, it would be appropriate to address some misconceptions expressed in the editorial. First, and according to the Liaison Committee on Medical Education (LCME): “Medical Schools are not ranked; while the quality of education is partly determined by the organization of programs and adequacy of resources, it also depends on the dedication of the faculty to teaching and creating an environment conducive to learning.” Therefore, to the LCME, it is the standard of medical education provided by a medical school and not its geographic location that matters. One foreign school, the University of Health Sciences, Antigua (UHSA) has designed a curriculum for oral and maxillofacial surgeons to earn their MD degree that is very similar to the current course work for US dual-degree programs for medical school. The major difference is that UHSA allows OMSs to pursue their MD degree while maintaining at least a part-time practice, if desired. Certainly, the updated medical education received allows OMSs to improve the health care delivered to their patients and to compete in a market that has demonstrated its unfairness to singledegree OMSs. It is an open program that draws its strength from online lecture material from recognized US medical school educators and faculty. An OMS who chooses to be a full-time student, and who has access to faculty who are members of a US medical school clinical faculty, will have little problem with getting rotations on time. In these rotations we work side by side with US medical students and residents. For those who choose to practice part-time while attending this program, it can take longer than 18 months to meet the requirements for graduation. However, it should be pointed out that nearly all OMSs who have participated in this innovative MD program have done so along side US medical students and residents at US medical school training hospitals and all are eligible to take the USMLE. Two members of our class have already been accepted to US medical residencies after passing their USMLE prior to graduation. Most of us have taken the USMLE or are scheduled to do so. Some of my OMS colleagues have even expressed some interest in continuing postgraduate education in a medical residency, while the majority just want to get back to their practice. This will be a little easier now that we have somewhat leveled the playing field with those who would like for us not to have other than extraction privileges and be assigned to the ancillary staff rather than the medical staff in our hospitals. To us the real “double standard” is that OMSs have to pursue a medical degree in the first place. After all, we are trained as surgeons and a significant part of our education is provided by rotations in American Medical Association-approved residency programs. Should not board certification be the gold standard for OMSs as it is for physicians? Of course it should, but in today’s economic world it is not enough for many hospitals, which are dominated by competing surgical specialists. When forced to pursue a medical degree by select medical specialties to practice full-scope oral and maxillofacial surgery, the last thing we need is a house divided by criticism from our own OMS colleagues. After all, there are many foreign medical graduates practicing in the United States. Many are nationally recognized for
To the Editor:—We have had the opportunity to discuss the September 2000 editorial in the Journal of Oral and Maxillofacial Surgery entitled “A Double Standard in Double Degree” and believe that the other side of this issue should be presented. Our intent in this letter is to present factual information that was not included in the editorial to give other oral and maxillofacial surgeons (OMSs) a more accurate look at the double degree issue as we see it. The editorial addressed what was described as a “double standard” among OMSs. Primarily, the issue of this editorial appeared to be the licensure of some dual-degree OMSs for the practice of medicine and the lack of such a license by other dual-degree OMSs. There was also some suggestion that graduates from foreign medical schools, particularly “off-shore” schools, were not qualified for a medical license because their education was inadequate. It is important to recognize that those dual-degree OMSs who choose to practice with their dental license, and without a medical license, do so because of choice and not because their medical education was unacceptable to qualify for a state medical license. It is true that in the recent past there have been bogus medical schools that have defrauded OMSs by making claims of validity for their MD program while taking as much as $20,000.00 or more in tuition, and being unable to produce a program whose students are United States Medical Licensing Examination (USMLE) eligible. However, these schools are not limited to “off-shore.” They even occur in the United States, as was seen in Oregon where a school claiming to be a division of an English University solicited the purchase of an MD degree from many OMSs. This school has now been put out of business by the Oregon Attorney General, but this does not mean that there will not be more such bogus schools in view of the interest in dual-degree programs by OMSs. From our perspective, it is the USMLE that is the gold standard for validation of the quality of medical education. When a foreign school has qualified for World Health Organization recognition and has been approved by the Educational Commission of Foreign Medical Graduates to allow their graduates to take the USMLE, it has met the standards for delivering a quality education. After all, passing the USMLE parts 1, 2, and 3 is the same standard required of US medical school graduates before obtaining state licensure for postgraduate education. There is no double standard in medical education that is
Letters to the Editor are considered for publication (subject to editing and abridgment), provided they are submitted in 1 of 2 ways. If typewritten, they must be submitted in duplicate, signed by all authors, double-spaced, and should not exceed 40 typewritten lines of manuscript text (excluding references). You may also e-mail your Letters to the Editor to [email protected]. The same length limits apply. Letters should not duplicate similar material being submitted or published elsewhere. Letters to a recent Journal article must be received within 6 weeks of the article’s publication. Receipt of letters is not acknowledged and there is no guarantee that your letter will be published. We cannot provide prepublication proofs. Submitting the letter constitutes your permission for its publication in any current or subsequent issue or edition of the Journal, in any form or media, now known or hereafter developed.
714
715
LETTERS TO THE EDITOR their superb medical expertise, and not that they are foreign medical graduates. If dual licensure is to be the standard for recognition of education, why do we not require the plastic surgeons who proudly display their DDS alongside their MD to take state dental boards? Why do we not criticize them for their unfamiliarity with the dentition, physiology of mastication, and the complex masticatory apparatus? Should we not point out all of their failures in the treatment of jaw fractures? Should we not point out the thousands of dental infections that have been treated by US physicians using only antibiotics, which has placed many of these patients at significant risks? We do not because it is simply not professional to do so. Most of us accept that we are not always perfect and, if anything, we need to support each other whether we are dual- or single-degree OMSs. After all, we do share the commonality of being an OMS and we have enough criticism from those in economic competition with us without being enemies of each other. Finally, no matter how many degrees or licenses we have, we are a DENTAL SPECIALTY, and our single-degree OMS colleagues are our equals. WILLIAM H. PETRI III, DMD, MD, PHD STEVEN GUTTENBERG, DDS DAVID D. WOODS, DMD CHARLES D. HASSE, DDS LAWRENCE HERMAN, DMD MARCOS L. DEL VALLE-SEPULVEDA, DMD, MD ROBERT A. STRAUSS, DDS NORMAN K. COLEMAN, DDS, MD, MS LARRY DENNEY, DMD, MD KERRY M. MCKAY, DDS
Complications With Open Treatment of Mandibular Condyle Process Fractures.” In the August 1994 issue of JOMS, I authored an article entitled “An Accurate Method for Open Reduction and Internal Fixation of High and Low Condylar Process Fractures.” Our experience was similar to Ellis et al’s experience and the experiences of the authors referenced in their literature review—a low complication rate. Interestingly, they did not reference our article in the literature review. Our study involved 23 fractures in 22 patients. Complications consisted of 7 facial (motor) nerve deficits, all of which were temporary and resolved in a 2- to 3-month period. Our numbers using the reported protocol now exceeds 60 cases. There have been no permanent motor or sensory nerve deficits and there have been only 2 complications. One patient developed avascular necrosis following treatment of a 10-day-old fracture. The patient subsequently underwent total joint replacement with no complications. The other patient showed evidence of breakage of a double-T plate at 3 weeks. This did not affect the position of the condyle or the outcome. The plate did not require removal. I perform the full scope of temporomandibular joint (TMJ) surgery, including total joint replacement, on a regular basis. In the hands of experienced TMJ surgeons, temporary motor nerve weakness following preauricular approaches is the rule and not the exception. Permanent motor nerve weakness is the exception and not the rule. Among surgeons who do not regularly perform joint surgery there exists a misconception that the incidence of permanent nerve injury is high. In experienced hands it is less than one half of 1%. Hats off to Ellis et al for once again revealing the truth about preauricular approaches.
doi:10.1053/joms.2001.24811
R. ALEXANDER, DDS New York, NY
SEVENTH NERVE INJURY DURING TEMPOROMANDIBULAR JOINT SURGERY To the Editor:—I read with great interest the article by Ellis et al in the September 2000 issue of JOMS entitled, “Surgical
doi:10.1053/joms.2001.24810
A SINGLE STANDARD IN DOUBLE DEGREE
dependent on licensure or ranking. It is only when the MD degree is bogus, as previously described, that a double standard is indeed a fact. Thus, it would be appropriate to address some misconceptions expressed in the editorial. First, and according to the Liaison Committee on Medical Education (LCME): “Medical Schools are not ranked; while the quality of education is partly determined by the organization of programs and adequacy of resources, it also depends on the dedication of the faculty to teaching and creating an environment conducive to learning.” Therefore, to the LCME, it is the standard of medical education provided by a medical school and not its geographic location that matters. One foreign school, the University of Health Sciences, Antigua (UHSA) has designed a curriculum for oral and maxillofacial surgeons to earn their MD degree that is very similar to the current course work for US dual-degree programs for medical school. The major difference is that UHSA allows OMSs to pursue their MD degree while maintaining at least a part-time practice, if desired. Certainly, the updated medical education received allows OMSs to improve the health care delivered to their patients and to compete in a market that has demonstrated its unfairness to singledegree OMSs. It is an open program that draws its strength from online lecture material from recognized US medical school educators and faculty. An OMS who chooses to be a full-time student, and who has access to faculty who are members of a US medical school clinical faculty, will have little problem with getting rotations on time. In these rotations we work side by side with US medical students and residents. For those who choose to practice part-time while attending this program, it can take longer than 18 months to meet the requirements for graduation. However, it should be pointed out that nearly all OMSs who have participated in this innovative MD program have done so along side US medical students and residents at US medical school training hospitals and all are eligible to take the USMLE. Two members of our class have already been accepted to US medical residencies after passing their USMLE prior to graduation. Most of us have taken the USMLE or are scheduled to do so. Some of my OMS colleagues have even expressed some interest in continuing postgraduate education in a medical residency, while the majority just want to get back to their practice. This will be a little easier now that we have somewhat leveled the playing field with those who would like for us not to have other than extraction privileges and be assigned to the ancillary staff rather than the medical staff in our hospitals. To us the real “double standard” is that OMSs have to pursue a medical degree in the first place. After all, we are trained as surgeons and a significant part of our education is provided by rotations in American Medical Association-approved residency programs. Should not board certification be the gold standard for OMSs as it is for physicians? Of course it should, but in today’s economic world it is not enough for many hospitals, which are dominated by competing surgical specialists. When forced to pursue a medical degree by select medical specialties to practice full-scope oral and maxillofacial surgery, the last thing we need is a house divided by criticism from our own OMS colleagues. After all, there are many foreign medical graduates practicing in the United States. Many are nationally recognized for
To the Editor:—We have had the opportunity to discuss the September 2000 editorial in the Journal of Oral and Maxillofacial Surgery entitled “A Double Standard in Double Degree” and believe that the other side of this issue should be presented. Our intent in this letter is to present factual information that was not included in the editorial to give other oral and maxillofacial surgeons (OMSs) a more accurate look at the double degree issue as we see it. The editorial addressed what was described as a “double standard” among OMSs. Primarily, the issue of this editorial appeared to be the licensure of some dual-degree OMSs for the practice of medicine and the lack of such a license by other dual-degree OMSs. There was also some suggestion that graduates from foreign medical schools, particularly “off-shore” schools, were not qualified for a medical license because their education was inadequate. It is important to recognize that those dual-degree OMSs who choose to practice with their dental license, and without a medical license, do so because of choice and not because their medical education was unacceptable to qualify for a state medical license. It is true that in the recent past there have been bogus medical schools that have defrauded OMSs by making claims of validity for their MD program while taking as much as $20,000.00 or more in tuition, and being unable to produce a program whose students are United States Medical Licensing Examination (USMLE) eligible. However, these schools are not limited to “off-shore.” They even occur in the United States, as was seen in Oregon where a school claiming to be a division of an English University solicited the purchase of an MD degree from many OMSs. This school has now been put out of business by the Oregon Attorney General, but this does not mean that there will not be more such bogus schools in view of the interest in dual-degree programs by OMSs. From our perspective, it is the USMLE that is the gold standard for validation of the quality of medical education. When a foreign school has qualified for World Health Organization recognition and has been approved by the Educational Commission of Foreign Medical Graduates to allow their graduates to take the USMLE, it has met the standards for delivering a quality education. After all, passing the USMLE parts 1, 2, and 3 is the same standard required of US medical school graduates before obtaining state licensure for postgraduate education. There is no double standard in medical education that is
Letters to the Editor are considered for publication (subject to editing and abridgment), provided they are submitted in 1 of 2 ways. If typewritten, they must be submitted in duplicate, signed by all authors, double-spaced, and should not exceed 40 typewritten lines of manuscript text (excluding references). You may also e-mail your Letters to the Editor to [email protected]. The same length limits apply. Letters should not duplicate similar material being submitted or published elsewhere. Letters to a recent Journal article must be received within 6 weeks of the article’s publication. Receipt of letters is not acknowledged and there is no guarantee that your letter will be published. We cannot provide prepublication proofs. Submitting the letter constitutes your permission for its publication in any current or subsequent issue or edition of the Journal, in any form or media, now known or hereafter developed.
714
715
LETTERS TO THE EDITOR their superb medical expertise, and not that they are foreign medical graduates. If dual licensure is to be the standard for recognition of education, why do we not require the plastic surgeons who proudly display their DDS alongside their MD to take state dental boards? Why do we not criticize them for their unfamiliarity with the dentition, physiology of mastication, and the complex masticatory apparatus? Should we not point out all of their failures in the treatment of jaw fractures? Should we not point out the thousands of dental infections that have been treated by US physicians using only antibiotics, which has placed many of these patients at significant risks? We do not because it is simply not professional to do so. Most of us accept that we are not always perfect and, if anything, we need to support each other whether we are dual- or single-degree OMSs. After all, we do share the commonality of being an OMS and we have enough criticism from those in economic competition with us without being enemies of each other. Finally, no matter how many degrees or licenses we have, we are a DENTAL SPECIALTY, and our single-degree OMS colleagues are our equals. WILLIAM H. PETRI III, DMD, MD, PHD STEVEN GUTTENBERG, DDS DAVID D. WOODS, DMD CHARLES D. HASSE, DDS LAWRENCE HERMAN, DMD MARCOS L. DEL VALLE-SEPULVEDA, DMD, MD ROBERT A. STRAUSS, DDS NORMAN K. COLEMAN, DDS, MD, MS LARRY DENNEY, DMD, MD KERRY M. MCKAY, DDS
Complications With Open Treatment of Mandibular Condyle Process Fractures.” In the August 1994 issue of JOMS, I authored an article entitled “An Accurate Method for Open Reduction and Internal Fixation of High and Low Condylar Process Fractures.” Our experience was similar to Ellis et al’s experience and the experiences of the authors referenced in their literature review—a low complication rate. Interestingly, they did not reference our article in the literature review. Our study involved 23 fractures in 22 patients. Complications consisted of 7 facial (motor) nerve deficits, all of which were temporary and resolved in a 2- to 3-month period. Our numbers using the reported protocol now exceeds 60 cases. There have been no permanent motor or sensory nerve deficits and there have been only 2 complications. One patient developed avascular necrosis following treatment of a 10-day-old fracture. The patient subsequently underwent total joint replacement with no complications. The other patient showed evidence of breakage of a double-T plate at 3 weeks. This did not affect the position of the condyle or the outcome. The plate did not require removal. I perform the full scope of temporomandibular joint (TMJ) surgery, including total joint replacement, on a regular basis. In the hands of experienced TMJ surgeons, temporary motor nerve weakness following preauricular approaches is the rule and not the exception. Permanent motor nerve weakness is the exception and not the rule. Among surgeons who do not regularly perform joint surgery there exists a misconception that the incidence of permanent nerve injury is high. In experienced hands it is less than one half of 1%. Hats off to Ellis et al for once again revealing the truth about preauricular approaches.
doi:10.1053/joms.2001.24811
R. ALEXANDER, DDS New York, NY
SEVENTH NERVE INJURY DURING TEMPOROMANDIBULAR JOINT SURGERY To the Editor:—I read with great interest the article by Ellis et al in the September 2000 issue of JOMS entitled, “Surgical
doi:10.1053/joms.2001.24810