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Oral and Jaw Surgery Curriculum
 

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    Oral and Jaw Surgery Curriculum Oral and Jaw Surgery Curriculum Document Transcript

    • The Egyptian Fellowship Board Oral and JawSurgery Curriculum
    • PrefaceT he Egyptian Fellowship Board and the Oral and Jaw surgery scientific council worked col- laboratively to make this curriculum available for trainees’ guidance and support.Postgraduate medical education world wide are now governed by sets of academic standards thatdescribe the qualities and abilities of graduates. In addition, there are standards for the trainingprocesses , trainers’ selection and methods of assessment. standards ensure transparency andclarify expectations.The Egyptian fellowship board had defined and published its standards for the general and profes-sional competencies expected from our graduates in different specialties upon successful comple-tion of training. These expectations are reflected in the oral and Jaw surgery curriculum.The curriculum describes what trainees will know and be able to do upon completion of training.In additions, methods of teaching and learning needed to deliver the curriculum are listed . Thecurriculum also describes in details, expectations from trainees during their rotations in “Thetraining rules and regulations section”. Methods of assessment and examination regulations arealso available in the last section of the curriculum.All topics covered during practical and theoretical studies are outlined. This will help trainees toguide their readings and their choice of learning activities. To help our trainers, supervisors andmaximize benefits, we provided a guide for required lectures at various training stages. Mandatorycourses are also mentioned in the logbook and the Egyptian Fellowship Board will work closelywith the oral and Jaw surgery scientific council to ensure proper organization and implementationof courses at appropriate training stages.We strongly advise our trainees and trainers to refer on regular basis to the Egyptian Board web-site for new updates on curriculum, training, assessment and electronic learning opportunitiesWe hope that all our trainees, trainers and educational supervisors will follow the guides providedin the curriculum and cooperate with The Egyptian Fellowship Board and Oral and Jaw surgery Sci-entific Council to implement the curriculum in the best ways.Esmat Ahmed ShebaSecretary GeneralHigher Committee of Medical Specialties
    • AcknowledgementThis curriculum has been created through collaboration between The Oral and Jaw surgeryScientific Council and The Egyptian Fellowship Curriculum Committee. The following mem-bers of the Oral and Jaw surgery Scientific Council have made substantial contribution tothe curriculum development as subject matter experts Professor Dr Emad Yusuf, Senior Consultant of oral and Jaw surgery El Sahel Teaching hospital Professor Dr Emad Tawfeek Mahmoud, Professor of oral and Jaw surgery, Cairo UniversityThe Egyptian Fellowship Curriculum Committee has made significant contribution to Thecurriculum through Collaboration with the council in the design and formulation of the educa-tional structure. The Member who participated in The work is Associate Professor Dr Ghada Mohammed Anwar , Associate Professor of Pediatric endocrinology and Educational expert at the Medical Education Development Cen- tre, Faculty of medicine, Cairo UniversityThe Committees consulted international and national curricula in oral and Jawsurgery. The external references for the development of this curriculum are:1. The maxillofacial curriculum approved by the Joint Royal Colleges of Sur- geons Training Board 20072. The previous Egyptian Board curriculum in Oral and Jaw Surgery3. The Egyptian Board Guidelines for curriculum development 20074. Postgraduate Medical Education and Training Board UK (Guidelines for curriculum development 2006)The curriculum then has been revised and approved by the Oral and Jaw Sur-gery Scientific council at May 2008
    • Oral and Jaw Surgery Egyptian Fellowship Board…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….……………………. 6
    • Oral and Jaw Egyptian Fellowship Board…………………….……………………. CONTENTS………………….…………………….…………………….…………………….…………………….  The Structure of Oral and Jaw Surgery...…...….….. 9…………………….…………………….  Trainees duties and obligations ……………..….…... 11…………………….  General rules and regulations……………………….. 13…………………….…………………….  Rational statement……………………...…………… 14…………………….  Curriculum aim…………………………………….... 14…………………….  Intended learning outcome………………….……… 15…………………….  Basic Surgical Skills and Knowledge…………………… 16…………………….…………………….  First part syllabus 20…………………….  Oral and jaw surgery intended learning outcomes 24…………………….  Key Clinical Cases …………………………………... 41…………………….…………………….  Key Lectures in Oral and Jaw Surgery……………... 44…………………….  Surgical Procedures and Levels of Competency 47…………………….  Methods of teaching and training 55…………………….…………………….  Methods and regulations of assessment…………….. 57…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….……………………. 7
    • Oral and Jaw Surgery Egyptian Fellowship Board…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….……………………. 8
    • Oral and Jaw Egyptian Fellowship Board…………………….……………………. The structure of Oral and Jaw……………………. Surgery Training Program…………………….……………………. The Egyptian Fellowship Board requires five years of supervised training program……………………. that must be conducted in accredited hospitals before sitting for the final examina-……………………. tion. It also requires the presentation of a review article on a subject approved by……………………. the supervisors. A list of accredited hospitals will be announced yearly by the board. During the entire training program, the candidate must be dedicated full time……………………. and must be responsible for patient care under supervision. The program has the……………………. following requirements for trainees who are affiliated to MOHP:……………………. 1. Graduation from dental school and successful completion of the pre-……………………. registration house officers year.……………………. 2. Enrolment in the Ministry of health and population residency program as……………………. oral and jaw surgery resident.……………………. 3. Trainees who finished their master degree in oral and jaw surgery will join……………………. the program from the third year and are exempted from the first part exam.……………………. It is to be noted that this rule only applies for those who get their master……………………. degree within five years, otherwise they must resite for the first part exam.……………………. 4. Trainees who finished their oral and jaw surgery diploma might join the program from its second year. However, they must sit for the first part……………………. exam.…………………….……………………. First and Second years…………………….……………………. The trainees should spend the first two years of training in oral and jaw surgery……………………. practice and emergency department. During this period, they will work as full time……………………. residents……………………. Important notice……………………. Trainees must pass successfully all the foundation courses before……………………. being promoted to the second year of training. Full information about……………………. foundation courses is available at the EF website and administration office.…………………….……………………. Third and fourth years…………………….……………………. During the third and fourth years of training, trainees must get experience in differ- ent medical and surgical specialties mentioned in the curriculum. The training cen-……………………. ters should have these specialties’clinics and operative services that ensure full cov-……………………. erage of all cases and operative procedures mentioned in the curriculum.……………………. 9
    • Oral and Jaw Surgery Egyptian Fellowship Board……………………. The trainees will have rotations in different medical and surgical specialties as……………………. follows:……………………. Rotation The determined Expected cases……………………. duration……………………. (months)……………………. Orthopedic surgery 3 Bone grafting……………………. Neurosurgery 1 Multiple trauma, head injury……………………. Plastic surgery 6 Cleft lip, cleft palate, wound closure,……………………. skin graft and flaps……………………. General surgery 3 Poly-traumatized patients……………………. ENT 1 Tracheostomy, O.A.F operation…………………….……………………. General medicine 2 Medical diseases related to oral and jaw surgery.…………………….……………………. Anesthesia and ICU 4 CPR, management of bleeding and syncope, intubations (nasal and oral)…………………….……………………. Pediatric and genetic 1 Pediatric and genetic diseases related department to oral and jaw surgery……………………. Dermatology 1 Dermatological diseases of dental……………………. interest.…………………….  The rotations will be on part time basis depending upon the predetermined ar-……………………. rangement between the trainers and other specialties. Trainees shall spend two……………………. or three days in the rotation and the rest of the week in the oral and jaw surgery……………………. services…………………….  Rotation will be either in or outside the campus depending on presence of……………………. accredited centers. There will be weekly assignments at ER depending on the……………………. hospital’s rules and regulations.…………………….  It is to be noted that those with oral and jaw surgery diploma will spend the first……………………. 2 years in oral and jaw surgery practice, then 1 year in different rotation……………………. specialties, and the final year back to oral and jaw surgery practice; while those with master or MD degrees in oral and jaw surgery will spend the first year in……………………. oral and jaw surgery practice, then 1 year in different rotation specialties, and……………………. the final year back to oral and jaw surgery.…………………….……………………. The fifth year…………………….……………………. The fifth year of the training should be spent in the oral and jaw surgery practice, so……………………. that the trainees would have chances to apply what they learnt in the previous year. Their obligations, duties and responsibilities will be matching their experience, level……………………. of training, and available supervision. 10
    • Oral and Jaw Egyptian Fellowship Board……………………. Trainees duties and obligations…………………….……………………. 1. Trainees must attend at least 75% of lectures on surgical subjects.……………………. 2. They should be actively involved and fully responsible for patient care includ-……………………. ing sharing in the decision making about diagnosis and management under su- pervision of the consultant.……………………. 3. They must attend 75% of weekly meeting including clinical rounds, tutorials,……………………. journal clubs and morbidity and mortality meeting.……………………. 4. Their performance will be monitored and evaluated by trainers and a report will……………………. be issued on monthly basis to the Egyptian Fellowship Board.……………………. 5. All trainees will work as residents in the training specialty and they must fulfill……………………. all residents jobs defined by supervisors and trainers.……………………. 6. They should be responsible under supervision for outpatients and inpatients rou-……………………. tine care and must take supervised shifts according to hospital regulations.…………………….……………………. During the hospital rotations…………………….…………………….……………………. 1. The admitted patients:……………………. a. The trainee will be responsible for supervised admission of patients from the……………………. outpatient department or emergency room.……………………. b. He will share in the completion of the following documents under supervision……………………. for each case:…………………….  Complete history and physical examination form.…………………….  Investigation requests, (laboratory, radiology, pathology, etc.).…………………….  Documentation of results of the investigations.…………………….  Plan of management.…………………….  Preoperative assessment and preparation.  Operative consent and invasive procedure consent.…………………….  Operative records.…………………….  Postoperative orders.…………………….  Daily progress notes.…………………….  Orders and medication sheets…………………….  Orders of the necessary diagnostic procedures…………………….  Discharge summaries.…………………….  Sick leaves and medical reports.……………………. The trainee should inform the senior staff of any high risk patient admission…………………….……………………. 11
    • Oral and Jaw Surgery Egyptian Fellowship Board……………………. 2. The outpatients clinics:…………………….…………………….  The trainee should attend the outpatient clinics related to the rotation and its sub-……………………. specialties as requested by trainers and supervisory staff.…………………….  He should also attend operative sessions in outpatients.…………………….……………………. 3. Mandatory clinical and academic activities:……………………. The trainees must attend and participate in the mandatory academic and clinical ac-……………………. tivities of the department. Attendance and participation should not be less than 75%……………………. of the total number of activities within any training rotation / period including.…………………….  Daily morning endorsement meetings.…………………….  Clinical round…………………….  Journal club meeting.…………………….  Surgical morbidity/mortality meetings and audit sessions.…………………….…………………….……………………. 4. The log book: The trainees shall be required to keep a Logbook where they record all activities and……………………. skills performed and learned during the training program. The activities should be……………………. dated and categorized to whether been performed by the trainee him/herself or as an……………………. assistant or participant. Each activity registered in the Logbook should be counter……………………. signed by the trainer and finally the educational supervisor. The Trainer and educa-……………………. tional supervisor shall sign the completed Logbook.…………………….……………………. 5. The review article:…………………….……………………. The trainee shall write one review article during the training program under the……………………. guidance and supervision of the trainer. Such review article should be written,……………………. discussed and accepted before the trainee is accepted for admission to the final certifying examination.…………………….…………………….……………………. Before the completion of the training program:……………………. The trainee should have completed satisfactorily the rotations described in the……………………. structure of the program and performed him/herself and assisted in the various……………………. requested procedures and operations.…………………….…………………….……………………. 12
    • Oral and Jaw Egyptian Fellowship Board…………………….……………………. General rules and regulations…………………….…………………….……………………. a. Holidays and on call duties…………………….……………………. According to Ministry of Health and Population regulation…………………….……………………. b. Evaluation procedures…………………….…………………….…………………….  Performance of the trainee shall be evaluated on regular and continuous basis, the……………………. evaluation process should involve all aspects of the training including theoreti-……………………. cal, clinical and operative procedures skills as well as his attendance and partici-……………………. pation.…………………….  The trainers who are required to write confidential reports of the performance of……………………. each trainee should evaluate the trainee periodically. The trainee should not be……………………. allowed to proceed in the training program and move to the next stage of training……………………. unless he/she attains a satisfactory level of performance acceptable to the respon-……………………. sible trainer and educational supervisor.  The trainee shall not be allowed to proceed to year 3 before successfully passing……………………. the first part Exam…………………….…………………….…………………….…………………….…………………….……………………. Interruption of training…………………….…………………….……………………. It is not permissible to interrupt such a structured training program except in major……………………. unavoidable circumstances. Such circumstances should be convincing and approved……………………. by the Secretary General. The Interruption once approved should not be for more than one year. Interruption of the training program for more than one year shall re-……………………. sult in dismissal from the program and cancellation of the preceding training period.…………………….…………………….…………………….……………………. 13
    • Oral and Jaw Surgery Egyptian Fellowship Board……………………. The Rationale Statements…………………….…………………….……………………. The purpose of this curriculum is describe the knowledge, skills, behaviors and atti-……………………. tudes expected from oral and jaw surgeon upon completion of training in Egyptian……………………. Fellowship for oral and jaw surgery. The curriculum also describes the methods of……………………. teaching and learning that will be used to facilitate the delivery of curriculum. In……………………. addition, it highlights the different methods of trainees’ performance evaluation that……………………. are going to be used whether formative or summative. The curriculum contents have been delivered through the following methods:……………………. 1. Revision of previous fellowship curriculum……………………. 2. Revision of international curricula for postgraduate training in oral and jaw sur-……………………. gery. We specifically mention the maxillofacial curriculum approved by the……………………. Joint Committee on surgical training and PMETB 2007……………………. 3. Consultation of experts in the field of oral and jaw surgery and other related spe-……………………. cialties. Experts were consulted regarding their vision for oral and jaw surgery……………………. practice in Egypt and how international standards would fit. We also consulted……………………. them regarding the level of knowledge and skills required in each training year……………………. and in each specialty while putting in mind expected practice constrains.……………………. 4. The curriculum then was re-revised by representative members from the oral and……………………. jaw surgery scientific council and approved by the council in April 2008.…………………….……………………. Curriculum aim…………………….……………………. Aims of the Oral and Jaw Surgery Fellowship training…………………….…………………….  To provide the trainees with the knowledge, and skills which enable him/her to……………………. identify, assess and manage common and important oral and jaw surgical prob-……………………. lems, whether elective or emergent.…………………….  To enable the development and application of appropriate professional attitudes,……………………. ethical principles and communication skills necessary for safe and effective practice in the field of oral and jaw surgery…………………….…………………….…………………….…………………….…………………….…………………….……………………. 14
    • Oral and Jaw Egyptian Fellowship Board…………………….……………………. Intended Learning Outcomes…………………….……………………. Generic Surgical Skills and Knowledge…………………….……………………. 1. Basic sciences…………………….……………………. Knowledge……………………. By the end of this module the trainee will be able to discuss the following topics in……………………. the following basic sciences:…………………….  Applied anatomy: Development, organs and structures, surface and imaging……………………. anatomy of head and neck as appropriate for surgical operations.…………………….  Physiology: Homeostasis, thermoregulation, metabolic pathways, blood loss,……………………. sepsis, fluid balance and fluid replacement therapy, and metabolic abnormali-……………………. ties.…………………….  Pathology: Inflammation, wound healing, cellular injury, vascular disorders,……………………. disorders of growth differentiation and morphogenesis as related to oral and……………………. jaw surgery.…………………….  Microbiology: Surgically important microorganisms, sources of infection,……………………. asepsis and antisepsis, sterilization, antibiotics, high risk patient management.…………………….  Pharmacology and therapeutics: pharmacological basis of antimicrobial……………………. agents, analgesics, local anesthetic agents.…………………….  Radiology: Principles of diagnostic and interventional radiology as it applied……………………. to the field of oral and jaw surgery.…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….……………………. 15
    • Oral and Jaw Surgery Egyptian Fellowship Board……………………. 2. Basic surgical skills…………………….……………………. By the end of this module, the trainee will be able to outline the principles and per- form competently without assistance the following surgical techniques:…………………….  Incision and closure of skin and subcutaneous tissue.…………………….  Knot tying.…………………….…………………….  Hemostasis: control of bleeding vessel.…………………….  Tissue retraction.…………………….  Use of drains: insertion, fixation, and removal.…………………….  Tissue handling……………………. 3. The Assessment and Management……………………. of the Surgical Patient…………………….…………………….……………………. Clinical skills…………………….  Take surgical history and examination (elective and emergency).…………………….  Construct a differential diagnosis.…………………….  Plan for appropriate investigations.…………………….  Plan initial and subsequent management…………………….  Take consent from patients for all types of invasive interventions……………………. 4. Peri-operative care…………………….……………………. Knowledge…………………….……………………. By the end of training, the trainee will be able to discuss the following topics:…………………….  Preoperative assessment and management including, cardio-respiratory risk and diseases, diabetes mellitus, renal failure, blood loss, sepsis and other……………………. risk factors for surgeries…………………….  Intraoperative care including, safety in theatre , sharps safety, diathermy,……………………. laser use, infection risks, radiation use and risks, tourniquets, principles of……………………. local, regional and general anesthesia.…………………….  Postoperative care.…………………….  Blood Products: use and complications.…………………….  Use of antibiotics , common pathogens in surgical patient, antibiotic……………………. sensitivities, antibiotic side-effects, principles of prophylaxis and treatment.…………………….…………………….……………………. 16
    • Oral and Jaw Egyptian Fellowship Board……………………. Clinical skills…………………….……………………. By the end of the course, the trainee will be able to perform competently the……………………. following:…………………….  Preoperative assessment and management: history and examination,……………………. interpretation of preoperative investigations, management of co-morbidities in collaboration with colleagues from other medical and surgical specialties…………………….…………………….  Resuscitation according to the principles of fundamental life support…………………….  Safe conduct of intraoperative care.…………………….  Postoperative care: postoperative analgesia, fluid and electrolyte management, monitoring of patient, detection and initial management of……………………. impending organ failure and shock.…………………….  Use of blood products and Appropriate prescription of antibiotics.…………………….  Consult medical and surgical specialties appropriately and when indicated…………………….…………………….……………………. Professional Skills…………………….…………………….  Communicate effectively with patient, relatives and other staff members.…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….……………………. 17
    • Oral and Jaw Surgery Egyptian Fellowship Board……………………. 5. Bleeding diathesis…………………….……………………. Clinical Skills…………………….  Recognize abnormal bleeding during surgery.…………………….  Perform corrective measures, e.g. warming, packing.…………………….……………………. 6. Venous thrombosis and embolism…………………….……………………. Knowledge…………………….  Discuss coagulation: clotting mechanism, effect of surgery and trauma on……………………. coagulation.…………………….  List methods of investigation for suspected thrombo-embolic disease.…………………….  Describe various treatment modalities including prophylaxis.…………………….……………………. Clinical skills……………………. By the end of the course, the trainee will be able to:…………………….  Recognize patients at risk and take prophylactic measures.…………………….  Diagnose, investigate, initiate and monitor treatment of coagulation disorders.…………………….……………………. 7. Nutrition…………………….……………………. Knowledge…………………….  List effects of malnutrition, both excess and depletion.…………………….  Discuss methods of screening and assessment.……………………. Clinical skills…………………….…………………….…………………….  Recognize the need for and arrange access to artificial nutritional support, via a……………………. nutrition team: enteral and parenteral.…………………….…………………….…………………….…………………….…………………….…………………….…………………….……………………. 18
    • Oral and Jaw Egyptian Fellowship Board……………………. 8. Endocrine and Metabolic Disorders…………………….……………………. Knowledge……………………. By the end of the training, the trainees will be able to discuss the pathophysiology,……………………. clinical presentation, surgical impact of:…………………….  Thyrotoxicosis.…………………….  Hypothyroidism.…………………….  Hypercalcemia.…………………….  Cortico-steroid therapy.…………………….  Diabetes Mellitus.…………………….  Hyponatremia.……………………. Clinical skills…………………….……………………. Trainees must be able to recognize the previous conditions in the peri-operative……………………. period and consult appropriate medical and surgical specialties regarding their……………………. management.…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….……………………. 19
    • Oral and Jaw Surgery Egyptian Fellowship Board……………………. First part Syllabus for oral and jaw surgery…………………….…………………….……………………. 1. Anatomy…………………….……………………. Knowledge…………………….……………………. The trainee should be able to describe the embryology and applied surgical anatomy of the following :…………………….  Skull, brain and cranial cavity.…………………….  Orbit and eye.…………………….  Nose and paranasal sinuses.…………………….  Facial musculature/soft tissues.…………………….  Temporomandibular joint and infratemporal fossa…………………….  Functional anatomy of the TMJ.…………………….  Oral cavity, teeth and supporting structures, pharynx.…………………….  Mandible and maxilla.…………………….  Larynx, trachea, neck and thoracic inlet.…………………….  Blood supply to skin, fascia, muscle and bone of the head and neck:…………………….  Regional anatomy relevant to bone grafts and common pedicled/free flaps.……………………. Clinical skills…………………….……………………. Apply the previous knowledge appropriately in the clinical setting.…………………….…………………….……………………. 2. Physiology…………………….……………………. Knowledge…………………….……………………. The trainee will be able to discuss the following:…………………….  Metabolism and functions of the oral mucosa and connective tissues of the oral cavity.…………………….  Calcium/phosphorus metabolism:…………………….  Mineral, calcium and phosphates metabolism.…………………….  Composition and metabolism of bone and teeth.…………………….  Mechanisms of calcification.…………………….…………………….……………………. 20
    • Oral and Jaw Egyptian Fellowship Board…………………….  Bone growth and remodelling:…………………….  Mechanisms of osteogenesis, ossification and bone growth.…………………….  Bone remodeling.…………………….  Mechanisms of tooth eruption:…………………….  Normal and abnormal tooth eruption.  Salivary glands and saliva…………………….  Composition and functions of saliva and mechanism of salivation.…………………….  Importance of saliva in relation to oral disease.…………………….  Immunology and defense mechanisms of the mouth:…………………….  Mechanical, chemical, immunological and hormonal factors protecting the……………………. oral cavity.…………………….  Properties and functions of the muscles of mastication.…………………….  Taste and olfaction.…………………….  Control of deglutition, and dysphagia.…………………….  Effects of dietary deficiencies and hormonal imbalances on the oral and jaw……………………. health…………………….  Age changes in the oral structures.  Physiological responses to surgical treatment:…………………….  Physiology of stress.…………………….  The anxious patient.…………………….  Vasovagal reactions, hyperventilation and arrhythmias.…………………….  Wound healing.…………………….  Oro-facial pain:…………………….  Sensory innervation of the head and neck.…………………….  Referred pain.……………………. Clinical skills…………………….…………………….  Apply these knowledge appropriately in the clinical setting.…………………….……………………. 3. Surgical Pathology…………………….……………………. Knowledge…………………….……………………. The trainee will be able to discuss the pathology of the following:…………………….  Inflammation and inflammatory reaction…………………….  pathological basis for the immune response.…………………….  Hyperplasias, hamartomas, and neoplasms of soft tissues and bones.…………………….  Benign epithelial tumors of the mucosa and skin.……………………. 21
    • Oral and Jaw Surgery Egyptian Fellowship Board…………………….  Potentially malignant and malignant epithelial tumors of the mucosa and skin:…………………….  Mechanisms of growth, malignant transformation and metastasis.…………………….  Tumor staging.…………………….  Effects of radiation and osteoradionecrosis.  Benign soft tissue tumors of mesenchymal origin.…………………….  Malignant soft tissue tumors of mesenchymal origin:…………………….  Mechanisms of tumors initiation and growth, malignant transformation.…………………….  Tumors staging.…………………….  Non-neoplastic salivary gland diseases.…………………….  Salivary gland neoplasms: metastasis, and staging.…………………….  Odontogenic and non-odontogenic cysts.…………………….  Odontogenic tumors, hamartomas and neoplasms.…………………….  Pigmented lesions of the skin and mucosa: normal and abnormal pigmentation.…………………….  Fibro osseous diseases and systemic diseases affecting bone.…………………….  Benign and malignant neoplasms of bone:…………………….  Mechanisms of tumor initiation, growth, and metastasis.  Tumor staging.…………………….  The immune system: Hypersensitivity, tissue grafts and autoimmunity.…………………….  Trauma:…………………….  Hemorrhage and shock.…………………….  Edema.…………………….  Fever and hypothermia.……………………. Clinical skills…………………….…………………….  Prepare and preserve pathological specimens.…………………….  Apply previous knowledge appropriately in the clinical setting.…………………….……………………. 4. Clinical pharmacology…………………….……………………. Knowledge……………………. The trainee will be able to outline the following:…………………….  The principles of drug prescription.…………………….  Drug interactions, and adverse reactions.…………………….  Differences in drug therapy in different age groups and pregnancy .…………………….  Drug therapy of systemic disease relevant to oral and jaw surgical practice .…………………….…………………….…………………….……………………. 22
    • Oral and Jaw Egyptian Fellowship Board…………………….  Relief of pain and anesthesia:…………………….  Mechanism of action and practical use of analgesics.…………………….  Treatment of intractable pain (e.g. in terminal care).…………………….  Local and general anesthetics.…………………….  Drug dependence and abuse.  Principles of cancer chemotherapy and immunosuppression.…………………….……………………. Clinical skills…………………….…………………….  Applying this knowledge appropriately in the clinical setting.…………………….……………………. 5. Clinical Microbiology…………………….……………………. Knowledge…………………….……………………. The trainee will be able to outline the following:…………………….  Classification and pathogenesis of micro-organisms.  Antimicrobial chemotherapy: spectrum of activity, principles of clinical use,……………………. antibiotic resistance.…………………….  The immuno-compromised patient:…………………….  Causes and related conditions.…………………….  Specific precautions and management protocols.…………………….  Septicemia:…………………….  Clinical features and causative organisms.…………………….  Investigation and antimicrobial treatment.…………………….  Opportunistic and fungal infections:…………………….  Diagnosis and treatment.…………………….  Specific infections of the head and neck:…………………….  Odontogenic infections.  Infections of the paranasal sinuses.…………………….  Osteomyelitis.…………………….  Tissue space infections and skin infections.…………………….  Necrotizing fasciitis.…………………….  Infective endocarditis:…………………….  Clinical features and predisposing factors.…………………….  Investigation, Treatment and prophylaxis.…………………….  Hospital acquired infection.…………………….  Principles of disinfection and sterilization……………………. Clinical skills…………………….  Applying this knowledge appropriately in the clinical setting. 23
    • Oral and Jaw Surgery Egyptian Fellowship Board……………………. Oral and Jaw Intended Learning Outcomes…………………….…………………….……………………. Dentoalveolar pathology…………………….……………………. Knowledge…………………….……………………. The trainee will be able to discuss:…………………….  The signs and symptoms, differential diagnosis, investigations and radiographic interpretation.…………………….  The methods of medical management including treatment of inflammation/……………………. infection.…………………….  The relevance of endoscopic examination of maxillary antrum.…………………….  The indications and techniques of oro-antral communication.…………………….  The presentation and management of cystic lesions of the jaw.…………………….  The potential complications including management of compromised airway.…………………….……………………. Clinical skills…………………….……………………. At the end of training, trainees must be able to:…………………….  Formulate treatment plan.  Treat/drain infection and/or remove tooth.…………………….  Manage compromised airway (surgical airway).…………………….  Recognize and initiate management of systemic sepsis (sepsis syndrome).…………………….  Recognize infection as an early indicator of immuno suppression e.g. diabetes.…………………….  Institute aftercare.…………………….……………………. 1. Impacted Wisdom Tooth, Dental Extrac-……………………. tions and Unerupted Tooth…………………….……………………. Technical Skills…………………….……………………. The trainee will be able to perform competently:  Surgical extraction of unerupted/impacted teeth and roots:…………………….  Local anesthetic and sedation techniques.…………………….  Treat/drain infection and/or remove tooth.…………………….  Techniques of bone removal and tooth division.…………………….  Intra-oral suturing techniques.…………………….……………………. 24
    • Oral and Jaw Egyptian Fellowship Board……………………. 2. Oro-antral communication/……………………. root in Maxillary antrum…………………….……………………. Technical Skills…………………….……………………. The trainee will be able to perform competently:…………………….  Closure of oro-antral communication:…………………….  Techniques of local flap closure.…………………….  Techniques of antral exploration / lavage.…………………….  Antrostomy.…………………….  Removal of retained root or dental fragment from maxillary antrum…………………….  Endoscopic examination of maxillary antrum .…………………….……………………. 3. Prominent lingual / labial frenum…………………….……………………. Technical Skills…………………….…………………….  Intra-oral suturing techniques .…………………….……………………. 4. Jaw Cysts…………………….……………………. Technical Skills…………………….……………………. The trainee will be able to perform competently:…………………….  Apical surgery / excision of jaw cyst.…………………….  Techniques of exposure, bone removal and enucleation of pathology.…………………….…………………….……………………. 5. Benign oral soft tissue/hard tissue lesion……………………. /Abscess/Infection…………………….……………………. Technical Skills…………………….……………………. The trainee will be able to perform competently:……………………. Excision / biopsy of benign oral soft tissue / hard tissue lesion:…………………….  Techniques of incisional / excisional biopsy.  Local flap closure.…………………….  Control of hemorrhage. 25
    • Oral and Jaw Surgery Egyptian Fellowship Board……………………. Oral mucosal lesions…………………….……………………. Oral ulceration and leukoplakia…………………….…………………….……………………. Knowledge……………………. Trainee will be able to discuss…………………….  Etiological factors, differential diagnosis and investigations.…………………….  Possible relationship to systemic disease.…………………….  Signs of malignant disease.…………………….……………………. Clinical skills…………………….  Examine the oral mucosa.…………………….  Perform biopsy/cytology techniques.…………………….  Interpret results.…………………….……………………. Technical Skills…………………….…………………….  Carry out steps of procedure safely and correctly including harvesting pathol-……………………. ogically appropriate specimen.…………………….  Discriminate between those who need surgery or not.…………………….……………………. Infections of the Head and Neck…………………….……………………. Knowledge……………………. Trainees will be able to discuss:…………………….  Causes of swelling of head and neck and methods of their investigations.…………………….  Potential complications.…………………….  Relevance to immunocompromized state.…………………….  Principles of medical and surgical management.…………………….  Techniques of surgical and non-surgical airway management.……………………. Clinical skills…………………….…………………….  Examine the head, neck and salivary glands.…………………….  Recognize infections specific to the head and neck.…………………….  Treat acute infected swelling.…………………….  Drain facial abscess 26
    • Oral and Jaw Egyptian Fellowship Board……………………. Technical Skills…………………….……………………. The trainee will be able to perform competently:…………………….  Drainage of tissue space infection.…………………….  Surgical access to airway ( assist in Tracheostomy / cricothyroidotomy):…………………….  Exposure and access to airway.…………………….  Placement and securing of tube in airway.…………………….……………………. Cranio Maxillofacial Trauma……………………. Knowledge…………………….……………………. Trainee will be able to discuss:…………………….  Classification of dental trauma and dento-alveolar fractures.…………………….  Classification of condylar fractures.…………………….  Classification of mid-facial fractures.…………………….  Signs and symptoms of fractures of facial skeleton.…………………….  Clinical manifestations of lacrimal/parotid duct injury and appropriate investi-……………………. gations.…………………….  Assessment of airway and level of consciousness (Glasgow coma scale).…………………….  Eyes/ears assessment.  Assessment of head injury and cranial nerve function.…………………….  Relevant investigations and radiographic interpretation.…………………….  Management/prevention of unfavorable scarring.…………………….  Prevention and treatment of infection.…………………….  Principles of stenting of lacrimal/parotid duct.…………………….  Benefits and indications of both open and closed treatments.…………………….  Surgical approaches to the orbit.…………………….  Available techniques for orbital wall reconstruction.…………………….……………………. Clinical skills…………………….…………………….  Assess traumatized patient.  Assess patient with facial laceration (s)/trauma.…………………….  Recognize involvement of other anatomical structures e.g. nerves, parotid duct…………………….  Examine eyelids and lacrimal apparatus.…………………….  Examine oral cavity, facial skeleton and cranial nerves.…………………….  Prioritize management (airway management/emergency treatment of facial……………………. trauma.…………………….  Infiltration/ nerve block anesthesia. 27
    • Oral and Jaw Surgery Egyptian Fellowship Board……………………. 1. Facial Lacerations…………………….……………………. Technical Skills…………………….……………………. The trainee will be able to perform:…………………….  Repair of facial laceration (s):…………………….  Management of contaminated wound, thorough debridement.…………………….  Management of laceration involving key structures or tissue loss.  Management of nerve/parotid duct injury.…………………….…………………….……………………. 2. Lacrimal/Parotid duct injury……………………. Technical Skills…………………….……………………. The trainee will be able to perform:…………………….  Use of loupes / operating microscope.…………………….  Surgical repair under magnification.…………………….  Stenting of the duct.…………………….……………………. 3. Dental Trauma and dento-alveolar fractures…………………….……………………. Technical Skills…………………….……………………. The trainee will be able to perform competently:…………………….  Techniques of preservation of damaged teeth, reduction and fixation.…………………….…………………….……………………. 4. Nasal Fractures…………………….……………………. Technical Skills…………………….……………………. The trainee will be able to perform competently:…………………….  Manipulation of nasal bones and septum.…………………….  Management of epistaxis.…………………….  Nasal packing and external splint.…………………….…………………….……………………. 28
    • Oral and Jaw Egyptian Fellowship Board……………………. 5. Fractured Zygoma…………………….……………………. Technical Skills…………………….……………………. The trainee will be able to perform competently:…………………….  Basic ophthalmic and orthoptic assessment.…………………….  Techniques of exposure of fracture site (s) and bone manipulation.…………………….  Plate handling skills.…………………….  Soft tissue handling and suturing techniques.…………………….……………………. 6. Fracture of mandible (excluding condyle)…………………….……………………. Technical Skills…………………….……………………. The trainee will be able to perform competently:…………………….  Techniques of inter-maxillary fixation.…………………….……………………. 7. Fracture of mandibular condyle…………………….……………………. Technical Skills…………………….……………………. The trainee will be able to perform competently:…………………….  Closed reduction:…………………….  Techniques of inter-maxillary fixation.…………………….  Open Reduction…………………….  exposure of the fracture site and manipulation of condylar fragments.…………………….  plate handling skills.…………………….……………………. 8. Fracture of maxilla…………………….……………………. Technical Skills…………………….……………………. The trainee will be able to perform competently:…………………….  Techniques of cranio-maxillary fixation.…………………….…………………….……………………. 29
    • Oral and Jaw Surgery Egyptian Fellowship Board……………………. 9. Fracture of orbital floor…………………….……………………. Technical Skills…………………….……………………. The trainee will be able to assist in :…………………….  Assessment of eye function.…………………….  Techniques for approach to orbital floor.…………………….  Safe exposure of fracture sites and reduction of fragments.  Bone grafting and plating skills.…………………….…………………….……………………. 10. Fractures of Naso-orbito-ethmoid complex,……………………. frontal bones and craniofacial fractures…………………….…………………….……………………. Technical Skills…………………….……………………. The trainee will be able to assist in :…………………….  Techniques for approach to naso-ethmoid complex, and frontal bones fractures.…………………….  Safe exposure of fracture sites and reduction of fragments.  Bone grafting and plating skills.…………………….  Management of frontal sinus involvement.…………………….…………………….…………………….…………………….……………………. Facial pain…………………….……………………. 1. Oro-facial pain…………………….……………………. Knowledge…………………….……………………. trainee will be able to discuss:…………………….  Signs and symptoms of common causes of oro-facial pain and required……………………. investigations.…………………….  Methods of medical and surgical management.…………………….  Various techniques of nerve blockade relevant to oral and jaw surgical interven-……………………. tions.……………………. 30
    • Oral and Jaw Egyptian Fellowship Board……………………. Clinical skills…………………….…………………….  Elicit and interpret an accurate pain history.…………………….  Examine patient.…………………….……………………. Technical Skills……………………. The trainee will be able to perform…………………….  Local anesthetic techniques including nerve blocks.…………………….  Cryo blockade, neurolysis and surgical nerve disruption.…………………….…………………….……………………. 2. Temporomandibular joint disorders…………………….……………………. (Intra-capsular TMJ and condylar head pathology/recurrent dislocation/ankylosis/disc displacement/reconstruction of TMJ)…………………….…………………….……………………. Knowledge……………………. trainee will be able to discuss:…………………….  Signs and symptoms of TMJ dysfunction.…………………….  Causes of TMJ/capsular/meniscal pathology.…………………….  Investigations and radiographic interpretation.…………………….  Indication for joint replacement and reconstruction.…………………….  Methods of medical and surgical management.…………………….  Indication for open surgery.…………………….……………………. Clinical skills…………………….…………………….  Examine TMJ and muscles of mastication.……………………. Technical Skills…………………….……………………. The trainee will be able to perform competently:…………………….  Use of occlusal adjustment therapy.…………………….  Arthrocentesis, arthrograms and arthroscopy.…………………….  Open joint procedures e.g. disc plication, eminectomy.…………………….  Approaches to the TMJ and mandibular condyle.…………………….  Harvest of costochondral graft.……………………. 31
    • Oral and Jaw Surgery Egyptian Fellowship Board……………………. Peri-operative care…………………….…………………….……………………. Knowledge……………………. Trainee will be able to explain…………………….  Pre-operative Care…………………….  Necessary pre-operative investigations.…………………….  Outcomes and complications of surgery.…………………….  Intra-operative care…………………….  Knowledge of alternative procedures in case of encountering difficulties.…………………….  Post-operative care…………………….  Potential complications of procedure.…………………….  Likely post-operative progress from disease process and intervention.……………………. Clinical skills…………………….…………………….  Pre-operative care…………………….  Take history and perform examination for operative management plan.…………………….  Explain procedure and outcomes to patient and caregivers at an appropri-……………………. ate level.…………………….  Take informed consent.…………………….  Intra-operative care…………………….  Communicate with other members of theatre team.…………………….  Post-operative Care…………………….  Assess the patient and physiological parameters.…………………….  Use communication skills for dealing with team members, patients and carers.…………………….  Recognize different complications of the procedure.…………………….……………………. Salivary glands/ Neck swellings…………………….…………………….……………………. Knowledge…………………….……………………. Trainee will be able to outline:…………………….  Causes of intermittent/persistent swelling of neck.…………………….  Relevant investigations.…………………….  Methods of medical and principles of surgical management.……………………. 32
    • Oral and Jaw Egyptian Fellowship Board……………………. Clinical skills…………………….…………………….  Take and interpret medical history for patients with neck swelling.…………………….  Examine the neck and salivary glands.…………………….  Treat acute infected swelling.…………………….  Drain neck abscess.…………………….……………………. 1. Neck swellings…………………….……………………. Technical Skills……………………. The trainee will be able to perform competently:…………………….  Drainage of tissue space infection:…………………….  Exposure and exploration of tissue space (s).…………………….  Collection of samples.…………………….  Securing appropriate drains and dressings.…………………….  Cervical node biopsy:…………………….  Localization of mass and dissection.…………………….……………………. 2. Mucous Cyst of Sublingual Salivary Gland/ Ranula…………………….……………………. Technical Skills……………………. The trainee will be able to perform competently:…………………….  Excision of mucocele of lip / labial gland biopsy.…………………….  Sublingual gland excision:…………………….  Intra-oral dissection.…………………….  Identification and protection of submandibular duct/lingual nerve.…………………….……………………. 3. Stone Retrieval…………………….……………………. Technical Skills…………………….……………………. The trainee will be able to:…………………….  Remove stone from submandibular duct:…………………….  Expose submandibular duct and do safe retrieval of stone.…………………….  Perform intra-oral soft tissue dissection and suturing techniques.…………………….……………………. 33
    • Oral and Jaw Surgery Egyptian Fellowship Board……………………. 4. Obstructive/inflammatory disease of submandibular gland…………………….……………………. Technical Skills…………………….……………………. Trainee will be able to perform competently:…………………….  Submandibular gland excision:…………………….  Identification and protection of facial nerve..…………………….  Dissection of gland and ligation of duct.…………………….……………………. 5. Neoplasm of Minor Salivary……………………. Glands (sublingual/ submandibular)…………………….……………………. Technical Skills…………………….……………………. Trainee will be able to perform competently:…………………….  Excision of neoplasm of minor salivary gland:…………………….  Biopsy techniques.…………………….  Excision and local flap repair.…………………….  Sublingual gland excision:  Identification and protection of submandibular duct/lingual nerve.…………………….  Submandibular gland excision:…………………….  Identification and protection of facial nerve.…………………….  Dissection of gland and ligation of duct.…………………….…………………….……………………. Head and Neck Cancer…………………….……………………. 1. Oro-Pharyngeal Cancer…………………….……………………. Knowledge……………………. trainee will be able to outline…………………….  Etiological factors and differential diagnosis.…………………….  Specialized investigations.…………………….  Interpretation of radiographs / scans.…………………….  Common access techniques to oral and jaw cancers.…………………….  Common excisional techniques for orofacial cancer including conservation……………………. surgery.…………………….  Requirements for functional rehabilitation. 34
    • Oral and Jaw Egyptian Fellowship Board……………………. Clinical skills…………………….…………………….  Take history and examine the patient with oral and jaw cancer.…………………….  Formulate treatment plan.…………………….  Carry out appropriate surgery according to competency.…………………….  Perform post-operative care and follow-up.…………………….  Demonstrate ability to function as part of a multidisciplinary team .…………………….……………………. Technical Skills…………………….……………………. The trainee will be able to perform:…………………….  Biopsy techniques, incisional FNA TruCut.…………………….  Excision of Oral or Jaw Malignancy:…………………….  Sharp and blunt dissection of soft tissues.…………………….  Osteotomy technique and plate handling skills.  Safe isolation of tumor.…………………….  Preservation of vital structures.…………………….…………………….……………………. 2. Skin Cancer…………………….……………………. Knowledge…………………….…………………….……………………. Trainee will be able to outline:…………………….  The skin age changes.…………………….  The etiology and pathology of common skin cancers.  The principles of wound healing.…………………….  The techniques of skin excision and closure.…………………….  The common reconstructive skin procedures e.g. skin grafts, local flaps.…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….……………………. 35
    • Oral and Jaw Surgery Egyptian Fellowship Board……………………. Facial Deformity…………………….……………………. Developmental/acquired deformity of facial skeleton…………………….……………………. Knowledge……………………. trainee will be able to outline:…………………….  Etiological factors.…………………….  Specialized investigations.…………………….  Classification of malocclusion/deformity.…………………….……………………. Technical Skills…………………….  Perform orthognathic surgery techniques.…………………….……………………. Orthognathic Surgery…………………….……………………. Genioplasty/ Mandibular ramus osteotomy/……………………. Maxillary osteotomy/ Zygomatic osteotomy…………………….……………………. Knowledge…………………….……………………. Trainee will be able to outline:…………………….  Norms of facial proportions.  Classification and assessment of facial deformity.…………………….  The psychological impact of facial deformity.…………………….  Techniques of cephalometric analysis.…………………….……………………. Clinical skills…………………….…………………….  Take history and perform examination of the patient with facial deformity.…………………….  Perform different Orthognathic surgery techniques according to the level of……………………. training.…………………….……………………. Technical Skills……………………. Trainee will be able to perform:…………………….  Approaches to the anterior mandible…………………….  Identification and protection of mental nerves.…………………….  Safe use of power tools.…………………….  Plating and fixation skills. 36
    • Oral and Jaw Egyptian Fellowship Board…………………….  Approaches to the mandibular ramus…………………….  Identification and protection of key structures.…………………….  Intermaxillary fixation techniques.…………………….  Approaches to the maxilla.…………………….  Approaches to the zygoma.…………………….……………………. Reconstructive Surge……………………. 1. Harvest of bone graft (non-vascularized bone grafts)…………………….……………………. Knowledge…………………….……………………. Trainee will be able to outline…………………….  Advantages/disadvantages of different sites.  Surgical approaches to different sites.…………………….  Intraoral and extraoral donor sites.…………………….  Risks and complications of procedure.…………………….  Techniques of bone graft harvesting e.g. open versus closed, use of bone……………………. trephines.…………………….……………………. Clinical skills…………………….…………………….  Selection of appropriate anesthetic technique.…………………….  Choose site appropriate for graft of required size/type.…………………….  Care of bone graft prior to fixation.…………………….……………………. Technical Skills…………………….  Safe harvesting of graft of appropriate size/type.…………………….  Repair of donor site.…………………….  Insetting and fixation of graft to recipient site.…………………….……………………. 2. Local Skin Flaps…………………….……………………. Knowledge…………………….……………………. Trainee will be able to outline……………………. Techniques of local flap design and use. The principles of skin tension lines.…………………….……………………. 37
    • Oral and Jaw Surgery Egyptian Fellowship Board……………………. Clinical skills…………………….…………………….  Select the most appropriate flap.…………………….  Utilize the principles of skin tension lines to the advantage of the surgical repair.……………………. Technical Skills…………………….……………………. Trainee will be able to perform:…………………….  Raising, mobilizing and insetting local flap.  Tissue handling and suturing techniques.…………………….……………………. 3. Pedicled flaps…………………….……………………. Knowledge……………………. Trainee will be able to outline:…………………….  Indications for different types of flap.…………………….  Limitation of techniques .…………………….……………………. Technical skills……………………. The trainee will be able to perform:…………………….  Raising of pedicled cutaneous, muscle and myocutaneous flaps.  Insetting of flap.…………………….  Management of donor site and closure.…………………….  Management of complications.…………………….……………………. 4. Free tissue transfer…………………….……………………. Knowledge……………………. Trainee will be able to outline:…………………….  Principles of microvascular anastomosis.…………………….  Limitation of techniques.…………………….……………………. Technical skills…………………….……………………. The trainee will be able to perform:…………………….  Raising of soft tissue and composite flaps.…………………….  Insetting of flap.…………………….  Use of operating microscope and loupes.…………………….  Preparation of donor and recipient vessels.  Arterial and venous microvascular anastomosis.…………………….  Management of donor site and closure. 38
    • Oral and Jaw Egyptian Fellowship Board……………………. Aesthetic Surgery…………………….……………………. Scar Revision / Z-plasty…………………….……………………. Knowledge……………………. Trainee will be able to outline…………………….  Psychology of body dysmorphopsia and post-traumatic stress.…………………….  Techniques of scar revision and disguise.…………………….  Techniques of non surgical scar modification.…………………….……………………. Clinical skills…………………….…………………….  Carefully select patient..……………………. Technical Skills…………………….…………………….  Tissue handling and suturing techniques.…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….……………………. 39
    • Oral and Jaw Surgery Egyptian Fellowship Board…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….……………………. 40
    • Oral and Jaw Egyptian Fellowship Board…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….……………………. Key Clinical Cases…………………….……………………. for…………………….……………………. Oral and Jaw Surgery…………………….……………………. Training Program…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….……………………. 41
    • Oral and Jaw Surgery Egyptian Fellowship Board…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….……………………. 42
    • Oral and Jaw Egyptian Fellowship Board……………………. Key Clinical Cases for Oral and Jaw Surgery Program…………………….……………………. At the end of the program, the trainees should competently assess and……………………. manage (including operative management) patients with the following……………………. clinical presentations:……………………. Cases/ Condition Cases/ Condition…………………….  Dental trauma and dento-alveolar…………………….  Dentoalveolar pathology: fracture…………………….  Exodontias  Facial pain and neuralgia…………………….  Temporomandibular joint…………………….  Oroantral fistula disorders:…………………….  Root in maxillary antrum  Myofascial dysfunction syndrome…………………….  Preprosthetic surgery  Internal derangement…………………….…………………….  Jaw cysts and related structures  Ankylosis…………………….  Oral and paraoral cysts  Condylar hyperplasia…………………….  Benign and malignant oral soft…………………….  TMJ dislocation tissue/hard tissue lesions:…………………….  Soft tissue tumors of the tongue,……………………. lips, soft palate  Salivary gland swellings:…………………….  Hard tissue tumors of jaw (benign……………………. and malignant) including odonto-  Stones……………………. genic tumors.…………………….  Abscess/ infection:  Cysts…………………….  Dentoalveolar abscess  Tumor…………………….  Facial space infections  Sialadenitis…………………….  Oral mucosal lesions:  Neck swellings…………………….  Oral ulcers, white patches, and oral…………………….  Facial deformities pigmentations.…………………….  Irregularities of the dentoalveolar…………………….  Cleft lip and palate ridges/ ebulus (mucosal swellings).…………………….  Cranio-Maxillo-Facial Trauma:  Micro and macrognathia…………………….  Zygomatic complex  Open bite deformities…………………….  Fracture middle third of the face  Prognathism…………………….…………………….  Fracture mandible  Facial asymmetry…………………….  Long face syndrome and other  Facial lacerations oro-facial and cranial syndromes. 43
    • Oral and Jaw Surgery Egyptian Fellowship Board……………………. Key Lectures in Oral and Jaw Surgery…………………….…………………….……………………. Lectures of the first year of the training program (Basic……………………. Sciences):……………………. Anatomy…………………….…………………….  Embryology of the maxillofacial region…………………….  Innervation and blood supply of the head and neck (cranial nerves anatomy)…………………….  Musculoskeletal anatomy of the face…………………….  Applied incisions of the face (2 hr)…………………….……………………. Physiology…………………….  Fluids and electrolytes balance…………………….  Calcium, phosphorus and bone metabolism…………………….  Blood products transfusions…………………….  Interpretation of important laboratory tests…………………….  Cardiovascular physiology and ECG interpretation…………………….  Principles of immunology…………………….  Hormones of maxillofacial interest…………………….  Systemic diseases in relation to oral surgery and oral manifestations of systemic……………………. diseases…………………….……………………. Surgical pathology…………………….…………………….  Inflammation and infections…………………….  Hyperplasia, hamartomas, and neoplasm (benign and malignant)…………………….  Bone diseases affecting maxillofacial region…………………….  Salivary glands (anatomy, physiology, pathology )…………………….  Endocrine glands…………………….  Hemorrhage and shock……………………. Clinical pharmacology…………………….…………………….…………………….  Antimicrobial therapy in oral and jaw field…………………….  Local anesthesia and pain killers…………………….  Interactions between systemic drug administration and oral and jaw practices 44
    • Oral and Jaw Egyptian Fellowship Board……………………. Clinical microbiology…………………….…………………….  Principles of disinfection and sterilization in maxillofacial practice.…………………….…………………….……………………. Lectures for the rest of the training program:…………………….…………………….  Oral and Jaw cysts (pathology and management)…………………….  Impacted and unerupted teeth/exodontia…………………….  Oro-antral communication and maxillary sinus…………………….  Management of benign and malignant tumors of oro-Maxillo-facial region…………………….  Oral ulceration and white patches…………………….  Oral and jaw Infections  Repair of soft tissue lacerations…………………….  Management of fractures of facial bones…………………….  Oro-facial pain…………………….  Temporomandibular joint (disorders and fractures)…………………….  peri and post-operative care…………………….  Disorders of salivary glands…………………….  Neck swellings…………………….  Facial deformities (congenital and acquired)…………………….  Orthognathic surgery…………………….  Reconstructive surgery (soft and bony tissue)…………………….  Esthetic surgery…………………….  Prosthetic surgery and dental implantology.…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….……………………. 45
    • Oral and Jaw Surgery Egyptian Fellowship Board…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….……………………. 46
    • Oral and Jaw Egyptian Fellowship Board…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….……………………. Oral and Jaw Surgical…………………….……………………. Procedures…………………….……………………. with Levels of…………………….……………………. Competency…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….……………………. 47
    • Oral and Jaw Surgery Egyptian Fellowship Board…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….……………………. 48
    • Oral and Jaw Egyptian Fellowship Board……………………. Level of competency:…………………….  O: observation…………………….  A: Assistance…………………….  Ps: Supervised performance  Pi: Independent performance…………………….…………………….…………………….……………………. 1. History and clinical examination (100 case)…………………….…………………….……………………. 2. Simple and surgical extraction…………………….……………………. Procedure Name O A Ps Pi…………………….…………………….  Simple extraction of maxillary and mandibular teeth 10 30 50…………………….…………………….  Multiple extraction 1 3 10…………………….…………………….  Surgical extraction 5 10 30……………………. Expected year of achievement 1st -5th year…………………….……………………. Expected rotation: oral and jaw surgery.…………………….…………………….…………………….……………………. 3. Endodontic surgery…………………….…………………….……………………. Procedure Name O A Ps Pi…………………….  Apicectomy 5 5 10…………………….…………………….  Apical curettage 1 2 2…………………….  Enucleation/ Marsupialization of cyst 1 2 2…………………….……………………. Expected year of achievement 2nd -3rd year…………………….……………………. Expected rotation: oral and jaw surgery. 49
    • Oral and Jaw Surgery Egyptian Fellowship Board……………………. 4. Salivary gland surgery…………………….…………………….……………………. Procedure Name O A Ps Pi…………………….…………………….  Removal of salivary gland stones and cyst 2 4 4…………………….  Removal of tumors 1 2 2…………………….……………………. Expected year of achievement 2nd -3rd year……………………. Expected rotation: oral and jaw surgery.…………………….…………………….……………………. 5. Surgical management of infection…………………….……………………. Procedure Name O A Ps Pi…………………….  Abscess drainage 2 4 10…………………….…………………….  Facial space 1 1 5…………………….  Others 1 1 3…………………….…………………….  Bone sequestrectomy 1 1 3……………………. Expected year of achievement 1st — 5th year…………………….……………………. Expected rotation: oral and jaw surgery.…………………….…………………….……………………. 6. Maxillary antrum surgery…………………….……………………. Procedure Name O A Ps Pi…………………….…………………….  Caldwell Luc. 1 1 1…………………….  Antrostomy 1 1 1…………………….  Removal of tooth from antrum 1 1 1…………………….…………………….  Closure of antral fistula 2 2 2……………………. Expected year of achievement 2nd -3rd year……………………. Expected rotation: oral and jaw surgery and ENT. 50
    • Oral and Jaw Egyptian Fellowship Board…………………….……………………. 7. Periodontal surgery…………………….……………………. Procedure Name O A Ps Pi…………………….  Gingivectomy 1 2 2…………………….…………………….  Repositioned flap 1 1 1…………………….  Gingivoplasty 1 1 1…………………….  Mucosal graft 1…………………….  Bone regeneration technique 1…………………….……………………. Expected year of achievement 1st -3rd year.……………………. Expected rotation: oral and jaw surgery.…………………….…………………….……………………. 8. Skin surgery…………………….……………………. Procedure Name O A Ps Pi…………………….…………………….  Excision and primary closure 1 1 2 1…………………….  Skin graft 1 1 2 1…………………….  Skin biopsy 1 2 2 5……………………. Expected year of achievement 2nd -5th year…………………….……………………. Expected rotation: oral and jaw surgery.…………………….…………………….……………………. 9. Intraoral soft tissue surgery…………………….…………………….……………………. Procedure Name O A Ps Pi…………………….…………………….  Biopsy 1 2 2 5…………………….  Removal of soft tissue tumor 1 2 2 2…………………….……………………. Expected year of achievement 2nd-5th year……………………. Expected rotation: oral and jaw surgery. 51
    • Oral and Jaw Surgery Egyptian Fellowship Board……………………. 10. Local anesthesia…………………….……………………. Procedure Name O A Ps Pi…………………….…………………….  Infiltration 1 50…………………….  Nerve block 1 50…………………….  Field block 1 10…………………….……………………. Expected year of achievement 1st-5th year……………………. Expected rotation: oral and jaw surgery.…………………….…………………….……………………. 11. Jaw osteotomies…………………….……………………. Procedure Name O A Ps Pi…………………….…………………….  Mandibular osteotomy 2 2 1…………………….  Maxillary osteotomy 1 1 1…………………….  Mandibular distraction 1 1…………………….  Maxillary distraction 1 1…………………….…………………….  Bone graft 2 2……………………. Expected year of achievement 3rd-5th year…………………….……………………. Expected rotation: oral and jaw surgery.…………………….…………………….……………………. 12. Oral, Jaw and Mandibular trauma…………………….……………………. Procedure Name O A Ps Pi…………………….…………………….  Inter-maxillary fixation 2 2 3 10…………………….  Open reduction and rigid fixation 2 2 2 5…………………….  Other means of fixation 2 2 2…………………….……………………. Expected year of achievement 2nd-5th year……………………. Expected rotation: oral and jaw surgery. 52
    • Oral and Jaw Egyptian Fellowship Board……………………. 13. Mid-face trauma…………………….……………………. Procedure Name O A Ps Pi…………………….…………………….  Suspension 2 2 2 4…………………….  Open reduction and rigid fixation 2 2 2 2…………………….  Others 2 2 2 2……………………. Expected year of achievement 3rd-5th year…………………….……………………. Expected rotation: oral and jaw surgery.……………………. 14. Prosthetic surgery…………………….……………………. Procedure Name O A Ps Pi…………………….…………………….  Frenectomy 1 1 1 4…………………….  Vestibuloplasty 2 2 2 2…………………….…………………….  Maxillary tuberosity reduction 2 2 2 2…………………….  Removal of hyperplastic tissue 2 2 2 2…………………….  Removal of bone exostosis 2 2 2 2…………………….  Insertion of dental implants 2 2 2…………………….……………………. Expected year of achievement 3rd-5th year……………………. Expected rotation: oral and jaw surgery.…………………….……………………. 15. Temporomandibular joint procedures…………………….……………………. Procedure Name O A Ps Pi…………………….…………………….  Arthrocentesis 2 2 2…………………….  Dislocation 2 2 2 5…………………….  Subluxation ( Diagnosis) 2 2 2…………………….  Surgical treatment of ankylosis 2 2…………………….…………………….  Management of internal derangement 2 2 2……………………. Expected year of achievement 3rd-5th year……………………. Expected rotation: oral and jaw surgery. 53
    • Oral and Jaw Surgery Egyptian Fellowship Board……………………. 16. Facial surgery…………………….…………………….……………………. Procedure Name O A Ps Pi…………………….  Face lift 1 1…………………….  Revision of scar 3 2 2 2…………………….  Dermabrasion 3 3…………………….……………………. Expected year of achievement 3rd-5th year……………………. Expected rotation: plastic surgery.…………………….…………………….……………………. 17. Facial deformity surgery…………………….……………………. Procedure Name O A Ps Pi…………………….…………………….  Cleft lip 2 2 1…………………….  Cleft palate 2 2 1…………………….  Others 1 1…………………….……………………. Expected year of achievement 2nd -3rd year……………………. Expected rotation: plastic surgery / Oral and Jaw surgery…………………….…………………….……………………. 18. Emergency procedures…………………….…………………….……………………. Procedure Name O A Ps Pi…………………….  Tracheotomy 1 1 1…………………….…………………….  Tracheostomy 1 1…………………….  Control of hemorrhage 1 2 2 5……………………. Expected year of achievement 2nd -3rd year…………………….……………………. Expected rotation: ER and ENT surgery.…………………….……………………. 54
    • Oral and Jaw Egyptian Fellowship Board…………………….……………………. Teaching and learning methods…………………….……………………. The following methods of teaching and learning will be used in the fellowship of……………………. oral and jaw surgery training program:…………………….……………………. - Apprenticeship learning during surgical work (experiential learning):……………………. a) Observation…………………….……………………. b) Assisting……………………. c) Participation……………………. d) Supervised Performance……………………. e) Independent Performance…………………….……………………. - Formal Teaching:……………………. a) Lectures……………………. b) Seminars……………………. c) Clinical ward rounds…………………….……………………. d) Crash courses……………………. e) Workshops……………………. - Self-study:……………………. a) Library…………………….……………………. b) Textbooks……………………. c) Journals……………………. d) Internet……………………. - Meetings and Conferences…………………….……………………. - Supervised Research…………………….…………………….…………………….…………………….…………………….…………………….……………………. 55
    • Oral and Jaw Surgery Egyptian Fellowship Board…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….……………………. 56
    • Oral and Jaw Egyptian Fellowship Board…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….……………………. Methods and Regulations…………………….……………………. of Assessment…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….…………………….……………………. 57
    • Oral and Jaw Surgery Egyptian Fellowship Board…………………….……………………. The general rules and regulations of assessment approved by the Egyptian fellowship……………………. board and published at the training handbook and at the board web site applies for the……………………. oral and jaw surgery specialty. In addition to the successful completion of the training program, all candidates must successfully pass three exams in order to get the fellow-……………………. ship certificate “Fellowship of the Egyptian Board of Oral and Jaw Surgery”.…………………….…………………….……………………. First part Exam…………………….……………………. The first part exam is a written exam. Trainees are allowed to sit for the first part……………………. exam after at least six months of training. Each candidate has three chances to pass……………………. the exam and one more additional chance may be granted in some special circum-……………………. stances approved by the secretary general of the higher committee of medical special-……………………. ties.……………………. It is to be noted that after one year of training each time the candidate choose not…………………….……………………. to enter the exam will be calculated as one of his three attempts.…………………….…………………….……………………. Pre-requisites for entering the first part exam……………………. Trainees should pass the following courses in order to be eligible for……………………. the first part exam……………………. 1. Local TOEFEL with a score of at least 500……………………. 2. Computer courses in word processing, power point and internet…………………….…………………….……………………. Second part exam…………………….……………………. The second part exam is a written exam. Trainees are allowed to sit for the second part……………………. exam after passing successfully the first part and after completion of the five-year……………………. training period. In addition, each candidate must submit his log book for final as-……………………. sessment. The log book requirements must all be completed and signed by the……………………. trainer and educational supervisor. The candidate will also submit his review article……………………. before the final exam. This review article should be approved by the trainer. Each……………………. candidate has three chances to pass the exam and one more additional chance may be granted in special approved circumstances.…………………….……………………. 58
    • Oral and Jaw Egyptian Fellowship Board……………………. The third part exam…………………….……………………. The third part exam is a clinical, practical and oral exam. Candidates who pass suc-……………………. cessfully the second part are allowed to sit for the third part. Again each candidate……………………. has three chances to pass the clinical exam and an additional fourth chance may be……………………. granted in special approved circumstances.…………………….……………………. Holders of the master degree are exempted from the first part exam,……………………. provided that no more than five years have passed since they got their……………………. master degree.…………………….…………………….……………………. The structure of the examination…………………….……………………. The first part exam…………………….……………………. aims to test trainees knowledge in basic science as it applies to the oral and jaw sur-……………………. gery practice (basic sciences mentioned in the curriculum).…………………….……………………. The structure of the first part exam…………………….…………………….……………………. PART I examination consists of two papers: 1. Paper I (2 hours): Multiple choice questions with a single best answer format.……………………. 2. Paper II (2 hours): short answer and /or problem solving questions.…………………….……………………. The Second part exam…………………….……………………. aims to test trainees knowledge, interpretative and patient’s management skills. In……………………. this exam all the curriculum will be covered.…………………….……………………. The structure of the second part exam…………………….……………………. 1. Two MCQ papers each two hours in duration. In both papers, facts, problem……………………. solving, and patient’s management skills are going to be assessed. You will choose one best answer in each question.……………………. 2. Two short assay papers each two hours in duration. They cover all subtopics……………………. listed in the curriculum. Questions will assess Trainees knowledge about various……………………. oral and jaw surgical diseases and their management. 59
    • Oral and Jaw Surgery Egyptian Fellowship Board……………………. The third part exam…………………….……………………. The structure of the third part exam…………………….……………………. It is the final certifying examination in Egyptian fellowship training program in oral……………………. and jaw surgery. Part III exam is a clinical, practical, and oral exam:……………………. Clinical exam……………………. The clinical exam remains the most important part of the examination as the long……………………. case evaluates the potential performance of the candidate in oral and jaw surgery……………………. practice while short cases assess clinical examination and history taking skills in……………………. various problems. Passing this component of the exam independently is essential for……………………. certification.……………………. The date and place of the clinical examination will be announced by the Egyptian……………………. Fellowship Board……………………. 1. Long Clinical Case : the candidate is observed in silence for the first part of the……………………. examination by two examiners where he/she is taking the history from the patient……………………. and performing physical examination and then the examiner asks him to present the……………………. findings in history and examination and discuss his plan of management of the case.……………………. Marks are given according to the predetermined weighting of the components of the exam.……………………. 2. Short Clinical Case: each candidate examines two patients. The examiners……………………. evaluate his ability to correctly elicit and interpret physical signs or his ability to……………………. take focused clinical history. An agreed marking system is used to ensure objectivity……………………. and fairness of the exam.……………………. 3. VIVA (the oral exam): the oral exam will follow the clinical exam and consists……………………. of one station with three examiners, three topics will be covered, one by each exam-……………………. iner, and the whole duration of the oral exam is 20 min.……………………. 4. OSPE (Objective Structured Practical Examination) is a multiple station ex-……………………. amination consists of 15-20 OSPE stations, each station will focus on one of the fol-……………………. lowing topics:…………………….  Radiological interpretation.  Instruments.…………………….  Problem solving and interpretation of investigations.…………………….  Medical ethics.…………………….  Infection control.…………………….  Photos.……………………. Each station will be designed and approved by three examiners. The model an-……………………. swer to each question in these stations will be approved by all examiners.……………………. 60