Oral and Maxillofacial Surgery is a mouthful (no pun intended), but you may have heard of it referred to as OMFS or, more affectionately, Maxfacs. A speciality of the head and neck, you will often hear Maxfacs trainees joke about how their job starts above the clavicle.
My own path started when I heard of these elusive surgeons on a general surgical placement during medical school.
Medical students are unfortunate in that they get little to no exposure to the speciality at university, but I was lucky because during a full ENT clinic (excused with the ever familiar line ‘Sorry there’s no space for a student here’), the nurse walking into the clinic as I was leaving grabbed me before I could sneak off and told me to go the other clinic being held in the same place – the maxillofacial clinic. The consultant in the room was ever welcoming, probably because he had never been given a student before, and beckoned me in.
Since then, I’ve realised that it is a quirk of working in the smallest of small specialities that is one of the most attractive features – everyone knows everyone, everyone is supportive and everyone cares.
Where do I get more experience?
To enjoy a career in OMFS, you will need to provide almost a decade of dedication, and that’s before you even start training in it. Most people who get exposure in the speciality are dentists who have completed their Dental Foundation Training year, worked in practice for a few years, and gone on to do their Dental Core Training (DCT) jobs to get experience in more nuanced dental specialities; there are 13 in the UK total, and OMFS is not included as a dental speciality, rather, a medical one. However, most OMFS Senior House Officer (SHO) jobs are done by Dental Core Trainees (DCTs) who have a placement in Maxfacs. If they choose to pursue a career, they must then undertake a second degree in Medicine, in order to fulfil the person specification mandatory requirement of having both a BDS and MBBS. Luckily for the dental-firsts, they have a larger pool of medical schools to apply for that offer an accelerated 3-year medical programme.
Those (un)lucky medics who manage to get a taste in medical school have an arguably easier time getting into the speciality. They will have completed, at the very least, Foundation Years 1 and 2 (FY1/2), but most tend to have done a year out working as a trust grade OMFS SHO in a unit that allows medic-only doctors to do so – these are fewer than the DCT posts and are non-training posts, unlike the DCT jobs. Some will have done Core Training years 1 and/or 2 before applying to dental school and going that way around. Medics have only one choice currently for an accelerated 3-year dental programme, however, there are many 4 year dental programmes available. There are other roundabout ways to go about things – international graduates who come from an area that doesn’t require a medical degree to become an OMFS specialist, for example, have a different path altogether, but ultimately all who end up working as a training registrar in OMFS in the UK will need both degrees.
So in summary, how long do I spend studying/ at university!?
This all sounds daunting because the astute will have noticed that the minimum time required in undergraduate education is 8 years, and that excludes previous degrees or intercalations. It also does not include the interim postgraduate training one must undertake before speciality training even starts. Then you have the standard surgical training that follows – either CT1/2 onto ST3 and beyond, or ST1 run-through posts. Training lasts a minimum of 5 years. There are avenues for people to skip a year of core training if competencies are met, but this is dependent on the College Tutors and Supervisors and is not always guaranteed.
Then why do the speciality?
Now that I have successfully scared some people off, let me explain why OMFS is a brilliant speciality to work in. Alongside the support you’ll receive, you’ll be looking after patients with extensive medical needs. No one day is the same and indeed, no one department is the same. You will be working with both adults and children with a wide variety of acute pathologies, e.g., trauma, airway emergencies, facial infections, post-surgical complications, etc.
As the SHO, you are the first port of call for your ED and your registrar will be resident, but not necessarily to hand – if you are one of those people who likes to be hands-on and responsible for your own patients, this means you get to do so! Those cases that need surgery are listed by you on the CEPOD (emergency) list for the morning (it is very rare to do Maxfacs cases overnight, but is possible – see Ludwig’s angina for example).
If you are competent, your lists are done by you, but those cases that need a more experienced hand are done together with your registrar – all I have encountered are more than willing to let you do more than just assist. So, if you like to get stuck in, have your own responsibility but be well supported whilst you gain your confidence, this speciality is for you. Not only that, but if you have a keen eye for aesthetics, have good fine motor skills and are reasonably dextrous, OMFS is a good home.
Plus, you will be doing a job where you gain the skills of multiple surgical specialities – microvascular repairs, flap surgeries, bone grafting, and so much more. All of this to help a patient express themselves, speak, smile or even just give them confidence. Maxfacs, in this regard, is unique. Maxfacs is the only specialty that manages both hard and soft tissues giving a wide variety of work.
Additionally, following dental school, you have the ability to locum on weekends and holidays to lessen the financial burden of going back to university to study for your medical degree.
How do I get started?
My biggest piece of advice for you is this. If you are interested, get stuck in. First-degree students need simply to ask their local Maxfacs department if they can shadow or undertake a speciality choice module. If you’re a doctor and are interested, approaching your Educational Supervisor for support on taking a study week or two in the field to get more experience is a good place to start. You may even want to take time to shadow a GDP! And for the dentists reading this, I know of no department that would say no to you.
Usually, the experience comes via your formative years of DCT but I say, there is no time like the present, and if you’re thinking about it, drop a line to the Maxfacs department you usually refer those weird oral medicine cases to.
Once you’ve made the decision, be sure to make a log of your experiences, your publications and poster presentations etc. They will be really important when you’re applying for a registrar training post at either ST1 or ST3 level.
British Association of Oral and Maxillofacial Surgeons (BAOMS) is a must-join – there is a Junior Trainees Group (JTG) on Facebook that is easily searchable (or on Instagram), and joining this allows you more information, insights, a forum to ask questions and some formal training to help you accelerate the process. The JTG also works with your current role and supervisors to facilitate a smooth transition process between the different stages of your learning and training.
So, if you’ve read to the end of this, I presume you’ve probably done some reading already and are interested in this small speciality. I am by no means an expert on the process, going through it myself, but by all means, feel free to reach out and I will try to answer any questions as best I can. If you are dead set on going down this road, then hopefully in a few years, we may cross paths as colleagues. There will be times where it seems tough, especially in your second degree, but no-one I’ve met in senior roles has ever expressed regret in pursuing a career in Oral and Maxillofacial Surgery.
Written by Mr Usama Asif (Second-degree final year dental student)
Reviewed by Dr Janhvi Shah (OMFS SHO)
Edited by Dr Samsul Islam (FY2)
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