What causes trainees to leave oral and maxillofacial surgery? A questionnaire survey

United Kingdom oral and maxillofacial surgeons support changes to current specialty recruitment process, which could include 'Walport' style local selection and national benchmarking

Recruitment to oral and maxillofacial Surgical (OMFS) specialty training was centralised in 2010. The 'flexibility' for OMFS to respond to specialty specific recruitment issues is reducing and many Specialty Trainees' (ST) posts are left unfilled. The National Institute for Health and Care Research (NIHR) appointment process designed to address the problem of recruiting and appointing academic surgeons with local selection with national benchmarking has worked. Using a database of all UK OMFS consultants/trainees, an electronic questionnaire was shared by e-mail, WhatsApp, and other social media. Of 306 replies, 125 (41%) were Consultants/post-certificate of completion training (CCT) individuals, 66 (22%) ST, 61 (20%) second degree students, 27 (9%) pre-second degree, 26 (9%) dual degree pre-ST trainees, and one did not indicate their status. A total of 249 (76%) studied dentistry first and 230 (75%) were male. Of those replying, 147 (48%) had no direct experience of national selection. 120 (39%) had experience as a candidate, 20 (7%) as a selector only, 17 (6%) as a candidate and selector, and two did not record their experience. Of 250 expressing an opinion, 156 (62%) supported local selection with 140 (56%) supporting local selection and national benchmarking, which is a process used for research training posts by the NIHR. Geographical continuity was most important for 78% of pre-second-degree trainees, 45% of STs, and 54% of second-degree students. A total of 57 respondents completed free text comments. There is support for changes in OMFS ST selection including creating OMFS posts which include Foundation and second-degree training in NIHR style locally recruited nationally benchmarked posts.

Can we support second degree students by incorporating non-surgical facial aesthetics into undergraduate dentistry during the first degree?

Non-surgical facial aesthetics (NSFA) are cosmetic procedures intended to reduce signs of ageing and provide facial rejuvenation. There is currently no recommendation for NSFA to be included in the undergraduate dental curriculum globally. This study aims to gain the views of final year dental students about pursuing a career in NSFA. An online survey was completed by 114 final year dental students across two English Universities. A total of 67% (77/114) of students would pursue a career in NSFA. A total of 76% (87/114) and 75% (86/114) of students were not aware of the complications associated with the administration of dermal fillers and Botox injections, respectively. Most students considered NSFA upon graduation. NSFA provides a transferable skillset and useful anatomical knowledge. Incorporation of NSFA in undergraduate education could financially support oral and maxillofacial surgery (OMFS) trainees within their second degree. This may in turn promote retention within the speciality with high financial costs associated with OMFS training.

Working whilst studying: a survey of medically qualified dental students

Medically-qualified junior trainees who are interested in oral and maxillofacial surgery (OMFS) are faced with the challenging decision to undertake the minimum three years required to obtain a Bachelor of Dental Surgery (BDS) with its associated expenses and loss of income from full-time employment, or to follow a different career path. Trainees have reported duration of training and financial factors, such as cost of attaining additional qualifications and loss of income, as common reasons for loss of interest in OMFS. This survey of students enrolled on King's College London's three-year BDS dentistry entry programme for medical graduates (DPMG)shows that most studentsundertake paid part-time work in various settings and specialties alongside their studies. The average number of hours worked by students whilst studying is reported to be 27.0/week. Students report a wide range of incomes from various sources including secondary-care shifts in the NHS and private sector, as well as non-secondary-care activities such as non-surgical facial aesthetics. Direct correlation is noted between the number of hours worked and earnings, with comparable potential income in OMFS and non-OMFS specialties. Participants working in OMFS report greater educational and training value compared with non-OMFS work.

What are the concerns of second-degree medical students entering specialty OMFS training?

Oral and maxillofacial surgery (OMFS) applicants are faced with numerous challenges. Previous research has demonstrated that financial burden, length of OMFS training, and impact on personal life are cited as major drawbacks to pursuing the specialty, with trainees having concerns about the Membership of the Royal College of Surgeons (MRCS) examinations. The current study aimed to explore second-degree medical students' concerns about obtaining a specialty training post in OMFS. An online survey was distributed via social media to second-degree students across the United Kingdom and 106 responses were received. A lack of publications and lack of involvement in research (54%) as well as attaining accreditation with the Royal College of Surgeons (27%) were cited as the primary and secondary concerns in relation to securing a higher training post. Seventy-five per cent of respondents had no first-author publications, 93% expressed concerns about passing the MRCS examination, and 73% had more than 40 OMFS procedures within their logbook. Second-degree medical students reported having ample clinical and operative experience in OMFS. Their main concerns were about research and MRCS examinations. To alleviate these concerns, BAOMS could provide educational initiatives and dedicated mentorship programmes for second-degree students, and could adopt a collaborative approach with discussion with major postgraduate training stakeholders.

Three changes to reduce the loss of dual degree trainees from OMFS national specialty selection in the UK: evidence based proposals

The training pathway for oral and maxillofacial surgery (OMFS) has remained relatively stable for around 30 years. Circumstances surrounding the training pathway have changed including the priorities of individuals considering entering OMFS training. Run-through Specialty Training (ST1) OMFS posts (which include core surgical training) are oversubscribed while direct entry to Specialty Training (ST3) OMFS specialty recruitment rounds have unfilled posts, including places declined by appointable candidates. As part of a project to refine and improve OMFS recruitment and retention, data drawn from the British Association of Oral and Maxillofacial Surgeons (BAOMS) and the OMFS National Selection administering Deanery, Health Education England South West were scrutinised. Numbers of students starting second undergraduate degrees (medicine or dentistry) to pursue an OMFS career are increasing. Of a total of 43 candidates deemed appointable at OMFS ST1 selection but not offered an available post, 16 did not subsequently apply for ST3 selection. In the period studied (2015-20), of a total of 116 unfilled ST3 posts, 39 remained vacant because appointable candidates declined the available posts (33%). Appropriate changes to the current national selection processes could help address the perceived OMFS ST recruitment problems. By increasing the number of available ST1 posts, widening the window during which appointable candidates can continue into training and increasing prior experience recognition (including creating benchmarking processes prior to ST). These 3 clear, fair and transparent changes could reduce the current levels of attrition.

Burnout and work-life balance in neurosurgery: Current state and opportunities

Background:

Burnout is a syndrome characterized by emotional exhaustion, depersonalization, and reduced sense of personal accomplishment. The syndrome has been recognized as a pandemic among physicians. The demanding nature of neurosurgery makes neurosurgeons, particularly prone to burnout. In recent years, pioneering work has shed light on burnout in the field of neurosurgery.

Methods:

We have reviewed the literature in PUBMED on burnout in physicians, focusing on neurosurgical publications.

Results:

In this manuscript, we explore the topic of burnout in neurosurgery by reviewing definitions, magnitude, etiologies, sequelae, and mitigation strategies.

Conclusion:

Ongoing education, recognition, and targeted interventions for neurosurgeons at different career stages are needed to manage burnout proactively and ensure a resilient neurosurgery workforce.

The UK Mentoring and Support Programme (MSP) for those considering a career in Oral and Maxillofacial Surgery (OMFS). A review of a 'Register Interest in OMFS' website and the MSP as two key resources created by the British Association of Oral and Maxillofacial Surgeons to promote recruitment and retention (2008-2020)

In 2008, to create a rapid route for information transfer in relation training and recruitment for OMFS trainees, the British Association of Oral and Maxillofacial Surgeons (BAOMS) created a website to "Register Your Interest in OMFS" (RYIO). From 2011 a Mentoring and Support Programme (MSP) was created to provide focussed guidance for trainees aiming for specialty training. This paper reviews the effectiveness and cost of these programmes. Between 2008 and 2020, 1744 individuals used RYIO on 2715 occasions. Of these registrations, 1772 were by dentists, 193 dental students, 589 doctors and 161 medical students. 2354 were from UK and Ireland and 351 from the rest of the world. 188 registrants subsequently became UK OMFS trainees or specialists. All registrants valued the information provided. In response to RYIO trainee feedback the new 'Taste of OMFS 2020' programme was created. The MSP was originally called the Junior Trainee Programme (JTP). The MSP scheme provides a layer of mentorship/support which runs parallel to the medical/dental training post or period of study. Of 180 members of MSP, 72 have obtained specialty training posts in OMFS. There are 88 current members. Full information is available on the BAOMS website www.baoms.org.uk. Reviewing both programmes, participant feedback is excellent with tangible results whilst cost effectiveness is high.

Oral and Maxillofacial Surgery - the future is in our collective hands. Re: Editorial: Our specialty, our future, is the writing on the wall?

We offer a response to the Editorial 'Our Specialty, Our Future, Is the Writing on the Wall?' by Newman et al¹ and suggest opportunities to support recruitment, retention and education in Oral and Maxillofacial Surgery.

Dental and medical dual qualification in Oral and Maxillofacial Surgery: a global identity

The argument of whether or not Oral and Maxillofacial Surgery (OMFS) should have both dental and medical core education in the training pathway remains an issue of debate and contention to date. The mid-90s witnessed a gradual trend internationally towards a dual qualification which has slowed down or come to a standstill the last 10 years. This has been more evident in rapidly growing nations in the Middle East/North Africa and Asian subcontinent regions. The maxillofacial identity of a dual degree is being questioned in OMFS-pioneering countries, such as the United Kingdom (UK), which has played a role in the domination of the single degree pathway globally. In this mini review, we will attempt to shed light on the aforementioned regions and put forward a more global role the UK can play in standardising education and training while addressing the cost burden of the dual qualification pathway.

Does the current oral and maxillofacial surgery training pathway disadvantage female trainees?

Women make up a minority of OMFS consultants and trainees. The long training pathway has been highlighted as a barrier for prospective applicants. Maternity leave and less than full-time training extend time in training. Efforts to streamline and shorten the training pathway will help ensure the diversity and inclusivity of OMFS.

Social factors as career obstacles for female oral and maxillofacial surgeons in three Middle Eastern countries

Despite the feminization of dentistry in many areas of the world, female representation in the field of oral and maxillofacial surgery (OMFS) is poor. The purpose of this study was to identify factors perceived by female oral and maxillofacial surgeons in Egypt, Jordan, and Saudi Arabia as being obstacles to their career progression and to compare them to factors identified by their male colleagues. This was a cross-sectional questionnaire-based study. A Google Forms questionnaire was designed to collect data on socio-demographics and perceived career obstacles in OMFS. This was distributed to oral and maxillofacial surgeons in Egypt, Jordan, and Saudi Arabia. Statistically significant differences between the genders were evident in terms of marital status (P=0.001), spouse's education (P=0.005), and spouse's occupation (P<0.001). When compared to male surgeons, female surgeons more often considered that their spouse's occupation hindered their career progression (P<0.001). Female surgeons, but not male surgeons, perceived sexism and social factors such as marriage, children, and the attitudes of society to be major career obstacles (P<0.005). In conclusion, female maxillofacial surgeons in some Middle Eastern countries were found to have different socio-demographic characteristics compared to their male colleagues and they considered sexism, marriage, children, and the attitudes of society to be major career obstacles.

Six weeks' notice of the on-call roster: fact or fantasy? An audit study

INTRODUCTION:

Work-life balance is directly linked to morale, job satisfaction and staff retention - all of which are linked to high quality patient care. Receiving the duty roster in advance is the first step towards achieving any work-life balance, but anecdotally doctors frequently receive very little notice of this. This audit assessed NHS trusts' compliance with the Code of Practice, with specific reference to advance notification of duty rosters.

METHOD:

The duty roster should be made available 6 weeks before commencement of post. The initial audit comprised a survey sent to all London surgical CT1s starting in October 2016. The interventions introduced following this were creation of a shared spreadsheet containing roster coordinator contact details, reminder emails sent to roster coordinators and distribution of results to NHS Improvement. A repeat survey was sent to all London surgical CT1s and CT2s starting in October 2017.

RESULTS:

In the initial audit 48/88 (55%) responded, of whom 4/48 (8%) received their duty roster in accordance with the standard and 9/48 (19%) did not receive the roster at all before starting. A total of 40/48 (83%) of trainees had to make specific contact with their future NHS trust in order to obtain their roster. In this initial audit 12/48 (25%) of trainees were satisfied or very satisfied with the amount of notice given. In the reaudit 133/178 (75%) responded, of whom 23/133 (17%) had received their roster in accordance with the standard and 25/133 (19%) did not receive the roster at all before starting. A total of 97/133 (73%) of trainees had to make specific contact with their future NHS trust in order to obtain their roster. In the reaudit 56/133 (42%) of trainees were satisfied or very satisfied with the amount of notice given.

CONCLUSIONS:

This closed loop audit led to a doubling in the proportion of trainees receiving their rosters in accordance with the standard, and this was associated with an increase in trainee satisfaction levels. However, adherence to the standard remained low in both phases of the audit, and a significant proportion of trainees continue to commence jobs without any knowledge of their on-call roster. A range of measures is proposed to address this.