곳에 올린 글은 지극히 주관적이고 약간 무례할 수 있는 내용이 있을 수 있습니다.. 혹시나 문제의 소지가 있으면 언제든 토론할
용의가 있으니 문제 있다고 생각되시면 메일바랍니다.
| 만약 9개의 외과분과속에 구강악안면외과가 들어가게 된다면 |
서구의 사고 방식과 우리나라의 사고 방식은 다를까??
만약 9개의 외과분과속에 구강악안면외과가 들어가게 된다면 한국에선
어떤 현상들이 생길까..
현 한국의 현실에서 dual qualification이 가능할까..
British Medical Journal 에서 발췌...
This is a Career Focus article about oral and maxillofacial surgery
in the April 2000 issue of the BMJ:
Oral and maxillofacial surgery
It's a long road to fully-fledged practice for these doubly-qualified surgeons. Shakeel Akhtar and Christopher Lloyd outline the route:
Oral and maxillofacial surgery is a relatively young specialty in its current form and is the newest of the nine surgical specialties recognised by the Senate of Surgery of Great Britain and Ireland. Practitioners must be both dentally and medically qualified and be on both registers. As with all other surgical specialties, a basic surgical background before entering higher surgical training is required. This long training pathway has created a cohort of extremely experienced surgeons in all aspects of head and neck surgery.
Oral and maxillofacial surgery provides 'a comprehensive diagnostic and surgical service for acquired and congenital disabilities affecting the mouth, jaws and face and spill over into surrounding tissue.` Much of the routine workload in the specialty relates to the management of pathology of the orofacial structures (including salivary glands), and the management of facial trauma (hard and soft tissue) is a core component of the speciality. In addition, about 80%of oral cancer is managed by oral and maxillofacial surgeons. Such surgeons are in a unique position, by virtue of their dual qualification, to manage all aspects of orofacial reconstruction (both soft and hard tissue). The treatment of congenital abnormalities (including cleft lip and palate and craniofacial surgery) is a major subspecialty interest in many regional and subregional units.
Historically, oral and maxillofacial surgeons were singly qualified. With the development of the specialty, it became obvious that training programmes would have to evolve to match these changes. The natural development was the progression to doubly qualified surgeons, as exist today.
The satisfaction that the specialty offers is related to the unique position of the dual qualification. Oral and maxillofacial surgeons are in a position to provide a comprehensive, anatomically based, specialist service that had not existed previously. They can provide a service that had previously been fragmented and provided by a variety of other specialties (ear, nose, and throat; general surgery; and plastic surgery). This development in the specialty has been line with changes that are becoming evident in the NHS (such as cancer services). The dual qualification has produced surgeons with the training to provide a comprehensive and unparalleled ability to reconstruct both hard and soft facial tissues. The wide ranging nature of the specialty can offer something to surgeons with different subspecialist interests and yet provide a common goal of maintaining function and aesthetics.
Most house officer and senior house officer posts in oral and maxillofacial surgery are suitable for dentally qualified staff. A few senior house officer posts are now being advertised for medically qualified practitioners. A variable period is spent in hospital posts completing either the fellowship in dental surgery (FDS) or the membership in the faculty of dental surgery (MFDS) before application to medical school. Competition for medical school places for dental graduates is intense.
Most trainees have a primary qualification in dentistry, although a few have a primary medical qualification. Most dental graduates have to complete the full medical undergraduate course. It is recognised that there is often considerable overlap in the preclinical aspects of the two courses, and some medical schools offer shortened courses (three to four years). A list of medical schools' differing requirements is available on the website of the British Association of Oral and Maxillofacial Surgeons (BAOMS). Very few trainees receive any financial support during medical school and most have to fund this by doing locum work or run up large overdrafts. Students are, however, eligible to apply for student loans in the same way as other students. A high level of motivation is required for individuals to contemplate a second undergraduate course, especially in view of the dearth of financial support. Although most dentists undertaking medical courses intend to do oral and maxillofacial surgery, longitudinal studies have shown a 'dropout` rate (to the specialty) of about 50%mainly due to trainees undertaking training in other surgical specialties. Completion of preregistration house jobs and a period of one to three years in basic surgical training are required to fulfil the current requirement for fellowship or membership of the Royal College of Surgeons (FRCS or MRCS). The motivation to learn, coupled with the maturity of having completed two undergraduate courses, has made these graduates very competitive in the job market.
Higher surgical training
Higher surgical training in oral and maxillofacial surgery takes five years. Some trainees undertake an additional year in a fellowship programme (such as craniofacial surgery). There are currently about 110 specialist registrars in oral and maxillofacial surgery (89 specialist registrars, 9 fixed term training appointments (FTTAs), 6 training locum appointments (LATs), and 6 trainees currently out of programmes), with a further eight in academic (AACOMS) posts. All trainees are required to have the FRCS (or MRCS) within 12 months of starting a specialist registrar post (most trainees take the exam before entry to specialist registrar posts). Training is supervised by the Specialist Training Authority on a regional basis, with a satisfactory annual review being required to allow progression to the next stage.
Most training posts involve rotation throughout several hospitals in a region. This can involve either several periods of domestic upheaval or commuting considerable distances. Trainees in oral and maxillofacial surgery tend to be older than other medical trainees, by virtue of the two undergraduate degrees undertaken, and many have children of school age, creating some degree of domestic conflict. Much of oral and maxillofacial surgery is provided in district general hospitals, which provide good training in most aspects of the specialty. More specialised aspects (such as craniofacial surgery) are available at regional and subregional centres, which form a part of most rotations. Although a formal period of research is not mandatory, many trainees undertake research during the periods spent at academic centres on the rotation. On call commitments are usually less than 1 in 4 in most units, but there are still many units where a 1 in 3 duty is still operating with the agreement of individual trainees. A five year period in specialist training is followed by the intercollegiate FRCSOMFS. This is usually completed in the penultimate year of training. Many trainees spend three to six months overseas on either a formal rotation or fellowship programmes. A typical training period before appointment as a consultant oral and maxillofacial surgeon is 17 years. Despite this level of training, however, oral and maxillofacial surgeons are often, rather disappointingly, referred to as 'hospital dentists.`
A parallel training in academic oral and maxillofacial surgery exists. Trainees can embark on the training as discussed above (with a separate period of research and a research degree, a PhD or MD, during higher surgical training) or, more commonly, can enter specialist training without medicine but with a PhD. Training leads to an academic appointment with honorary consultant status.
Dentoalveolar surgery forms much of the routine workload in the specialty.
Congenital disordersCraniofacial and cleft surgery is undertaken in several centres.
Orthognathic surgery is available in most district general hospitals.
Orofacial oncology and reconstructionThe ablation and reconstruction of both soft and hard tissues of the orofacial region (with special regard to functional and aesthetic reconstruction) is increasingly undertaken by oral and maxillofacial surgeons. Many oral and maxillofacial surgery units also offer a comprehensive service for the management of dermatological malignancy of the head and neck.
Salivary gland disordersBoth surgical and non-surgical management of salivary gland disease are an integral part of the specialty.
Aesthetic facial surgeryWith the need for rehabilitation of patients with both trauma and orofacial malignancy, the demand for aesthetic surgery is expected to increase greatly.
Oral medicine covers the management of diseases of the oral mucosa and its supporting structures.
Management of disorders of the temporomandibular joint.
Thyroid gland surgery is undertaken in some centres.
There is a relative lack of consultants in oral and maxillofacial surgery. Despite the plan for a 2%expansion of consultant numbers, this has not materialised. Most consultant posts now involve work at more than one site and with more than one hospital trust, creating administrative and management problems. The career prospects for oral and maxillofacial surgery trainees depend to some extent on their individual subspecialist interests.
In 1997 it was estimated that there were about 150 dental graduates undertaking undergraduate courses in medicine. Most longitudinal studies of these groups suggest that there is a 'natural wastage` of about 50%Assuming an average course length of four years, there should be 20 new trainees ready each year. Current trends show around 15-20 consultant vacancies a year. Therefore, despite the lack of consultant expansion in the specialty, the ratio of trainees to consultants seems to be a well matched. If the number of consultants taking early retirement increases, as is the case with most other specialties, then there will be a shortfall in the number of trainees. Job prospects over the next five years look promising, but in the longer term they are a little unclear because of a planned reduction in the number of specialist registrar posts. Further centralisation of major oral and maxillofacial surgery may see the development of fewer but substantially larger centres. These changes have potential implications for training in the specialty.
consultant oral and maxillofacial surgeon, Victoria Hospital (Blackpool) and Royal Preston Hospital, Preston PR2 4QF, firstname.lastname@example.org
Christopher J Lloyd
specialist registrar in oral and maxillofacial surgery, Glan Clwyd Hospital, Bodelwyddan Rhyl, Clwyd LL18 5UJ, email@example.com
BMJ 2000;320:S2-7242 ( 22 April )