British Journal of Oral and Maxillofacial Surgery 51 (2013) e155e164

Available online at www.sciencedirect.com

Dental foundation year 2 training in oral and maxillofacial
surgery units the trainees perspective
T. Wildan
a,
, J. Amin
b
, D. Bowe
b
, B. Gerber
a
, N.R. Saeed
c
a
Specialist Trainee, Oral and Maxillofacial Unit, The John Radcliffe Hospital, Headington, Oxford OX3 9DU, United Kingdom
b
Dental Foundation Year 2 Trainee, Oral and Maxillofacial Unit, The John Radcliffe Hospital, Headington, Oxford OX3 9DU, United Kingdom
c
Consultant, Oral and Maxillofacial Unit, The John Radcliffe Hospital, Headington, Oxford OX3 9DU, United Kingdom
Accepted 5 June 2012
Available online 11 July 2012
Abstract
Most dental foundation year 2 (DF2) training takes place in oral and maxillofacial surgery (OMFS) units. We did a survey of DF2 trainees in
these units by telephone interviews and an online questionnaire to nd out about their experience of training and their career aspirations. A
total of 123 responded, which is roughly 41% of the total estimated number of trainees. Trainees applied for these posts mainly to improve
their dentoalveolar skills (50%), and this was cited as the best aspect of the training. Most (81%) were on-call at night and this was generally
thought to be a valuable training experience (77%), but 20% thought that it was the worst aspect of the job. Most did not regret taking up the
post although the experience had caused 75% to alter their intentions about their future career; general dental practice was the commonest
choice. In conclusion, trainees are generally satised with their training and these positions have guided their choices about future careers.
2012 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Keywords: Dental foundation training; Trainees; Oral and maxillofacial surgery units
Introduction
Historically, those holding junior posts in oral and maxillo-
facial surgery (OMFS) units were designated as senior house
ofcers (SHOs) and they were recruited from UK and over-
seas dental graduates who were keen either to pursue a career
in OMFS or to acquire the necessary postgraduate degree
for specialisation.
1
With the changes in postgraduate med-
ical and dental training these positions have become dental
foundation 2 (DF2) posts. They are approved by the Fac-
ulty of Dental Surgery of the Royal College of Surgeons of
England and are recommended by the Hospital Recognition
Committee.
2
Nationally, most DF2 posts are based in OMFS
units, which is similar to the previous system, but trainees no
longer consist only of those interested purely in a career in
OMFS or in specialisation.
1

Corresponding author. Tel.: +44 7737 33 5579; fax: +44 01604 54 4579.
E-mail address: drtwildan@gmail.com (T. Wildan).
The primary aim of this survey was to ascertain the rea-
sons why dental graduates had applied for DF2 posts and
whether their expectations were being met. We also asked
if they thought that the experience would benet their future
careers. Finally, we wanted to establish whether DF2 trainees
thought that they were given adequate support to manage
OMFS patients with complex problems.
Method
We identied DF2 trainees by contacting OMFS units
throughout the country using the British Association of
Oral and Maxillofacial Surgeons register, which we cross-
referenced with the postgraduate dental deaneries. Trainees
were invited to respond to 33 questions using an online sur-
vey (Kwik Surveys).
3
Questionnaires were sent directly by
email or were sent to secretaries at OMFS units to distribute
to the trainees. To further increase the response rate, we
contacted trainees individually by phoning their respective
0266-4356/$ see front matter 2012 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.bjoms.2012.06.001
e156 T. Wildan et al. / British Journal of Oral and Maxillofacial Surgery 51 (2013) e155e164
Table 1
Number (%) of responses to the question: why did you undertake this max-
illofacial job? (n =123).
No. (%)
To improve skills in oral surgery 61 (50)
Interested in maxillofacial career 29 (24)
To specialise in future 24 (20)
Other 5 (4)
Did not want to go into practice 2 (2)
Not sure 2 (2)
OMFS units, and completed the online questionnaire on their
behalf. The questionnaire consisted of a mixture of open and
closed questions and was initially piloted among OMFS DF2
trainees in the Oxford deanery (Appendix 1). Responses were
anonymous. A one sample and two sample t-tests between
proportions were used as statistical analysis to determine
signicant difference between the groups.
Results
The total number of DF2 trainees throughout the country
is estimated to be 303. Responses were obtained from 123
giving a rate of 41%. The sex distribution was almost equal
with 63 (51%) men and 60 (49%) women. The reasons given
for wanting to train are shown in Table 1. A one-sample t
test between proportions showed a signicant difference for
respondents who chose to improve their skills in dentoalveo-
lar surgery above that of a career in OMFS (p < 0.001).
Most DF2 trainees do ward rounds (n = 117, 95%) and
most (n = 100, 81%) are also on call at night. Most felt that
they were well supported during nights on call (n = 87, 71%),
and 77% considered that being on-call at night was a valuable
training experience (p < 0.001).
Table 2 shows the aspects of training that were most pop-
ular, and Table 3 shows those that were least enjoyable. Of
note, nearly half the trainees considered that their experi-
ence of dentoalveolar surgery was not adequate (n = 48, 39%)
(p < 0.05).
Trainees commented that dedicated teaching sessions var-
ied in quality and availability, and nearly half (n = 52, 43%)
had less than half an hour/week. However, almost a third
(n = 37, 31%) thought that they were valuable. Registrars
Table 2
Number of responses to the question: which aspect of oral and maxillofacial
surgery have you enjoyed the most?
No. (%)
Dentoalveolar surgery 80 (65)
Facial trauma 20 (16)
Deformity (orthognathic surgery and cleft surgery) 9 (7)
Head and neck cancer 8 (7)
Oral medicine 2 (2)
Facial pain/TMJ 3 (2)
Salivary gland 1 (1)
Table 3
Number (%) of responses to question: which aspect of oral and maxillofacial
surgery have you least enjoyed?
No. (%)
Facial pain/TMJ 62 (50)
Head and neck cancer 26 (21)
Deformity (orthognathic surgery and cleft surgery) 13 (11)
Salivary gland 10 (8)
Dentoalveolar surgery 8 (7)
Oral medicine 3 (2)
Facial trauma 1 (1)
Table 4
Number (%) of responses to the question: what has been the best part of this
job? (n =123).
No. (%)
Improving skills in dentoalveolar surgery 54 (44)
Increased condence to manage patients with
medical conditions
38 (31)
Experience of working in a multidisciplinary
team
18 (15)
Experience in practical skills such as
cannulation and venepuncture
8 (7)
Other 5 (4)
Table 5
Number (%) of responses to question: what has been the worst part of this
job? (n =123).
No. (%)
Lack of medical knowledge 38 (31)
Being on call at night 25 (20)
Doing ward duties 24 (20)
Other 14 (11)
Being on call during the day 11 (9)
Lack of support 7 (6)
Not relevant to future career 4 (3)
taught most of the sessions (63%), and the best learning
opportunities were gained in the operating theatre (53%).
The aspects of training considered best are shown in
Table 4 and those considered to be the worst are shown
in Table 5. Most (n = 101, 82%) thought that the training
met their expectations and they did not regret taking up
the post (p < 0.0001). Three-quarters acknowledged that the
experience had caused them to change their intentions about
Table 6
Number (%) of responses by sex to the question: what is your future career
plan? (n =123).
Total no. (%) Male Female
General dental practice 27 (22) 12 17
Oral surgery 24 (20) 15 9
Oral and maxillofacial surgery 19 (15) 16 3
Orthodontics 19 (15) 6 13
Other 18 (15)
Paediatric dentistry 6 (5)
Salaried service 4 (3)
Prosthodontist 3 (2)
Periodontist 3 (2)
T. Wildan et al. / British Journal of Oral and Maxillofacial Surgery 51 (2013) e155e164 e157
their career (Table 6). Male respondents inclined towards a
career in oral surgery (p = 0.22) and OMFS (p < 0.05) and
female respondents inclined towards general dental practice
(p = 0.228) and orthodontics (p = 0.065).
Discussion
As the initial response rate was low we doubled it by contac-
ting the trainees directly by telephone and lling in the online
questionnaire on their behalf. This non-standardised method
introduced bias from the outset, as it did not allow us to iden-
tify duplication errors and inclusion of a different group. As
we limited the study to DF2 trainees in OMFS units, it is not
representative of the whole population of DF2 trainees.
Although the response rate was lower than anticipated,
we think that some important points have been made, and the
survey gives some insight into the perceptions and expecta-
tions of trainees about their posts. This could help to balance
service commitment and training when training programmes
are planned. Although the primary motivation for taking up
these posts was not to pursue a career in OMFS, trainees still
considered them to be of value. Previous studies have shown
that trainees are often undecided about their future careers
at this time,
4,5
and motivational factors are often linked to
professional development. Being taught by experienced cli-
nicians, developing clinical skills, and gaining the condence
to manage patients are common reasons for seeking these
posts.
1
DF2 posts are partly funded by the dental deanery (50% in
England and Wales, 100% in Scotland) and are designed to
provide postgraduate training for dental graduates. As they
are mainly in OMFS units they attract not only dental gradua-
tes who wish to pursue a career in OMFS, but also those who
wish to pursue a variety of other dental specialties. How-
ever, seeking admission to a specialist list or fullling the
requirements for a postgraduate examination do not inu-
ence trainees applications,
1
and the main reason given in
this survey for taking on a DF2 post in OMFS was to improve
skills in dentoalveolar surgery. Less than a fth of trainees
mentioned interest in a future specialist career.
The nding that dentoalveolar surgery and improving
skills in this area were the most useful and enjoyable aspects
of the training is consistent with a study that reported that
vocational dental practitioners and their trainers felt least
prepared for surgical exodontia from dental undergraduate
training.
6
OMFS units may need to consider this aspect of
training to make DF2 posts appeal to prospective applicants.
Almost half the respondents felt that the post did not give
themadequate dentoalveolar experience therefore a substan-
tial amount of exposure to supervised dentoalveolar surgery
should be incorporated in the rotation. COPDEND (Commit-
tee of Postgraduate Dental Deans and Directors) suggested
that all posts should include at least one session in minor oral
surgery, and a session with a designated trainer operating on
a patient who is under general anaesthetic.
2
Many DF2 trainees reported that the worst aspect of their
experience was their lack of medical knowledge, and that
being on-call at night was the second. These factors might
be inter-related as being the rst on call at night without sup-
port could potentially expose a lack of medical knowledge.
However, over three-quarters felt that they had support at
night and found the experience valuable. Suggested timeta-
bles could be modied so that trainees do not need to cover
the whole night when work is less intense and there are
fewer opportunities for training. Arrangements for the night
could include Hospital at Night cover or cover with other
related surgical specialties. With the introduction of the Euro-
pean Working Time Directive (EWTD), there has been a
trend to reduce night time activity for all doctors,
7
but in
a recent survey nearly half the OMFS senior house ofcers
still do a week of consecutive nights which is against EWTD
directives.
4
The joint statement agreed between the council of the
British Association of OMFS (BAOMS) and COPDEND in
April 2010 suggested the development of emergency services
that do not rely on foundation trainees being on call through-
out the night.
8
It advised that being on call should not include
the period between 10 pm and 8 am as supervised exposure
to emergency care is generally not provided.
Trainees can improve their medical knowledge by attend-
ing relevant courses such as Dentists on the Ward before
taking up a post, and already there has been an increase in
attendance at these courses by trainees.
4
Other ideas include
a period of shadowing where prospective trainees follow their
predecessors before they start the job; it is a common practice
in the programme for medical foundation training.
Regular dedicated teaching sessions can also help to edu-
cate trainees about the management of patients, conditions,
and academic theory. We found that dedicated teaching ses-
sions were considered to be valuable and OMFS units might
need to focus on this in their postgraduate dental training.
Feeling out of depth and lacking in condence correlated with
a lack of dedicated teaching sessions.
5
Anxiety about a lack
of medical knowledge could be allayed if medically qualied
foundation doctors or core surgical trainees were included in
the OMFS team. As the workload in OMFS includes patients
with complex problems, it is reasonable to ask whether DF2
trainees can manage tasks without adequate supervision or
medical help close at hand. If DF2 trainees work with med-
ically qualied foundation trainees or core surgical trainees
it could benet each group.
It can be postulated that a number of trainees changed their
minds about a career in OMFS during the post because there
was a mismatch in the number who initially cited that this
motivated them to obtain the post and those who wished to
pursue OMFS as a career when it ended.
Many trainees wished to return to general dental practice.
This might be because they realised how demanding aspects
of OMFS surgery can be or because of other issues such as
the increase in university fees for a second degree, or the
introduction of a career in oral surgery.
9
e158 T. Wildan et al. / British Journal of Oral and Maxillofacial Surgery 51 (2013) e155e164
Notably, COPDEND commented that foundation train-
ing within OMFS departments is benecial irrespective of
the career ultimately chosen by dental graduates, and that
training within OMFS departments should aim to increase
the condence of new dental graduates.
Conclusion
Overall, DF2 trainees are satised with their training in
OMFS even though most do not wish to pursue a career
in the specialty. However, with increasingly complex cases
it would be benecial to ask DF2 trainers whether they
think that the present arrangements might compromise the
medical care of their patients. Does this lead on to ask whether
medically qualied personnel such as junior doctors should
be included in the OMFS team?
We think that it would be good to nd out the answer.
Limited conclusions can be made from this survey as we
had a low response rate, and our ndings cannot be gener-
alisedto whole DF2 trainee population as those in other dental
specialties could reect a different perspective. However, it
does highlight some important aspects for future workforce
planning.
Appendix A. Questionnaire
Queson 1
What is your Gender? M F
Queson 2
What is your age?
Queson 3
Which maxillofacial unit do you currently work in? Please state your base hospital.
Queson 4
Why did you undertake this maxillofacial job?
To improve oral surgery skills
To specialise in the future
Did not want to go into pracce
Interested in maxillofacial career
Unsure
Other
Queson 5
Did you shadow anyone in maxillofacial surgery before undertaking this post?
Yes No
Queson 6
If yes, do you feel that shadowing before this post gave you a beer understanding of what was
expected?
T. Wildan et al. / British Journal of Oral and Maxillofacial Surgery 51 (2013) e155e164 e159
Yes No
Queson 7
Have you undertaken any previous hospital or community posts?
Yes No
Queson 8
How long is your post for?
How long is your post for?
Less than 6 months
6 months-12 months
More than 12 months
Queson 9
Was a trust inducon organised?
Yes No
Queson 10
Was a departmental inducon organised?
Yes No
Queson 11
Was it Helpful?
Yes No
Queson 12
Did you receive any handbooks from the department?
e160 T. Wildan et al. / British Journal of Oral and Maxillofacial Surgery 51 (2013) e155e164
Yes No
Queson 13
Has the handbook been helpful for your daily dues?
Yes No
Queson 14
Do you undertake ward rounds with registrars/consultants?
Yes No
Queson 15
Do you undertake night on-call?
Yes No
Queson 16
If so, do you think night on-call is valuable for your training experience?
Yes No
Queson 17
Have you received good support from your registrars for your on-call dues?
Yes No
Queson 18
How USEFUL do you feel the following aspects of your SHO experience are to your future career plans?
(Please choose the most relevant box 1= Most Useful 7 = Least Useful)
1 2 3 4 5 6 7
Dentoalveolar Surgery
T. Wildan et al. / British Journal of Oral and Maxillofacial Surgery 51 (2013) e155e164 e161
Deformity (orthognathic and cle surgery)
Head and Neck Cancer
Facial Trauma
Salivary Gland
Oral medicine
Facial pain/TMJ
Queson 19
Do you feel the amount of dentoalveolar surgery experience you have undertaken this year is:
Less than adequate
Adequate
More than adequate
Queson 20
Are there opportunies to get involved with surgery in theatres?
Yes No
Queson 21
Which aspect of oral and maxillofacial surgery have you ENJOYED the most?
(Please rank 1=Most Enjoyed 7=Least Enjoyed)
1 2 3 4 5 6 7
Dentoalveolar Surgery
Deformity (orthognathic surgery and cle surgery)
Head and Neck Cancer
Facial Trauma
Salivary Gland
e162 T. Wildan et al. / British Journal of Oral and Maxillofacial Surgery 51 (2013) e155e164
Oral Medicine
Facial pain/TMJ
Queson 22
Why have you enjoyed the above rotaon the least?
Queson 23
How many hours of dedicated teaching do you receive per week?
0-15 mins
15-30 mins
30 mins-1 hour
1-2 hours
2 hours +
Queson 24
Who leads these regular teaching sessions?
Registrars
Consultants
SHOs
Queson 25
Where do you gain the most teaching opportunies?
(Please rank 1=Most Teaching 5=Least Teaching)
1 2 3 4 5
Theatres
Ward rounds
Teaching sessions
T. Wildan et al. / British Journal of Oral and Maxillofacial Surgery 51 (2013) e155e164 e163
On-calls
Medical SHOs
Queson 26
What has been the best part of this job?
Improving dentoalveolar surgery skills
Increased condence of management of paents with medical condions
Experience of working in a mul-disciplinary team
Experience in praccal skills e.g. cannulaon venepuncture
Other
Queson 27
What has been the worst part of this job?
Lack of medical knowledge
Lack of support
Night on-calls
Day on-calls
No relevance to future career
Undertaking ward dues
Other
Queson 28
Have your inial aims for taking this DF2 role been met from this post?
Yes No
Queson 29
In hindsight would you have undertaken this job now knowing what is involved?
e164 T. Wildan et al. / British Journal of Oral and Maxillofacial Surgery 51 (2013) e155e164
Yes No
Queson 30
Do you think this post has made a dierence to your future career plans?
Yes No
Queson 31
What are your plans immediate to this post nishing?
Hospital placement
Pracce (GDP)
Salaried service (e.g. community placement)
Unsure
Queson 32
What is your future career plan?
GDP
Oral and Maxillofacial Surgery
Oral Surgery
Orthodoncs
Paediatric Denstry
Prosthodonst
Periodonst
Salaried service
Other
Queson 33
How would you improve your DF2 experience?
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