Hedayat, Fatemeh

Kyzas, Panayiotis

Lakunina, Svetlana

Verma, Devika

CLoK

Protocol Title The effect of medical students’ exposure to oral and maxillofacial surgery: A prospective observational multicentre cohort study Authors and affiliations Fatemeh Hedayata,b, Svetlana Lakuninaa,c, Devika Vermaa,d, Panayiotis Kyzas a,e a. School of Medicine, University of Central Lancashire, Preston, PR1 2HE, United Kingdom b. Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton, TA1 5DA, United Kingdom c. John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, United Kingdom d. Queens Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Burton, DE13 0RB, United Kingdom e. Department of Oral and Maxillofacial Surgery, East Lancashire Hospitals NHS Trust, Blackburn, BB2 3HH, United Kingdom Sources of support None. Declaration of interests None. Acknowledgements None currently. Background and Significance Oral and Maxillofacial Surgery (OMFS) is one of the ten surgical specialities recognised by the General Medical Council (GMC) and endorsed by the Royal Colleges of Surgeons (RCS) in the United Kingdom.1 At present, specialising in OMFS in the UK requires both a medical and a dental degree. The majority of OMFS surgeons have traditionally first trained as a dentist and subsequently as a doctor2, although this trend seems to be reversing over the last decade.  The implementation of accelerated graduate courses in dentistry has had an impact on the gradual increase in the number of those who train as a doctor first (Table 1).2 Bachelor of dental surgery (BDS) refers to those who entered speciality training with dentistry as a first degree. Despite a slow gradual increase in those who have a medical degree (MB) as their first degree, there is still a significant gap. Year of certificate of completion BDS MB 1996-2000 115 (99%) 1 (1%) 2001-2005 83 (98%) 2 (2%) 2006-2010 87 (88%) 12 (12%) 2011-2015 113 (88%) 16 (12%) 2016-2029 66 (73%) 25 (27%) Table 1. The number and percentage of those who entered OMFS training with either BDS or MB as their primary degree.2 The undergraduate surgical curriculum set by the GMC and the RCS outline that required learning outcomes could be achieved during Otorhinolaryngology  and/or OMFS placements for students.1,3 This means that medical schools could allocate students to only one of the two surgical specialities. The curriculum also specifies that medical students should develop an understanding of the ten surgical specialities and 35 surgical conditions deemed essential for every graduating doctor to comprehend.3  Evidence suggest that 53.2% to 72.3% medical students had inadequate knowledge of the training requirements and pathways for OMFS specialty training.4,5 64% to 81.9% had no exposure to OMFS during their undergraduate medical degree.4-8  Of note, the British Association of Oral and Maxillofacial Surgery (BAOMS) produced an overview highlighting the important link between OMFS and other hospital and non-hospital specialities.9 Yet, 38.1% to 56% medical students were not able to appropriately refer to OMFS.4,5,8  Interestingly, examination of the oral cavity is currently not incorporated in the curriculum, nurturing uncertainty in newly qualified doctors regarding detection and treatment of a number of conditions in the oral cavity.10 This could be attributed to factors related to the clear underrepresentation of OMFS among undergraduate medical students. A recent study (n = 47) demonstrated promising results after delivering a focussed simulation for undergraduate medical students. Students were able to retain the knowledge gained from the educational experience for up to six weeks.11 Study aims The primary outcome of interest in this study is medical student perception and understanding of OMFS before and after exposure to placements in an oral and maxillofacial unit.  Secondary outcomes will be as follows: • Improvement in knowledge of anatomy and/or OMFS conditions. • Confidence in recognising appropriate referrals to OMFS. • The percentage of students considering OMFS as a tentative career pursuit. • The impact of involvement in academic work (e.g., audit, QIP, systematic review, etc.) on student interest in the specialty. Administrative organisation This investigation will be conducted in the oral and maxillofacial department of Royal Blackburn Hospital, Musgrove Park Hospital, John Radcliffe Hospital, and University Hospitals of Derby & Burton. Data collection will be done in all sides by all investigators; data storage, analysis and management will be the responsibility of the lead unit/organisation (ELHT/UCLan) Study design In this prospective cohort study, students in their penultimate or final year will be requested to take part in our study and asked to fill out an anonymised survey before the start of their clinical attachment, and once again at the end of their placement. The baseline data regarding student’s  knowledge and perception of OMFS will be collected before placements by the means of anonymised online surveys by FH, SL, and DV. The follow-up data collection regarding the improvement of knowledge and perception will be done during the final placement week. The survey used for data collection is available in Appendix.  The main form of contact in this prospective study will be via email. Data Analysis  The cohorts of interest in this study are the pre-intervention group, prior to exposure to OMFS clinical attachment, and a post-intervention group, following OMFS specialist clinics, multidisciplinary meetings, and theatre. The software used for data collection will be Google Forms. The results of the data collection will be presented in a graphical form for the outcomes assessor (PK) to analyse. All the data will be securely stored on the Google Drive with restricted access only for investigators of the study in accordance with the Data Protection Act 1998.12    References 1) Outcomes for graduates, Available from URL: https://www.gmc-uk.org/-/media/documents/dc11326-outcomes-for-graduates-2018pdf-75040796.pdf. (last accessed 1 May 2021) General Medical Council; 2018. 2) Magennis P, Begley A, Dover S. Changing first degrees of OMFS trainees and specialists 1996–2020. British Journal of Oral and Maxillofacial Surgery. 2015;53(10):e79. 3) The intercollegiate surgical curriculum: educating the surgeons of the future. Oral & Maxillofacial Surgery from 2010. Intercollegiate Surgical Curriculum Programme (ISCP). Avail- able from URL: https://www.gmc-uk.org/-/media/documents/ OMFS inc. Trauma TIG.pdf 72601045.pdf. (last accessed 1 May 2021). 4) Harris K, Jefferies C. A multi-site cross-sectional survey exploring medical undergraduate knowledge of oral and maxillofacial surgery. J Maxillofac Oral Surg 2019;18:623–7.  5) Goodson AM, Payne KF, Tahim A, et al. Awareness of oral and maxillo- facial surgery as a specialty and potential career pathway amongst UK medical undergraduates. Surgeon 2013;11:92–5  6) Mahalingam S, Kalia P, Mugilan S. Oral and maxillofacial surgery in medical schools in the United Kingdom. Br J Oral Maxillofac Surg 2015;53:295–7.  7) Kalia P, Mahalingam S. An evaluation of oral and maxillofacial surgery in UK medical schools. Br J Oral Maxillofac Surg 2012;(50 Suppl):S53–4.  8) Hamid S, McNeillis B, Saeed N. Knowledge of final-year medical stu- dents about oral and maxillofacial surgery: a two-centre study. Br J Oral Maxillofac Surg 2018;56:582-5.  9) Oral and Maxillofacial overview, Available from URL: https://www.baoms.org.uk/professionals/default.aspx (last accessed 1 May 2021) British Association of Oral and Maxillofacial Surgery. 10) Shanks L A, Walker T W, McCann P J, Kerim M J. Oral cavity examination: beyond the core curriculum? Br J Oral Maxillofac Surg 2011; 49: 640–642.  11) Zargaran A, Hirniak J, Zargaran D. Oral and Maxillofacial Surgical simulation: efficacy for medical students. Br J Oral Maxillofac Surg. 2020;58(10):1251-1254.  12) Uk Public General Acts (1998). Data protection act. Available from https://www.legislation.gov.uk/ukpga/1998/29/contents    Appendix  

PROTOCOL – The effect of medical students’ exposure to oral and maxillofacial surgery: A prospective observational multicentre cohort study

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PROTOCOL – The effect of medical students’ exposure to oral and maxillofacial surgery: A prospective observational multicentre cohort study

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