Oral and Maxillofacial Surgical simulation: efficacy for medical students (2022)


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  • Cited by (2)
  • Recommended articles (6)

British Journal of Oral and Maxillofacial Surgery

Volume 58, Issue 10,

December 2020

, Pages 1251-1254


Oral and Maxillofacial Surgery (OMFS) is underrepresented in the medical curriculum with 90% of medical students reporting no exposure to the specialty in medical school. This can result in clinicians having problems recognising emergency presentations, and referrals being made inappropriately. OMFS trainees delivered an educational simulation course on common OMFS pathologies to medical students, with theory and hands-on, high-fidelity simulations that covered anatomy, emergency presentations, and the training pathway. Delegates were assessed immediately before, immediately after, and six-weeks after the course. There were significant improvements in knowledge six weeks after the course, with mean scores improving by 23% for knowledge of anatomy (p<0.01), 21% for emergency management of patients (p<0.01), and 22% for knowledge of the training pathway (p=0.04). There was a 58% increase in interest in OMFS and improved confidence for an oral examination. This study found that improvements in knowledge about concepts in OMFS were sustained and significant. Given the lack of representation of the specialty in medical school, high-fidelity simulation should be more widely adopted as an educational adjunct to help bridge the gap between taught theory and applied practice.


Oral and Maxillofacial Surgery (OMFS) is one of the nine surgical specialties in the United Kingdom (UK), but it is unique in its complexity as a training pathway because of the requirement for dual qualification in medicine and dentistry which, over an 18-year period, amounts to a personal cost of over £110 000.1 Studies have reported that between 80% - 90% of UK undergraduate medical students have no exposure to OMFS in medical school,2, 3 and only 53% of students realise that non-healing oral ulcers should be referred within four weeks. As a result, OMFS referrals are often made inappropriately to ear, nose, and throat (ENT), and plastic surgeons.3

The inability to recognise malignancies and refer patients correctly to OMFS prompted the British Association of Oral and Maxillofacial Surgeons (BAOMS) to launch an initiative to raise awareness and improve knowledge amongst primary care providers.4 The problem, however, is not being addressed at a ‘grass-roots’ level, and in the latest consensus report from the Association of Surgeons in Training (ASiT), no mention was made of OMFS as part of the curriculum.5 This is in the context of recent reports that have highlighted the lack of consideration given to traumatic dental injuries in the undergraduate curriculum, despite their early management being an essential skill for doctors in accident and emergency because of the potentially life-threatening sequela of airway obstruction.6

We have designed, delivered, and evaluated a simulation course for medical students that has the potential to address the imbalance between taught theory and applied practice.

Section snippets


The design of the course was informed by a focus group comprising two consultant maxillofacial surgeons and three trainees. The course was divided into workshops that involved the teaching of dental anatomy, common OMFS procedures, the OMFS training pathway, and OMFS emergencies. These were followed by a practical element, with hands-on exploration of phantom dental heads, examination of the mouth, and examination and management of dental abscesses (simulated using grapes).

A total of 47 medical


A total of 46 medical students from UK institutions completed the course, and the assessments immediately before and after it. Thirty-six completed the assessment after six weeks, giving a response rate of 78%.

Immediately after the course, baseline knowledge across all the domains had improved significantly. The mean baseline score for knowledge of anatomy was 33.7%, and for emergency management of unwell patients was 47% (Table 1).

Significant improvements were seen across five of the 10


Globally, increased integration of simulation in the medical curriculum has been advocated to help address the shortfall in recruitment for surgical training.7, 8 Exposure can be limited by a lack of opportunities for students to be involved in busy hospital environments. In OMFS, this problem is exacerbated by a lack of curriculum content pertaining to the specialty, so increasing the integration of simulation to provide this exposure has obvious value.

There is a paucity of reports that



This study has shown that an OMFS course with teaching and hands-on simulation can improve the retention of knowledge in medical students for up to six weeks. The wider integration of such courses may help to address the under-representation of OMFS, and has the potential to inform safer referral patterns among future graduates.

Conflict of interest

We have no conflicts of interest.

Ethics statement/confirmation of patients’ permission

Ethics approval not required. No health outcomes evaluated and no personal data collected. Evaluation of educational course, with full informed consent gained from participants. Full informed consent obtained. No personal data or identifying information collected.

References (12)

There are more references available in the full text version of this article.

Cited by (2)

  • MaxSim: a novel simulation-based education course for OMFS emergencies

    2022, British Journal of Oral and Maxillofacial Surgery

    For oral and maxillofacial surgery (OMFS) senior house officers (SHOs) with no formal medical training, the first exposure to emergency scenarios will be the first time they have to manage them, usually alone. Simulation-based education (SBE) has been demonstrated to increase experience and confidence when used in medical education, so an OMFS SBE course was created to facilitate this. The course was centred on scenarios that necessitate a rapid response, including sepsis, retrobulbar haemorrhage, and carotid artery blowout. A questionnaire with a 10-point numerical score was given to assess the change in confidence when managing these scenarios. Learner numbers were limited due to the COVID-19 pandemic, but all 10 completed both questionnaires. There was an even distribution between first and second-year SHOs. Two had received simulation training before, but it was very limited. In all stations every learner felt an increase in confidence, on average by 45% (range 38%-56%, p<0.05) on the 10-point scale. Positive feedback was also given by them all. SBE has been shown to be an invaluable method of training for clinical scenarios and needs to become common in OMFS. The course is to be expanded post COVID-19 to become available nationally.

  • Remote yet engaging: Expanding learning opportunities through virtual platforms during the COVID-19 pandemic

    2021, Journal of Plastic, Reconstructive and Aesthetic Surgery

    (Video) Antibiotics in OMFS

Recommended articles (6)

  • Research article

    European OMFS in the time of Brexit – where did the UK fit and how might the future look?

    British Journal of Oral and Maxillofacial Surgery, Volume 58, Issue 10, 2020, pp. 1297-1303

    The specialty of OMFS in the UK is a dual degree specialty which was recognised in Europe within Annex V of Directive 2005/36/EU. Currently UK law matches that of the EU. Brexit may change this.

    Defines two specialties within European nations, Dental, Oro-Maxillo-Facial Training DOMFS (Basic dental & medical training) and Maxillofacial Surgery (basic medical training). The UK sat within DOMFS and so specialists from DOMFS nations could travel and work in the UK. Specialists from all other nations were required to use the Certificate of Eligibility for Specialist Registration (CESR) route.

    This directive updated 2005/36/EU regarding Mutually Recognised Professional Qualifications (MRPQ) including creating an international alert system for doctors in difficult

    Entry onto the UK OMFS Specialist List by CESR Route

    CESR application is a large and complex portfolio of evidence to demonstrate knowledge, skills and experience are equivalent to a Certificate of Completion of Training (CCT) holder. To date, no EU applicants have successfully completed a CESR application.

    Even after Brexit, the UK will remain a full member of UEMS. The OMFS Section of UEMS is a source of information and support for specialists wishing to work in other nations and for nations wishing to develop an OMFS specialty in their nation.

    Applicants meeting the person specifications for approved OMFS specialty training (ST) posts in the UK are welcome to apply to the national selection process for OMFS specialty training in the UK. Many have done so successfully. Fixed term appointments and Fellowships are advertised and represent a useful route to gain support for application for training or through the CESR Route.

    The UK remains part of the diverse OMFS community in Europe. There is support from within the UK and from UEMS for trainees and specialists interested in coming to the UK to train or to work.

  • Research article

    The future of OMFS lies in creating pathways to implement the PMETB recommendations and inspiring our trainees. Enough time has been spent debating, we need to deliver!: Re: Newman L, Brown J, Kerawala C, et al. Our specialty. The future. Is the writing on the wall? Br J Oral Maxillofac Surg 2020 (online ahead of print)

    British Journal of Oral and Maxillofacial Surgery, Volume 58, Issue 10, 2020, pp. 1351-1352

    The British Association of Oral and Maxillofacial Surgeons (BAOMS) has been at the centre of the transition of our specialty in the UK from a branch of dentistry to one of the 10 UK surgical specialties. In this role it has, at different times, pushed boundaries against resistance from other specialties, and redirected the ambitions of the deputy chair of the Postgraduate Medical Education and Training Board (PMETB) review to produce recommendations that were exactly what OMFS needed. The editorial Our specialty. The future. Is the writing on the wall? is just the most recent iteration of half a century of internal debate. Whilst there are some issues with how the authors have presented recruitment data (their figures omit ST1 run-through and do not recognise that the same single, unfilled post may be present for two or more national selection rounds) their first paragraph A debate that we feel is long overdue presents the greatest concern. In this short communication, we illustrate that in the last 20 years the specialty has not been short of debate. In the absence of new and specific evidence that any other route forward would be supported by our national training committee (OMFS SAC), our regulator (GMC), the breadth of our specialty (including our current specialists and our current and future trainees) and, most importantly, would actually address our problems, we should avoid putting energy into an empty debate. Our focus should be on delivering the PMETB recommendations and inspiring our future trainees.

    (Video) Orthognathic Surgery at North Jersey Oral & Maxillofacial Surgery, Teaneck, NJ

  • Research article

    How can oral and maxillofacial surgery units best support second degree students?

    British Journal of Oral and Maxillofacial Surgery, Volume 58, Issue 10, 2020, pp. 1348-1350

    Returning to study for a second degree to enter higher OMFS training often leaves students feeling ‘out in the wilderness’. Many OMFS units are keen to support these students and make use of their skills and enthusiasm by employing them. Often there are barriers to students and units working together. We have explored some of these barriers by surveying second-degree students (both medical and dental) to see what simple measures OMFS units can take to improve their support for students. From the survey we have devised a list of Essential and Desirable criteria to assist OMFS units in supporting students, aiming to have a positive effect on retention through the challenging but necessary period of the second degree.

  • Research article

    2012 – The year when BAOMS and its officers prevented closure of all UK shortened medical and dental courses

    British Journal of Oral and Maxillofacial Surgery, Volume 58, Issue 10, 2020, pp. 1343-1347

    In Spring 2011 the Department of Health (DH) received a request to review European Union Directive 2005/36 EU – the directive relating to the recognition of professional qualifications. The Department of Health lawyer raised concerns that the existing shortened dental courses may be in breach of EU law. There were three shortened dental courses in the UK: 4year graduate entry courses in Liverpool/Peninsula and 3-year Dental Programme for Medical Graduates (DPMG) in Kings, London. During the summer the General Dental Council (GDC) was made aware of these concerns. In autumn 2011 the Chief Dental Officer for England with the GDC, told the Dental Deans’ Council (DDC) that shortened dental courses were illegal. On 12th Jan 2012 students on the DPMG were told that they would have to complete a full 5-year dental degree. The GDC said that this interpretation of EU law would also impact on shortened medical courses. In view of the potentially enormous impact that this would have on OMFS training, BAOMS engaged all the resources it could and by assembling legal opinions including written contributions from Sir David Edward, whose opinion was being misinterpreted by the GDC and DH, and by sharing these resources with all the stakeholders, BAOMS was able to preserve shortened dental and medical courses. Now that the UK has left the European Union, negotiations around mutual recognition of qualifications may mean this issue will resurface. We should remain vigilant.

  • Research article

    We need to drive change for the future and support junior trainees whilst maintaining the highest training standards

    British Journal of Oral and Maxillofacial Surgery, Volume 58, Issue 10, 2020, pp. 1273-1275

    The oral and maxillofacial surgery (OMFS) community in the UK has always felt distinguished to be the only surgical specialty requiring dual qualification. There is no doubt that OMFS recruitment in the UK is in crisis, and we believe that the time has arrived to review the long training pathway. Policy-makers should think of alternative options to make the training programme more sustainable whilst maintaining the highest standards. The problem is serious, and the onus is on all consultants and higher surgical trainees. An urgent multi-pronged, structured approach is required to improve recruitment. It is important to find ways to reduce the training time whilst supporting trainees through their second degree. Consultants and higher surgical trainees need to come forward to participate in the BAOMS working group to create regional career mentors and part-time career development posts for potential trainees. We need to drive change for the future and support junior trainees whilst maintaining the highest training standards.

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© 2020 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.


1. Patient Story: Oral & Maxillofacial Surgery
(UIC College of Dentistry)
(Online Dentistry)
3. 2019 SciFam: CMD Maxillofacial Surgery Solutions
4. Wisdom Teeth Removal at North Jersey Oral & Maxillofacial Surgery, Teaneck, NJ
(North Jersey Oral & Maxillofacial Surgery)
5. Application of FEA Simulation in the Medical Device Field
(Rand Simulation)
6. Why an oral maxillofacial surgeon do not recommend surgery (double jaw, facial bone surgery)
(EU Surgery)

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