A career in Diagnostic Oral and Maxillofacial Pathology
A career in Oral and Maxillofacial Pathology (OMFP) is something that only a minority of dentists will ever consider. There are a few OMF pathologists in the UK (less than 30) and it is not likely that you will have had the opportunity to work closely with them and discover what a challenging specialty this is. This specialised field of diagnostic histopathology deals with diseases of the mouth and jaws and their associated structures such as the ear, nose and throat, and structures in the neck.
What is an Oral and Maxillofacial Pathologist?
Oral and Maxillofacial pathologists are dentists who, following a minimum 2 year period of General Professional Training (GPT) or Foundation Training, have undertaken a 5 year training programme in diagnostic histopathology. After passing the FRCPath exams and obtaining a Certificate of Completion of Specialist Training (CCST), they can be registered as a specialist with the General Dental Council. They are not required to be medically qualified, despite the fact that their work overlaps medicine and dentistry.
What do Oral Pathologists do?
The majority of Oral Pathologists work in dental schools, in their associated dental hospitals or acute medical NHS Trust hospitals. Most have four strands to their work: diagnostic histopathology, teaching, research and administration.
Diagnostic pathology involves the diagnosis of disease by microscopic examination of biopsy and excision specimens and examination of resection specimens from cases of head and neck cancer. This may occupy half or almost all a pathologist’s time, depending on his/her job plan. This time is not all spent looking down the microscope (though a fair proportion of it can be). The pathologist also dissects surgical specimens, provides advice on diagnosis and treatment and participates in clinico-pathological case conferences and Multidisciplinary Team Meetings (MDTs). Most OMF pathologists are also involved in management and organisation of service laboratories, prvision of head and neck/ENT serivce with some involved in NHS hospital management.
Teaching is mostly based in the dental schools. OMF Pathologists may be involved in delivering courses in basic science, pathology, microbiology, human disease, oral medicine and pathology, radiology or surgery depending on their experience and skills. These subjects are among the more academic and complex in the dental course and teaching students to understand disease and develop their diagnostic skills is a rewarding part of the job. It also keeps you in touch with dentistry.
Research is a major part of the job for some. If this is you, you will need a PhD and continuing research interest; this could be in OMF pathology, pathology in general or a basic science subject. The ability to gain research grants is necessary to obtain a post in some schools. In most specialties and schools, a PhD is required for promotion to Senior Lecturer/Consultant similar to other branches of academic dentistry. However, there are also ample opportunities to work within the NHS and get involved in research with an Honorary Lecturer status.
Other opportunities are also available for those with particular interests. Some undertake forensic odontology; others are involved at the highest level in the management of dental schools or other aspects of undergraduate or postgraduate dental education.
What about a NHS post?
There is a handful of OMF Pathologists that have full time NHS contracts. However, as most are attached to dental schools they are still required to help with teaching and undertake NHS service and research. Even fewer hold posts in District General Hospitals and work full time in Histopathology (ENT/Head and Neck/Endocrine).
Are there any private oral and maxillofacial pathologists in the UK?
No, not at present, though most services undertake a small amount of private practice. As the NHS changes, this may increase as pathology becomes more businesslike.
Any other perks?
Oral and Maxillofacial Pathology is a good specialty for flexible training and part time working. As a clinical academic or NHS dentist you will have 6 weeks annual paid leave plus study and professional leave as well as a relatively generous University or NHS final pension or superannuation scheme. The diverse nature of the job, especially in an academic environment, provides a lot of variety and considerable job satisfaction. There are also opportunities to travel and you don’t have to be on-call in the middle of the night like the surgeons do.
How long does all this training take?
After 2 years of broad based, general professional (or foundation) training you would undertake a minimum of 5 years training to become an OMF pathologist. For a career as a clinical academic a further period of 3 –4 years is needed to complete a PhD.
What sort of person becomes an Oral and Maxillofacial Pathologist?
Ideally, you would need to be academically strong, possibly with some exposure to research from a previous degree or intercalated BSc. You will need to have done well in the dental school in subjects of pathology, human disease, oral medicine or oral surgery. You may already know you have good microscope skills although this can be learnt on the job. As an applicant for a training post, you would need to be well organised with excellent communication skills and evidence of involvement in clinical governance, audits, presentations and/or publications. Pathologists like to get things right. You would be be expected to take on challenges and responsibilities as patients' future treatrment is decided on the basis of your opinion. You would have gained clinical experience in subjects relevant to the work of a pathologist, particularly oral and maxillofacial surgery and/or oral medicine. You would be exected to have finished your MFDS/MJDF and be eligible for registration with the GDC.
Do you have to be good with a microscope?
To a degree, though most people who are interested can be trained. Obviously you would be unwise to embark on this career unless you knew that you could get a single focused image with both eyes open. However, not all new trainees have histopathological knowledge or skills.
Will I have to give up seeing patients?
Most OMF Pathologists do not see patients on a regular basis but are often asked to see individual patients when diagnostic problems arise. Some provide consultant services in oral medicine, depending on training and experience. In order to do this at a Consultant level you would have to be on the GDC Specialist List for Oral Medicine as well. This is an area where the individual can influence their job description so that clinical sessions may be included for part of your training if you have no experience in, for instance, Oral Medicine or Dental and Maxillofacial Radiology.
How can I try out the specialty?
There are some DCT posts available that give provide one year of experience and training (e.g. Sheffield and Guy's). In some hospitals, DCTs in other departments may rotate through, or be offered attachments in Oral Pathology. There is always the possibility of spending some time in a department. Contact the Head of Department at one of the dental schools if you are interested.
How is the training structured?
Training is overseen by the General Dental Council and the Specialty Advisory Committee for the Additional Dental Specialties and examinations are under the control of the Royal College of Pathologists (http://www.rcpath.org). Oral and Maxillofacial Pathology is known as Histopathology (Oral) in their terminology and details are available on their website. Depending upon your previosu experience, the first year of training is usually spent in OMF Pathology, acquiring basic skills and knowledge. After that, trainees must spend a minimum of one year in General Pathology and will undertake training in histopathology, including working in cytology and observing or helping undertake post mortems. In some centres, you would visit for defined periods to undertake this one year training. Elsewhere, OMF Pathologists are already integrated into the medical pathology service and you may spend periods throughout the rest of your training rotating through relevant departments, such as dermatopathology, endocrine, haematopathology, musculoskeletal pathology etc.
Training is a mixture of formal training sessions and ‘on the job’ learning with Consultants using multi-headed microscopes followed by work based assessments. At the end of the each year, there is a formal assessment to check your progress and development against set objectives. The training process is monitored by the Postgraduate Deaneries by an annual review of training, as in other dental specialties.
To gain specialist recognition you must pass the FRCPath examination. This is in two parts. The first part covers mainly theoretical knowledge (including Geenral Histopathologogy) and is usually taken after 1 to 3 years of training. The second part is clinical and involves making diagnoses on a series of cases, performing specimen dissection followed by a viva and is usually taken near the end of training.
How will training change in the future?
Three year dental core training (DCT) has now been implemented. In some centres there may be short rotations (probably 3/4 months) through OMF pathology. This will be an ideal way to gain a taster of life as an OMF Pathologist. Following a DCT-1 (or DCT-2) year, you can apply for Oral and Maxillofacial Pathology/Oral Medicine DCT positions in Sheffield or Guy's Hospital, London. It is strongly advisable to do at least a year as a DCT in Oral and Maxillofacial Surgery (OMFS) prior to applying for Specialist Registrar training positions.
How can I get a training post?
These are advertised nationally. If you are serious about the specialty you will need to contact and seek advice from your local/regional unit and attend BSOMP meeting meetings. Entry to the specialty is competitive. MFDS/MJDF is not compulsory but it is expected that most applicants will have passed one of these exams. If you are an overseas candidate and are not eligible for full registration with the GDC you would be advised to pass the Overseas Registration Examination (ORE- run by the GDC) or LDS (run by the Royal College of Surgeons of England) to obtain full GDC registration before looking for a post. You will also need to ensure that you are eligible to stay and work in the UK. It is difficult to combine training with general dentistry and taking the ORE/LDS.
Who can I contact for more information?
Your nearest Oral and Maxillofacial Pathology (or Head and Neck Pathology) Department can either help you directly or put you in touch with the national specialist society or specialty advisor. You can also get in touch with the BSOMP secretary or other council members for advice.