- Citado por SciELO
versión impresa ISSN 1698-4447
Med. oral patol. oral cir. bucal (Ed.impr.) v.10 n.4 Valencia ago.-oct. 2005
Post Graduate training in Oral Surgery in Spain
Estudio de la Enseñanza Postgraduada Pública de Cirugía Bucal en España
Rodríguez Pérez M (1), Romero Olid MN (2), Manuel Vallecillo Capilla (3)
(1) Licenciado en Odontología
(2) Profesora Asociada de la Unidad Docente de Cirugía Bucal y Maxilofacial de la Facultad de Odontología
(3) Profesor Titular de la Unidad Docente de Cirugía Bucal y Maxilofacial de la Facultad de Odontología. Universidad de Granada
Correspondencia / Address:
Manuel Rodríguez Pérez.
C/ Madrid Nº 11. Maracena (Granada). C.P. 18200.
T.L.F.: 958-421114, 958-404830.
Recibido / Received: 21-04-2003 Aceptado / Accepted: 2-05-2005
Rodríguez-Pérez M, Romero-Olid MN, Vallecillo-Capilla M. Post graduate training in Oral Surgery in Spain. Med Oral Patol Oral Cir Bucal 2005;10:323-30.
The objective of this investigative study is to provide information on the type of public postgraduate training in oral surgery currently being taught in Spain. A descriptive study is made relating to the theoretical and practical syllabuses of the different Masters, through questionnaires answered by students who had previously completed the postgraduate course. Later, a possible relationship between age, sex and previous training in dentistry or stomatology was explored. The results show a poorer preparation in subjects related to the planning and carrying out of treatment of salivary gland pathologies, transposition of the inferior alveolar nerve, treatment of oral tumors, and the treatment planning for osteitis and osteomyelitis. There is a difference between the sexes in a number of answers, where females give higher scores. The stomatologist scores higher in treatment planning for complicated extractions and in the carrying out of dental transplants. It seems that the older the student, the less prepared they are to carry out a treatment plan which includes a biopsy, and the better prepared they are to treat dental emergencies, dentoalveolar trauma, osteitis and osteomyelitis. We can conclude principally that the students give a generally positive evaluation of the oral surgical training, both theoretical and practical, except in the more complex topic areas which appear to relate to the maxillofacial surgeons.
Key words: Postdoctoral general dentistry education, advanced education in general dentistry, evaluation.
El objetivo de este estudio de investigación es dar a conocer el tipo de enseñanza postgraduada pública en Cirugía Bucal que se está impartiendo actualmente en España, realizando un estudio descriptivo con relación a los contenidos teóricos y prácticos de los diferentes Máster, mediante encuestas contestadas por alumnos que han concluido el postgrado. Posteriormente se observa la posible relación existente con la edad, sexo y formación previa como odontólogo o estomatólogo. Los resultados muestran una peor preparación en los temas referentes a planificar y realizar el tratamiento de patología de glándulas salivales, de la transposición del nervio dentario inferior y de tumores bucales, y en la planificación de osteítis y osteomielitis. Existe un dimorfismo sexual en una serie de preguntas, en las que las mujeres dan una puntuación más alta. El estomatólogo puntúa más alto en la planificación del tratamiento de exodoncias complejas y para la realización de un transplante dentario. Parece que a mayor edad del alumno se encuentra menos preparado para realizar un plan de tratamiento que implique biopsiar y más preparado para tratar urgencias dentales, traumatismos dentoalveolares, osteitis y osteomielitis. Podemos concluir principalmente, que los alumnos dan una valoración general positiva en la formación quirúrgica bucal, tanto práctica como teórica, salvo en los temas más complejos, que parecen derivarse a los cirujanos maxilofaciales.
Palabras clave: Educación general odontológica postdoctoral, educación avanzada en odontología general, evaluación.
The introduction of postdoctoral general dentistry programs (PGD) dates back to the dental welfare services established in hospitals at the beginning of the 20th century. In 1972, the Commission for Dental Accreditation (CODA) of the American Dental Association (ADA) officially changed the name of these programs, designating them Residency, and publishing the requirements for the accreditation of the General Practice Residency Programmes (GPR), that should be practised in a hospital. The demand for these programmes began to increase from the 1970s onwards (1).
Oral surgery is recognised by the principal North American academic bodies and corporations, and likewise by European Union directives as that part of dentistry that deals with the diagnosis, surgery and coadjuvant treatment of the diseases, trauma and defects of the maxilla/mandible and adjacent areas (2).
The Dental Education Consultative Committee submitted to the European Community Commission the need to regulate the dental specializations, which gave rise to directive (78/686/CEE) of 27 July 1978, which recognises oral surgery and orthodontics as specializations in dentistry. On 20th November 1985, the Dental Education Consultative Committee approved the fields of activity and teaching programmes so that dentists could have access to the two recognised specializations in dentistry (III/D/1374/5/84). The general dental practitioner may carry out oral surgical treatment according to his abilities and always in the best interests of the patient (2).
In all member states of the European Union, the specialist in oral surgery is considered competent to carry out all types of dentoalveolar surgery, including implantology, surgery of the maxilla/mandible, including resection, and surgery of soft tissues in the oral cavity (2).
The history of education in oral surgery in Spain originates from the commencement of the teaching of Stomatology as a medical speciality with the subject of Stomatological Surgery, the name of which was changed by Professor Calatrava Páramo, Professor at the Universidad Complutense, Madrid, to that of Maxillofacial and Oral Surgical Pathology. With the advent of dental studies it went on to become known as Oral Surgery (2).
It can be said that certain differences exist between the different Faculties of Dentistry in Spain with respect to training in oral surgery, both in the undergraduate and postgraduate areas, which embrace courses of continuous assessment, doctoral studies, and studies oriented towards the Master in oral surgery and implantology.
Previous studies on postgraduate dental courses have covered different topics such as the motivational factors that inspire the choice of a particular postdoctoral course (which highlighted the interest in increasing knowledge about general medicine and the treatment of medically compromised patients) (3).
The type of oral implantology training at undergraduate and postgraduate levels in the University Dental Hospitals and Schools in the United Kingdom and Eire, has also been studied. Questionnaires were sent to the directors and co-ordinators of implantology training in these centers, finding that all university dental schools provide undergraduate training in oral implantology in accordance with the guidelines provided by the General Dental Council, 13 centres provide informal postgraduate training with the duration ranging from one to eighteen days, and that just eight centres provide formal academic graduate training based on oral implantology leading to recognised degrees (4).
Another study also compared the training of dental practitioners in three countries: Poland, Sweden and the UK, and also explored whether those dentists trained in Poland or Sweden are equipped to work in UK dental practice (5).
Currently, due to the increased number of postdoctoral courses offered, studies are being made on the educational quality offered by these courses, as is intended by the present study. Students at the School of Dentistry, Oral Pathology and Maxillo-facial surgery of the Catholic University of Leuven were asked to rate the educational quality of the different types of courses in the dental programme. In addition, the questionnaire was presented to 3 subgroups: 1. professors, undergraduate and postgraduate students; 2. academic personnel of the dental school; and 3. other academic members not directly connected with the school. The questionnaire comprised 108 questions in the form of statements, evaluating on a 6 point Likert-type scale the threshold below which the quality would be considered sub-optimal (6).
In 1999, the HRSA (Health Resources and Services Administration) contracted with the UCLA Dental School to evaluate the postgraduate general dentistry (PDG) training program, with the intention of comparing the characteristics of these training programs, according to whether the financier was either the Armed Forces or the Veterans Health Administration (VA) (7).
In Spain the current situation is that the different Masters and other courses are taught within what is considered necessary continuous training for the dental graduate in the various disciplines.
The aim of this investigative study is to provide information on the type of postgraduate training in Oral Surgery currently being provided by public education in Spain, making a descriptive study in relation to the practical and theoretical contents of the different Masters and observing the relationship between age, sex and previous training (stomatology or dentistry) before commencing the postgraduate course.
Thus we can specify the following objectives:
General objective: to evaluate postgraduate teaching in Oral Surgery in Spain.
Specific objectives: to measure the students ability to: prepare a medical history, complementary tests and oral surgical diagnosis, to carry out treatment planning, oral surgery and medical treatment; and finally to evaluate the students satisfaction with the training received.
MATERIAL AND METHODS
To begin with, information was gathered on the number and characteristics of the different Masters or postgraduate courses in oral surgery offered by Spanish public universities, completing a specific form for each one.
There are six public universities that provide postgraduate courses (Madrid, Barcelona, Granada, Sevilla, Santiago de Compostela and Valencia), to which the questionnaires were sent by registered post (Table 1), and completed anonymously only by those students who had completed the postgraduate course. The questionnaires, which were colour coded according to the source, each faculty having a different colour, collected respondents personal data with regard to age, sex, and previous training. There then followed instructions on how to complete the forms, where each question could be answered on a 5 point Likert-type scale, graded as follows: 1 not at all prepared, 2 slightly prepared, 3 adequately prepared, 4 quite well prepared, and 5 well prepared. The 80 questions were divided into blocks in order to obtain information about the knowledge and skills acquired by the postgraduate students in the different areas of Oral Surgery (clinical history, diagnosis and complementary tests, treatment planning, surgical treatment, medical treatment and students evaluation of the Master in Oral Surgery).
Of the faculties surveyed, 18 people replied from the university of Barcelona, 6 from Granada, 9 from Madrid, 7 from Santiago de Compostela, 2 from Sevilla and none from Valencia (being unable to locate past students), obtaining a sample of 42 individuals with an age ranging from 25 to 44 years. The small number of people polled was due to the great difficulty in locating past students who had completed the postgraduate course in Oral Surgery.
The questionnaires were returned from the respective centres by registered post and the results were processed using the SPSS 9.0 statistical package.
Said questionnaires were evaluated by descriptive statistics, initially obtaining frames of reference for the number of students per respondent centre, their age, sex and qualifications, evaluating all 80 answered questions.
Later, a comparative study was made between the answers given by each student with respect to his or her age, sex and qualifications.
Forty-two questionnaires were completed, of which data relating to age was missing in 6 cases, to sex in 2 cases, and to previous training in 3 cases.
Of the 42 questionnaires, 6 came from the Faculty of Dentistry Granada, 2 from Sevilla 9 from Madrid, 18 from Barcelona, and 7 from Santiago de Compostela.
The age range of those polled was from 25 to 44 years, with a distribution by sex of 18 males and 22 females. With respect to previous training 3 were stomatologists and 36 were dentists.
As can be observed in table 2, the answers were analyzed according to the percentage of scores for each value from 1 (not at all prepared) to 5 (well prepared) given by each respondent. The results reflected a worse preparation for the Oral Surgery postgraduates in those subjects relating to the treatment planning for salivary gland pathologies (Q22), the surgical treatment of said glands (Q54), to the treatment planning for maxilla/mandible osteitis and osteomyelitis (Q31), intervention plan for osteoradionecrosis (Q32), treatment plan for transposition of the inferior dental nerve (Q37), the carrying out of said transposition (Q69) and the planning of tumor surgery (Q21 and Q53). [Where Q = question].
A difference according to sex existed in a series of questions where the score given by the females was higher than that of the males. Specifically, these referred to the interpretation of oclusal radiographies (Q4), treatment planning for impacted teeth (non-wisdom) (Q14), treatment planning for complicated extractions (Q17), treatment planning for tumors (Q21), treatment planning for salivary gland pathologies (Q22), treatment planning for dentoalveolar traumata (Q23), planning a tissue biopsy (Q27), treatment planning for periapical infections (Q28), of bucco-sinusal communications (Q33), the surgical treatment of medically compromised patients (Q40), extraction of impacted widom teeth (Q42) complicated extractions (Q46), fenestration for orthodontia (Q49), treatment of cysts (52), treatment of soft tissue lesions (Q58), carrying out biopsies (Q59), treating osteoradionecrosis (Q64), and medical treatment of medically compromised patients (Q75).
In the section on previous training, the stomatologist feels better prepared in treatment planning for complicated extractions (Q17), and for carrying out a dental transplant (Q48).
Regarding the data for age, a non-parametric correlation was made using the Spearman Rho correlation, finding that the older the student the less prepared they felt (giving a lower score) to carry out a treatment plan that involved a biopsy (Q27) (r = -.391), but feeling better prepared (giving a higher score) for the treatment of dental emergencies (Q39) (r = .346), treatment of dentoalveolar trauma (Q55) (r = .370) and treatment of osteitis and osteomyelitis (Q63) (r = .269) (Table 3).
The postgraduate oral surgeons from the dental faculties of the Spanish public universities seem to be generally satisfied with the teachings and practices recieved on the courses. There are, however, complicated treatments such as the transposition of the inferior dental nerve, treatment of tumors, salivary glands and osteoradionecrosis which seem to relate largely to the maxillofacial surgeons. This implies an important contradiction, since, according to the European union member states, the specialist in oral surgery is considered competed to carry out dentoalveolar surgery, surgery of the maxilla/mandible, and surgery os the soft tissue of oral cavity (including palcement of resection and filler prosthes following surgical intervention, and surgical correction of congenital or acquired anomalies and malocclusions of the maxilla/mandible) (2). It seems therefore, that all surgery in the oral cavity should be covered both by the oral surgeon and the maxillofacial surgeon, both having the same training in the oral field. With respect to the difference found in some answers between dentists and stomatologists, this has already been hypothesised by Jan E. et al. (6) in a study on the quality of dental education at the Catholic University of Leuven, believing that following the evaluation of the questionnaires they would obtain different results depending on previous training and/or the academic position of those polled.
Atchison et al. (7), in their study evaluating the postgraduate courses at the UCLA School of Dentistry also sent out questionnaires which collected information regarding the infrastructure of the postgraduate courses, the program emphasis, resident preparation prior to entering the program, and a description of the patients treated. They received 81 completed questionnaires. More than half of the program directors reported a greater emphasis in implantology, and furthermore that a high proportion of the residents beginning these studies were not adequately prepared.
Eaton et al. (8), carried out a regional study to evaluate a project which provided dental courses by video conference (PROVIDENT) to participating dentists. It was made up of 41 video conferences distributed among the four campuses of the London Dental Schools and postgraduate centres in South East England. The video conferences were evaluated using pre-piloted questionnaires containing specific and open questions. The questionnaires were completed at the end of the video conferences by all participants, obtaining a positive response to the use of video conferences as a means of delivering educational material from dental schools to small groups, with the potential to respond to dentists specific needs directly at home or at work. This article opens up a way of disseminating knowledge among oral surgeons, through interactive courses in oral surgery based on theoretical studies and live video operations, to which access can be provided by Internet and which can be promoted by societies involved in oral surgery such as the Spanish Society of Oral Surgery (SECIB).
Brenzina (9), carried out a study evaluating postgraduate courses and explaining the different objectives, contents and methods of evaluating the teaching on said courses, offering different evaluation techniques, such as the training and knowledge obtained at the end of the courses, as in this investigative study.
Stiefel and Truelove (10) studied a five-year postgraduate dentistry training project for the treatment of patients with severe disabilities, in which participated dentists, dental hygienists, and assistants, demonstrating significant post-course gains in cognitive knowledge and confidence in the treatment of this type of patient. It would be interesting to promote specific thematic courses in oral surgery and follow-ups to postgraduate courses where pre-surgical professionals, dental auxiliaries can meet together in order to strengthen the integration of these personnel and to increase the quality of surgical treatment.
Chancellor (11) considers it important that postdoctoral programs on general anesthesia and sedation for dentists be accredited by the Commission on Dental Accreditation. Said discipline does not seem to be well represented in the Masters programs in oral surgery in Spain, and should be given greater importance so as to allow its indication in certain situations such as surgery on children or patients where local anesthetic cannot be used.
· A generally positive evaluation was given by the students to the education in oral surgery, both theoretical and practical, provided by the Oral Surgery postgraduate courses in Spain, except in the more complex areas such as the transposition of the dental nerve, treatment of tumors, treatment of salivary gland pathologies, and osteoradionecrosis, which seem to relate to the maxillofacial surgeons.
· Females either regard themselves as significantly better prepared, or they gave themselves a more positive score, in the majority of topics related to oral surgery.
· It would seem that with age comes greater experience and the possibility of studying more complex subjects such as dental emergencies, dentoalveolar trauma, osteitis and osteomyelitis.
· The stomatologists score themselves more positively, considering themselves better able to carry out more advanced treatment such as the transpositon of the inferior dental nerve, and the planning of complicated extractions.
To the directors and students of the Postgraduate coursesin Oral Surgery of the Facultades de Odontología de la Universidad de Barcelona, Madrid, Granada, Santiago de Compostela, Sevilla y Valencia, for their contribution to this study and to D. Juan de Dios Luna del Castillo (Profesor Titular de Bioestadística de la Facultad de Medicina de Granada)
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