ORAL AND MAXILLOFACIAL SURGERY TRAINING PROGRAM

The University of Adelaide, in association with the Royal Adelaide Hospital and the South Australian
Dental Service at the Adelaide Dental Hospital, offers an advanced education program in Oral and
Maxillofacial Surgery (OMFS), designed to meet the requirements of the Division of Oral and
Maxillofacial Surgery of the Royal Australasian College of Dental Surgeons, and the Australian and
New Zealand Association of Oral and Maxillofacial Surgeons. This program leads to Fellowship in
Oral and Maxillofacial Surgery of the Royal Australasian College of Dental Surgeons [FRACDS
(OMS)] and Clincal Doctorate degree [Clin. Dent. Doc. (OMS)] in Oral and Maxillofacial Surgery and a Medical
Degree (MBBS) from the University of Adelaide.

The program is designed to provide the trainee sufficient theoretical and educational background to
meet all current standards available in Oral and Maxillofacial Surgery in Australia and New Zealand. All
trainees are prepared for a career in Clinical Practice either in major public hospitals or private
practice. In addition, they are encouraged to develop skills in teaching and research which would be a
useful background for an academic career. The minimum duration after selection is eight years.
Generally, two years are spent in Clinical Oral and Maxillofacial Surgery Training plus general medical
and surgical background topics to ensure that the candidate fulfils the requirements in Basic Surgical
Science. This is followed by lateral entry into the fourth year of the Medical Degree. On completion of
the Medical Degree and Intern requirements, a further two years of advanced Oral and Maxillofacial
Surgery training is required, prior to gaining eligibility to sit the FRACDS (OMS).

Philosophically, the Unit works on an individual tailored basis and hence differing sequences of training
and Medical Degree subjects can occur. The [Clin. Dent. Doc. (OMS)] is commenced in the first two years, and
then finalised in the latter period of surgical training.

Registrars in the Oral and Maxillofacial Surgery period receive a salary. During the Medical Degree
component, no salary is paid. Appropriate University fees for the [Clin. Dent. Doc. (OMS)] and the Medical
Degree must be paid.

Clinical Doctorate Degree [Clin. Dent. Doc. (OMS)]

This program consists of either two years full-time plus clinical training or, more commonly, four years
half-time including clinical training.

The distribution of credit towards a Degree is clinical training 60%, course work 10%, research 30%.

The research project is usually in a clinical area, although animal laboratory studies are conducted. The research commitment may also be met by a series of publications in referred journals.

APPLICATION PROCEDURES

Applicants must hold a registrable Dental Degree. Following Dental training applicants should have had
at least two years' General Dental experience and are required to have passed the Primary Examination
of the Royal Australasian College of Dental Surgeons or its equivalent.

Applicants, in the first instance, should write to

Professor Alastair N. Goss,
Professor and Director, Oral and Maxillofacial Surgery,
The Adelaide University,
Adelaide, Australia 5005.

This application should include a Curriculum Vitae and names of referees who have expressed
willingness to be approached. Applicants who are unsure or who require advice, are encouraged to
speak with Professor Goss by telephone.

Visitation to the Unit is not mandatory but is strongly advised. This gives the applicant the opportunity
to visit and closely examine the Unit staff, facilities and patient pool at first hand. This is considered a
two-way process.

Visits are usually for two days and must be organised and approved in advance.

To arrange this, contact Professor Goss. If he agrees to your visit, then this is arranged via

Ms. Alison Hambour,
Administrative Officer,
Oral & Maxillofacial Surgery,
Adelaide, Australia 5005

Telephone: (61) (8) 8303 5103
Facsimile: (61) (8) 8303 4402.
Email: oral.surgery@adelaide.edu.au

New trainees are appointed as current trainees complete their requirements. On average, one new
trainee is appointed annually. Dependent on the progress of current trainees in some years, no places
may be available or, at maximum, two places.

MEDICAL GRADUATES

Medical graduates wishing to pursue a career in Oral & Maxillofacial Surgery require a dental degree.
The University of Adelaide Dental Faculty has an arrangement whereby Medical graduates may
laterally enter Dental School at 3rd Year. Such arrangements are subject to individually tailored
bridging requirements.

The usual pathway for medically qualified applicants would be:

- Medical degree.
- 1-2 years' experience with an emphasis towards surgery.
- Preferably first part RACS required (not mandatory).
- Demonstrated interest in Maxillofacial Surgery.
- Dental Bridging Course 4-6 weeks during January, February.
A fee will be charged for this course.
- Modified third year. BDS.
- Modified fourth year. BDS.
- Full fifth year. BDS.
Graduated and registrable BDS.

The candidate will then apply for training in advanced Oral & Maxillofacial Surgery.

- Acceptance into the BDS program at the University of Adelaide by
medically qualified applicants, does not imply automatic acceptance into the Oral & Maxillofacial
Surgery program.

- Applicants who are dually qualified in Dentistry and Medicine, will
compete for a place in the Oral & Maxillofacial Surgery program on the same basis as other applicants.

ADELAIDE UNIVERSITY FEES (2001)

1. Australian Residents and New Zealand Citizens:

Clin. Dent. Doc. (OMS) - $62,610 total.
($15,000 over 4 years)

Medical Degree - $5,870 per annum under the HECS Scheme.

2. Non-Australian Residents and Non-New Zealand Citizens:

Clin. Dent. Doc (OMS) - $154,500 total.
(usually $25,000 p.a. over 4 years)

Medical Degree - $26,500 for MBBS for 6 years.

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THE CAMPUS

Adelaide is the Capital City of the State of South Australia. This is a large State in the southern central
part of Australia. Overall, the State has a population of 1.4 million people, spread over its one million
square kilometres. Of these, however, 1.0 million people live within 15 kilometres of the centre of
Adelaide. Thus, essentially, it is a City-State. This means that the majority of the Health and
Educational facilities are located in Adelaide or in close proximity.

The Oral and Maxillofacial Surgery Unit is the sole public facility for Oral and Maxillofacial Surgery
services. Patients of a Dental nature are required to have a Health Care Card and meet eligibility
requirements. This covers approximately 40% of the population. Patients with more
Maxillofacial-related problems come under Medicare requirements for public hospital treatment. This is
available to the whole population. Thus there is a substantial patient pool.

The Oral and Maxillofacial Surgery Unit also provides the public facility for the Northern Territory. This
Territory, which is in the northern central region of Australia, has 160,000 people spread over an area
of 1.35 million square kilometres. Most of these people are either centred about Darwin (100,000
people), or Alice Springs (30,000 people).

The Oral and Maxillofacial Surgery Service is located at the following hospitals:

ADELAIDE DENTAL HOSPITAL

This Hospital facility is shared by the Specialist Clinical Services of the South Australian Dental
Hospital and the Faculty of Dentistry of the University of Adelaide. The Oral and Maxillofacial Surgery
Unit has its principle Outpatient Department in this building. This acts as the Outpatient Clinic for both
the Adelaide Dental Hospital and also for the Royal Adelaide Hospital. It sees a minimum of 16,000
patients per year. It is fully equipped with eight operatories, a full recovery suite and educational
facilities.

The Administrative and University offices, including an office for Registrars, are located in the same
building.

THE ROYAL ADELAIDE HOSPITAL

The Oral and Maxillofacial Surgery Unit is a fully autonomous surgical unit within the Royal Adelaide
Hospital. Administratively, it is part of the Gastrointestinal Services Functional Unit. This consists of
three General Surgical units, one General Medicine unit and Specialist Gastrointestinal Physicians, as
well as the Oral and Maxillofacial Surgery Unit. Ward facilities are shared with the General Surgical
Unit which specialises in ColoRectal surgery.

The Oral and Maxillofacial Surgery Unit conducts three day-stay lists per week, plus four Inpatient
Surgical Lists per week. Emergency surgery is provided through the Emergency Surgical Suite.
THE QUEEN ELIZABETH HOSPITAL

An Outpatient Clinic is run on a fortnightly basis. Emergency surgery is provided as required.

FLINDERS MEDICAL CENTRE

An Outpatient Clinic is conducted on a fortnightly basis. Emergency surgery is provided as required. A
monthly Cleft Palate Clinic is run in association with the Plastic Surgery Unit.

ADELAIDE WOMEN'S AND CHILDREN'S HOSPITAL

On alternate fortnights, an Outpatient Clinic and an Inpatient Theatre List are conducted. Emergency
surgery is conducted as required.

THE LYELL MCEWIN HOSPITAL

An alternate Outpatients and Inpatient Theatre List is conducted on an alternate fortnightly basis.

THE ROYAL DARWIN HOSPITAL

The Oral and Maxillofacial Surgery Unit provides a resident Registrar attached to the Division of
Surgery at this Capital City hospital. A Specialist Oral and Maxillofacial Surgeon from the Adelaide
Unit visits on a monthly basis, and an Oral and Maxillofacial Surgery Specialist is resident in Darwin.

Each Registrar in the Adelaide program would be expected to spend at least three months in Darwin. It
is usual that in total they will spend two rotations in Darwin. This Hospital provides good experience in
trauma, general surgery and tropical diseases.

TEACHING

The University of Adelaide/Royal Adelaide Hospital campus provides a wide exposure of educational
opportunities in all aspects of health and science. There is an expectation that Registrars will fully avail
themselves of these educational opportunities on an individual, rather than on a directed, basis.

The following Clinical Doctorate Degree [Clin. Dent. Doc. (OMS)] course components are mandatory:

(1) CLINICAL ORAL & MAXILLOFACIAL SURGERY
Trainees will spend the equivalent of four years' full-time in supervised clinical practice in Oral &
Maxillofacial Surgery.

(2) RESEARCH METHODS & ETHICS
This course of seminars provides an appreciation of scientific method including practical aspects of
biostatistics, experimental design, research methodology, laboratory safety, use of computers and
bibliographic databases, evaluation of the literature and paper writing.

(3) BRIDGING SUBJECTS FOR MEDICINE -

(a) Anatomy
Below the clavicles general anatomy. Candidates have full access to the dissecting room and facilities in
their first year. Complete Viva examinations on the abdomen, thorax and upper limb and lower limb.

(b) Communication Skills and Ethics
It is usually expected that candidates have sufficient background in this area, and accordingly are
examined in the subject only. In the event of failure or in particular for Registrars who do not have an
Australian background to their dental education, then they will be expected to sit this second year
Medical course. This is approximately one session per week for a year.

(c) Clinical Science Skills
This third year Medical subject takes three sessions per week during the academic term. There are
formal mid and final examinations in this time.

(4) BASIC SURGICAL SCIENCE TUTORIAL
One hour weekly.
(5) CURRENT CASE REVIEW
One-and-a-half hours weekly.

(6) SEMINAR/GENERAL REVIEW
Two hours weekly.

(7) ORAL PATHOLOGY
One-hour seminar weekly. On an individual basis, Registrars will be rostered to a block of Oral
Pathology training.

(8) ANAESTHETIC ROTATION
Registrars will normally complete two one-month rotations to Anaesthesia and Intensive Care.

(9) PROFESSORIAL WARD ROUND
This is conducted weekly.

(10) JOINT ORTHODONTIC/OMFS/ORTHOGNATHIC CONFERENCE
This is held for one afternoon per month. Orthognathic cases are presented and discussed.

(11) HEAD AND NECK CANCER CLINIC
A multidisciplinary Head and Neck Cancer Clinic is held for approximately two hours weekly. This
involves active participation by all surgeons interested in Head and Neck Surgery, Radiation and
Medical Oncology. All patients with Head and Neck cancer from the Oral and Maxillofacial Surgery
Unit are presented at this conference. Senior Registrars usually attend this meeting.

(12) HEAD AND NECK SURGERY ROTATION
Major Head and Neck cases are operated on monthly by the Head and Neck Surgeons. A Senior
Oral and Maxillofacial Surgery Registrar is present to assist with surgery.

(13) MEETINGS
Numerous local meetings on all aspects of Dentistry but including an Oral Surgery Implant Study Group
and a Head and Neck Cancer Study Group are held and Registrars are invited to actively participate in
these.

SAMPLE SCHEDULE
Monday: 8.00 a.m. - Basic Surgical Science Tutorial
12.30 - 2.00 p.m. - Clinical Review of Current Patients

Wednesday: 2.00pm - 3.00pm - Oral Pathology Tutorial
3.00 p.m. - 5.00 p.m. - Seminar/General Review or
once-monthly
2.00 - 5.00 p.m. Orthognathic Conference

Thursday : 2.00 p.m. - Head and Neck Clinic

Friday : 5.00 p.m. - Professorial Ward Round

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ROTATIONS

DAY STAY SURGERY
Monday morning
Tuesday morning
Friday morning

INPATIENT LIST
Monday afternoon
Wednesday morning
Friday morning and afternoon

CONSULTANT CLINICS
Each of the Consultants attached with the Unit, conduct a Consult Session:

Monday to Thursday mornings
Friday afternoon

OUTPATIENT CLINIC
Elective Dentoalveolar surgery and the Casualty Extraction Clinic, which is performed by
undergraduate dental students, are regularly attended by Registrars.

STATISTICAL INFORMATION

In 2000, the Oral and Maxillofacial Surgery Unit saw in excess of 16,000 patients and carried out the
following Inpatient and outpatient procedures:

Orthognathic Surgery - 50-80 patients per year

TM Joint Surgery - 30 patients per year

Trauma - 140+ patients per year

Pre-prosthetic - 20 patients per year

Pathology - 150-200 patients per year

Implants - 20 patients per year

Dentoalveolar Surgery - 1000 patients per year.
(medically compromised,
impacted third molars)
in Day Surgery Unit

REGISTRAR BENEFITS

REGISTRAR SALARIES

Salaries are subject to annual review. In 2001, the following minimum and maximum salary levels were
paid:

Registrar - First Year - ($22,515)
Senior Registrar - ($44,697)

Pro rata on hours actually worked. Registrars are rostered to a 1 in 2 call-back. Allowances are paid for this.

Salary is not paid during Medical School. Some Medical undergraduates with advanced Oral and
Maxillofacial training, do obtain Assistant positions with private Specialist Oral and Maxillofacial
Surgeons. This is a matter essentially between the Registrar and the private Consultant. This work must
not, however, interfere with medical studies. Outside practice is not allowed during the clinical Registrar
years.

It should be noted that salary is primarily paid by the South Australian Dental Service. Thus there are
minimum requirements for sessions spent in the Outpatient Department in the Adelaide Dental Hospital.
If for an individual these sessions are reduced, then the salary is correspondingly reduced.

VACATION AND SICK LEAVE

Vacation Leave is in accordance with the industrial requirements of the South Australian Dental
Service. Generally, this is 20 days of paid vacation per year. The timing of this Leave is at the discretion
of the Head of the Department. Generally, only one Registrar is allowed to be on Leave of any variety
at one time, as otherwise this is disruptive to the conduct of the Clinic. Sick Leave is likewise in
accordance with the rules of the South Australian Dental Service. Prolonged Sick Leave requires
medical certification.

ON-CALL COMMITMENT

All Registrars will perform On-Call duties. Generally, this is on the basis of one week on, one week off,
with two Registrars being On-Call at any one time. Variation in this On-Call requirement may only be
made with the permission of the Director or his nominee.

PRACTICE PRIVILEGES AND OTHER ACTIVITIES OUTSIDE THE TRAINING PROGRAM

The Department of Oral and Maxillofacial Surgery is the Registrar's primary employer and no outside
activities which may infringe on the commitment to the program are allowed.

REGISTRATION

All Registrars must be Registered with the Dental Board of South Australia to practice Dentistry.
Overseas trainees with a non-Registrable degree in South Australia, must obtain a restricted
Registration for supervised practice within the Oral & Maxillofacial Surgery Unit.

PROFESSIONAL LIABILITY COVERAGE

All Registrars are expected to have their own professional indemnity insurance. This should be with one
of the major professional indemnity organisations.

It is noted that public institutions such as the Royal Adelaide Hospital, the South Australian Dental
Service and The University of Adelaide, do have a limited degree of professional indemnity for work
carried out by employees. This is considered insufficient and incomplete, hence the requirement of
professional insurance.

EXAMINATION REQUIREMENTS RACDS

As well as internal examinations, all trainees are expected to complete the various examinations of the
RACDS. All trainees will have completed their Primary examination, but should remain enrolled as
candidates. The Basic Surgical Science examination is conducted regionally, usually after completion of
the Clinical Sciences course. This must be done two years prior to the exit examination. All candidates
will be expected to sit the FRACDS (OMS) on completion of training.

EARLY MANAGEMENT OF SEVERE TRAUMA

All Registrars should have completed the EMST Certificate. This is usually best completed following
Medical training.

CONFERENCES

All Registrars are required to present at ANZAOMS or RACDS Meetings. The topic and the
Registrar will be selected in consultation with the Professor and Director. Registrars will usually prepare
and present at least two such presentations during their attachment to the Unit.

Attendance at other educational courses, including the Senior Registrars course of the RACDS is
strongly encouraged.
Usually Registrars will pay own expenses but receive partial reimbursement from the Registrars Fund at
the completion of the period.

CURRENT ACCREDITATION STATUS OF THE PROGRAM
The program is fully accredited for five years from 2000 by the Accreditation Committee of the
RACDS.

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NOTE TO FOREIGN APPLICANTS

It is difficult for non-Australian residents and non-New Zealand citizens to gain access to the program.
This is because of the requirements to have completed the Primary Examination of the RACDS or its
equivalent.

However, these problems are not insurmountable. A number of trainees, particularly from Oceania and
South East Asia have completed training supported by the World Health Organisation or Aus Aid. This
usually requires Government sponsorship. The Oral and Maxillofacial Surgery Unit does not provide a
lesser program than its full program for overseas graduates.

BACKGROUND READING

ADELAIDE UNIVERSITY, Adelaide, Australia 5005.

- Postgraduate Prospectus 1998.
- Postgraduate Course for International Students 1998.

RACDS - FRACDS (OMS)

Guide to study and graduate training program for candidates undertaking the examination in
Oral and Maxillofacial Surgery

- Royal Australasian College of Dental Surgeons,
64 Castlereagh Street, SYDNEY, N.S.W. 2000

ORAL & MAXILLOFACIAL SURGERY

1. International Guidelines for Speciality Training in Oral & Maxillofacial Surgery.
Int. J. Oral Maxillofacial Surgery 1992. 21:130.

2. The Training and Scope of Oral & Maxillofacial Surgeons.
Goss A. N., Helfrick J., Szuster F. P., Spencer A. J. Int. J. Oral Maxillofacial Surgery. 1996. 74.

3. Oral & Maxillofacial Surgeons 1990. Workforce Study.
Australian Institute of Health & Welfare. Dental Statistics & Research Unit.
University of Adelaide, Adelaide, Australia 1992.

4. Development of a National Clinical Logbook System for Oral & Maxillofacial Surgery Trainees - the
RACDS (OMS) System.
Sambrook P., Smith A., Hewitt G., Goss A. N.
Int. J. Oral & Maxillofacial Surgery. 1996. 25. 242.

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STAFF

Alastair N. Goss BDS, DDSc, FRACDS (OMS), FICD Professor and Director
clinical interests:research interests: temporomandibular joint surgery, trigeminal nerve
damage temporomandibular joint disorders, chronic pain, education

Robert H. B. Jones BDS, MDS, FRACDS (OMS) Deputy Head, Royal Adelaide Hospital Senior
Surgeon
clinical interests:research interests: orthognathic and major reconstructive surgery orthognathic surgery,
relapse

Paul J. Sambrook BDS, MBBS, MDS, FRACDS (OMS) Assistant Director
clinical interests: research interests: pathology implants, psychological aspects of orthognathic surgery and surgical management of traumatic injuries.

Paul Duke BDS, BMBS, FDSRCPS, FRACDS Senior Visiting Consultant
clinical interests: pre-prosthetic surgery and implants

Miles Doddridge BDS, MBBS, MDS, FRACDS (OMS) Senior Visiting Consultant
clinical interests: pathology and reconstructive surgery

The Oral and Maxillofacial Surgery Unit has close associations with the

- Oral Pathology program - Associate Professor David Wilson
- and Orthodontics program - Professor Wayne Sampson.

CURRENT RESEARCH INTERESTS

Research is an essential activity of an Academic Unit in Oral and Maxillofacial Surgery. Some of the
current research activities at The University of Adelaide are as follows:

TEMPOROMANDIBULAR JOINT - ANIMAL MODEL
Several models of internal derangement, osteoarthritis and ankylosis have been developed.

These pathologic joints are then used to further understanding of the pathophysiology of the conditions.
They are also used to evaluate various means of surgical reconstruction. This ongoing project involves
the Aichi-Gakuin and Gifu Universities in Japan, and the Bioengineering Centre of the Orthopaedic
Department at the Royal Adelaide Hospital (RAH).

TEMPOROMANDIBULAR JOINT - CLINICAL TRIALS
A number of prospective trials of various treatment methods are in progress. These include
arthroscopy, temporalis muscle reconstruction, open reduction of fracture dislocations and TMJ implants.

HYPERBARIC OXYGEN
The role of hyperbaric oxygen in the prevention and management of radionecrosis is being evaluated in
a retrospective trial with the Hyperbaric Unit, RAH. A prospective trial is underway into the effect of
hyperbaric treatment of patients with radiation induced xerostomia. This is a two centre trial with the
Townsville Hospital.

ORTHOGNATHIC SURGERY - RELAPSE
A key issue is the stability, or lack of it, with various orthognathic procedures. A two year post
operative follow up study has been completed on mandibular advancements, and a similar trial is in
progress on setback procedures. These studies have been conducted in conjunction with the
Anthropology Unit of the Dental School.

PSYCHOLOGIC ASSESSMENT
It is well accepted that psychologic assessment is essential for chronic pain patients. A modified form of
this assessment has been applied prospectively to orthognathic surgical patients. This was a much better
predictor of patient satisfaction than the technical quality of the operation.
A simplified questionnaire, suitable for use in private practice, is under development.

IMPLANTS
A fifteen year follow-up of the transmandibular implant has been finalised. Currently hydroxyapatite
coated titanium implants are used and the prospective trials have reached five years, with a 90% plus
functional integration of fixtures.

Extra oral implants are also being evaluated.
This study is co-ordinated by the maxillofacial prosthodontist.

SLEEP APNOEA
Cephalometric studies on Sleep Apnoea patients have been comppleted.
Jaw repositions by either devices or surgery are in progress.

These studies are in collaboration with the Thoracic Medicine and Otorhinolaryngology Unit of the
Royal Adelaide Hospital.

PATIENT CONTROLLED SEDATION
Most dentoalveolar surgery requiring hospitalisation is done using intravenous techniques on a day
surgery basis at the RAH. In particular, the recovery rate, both physical and behavioural, from a patient
controlled sedative technique, is being evaluated. Thus far it has been shown to have considerable
advantages over other techniques.

These studies are being performed in association with the Anaesthetics and Psychology Departments at
the RAH and The University of Adelaide.

PROFESSIONAL EDUCATION
The least researched area in Oral and Maxillofacial Surgery is the effect of changes in education on
professional scope and practice. The ANZAOMS Workforce Study was conducted by The Dental
Statistics and Research Unit of The University of Adelaide, with a Consultancy from the Oral and
Maxillofacial Surgery Unit.

These are just the current and major areas of investigation. A number of other trials are under
consideration, student electives underway and Case Studies of unusual cases are published as they
arise.

Any Oral and Maxillofacial Surgeon requiring further details, or who would like advice on a project of
their own, is welcome to contact Professor Alastair Goss.
Telephone (08) 8303 5103 & Fax (08) 8303 4402. oral.surgery@adelaide.edu.au.

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