A comprehensive didactic program has been developed to exceed published standards and to provide a basis for successful performance on board examinations. This includes weekly didactic seminars; monthly grand rounds; journal club sessions; morbidity and mortality reviews; case presentations; and interdisciplinary conferences, such as cleft palate/craniofacial team meetings, tumor board, surgical/orthodontic conferences and implant treatment planning sessions. Each resident must successfully complete a one-semester course in Research Methods as well as a Head-and-Neck Cadaver Dissection course, and must achieve and maintain certification in advanced cardiac life support and advanced trauma life support. Residents also spend time in the Pathology Department reviewing pertinent cases and developing an understanding of the microscopic evaluation of surgical specimens.

Residents are encouraged to develop sound clinical judgment based upon valid scientific principles. The rationale for medical and surgical decisions is routinely discussed in conferences and on teaching rounds held by faculty at all three hospitals. Off-service rotations include four months in the Department of Anesthesiology, including assignment to cases involving pediatric and medically fragile patients. This training is supplemented by resident management of a large volume of adult and pediatric conscious sedation and ambulatory general anesthesia cases under attending supervision.

Residents are oriented to physical diagnosis upon enrollment in the program. After an introductory course within the department, first-year residents rotate at St. Joseph’s Regional Medical Center’s (SJRMC) family practice facility to acquire basic skills in history taking and physical examination. Later, residents are assigned to the Department of Medicine for two months and function as part of a team following patients admitted to the hospital for medical care. The four month general surgery rotation includes one month in the SICU. One additional month is made available for an elective rotation.

At SJRMC, residents participate in team meetings of the Craniofacial Center and operate with the center’s craniofacial surgeon, gaining experience in the evaluation and management of clefts and other craniofacial anomalies, craniosynostosis, swallowing disorders and velopharyngeal incompetence. Since SJRMC has no plastic surgery or ENT residents, senior oral and maxillofacial surgery residents are utilized to support the plastic surgery and otolaryngology/head-and-neck surgery services. Experience is gained in head- and-neck oncologic surgery, facial cosmetic procedures and the use of flaps for reconstructive surgery of the head and neck. The VA NJ Health Care System (VANJHCS) provides additional experience with head-and-neck oncologic surgery, as well as with dentoalveolar, preprosthetic and reconstructive surgery, including implant site preparation and placement. Geisinger Medical Center (GMC) is a level I trauma facility with an active OMS service. Residents gain valuable experience in third molar surgery, ambulatory anesthesia, management of maxillofacial trauma, temporomandibular joint and orthognathic surgery, as well as cosmetic procedures. The large number of surgical procedures performed by graduating residents spans the full spectrum of oral and maxillofacial surgery. Graduates are well equipped to enter practice, and are well prepared to begin the process of board certification.

Interested senior residents may be sponsored for the USMLE exam through an affiliation with St.  George’s University School of Medicine. Selected graduating residents will be offered advanced standing at St. George’s after passing USMLE I and successfully completing residency training.

Components of OMS Training 

Section 1 — Patient Assessment
Material for this section is derived from the following elements in the resident curriculum:

• Weekly didactic    schedule and grand rounds
• Introductory    course in physical diagnosis
• Off-service    rotations
• Physical     Diagnosis
• Medicine
• Anesthesiology
• General Surgery/ICU
• On-service    experience (SJRMC, VANJHCS, GMC)
• ER
• Admitted and     ambulatory patient care
• Rounds
• ACLS Course
• ATLS Course

Goals
1. To develop proficiency in history taking regarding a maxillofacial chief complaint;
2. To develop proficiency in examining the maxillofacial regions;
3. To develop a group of core competencies that are indices of resident achievement in this area (see below); and
4. To expose the resident to the evaluation and management of patients with complex medical histories and those who are acutely ill.

Core Competencies*
(* number listed with each item represents the year of training during which competence should be achieved)
1. Taking a patient history (1)
2. Performing a complete physical examination (1)
3. Ordering and interpretation of standard laboratory tests (1)
4. Accurate assessment of the emergency room patient (1)
5. Performing a preanesthetic evaluation and appropriately assigning an ASA classification (2)
6. Performing an inpatient postoperative assessment (2)
7. Ordering and interpretation of special/advanced laboratory tests (2)
8. Ordering and interpretation of appropriate maxillofacial imaging studies (2)
9. Performing a presurgical evaluation and appropriately assigning risk (2)

Objectives
1. Perform accurate medical risk assessment on more than 200 outpatients
2. Perform preanesthetic evaluations on more than 200 outpatients
3. Admit more than 200 patients to the OMS service
4. Evaluate and manage more than 200 patients in the emergency room
5. Successfully complete all elements of the physical diagnosis program
6. Successfully complete the patient examination at the conclusion of the medicine rotation
7. Successfully complete the rotations in internal medicine and general surgery/ICU
8. Successfully complete ACLS and maintain certification throughout the duration of the training program 

Section 2 — Anesthesia
Material for this section is derived from the following elements in the resident curriculum:

• Weekly didactic    schedule and grand rounds
• Off-service    rotations
• Physical     Diagnosis
• Anesthesiology    
• General     Surgery/ICU
• On-service    experience (SJRMC, VANJHCS, GMC)
• Local     anesthesia and nitrous oxide
• Adult     conscious sedation
• Pediatric     conscious sedation
• Adult deep     sedation/GA
• Pediatric deep     sedation/GA
• ACLS

Goals
1. To develop proficiency in the administration of local anesthesia and nitrous oxide;
2. To develop a group of core competencies that are indices of resident achievement in this area (see below); and
3. To expose the resident to the evaluation and anesthetic management of patients with complex medical histories and those who are acutely ill or seriously injured. 

Core Competencies*
(* number listed with each item represents the year of training during which competence should be achieved)
1. Performing a preanesthetic evaluation and appropriately assigning an ASA classification (2)
2. Complete and proper preparation of the ambulatory patient for sedation or GA (2)
3. Complete and proper preparation of facilities and equipment for sedation or GA (2)
4. Appropriate postanesthetic monitoring and discharge evaluation (2)
5. Safe and effective administration of parenteral sedation agents (3)
6. Safe and effective administration of general and dissociative anesthetics (4)
7. Prompt recognition and management of minor and major anesthesia-related complications (4) 

Objectives
1. Perform preanesthetic evaluations on more than 200 adult outpatients
2. Perform preanesthetic evaluations on more than 200 adult inpatients
3. Perform preanesthetic evaluations on more than 100 pediatric patients
4. Administer conscious sedation to more than 200 adult patients
5. Administer general anesthesia to more than 200 adult patients
6. Administer sedation, dissociative anesthesia and/or general anesthesia to more than 40 pediatric patients
7. Successfully complete the rotations in anesthesiology and pediatric anesthesiology
8. Successfully complete ACLS and maintain certification throughout the duration of the training program
9. Demonstrate supplemental local anesthetic techniques used as alternatives to conventional blocks and infiltrations.
10. Demonstrate appropriate patient management when administering nitrous oxide/oxygen

 

Section 3 — Dentoalveolar Surgery
Material for this section is derived from the following elements in the resident curriculum:

• Weekly didactic    schedule and grand rounds
• On-service    experience (SJRMC, VANJHCS, GMC)
• Outpatient     clinics
• OR cases
• Rounds
• Head-and-Neck    Anatomy Course

Goals
1. To develop proficiency in the extraction of teeth and associated surgical procedures; and
2. To develop a group of core competencies that are indices of resident achievement in this area (see below).

Core Competencies*
(* number listed with each item represents the year of training during which competence should be achieved)
1. Frenectomy (1)
2. Incisional and excisional biopsy of soft tissue lesions (1-2)
3. Surgical management of periodontal and periapical pathologic processes (2)
4. Maxillary tuberosity reduction (2)
5. Surgical management of odontogenic infection (2)
6. Surgical management of intrabony lytic lesions (2-4, depending on size and proximate anatomical structures)
7. Surgical extraction of impacted teeth (3)
8. Appropriate use of the CO2 laser in oral soft tissue surgery (3)
9. Surgical management of unerupted teeth for orthodontic purposes (3)
10. Removal of maxillary and mandibular tori (3)
11. Retrieval of root from maxillary sinus via Caldwell-Luc (4) 

Objectives
1. Perform more than 500 extractions of erupted teeth
2. Perform more than 100 extractions of impacted teeth
3. Perform more than 25 minor preprosthetic procedures
4. Perform more than 50 dentoalveolar surgical procedures on children
5. Perform more than 5 apicoectomies
6. Surgically manage more than 10 intrabony lytic lesions of the jaws not associated with dental apical pathology
7. Perform more than 50 incisional and/or excisional biopsies of the dentoalveolar soft and/or hard tissues
8. Perform more than 100 alveoloplasty procedures
9. Expose and bracket five or more unerupted teeth 

Section 4 — Oral and Craniomaxillofacial Implant Surgery
Material for this section is derived from the following elements in the resident curriculum:

• Weekly didactic    schedule, grand rounds and implant conferences
• On-service    experience (SJRMC, VANJHCS, GMC)
• Outpatient clinics
• OR cases
• Rounds
• Head-and-Neck    Anatomy Course

Goals
1. To develop a group of core competencies that are indices of resident achievement in this area (see below);
2. To expose the resident to different types of implants and provide experience in placement of screw-type and press fit fixtures;
3. To expose the resident to various surgical techniques used to develop or augment implant placement sites; and
4. To expose the resident to implant-assisted prosthetic rehabilitation of the eye, the ear and other maxillofacial regions outside of the mouth.

Core Competencies*
(* number listed with each item represents the year of training during which competence should be achieved)
1. Conducting a medical and surgical pre-implant evaluation (2)
2. Ordering and interpretation of maxillofacial imaging that will meaningfully enhance the database available prior to implant placement (2)
3. Developing an appropriately designed and properly sequenced implant treatment plan in collaboration with restorative dentist (3)
4. Placement of implants in the edentulous anterior mandible (3)
5. Placement of implants in other regions of the maxilla and mandible (4)
6. The use of bone or bone substitutes as an adjunct to implant placement (4)
7. Soft tissue procedures adjunctive to implant placement (4)

Objectives
1. Place more than 50 implants in the jaws and/or other facial bones
2. Perform more than 6 adjunctive surgical procedures with implant placement (staged or simultaneous)
3. Participate in collaborative treatment planning sessions with restorative dentists
4. Discuss the rationale and surgical technique for placement of endosseous implants in bones other than the jaws as part of a maxillofacial prosthetic treatment plan 

Section 5 — Surgical Correction of Dentofacial Deformities
Material for this section is derived from the following elements in the resident curriculum:

• Weekly didactic    schedule and grand rounds
• On-service    experience (SJRMC, VANJHCS, GMC)
• Outpatient     clinics
• OR cases
• Rounds
• Craniofacial team    meetings and orthognathic conferences
• Head-and-Neck    Anatomy Course 

Goals
1. To develop a group of core competencies that are indices of resident achievement in this area (see below);
2. To expose the resident to a variety of dentofacial deformities for which surgical-orthodontic correction is indicated; and
3. To expose the resident to the orthodontic treatment planning of surgical-orthodontic cases. 

Core Competencies*
(* number listed with each item represents the year of training during which competence should be achieved)
1. Identification of patients who may benefit from orthognathic surgery (1)
2. Stent fabrication (3)
3. Application of rigid fixation in orthognathic surgery (3)
4. Developing a diagnostic database and treatment plan for orthodontic-surgical correction (4)
5. Performing mandibular ramus osteotomies (4)
6. Performing osteotomies of the maxilla for RPE or other distraction cases (4)
7. Performing mandibular osteotomies for chin movements (4)
8. Performing osteotomies of the maxilla for segmental LeFort I surgery (4)
9. Use of autogenous bone grafting and bone substitutes in orthognathic surgery (4)   

Objectives
1. Comprehensively manage more than 10 patients with dentofacial deformities
2. Perform more than 12 mandibular osteotomies
3. Perform more than 10 maxillary osteotomies   

Section 6 — Cleft Lip and Palate and Craniofacial Anomalies
Material for this section is derived from the following elements in the resident curriculum:

• Weekly didactic    schedule and grand rounds
• On-service    experience (SJRMC, GMC)
• Outpatient     clinics
• OR cases
• Rounds
• Craniofacial team    meetings and orthognathic conferences
• Off-service    experience with craniofacial surgeon (expanded curriculum)
• Head-and-Neck    Anatomy Course

Goals
1. To develop a group of core competencies that are indices of resident achievement in this area (see below);
2. To expose the resident to a wide variety of craniofacial anomalies and their management;
3. To expose the resident to the full spectrum of surgical procedures indicated in the management of cleft lip and palate; and
4. To expose the resident to team management of craniofacial anomalies. 

Core Competencies*
(* number listed with each item represents the year of training during which competence should be achieved)
1. Identification of patients with craniofacial anomalies (1)
2. Describing the relationship between the structural components of the maxillofacial regions and critical functions such as ventilation, swallowing and speech (2)
3. Describing the different techniques for cleft lip repair with their advantages and disadvantages (3)
4. Describing the different techniques for cleft palate repair with their advantages and disadvantages (3)
5. Harvesting bone graft from the anterior iliac crest in pediatric patients (3)
6. Comprehensive management of the residual alveolar cleft with bone grafting (4) 
7. Participation in the team evaluation and management of patients with craniofacial anomalies (4)  

Objectives
1. Perform 5 anterior iliac crest bone harvestings in pediatric patients
2. Bone graft 5 residual alveolar clefts
3. Participate in 8 cleft lip repairs, cleft palate repairs and/or pharyngoplasties
4. Describe the indications for, technique for and timing of costochondral graft reconstruction in craniofacial microsomia 

Section 7 — Trauma Management
Material for this section is derived from the following elements in the resident curriculum:

• Weekly didactic    schedule and grand rounds
• On-service    experience (SJRMC, VANJHCS, GMC)
• Outpatient     clinics
• OR cases
• ER
• Rounds
• Off-service    rotations
• Physical     Diagnosis
• General     Surgery/ICU
• ATLS
• Head-and-Neck    Anatomy Course

 Goals
1. To develop proficiency in the initial assessment and emergency management of patients with maxillofacial injuries;
2. To develop proficiency in the management of mandibular fractures;
3. To develop a group of core competencies that are indices of resident achievement in this area (see below); and
4. To expose residents to the full spectrum of hard, soft and specialized tissue injuries to the maxillofacial and associated regions. 

Core Competencies*
(* number listed with each item represents the year of training during which competence should be achieved)
1. Utilizing splinting techniques for dentoalveolar trauma (1)
2. Repair of simple facial lacerations (1)
3. Performing closed reduction of isolated nasal fractures (2)
4. Ordering and interpretation of appropriate imaging to assist in the diagnosis and treatment planning of patients with maxillofacial injuries (2)
5. Repair of complex facial lacerations (2-3)
6. Performing ORIF of the fractured mandible (3)
7. Performing ORIF of the fractured ZMC complex (4)
8. Repairing orbital blow out fractures (4)
9. Comprehensive management of the panfacial fracture patient (4)
10. Surgical management of frontal sinus injuries (4)

Objectives
1. Describe the signs and symptoms of mandible fractures
2. Describe the signs and symptoms of midfacial fractures
3. Repair 50 facial lacerations
4. Perform 50 closed reductions of fractured mandibles
5. Perform 20 ORIF of fractured mandibles
6. Perform 20 ORIF of midfacial fractures
7. Participate in the management of two or more patients with frontal sinus injuries
8. Participate in the comprehensive management of five or more trauma patients with multiple injuries 

Section 8 — Surgical and Nonsurgical Management of TMD
Material for this section is derived from the following elements in the resident curriculum:

• Weekly didactic    schedule and grand rounds
• On-service    experience (SJRMC, VANJHCS, GMC)
• Outpatient     clinics
• OR cases
• Rounds
• Participation    with TMJ/Facial Pain team
• Head-and-Neck    Anatomy Course 

Goals
1. To develop proficiency in the initial assessment of patients with complaints of orofacial pain and/or temporomandibular dysfunction;
2. To develop a group of core competencies that are indices of resident achievement in this area (see below); and
3. To expose residents to a variety of surgical procedures which may be indicated in the management of TMD.

Core Competencies*
(* number listed with each item represents the year of training during which competence should be achieved)
1. Identifying patients who may benefit from treatment of orofacial pain and/or TMD symptoms (1)
2. Developing a nonsurgical treatment plan for these patients (2)
3. Recommending surgical treatment only when appropriate and indicated by recognized standards of care (3)
4. Developing a surgical treatment plan for the TMD patient (4)
5. Comprehensive management of the TMJ surgery patient (4)

Objectives
1. List indications for operative management of patients with orofacial pain/TMD
2. Discuss imaging modalities useful in the evaluation of TMD
3. Interpret MR images of normal and deranged TM joints
4. Perform two or more arthroscopic procedures
5. Perform three or more open joint surgical procedures
6. Describe the indications for joint replacement using alloplastic materials 

Section 9 — Diagnosis and Management of Pathologic Conditions
Material for this section is derived from the following elements in the resident curriculum:

• Weekly didactic    schedule and grand rounds and lectures by oral pathologist
• Tumor board
• On-service    experience (SJRMC, VANJHCS, GMC)
• Outpatient     clinics
• OR cases
• Rounds
• Off-service    rotations
• Pathology
• Physical     Diagnosis

Goals
1. To develop proficiency in the diagnosis and management of common pathologic entities of the oral cavity and associated tissues;
2. To develop a group of core competencies that are indices of resident achievement in this area (see below);
3. To expose the resident to a wide variety of pathologic entities of the maxillofacial regions; and
4. To expose the resident to the oral manifestations of a wide variety of systemic conditions that may impact upon oral health. 

Core Competencies*
(* number listed with each item represents the year of training during which competence should be achieved)
1. Developing a differential diagnosis (1)
2. Appropriately selecting and utilizing a biopsy technique for tissue diagnosis (1)
3. Ordering and interpreting imaging that provides meaningful information regarding a maxillofacial pathologic lesion (2)
4. Comprehensive management of patients with benign, non-aggressive cysts and tumors (2)
5. Comprehensive management of patients with benign, aggressive lesions of the jaws (3)
6. Comprehensive management of patients with submandibular sialolithiasis (3)
7. comprehensive management of patients with head-and-neck malignancy (4)
8. Prevention, diagnosis and management of osteoradionecrosis (4)
9. Comprehensive management of patients with mandibular osteomyelitis (4)
10. Providing a description of a hisopathologic slide and correlating with clinical information (4)

Objectives
1. Perform 25 biopsies
2. Use a toluidine blue staining technique on 10 patients
3. Surgically manage more than 10 benign soft tissue lesions
4. Surgically manage more than 10 benign intrabony cysts and/or tumors of the jaws
5. Surgically manage more than 10 patients with significant infections of the head and neck
6. Treat 4 or more children with maxillofacial pathologic conditions
7. Treat 2 or more patients with osteonecrosis or osteomyelitis of the jaws
8. Describe the relative merits and potential disadvantages of surgery and radiation therapy as primary modalities in the treatment of stage I SCCA
9. Diagnose and medically mange oral mucosal disease in 5 or more patients
10. Provide a satisfactory description of a histopathologic slide of a pathologic entity from the maxillofacial regions 

Section 10 — Reconstructive Surgery
Material for this section is derived from the following elements in the resident curriculum:

• Weekly didactic    schedule and grand rounds
• On-service    experience (SJRMC, VANJHCS, GMC)
• Outpatient     clinics
• OR cases
• Rounds
• Off-service    rotations
• Physical     Diagnosis
• Head-and-Neck    Anatomy Course

Goals
1. To develop a group of core competencies that are indices of resident achievement in this area (see below);
2. To expose the resident to a wide variety of acquired and congenital deformities requiring reconstruction;
3. To expose the resident to a wide variety of reconstructive materials and techniques; and
4. To expose the resident to the harvesting of autogenous tissues from a variety of donor sites.

Core Competencies*
(* number listed with each item represents the year of training during which competence should be achieved)
1. Identification of patients for whom reconstruction is indicated (1)
2. Developing a sound reconstructive treatment plan (2)
3. Harvesting split thickness skin and other soft tissue grafts (2)
4. Harvesting bone from the anterior iliac crest (3)
5. Comprehensive management of patients with mandibular continuity defects (4)
6. Comprehensive management of patients with severe atrophy of the mandible/maxilla (4) 

Objectives
1. Harvest 4 or more skin or other soft tissue grafts
2. Harvest 10 or more bone grafts from extraoral donor sites
3. Participate in 5 or more mandibular reconstruction cases
4. Describe the relative merits of prosthetic rehabilitation and biologic reconstruction for defects of the maxilla
5. List the indications and contraindications for reconstruction of acquired defects of the frontal bone
6. Participate in 4 or more cases of reconstruction of defects in the maxillofacial region other than the mandible
7. Participate in 4 or more preprosthetic reconstructive surgery cases  

Section 11 — Cosmetic Maxillofacial Surgery
Material for this section is derived from the following elements in the resident curriculum:

• Weekly didactic    schedule and grand rounds
• On-service    experience (SJRMC, GMC)
• Outpatient     clinics
• OR cases
• Rounds
• Off-service    experience with plastic, ENT and craniofacial surgeons at SJRMC and GMC
• Head-and-Neck    Anatomy 

Goals
1. To develop a group of core competencies that are indices of resident achievement in this area (see below);
2. To expose the resident to a variety of conditions that are associated with suboptimal facial esthetics; and
3. To expose the resident to procedures used in the enhancement of facial cosmesis.

Core Competencies*
(* number listed with each item represents the year of training during which competence should be achieved)
1. Identification of patients who may benefit from cosmetic maxillofacial surgery (1)
2. Developing a rational treatment plan for patients with desiring facial rejuvenation (3)
3. Developing a rational treatment plan for patients with cervicofacial soft tissue redundancy (3)
4. Developing a rational treatment plan for children and adults with external ear deformities (4)
5. Comprehensive management of patients with chin deformities (4)

Objectives
1. Surgically manage 4 or more patients with chin deficiencies
2. Describe the indications, contraindications and basic techniques for surgical management of:  

a. cervicofacial soft tissue redundancy

            b. facial scars and other soft tissue deformities

            c. maxillofacial lipomatosis

            d. eyelid deformities

            e. nasal deformities

            f. facial rhytids

3. Discuss the recognition and management of complications associated with each of the above procedures

Didactic Program
The formal didactic program has several components. Grand Rounds are held monthly at SJRMC and are attended by all on-service residents as well as available faculty and guests. These sessions include journal reviews with discussion focusing on four or five pre-selected articles. Residents present the material and attendings moderate the discussion. Case reviews, CPCs and, morbidity and mortality components are also included in the annual Grand Rounds schedule. Two hours of each of these evening sessions are devoted to a lecture by a guest presenter or faculty member. Topic/speaker selection is guided by results of needs assessment surveys, past performance on OMSSAT exams, the requests of residents and speaker availability.      

Weekly seminars led by Dr. Szumita and other attendings also take place at each training site. These follow a comprehensive 52-week schedule that cycles annually (see appendices).

The most difficult part of the didactic curriculum to document is the piece that may have the most profound effect on the residents. This is the ongoing exchange of ideas that takes place on rounds as well as chairside and tableside.