Curriculum, Goals & Objectives
Residency Training in Oral & Maxillofacial surgery

St. Joseph’s Regional Medical Center
affiliated with Seton Hall University, School of Health and Medical Services

H. Ephros, DMD, MD, Program Director and Chairman
R. P. Szumita, DDS, Associate Program Director

Draft 1  5/00
Accepted 7/00
Revised 3/01
Revised 3/04
Revised 10/04
Accepted 11/04
Revised 4/06
Revised 5/09
Accepted 5/09

The following is based upon the requirements of the American Board of Oral and Maxillofacial Surgery, the current Standards for Advanced Education in Oral and Maxillofacial Surgery published by CODA, a committee of the ADA, and on Parameters and Pathways, a comprehensive set of clinical practice guidelines published by the AAOMS.  The intent is to define the clinical and didactic curricula for the St. Joseph’s Regional Medical Center residency program in oral and maxillofacial surgery so that residents can have similar experiences, requirements will be uniform, advancement to higher levels of responsibility will be appropriate and so that the program satisfies the needs of its graduates in terms of board certification, privileging and the development of critical competencies.

Program Description and Philosophy

Introduction
The oral and maxillofacial surgery residency is a four-year program (with an MD option) based at St. Joseph’s Regional Medical Center in Paterson, New Jersey (SJRMC).  One affiliated institution plays a major role in resident education: the Veterans Administration New Jersey Health Care System (VANJHCS).  The program is accredited by the American Dental Association and the next site visit is scheduled for 2011.  

Curriculum
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 and 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 SJRMC’s 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, oculoplastics and otolaryngology/head & 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 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.  Residents also travel to Dr. Manolakakis’ office where they are exposed to and participate in 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.

St. George’s University is no longer able to support the MD option.  As such, this option is temporarily inactive pending the development of a relationship with one of several medical schools.

Faculty
The faculty consists of three full-time, one half-time and several part-time board certified oral and maxillofacial surgeons attendings.  Also included on the teaching faculty are orthodontists, an oral & maxillofacial pathologist, a craniofacial surgeon, an otolaryngologist/head & neck surgeon, a maxillofacial prosthodontist and restorative dentists.

• Hillel Ephros, DMD, MD
  Chairman and Program Director
• Richard P. Szumita, DDS, Associate Program Director
  SJRMC
• Kenneth Cheng, DDS
  Chief, Oral and Maxillofacial Surgery Service
  VANJHCS    

OMS faculty members       

• Thomas Barrios, DDS           
  
• Meredith Blitz, DDS           
  
• Robert DeFalco, DDS   
  
• Michael Erlichman, DDS       
  
• Shahin Ghobadi, DMD       
  
• Manolis Manolakakis, DMD        
  
• Mendel Markowitz, DDS
• Vito Modugno, DMD

Non-OMS faculty members

• Matthew Choi , DMD  (orthodontics)
• Lawrence Simon, DDS (orthodontics)
• Silvio Podda, MD  (plastic/recon/craniofacial surgery)
• James LaBagnara, MD  (otolaryngology/H&N surgery)
• David Lederman, DMD  (oral/maxillofacial pathology)
• Anthony Sallustio, DDS (maxillofacial prosthodontics)
  
  

Components of Oral and Maxillofacial Surgery 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)
•         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 which are indices of resident achievement in this area (see below);
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 over 200 outpatients
2. perform preanesthetic evaluations on over 200 outpatients
3. admit over 200 patients to the oral and maxillofacial surgery service
4. evaluate and manage over 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)
•         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 which are indices of resident achievement in this area (see below);
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 over 200 adult outpatients
2. perform preanesthetic evaluations on over 200 adult inpatients
3. perform preanesthetic evaluations on over 100 pediatric patients
4. administer conscious sedation to over 200 adult patients
5. administer general anesthesia to over 200 adult patients
6. administer sedation, dissociative anesthesia and/or general anesthesia to over
7. 40 pediatric patients
8. successfully complete the rotations in anesthesiology and pediatric anesthesiology
9. successfully complete ACLS and maintain certification throughout the duration of the training program
10. demonstrate supplemental local anesthetic techniques used as alternatives to conventional blocks and infiltrations.
11. 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)
•         Outpatient clinics
•         OR cases
•         Rounds
•     Head and Neck Anatomy Course

Goals

1. to develop proficiency in the extraction of teeth and associated surgical procedures;
2. to develop a group of core competencies which 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 over 500 extractions of erupted teeth
2. perform over 100 extractions of impacted teeth
3. perform over 25 minor preprosthetic procedures
4. perform over 50 dentoalveolar surgical procedures on children
5. perform over 5 apicoectomies
6. surgically manage over 10 intrabony lytic lesions of the jaws not associated with dental apical pathology
7. perform over 50 incisional and/or excisional biopsies of the dentoalveolar soft and/or hard tissues
8. perform over 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)
•         Outpatient clinics
•         OR cases
•     Rounds
•     Head and Neck Anatomy Course

Goals

1. to develop a group of core competencies which 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;
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 over 50 implants in the jaws and/or other facial bones
2. perform over 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)
•         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 which 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;
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 over 10 patients with dentofacial deformities
2. perform over 12 mandibular osteotomies
3. perform over 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)
•         Outpatient clinics
•         OR cases
•         Rounds
•     Craniofacial team meetings and orthognathic conferences
•     Off-service experience with craniofacial surgeon
•     Head and Neck Anatomy Course

Goals

1. to develop a group of core competencies which 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
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)
•         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 which are indices of resident achievement in this area (see below)
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 & 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)
•         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 which are indices of resident achievement in this area (see below)
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)
•         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 which 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;
4. to expose the resident to the oral manifestations of a wide variety of systemic conditions which 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 histopathologic 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 over 10 benign soft tissue lesions
4. surgically manage over 10 benign intrabony cysts and/or tumors of the jaws
5. surgically manage over 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)
•         Outpatient clinics
•         OR cases
•         Rounds
•     Off-service rotations
•         Physical Diagnosis
•     Head and Neck Anatomy Course

Goals

1. to develop a group of core competencies which 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
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)
•         Outpatient clinics
•         OR cases
•         Rounds
• Off-service experience with plastic, ENT and craniofacial surgeons at SJRMC
• Rotation at Dr. Manolakakis’ facility
• Head and Neck Anatomy

Goals

1. to develop a group of core competencies which are indices of resident achievement in this area (see below);
2. to expose the resident to a variety of conditions which are associated with suboptimal facial esthetics
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
1.     facial scars and other soft tissue deformities
2.     maxillofacial lipomatosis
3.     eyelid deformities
4.     nasal deformities
5.     facial rhytids
3. discuss the recognition and management of complications associated with each of the above procedures

Didactic Program

The formal didactic program is 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 preselected 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.

Off-Service Rotations  

Physical Diagnosis Rotation - Dr. Michael DeLisi

This first year rotation follows an introductory course in history taking and physical examination required of all incoming PGY1 Residents in the Department of Dentistry.  OMS residents spend six weeks (part-time) at the family medicine facility performing H&Ps under supervision.  

Goals

1. to contribute to the development of competency in history taking
2. to contribute to the development of competency in performing complete physical examinations
3. to expose the resident to the major areas in clinical medicine
4. to provide a basis for the clinical judgment required when evaluating patients prior to surgery and anesthesia
5. to expose residents to published guidelines on preoperative physical assessment and on the management of major entities such as diabetes and hypertension

Objectives

1. the resident will satisfactorily complete and document 25 H&Ps
2. the resident will be able to demonstrate the correct use of the tools of physical diagnosis
3. the resident will be able to discuss published guidelines on preoperative physical assessment and on the management of major entities such as diabetes and hypertension

Note: Along with the introductory course and the two month rotation in the Department of Medicine, this rotation provides core training in physical diagnosis.  Certification of competence in performing H&Ps is based upon successful completion of this rotation as judged by Dr. DeLisi or his designee and satisfactory performance during the medicine rotation. Additional training is acquired by performing pre-anesthetic evaluations during the anesthesia rotation.  Given satisfactory performance on all of these elements and a positive recommendation by the OMS faculty, the graduating resident will have his/her competency in physical diagnosis certified by the program director.

Anesthesiology - Dr. Seth Landa and Dr. Stephen Winikoff (SJ)

This is a four month rotation during the resident's first year.  The anesthesiology service at St. Joseph's is staffed by a committed group of clinician-educators and a large group of residents.  Sub-specialties represented include pediatric anesthesiology, cardiac anesthesiology, OB anesthesiology and pain management.  The OMS resident is absorbed into this academically oriented environment and participates fully in all educational activities.  The resident is expected to take evening call during the rotation to gain experience in the evaluation and management of emergent patients requiring general anesthesia.  This four month rotation provides an excellent background in anesthesiology and a wealth of clinical material for training.

Duties - The resident is expected to fulfill the responsibilities that would be assigned to a resident in Anesthesiology at a comparable level.  This includes attendance at seminars and conferences, full participation in any activities of the service and meaningful participation in the on call schedule as described above.

Goals

1. to contribute to the development of competency in medical risk assessment
2. to contribute to the development of competency in airway management
3. to contribute to the development of competency in the administration of anesthetic agents
4. to contribute to the development of competency in establishing venous access
5. to expose the resident to fluid management and blood replacement
6. to expose the resident to the use and significance of invasive monitoring techniques

Objectives

1. perform 25 or more pre-anesthetic evaluations of surgical patients scheduled for general anesthesia (adults and children)
2. describe the process of assigning risk categories to patients scheduled to receive anesthetics
3. establish venous access in over 50 patients
4. satisfactorily manage the airway in 25 or more patients under general anesthesia (adults and children)
5. perform 25 or more endotracheal intubations
6. describe the standard physiologic monitoring used during general anesthesia and the significance of the various measures
7. participate in the PACU care and discharge process for 25 or more patients who have undergone a procedure under general anesthesia
8. participate in the anesthesia management of 20 or more medically compromised patients (ASA III or IV)
9. describe the pharmacologic properties, clinical applications, contraindications, adverse reactions and potential interactions for:
1.     anesthetic gases
2.     intravenous anesthetic agents
3.     sedatives and anxiolytics
4.     opioids
5.     muscle relaxants
6.     reversal agents
7.     local/regional anesthetics
8.     adjunctive agents (vasopressors, blood pressure lowering medications etc.)

General Surgery / SICU - Dr. Carl Valenziano and Dr. Alan Sori (SJ)

This rotation of four months duration takes place at SJRMC where the OMS resident is fully absorbed onto the general surgery service and functions as a team member including participation in the call schedule.  For the first three months, the emphasis is clinical and a large volume and wide variety of surgical cases are encountered.  The resident then spends the final month as a surgical intensive care unit resident.  Here, didactic elements are reinforced daily on teaching rounds and by the nearly constant contact of the OMS resident with surgical intensivists who run the SICU, with general surgery attendings whose patients are in the unit and with senior level general surgery residents.

Duties - The resident is expected to fulfill the responsibilities that would be assigned to a resident in General Surgery at a comparable level.  This includes attendance at seminars and conferences, full participation in any activities of the service and participation in the on call schedule.

Goals

1. to contribute to the development of competency in surgical risk assessment
2. to contribute to the development of competency in evaluation and management of the trauma victim
3. to contribute to the development of competency in basic surgical skills
4. to contribute to the development of competency in medically managing the perioperative patient
5. to expose the resident to the establishment of central venous access
6. to expose the resident to fluid management and blood replacement
7. to expose the resident to the medical management of the critically ill surgical patient

Objectives

1. participate meaningfully in the comprehensive surgical management of 25 or more (non-OMS) surgical patients
2. participate meaningfully in the comprehensive management of 12 or more trauma victims
3. demonstrate satisfactorily the acquisition of basic surgical skills
4. describe all the anatomy imaged on a standard chest film and identify common pathologic findings noted on these films in surgical patients
5. participate meaningfully in the comprehensive care of 10 patients admitted to the SICU  
6. list the indications for mechanical ventilation and the parameters for weaning patients off of the ventilator
7. discuss the indications and techniques for establishment of emergent and nonemergent surgical airways

Internal Medicine - Dr. Anees Kahn and Dr. Robert Amoruso (SJ)

This two month rotation takes place at SJRMC.  The OMS resident is fully absorbed onto the medicine service and participates in all of its clinical and educational activities including the on call schedule.  The resident is assigned to a team that follows patients from admission through discharge.  The team is composed of senior and junior residents as well as medical students.  Each team is supervised by attending physicians from the Department of Medicine.

Duties - The resident is expected to fulfill the responsibilities that would be assigned to a resident in Internal Medicine at a comparable level.  This includes attendance at seminars and conferences, full participation in any activities of the service including the code team and meaningful participation in the on call schedule.

Goals

1. to contribute to the development of competency in history taking
2. to contribute to the development of competency in conducting a complete physical examination
3. to expose the resident to a wide variety of medical conditions that may require treatment
4. to provide clinical material for further development of physical diagnosis skills acquired in the ICS course.
5. to expose the resident to medical urgencies and emergencies and their management
6. to expose the resident to critically ill patients and their management
   

Objectives

1. perform over 25 complete H&Ps on patients admitted for medical management
2. participate meaningfully in the comprehensive management of 10 medical patients
3. evaluate and manage 20 or more patients with medical emergencies
4. describe the impact of HIV infection on all of the major human organ systems
5. describe the appropriate initial management of
1. ventricular tachyarrhythmias
2. bradycardia with hypotension
3. stable and unstable SVT
4. asystole
6. discuss the pathophysiology and clinical  manifestations of major disease processes which may include:
1. asthma
2. pneumonia
3. hypertension
4. coronary artery disease
5. congestive heart failure
6. valvular heart disease
7. diabetes mellitus
8. thyroid dysfunction 
9. hyperparathyroidism
10. tuberculosis
11. the infectious hepatitides
12. alcoholic liver disease and cirrhosis
13. congenital and acquired coagulopathies
14. bleeding diatheses
15. Crohn's disease and ulcerative colitis
16. peptic ulcer disease
17. sarcoidosis
18. rheumatoid arthritis 
19. psoriasis
20. myasthenia gravis
21. multiple sclerosis
22. primary malignancies of the lungs, stomach, pancreas, colon, rectum, prostate, breast, esophagus, liver and kidney
23. anemias
24. leukemias 
25. lymphomas
26. multiple myeloma
7. describe the significance of each of the more commonly ordered laboratory tests
   

Orthopedic Surgery - Dr. V. McInerney and Dr. F. Ghobadi (SJ)

This rotation of one month’s duration takes place at SJRMC where the OMS resident is fully absorbed onto the orthopedic surgery service and functions as a team member including appropriate involvement in the call schedule and in departmental didactic programs.

Duties - The resident is expected to fulfill the responsibilities that would be assigned to a resident in Orthopedic Surgery at a comparable level.  This includes attendance at seminars and conferences, full participation in any activities of the service and participation in the on call schedule.

Goals

1. to contribute to the development of competency in surgical risk assessment
2. to contribute to the development of competency in evaluation and management of the trauma victim
3. to contribute to the development of competency in basic surgical skills
4. to contribute to the development of competency in medically managing the perioperative patient
5. to contribute to the development of competency in assessing and managing fractures, dislocations and other bone and joint injuries
6. to contribute to the development of competency in arthroscopic surgical techniques
7. to expose the resident to joint replacement procedures

Objectives

1. participate meaningfully in the comprehensive surgical management of 12 or more orthopedic surgical patients
2. participate meaningfully in the comprehensive management of 8 or more trauma victims
3. demonstrate satisfactorily the acquisition of basic orthopedic surgical skills
4. compare and contrast various methods of fracture management
5. discuss the integration of maxillofacial and orthopedic management of the patient with multiple traumatic injuries
6. describe the techniques and instrumentation utilized in arthroscopic surgery of various joints
   
   

Elective/Cosmetic Rotation Month

During this month, the resident is expected to spend time at Dr. Manolakakis’ facility for the purpose of exposure to all phases of cosmetic OMS including pre-op visits, post-op visits as well as procedures. Given that there may be a number of work days during this month when there is no significant educational value to being at that facility, residents are encouraged to engage in other elective activities within SJ, or outside the hospital pending approval of the Program Director and the development of satisfactory arrangements.  The duties of the resident are based on the nature of the rotation and may not involve on call for this month.  

Rotation Evaluations

Residents are evaluated by the individuals named above (or their designees) for each rotation.  Off service mentors are asked to evaluate residents based upon the goals and objectives that are supplied prior to the arrival of an assigned resident.  Off service chiefs are periodically asked to comment on these goals and objectives and provide their opinions about the value of the rotation and its success in meeting its stated goals.  In addition, clinical rotations are evaluated by each resident at the conclusion of each rotation.  

Head and Neck Anatomy - Richard Szumita, DDS

This is an intensive 20 hour program in head and neck anatomy sponsored twice annually by Seton Hall University and St. Joseph's Hospital and Medical Center. This limited attendance program consists of lecture and cadaveric dissection.  OMS residents are scheduled to participate in this program twice during their period of training.    

Goals

1. to provide a comprehensive review of structural and functional relationships in the head and neck
2. to provide an anatomical basis for approaching oral and maxillofacial surgical procedures

Objectives

1. identify blood vessels in the head and neck and discuss their functional significance
2. identify muscles in the head and neck and discuss their functional significance
3. identify skeletal structures of the head and neck and discuss their functional significance
4. discuss the functions of the twelve cranial nerves and the structures they innervate
5. describe the fascia of the head and neck and its significance
6. discuss the anatomy and physiology of the temporomandibular joint
7. discuss the anatomy and physiology of the eye
8. discuss the anatomy and physiology of the ear
9. discuss the anatomy and physiology of the nose

Research Methods / Biostatistics - Vincent DeBari, PhD

In this graduate course given at Seton Hall University students explore methods of research and communication of new information to and from the clinician.  Systematic analysis of research problems, relationships between hypotheses and procedures and techniques for analyzing data and evaluating evidence are presented.

Goals

1. to expose the resident to data analysis
2. to provide the resident with an improved understanding of research methods
3. to provide the resident with a basis for critical evaluation of the scientific literature

Objectives

1. the resident will complete the course satisfactorily

Scholarly Activities

Residents are required to participate on an ongoing basis in scholarly activity.  Those activities may include: research - clinical or laboratory based, case reports for publication in the literature, production of abstracts for publication and/or presentation at major meetings and the presentation of educational programs in the hospitals, in study groups and/or at community functions.  

Goals

1. to contribute to the development of competency in scientific writing
2. to contribute to the development of competency in scientific oral presentation
3. to expose the resident to clinical research and statistical analysis

Objectives

1. to complete one paper suitable for publication in a peer reviewed journal, or
2. to present one paper or abstract at a regional or national meeting
3. satisfactory performance as evaluated by the faculty on case presentations and defenses done at joint conferences
4. to demonstrate ongoing involvement with scholarly activity by annual participation in the Seton Hall Research Colloquium

Expanded Curriculum for Senior Residents

Though it is no longer a requirement in CODA Standards, time is set aside for OMS residents to engage in expanded curricular activities.  The option of research exists and resources and faculty to support these endeavors are readily available.  The clinical option involves allowing each chief resident to participate meaningfully in all of the plastic, neurosurgery, ENT and craniofacial cases at SJRMC during three of the six months that both chiefs are assigned to SJRMC.  This includes an expanded involvement with lip and palate surgery, pharyngoplasty, cranioplasty, adult and pediatric neurosurgery, parotid, thyroid and parathyroid surgery and other cases of interest.  During the six months spent at GMC, when the OMS service is not on trauma call, the OMS resident has the opportunity to operate with oculoplastics and ENT and to explore other areas of interest.  This time comprises at least two of the six-month assignment to GMC.  The one-month elective rotation provides additional flexibility, allowing each resident to choose an area of interest in which expanded experiences may be gained.

OMSSAT and Mock Boards

Each resident is expected to participate annually in the OMSITE, an ABOMS sponsored evaluation mechanism.  Mock boards are administered each spring and are designed to follow the format of the oral certifying examination.  Results of these assessments are used to direct and focus resident study and to guide the ongoing development of the program’s curriculum.