InterMod OMFS
InterMod OMFS
InterMod OMFS
In
orAl & mAXIlloFACIAl
SurGerY
REQUIREMENTS FOR TRAINING & EXAMINATION
PY
CO
2011 CE
FI
OF
Addendum
Basic Life Support (BLS) is a mandatory course for
CoLLege oF
all postgraduate trainees
PhySICIAnS And
(FCPS and MCPS). All Fellowship residents are
SurgeonS
required to attend BLS course before they can
PAkIStAn
appear in Intermediate Module (IMM) examination.
Composed by:
Syed Faisal Babar
Department of Medical Education
COLLEGEOF PH YS I
CIA N S A N D S U R GEON S PA K I
ST A N
7th Central Street, Defence Housing Authority, Karachi-75500.
Phone No. 99207100-10 UAN: 111-606-606 Fax No. 99266432
CONTENTS
9 ASSESSMENT
14 SYLLABUS
Since its inception, the College has taken great strides in improving
postgraduate medical and dental education in Pakistan. Competency-
based structured Residency Programs have now been developed,
along with criteria for accreditation of training institutions, and for the
appointment of supervisors and examiners. The format of examinations
has evolved over the years to achieve greater objectivity and reliability
in methods of assessment. The recognition of the standards of College
qualifications nationally and internationally, particularly of its
Intermediate Module in Oral & Maxillofacial Surgery 2011
After completing two years of core training during IMM, the trainees
are allowed to proceed to the advanced phase of FCPS training in the
specific specialty of choice for 2-3 years. However, it is mandatory to
qualify IMM examinations before taking the FCPS-II exit
examinations.
1
The prospectii of IMM in each discipline have been extensively
revised and structured so as to delineate well defined competencies
to be achieved along with their level of participation. These
prospectuses have been complemented by color coded Structured
Visual Curriculum Display (SVCD) charts to be placed at a prominent
place in each training Unit. They help remind at a glance, the trainees
and the supervisors, about the competencies and their levels to be
achieved at a given time period along with the minimum number of
cases. They also describe the rotations to be performed along with
their duration and objectives, mandatory workshops to be attended,
and the requirements and deadlines for submitting research synopsis
and dissertation (or two research articles in lieu of the dissertation as
per CPSP rules).
2
It is important to note that in the overall scenario of health delivery
over 85% of the total functioning and registered health care
specialists of the country have been provided by the CPSP. To
coordinate training and examination, and provide assistance to the
candidates stationed in cities other than Karachi, the College has
established 14 Regional Centers (including five Provincial
Headquarter Centers) in the country.
3
INTERMEDIATE MODULE
4
TRAINING AND
EXAMINATION
GENERAL REGULATIONS
Candidate will be admitted to the examination in the name (surname
and other names) as given in the BDS degree and PMDC certificate.
CPSP will not entertain any application for change of name on the
basis of marriage / divorce / deed.
DURATION
The duration of training for the Intermediate Module (IMM) is two
years; the Intermediate Module examination is taken on
completion of the two years training.
5
ROTATIONS
The two years of competency based training in Oral &
Maxillofacial surgery includes two months rotation in each of the
following disciplines:
● General surgery ● Anaesthesia
ROAD MAP
COMPONENTS OF TRAINING
Mandatory Workshops
It is mandatory for all Intermediate Module trainees to attend the
Intermediate Module in Oral & Maxillofacial Surgery 2011
6
Logbook
Trainees are required to maintain a logbook in which entries of
academic / professional work done during the period of training
should be made on daily basis, and signed by the supervisor.
Completed and duly certified logbook will form part of the application
for appearing in IMM examination.
E-logbook
The CPSP council has decided to introduce E-logbook system for all
residency program trainees in FCPS. Upon registration with RTMC
each trainees is allocated a registration number and a password to
log on to the e-logbook on the CPSP website. The trainee is required
to enter all work performed and the academic activities undertaken in
the logbook on daily basis. The concerned supervisor is required to
verify the entries made by the trainee. This system ensures timely
entries by the trainee and prompt verification by the supervisor. It also
helps in monitoring the progress of trainee and vigilance of
supervisors.
General Requirements
Training should incorporate the principle of gradually increasing
responsibility, and provide each trainee with a sufficient scope,
volume and variety of experience in a range of settings, with patients
varying from simple to complex management requirements. The
emphasis shall be on principles of consultation with other specialties
and essential concepts of patient care undergoing oral and
maxillofacial surgery.
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Instructional Methodology
Teaching occurs using several methods that range from formal
didactic lectures to planned clinical experiences. Aspects covered
will include knowledge, skills and practices relevant to the
discipline in order to achieve specific learning outcomes and
competencies.
The theoretical part or the curriculum represents the current body
of knowledge necessary for practice. This can by imparted
through lectures, clinical and technical exercises, clinic-
pathological meetings, competition / problems review meetings,
literature reviews and presentation, journal clubs meetings, self
directed learning, conferences and seminars.
8
ASSESSMENT
ELIGIBILITY REQUIREMENTS
For appearing in Intermediate Module examination a candidate
should have:
● Passed FCPS I in Dentistry or granted exemption
● Completed two years of RTMC registered training under an approved
supervisor in an institution recognized by the CPSP. A certificate of
completion must be submitted.
● Submitted a complete and attested logbook by respective
supervisors.
● Submitted certificates of attendance of mandatory workshops.
● Submitted synopsis of dissertation or abstract of research articles.
EXAMINATION SCHEDULE
● The intermediate Module theory examination will be held twice a
year
● Theory examinations are held in various cities of the country
usually at Abbottabad, Bahwalpur, Fasisalabad, Hyderabad,
Islamabad, Rawalpindi, Karachi, Nawabshah, Larkana, Lahore, Intermediate Module in Oral & Maxillofacial Surgery 2011
9
EXAMINATION FEE
● Application along with the prescribed examination fee and
required documents must be submitted by the last date notified for
this purpose before each examination.
● The detail of examination fee and fee for change of centre,
subject, etc. shall be notified before each examination.
● Fee deposited for a particular examination shall not be carried
over to the next examination in case of withdrawal, absence or
exclusion.
REFUND OF FEES
If after submitting an application for examination, a candidate decides
not to appear, a written request for a refund must be submitted before
the last date for withdrawal with the receipt of applications. In such
cases a refund is admissible to the extent of 75% of fees only. No
request for refund will be accepted after the closing date for receipt of
applications. If an application is rejected by the CPSP, 75% of the
examination fee will be refunded, the remaining 25% being retained
as a processing charge.No refund will be made for fees paid for any
other reason, e.g late fee , change of centre/subject fee ,etc
FORMAT OF EXAMINATIONS
Intermediate Module examination consists of the following two
Intermediate Module in Oral & Maxillofacial Surgery 2011
components:
Theory examination:
Theory examination consists of:
Paper I 10 Short Answer Questions (SAQs) 3 hours
Paper II 100 Single Best MCQs 3 hours
Clinical examination:
To test clinical skills, the examination shall consist of:
TOACS (Task Oriented Assessment of Clinical Skills)
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TOACS
TOACS will comprise of 10 to 15 stations with time alloted at each
station being 5-8 minutes and change over time of one minute to
move from one station to the other. The stations may have an
examiner, a patient or both Structured clinical tasks will be set at
each station. At stations where no examiner is present the
candidates will have to submit written responses to short answer
question/s MCQs on a response sheet.
11
COURSE WORK FOR ORAL &
MAXILLOFACIAL SURGERY TRAINING
PROGRAM
GENERAL OBJECTIVES
Upon completion of specified training the resident must have acquired
the competencies comprising of knowledge, skills and attitudes
forming the foundation of the standard practice for an Oral &
Maxillofacial specialist who is able to:
● Provide an appropriate, cost effective and standard care to patients
seeking consultation.
● Promote health and prevent disease in patients, families and
communities.
● Apply Knowledge and expertise in clinical and procedural
management of diseases.
● Perform prescribed Maxillofacial surgical skills.
● Attain decision making skills for dealing with oral & maxillofacial
problems
● Participate in Continuing Professional Development programs.
12
COMPETENCIES
The competencies prescribed for the Intermediate Module are:
● Communicate effectively with patients, attendants & others
● Take proper history of the case
● Advise appropriate investigations & interpret them
● Refer patient to appropriate facilities, when needed
● Perform standardized clinical examination of the OMF region
● Establish final diagnosis of the case & manage it accordingly
● Practice safe and ethical OMFS
● Work as a leader or member of health care team
● Develop scientific paper writing and presentation skills
● Follow up and maintain patient records
● Work as OMFS professional, academician & researcher
13
SYLLABUS
PRINCIPLES OF OMFS REGARDING:
● Evaluation of the preoperative health status of the surgical patient
● Making a surgical diagnosis and prerequisites of surgery
● Principles & types of incisions, flap design & methods of tissue
handling
● Haemostasis, edema control, decontamination, surgical wound
toilet
● Patho-physiology and principles of wound repair/ significance of
wound healing
● Mechanisms of scar and contracture formation & its prevention
● Surgical infection and its prevention and control
● Body response to infection and appropriate methods for carrying
out surgery in Hepatitis, HIV carriers and all other medically
compromised conditions.
● Use of common surgical instruments and operation theatre
appliances (suction, diathermy, retractors, general instruments etc)
● Appropriate uses of suture/ ligature materials and basic Principles
of anastamosis.
Intermediate Module in Oral & Maxillofacial Surgery 2011
EXODONTIA:
a) General Principles
- Armamentarium used for basic Oral surgical practice
- Assesses medical condition of patient preoperatively and
knows basic principles of managing pain and anxiety control
- Indications and contraindications of performing tooth
extraction & related procedures
- Clinical and radiological assessment for tooth extraction
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b) Uncomplicated Exodontia
- Patient and surgeon preparation, chair positioning and
mechanical principles involved in tooth extraction.
- Principles of Forceps, Elevator use and procedures for
closed extractions including specific techniques for removal
of each tooth
- Post-extraction care of alveolar socket
c) Complicated Exodontia
- Flap design, types & development technique and
management
- Basic principles of suturing for complex cases
- Indications and contraindications of surgical extractions
- Techniques for performing surgical removal of single,
multi-rooted teeth, & root fragments
- Extraction sequence & technique when planning multiple
extractions for special scenarios.
- Management of post extraction complication.
15
ANTIMICROBIAL THERAPY / ANALGESICS USE IN OMFS / DENTISTRY
● Commonly used antimicrobials and analgesics
● Basic principles of prophylactic and therapeutic antibiotic use
● Basic principles of analgesic use
● Indications, precautions & contraindications of antibiotic therapy
● Drug interactions, advantages & disadvantages of combination
therapy
● Significance of culture and sensitivity testing with basic
knowledge of dosage and routes of administration & their issues
● Consequences of under or over dosage, allergic reactions to
antibiotics and analgesics & their management
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MANAGEMENT OF PATHOLOGIC LESIONS AFFECTING OMFS
REGION:
● Basic principles of biopsy procedure
● Differential diagnosis
● Goals and principles of surgical management of oral pathologic
lesions
● Cysts and tumors of the OMFS region
17
PRE-PROSTHETIC ORAL SURGERY:
● Objectives of pre-prosthetic surgery
● Principles of evaluation, treatment planning & needs of the
patient
● Various procedures of alveolar ridge augmentaion and their
relation with the jaws
● Maxillary and mandibular tori procedures and etc
18
ANAESTHESIA (LOCAL/ REGIONAL/ GENERAL):
● Primary goals of giving local, general and sedation anesthesia
● Requesting preoperative G/A fitness from Anesthesiologist
● Classification, chemistry and pharmacologic effects of local and
general anesthetic drugs
● Adverse effects and drug interactions of local and general
anesthetic drugs
● Preparations and dosage of local anesthetic drugs, their
general therapeutic uses and side effects when used in dentistry
● Methods of administration and mechanisms of action of general
anesthetic drugs including inhalation agents and intravenous
agents
● Differentiation between analgesia and sedation and their
application in oral surgery
● Principles of general anesthesia and IV sedation
ORTHOGNATHIC SURGERY:
● Dentofacial deformities
● Assessment of the dentofacial deformity patient; including
clinical assessment, essential imaging, cephalometry and
current assessment tools.
● Liason between orthodontic and maxillofacialsurgery in
planning for orthognathic surgery
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● Model surgery; inclucing facebow transfer and articulator
mounting
● Maxillary, mandibular and genioplasty osteotomies ; indications
and surgical technique
● Patients , attendants etc counseling where needed
● Basic concepts of distraction osteogenesis
● Perioperative care of the orthognathic surgical patient
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PROCEDURES:
The level of competence to be achieved each year is specified
according to the key, as follows:
Levels of competencies:
1. Observer status.
2. Assistant status.
3. Performed under supervision.
4. Performed under indirect supervision.
5. Performed independently
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Procedural Competencies
Procedures/Tasks
1st Year 2nd Year Min #
Cases/year
Core Skills For OMFS Practice
History taking 4 4 50
Communicating effectively with
patients, families and Other Related
Health team Members 4 4 50
Understanding & obtaining
informed Consent 4 4 50
Performing clinical examination of
OMFS Region 4 4 50
Ordering appropriate investigations 2 3 50
Interpreting investigation results 2 3 50
Ordering Routine Radiology &
Ultra sound for OMFS region 2 3 25
Imaging for OMF problems: CT scan,
MRI, Doppler etc 2 3 25
Assessing patient fitness: for OMFS
procedure 3 4 50
Positioning of patient for diagnostic and
operative OMFS procedures under
Local & General Anesthesia 4 4 50
Intermediate Module in Oral & Maxillofacial Surgery 2011
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Procedures/Tasks
1st Year 2nd Year Min #
Cases/year
Application of knowledge of
Basic Principles of Surgery 4 4 50
Use & Application of common surgical
instruments, suture materials and
techniques 4 4 50
CPR & related management 2 3 5
Procedural Skills
A) General
Suturing OMFS region soft tissues 2 3 25
OMFS ward patient management 2 3 25
OMFS OPD patient management 2 3 25
Prescribing suitable medications 2 3 20
B) Minor Oral Surgery
Complicated Exodontia Cases
under L/A 2-3 4 50
Pre-Prosthetic Surgery cases 2 3-4 30
Management of Impacted teeth 2-3 4 40
Re-implantation of Avulsed/ Intermediate Module in Oral & Maxillofacial Surgery 2011
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Procedures/Tasks
1st Year 2nd Year Min #
Cases/year
D) OMFS Infections
Diagnosis & management of
Odontogenic & related fascial space
infections in OMFS 2 3 10
Diagnosis, Prevention and
management of the spread of
complex Bacterial, Viral, Fungal and
Protozoal infections related to OMFS 2-3 3-4 10
E) Trauma - Management of
Dent alveolar fractures 2-3 4 10
Nasal fracture 2 3 10
Fracture Mandible 2 2-3 20
Fracture Maxilla 2 2-3 20
Fracture ZMC & Orbit 2 2-3 10
Fracture nose and frontal bone 1 2-3 05
F) TMj Related Pain Disorders
Intermediate Module in Oral & Maxillofacial Surgery 2011
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Procedures/Tasks
1st Year 2nd Year Min #
Cases/year
H) OMFS Pathology/Oncology
Management of Oral
Submucous Fibrosis 1 2-3 05
Management of Odontogenic &
non Odontogenic Cysts & Tumours 2 3-4 15
Diagnosis & Management of
Ulcerations & Vesiculobullous Lesions
of OMF region 2 3 20
Soft tissue Extirpation 1 2 05
Diagnosis and management of
Fibro-osseous lesions of
the OMFS region 1 2 05
Maxillectomy procedures 1 2 05
Mandibulectomy/Resection procedures 1 2 05
OMFS Pre- Malignancies &
their Management 1 2 05
I) Reconstuctive And Plastic Surgery
Bone harvesting procedures 2 2-3 5
Intermediate Module in Oral & Maxillofacial Surgery 2011
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Procedures/Tasks
1st Year 2nd Year Min #
Cases/year
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COMPETENCIES FOR ROTATION
SURGERY
The purpose of rotation in General Surgery is that an OMFS resident
learn the basic principles and acquire core competencies required for
the practice of any discipline of surgery including Oral and Maxillo-
facial Surgery. These competencies are given below:
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FIRST MONTH SECOND MONTH
Total
Competencies Cases
Level Cases Level Cases
Pre-operative preparation for surgical procedures
Use of aseptic technique 3 20 4 20 40
Positioning of patient for diagnostics
and operative procedures 3 10 4 10 20
Identification and appropriate use of
common surgical instruments,
suture materials and appliances 3 10 4 10 20
General Surgical Procedures
Hemorrhage control 2 10 3 10 20
Debridement, wound excision,
closure/suture of wound 2 5 3 10 15
Urethral catheterization 2 5 3 5 10
Nasogastric intubation 2 10 3 10 20
Tube thoracostomy 1 2 2 2 4
Venesection 1 3 2 3 6
Biopsy of neck lymph nodes 2 5 3 5 10
Biopsy of skin lesions,
subcutaneous lumps or swellings 2 5 3 5 10
Excision of soft tissue tumors and
cysts (surface surgery) 1 3 2 3 6
Intermediate Module in Oral & Maxillofacial Surgery 2011
Cricothyroidotomy 2 1 3 1 2
Percutaneous needle aspiration,
preferably under ultrasound guidance 2 1 3 1 2
Burn care 1 2 2 2 4
Wound healing and peri-operative
complications 1 3 2 3 6
Fluid and electrolyte balance 2 5 3 5 10
Care of unconscious patient 2 5 3 5 10
Replacement of Fluid and nutrition 2 5 3 5 10
Thyroid and Parathyroid Surgery 1 2 2 2 4
ER Abdominal trauma management 1 2 2 2 4
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ANESTHESIA
The OMFS Resident should be trained in such a manner so that
he/she is able to diagnose and accordingly manage cases requiring
anesthesia and develop clinical skills as identified below so as to
provide better patient care and improve the standard of Oral and
Maxillofacial Surgical practice in Pakistan.
Procedures
Airway management
Facemask & supraglottic airway devices 3 2 3 3 5
Endotracheal intubation 3 10 3 15 25
Management of difficult airway 3 5 3 5 10
I.V. Cannulation 3 10 3 15 25
Use of anesthesia equipment 2 4 3 6 10
Use of monitors (ICU) 2 10 3 15 25
Lumbar puncture 2 2 2 2 5
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USEFUL ADDRESSES
AND TELEPHONE
NUMBERS
1. Regional Offices of the CPSP
MUZAFFARABAD LAHORE
CMH Muzaffarabad Next to INMOL, Hospital
Azad Kashmir New Muslim Town, Block-D
TEL: 058810 - 43307 Lahore.
FAX: 058810 - 43902 UAN: 042-111-666-666
Email: [email protected] TEL: 042- 9231320-8
FAX: 042- 9231327
ABBOTTABAD Email: [email protected]
Ayub Hospital Complex
Abbottabad
MULTAN
TEL: 0992-383330
Nishtar Medical College,
Email: [email protected]
Distt. Jail Road, Opp Circuit House,
Multan.
PESHAWAR
Hayatabad Medical Complex UAN: 061-111-666-666
Phase IV, Hayatabad, TEL: 061-9200946, 9200952
Peshawar Email: [email protected]
UAN: 091-111-666-666
TEL: 091-9217011, 091-9217320-1 BAHAWALPUR
FAX: 091-9217062 Quaid-e-Azam Medical College
Intermediate Module in Oral & Maxillofacial Surgery 2011
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HYDERABAD QUETTA
Adjacent to Sir Cowasji Jehangir
CPSP Bolan Medical College
Institute of Psychiatry,
Hyderabad, Sindh. Sandeman Civil Hospital
TEL: 022-3860056
FAX: 022-3860057 TEL: 081- 9202424
Email: [email protected] Email: [email protected]
KARACHI
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Intermediate Module in Oral & Maxillofacial Surgery 2011
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