Residency Training Program In Oral and Maxillofacial Pathology
John R. Kalmar, DMD, PhD
Susan R. Mallery, DDS, PhD
Kristin K. McNamara, DDS, MS
The Oral Pathology Residency Program in the Ohio State University College of Dentistry is designed to provide the post-graduate dental resident with the clinical and microscopic skills necessary for the practice of oral pathology. In addition, emphasis on critical evaluation of biomedical literature, teaching skills and research design and protocol will provide the resident with the broad background information which is required in order to survive in today's academic setting. In other words, the program seeks to provide a well-rounded educational experience in all aspects of oral pathology so that its graduates will feel equally at home whether reviewing a histologic section, examining a patient, or writing a grant proposal. In order to achieve this goal, residents are expected to attend and participate in a diverse blend of didactic courses, seminars, special clinics, conferences, lectures and clinical consultation sessions. To successfully negotiate this curriculum, full-time attendance, Monday through Friday, plus other specially scheduled weekend rotations, duties, meetings and seminars, is expected. Performance in these areas will be regularly evaluated and reviewed with the resident to continually improve both the program and the individual learning experience.
It is hoped that your educational experience in the residency program in oral pathology will be a rewarding one. Our goal is to create an informal environment that promotes higher learning. We seek to guide your development, not only in terms of clinical and microscopic skills, but in terms of intellectual and professional acuity that will help you face the challenges of the future and emerge as a leader in the field of oral and maxillofacial pathology.
As with all post-doctoral training, the faculty can provide direction,
consultation, and camaraderie, but ultimately the quality of the program
is a direct reflection of your level of dedication, initiative, participation,
and time spent at the microscope, in seminars and rotations, in the
library and in the laboratory. The faculty and staff are ready to
assist you in all aspects of your training and you should feel free
to seek our advice and let us help you if any problems arise. The
program is operated on a friendly and informal basis. The expectation
is that this informality will foster a free exchange of ideas, produce
a relaxed atmosphere for education and will permit the resident to
develop an individualized style and philosophy for the practice of
oral pathology. With this informality, however, goes the responsibility
of each resident to pursue his or her education with serious intent.
Explicit care must be utilized in all departmental activities, including
the grossing, processing, and diagnosing of tissues as well as coursework,
teaching responsibilities and research projects.
Professionalism: All residents are expected to adhere to guidelines set forth by the Administration of the College of Dentistry regarding professional conduct while in the oral pathology training program. This will include such things as appropriate record keeping, care of University and Departmental property, concern for the security of the Department and building, and adherence to the policies regarding operations as directed by the Program Director and the Associate Dean for Clinical Affairs. Residents are expected to maintain professional decorum at all times. Personal attire and appearance should be neat and appropriate. Oral pathology work areas must be kept neat and clean at all times: janitorial maintenance services are provided for these areas but the overall appearance and organization remain the responsibility of the residents.
Security: Security of the department is the responsibility of the resident. There is much expensive equipment within the department and each resident is expected to extinguish all lights and secure all doors to the area, where appropriate, when you are the last to leave. Making certain that the door to the area exited is locked is also a responsibility.
Attendance: Attendance at all program functions, both scheduled and informal, is expected. Under certain extenuating circumstances, residents may be excused. The faculty member in charge, however, should be given the courtesy of prior notice of any scheduled absence.
Biopsy Service: Gross examination of specimens is the primary responsibility of the residents, who share equally in the distribution of the caseload. During the first few weeks of the program, this activity will be supervised either by one of the staff or by one of the senior residents. Residents are responsible for insuring the accuracy of maintaining accession log and numbers, and gross examination. Every tissue specimen received must be handled with utmost care, making sure that a correct accession number is assigned to each biopsy request form and specimen.
The handling of all tissues during grossing must always be done with care and precision since the health or life of the patient may depend upon the accuracy of this work. Furthermore, there is a medicolegal responsibility to maintain accuracy in records.
It is the responsibility of the resident performing the gross examination to see that the tissue processor is in proper working condition, and set correctly for the time interval required.
Medical: Residents must provide evidence of hepatitis B and rubella immunization or antibody titers. Current valid CPR certification at time of matriculation is required and must be maintained during the residency program.
An important part of the daily activities in the department revolve around the daily surgical pathology sign-out. Depending upon the number of surgicals for that day, the histotechnician should have the slides prepared by 8:30 – 9:30 AM. All residents not on other rotations or fulfilling other duties should participate in the daily sign-out.
Daily reports will be dictated by one of the faculty members while reviewing the slides with the residents. This is done on a multi-headed microscope. Depending upon specimen case load, a portion of the routine specimens will usually be assigned to the resident(s), who will be expected to provide initial write-ups and diagnosis of the cases. Proper management of these cases, including ordering of recuts or special stains, will primarily be the resident’s responsibility, in consultation with the assigned faculty member.
Clinic patients with oral lesions are seen on consultation by the oral pathology residents for evaluation and management. The staff will provide guidelines as to which resident is responsible for seeing consultations at any given time. The resident should work-up the patient in an organized fashion and, when necessary, present the case to the attending staff for feedback and input. The resident will be expected to document the findings in the patient’s record, provide a differential diagnosis, take clinical photographs when appropriate, and ensure a proper disposition of the patient and final diagnosis. Follow-up should be noted as it becomes available.
In order to improve communication between staff and pathology residents, the position of "Chief Resident" has been established. The Chief Resident is a third-year resident whose duties consist of:
1. Informing the staff and/or residents of any changes in the seminar schedule, teaching schedule, lecture schedule, or clinic schedule. Keeping residents informed of outside conference dates.
2. Making necessary arrangements for seminars, case presentations, etc... This will include securing the room, audiovisual equipment and any other equipment needed.
3. Serve as an ombudsman between the staff and residents. Any problems should be brought to the attention of the program director.
4. Assume greater responsibility for initial diagnoses of cases.
The Chief Resident is expected to be fair and equitable in dealing with fellow residents and faculty. The Chief Resident is directly answerable to the Program Director and will be held responsible for any failure to carry out responsibility.
Attendance at all sessions is critically important. A schedule will be provided at the beginning of each semester describing the days that these events will take place. Resident performance will be evaluated on each of these seminars. This evaluation will be contingent upon the degree of participation, preparation and contribution (where appropriate).
Seminars are usually two to three hours in duration. Unless previously arranged, residents are required to read all references provided per session. Please remember the strength or weakness of any seminar is directly related to the degree of preparedness of the participants.
Residents will rotate through general pathology for six months during the program. Assignment will be made by the Anatomical Pathology Director of the Department of Pathology, and the resident will be under the supervision of that person. The resident will serve as a resident in general pathology performing, under supervision, all aspects of training including grossing and signing out of surgical specimens and performing and signing out of autopsies. All conferences and other activities of the pathology department during this rotation will be attended. There are also elective and/or required rotations through clinical pathology, oncology/radiology, oral and maxillofacial radiology, ENT, dermatology, etc.
Each resident is expected to teach as part of the training and learning experience in pathology. Residents will be assigned to deliver a small number of lectures or seminars during their first, second or third years in dental hygiene or pre-doctoral dental courses. Supervision and teaching of pre-doctoral dental students is required for one to two half-days per week while clinics are in session. All residents are expected to make case presentations from time to time.
Most residents should be interested in acquiring a significant background in research. During the three-year course of the certificate program, an adequate amount of time is generally available to complete the work necessary for a Master of Science degree. For those individuals who are interested in remaining in an academic environment in the United States, a Ph.D. degree is highly desirable in order to successfully compete for extramural funding, which is necessary to achieve promotion and tenure in many academic positions.
Each resident is encouraged to attend, when possible, the American Academy of Oral Pathology annual meeting. It is considered very important that the resident present an abstract or paper at the meeting at some point in their training. This should be done under the direction of and with the consent of one of the attending staff. Every attempt will be made by the faculty to arrange financial support, at least in part, for travel to the meetings; however, this cannot be guaranteed. Residents who do not present will typically not be eligible for support.
Publication of original manuscripts is encouraged, but not required. Ideally, the resident should be able to prepare at least one case report of an unusual lesion as well as submit the findings of the research project for publication during the three-year course of the residency program.
Attendance in all aspects of the program is expected. Unexcused absences are subject to appropriate disciplinary action. All official University holidays are listed on the academic calendar and may be observed by the residents. In addition, all residents are entitled to two weeks (10 working days) vacation per year which must be scheduled during "down-time" and cannot conflict with regularly scheduled activities. Vacation time must be coordinated with the Program Director, and it cannot be taken in the terminal 30 days of the program. There can be no carry-over of vacation time from one year to the next. In addition, under certain circumstances which must be approved by the Program Director, other vacation, emergency, or personal leave time may be granted.
Progress will be monitored carefully by the attending staff that has primary responsibility for your training. Semiannually, the resident will be evaluated by the Program Director, and the resident will have an opportunity to respond to this evaluation either in writing or by a direct conference. Residents will also have the opportunity to evaluate their rotations and the program as a whole.
Dismissal from the residency program requires a unanimous vote of faculty directly responsible for your training. Grounds for dismissal include poor clinical performance and unprofessional conduct. Less serious offenses may result in suspension from the program for a prescribed period determined by the Program Director. Repeated offenses can result in dismissal from the program. Appeals of suspension and/or dismissal are made in written form as indicated in the Graduate Student Handbook under "Due Process".
The residency program is conducted very informally so that unofficial discussions with the attending staff are possible at most times. The Program Director is usually available for conferences and consultations, and a mutually agreeable time may be arranged if necessary.
Prior to certification, all of the aforementioned requirements must be met. Even though no formal examinations are given at the termination of the program, the overall performance of the resident will be evaluated by the faculty members. If the evaluation is satisfactory, a certificate of training will be issued. The semiannual evaluations should provide insight for the resident as to whether satisfactory performance is being achieved.
While it is not required as a condition for certification, it is expected that residents apply to take the American Academy of Oral Pathology Fellowship Examination during the third year of the program. Clearance for application must be obtained through the Program Director in order to ascertain if the resident is ready for the examination.
The services of the secretaries and technician within the department may not be utilized directly by the residents since these personnel are responsible to the faculty of the department. In the event that services are needed for routine assignment of tasks or for special projects, permission should be obtained from the attending staff with the request and instructions for that project should be issued by them.
All correspondence to patients, referring dentists or physicians, or articles for publication is the responsibility of the resident, not the department secretary. However, with faculty permission, the secretary will be available for support. The resident will be expected to learn basics of word processing and will construct initial drafts of letters or articles on the computer.
Most textbooks relating to oral pathology will be available either in the residents’ room or from one of the oral pathology staff. Residents may have to purchase textbooks or laboratory manuals used in other courses, though this is usually minimal. Every effort will be made to fund a trip to the American Academy of Oral and Maxillofacial Pathology annual meeting for the chief resident so that this person may present a paper and/or take the Fellowship examination of the Academy.