You are a trainee, and as such you are not expected to know everything about OMFS before starting specialty training: it will be normal to be confronted with new clinical situations, and this will persist through to consultancy. Training will help you develop the skills to deal with these situations. Many will have worked in the specialty in various roles, such as SHO’s, Foundation doctor, core trainee or middle grade. There are many courses designed for early stages of training as a ST in OMFS. Examples include:

• Basic surgical skills and advanced skills in OMFS
• The CCrISP
• AO- CMF principle of fixation
• Emergencies skills in OMFS

In preparing for Registrar training trainees are advised to browse the Royal Colleges, BAOMS, EACMFS, ENT-UK and BAPRAS websites for further information. Getting a good structure and working understanding of common OMFS emergencies will make you far more comfortable oncall and help you to hit the ground running.

Fellow Registrars and your supervising Consultants are a valuable source of information; they have been there before. Ask for their advice regarding useful courses, books and training related material and they have vast experience to direct you. As each unit is unique it is advisable to speak to the incumbent trainee to get a guide to the unit dynamics, facilities available and nature of work commonly provided. This will help you maximise your learning opportunities.

Take time to go over your portfolio and decide on which courses you need to do, and how you are going to fund them. Discussions with your local consultants (Academic educational supervisor) and fellow Trainees will help you plan these. You should stagger these courses throughout the year. Deanery reimbursement has recently changed. The new study leave budget from HEE England allows trainees to claim from a list of mandatory and essential courses for OMFS. The courses not listed may be approved by the local TPD if deemed suitable. There is currently no cap on the amount of money claimed, but there are limitations in what they will pay for such as foreign travel costs. It is worthwhile familiarizing yourself with the guidance and to be aware this is new guidance and may change further.

It would be worthwhile contacting the Training program director or Specialist Trainee representative in your rotation to obtain dates for deanery studies days, make sure you book these dates off with leave requests. It is also important to block off dates for BAOMS, EACMFS, ICOMS conference and the dates for the annual Fellows–in-Training conference. It is your responsibility to make sure these dates are booked off and they can change over the year. All trainees should be aiming for 100% attendance, because beyond the education they offer they are a useful way of learning about useful courses, other units and opportunities you may not have been made aware of. The additional informal peer-support these days provide is invaluable, especially for trainees in smaller units.

Remember to advise your defence organisation you are now a senior trainee so that you are covered appropriately and your indemnity is not invalidated.

BMA can also check your contract to ensure its compliance.

As a minimum your induction should provide you with the following information:

• Outpatient clinics
• In-patient wards
• Day case area
• Theatre locations
• Emergency cases admissions
• Administration office
• Management protocols

You will need to get all the necessary access to hospital systems to perform your job properly (e.g. access to imaging, investigation results, patient records, theatre lists, parking, passes etc). You will be issued with passwords.

The minimum sessions the SAC in OMFS recommends per week for each trainee are:

• Four consultant supervised theatre sessions (2 operating days). This could be session in theatre, or surgical session in outpatient clinic 
• Two consultant supervised outpatient clinics each week
• Exposure to MDT clinic
• One session per week protected study time, which would usually be expected to result in publications and presentations
• 2 hours of facilitated formal teaching each week on average). This can be locally provided teaching, regional meetings, annual specialty meetings, journal clubs and radiology meetings
• On-call commitments covering out of hours work and emergency cases

On most days your day will start by attending ward round.

Organisation of registrars ward cover varies among units. Ward rounds are usually lead by consultants and ST’s are expected to assess patients under supervision and discuss management with their supervisor. If you are unavailable to attend the ward round due to other commitments then arrange for another ST to do so and ensure the rest of the team know whom to contact. 

Use this as an opportunity to get WBAs when appropriate.

Learning opportunities will vary depending on the structure of each clinic. They can be new, or review patients. Some units also have dedicated trauma clinics. Discuss with your supervising consultants what is he/she expects from you as a new ST and how they like to run their clinics. It may be useful to present each patient whom you see to the consultants during early and final year of your training. This will help you to develop a system, communicate clearly and precisely until this becomes second nature.

It is worthwhile discussing new patients with the consultant before you start seeing them, especially when you are new to a team.

You need to see:

• Referral letter and copies of blood tests, histology and radiology reports. This is vital to avoid any confusion or misunderstanding (know the story inside out).

You need to:

• Take a full History
• Perform the relevant Examination
• Consider the Investigations
• Check the patient's expectations and understanding of reason for referral
• Check how much the patient wishes to know about the diagnosis and treatment
• Explore if they wish relative or someone else presence.
• Discuss the treatment plan
• Outline the treatment options (including no treatment) and their pros and cons.
• Discuss the recommended treatment options and reasons for this
• Explain the practicalities of treatment, including how the treatment is given, and discuss the likely side effects and how these will be managed.
• Ensure that the patient has all of the written information about proposed treatment that he/she requires and relevant contact details

Patients have either had treatment, are awaiting results and/or developing new symptoms.

Before you see the patient, read all relevant notes and establish why the patient is coming for a review (obtaining results, post-injury follow-up etc). On seeing patients ask how they have been and if they have any concerns.

Check for symptoms and signs of relevance to diagnosis and present these to your consultant. Attempt at formulating a plan and have a logical reason to back it up.

These as are of significant importance to learning, they should help you understand the rationale behind the decision making process. They will be at a fixed time and can be quite lengthy sometimes.

OMFS trainees can attend many different types of MDTs. Head and Neck Oncology, Dermatology, Orthognathic, Craniofacial, Cleft and or complex trauma MDTs are some of the examples. If you are asked to arrange for a patient to be discussed at a MDT meeting, you will need to do that through the MDT co-ordinator or the consultant’s secretary. Make sure that you understand fully the rationale for the decision so you can communicate it to co-ordinator and what does the consultant expect from you.

MDT are exceptionally good in learning about the staging and relevant investigations for the particular cases. Rare cases and complex decisions are usually managed in MDTs. Experience the teamwork approach to management of complex clinical questions. You may have to present patients, and in time provide an opinion. If you’re not clear about something regarding management, this can be a good time to ask. If there is no opportunity to ask during the meeting, make sure that you ask after the meeting.

On calls
Being the ST on call for the first time can be daunting. Make sure you know how hand over process works and if you have a formal hand-over from the day ST/ ward team. Do the evening ward round and with ward doctors and nurses if there are any problems before you go home. 

Clarify your roles and responsibilities:

What are your admission criteria? Who should you definitely admit, and who can be managed locally or under another team? 

Although some units have a full shift system for work, this is not a widely spread practice in OMFS. The on-calls are usually done from home, but there be will be instances when you need to come in to see patients or even travel to other hospitals.  Establish if the consultants want you to ring them individually if their patients’ are ill, or only the consultant on-call. Know how you can arrange for emergency admission, rules for emergency theatre and your consultants' contact details.  If unsure then ask more senior STs or the consultant oncall with you. Remember to record all surgical cases for your logbook.

Administration
Establishing a good working relationship with administrative staff is very important. They are the ones to ask about clinical letters, putting people on MDTs for discussion, managing theatre lists, co-ordinating annual leave, study leave etc. They also can let you know when they receive results for an investigation you may have requested.