British Journal of Oral and Maxillofacial Surgery (1989) 27, 287-290 0 1989 The British Association of Oral and Maxillofacial Surgeons 0266-4356Xl89/0027-0287/$10.00

A SHORT GUIDE TO STUDYING MEDICINE FOR

THE DENTAL GRADUATE

S. G. LANGTON, B.D.s., M.B., co., F.D.S.R.C.P.S. and P. D. EARL, B.D.s., M.B., B.S., F.D.S.R.C.S.

North Tees General Hospital, Hardwick, Stockton on Tees, Cleveland TS19 8PE

Summary. Advice is offered to dentally-qualified trainees with an interest in oral and maxillofacial surgery who may be considering applying for a place in medical school from two trainees who have recently completed their medical studies.

Introduction

For most dental graduates who aim at a career at consultant level in oral and maxillofacial surgery a medical qualification has become a necessary step in the training pathway. Advocated by the British Association of Oral and Maxillofacial Surgeons (BAOMS) in 1982 it is now included in the recently produced career outlines recommended by the Association. However, obtaining such a qualification presents the trainee with a considerable number of varied problems; as to the method and timing of entry to medical school; as to what qualifications will be required; as to the financing of the course; the concern over family responsibilities and the problems of studying as a mature student. This paper aims to outline some of the problems that may be of concern to the prospective dentally qualified medical student and attempts to offer some advice on how they may be overcome.

Entry to medical school

BAOMS recommends that undergraduate training in medicine follows an initial period of general dental and oral surgery training of between 2 and 3 years during which the trainee is expected to gain the primary Fellowship in Dental Surgery (FDS) examination. However, entry will obviously be influenced by the selection policy of the individual medical school and there is considerable variation in the criteria for entrance for dental graduates. Some may obtain entry directly from dental school whilst others are required to have passed the final FDS examination before being admitted. There has been a wide range of postgraduate dental experience reported prior to medical studies, in some cases over 10 years (Langton, 1988a).

In our experience it would seem that some medical schools are well-informed and sympathetic to the trainee oral and maxillofacial surgeons, whilst others are not. We therefore suggest that the prospective medical student contacts each individual medical school and determines their current selection policy with regard to dental graduates and/or mature students. There is obviously little point in wasting an entry on the UCCA application form to an establishment unlikely to offer a place. Once

(Received 21 October 1988; accepted 23 February 1989)

Correspondence: Mr. S. G. Langton, 4 Elm Walk, Bearsden, Glasgow G61 3BQ.

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a short list of suitable schools have been assembled, we suggest that a personal visit is undertaken to each of these schools to ensure that the often poorly-understood oral and maxiilofacial training pathways are discussed with the medical school staff. It is, of course, vital to have the support of a sympathetic and informed referee to supply the confidential report on the UCCA form.

It is worthwhile attempting to determine whether any exemptions from parts of the medical course are possible, particularly during the pre-clinical years. Alternatively, it may be possible to undertake a diploma rather than a degree course, aiming to sit the M.R.C.S., L.R.C.P. (‘conjoint’) examination, which can considerably reduce the period of undergraduate medical training. In the past, a small number of individuals have completed the first (preclinical) part of the conjoint before entering medical school full-time and then have undertaken their clinical studies in the medical school before sitting the final parts of this examination.

Timing of entry demands consideration of a number of factors. It is obviously important that one should have a clear idea of what a career in oral and maxillofacial surgery entails and what the demands are likely to be. On the other hand, we do not feel that it is wise to wait too long before starting at medical school and not later than 30 years of age. Entry may be limited by the actual availability of place (for example, if the school has a policy of admitting a dentist every 2 years) and by the entrance requirements (some schools demand final FDS). Clearly one has to ensure that sufficient funds are available for the duration of the course and indeed some schools insist that a guarantee of financial security is given.

In our experience we feel, on balance, that the optimum period before starting medicine is about 3 years. This gives an opportunity to gain, at least, a fair insight into a career in oral and maxillofacial surgery and also is sufficient time in which to complete and obtain FDS. Holding the dental fellowship increases ones chances of gaining entry to a medical course and, in the addition, we feel that it is probably easier to study and to sit this examination before one has spent 5 years away from full-time dentistry. On the other hand a small number of individuals do manage to sit postgraduate dental examinations whilst at medical school, although this is not the easiest option. Attempting postgraduate examinations during the most junior medical posts is, we feel, very difficult.

In summary it should be remembered that different medical schools set fairly flexible and variable requirements for mature students seeking entry and a personal approach to the Admissions Tutor in order to establish a good case for entry is often required. In many cases persistence will be required to produce a satisfactory result.

Financial aspects For the dental graduate the cost of returning to university for 5 years is

considerable. There is, of course, a substantial loss of income and many students are required to pay tuition fees in full. Over half the trainees receive no local authority grant for their medical course (Langton, 1988a). However, the possibility of obtaining a local authority award should not be overlooked, especially for the duration of the clinical course. Most individuals undertake locum work in hospitals or general dental practice during the vacation periods and many are able to find regular part-time work in one or both of these fields. A hospital position in oral surgery, especially on a regular basis, has the advantage of ‘keeping one’s hand in’ and may possibly be included as recognised experience in the overall training pathway.

MEDICINE FOR THE DENTAL GRADUATE 289

There are a number of established charities providing financial assistance for the cost of education which may be able to provide help for needy cases, although the holder of a dental qualification may not be viewed as such. The Bowdler Henry Scholarship is directed specifically at those who aim at a double qualification in medicine and dentistry and is advertised in the dental press as it becomes available.

It is important to note that one often becomes re-eligible for many student concessions such as cheaper rail travel and, in addition, one may be able to request a reduction on various professional expenses, such as conference fees, association subscriptions and the cost of journals. When the time comes to apply for pre- registration medical and surgical posts it is well worth remembering that one should be eligible for a protected salary commencing at the same grade at which one left the hospital dental service. This usually requires prior approval by the authorities concerned, so we suggest that this is applied for at the earliest opportunity and the British Medical Association consulted should problems arise. We would also advise the prospective medical student to contact the relevant authority regarding one’s position with regard to superannuation as ‘added years’ may need to be purchased and this can most advantageously be done in the year following graduation.

Overall, by undertaking a combination of locum and part-time posts most dentally-qualified medical students appear to remain financially solvent through their medical course, though obviously some sacrifices are necessary during this period.

Studying medicine as a dental graduate

Entering university for a second time can be an unsettling experience. Given that over half of those who undertaken this type of training have Registrar experience and that a similar number have completed postgraduate Fellowship examinations, it is understandable that many should feel that they have taken a retrograde step and that progress has been retarded. There is certainly frustration during the early part of the course as it appears that much of the work is merely repetition of study undertaken during undergraduate dental studies. However, in our experience, most individuals find considerable improvement as the clinical part of the course progresses. It is our observation that most people who undertake the medical course after dentistry do not have many problems with the academic component; one’s experience of studying and sitting examinations is a distinct advantage. Although the relative youth of one’s student colleagues may be a surprise initially, most oral surgeons appear to have few problems integrating socially. The advantages of the wide range of sporting and social facilities found at any university should not, of course, be overlooked.

We would advise prospective entrants to contact the Medical Students’ Group of the BAOMS. They meet annually at the Autumn meeting of the Association, which gives a good opportunity to discuss the various problems and subjects relating to trainees at the medical undergraduate stage and also a means of attending a national meeting of BAOMS. It has, in the past, also been an enjoyable social occasion.

It is difficult to estimate the number of dentally qualified medical students in the UK and the number will vary from year to year but in 1987 there were 79 (Langton, 1988a). Of these, approximately 40% will probably not continue in oral and maxillofacial surgery (Langton, 1988b). Therefore, an average of approximately 10 medically qualified dental graduates will enter oral and maxillofacial surgery each

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year. The prospects for those who complete a medical degree and who wish to progress in the specialty are, therefore, reasonably favourable.

Acknowledgements

The authors wish to thank Mr B. S. Avery, for his assistance with this paper.

References

Langton, S. G. (1988a). A study of dental graduates at British medical schools in April 1987. British Journal of Oral and Maxillofacial Surgery, 26, 89.

Langton, S. G. (1988b). A Career survey of dental graduates who subsequently qualified in medicine between 1970 and 1979 with special reference to oral and maxillo-facial surgery. British Dental Journal, 165, 174.