The recognised higher specialist qualification in Oral and Maxillofacial Pathology is the Fellowship of The Royal College of Pathologists (FRCPath), obtained by examination. As Oral and Maxillofacial Pathology is a dental specialty, formal recognition of the status of specialist oral and maxillofacial pathologists is the responsibility of the GDC and this allows inclusion of individuals on the Oral and Maxillofacial Pathology specialist list. The GDC delegates responsibility for the quality management of specialist training to Postgraduate Deaneries. The relevant Specialist Advisory Committee (SAC) will provide external advice when it is requested by Deaneries. Oral and Maxillofacial Pathology comes under the remit of the SAC in the Additional Dental Specialties (SAC ADS). The SAC for the Additional Dental Specialties is concerned with the four additional dental specialties; these are Oral Medicine, Oral and Maxillofacial Pathology, Dental and Maxillofacial Radiology, and Oral Microbiology.

The award of the FRCPath in Oral and Maxillofacial Pathology, by examination, to dentally qualified candidates is critical in maintaining the training and standards of Oral and Maxillofacial Pathology as the equivalent of all other branches of pathology. The conduct of examinations for Fellowship of The Royal College of Pathologists in Oral and Maxillofacial Pathology is the responsibility of The Royal College of Pathologists. Postgraduate Deaneries are responsible for the educational approval of Oral and Maxillofacial Pathology training programmes. From time to time, Deaneries may seek external advice from the SAC. Deanery approval and quality management of training programmes is essential and ensure that programmes meet the requirements for entry to the FRCPath examination. The GDC is responsible for the external quality assurance of specialty training managed by Postgraduate Deaneries. Specialty training programmes are locally managed by Training Programme Directors; these posts are Deanery appointments. All trainees are required to have a named Educational Supervisor who is responsible for ensuring that Workplace Based Assessments (WBAs) and appraisals are carried out.

The Postgraduate Deanery is responsible for the appointment of trainees to training programmes and is also responsible for the annual assessment of trainees through the Annual Review of Competency Progression (ARCP) process. 

Completion of training requires:

1. Satisfactory completion of 60 months of training (whole-time equivalent) as determined by the Postgraduate Deanery responsible for training in conjunction with the Training Programme Director.
2. Satisfactory completion of all areas of the curriculum as judged by a satisfactory ARCP outcome at the annual training review meetings undertaken by the Deanery and reported to the SAC and, at the end of training, completed the Annual Review of Competence Progression (outcome 6).
3. A pass in Parts 1 and 2 of the FRCPath examination in Oral and Maxillofacial Pathology, as determined by the Royal College of Pathologists.

On completion of training and having satisfied 1-3 above, the local Postgraduate Dental Dean will sign off GDC form Rec 1 in order to recommend that the trainee be awarded a CCST and so be eligible for specialist listing

Note that you must hold FULL registration with the General Dental Council to be awarded a CCST. Ideally, overseas, non-EEA, non-UK trainees should have obtained full registration prior to entering specialty training so that working towards a CCST is not compromised by studying for the GDC Overseas Registration Exam (ORE) or equivalent exam.

The discipline of Oral and Maxillofacial Pathology is a clinical specialty, undertaken by laboratory-based dentists, that is concerned with the diagnosis and assessment of diseases of the oral and maxillofacial region. It is a branch of histopathology and, in common with medical histopathologists, oral and maxillofacial pathologists provide reports based on interpretation of tissue biopsies of varying types and of surgical resection material. The main method of examination of specimens is by light microscopy, but this is supplemented by other techniques as appropriate, such as immunohistochemistry, molecular analysis and electron microscopy. The majority of specialists are senior academics with honorary consultant status who are based in dental schools; however, there is a small number of specialists appointed to NHS posts in regional or district hospitals. Academic trainees, such as Lecturers, Academic Clinical Fellows (ACFs) and Academic Clinical Lecturers (ACLs), will need to obtain higher academic degrees related to proficiency in research, as well as specialist training in Oral and Maxillofacial Pathology.

The designation “oral pathology” has traditionally referred to all aspects of the pathology of the mouth and related tissues. This general description, which has remained unchanged for many years, reflected the academic and service responsibilities of most pathologists based within university dental schools. In recent years, there has been a significant increase in the scope and complexity of diagnostic work undertaken. This has arisen partly because of the range of surgery now undertaken by specialists in oral and maxillofacial surgery (OMFS), blurring of some boundaries between OMFS and ear, nose and throat (ENT) surgery, the development of head and neck cancer services and the trend for increasing specialisation within diagnostic histopathology.

It is the view of the Specialty that training in Oral and Maxillofacial Pathology should be sufficiently broad and detailed to allow successful trainees to apply for specialist posts in head and neck pathology in medical histopathology departments. 

Please note that although the GDC and others recognise the name Oral and Maxillofacial Pathology as the name of the specialty, the Royal College of Pathologists remains in transition to the new name and the specialty may appear as Oral Pathology or Histopathology (Oral).  These should be considered synonymous.

All candidates for specialist training in Oral and Maxillofacial Pathology in the UK and Ireland must have full, or be eligible for temporary, registration with the GDC. Candidates must have completed broad based training such as that achieved following two years of Dental Foundation Training and will normally have obtained the MJDF or MFDS examination (or equivalent) to mark the end of Foundation Training. Postgraduate Deaneries are responsible for the appointment of trainees to specialty training programmes and for drawing up detailed job descriptions and person specifications for each specialty training post. Posts are advertised nationally and appointed in open competition. Trainees in the dental specialties, including Oral and Maxillofacial Pathology, are allocated a National Training Number (NTN). In Oral and Maxillofacial Pathology, these training numbers are awarded in conjunction with the Lead Dean for the Additional Dental Specialties. The use of NTNs is associated with monitoring the workforce in England and Wales and this monitoring is done in collaboration with Scotland and Northern Ireland.

The current version of the full curriculum in Oral and Maxillofacial Pathology, published in May 2015, is available from the General Dental Council website in the area on how to apply for registration on a specialist list at URL:

https://www.gdc-uk.org/registration/your-registration/specialist-lists

The curriculum is an extensive document with a syllabus and outlines of training and assessments.  In outline, it is expected that trainees will follow a structured training pathway with workplace based assessments for a period of four years minimum, with 5 years normally taken to complete all the requirements to be awarded the Certificate of Completion of Specialty Training (CCST) necessary for the local Postgraduate Dean to make a recommendation to the GDC for inclusion on the specialist list and to be eligible for a UK NHS Consultant post.  At least one of those years must be in a general pathology environment; in practice the majority of UK trainees are linked into medical histopathology departments for much or all of their training. 

It is expected that trainees will normally sit the FRCPath part 1 examination after 2½-3 years of training, including one in general histopathology, and the part 2 examination at around 4½-5 years of training.  

The Part 1 is a written test of core knowledge. The examination will comprise two papers with a combination of short answer questions. There will be 11 questions on each paper, of which 8 must be answered per paper. All questions are equally weighted.

Paper 1 will cover general pathological principles and will include aspects of general histopathology relevant to oral and maxillofacial pathology.  Paper 2 will be slanted to oral and maxillofacial pathology.

The practical examination is comprised of five  components taken over two days. The examination will take place at one of the regional centres which currently include: London, Bristol, Southhampton and Edinburgh. The  examination comprises practical and oral components  and is designed to test the capability of the candidate to be an independent consultant specialist in diagnostic oral and  maxillofacial pathology and to enter the continuing professional development and external quality assurance schemes.

The Part 2 examination is conducted in five sections (designated A, B, C, D and E) with specified objectives. Candidates must pass Section A and B in order to be eligible for a pass. The aggregation of the scores in the different parts of the examination and any compensation between parts is at the discretion of the three examiners, who will take into account the entire performance of the candidate over the two days in reaching their agreed final decision of pass or fail. 

Candidates are advised to read the Royal Colleges Examinations Regulations and Guidance

Section A. Short Cases 

Twenty cases will be provided composed of haematoxylin and eosin (H&E) stained slides and a non gynaecological cytology case over a 3 hour time period.  The cases include a balanced mixture of neoplastic and non-neoplastic material ranging in complexity that may present to an oral&maxillofacial pathologist . The cases are drawn from a wide range of oral and maxillofacial material including skin, salivary, soft tissue, osteoarticular, lymphoreticular and endocrine systems and may include conditions which present as metastasis   from the upper and lower gastrointestinal tract, gynaecological tract, breast,respiratory,  genito urological . This list is not comprehensive. The cases will represent a range of difficulty from straightforward cases readily diagnosable on a single H&E section, more complex cases requiring more detailed description, differential diagnosis and special techniques, and cases not capable of diagnosis on a single H&E which should prompt an approach for further techniques, extra blocks and specialist opinions. The overall level is designed to recognise pathologists close to or at  the end of training, such that they demonstrate an appropriate approach ready for  independent consultant practice. The responses will be marked  according to pre-determined criteria, using the closed marking system.

This is a written component of the examination.

Section B Long Cases

There are 5  cases over 3 hours . They will include cases which cannot conventionally be covered by a single H&E stained section and require additional stains such as immunohistochemistry , immunofluorescence or molecular pathology. One of the cases candidates will be provided first with the H&E section and will request the immunohistochemistry they require. Cases may include complex resections, core biopsies, lymph nodes or masses or cases with multiple biopsies. The cases are drawn from a wide range of oral and maxillofacial material including skin, salivary,  soft tissue, osteoarticular, lymphoreticular and endocrine systems and may include conditions which present as metastasis  from the upper and lower gastrointestinal tract, gynaecological tract, breast, respiratory,  genito urological .  This list is not exhaustive and other types of cases may also be used.

The overall level is designed to recognise pathologists close to or at  the end of training, such that they demonstrate an appropriate approach ready for  independent consultant practice. The responses will be marked centrally according to pre-determined criteria, using the closed marking system.

This is a written component of the examination.

Section C Macroscopic Pathology

Four cases will be provided in the form of photographs of gross pathology specimens or wet formalin fixed specimens.  The exam will last no more than 1 hour . Candidates will not be required to dissect any specimen. There will be a gap between each case to allow the candidate to examine the next case. Candidates will be provided with clinical information and will be asked to prepare their responses to specific questions and to mark or indicate  on the photographs/ wet specimens where they would take blocks. This section is marked on the basis of discussion with the examiner/s only. This section is designed to allow candidates to demonstrate their capabilities in discussing gross pathology and familiarity with block selection in the context of the RCPath Minimum Datasets and good practice . Each case is marked to a pre-determined marking scheme.

Section D. MDM discussion

There will be 4 cases to be viewed in 1 hour  which may include H&E stained sections and additional stains such as immunohistochemistry before meeting with a pair of examiners in a 1 hour station across a multi -headed microscope, cases will be drawn from a similar range to those from sections A and B . Candidates should make notes, to form the basis for face-to-face discussion with 2 examiners who will expect a discussion consistent with the report given to an MDM or requesting surgeon.  This section is marked on the basis of discussion with the examiners only and not a candidate's written preparatory notes.

Each case is marked to a pre-determined marking scheme.

Section E OSPEs

OSPE1 and 2 are conducted face-to-face with 2 examiners and will last not more than one hour  Possible topics include management/clinical governance/health and safety type  cases, although this list is not exhaustive.