- Title
- Mouth, jaw and face - head and neck surgery : a maxillofacial surgeon's fulfilment of curriculum, core competencies and critical analysis in head and neck surgery
- Creator
- Hoffman, Gary Russell
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2015
- Description
- Higher Doctorate - Doctor of Medicine (MD)
- Description
- Prologue: Surgery can be defined as the art and science of the operative management of human injury, deformity or disease. It historically has been, and continues to be, achieved by either manual or instrumental means. Recently it has borne witness to the introduction of minimally invasive and robotic technologies. Surgical procedures have been variously described since the era of the ancient great river civilizations, circa 7000 BC. Historically, Practitioners of surgery have been identified throughout classical antiquity, medieval times, the Renaissance and the age of Enlightenment. They were typified by an eclectic mix of philosopher nobleman, knowledgeable clergymen, Barbers and Battlefield surgeons. They all provided detailed analyses of their surgical techniques and operative outcomes, which have in the main been methodically preserved for posterity. Despite the introduction by medieval universities of defined curricula in medicine, science and the arts, there remained a distinct separation in the respective developments of the disciplines of medicine (physic) and surgery. Within the latter, Guilds of Barbers and Surgeons were initially established and subsequently paved the way for a more formalized training of surgeons. This in turn led to the development of gazetted Colleges of Surgeons. Head and neck surgery has progressively developed as an anatomically defined regional surgical specialty. Tumors of the head and neck are treated by a variety of surgical disciplines. In addition, radiation and medical oncologists also provide primary and or adjuvant management of selected pathology. Surgeons practicing within the head and neck include the otolaryngologist, maxillofacial surgeon, general surgeon and plastic surgeon. They each come from a different and unique surgical background. This is particularly evident in their individual approaches to the management of head and neck pathology. However, regardless of their respective backgrounds, the “contemporary head and neck surgeon” is required to achieve independent, competent and proficient surgical practice. These demands remain rooted in the successful completion of a “surgical apprenticeship”. Significantly, the Halstedian theory of “see one, do one and teach one”, which to a greater extent shaped twentieth century surgical training, has been strengthened in the twenty first century by the inclusion of the trilogy of curriculum, core competency and critical analysis. Critical analysis can be defined as the systematic appraisal of research methodology. In the broadest sense, it is based on the scientific evaluation of (health related) clinical care. In contemporary surgical practice, critical analysis embodies activities like audit (the evaluation that pre-defined standards have been met), quality assurance, and clinical and biomedical research. Ultimately, it aims to contribute to the establishment, maintenance and promotion of an ongoing scientific body of knowledge in defined areas of specialty (surgical) practice. This scientific body of knowledge is considered by resources such as Medline and Pubmed, which index journals and catalogue their articles. Purpose: All medical treatments aim to save or prolong life, to relieve symptoms, to provide care or to improve health related quality of life. The aim of this research was to undertake a critical analysis of selected aspects of the biopsycho-social outcomes that resulted from the surgical management of a cohort of patients who were diagnosed with a head and neck cancer. The surgery and its outcomes were a direct result of the author’s fulfilment of curriculum and core competencies, which underpin competent and proficient practice. A treatment catalogue of a substantial patient cohort who had developed a head and neck cancer was established and maintained by the author. Patients considered for inclusion in the various studies were initially assessed by a Head and Neck Multi-disciplinary Team. The patients were subsequently admitted under the care of the author to a tertiary referral hospital and underwent surgical management of their cancer according to the recommendations of the MDT assessment. The advanced study was based on the systematic critical analysis of aspects of the quality of care provided by the author. Results: Publications that resulted from the study were based on clinical audit investigation, metaanalysis, technical innovation and unique case reports supported by literature review/discussion. The thesis that was subsequently developed consisted of an extended discourse on the history of surgery and in particular, head and neck surgery, combined with a compendium of original research works which had been published in peer reviewed journals. Conclusion: Maxillofacial surgery is a bona fide surgical specialty. It has evolved to manage a range of diseases, deformities and defects that afflict the mouth, jaws, face – head and neck. In keeping with the trials and tribulations of my surgical forebears, this body of scientific works consists of a series of peer reviewed papers and monographs that have been published in relevant specialty journals. It is my contention that the research has provided an original and substantial contribution to the literature. In particular, it expands the existing body of knowledge in the field of head and neck surgery. In conclusion, the author considers that he has fulfilled an appropriate curriculum, addressed core competencies and applied critical analysis to his resultant surgical outcomes in the discipline of head and neck surgery.
- Subject
- head and neck surgery; evolution of surgery; cervical lymphadenectomy; quality of life; accessory nerve shoulder dysfunction; microvascular reconstruction; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1305609
- Identifier
- uon:21075
- Rights
- Copyright 2015 Gary Russell Hoffman
- Language
- eng
- Full Text
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| View Details Download | ATTACHMENT02 | Thesis | 20 MB | Adobe Acrobat PDF | View Details Download |