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 oral pathologists based within university dental schools. In recent years, there has been a significant increase in the scope and complexity of diagnostic work undertaken by oral pathologists. 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 ENT surgery, the development of head and neck cancer services and the trend for increasing specialisation within diagnostic histopathology. Following from this has been an increasing awareness of the need for specialist posts in head and neck pathology within some NHS Trusts, particularly those with cancer centres for which trainees in oral pathology should be well-qualified to apply. The breadth of experience of trainees in oral pathology is not well understood by those outside the specialty.
For these reasons, it was felt timely to review the scope of oral pathology and the levels of competency expected of an oral pathologist on the award of a CCST. It is intended that this information should be useful to those planning specialist training programmes in oral pathology as well as to trainees, other histopathologists and employing authorities.
With regard to the level of competency, this must be sufficient so that, on completion of training, the trainee is capable of providing an independent oral pathology diagnostic service at the level required for the award of a CCST in the specialty, be able to offer a specialist opinion on referred cases and be able to provide specialist advice to clinicians with direct responsibility for the treatment of patients.
Because of differences in the structure of training programmes, case mix between centres and special interests of trainers and/or trainees, some variation in experience in the different fields of histopathology in the head and neck region is to be expected. For this reason, the following phrases have been used to describe the levels of competency expected in different aspects of head and neck pathology for the award of a CCST:
· ‘to be able to diagnose’ – material for which accurate and complete reports are expected, taking account of all relevant specialist reporting guidelines
· ‘to be able to offer at least a working diagnosis’ – material with which trainees will be familiar and will have had experience of reporting, but for which discussion with a specialist is considered best practice before issuing a definitive report (e.g. neoplasia of the lymphoreticular system)
· ‘to be able to offer at least a differential diagnosis’ – material that the trainee will be aware of, but may have had only limited or no experience of directly reporting. This material will include some rare/uncommon lesions diagnosable after personal research and lesions for which a specialist opinion will be required (e.g. the rarer types of odontogenic tumours; neoplasms of bone/soft tissue).