Advanced Graduate Education Program in Oral and Maxillofacial Pathology
Program director: Sook-Bin Woo, DMD, MMSc
The goal of the advanced graduate oral and maxillofacial pathology program is to train a specialist who is able to:
- provide the highest level of microscopy diagnostic skills utilizing, when appropriate, new technologies in immunohistochemistry and molecular studies;
- diagnose and manage patients with mucosal disease and head and neck pain syndromes whose primary treatment modality is nonsurgical;
- compete successfully for research grants from industry and other sponsoring institutions; and
- excel as teachers and leaders in the specialty.
Students in this program work toward a doctor of medical science (DMSc) degree. An original research project is part of the requirement for the degree. In addition to the required courses and rotations (see below), the program offers several elective courses and rotations as well.
The oral and maxillofacial pathology program begins with an intensive didactic curriculum that provides a broad understanding of the pathophysiology and behavior of disease and a strong theoretical background in the area of students’ research interests. All students take several oral biology core courses at the Harvard School of Dental Medicine. In addition, students choose from a wide range of courses offered at Harvard Medical School, the Harvard School of Public Health, or the Harvard Graduate School of Arts and Sciences. Each student must demonstrate competency in statistical methods by successful completion of a course in biostatistics at HSDM or the School of Public Health. The total number of courses that must be completed is determined by the candidate’s degree selection.
Clinical training in oral and maxillofacial pathology includes two components: diagnostic histopathology and direct patient care. Students receive rigorous training in oral, head and neck, and general pathology. They also learn to diagnose and treat patients with mucosal disease in block rotations at Brigham and Women’s Hospital. Students are encouraged to achieve competency in oral and maxillofacial pathology to at least the level of fellowship in the American Academy of Oral and Maxillofacial Pathology.
Research leading to the DMSc degree is required of all advanced graduate students in this program. Students are required to successfully write and defend an original thesis based on their independent research in order to qualify for the awarding of the degree. This research may be performed at any of the laboratories in the Longwood Medical Area, which offers a wide range of opportunities to work with nationally and internationally renowned researchers, and are mentored by the principal investigators in those laboratories.
All students are encouraged from the first year to familiarize themselves with the scope of research opportunities available to Harvard postdoctoral students, and are given opportunities to identify a project that is suited to their individual interests and needs. By the middle of the second year, students are expected to identify a research mentor and to begin their research activities. Research occupies an increasing portion of the students’ time after the beginning of the third year, although such activities as the departmental histopathology seminar continue to take up one half-day per week. Costs of research equipment, reagents, and facilities are funded through the support mechanisms of the research sponsors. Students are also encouraged to present their research at the annual meeting of the American Academy of Oral and Maxillofacial Pathology.
Program faculty believe that effective teaching is both a science and art, and that teachers must study and practice teaching as well as the subject matter of their discipline in order to achieve excellence. Thus, students in the program are encouraged to learn about teaching techniques and are required to present cases at Children’s Hospital Boston every month as part of the ongoing clinicopathologic correlation conference series. Students also have the opportunity to give presentations to faculty and peers throughout the year. We believe, however, that we should not burden graduate students with excessive teaching obligations at the expense of time needed for their own training, study, and research. Students are offered the opportunity to present lectures to undergraduate students and to moderate discussion groups in all of the courses that are taught by the division. Assignments are made according to students’ interest and available time. Students with a specific interest in teaching are offered increasing opportunity for participation and may take part in formal teaching programs run for faculty development both at the Harvard School of Dental Medicine and at Harvard Medical School.
One day per week is set aside during Years One and Two for course work in oral biology. Detailed course descriptions, faculty, and the hours of each course may be found in the course catalog offered by the Office of Dental Education. Candidates are required to complete at least 12 credit hours of oral biology during the first two years of the program, with advanced oral pathology required during Year One or Year Two. The purpose of these courses is to establish a foundation of knowledge in major areas of oral biology and to acquaint students with important issues and research topics in the various areas of consideration, such as oral microbiology, immunology, and molecular biology.
Diagnostic Histopathology Seminar
All oral and maxillofacial pathology graduate students are required to participate in the weekly departmental seminars in diagnostic histopathology. These seminars are offered each week for six hours, and run during both fall and spring semesters. A total of eight semesters of satisfactory participation is required, for a total of 24 credit hours.
These seminars are divided into two sections. For the first two to four hours, the student dictates all accessioned cases for the day and renders a diagnosis. The attending oral and maxillofacial pathologists then “sign out” the cases with the students. The second part of the session consists of a review of archival cases or study sets, or clinical cases with a discussion of the appropriate literature. Generally candidates spend at least two to four hours in advance preparation for the seminar each week, reviewing the cases and preparing for presentation/discussion of the slides. The objectives of the seminar are to expose the students to a diverse sampling of surgical oral pathology cases, to provide an occasion for candidates to review both the clinical and microscopic aspects of oral and maxillofacial diseases, and to provide a forum for critique of case dictation protocol. Care is taken in organizing the seminar to include not only typical and atypical examples of common entities, but also examples of rare and interesting conditions as well.
Additional Required Courses
These include one semester each of biostatistics, general pathology, and hematology/oncology (which may be taken during either Year One or Two, depending on constraints of scheduling). These courses provide students with a review of basic scientific principles that are deemed to be essential for the understanding of oral and maxillofacial disease. Biostatistics reviews concepts of statistical probability, measures of central tendency of data, and statistical inference that are necessary for anyone reading the scientific literature or conducting experiments. Detailed course descriptions, faculty, and hours are provided in the course catalogs of the Harvard Medical School and School of Public Health.
Graduate-Level Basic Science
Candidates for the doctor of medical science (DMSc) degree are required to take at least three courses in graduate-level basic science. A wide selection of courses is offered through other schools at Harvard University and the Massachusetts Institute of Technology, and candidates are encouraged to select courses in line with their particular bioscience interests. Examples of topics include molecular biology, immunology, microbiology, and biology of the cancer cell. The objective of this requirement is to allow students in-depth study of topics in which they are interested, and also to facilitate interactions between oral and maxillofacial pathology graduate students and those from other schools. Detailed course descriptions, faculty, and hours are to be found in the graduate course catalogues of specific schools at Harvard University and Massachusetts Institute of Technology.
General Surgical Pathology
Site: Brigham and Women’s Hospital or Beth Israel Deaconess Medical Center
Preceptor: Attending pathologist
At least six months of general pathology are required. The students are supervised by the pathology staff and the chief resident of the institution at which they rotate. The department chair or delegated director of residency education reports the students’ evaluations to the oral and maxillofacial pathology program director. The objectives of the rotation are to provide the students with experience in the gross and histologic examination of specimens from the surgical and autopsy services (including frozen section diagnosis) and to familiarize the students with the conduct and reporting of postmortem examinations. Students rotate through all subspecialties of pathology, namely head and neck pathology, dermatopathology, general surgical pathology, neuropathology, gynecologic pathology, genitourinary pathology, breast pathology, hematopathology, and bone and soft-tissue pathology. Students participate in all the didactic and clinical conferences that take place in the pathology department during their rotations and complete any exercises usually required of residents, such as oral presentations and participation in clinicopathological conference. This requirement is typically completed during the spring of Year Two or the summer of Year Three.
Surgical Oral and Maxillofacial Pathology
Site: Pathology Services Inc.
Preceptor: Sook-Bin Woo
At least eight semesters of surgical oral and maxillofacial pathology are required. This rotation takes place concurrently with the diagnostic histopathology seminar each week. The objectives of the rotation are to familiarize students with the conduct of surgical oral and maxillofacial pathology. Students learn about the organization and management of a pathology laboratory; the accession, handling, and processing of specimens; the production of routine microscopic slides; and the application of special diagnostic techniques such as histochemistry and immunohistochemistry. Students take initial responsibility for the microscopic diagnosis and reporting of cases accessioned at PSI. The students’ progress is assessed continually through interaction with the staff oral and maxillofacial pathologists, and feedback on their progress is given directly to students and discussed with the program director. In the event that either the staff or the student perceives further experience to be required, additional time in this rotation is available as needed.
Site: Brigham and Women’s Hospital, Beth Israel Deaconess Medical Center
Preceptor: Attending cytopathologist
At least two weeks of training in cytology are required. The objective of this rotation is to familiarize students with the various applications of cytologic studies in modern pathology. Cytology of cervical smears, aspirated and lavaged fluids, and fine-needle aspirations of suspected tumors are among the specimens considered. True expertise in this highly specialized area requires extensive knowledge and experience; the two-week rotation is an introductory experience provided to students in the program at Brigham and Women’s Hospital. Students who are interested in pursuing this area in greater depth may do so.
Site: Brigham and Women’s Hospital, Beth Israel Deaconess Medical Center
Preceptor: Attending clinical pathologist
At least four weeks of training in clinical pathology are required. Oral and maxillofacial pathology students rotate through these facilities to familiarize themselves with the operation of large-scale testing facilities utilizing various types of automated and manual equipment, computerized record-keeping and reporting systems, and state-of-the-art quality-control procedures.
Site: Pathology Services, Inc.
Preceptor: Sook-Bin Woo
All students are required to participate in weekly journal club meetings, lasting between one and two hours. As with the departmental seminars, eight semesters of participation in this activity are required. Students are assigned one or more journals to review, and each week students present articles of interest. General discussion of each article follows the presentation, and participants may obtain complete copies of interesting articles for their personal collections. The objective of journal club is to assure coverage of recent literature of interest to oral and maxillofacial pathologists and to provide a forum for dissemination and discussion of emerging information among students and faculty. This session is run concurrently with the diagnostic histopathology seminar.
Site: Brigham and Women’s Hospital
Preceptors: Sook-Bin Woo, Nathaniel Treister, Stephen T. Sonis
At least one month of oral medicine is required of all students. The objective of the rotation is to familiarize students with the clinical evaluation of patients with a wide variety of oral diseases and conditions as encountered in the outpatient populations. Laboratory and radiographic examinations are performed where appropriate, and test interpretation is discussed. Patient management is planned and instituted by students under the supervision of the staff. Evaluation is continuous and interactive as students and staff work together in a clinical setting. In the event that either the staff or the student perceives further experience to be required, additional time in this rotation is available as needed.
Head and Neck Radiology
Site: Harvard School of Dental Medicine, Massachusetts General Hospital
Preceptors: Bernard Friedland, Hugh Curtin
Students will be required to spend at least two weeks of formal training in head and neck imaging. They will familiarize themselves with frequently used imaging techniques such as the panoramic film, CT scans, and MRIs and the indications and limitations of these techniques. In addition, students will learn application of nuclear medicine and imaging and newer techniques such as PET scanning and cone beam CT scans.
In addition to the required material, the program offers several elective courses and rotations.