Dr Jocelyn Shand is a consultant oral and maxillofacial surgeon at the Royal Children’s Hospital, Melbourne, and in private practice at Melbourne Oral and Facial Surgery. She subspecialises in paediatric maxillofacial surgery and has dedicated much of her time to education in the specialty. She is deputy chair of the Board of Studies for oral and maxillofacial surgery and, as the immediate past president of the Australian and New Zealand Association of Oral and Maxillofacial Surgeons, continues to work at an executive level.
“The first step on the road to this medical specialty for me was a dental degree in New Zealand. At the end of my training, I was a resident at Dunedin Hospital for 2 years and realised I enjoyed the medical and surgical aspects of patient care, and began exploring the option of training in oral and maxillofacial surgery. I spent 2 years in Cambridge, UK, as a senior house officer before entering the Victorian training program to complete a medical degree, followed by 4 years of advanced training in oral and maxillofacial surgery (OMS). Research is a mandatory training requirement and I undertook a masters degree at the University of Melbourne.
I enjoy the challenge and variety in oral and maxillofacial surgery. Treatment involving the facial and jaw region is functionally important and highly visual. Our specialty can make significant facial changes, to provide dramatic and sometimes life-changing improvements. We also have something unique in medicine; an understanding of the worlds of medicine, surgery and dentistry.
Another factor that drew me to this specialty was the scope for subspecialisation. There are options to concentrate on specific areas such as head and neck oncology, facial trauma and reconstruction. I chose to subspecialise in paediatric maxillofacial surgery. I undertook training fellowships in Oklahoma and Pittsburgh in the US, where I gained experience in cleft and paediatric maxillofacial surgery and trauma.
For me, the most satisfying surgery is managing neonatal and infant patients who have upper airway obstruction due to the small size of their jaws (micrognathia) and are nasopharyngeal-tube dependent. The jaw is lengthened incrementally using mandibular distraction to carry the tongue base forward, which relieves airway obstruction. Feeding also improves and neuropsychological development in these infants is optimised as a result. This is one of the most rewarding aspects of my work. We undertake this work in collaboration with neonatologists and other specialists and it’s gratifying to be part of such a team.
I enjoy managing patients with cleft lip and palate disorders. They require surgery in stages and the cleft team looks after these patients from childhood into their adolescent years and beyond and, hence, we get to know them over the long term. I have had the opportunity to conduct research in this area through the Royal Children’s Hospital with the assistance of the Melbourne Research Unit for Facial Disorders, University of Melbourne.
I believe that quality training is the key to the development of any specialty and my involvement in training makes up a large and fulfilling part of my work. Currently, I am the director of training for our specialty in Victoria and Tasmania and deputy chair of the Board of Studies in our College. Our training pathway has been accredited by both the Australian Medical Council and Australian Dental Council, and OMS is now recognised as one of the primary surgical specialties. The training requirements of OMS make for a long road through medicine, dentistry, basic surgical training and advanced surgical training. Mentoring is thus a very important component to keep aspiring trainees on track, particularly while undergraduates are completing the second degree. Although the career path is demanding, it is well worth it for a satisfying career.
There are financial and personal implications in undertaking a long training pathway, and our trainees have to maintain their determination and focus to study, work part-time and manage their family commitments.
I also had the privilege of being president of the Australian and New Zealand Association of Oral and Maxillofacial Surgeons. I became vice-president in 2007 and served as president between 2009 and 2011. This involvement in some of the political aspects of the specialty allowed me to gain exposure to different aspects of health care, such as liaising with Medicare, government associations and the registering boards.
I’ve channelled a lot of my energy recently into the issue of registration of overseas-trained specialists in our field and have advocated for the importance of ensuring that their training is equivalent to that of locally trained practitioners.
One of the problems we face as one of the smaller surgical specialties, from a numbers standpoint, is that many people do not realise the scope and extent of our training. I would like to see our specialty gain wider exposure to give the public and other medical professionals a better understanding of our expertise and credentials.”