Dr Keith Smith
DDU council member Dr Keith Smith describes his career path and offers some timely words of advice.
How did you first get into dentistry?
I didn't choose dentistry as a career until the sixth form at school. I was the first in my family to go to university and so I had no family pressure about choice of career. I do, however, distinctly remember reading a prospectus for the old Newcastle Dental School in the school careers office and something 'clicked', and I thought this was the career for me.
What inspired you to pursue your specialty?
On graduation there were really only two career options at that time; general dental practice as associate or a house officer post. Like many contemporaries, two house officer posts in the Dental Hospital in Newcastle were followed by a Senior House Officer post in oral surgery in Taunton, which was an amazing year and probably one of the most enjoyable of my career. The department consisted of two consultants and two SHOs doing a one-in-two on-call rota, covering all of West Somerset. The post was very busy but I loved it, and I got the bug for oral surgery.
Like many dental graduates today completing their DCT posts in oral and maxillofacial surgery, I was faced with that very difficult decision of whether or not to go back to medical school with the aim of pursuing a career in oral and maxillofacial surgery. I had returned north for a two year registrar post in oral surgery followed by a locum Senior Registrar post. Training was different in the 1980s, as specialist training was at Senior Registrar level.
I was in the process of applying for medical school when an opportunity arose and I was appointed to a lecturer post in oral surgery in Sheffield that was recognised for higher specialist training. The appointment of Professor Peter Robison as head of department soon afterwards was to make a significant impact on my career. He was inspirational; he changed the whole ethos of the department, Sheffield becoming one of the best academic oral and maxillofacial surgery units in the country.
I completed both higher surgical training, gaining a certificate of accreditation in oral and maxillofacial surgery, and an excellent period of research training, gaining a PhD. I was awarded a Wellcome Research Fellowship which allowed me to do full time research for a year before being appointed as a Senior Lecturer/Hon. Consultant in oral and maxillofacial surgery in 1995. For anyone contemplating a career in clinical academia I cannot emphasise more the need to obtain both a good clinical training and a good research training.
How does it differ from other specialties or settings?
Oral and maxillofacial is a demanding choice of career, and now most trainees do complete a second degree in medicine as well as dentistry. The current trend is for trainees to specialise in head and neck oncology or orthognathic surgery, the management of facial deformity.
The rewards are worth the training. My own specialist interest, orthognathic surgery, literally involves changing people's faces, and as a result changing their lives, which can be extremely rewarding. Our patients usually undergo two to three years of treatment, involving orthodontics and surgery, and occasionally restorative dentistry for patients with hypodontia. Orthognathic surgery provides the opportunity to work closely with a wide range of specialist colleagues, not only in dentistry but other allied specialties such as speech therapy.
What additional skills have you learned as a result?
I investigated different methods of lingual nerve repair for my PhD, and these laboratory based studies enabled me to develop my microsurgical skills which were essential when transferring the nerve repair techniques to the treatment of patients. We began carrying out microsurgical repairs for patients with lingual nerve injuries in Sheffield in 1991, and we still run a dedicated monthly nerve injury clinic which receives referrals from all over the UK, Ireland and parts of Europe.
The lingual nerve neuromas we excise from the patients at the time of nerve repair has provided a wealth of material for our ongoing laboratory studies into the sequelae of nerve injuries, particularly post-injury nerve pain and dysaesthesia.
For anyone contemplating a career in clinical academia I cannot emphasise more the need to obtain both a good clinical training and a good research training.
Invariably with my expertise and knowledge I have also become involved in the medico-legal aspects of lingual nerve injury. When we began repairing injured lingual nerves we did have concerns about the medico-legal implications of the surgery; it would invariably provide irrefutable evidence that the lingual nerve had been injured during the removal of the wisdom tooth. But was that injury to the lingual nerve due to negligence on the part to the surgeon or was it due to an unfortunate complication of the surgical procedure?
We actually felt quite strongly that these injuries were an unfortunate complication of the surgery rather than due to negligence and that is how I first became involved with the DDU, defending surgeons who had been accused of clinical negligence after having inadvertently caused a lingual nerve injury. I have continued doing medico-legal work and last year I was invited to join the Council and the Dental Advisory Committee of the MDU.
What advice would you give to students considering a career in clinical academia?
Being a clinical academic can be a very rewarding career but is also very demanding, and it should never be considered an easy option. Academic oral and maxillofacial surgery is particularly demanding in that there is a need to do sufficient clinical work, including operating, to maintain your surgical skills in addition to all the academic work.
As a clinical academic you will always have two masters, the university and the hospital, both of whom will compare you with your full time contemporaries. The university will expect high level research and teaching comparable with full-time academics, and the hospital will expect of you the same level of training and clinical expertise as a full time NHS consultant.
There are, however, many advantages, particularly being able to pursue clinical research and present your work at international meetings around the world. There is also the diversity and job satisfaction from the combination of doing three separate but overlapping types of work, clinical, research and teaching, different roles, with different demands and often all at the same time.
Dr Keith Smith
Keith qualified from Newcastle in 1981. He completed his oral and maxillofacial surgery training in Sheffield and was awarded his PhD 1994. Keith was appointed Senior Lecturer and Hon. Consultant in Oral and Maxillofacial Surgery in Sheffield in 1995. He lives in Bakewell in the Peak District with his wife Joy, and has three stepdaughters.
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