Sir, I would like to add further comment to P. Ramsay-Baggs' letter (BDJ 2009; 207: 191) regarding the management of emergencies in practice. The maxillofacial hospital post was highlighted as being a good source of training and experience for such events – with management of the sublingual haematoma and risk of airway compromise (BDJ 2009; 206: 449) being used as the example.

Yes, I understand the anxiety that some of our seniors within the deaneries have regarding 'dental' SHOs being responsible for patients (who are often quite unwell) on the ward, in A&E etc. May I raise the point that this has been the successful system for years in many institutions.

Indeed, I am not suggesting that following employment as a maxillofacial SHO, the individual has acquired the skill set of a registrar or consultant. If anything, the clinician has learnt to identify the potential clinical emergency, determine its urgency, make the appropriate referral and provide interim care/relief if within his/her remit. Surely, this can only serve to improve quality and consistency of care in both primary and secondary sectors?

As a recent graduate myself (2007), I have just completed six months as a maxillofacial SHO in a London teaching hospital following vocational training. I gained much exposure to a variety of hard and soft tissue facial and dentoalveolar trauma and emergency (often affecting the medically compromised patient) in a supported, safe environment. The time spent 'on call' was invaluable in developing diagnostic and management skills. One learns to prioritise clinical need, refine record keeping and surgical skills and liaise confidently with seniors and colleagues from other specialities.

I wholeheartedly agree with P. Ramsay-Baggs' suggestion of 'on call' being part of a compulsory F2 post and would go one step further in proposing a minimum six-month maxillofacial stint as part of foundation training. SHOs would only feel overwhelmed by, or incapable of, doing the job if they were poorly selected at interview and/or not offered sufficient support and teaching during their post.

I am yet to meet a colleague who regrets doing such a post. For me personally, it gave me perspective on dentistry in the 'wider context' of medicine, general confidence in 'people management' and sheer physical stamina!