Latin American hepatopancreatobiliary fellowships accreditation: Assessing desire and barriers

Abstract

Presenter: Morgan Bonds MD | Virginia Mason Medical Center Background: Hepatopancreatobiliary (HPB) surgery is a challenging field, both clinically and technically. Latin America has a significant burden of HPB disease which has fostered a number of fellowships. However, despite belonging to the Americas Hepatopancreatobiliary Association (AHPBA), there are no Latin American HPB fellowship programs participating in AHPBA fellow certification through Fellowship Council program accreditation. The purpose of this study is to assess whether interest in this process exists among Latin American fellowship program directors and what barriers exist to their participation. Methods: This was a prospective mixed-methods study. Initially, a 20 item survey was constructed to assess the demographics of Latin American HPB fellowships and attitudes toward the accreditation process. The survey was validated by consensus of 2 North American and 2 Latin American HPB fellowship directors. Latin American HPB fellowship directors were identified through the International Hepatopancreatobiliary Association website or by contacting local AHPBA chapters. Surveys were administered electronically. Statistical analysis was performed on the survey responses. An interview was requested of all participants to further assess attitudes and barriers to fellowship accreditation. Interview responses were analyzed using a validated qualitative thematic network technique. Results: Nineteen Latin American fellowship program directors were identified, and 13 (68.4%) responded to the survey. All program directors were members of AHPBA. Most programs reported having 3 or more clinical fellows each year. Five (38.5%) programs had an adequate number of pancreas cases per fellow for certification, 9 (69.2%) had adequate major liver cases, and 7 (53.8%) had adequate biliary cases. Laparoscopic HPB was practiced by 69.2% of the programs. The majority of program directors were interested in AHPBA certification (10/13) and the other respondents reported neutral feelings toward the process. All participants reported that certification and accreditation would be beneficial to the fellowship program and the fellows. Interviews were conducted with 8/13 (61.5%) survey respondents. The interviews revealed there was a desire among Latin American HPB fellowship directors to pursue certification because outside critique provides structured quality improvement for their program. They also felt the fellows would benefit from the international recognition and collaboration that the North American HPB fellows experience. Benefits to HPB societies were also identified as a positive consequence of accrediting Latin American fellowships. No negative consequences were identified. The primary barriers to meeting certification requirements were financial as well as concerns regarding clinical case volumes. Conclusion: Latin American HPB fellowship program directors show a high level of interest in AHPBA certification through Fellowship Council accreditation. Several positive outcomes of participating in this process were identified and align with previous research on the benefits of accreditation. Strategies should be developed to reduce the barriers to Latin American HPB programs that seek to participate in this process.