Hepatology Training Research Articles

PWE-426 Hepatology training in the uk – results from the bsg training survey 2014

Introduction Issues around hepatology service delivery and training in the UK have been highlighted by the recent Lancet Commission. 1 Currently, the majority of liver services are delivered by gastroenterologists with 2 training opportunities are variable. Method The 2014 trainee survey was sent to all UK trainees. 263/806 (32.6%) responded. Within the hepatology section of the survey, respondents were asked about future career plans, satisfaction with training, training opportunities and self assessed competence. Results Subspecialism: 8% of trainees plan to be a subspecialist hepatologist and 6% an academic hepatologist which is lower than those planning a career in general gastroenterology (16%), advanced endoscopy (12%) and IBD (10%). Overall experience: 68% of respondents rated themselves as either satisfied/very satisfied with their hepatology training. This is lower (p Barriers to training: 25.3% of trainees who wished to undertake formal hepatology training identified a barrier to accessing this. The main barriers were lack of local training opportunities and not wishing to move region to access hepatology training. Opportunities: All trainees should have at least 12 months in a level 2 or 3 centre. 2 However of current senior trainees (ST6+) less than 70% reported spending 6 months or more in at least one of these centres. Self reported competence of senior trainees to act as a consultant in a district general hospital found that 50% felt they were not competent in post transplant, viral and autoimmune liver disease and 30% felt they were not competent managing complications of portal hypertension including variceal bleeding. Conclusion The results confirm variability in hepatology training. This exists not only in access to advanced training but also core training competencies. All deaneries should aim to organise training rotations to maximise the opportunities especially in the deaneries which do not contain a level 3 centre. Early exposure of all trainees to hepatology units and clinics may allow better understanding of training pathways and early career planning. Disclosure of interest None Declared. References Williams R, Aspinall R, Bellis M, Camps-Walsh G, Cramp M, Dhawan A, et al . Addressing liver disease in the UK: a blueprint for attaining excellence in healthcare and reducing premature mortality from lifestyle issues of excess consumption of alcohol, obesity and viral hepatitis. Lancet 2014;384(9958):1953–1997 BSG Liver Section Training information 2014. http://www.bsg.org.uk/sections/liver-training/index.html

Gastroenterology fellowship programs: the fellows' perspective.

Gastroenterology fellowship programs: the fellows' perspective.

European Society for Pediatric Gastroenterology, Hepatology, and Nutrition syllabus for subspecialty training: moving towards a European standard.

The requirements for and conditions of subspecialty training in paediatric gastroenterology, hepatology, and nutrition (PGHN) are rather variable across European countries. The European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) agreed on a training syllabus aimed to foster a harmonised European PGHN curriculum and to support national PGHN societies and governmental bodies to promote and establish high-quality training programmes and levels of certification in the field. The document provides PGHN training prerequisites and objectives and the basic knowledge elements to acquire the clinical, technical, and management skills needed. Guidelines and instruments for self-monitoring and appraisal are proposed, and a logbook is available online. These training standards are a first step towards a European certification and recognition as a specialist in PGHN.

Training Directors Have Positive Perceptions of a Competency-Based Gastroenterology and Transplant Hepatology Fellowship Program

In 2012, the American Board of Internal Medicine approved a pilot competency-based transplant hepatology (TH) training program. This program allows gastroenterology (GI) and TH fellowships to be completed in 3 years. We investigated the perceptions and beliefs of GI and TH division and fellowship program directors on the competency-based TH training program. All current GI and TH division and fellowship program directors from the 162 fellowship programs accredited by the Accreditation Council for Graduate Medical Education were invited via e-mail to anonymously complete the online survey. The survey questioned their perceptions of the 3-year combined GI and TH training program. A total of 116 participants completed the survey (∼38% response rate). Most respondents were GI fellowship directors (61%); 15% were GI and hepatology division directors, 19% were TH fellowship directors, 14% were TH division directors, and 5% were GI division directors. Most of the respondents were in favor of the pilot program (85%). Only 63% of all respondents believed that graduates of the pilot program would achieve the same level of competency in GI as those who completed the traditional program. Overall, 71% believed incorporation of the 3-year training model would increase interest and participation in TH fellowships. Most of the academic GI and TH division and fellowship program directors embrace competency-based fellowship education and TH subspecialty training during the designated 3-year GI fellowship. Future studies will be needed to reevaluate these beliefs after several years.

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Growth and Development of a New Subspecialty: Pediatric Hepatology

Several major forces converged to catalyze the formal emergence of a body of knowledge and an organized focus on disorders of the liver in early life. Attendant to the development of a focused clinical subspecialty the pace of patient- and laboratory-based research in the field quickened in parallel to decipher the consequences of genetic or metabolic aberrations on immature liver structure and function. The key research observations that catalyzed the emergence and subsequent rapid growth of Pediatric Hepatology include: (1) an understanding of the dynamic events occurring during hepatobiliary development and the importance of these physiologic variables that occur during liver maturation; (2) the recognition of the unique nature of inherited and acquired liver diseases that affect infants and children-such as biliary atresia and Reye's syndrome; and (3) redefinition of the once obscure inherited intrahepatic cholestatic diseases of the liver, which, in turn, provided insight into normal and abnormal hepatobiliary physiology. The clinical advances were highlighted by the development of specific approaches to the diagnosis and management of liver disease in infants and children, including both liver transplantation and nontransplant treatment options. These seminal events led to the expansion of the workforce, creating a critical mass consisting of individuals with focused, specialized skills and techniques. In-depth expertise allowed more accurate diagnosis and highly effective treatment strategies for advanced hepatobiliary disease in children. The demand for pediatric clinicians with experience in advanced hepatology allowed sub-sub-specialization to flourish. Continued maturation of the field led to definition of hepatology-focused curricular elements and educational content for Pediatric Gastroenterology training programs, and subsequently the development of program requirements for those who wished to acquire additional training in Pediatric Hepatology. A significant rite of passage was marked by the election of pediatric hepatologists to leadership positions in the American Association for the Study of Liver Diseases (AASLD). Further validation of the field occurred with approval of the petition for establishing a Certificate of Added Qualification in Transplant Hepatology by the American Board of Pediatrics. Here I relate my perspective on the history of the advances in our field and the contributions of many of the clinicians and scientists whose efforts led to the development of focused clinical, research, and training programs that improved the care of children with diseases of the liver.

NASPGHAN Guidelines for Training in Pediatric Gastroenterology

G.G.C. has received com M.C. has served on th served on the board o and Enteral Nutrition; her institution has rec collaborative and Prov pensation from Child L.A.G. has received c received compensatio employment, expert t stocks/stock options; LLC, consulted to No received or has grants Institutes of Health, th holds equity interest in has received compens Fibrosis Foundation; M Abbott Laboratories, Foundation, the Natio Diseases/National Ins ticals; E.A.R. has rece sionalism & Ethical institution has receive as the medical editor has received compen Pharmaceuticals, and Nutrition; J.T. has rec Pediatrics, Prometheu conflicts of interest. Copyright # 2012 by E Hepatology, and Nut Gastroenterology, He DOI: 10.1097/MPG.0b01

Nutrition Education for Pediatric Gastroenterology, Hepatology, and Nutrition Fellows

The aim of the study was to assess the methodology and content of nutrition education during gastroenterology fellowship training and the variability among the different programs. A survey questionnaire was completed by 43 fellowship training directors of 62 active programs affiliated to the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition, including sites in the United States, Canada, and Mexico. The data were examined for patterns in teaching methodology and coverage of specific nutrition topics based on level 1 training in nutrition, which is the minimum requirement according to the published North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition fellowship training guidelines. The majority of the teaching was conducted by MD-degree faculty (61%), and most of the education was provided through clinical care experiences. Only 31% of the level 1 nutrition topics were consistently covered by >80% of programs, and coverage did not correlate with the size of the programs. Competency in nutrition training was primarily assessed through questions to individuals or groups of fellows (77% and 65%, respectively). Program directors cited a lack of faculty interested in nutrition and a high workload as common obstacles for teaching. The methodology of nutrition education during gastroenterology fellowship training is, for the most part, unstructured and inconsistent among the different programs. The minimum level 1 requirements are not consistently covered. The development of core curriculums and learning modules may be beneficial in improving nutrition education.

Hepatology training in the UK

ObjectivesTo establish the perceived adequacy of the hepatology training component of the unified gastroenterology and hepatology training programme in the UK by assessing the attitudes and experiences of trainees in...

“What Color Is My Parachute”: Career Opportunities in Academic Gastroenterology and Hepatology

“What Color Is My Parachute”: Career Opportunities in Academic Gastroenterology and Hepatology

Transplant Hepatology Training for Board Certification: 6 Months During Internal Medicine Residency and 6 Months During Gastroenterology Fellowship?

1Division of Gastroenterology and Hepatology, William Beaumont Hospital, and Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA Correspondence: Mitchell S. Cappell, MD, PhD, Division of Gastroenterology and Hepatology, MOB 233, William Beaumont Hospital, 3535 W Thirteen Mile Road, Royal Oak, Michigan 48073, USA. E-mail: [email protected] This letter underwent AJG editorial review.

The current state of hepatology training in UK – results from a national trainee survey

IntroductionHalf of all gastroenterologists in DGH in a recent study had not received any ‘pure’ hepatology training and yet 20% of their workload was related to the management of liver...

* Are uk gastroenterology trainees confident in managing hepatology?

IntroductionTrainee self-reported confidence levels have been used to assess adequacy of training and identify areas in training programs that are in need of improvement1. Currently, there is no data on...

PTU-084 Should UK gastroenterologists be trained in transcutaneous liver biopsy?: Abstract PTU-084

<h3>Introduction</h3> The UK Joint Committee of Higher Medical Training Gastroenterology curriculum (Feb 2005) suggests that specialist registrars should be “skilled in liver biopsy”. The Joint Royal College of Physicians Training Board Speciality curriculum for gastroenterology (May 2007) states that “liver biopsy is mandatory for those trainees doing liver subspecialty, however other trainees may have and wish to take the opportunity to learn this technique either while doing their hepatology training or at other points in their training rotation”. Increasingly liver biopsy is performed under ultrasound guidance, which has subsequently reduced trainees9 exposure to the technique. In 2005 we surveyed trainee gastroenterologists and demonstrated a low level of practical experience and theoretical knowledge of transcutaneous liver biopsy.¹ The aim of this study was to establish whether these deficiencies had improved. <h3>Methods</h3> All gastroenterology SpRs and ST trainees in the Wessex deanery received a questionnaire aimed at assessing practice training in liver biopsy and knowledge of the current BSG guidelines. The results of the survey were compared to previously published data from 2005. <h3>Results</h3> 66% of the 31 gastroenterology trainees surveyed responded. Similar to 2005, all of the trainees worked in hospitals where liver biopsies were performed exclusively under ultrasound guidance by radiologists. 43% (compared with 54% in 2005) had performed liver biopsy with supervision and only 19% (29% in 2005) were independently competent. Only 19% of trainees felt that either gastroenterologists or herpetologists should be performing transcutaneous liver biopsy. The average number of liver biopsies performed per trainee had dropped from 14.1 in 2005 to 9.7 in 2009. Only 13% of trainees had performed liver biopsy without supervision; a significant drop from 39% in 2005. None of the trainees experienced in liver biopsy had a written record of this. Knowledge of the suggested safe platelet count, INR and complication rates were: <h3>Conclusion</h3> This survey of gastroenterology trainees demonstrates a low level of practical and theoretical knowledge with respect to transcutaneous liver biopsy. These findings concur with data from 2005 and in fact reveal a decline in the number of liver biopsies performed by trainees and independent competency. If training in liver biopsy is to remain mandatory for hepatology trainees and recommended for gastroenterologists, training in ultrasound is necessary and training should be aligned with that undertaken by radiologists.

Report of the Multisociety Task Force on GI Training

In summary, the task force recommends that the 4 gastroenterology/hepatology societies work with the ABIM to develop a competency-based curriculum that incorporates the Maintenance of Certification process to accommodate the need and desire for training and subsequent practice in specific areas of gastroenterology/hepatology. Given the increasing complexity of treating digestive diseases, allowing trainees the opportunity to develop enhanced ability and experience in specific disease areas or procedures will benefit patients. By developing these training pathways, training programs will need to measure the achievements of trainees in terms of specific defined competencies rather than the duration of training alone.

Response: Evolution of Training in Gastroenterology and Hepatology: Working Together Is the Solution

Response: Evolution of Training in Gastroenterology and Hepatology: Working Together Is the Solution

Separation of Specialty Training in Hepatology and Gastroenterology: The Imminent Divorce of Gastroenterology and Hepatology?

Separation of Specialty Training in Hepatology and Gastroenterology: The Imminent Divorce of Gastroenterology and Hepatology?

Utilization of and Adherence to the Gastroenterology Core Curriculum on Hepatology Training During a Gastrointestinal Fellowship

The gastroenterology core curriculum (GCC) represents the knowledge/skills desired at the completion of fellowship training. The hepatology subset (H-GCC) is the focus of this research. The aims were to measure adherence of the H-GCC within gastrointestinal training programs, compare the perceptions of the H-GCC compliance by fellows and program directors, and provide comparative information to improve gastrointestinal training programs. A questionnaire was designed to assess the general and hepatology components of the GCC. Fellows and program directors were invited to participate by means of 3 sequential mailings. Pearson chi(2) and Fisher exact tests were used for statistics. Of 971 potential respondents, the questionnaire was returned by 42% of program directors and 33% of fellows. There was <70% agreement by either fellows or program directors for minimum > or =18 months of clinical training (minimum > or =30% hepatology), and minimum > or =20 paracentesis/liver biopsies. Most prescribed hepatology core topics were covered; however, >10% of fellows claimed deficiency in physiology, pregnancy issues, angiography, immunosuppressant use, and congenital disorders. Fellows in non-liver transplant institutions more often reported lack of training in fulminant disease, transplant patient selection, and diagnosis/management of rejection (P < .001). (1) Fellow and program director assessments were highly concordant, with most H-GCC criteria being met. (2) Attention is required to provide adequate time for clinical training and prescribed procedures. (3) Improved instruction in several hepatology topics seems warranted. (4) A nonevaluative questionnaire is a practical means to measure compliance. Future studies measuring compliance with other components of the GCC by using this methodology seem feasible.

The Gastroenterology Core Curriculum, Third Edition

The Gastroenterology Core Curriculum, Third Edition

Hepatology as a Distinct Specialty – Born in the USA?

Hepatology as a Distinct Specialty – Born in the USA?