UEMS Section of Gastroenterology Workhop
BASL Proposals for Hepatology Training
P. Michielsen
Brussels, Nov. 29, 2000
Belgian Association for the Study of the Liver (BASL)
• MB/BS 09.03.2000
• Aims– stimulate collaboration between physicians and
scientists in the field of Hepatology– coordination of clinical studies in Hepatology at
national level– organisation of postgraduate teaching– cooperation with sister societies (NvH, AFEF,…)– national society for contacts with EASL
Belgian Association for the Study of the Liver (BASL)
• Steering Committee: representatives of the Belgian Universities and non-university centres
• Meetings– Spring Meeting
• peer reviewed communications on clinical and basic research• invited lectures
– Winter Meeting • interactive discussions on clinical problems with expert(s),
panel and public• case reporting
Belgian Association for the Study of the Liver (BASL)
• Publications– Newsletter– Acta Gastroenterologica Belgica
• Abstracts Spring Meeting• Proceedings Winter Meeting
Training in HepatologyIntroduction
• Expansion of diagnostic and therapeutic possibilities
• Reflected by increase in scientific papers on hepatology and creation of specific hepatological Journals
• Need to define – content of training– faculty, facilities and resources for training a
hepatologist
Actual Training in GastroenterologyEurope: UEMS Gastroenterology Section
• 6-year training period 2 years General Internal Medicine– 3-4 years specific training in
Gastroenterology
• European Diploma in Gastroenterology
Actual Training in GastroenterologyBelgium
• 5-year training period– 3 years common training in General
Internal Medicine– 2-year specific training in Gastroenterology
• Proposal: 6-year training (3+3)
• In most Belgian centres 6-year training (3+3) is imposed or recommended
Actual Training in GastroenterologyUS: Gastroenterology Leadership
Council
• 3-year residency in Internal Medicine
• Gastroenterology Core Curriculum ( 3 years ) 18 months in and outpatient clinical work 6 months research experience 12 months clinical work according to the
trainee’s skills, interests or career goals
Training in Hepatology: US
• AASLD Ad Hoc Committee for Hepatology Training (1988)
• Guidelines– educational content– faculty– facilities and resources
• Adopted by AASLD Council March 1992
• Published in Hepatology 16; 1084-5, 1992
Training in Hepatology: USGastroenterology Leadership Council• Level 1:
– necessary for all gastroenterologists, for management of hepatological problems in a typical gastroenterological practice
– to be completed in standard 3-year training
• Level 2:– necessary to practice hepatology almost exclusively
(usually in academic setting)– usually a 4th year of specific hepatology training is
necessary
Training in Hepatology: US
Gastroenterology Leadership Council
Transplant physician:
additional criteria of UNOS 6 months on active transplant service– 6 months transplant-related activities,
including research
during a 4th year of training
Training in Hepatology: EuropeBASL proposals
Training Program
• Fundamental information core on physiology and physiopathology of liver diseases and diagnosis and treatment of hepatobiliary disorders
• Familiarity with techniques and procedures applicable to hepatobiliary disorders
• Procedural skills
• Scientific experience
Training in Hepatology: EuropeBASL proposals
1. Fundamental information core• biology and pathobiology of the liver• clinical management of patients with
– acute viral, drug and toxic hepatitis– fulminant liver failure– chronic hepatitis and cirrhosis– complications of chronic liver disease– nonviral causes of chronic liver disease– hepatobiliary disorders associated with pregnancy– perioperative management of patients with liver disease
Training in Hepatology: EuropeBASL proposals
1. Fundamental information core• use of antiviral and immunosuppressive agents in liver
diseases• selection and care of patients awaiting and following liver
transplantation• management of nutritional problems in chronic liver diseases• understanding principles design, statistics, epidemiology to
interpret medical literature• familiarity with pediatric and congenital hepatobiliary disorders• familiarity with liver pathology
Training in Hepatology: EuropeBASL proposals
2. Familiarity with techniques and procedures• ERCP• Abdominal US• Radiology liver and biliary tract• Nuclear Medicine studies• PTC• TIPS• Percutaneous and transvenous liver biopsy• Hepatic venous catheterisation• Percutaneous invasive hepatological techniques
Training in Hepatology: EuropeBASL proposals
3. Required skills• Percutaneous liver biopsy• Hepatic venous catheterisation and transvenous
liver biopsy• Endoscopy UGI tract (EVS+EVL)• Abdominal US and US-guided puncture procedures• Diagnostic and therapeutic paracentesis
4. Scientific experience
Training in Hepatology: EuropeBASL proposals
Practical organisation• Level 1
– basic knowledge in Hepatology, for all gastroenterologists– 30% of clinical training should deal with hepatology– acquire knowledge on subjects 1 (and 2)– skills:
• EVS/EVL (n=20)• percutaneous liver biopsy (n=15)
– postgraduate courses
To be completed within 3 year training in GE
Training in Hepatology: EuropeBASL proposals
• Level 2– thorough knowledge on management of hepatic disease including
• complications of end stage liver disease• therapy in liver disease• management of liver transplant patients and candidates
– thorough skill in techniques a.o.• transjugular procedures• applications abdominal US
– research
Requires additional year of training, including 2 months on liver transplant service
Training in Hepatology: EuropeBASL proposals
Training Centres
Faculty
Supervised by full time faculty member, experienced in– clinical hepatology– clinical and/or basic research– expertise in management transplant patients (level 2)
Training in Hepatology: EuropeBASL proposals
Criteria for training centresLevel 1: as for Gastroenterology
Level 2: facilities– hospitalisation– outpatient department– emergency department– ICU– medical laboratory– GE department (diagnostic and therapeutic GI and hepatobiliary endocopy)– pathology department– diagnostic and therapeutic radiology department– nuclear medicine department– close collaboration with general and hepatobiliary surgery and oncology– medical library– meeting and study rooms– research facilities– organisation of clinical and research meetings
Training in Hepatology: EuropeBASL proposals
Accreditation– minimal amount of in- and outpatients contacts (to be
defined)– CME
Evaluation of training and accreditation– training: subcommittee Gastroenterology Training
Committee (academic and professional authorities)– CME accreditation by National CME Accreditation
Committee