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 physicia...
Belgian Association for the
Study of the Liver (BASL)
• Steering Committee: representatives of the
Belgian Universities an...
Belgian Association for the
Study of the Liver (BASL)
• Publications
– Newsletter
– Acta Gastroenterologica Belgica
• Abst...
Training in Hepatology
Introduction
• Expansion of diagnostic and therapeutic
possibilities
• Reflected by increase in sci...
Actual Training in Gastroenterology
Europe: UEMS Gastroenterology Section
• 6-year training period
  2 years General Int...
Actual Training in Gastroenterology
Belgium
• 5-year training period
– 3 years common training in General
Internal Medicin...
Actual Training in Gastroenterology
US: Gastroenterology Leadership
Council
• 3-year residency in Internal Medicine
• Gast...
Training in Hepatology: US
• AASLD Ad Hoc Committee for
Hepatology Training (1988)
• Guidelines
– educational content
– fa...
Training in Hepatology: US
Gastroenterology Leadership Council
• Level 1:
– necessary for all gastroenterologists, for
man...
Training in Hepatology: US
Gastroenterology Leadership Council
Transplant physician:
additional criteria of UNOS
  6 mon...
Training in Hepatology: Europe
BASL proposals
Training Program
• Fundamental information core on
physiology and physiopath...
Training in Hepatology: Europe
BASL proposals
1. Fundamental information core
• biology and pathobiology of the liver
• cl...
Training in Hepatology: Europe
BASL proposals
1. Fundamental information core
• use of antiviral and immunosuppressive age...
Training in Hepatology: Europe
BASL proposals
2. Familiarity with techniques and procedures
• ERCP
• Abdominal US
• Radiol...
Training in Hepatology: Europe
BASL proposals
3. Required skills
• Percutaneous liver biopsy
• Hepatic venous catheterisat...
Training in Hepatology: Europe
BASL proposals
Practical organisation
• Level 1
– basic knowledge in Hepatology, for all ga...
Training in Hepatology: Europe
BASL proposals
• Level 2
– thorough knowledge on management of hepatic disease
including
• ...
Training in Hepatology: Europe
BASL proposals
Training Centres
Faculty
Supervised by full time faculty member, experienced...
Training in Hepatology: Europe
BASL proposals
Criteria for training centres
Level 1: as for Gastroenterology
Level 2: faci...
Training in Hepatology: Europe
BASL proposals
Accreditation
– minimal amount of in- and outpatients contacts (to be
define...
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Uems

  1. 1. UEMS Section of Gastroenterology Workhop BASL Proposals for Hepatology Training P. Michielsen Brussels, Nov. 29, 2000
  2. 2. 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
  3. 3. 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
  4. 4. Belgian Association for the Study of the Liver (BASL) • Publications – Newsletter – Acta Gastroenterologica Belgica • Abstracts Spring Meeting • Proceedings Winter Meeting
  5. 5. Training in Hepatology Introduction • 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
  6. 6. Actual Training in Gastroenterology Europe: UEMS Gastroenterology Section • 6-year training period   2 years General Internal Medicine – 3-4 years specific training in Gastroenterology • European Diploma in Gastroenterology
  7. 7. Actual Training in Gastroenterology Belgium • 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
  8. 8. Actual Training in Gastroenterology US: 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
  9. 9. 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
  10. 10. Training in Hepatology: US Gastroenterology 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
  11. 11. 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
  12. 12. Training in Hepatology: Europe BASL 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
  13. 13. Training in Hepatology: Europe BASL 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
  14. 14. Training in Hepatology: Europe BASL 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
  15. 15. Training in Hepatology: Europe BASL 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
  16. 16. Training in Hepatology: Europe BASL 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
  17. 17. Training in Hepatology: Europe BASL 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
  18. 18. Training in Hepatology: Europe BASL 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
  19. 19. Training in Hepatology: Europe BASL 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)
  20. 20. Training in Hepatology: Europe BASL proposals Criteria for training centres Level 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
  21. 21. Training in Hepatology: Europe BASL 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

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