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 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 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

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

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

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

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; , 1992

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

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: 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

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

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

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

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

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

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

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)

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

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