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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

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UEMS Section of Gastroenterology Workhop

BASL Proposals for Hepatology Training

P. Michielsen

Brussels, Nov. 29, 2000


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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


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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


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Belgian Association for the Study of the Liver (BASL)

  • Publications

    • Newsletter

    • Acta Gastroenterologica Belgica

      • Abstracts Spring Meeting

      • Proceedings Winter Meeting


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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


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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


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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


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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


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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


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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


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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


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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


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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


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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


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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


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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


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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


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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


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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)


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Training in Hepatology: EuropeBASL 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


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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


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