Can hepatology lead the way? Synthesising current global curricula and proposing a model for an international specialty curriculum.

BACKGROUND

Increased understanding and treatments for liver disease have led in recent decades to the emergence of hepatology as a subspecialty within gastroenterology, and as a standalone medical specialty. Growing challenges in hepatology are a global problem, yet no global framework for education and training has been established. We therefore aim to conduct feasibility work to compare existing international curricula, examine the ability to merge existing frameworks and hypothesise a basis for a shared curriculum leading to a standardised global accreditation.

METHOD: We employed a cross-sectional content mapping approach to assess the hepatology training of eight regions across five continents. Regions were selected that had an English language curriculum to allow accurate comparison. Data were gathered for entry requirements, training pathway, research and procedural elements. These were structured using an established framework allowing for direct comparison to be drawn.

RESULTS

Endoscopic competency for oesophago-gastroduodenoscopy (OGD) is the only procedural requirement shared between all regions that is necessary for completion of hepatology training. Trainees are assessed through a combination of clinical-based discussions / clinical examinations (CBD/CEX), direct observation of practice (DOP), logbooks, supervisor evaluations and oral examination using at least two of these methods.

CONCLUSION

We found areas of considerable homogeneity between the eight curricula examined, which would be favourable and practical to develop a shared curriculum. Where differences exist, they may reflect the variation in local medical requirements. By adopting a competency-based assessment system, we believe there is the capacity to develop a global curriculum without compromising the quality of hepatology training. We propose a possible framework and areas of focus to establish the minimum standards to provide global uniformity in hepatology training and assessment while allowing for additional competencies to adapt the curriculum to local exigencies.