Adult Gastroenterology Training Program

Hepatology Curriculum

Introduction

The overall goal of the hepatology curriculum is to train gastroenterologists who are competent to manage the broad spectrum of liver-related problems encountered in a typical gastroenterology practice.  To obtain the core knowledge required for the hepatology curriculum, trainees will be required to attend lectures during academic half day on hepatology topics, as well as complete selected readings. The clinical experience will be provided by rotation in outpatient clinic dedicated to hepatology patients and problems, and through interaction with hepatology physicians.

Trainees will acquire a broad knowledge of the physiology of the liver and a thorough knowledge of the management of patients with hepatobiliary diseases obtained through teaching rounds, outpatient clinic experience, didactic lectures and personal reading / research. The program will ensure exposure to the following specific basic knowledge/skills:

  1. Significant knowledge about genetic markers of liver disease, immunology, virology, and other pathophysiological mechanisms of liver injury; the basic biology and pathophysiology of the liver and biliary systems as well as a thorough understanding of the diagnostic and treatment of a broad range of hepatobiliary disorders.
  2. Skill in the performance of certain diagnostic and therapeutic procedures.
  3. An appreciation of the indications and use of a number of diagnostic and therapeutic procedures that are needed to manage hepatobiliary disorders.

It is anticipated that all gastroenterology fellows enrolled in the McMaster University Gastroenterology Training Program will be a participant.  To allow early exposure to Hepatology and to help with career choice, the one-month rotation is mandatory for First Year residents.  In addition, Second Year residents are encouraged to obtain additional training in hepatology during their elective months and during the clinic/endoscopy rotation.               

Rotation Schedule
 
AM
PM
Monday Clinic (Puglia) Endoscopy (Puglia)
Tuesday Clinic (Witt-Sullivan) Endoscopy (Puglia)
Wednesday Academic half-day Endoscopy (Tsoi)
Thursday Clinic (Witt-Sullivan) Endoscopy (Tsoi)
Friday Paracentesis / Liver Biopsy Clinic (Tsoi)

** Multi-disciplinary hepatobiliary rounds (optional) on Friday 7-9 am

General Requirements:

  • To acquire knowledge and skills in the diagnosis and management of common and uncommon disorders of the liver, and the management of patients with end stage liver disease
  • To gain exposure to the selection and management of liver transplant patients.

Specific goals and objectives of the hepatology curriculum in CANMEDs format are as follows:

Medical Expert
Communicator
Collaborator
Manager
Health Advocate
Scholar
Professional

Medical Expert

  • Discuss approach to patients with abnormal liver enzymes, both transaminitis and cholestatic enzyme abnormalities
  • Acquire knowledge in epidemiology, natural history, diagnosis, treatment and prognosis of liver diseases:
    • Viral Hepatitis (A, B, C, D, E, Epstein-Barr Virus) with or without HIV coinfection
    • Alcoholic liver disease and alcoholic hepatitis
    • Non-Alcoholic Fatty Liver Disease (NAFLD) and Non-Alcoholic Steatohepatitis (NASH)
    • Autoimmune Hepatitis, Primary Biliary Cirrhosis (PBC), Primary Sclerosing Cholangitis (PSC) and overlap syndrome
    • Inherited Liver Disease – hemochromatosis, Wilson’s Disease, Alpha-1 antitrypsin disease
    • Discuss approach, diagnostic criteria and management of liver mass, both benign and malignant causes
    • Manage patients with decompensated liver cirrhosis, including discussion of  indications, contraindications and workup for liver transplantation
    • Exposure to management of patients post-liver transplantation, focusing on hepatic and non-hepatic complications both in the acute and chronic setting
  • Indications for liver biopsy, hepatic imaging modalities including computed tomography, magnetic resonance-based techniques (magnetic resonance imaging, magnetic resonance angiography, magnetic resonance cholangiography), hepatic angiography, and ultrasound (including Doppler evaluation of hepatic vasculature) and TIPS in the evaluation and management of liver diseases

Communicator

  • Communicate difficult diagnoses with patients in a professional manner
  • Communicate strategies of risk reduction for patients with communicable disease
  • Create and sustain a therapeutic and ethically sound relationship with patients having advanced liver disease, and with their families
  • Counsel and educate patients and families concerning health issues relating to liver disease and transplantation
  • Work with others as an effective team member

Collaborator

  • Develop awareness of multidisciplinary approach in the management of hepatobiliary diseases
  • Establish collaboration between hepatobiliary surgery, radiology and hepatology
  • Develop skills in managing patients in collaboration with another medical institution such as a liver transplant center

Manager

  • Aware of community resources available to assist hepatology patients
  • Effectively utilize consultants and diagnostic services (radiology and pathology)
  • Understand resource allocations in liver disease especially in liver transplantation

Health Advocate

  • Appreciate complexity behind government funding process for financial support towards medications in treatment for viral hepatitis
  • Develop an awareness of the process in the evaluation of candidacy of patients for liver transplantation
  • The ability to institute preventative measures in patients with liver disorders including hepatitis A and B vaccination, other appropriate adult vaccinations, and prophylactic use of antibiotics in cirrhotics with GI bleeding and patients with a history of SBP
  • The ability to screen for hepatoma in appropriate patients

Scholar

  • Utilization of medical literature, especially relevant clinical trials, to guide recommendations to treatment strategies

Professional

  • Demonstrate strategies to maintain and advance professional competence
  • Evaluate one’s own abilities, knowledge, skills and limitations of professional competence
  • Demonstrate integrity, respect, compassion and empathy for patients
  • Demonstrate timeliness, respect toward duties, and respect for team members

Evalutations

Residents would receive verbal evaluations at the end of each week, and at the end of each month by individual supervisors.  The final evaluation will be provided to the residents in a written format, with each area of CANMEDS objectives being addressed.  It would be a composite of evaluations from all supervisors directly involved.  Residents will also have an opportunity to evaluate each supervisor on the teaching and clinical experience, as well as an evaluation of the hepatology rotation as a whole.  The format will be through the One45 web-based evaluation system.

Research Opportunities

Residents are encouraged to gain exposure through participation in activities at the Hamilton Hepatology Clinical Research Unit.  They are invited to collaborate with staff hepatology supervisors in available research opportunities, and in successful cases present in local, national and international conferences.