As information in the field of internal medicine expands, the specialized knowledge and skills relating to the diagnosis and treatment of liver and biliary tract disease have become a well-defined discipline. National and international organizations and medical journals devoted to the study of liver diseases are well established. Hepatobiliary diseases now rank among the leading causes of morbidity and death in the United States. There must be a sufficient cadre of trained physicians to provide expert evaluation and management of patients afflicted with these diseases. Hepatology is already a well-recognized, established specialty in many other countries with advanced systems of health care.
With the evolution of this discipline it has become necessary to describe its essential components to insure the consistent teaching of hepatology in all gastroenterology programs, to define the training needs of the consultant hepatologist and to indicate the required scope of a program for those who wish to train solely in hepatology. This document deals with the educational content, faculty, facilities and resources necessary to train a hepatologist.
At present the major pathway for training in hepatology is the gastroenterology fellowship. This may be inadequate to achieve the goal of preparing the trainee to function as a fully qualified consultant in both hepatology and gastroenterology. To achieve specialized competence in hepatology, for the person who is already being trained in gastroenterology, at least one full year of clinical training in hepatobiliary diseases is required. Such specialized training in hepatology can be acquired in a three-year gastroenterology training program. Alternatively, an additional year of training may be required for those who have completed a two-year gastroenterology program.
For individuals who choose to enter hepatology training directlythat is, by bypassing conventional gastroenterology training-it is necessary that the trainee first become board eligible in internal medicine or pediatrics and then obtain a minimum of two additional years of training in hepatology. At least one of *These guidelinea were d r a h d by the Ad Hoc Committee for Hepatology Training of AASLD and adopted unanimously as an official statement of the