Hepatology Fellowship Curriculum

Fellows are expected to:

• Perform an accurate physical examination and present information concisely including an initial assessment and plan. Follow the patient’s disease course during the hospital stay. Formulate a final assessment and plan with the assistance of attending physician and communicate the recommendations to the primary service. When indicated, consent patients for procedures and order appropriate diagnostic tests in conjunction with the primary/referring service. Ensure that patients are followed in hepatology clinic post discharge. Attend hepatology clinic and take ownership of managing outpatients with an entire spectrum of liver disease.
• Perform with supervision the following basic procedures:

Abdominal Paracentesis:

• Demonstrate competence in the performance of diagnostic and therapeutic paracentesis after receiving formal instruction and given opportunity for clinical practice of the procedure

Transient elastography (FibroScan):

• Demonstrate competence in performing and interpretation of FibroScan

Demonstrate competence in:

• Prevention of acute and chronic liver disease
• Evaluation and management of acute and chronic liver disease
• Evaluation and management of acute liver failure
• Evaluation and management of potential liver transplant candidates
• Diagnosis and management of drug-induced liver injury
• Diagnosis and management of autoimmune hepatitis
• Diagnosis and management of cholestatic liver diseases: primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC)
• Diagnosis and management of nonalcoholic fatty liver disease (NAFLD)
• Diagnosis and management of iron overload states
• Diagnosis and management of Wilson’s disease
• Diagnosis and management of alpha-1-antitrypsin disease
• Diagnosis and management of hepatocellular carcinoma (HCC) including indications for imaging, biopsy, RFA, TACE, TARE, resection and liver transplant
• Providing advice on nutritional support of patients with acute and chronic liver disease
• Manage patients with high MELD-NA scores in the intensive care setting with complications of end-stage liver disease including: refractory ascites, hepatic hydrothorax, hepatorenal syndrome, hepatopulmonary and portopulmonary syndromes, and refractory portal hypertensive bleeding
• Manage patients with chronic viral hepatitis in the pre-, peri-, and post-transplantation settings
• Teach management of symptoms of liver disease to patients, family members, support staff and other trainees.

Learn to provide inpatient care that is safe and compassionate and to develop the ability to thoroughly and clearly educate the patients and their families on liver disease prevention, detection, progression and treatment.

Fellows are expected to demonstrate knowledge of established and evolving medical, epidemiological and social/behavioral sciences, as well as the applications of this knowledge to care for  patient’s with liver diseases:

• Demonstrate knowledge of the scientific method of problem solving and evidence based decision making
• Demonstrate knowledge of indications, contraindications, limitations, complications, techniques and interpretations of results of diagnostic and therapeutic procedures indicated in patients with liver disease
• Demonstrate knowledge of anatomy, physiology, pharmacology, pathology and molecular biology related to liver and biliary tract
• Demonstrate knowledge in interpretation of abnormal liver chemistries
• Demonstrate knowledge of indications and contraindications for liver transplantation as well as familiarity with care of pre-and post-transplant patients
• Demonstrate knowledge of surgical procedures employed in relation to liver and biliary tract disorders and their complications
• Demonstrate knowledge of interventional radiology procedures employed in relation to liver and biliary tract disorders and their complications
• Take a leadership role at core curriculum conferences and teaching rounds
• Be responsible for organize the team’s performance at teaching rounds
• Keep up to date with current hepatology literature
• Take an active role in teaching and mentoring medical students, residents and other trainees

Fellows are expected to:

• Become familiar with the concepts of quality improvement
• Systematically analyze hepatology practice, both inpatient and outpatient, using quality improvement methods, and implement changes with a goal of practice improvement
• Identify deficiencies and limits of their knowledge and expertise and come up with learning objectives to correct the deficiencies
• Participate in conferences such as M&M, geared to the systematic review of adverse events
• Begin to review, analyze and utilize scientific evidence from the hepatology literature for the management of patients with liver disease
• Participate in the education of patients, families, community, other learners and health professionals on basic concepts of liver health and disease
• Obtain procedure-specific informed consents by competently educating patients about the rationale, technique and complications of the procedures
• Participate in project groups, committees and hospital groups when requested
• Provide constructive feedback to medical students, residents and other trainees based on observation of their performance and assess effectiveness of the feedback
• Participate in quality improvement projects
• Review, analyze and utilize scientific evidence from the hepatology literature for the management of patients with liver disease

Fellows are expected to:

• Interview patients and family members across the broad range of socioeconomic and cultural backgrounds accurately, patiently and compassionately and present information in an understandable and empathetic manner
• Communicate effectively with staff, peers, attendings, referring physicians and other consultants
• Work closely with a palliative care team to acquire skills in management of patients at the end-of-life
• Maintain comprehensive and timely medical records with the focus of consultative role to other physicians and health professionals
• Plan patient and family conferences
• Counsel patients about transitioning to palliative care, when indicated
• Present cases succinctly, in a problem-based manner
• Become a respected teacher of hepatology to medical students, residents and other healthcare professionals

Fellows are expected to:

• Demonstrate professional behavior in all daily activities
• Interact collegially and respectfully with peers, superiors, support staff and trainees
• Learn to practice ethical principles related to patient care and confidentiality
• Practice appropriate interactions with pharmaceutical representatives to avoid future bias in providing care for the patients
• Provide care that is sensitive to cultural, age, gender, race and disability issues
• Work cooperatively with other fellows to ensure seamless coverage of hepatology patients.
• Provide appropriate feedback to the colleagues on patient management or professionalism issues
• Participate in program planning
• Demonstrate investment in the future success of the program
• Mentor residents, medical students, other trainees and first year fellows in the professional conduct
• Interact collegially with peers and other healthcare professionals, including acting responsibly in the larger context of ensuring the success of the training program

Fellows are expected to:

• Work effectively in various health care delivery settings and systems relevant to hepatology
• Coordinate care of the patients with liver disease within the health care system including pre- and post-transplant care coordination
• Incorporate considerations of cost awareness and risk-benefit analysis in patients with liver disease and in general population as it relates to liver health
• Advocate for quality patient care
• Work effectively in interdisciplinary patient care teams
• Participate in identifying system errors and implementing potential solutions as it pertains to the entire spectrum of hepatology practice
• Assist other trainees in the utilization of appropriate health care resources for the best care of patients with liver disease across the entire continue him of care
• Model appropriate interactions in multidisciplinary planning, including standard operating procedures and quality improvement initiatives

Hepatology fellows will participate in the daily functioning of the hepatology team throughout the year of training. Teaching methods include bedside rounds, teaching rounds, clinic precepting, didactic lectures, pathology and radiology conferences, hepatobiliary conference. Teaching of medical students, residents and other trainees is considered an integral part of the experience during this rotation. Attendance of all required conferences is mandatory.