Development of a Competency-Based Transplant Hepatology Fellowship
AASLD LiverLearning®. Herrine S. Nov 13, 2012; 24452
Topic: Health Services Research
Disclosure(s): Research support: BMS, Merck, Gilead, Vertex
Dr. Steven Herrine
Dr. Steven Herrine

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Abstract
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Purpose: The Accreditation Council for Graduate Medical Education (ACGME) next accreditation system (NAS) provides incentive for medical educators to understand and implement competency-based medical education (CBME) training and assessment in their programs. Noting decreasing enrollees for the American Board of Internal Medicine (ABIM) Transplant Hepatology (TH) exam, workforce concerns in TH, and questionnaire data from Gastroenterology (GI) fellows and Program Directors (PDs), we developed an ABIM-approved one-year competency- based TH pilot program.

Methods/Results: Responding to a Multi-society Task Force on GI Training recommendation that Board Certification in TH be abandoned in favor of a “Focused Recognition” model and survey results suggesting that training duration had a detrimental effect on retaining trainees’ interest in TH careers, a competency-based three year combined GI/TH program was proposed, followed by participation in an ABIM workshop exploring CBME program development. The authors then participated in an ABIM “just-in-time” faculty development session.

Our pilot employs a hybrid design of the ABIM/ACGME milestones model1 and the entrustable professional activities model (EPA) of ten Cate2. Our 14 EPAs include management of disorders frequently seen at a referral liver center. The pilot utilizes a one-year time frame, is approved for ten years and will start enrolling trainees in July 2012. Any institution with an ACGME-approved TH program is eligible to participate. Trainees must be certified as competent (using traditional methods) in GI as a pre-requisite to enrollment. Faculty development will be available at national meetings and participating institutions. Outcomes measures include trainee achievement of level 4 or 5 entrustability for EPAs, TH Board Examination pass rate, Care Transition Measure instrument (CTM-3) scores, trainees’ participation in continuous maintenance of certification activities, hospital readmission rates and hospital CAHPS scores.

Conclusions: In an effort to respond to workforce needs while meeting ACGME NAS requirements, we developed a CBME-based one year program in TH. We anticipate that both GI and TH training can be completed in three years and that the lessons learned from the early implementation of our CBME-based program will be generalizable to other areas of Graduate Medical Education
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