The tremendous advances in clinical hepatology are a great success story in the practice of internal medicine. Hepatology has now evolved from an observational medical science to one that has a myriad of interventions, ranging from improved diagnostics, preventive strategies, and antiviral therapies, and, of course, liver transplantation. Therapies for viral hepatitis and liver cancer as well as the care of patients with end-stage liver disease have become increasingly complex. Care of patients with liver disease requires the special expertise of dedicated physicians. However, our training programs designed to developing physicians with this expertise have not kept pace with the medical advances. In fact, the length of the required hepatology training has been increased. Multiple barriers have been placed between internal medicine residents who are interested in hepatology and their career goal of being recognized as a hepatology expert. Current training in transplant hepatology requires the candidate to successfully complete a traditional 3 year fellowship in gastroenterology. There are now 39 transplant hepatology programs accredited by the ACGME but these programs are having difficulty filling their training slots. The lack of success in attracting potential hepatologists is due to the competiveness of getting into gastroenterology programs, the 7 years required of post graduate training and the financial burden of perpetual training. Under the leadership of the AASLD, the ABIM has approved a pilot program to train hepatologists that seeks to circumvent these pitfalls. Under special circumstances, candidates can complete their clinical training in both gastroenterology and hepatology in 3 years. They will be eligible to sit for the gastroenterology boards and if successful in passing the GI board examination, can sit for the transplant hepatology boards. Institutional programs and individual candidates for this pilot program are carefully selected by an AASLD committee that also has oversight into ensuring that the pilot program is innovative in its medical education. Pilot programs will utilize EPAs, newly developed milestones, a recently created transplant hepatology inservice examination, and will be monitored by many novel feedback instruments. In summary, the growing need for physicians with an expertise in advanced and transplant hepatology has necessitated a change in our paradigm on how we train hepatologists. The future of hepatology has never looked brighter and the AASLD and its partners are committed to providing innovative educational and training avenues as we enter a new era in the world of liver diseases. © 2013 by the AGA Institute.
