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Clin Gastroenterol Hepatol. 2008 Jun;6(6):682-688.e2. doi: 10.1016/j.cgh.2007.12.038. Epub 2008 Mar 20.

Utilization of and adherence to the gastroenterology core curriculum on hepatology training during a gastrointestinal fellowship.

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Department of Gastroenterology and Hepatology, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.



The gastroenterology core curriculum (GCC) represents the knowledge/skills desired at the completion of fellowship training. The hepatology subset (H-GCC) is the focus of this research. The aims were to measure adherence of the H-GCC within gastrointestinal training programs, compare the perceptions of the H-GCC compliance by fellows and program directors, and provide comparative information to improve gastrointestinal training programs.


A questionnaire was designed to assess the general and hepatology components of the GCC. Fellows and program directors were invited to participate by means of 3 sequential mailings. Pearson chi(2) and Fisher exact tests were used for statistics.


Of 971 potential respondents, the questionnaire was returned by 42% of program directors and 33% of fellows. There was <70% agreement by either fellows or program directors for minimum > or =18 months of clinical training (minimum > or =30% hepatology), and minimum > or =20 paracentesis/liver biopsies. Most prescribed hepatology core topics were covered; however, >10% of fellows claimed deficiency in physiology, pregnancy issues, angiography, immunosuppressant use, and congenital disorders. Fellows in non-liver transplant institutions more often reported lack of training in fulminant disease, transplant patient selection, and diagnosis/management of rejection (P < .001).


(1) Fellow and program director assessments were highly concordant, with most H-GCC criteria being met. (2) Attention is required to provide adequate time for clinical training and prescribed procedures. (3) Improved instruction in several hepatology topics seems warranted. (4) A nonevaluative questionnaire is a practical means to measure compliance. Future studies measuring compliance with other components of the GCC by using this methodology seem feasible.

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