Transplant Hepatology Policies
The Transplant Hepatology Certification Program is jointly developed by the American Board of Internal Medicine (ABIM) and the American Board of Pediatrics (ABP). The examination is administered to candidates from both Boards at the same time in the same testing centers. The American Board of Internal Medicine is responsible for administering the examination.
- Eligibility for Certification and Board Policies
- General Requirements
- Training and Procedural Requirements
- Clinical Competence Requirements
- Candidates for Special Consideration
- Certification Using the Research Pathway
Eligibility for Certification and Board Policies
The information provided on ABIM's website and in ABIM's print publication, Policies and Procedures for Certification, October 2008 (pdf), governs the American Board of Internal Medicine's decision about eligibility for certification. The October 2008 edition supersedes all previous publications. The Board reserves the right to make changes in fees, examinations, policies and procedures at any time without advance notice. Admission to the Board's examinations will be determined by policies in force at the time of application. ABIM is a member of the American Board of Medical Specialties (ABMS).
General Requirements
To become certified in the subspecialty of Transplant Hepatology, physicians must have:
- Been previously certified in internal medicine by ABIM
- Maintained a current underlying certificate in gastroenterology
- Satisfactorily completed the requisite graduate medical education fellowship training
- Demonstrated clinical competence in the care of patients
- Met the licensure and procedural requirements
- Passed the Certification Exam in Transplant Hepatology
No credit will be granted toward certification in a subspecialty for training completed outside of an accredited U.S. or Canadian program.
Fellowship training taken before completing the requirements for the MD or DO degree, training as a chief medical resident, practice experience, and attendance at postgraduate courses may not be credited toward the requirements for subspecialty certification.
To be admitted to an examination, candidates must have completed the required training in the subspecialty, including vacation time, by October 31st of the year of examination.
Candidates for certification in the subspecialties must meet the Board's requirements for duration of training as well as minimum duration of full-time clinical training. Clinical training requirements may be met by aggregating full-time clinical training that occurs throughout the entire fellowship training period; clinical training need not be completed in successive months. Time spent in continuity outpatient clinic, during non-clinical training, is in addition to the requirement for full-time clinical training. Educational rotations completed during training may not be double counted to satisfy both internal medicine and subspecialty training requirements. Likewise, training which qualifies a diplomate for admission to one subspecialty exam cannot be double-counted toward certification in another subspecialty, with the exception of formally approved pathways for dual certification.
Practice Experience and Training Requirements
Because certification in transplant hepatology applies to a discipline that requires both cognitive and procedural expertise, documented experience will serve as a surrogate for technical proficiency. To begin, ABIM will offer two pathways for entrance to this examination - a practice pathway and a training pathway.
Practice Pathway
The practice pathway is available only to candidates who complete the training required for certification in gastroenterology prior to July 1, 2007.
For the first five years and three examinations (2006, 2008, and 2010), gastroenterologists certified by ABIM who have not completed formal training in transplant hepatology* will be eligible to apply for the transplant hepatology examination if they can:
- Demonstrate that they spent either 40% of their post-training practice time in clinical activity (or 25% of their post-training total professional time) involved in pre-, peri-, or post-transplant hepatology for at least three out of the past five years. Partial training in transplant hepatology (less than 12 months) will be credited on a month-by-month basis as practice experience.
- Substantiate practice experience on a "Form Attesting Transplant Hepatology Practice" signed by the Medical Director of a United Network for Organ Sharing (UNOS)-approved Liver Transplant Center.
Training Pathway
The training pathway involves satisfactory completion of training required for certification in Gastroenterology plus an additional 12 months of satisfactorily completed transplant hepatology fellowship training* which meets the following criteria:
- Transplant hepatology fellowship traning undertaken July 1, 2011 and thereafter must be accredited by the Accreditation Council for Graduate Medical Education (ACGME). Transplant hepatology fellowship training undertaken prior to July 1, 2011 must be conducted within an ACGME-accredited gastroenterology program.
- Training experience must include meaningful patient care responsibility for perioperative care of 20 liver transplant patients in a UNOS-approved transplant center.
- Training experience must be consistent with guidelines established by the American Association for the Study of Liver Disease/American Society of Transplantation (AASLD/AST).
* NOTE: Transplant hepatology fellowship training which was credited toward the third year of gastroenterology fellowship training, cannot be used to fulfill requirements for admission to the Transplant Hepatology Exam through the Training Pathway.
TopTraining and Procedural Requirements
The total months of training required, including specific clinical months, and requisite procedures are outlined below.
| Minimum Months of Training |
Clinical Months Required |
Procedures |
|---|---|---|
| 12 | 12 | Performance of at least 30 percutaneous liver biopsies, including allograft; interpretation of 200 native and allograft liver biopsies; and knowledge of indications, contraindications, and complications of allograft biopsies |
Clinical Competence Requirements
The Board requires documentation that candidates for certification are competent in (1) patient care (which includes medical interviewing, physical examination and procedural skills), (2) medical knowledge, (3) practice-based learning and improvement, (4) interpersonal and communication skills, (5) professionalism, and (6) systems-based practice.
Through its tracking process, the Board requires verification of fellows' clinical competence from the training program director.
As outlined in the Program Director Ratings of Clinical Competence table below, all fellows must receive satisfactory ratings of overall clinical competence and moral and ethical behavior in each of the required years of training. In addition, fellows must receive satisfactory ratings in each of the components of clinical competence and the requisite procedures during the final year of required training. It is the fellow's responsibility to arrange for any additional required training.
Program Director Ratings of Clinical Competence
| Ratings | Fellows (any year) |
|---|---|
| Satisfactory | Full credit |
| Unsatisfactory | No credit, must repeat year |
| Ratings | Fellows (any year) |
|---|---|
| Satisfactory | Full credit |
| Unsatisfactory | Repeat year or, at the Board's discretion, a period of observation will be required |
| Ratings | Fellows (any year) |
|---|---|
| * The six required competencies are: (1) patient care (which includes medical interviewing, physical examination and procedural skills), (2) medical knowledge, (3) practice-based learning and improvement, (4) interpersonal and communication skills, (5) professionalism, and (6) systems-based practice. | |
| Satisfactory | Full credit |
| Unsatisfactory | Must repeat year if during final year of required training |
Candidates for Special Consideration
ABIM diplomates in internal medicine may be proposed for special consideration for admission to a subspecialty examination by the program director of an accredited fellowship program if they:
- Have completed the full training required by ABIM in the subspecialty in another country and have met all current applicable ABIM procedural requirements.
- Are a full-time Associate Professor or higher in the specified subspecialty division of the Department of Medicine in an LCME-accredited medical school or an accredited Canadian medical school at the time of proposal.
- Have served eight years, after formal training, as a clinician-educator or clinical investigator with a full-time appointment on a medical school faculty.
- Possess a valid, unrestricted license to practice medicine in a state, territory, commonwealth, province or possession of the United States or Canada.
Guidelines for proposals are available in Proposing Candidates for Special Consideration.
TopCertification Using the Research Pathway
The ABIM Research Pathway is designed to integrate training in research and clinical internal medicine for those physicians who are seriously pursuing careers in basic science or clinical research. The value of the ABIM Research Pathway is that while it requires core clinical training, it concentrates on fostering a research experience that is comprehensive in terms of time, formal curriculum, and structured evaluation and feedback. These components are essential for professional growth and development and to promote continuous quality improvement.
Guidelines for certification using the research pathway are available in Research Pathway.
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