Hepatology Training Pathways

Transplant Hepatology Fellowship Programs

There are two pathways available to achieve certification in transplant hepatology:

• Accredited transplant hepatology training after accredited gastroenterology fellowship (“fourth year”)
• Dual certification training in transplant hepatology during accredited gastroenterology fellowship (formerly known as the “Pilot”)

Transplant Hepatology Training After Gastroenterology Fellowship ("Fourth Year")

• One year of accredited training for those who have completed a three-year fellowship in gastroenterology (total of four years for completion of gastroenterology and transplant hepatology fellowship training)
• Benefits of an additional year of fellowship training after completion of a gastroenterology fellowship include:
  • Advanced training in general and transplant hepatology
  • More time available for training and development of competence in gastroenterology
  • More time to pursue scholarly activities including research and/or an advanced degree during the three-year gastroenterology fellowship
  • Opportunity to pursue advanced training at a different institution
• Ideal for trainees interested in an academic hepatology career, advanced degree, and/or a career with a significant research focus

When and How to Apply

• Visit the AASLD Transplant Hepatology Fellowship Application System to search for available transplant hepatology fellowship positions. You can reach out to learn more about programs and/or submit applications to participating programs through the site 
• Programs can be viewed and applications submitted in January-March of the year before anticipated start of transplant hepatology fellowship training 
• Interviews take place in March and April 
• Match Day is in May of the year prior to start of training
• Visit the AASLD Transplant Hepatology Fellowship Application System for the current schedule and to search for participating programs

Dual Certification Training in Transplant Hepatology During Gastroenterology Fellowship (Formerly Known As The “Pilot”)

• Transplant hepatology training during the three-year accredited gastroenterology fellowship (total of three years for completion of gastroenterology and transplant hepatology fellowship training)
• Benefits of dual-certification training include:
  • Advanced training in general and transplant hepatology
  • Less time in training that may not align with career interests
  • Shortened overall duration of training
• Ideal for trainees interested in a clinically-focused hepatology career
• Most, but not all ACGME-accredited transplant hepatology fellowship programs offer the dual certification pathway.

When and How to Apply

• The dual certification pathway is available to existing gastroenterology fellows at a program with an accredited transplant hepatology fellowship program at the same institution
• In some programs, this pathway may be competitive depending on the number of interested fellows and other program-specific factors
• Discuss your interest in this pathway with gastroenterology fellowship program directors during interviews and/or during your first year of gastroenterology fellowship
• See ABIM and ACGME websites for program requirements

Transplant Hepatology Certification

• Upon completing accredited transplant hepatology training and passing the gastroenterology board certification, fellows will be eligible to take the Transplant Hepatology Board Certification Exam jointly offered by the ABIM and ABP
• The dual certification pathway is currently only eligible for certification through the ABIM and is not available through the ABP

Transplant Hepatology Training Before Gastroenterology Training

• Transplant hepatology is a subspecialty that is dependent on first obtaining gastroenterology certification. Accordingly, the ACGME Program Requirements for Transplant Hepatology state that fellows “should have completed a three-year gastroenterology fellowship” before appointment (Program Requirement 3.2.a.1)
• This requirement reflects the expectation that competency in gastroenterology is important preparation for transplant hepatology training. 
• ACGME Program Requirements describe the average trainee in the average training program.
• For ABIM certification in transplant hepatology, physicians must “be previously certified by ABIM in gastroenterology” at the time they apply for the transplant hepatology certification exam. 
• However, neither the ACGME nor the ABIM mandates a specific sequence of accredited training. The ABIM only requires that certification in gastroenterology precede certification in transplant hepatology. 
• In rare cases, a trainee may complete ACGME-accredited transplant hepatology training before gastroenterology training. They will only be eligible for transplant hepatology certification if the trainee later: 
  • completes an ACGME-accredited gastroenterology fellowship, and 
  • becomes ABIM-certified in gastroenterology before applying for transplant hepatology certification 
• Confusion has arisen because many assume that trainees without prior gastroenterology fellowship training cannot enter an ACGME-accredited transplant hepatology program, or that such training would not count as ACGME-accredited training because of the sequence of training. That assumption is incorrect. 
• ACGME-accredited transplant hepatology programs may occasionally accept a trainee who has not yet completed gastroenterology training. Doing so does not jeopardize program accreditation, as long as the program has historically been in substantial compliance with ACGME requirements, and most fellows follow the standard pathway (gastroenterology fellowship before transplant hepatology). 
• In these cases, the trainee is considered an exception and the program would remain in substantial compliance with ACGME Program Requirements (i.e., not risk a citation). 
• The training must be in accordance with ACGME Program Requirements and must be designated as such on the ADS Fellow Roster for the duration of the fellow’s training.
• Programs choosing to occasionally (not regularly) appoint such trainees must ensure complete transparency. The DIO, program director, and fellow should all understand at the beginning of the application process that the fellow will not be eligible for transplant hepatology certification unless the fellow later completes gastroenterology training and obtains gastroenterology certification. 
• Programs may also establish separate, non-standard training tracks that do not comply with all ACGME Program Requirements (for example, research-focused pathways or tracks without continuity clinic). Those pathways are distinct from the ACGME-compliant training pathway described here and will not lead to transplant hepatology certification.

In summary, ACGME-accredited transplant hepatology programs may occasionally accept trainees directly from internal medicine residency, even if they have not yet completed gastroenterology fellowship training. Such training may still be considered ACGME-accredited transplant hepatology training, provided the program otherwise complies with ACGME requirements and the trainee is informed about the implications for future certification eligibility. To become eligible for ABIM certification in transplant hepatology, the trainee must subsequently complete ACGME-accredited gastroenterology training and obtain ABIM certification in gastroenterology.

For ACGME and other accreditation-related questions, contact Jerry Vasilias, Executive Director of the ACGME Review Committee on Internal Medicine, at jvasilias@acgme.org.

For questions about individual training pathways and other certification-related questions, contact AcademicAffairs@ABIM.org.

Retroactive “Credit” for Transplant Hepatology Training

• If transplant hepatology training occurred in an ACGME-accredited transplant hepatology fellowship program, but the fellow was not listed on the ACGME’s ADS Fellow Roster or registered in ABIM’s FasTrack at the time, the physician may still be eligible for transplant hepatology certification after obtaining GI certification
• The transplant hepatology program will need to provide documentation that all training was in compliance with ACGME Program Requirements and did not deviate from the curriculum and structure of the program’s ACGME-accredited transplant hepatology fellowship, including fellow complement limits
• If hepatology training occurred in an unaccredited program or was not in compliance with ACGME Program Requirements, the physician will not be eligible for future transplant hepatology certification
• For a formal review of documentation to be considered for eligibility, contact ABIM at AcademicAffairs@ABIM.org

For Transplant Hepatology Fellowship Program Directors

Managing fellow participation in the Dual Certification Training Pathway

• ABIM: 
  • This is considered a standard training pathway for certification and is tracked through ABIM’s FasTrack Evaluation System
  • Like all accredited training, program directors report the accredited fellowship training in FasTrack. The gastroenterology program directors report the gastroenterology training and the transplant hepatology program directors report the transplant hepatology training, totaling 3 years.
• ACGME:
  • Gastroenterology programs that have approved a fellow to participate in the dual gastroenterology/transplant hepatology pathway must be designated as such on the ADS Fellow Roster
  • In the fellow’s record, select “Dual GI/TH Pathway” from the “Specialty Track” drop-down list in the “Fellow Status” section
  • Fellows participating in the “Dual GI/TH Pathway” should only appear on the gastroenterology program’s ADS Fellow Roster for the duration of their training
  • As described in the ACGME Program Requirements, fellows must not be identified as being in the “Dual GI/TH Pathway” until they are in the second or third year of the gastroenterology program (Gastroenterology Program Requirement 3.2.a.1.c.)
  • For questions about ACGME management of fellow participation, contact Christine Famera, Associate Executive Director for the ACGME Review Committee of Internal Medicine at cfamera@acgme.org