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. ABIM is responsible for administering the examination.
Eligibility for Certification and Board Policies
The information provided on ABIM's website and in ABIM's print publication, Policies and Procedures for Certification, Octoeber 2024 (pdf), governs ABIM's decision about eligibility for certification. The March 2024 edition supersedes all previous publications. ABIM reserves the right to make changes in fees, examinations, policies and procedures at any time without advance notice. Admission to ABIM's certification process is 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:
- At the time of application, be previously certified by ABIM in gastroenterology;
- Satisfactorily complete the formal training requirements;
- Demonstrate clinical competence, procedural skills, and moral and ethical behavior in the clinical setting;
- Hold a valid, unrestricted and unchallenged license to practice medicine; and
- Pass the Transplant Hepatology Certification Examination.
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 31 of the year of examination.
Candidates for certification in the subspecialties must meet ABIM'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.
Dual Certification Requirements - Gastroenterology and Transplant Hepatology
New in 2019, candidates seeking dual certification in gastroenterology and transplant hepatology must complete a minimum of three years of accredited combined training, 18 months of which must be clinical training in gastroenterology and 12 months of clinical training in transplant hepatology. Combined training must be completed in a single institution which has accredited training programs in both gastroenterology and transplant hepatology.
During the entire three years, the fellow must maintain a continuity outpatient clinic structured in a way consistent with ACGME requirements for continuity clinic in the discipline. Time spent in continuity outpatient clinic, during non-clinical training, is in addition to the requirement for full-time clinical training.
Candidates must complete all three years of required combined training before being admitted to the Gastroenterology Certification Examination. Certification in gastroenterology must be achieved before the candidate is eligible to apply for admission to the Transplant Hepatology Certification Examination. Should the candidate transfer to another training program they would no longer be eligible for dual certification unless they meet the standard training requirements separately to apply for both exams.
| Minimum Months of Training |
Clinical Months Required |
Procedures |
|---|---|---|
|
* For deficits of 35 days or less in required training time, ABIM will defer to the judgment of the program director and promotions or competency committee in determining the need for additional training. With program director attestation to ABIM that the trainee has achieved required competence, additional training time will not be required. Trainees cannot make a request to ABIM on their own behalf. |
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| 36* | Gastroenterology - 18 | Diagnostic and therapeutic upper and lower endoscopy |
| Transplant Hepatology - 12 |
Fellows must have the opportunity to train in liver biopsy to the level of competent and independent performance for those fellows who perceive the need to learn the procedure for their future practice. Not all fellows would be required to perform the procedure to be eligible for certification. A minimum of 200 liver biopsy specimens, including native and allograft, should be interpreted during the transplant hepatology fellowship year using resources available within the fellowship program and/or from outside resources such as teaching slide-sets. Demonstrate knowledge of the indications, contra-indications, limitations, complications, alternatives and techniques of native and allograft liver biopsy and noninvasive methods of fibrosis assessment. |
|
Training and Procedure Requirements
The training pathway involves satisfactory completion of training required for certification in gastroenterology plus an additional 12 months of satisfactorily completed clinical transplant hepatology fellowship training* which meets the following criteria:
- Transplant hepatology fellowship training 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 in an institution which has an 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 Certification Examination through the Training Pathway.
Training and Procedures Requirements In or After Academic Year 2022-2023
The ABIM Gastroenterology Subspecialty Board has approved revised procedures for ABIM certification in Transplant Hepatology. The requisite procedures for fellows beginning their fellowship in or after Academic Year 2022-23 are outlined below:
| Minimum Months of Training |
Clinical Months Required |
Procedures |
|---|---|---|
|
* For deficits of 35 days or less in required training time, ABIM will defer to the judgment of the program director and promotions or competency committee in determining the need for additional training. With program director attestation to ABIM that the trainee has achieved required competence, additional training time will not be required. Trainees cannot make a request to ABIM on their own behalf. |
||
| 12* | 12 |
Fellows must have the opportunity to train in liver biopsy to the level of competent and independent performance for those fellows who perceive the need to learn the procedure for their future practice. Not all fellows would be required to perform the procedure to be eligible for certification. A minimum of 200 liver biopsy specimens, including native and allograft, should be interpreted during the transplant hepatology fellowship year using resources available within the fellowship program and/or from outside resources such as teaching slide-sets. Demonstrate knowledge of the indications, contra-indications, limitations, complications, alternatives and techniques of native and allograft liver biopsy and noninvasive methods of fibrosis assessment. |
Clinical Competence Requirements
ABIM requires documentation that candidates for certification are competent in: (1) patient care 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, FasTrack®, ABIM requires verification of fellows' clinical competence from a program director certified by ABIM in the discipline for which they are program director (other ABMS Board and Canadian certification is acceptable, if applicable).
As outlined in the Program Director Ratings of Clinical Competence table below, all fellows must receive satisfactory ratings of overall clinical competence. In addition, fellows must receive satisfactory ratings in each of the six ACGME/ABMS Competencies and the requisite procedures during the final year of required training. It is the fellow's responsibility to arrange for any additional training needed to achieve a satisfactory rating in each of the six ACGME/ABMS Competencies and overall clinical competence.
Program Director Ratings of Clinical Competence
Six ACGME/ABMS Competencies:
The resident/fellow is demonstrating satisfactory development of the knowledge, skill and attitudes/behaviors needed to advance in training. S/he is demonstrating a learning trajectory that anticipates the achievement of competency for unsupervised practice that includes the delivery of safe, effective, patient-centered, timely, efficient and equitable care.
| Components and Ratings | Residents/Fellows: Not Final Year of Training |
Residents/Fellows: Final Year of Training |
|---|---|---|
|
* The six required competencies are: (1) patient care and procedural skills, (2) medical knowledge, (3) practice-based learning and improvement, (4) interpersonal and communication skills, (5) professionalism and (6) systems-based practice. † At the discretion of the program director, training in the final year may be extended as necessary to achieve satisfactory ratings in overall clinical competence and/or the six ACGME/ABMS competencies. |
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| Yes | Full credit | Full credit |
| Conditional on Improvement | Full credit | No credit; must achieve satisfactory rating before receiving credit † |
| No | Full credit | No credit; must repeat year |
Overall Clinical Competence
This rating represents the assessment of the resident/fellow's development of overall clinical competence during this year of training:
| Components and Ratings | Residents/Fellows: Not Final Year of Training |
Residents/Fellows: Final Year of Training |
|---|---|---|
| * At the discretion of the program director, training in the final year may be extended as necessary to achieve satisfactory ratings in overall clinical competence and/or the six general competencies. | ||
| Satisfactory or Superior | Full credit | Full credit |
| Conditional on Improvement | Full credit | No credit; must achieve satisfactory rating before receiving credit* |
| Unsatisfactory | No credit; must repeat year | No credit; must repeat year |
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.
Guidelines for proposals are available in Proposing Candidates for Special Consideration.
Certification 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.
Information for Candidates Certified by ABP
The policy information above applies only to ABIM diplomates who are seeking admission to the Transplant Hepatology Certification Examination via ABIM. Candidates from the American Board of Pediatrics (ABP) should contact ABP with any questions regarding certification policies or eligibility to apply for admission to the examination.