Delphi survey to explore core curriculum for training the next generation of hepatologists
Abstract
BACKGROUND & AIMS: Hepatology is experiencing major shifts in disease etiologies and is raising demand for multidisciplinary care. However, a globally harmonized framework defining core training content remains lacking. We aimed to develop a globally informed expert consensus framework for the content of core hepatology training, to provide a structured foundation for curriculum development. METHODS: A two-round modified Delphi using the RAND/UCLA Appropriateness Method was conducted. A comprehensive list of curriculum items was developed from international training standards, refined by a steering committee, and rated by a stratified international panel. Consensus was determined using medians and a disagreement index (DI), which classified curriculum items as essential, desirable, or optional. RESULTS: A total of 456 experts completed Round 1, of whom 78.7% also completed Round 2. Consensus was strongest for foundational knowledge and core diagnostic skills, including interpretation of abnormal liver function and liver screening test results, and non-invasive fibrosis assessment (both DI = 0). Management of major liver diseases was consistently prioritized as essential. Procedures with the highest endorsement for independent performance were paracentesis, transient elastography, variceal screening, and endoscopic variceal therapy. Consensus was limited for conventional ultrasonography and advanced interventions, reflecting regional variability in resources and scope of practice. Most experts (79.1%) supported formal training in research methodology, and the median recommended fellowship length was 24 months. Subgroup differences were mainly observed in selected resource-dependent or highly specialized items. CONCLUSIONS: This global consensus offers a priority-stratified outline of core hepatology training content providing a practical foundation for curriculum development and staged implementation across diverse health systems. IMPACT AND IMPLICATIONS: Our study provides a consensus-based, priority-stratified framework for core hepatology training content that may inform curriculum development and local adaptation, given the growing global burden of liver disease and the heterogeneity of training standards. This framework may support curriculum mapping and local adaptation for trainees, program directors, professional societies, and policymakers, including in settings where structured hepatology training pathways are still evolving. In practical terms, these findings may assist educators and institutions in reviewing and refining national curricula and training structures. However, specific implementation decisions, including accreditation requirements and procedural training standards, will need to be adapted to local regulatory and resource contexts. Recognizing that these recommendations are based on expert consensus rather than outcome data and may be variably implementable in resource-limited settings, the next steps are pilot implementation in diverse settings, evaluation of trainee and patient outcomes, and iterative revision, supported by coordinated efforts from societies, governments, and training institutions.
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BibTeX
@article{xu2026delphi,
title = {{Delphi survey to explore core curriculum for training the next generation of hepatologists}},
author = {Xinyi Xu and Yu Shi and Frank Tacke and Vincent Wai-Sun Wong and Wenhao Li and Giada Sebastiani and Philip Newsome and Manuel Romero-Gomez and Calvin Pan and Laurent Castera and Jin Chai and Won Kim and Luca Valenti and Yusuf Yilmaz and Khin Maung Win and Xianbin Xu and Ponsiano Ocama and Hasmik Ghazinyan and Mamun Al Mahtab and Saeed Hamid and Cosmas Rinaldi A. Lesmana and Stefano Romeo and Marlen Ivon Castellanos Fernandez and Xia Yu and Panu Luukkonen and Hirokazu Takahashi and Phunchai Charatcharoenwitthaya and Jerome Boursier and Ian Homer Cua and Hang Viet Dao and C. Wendy Spearman and Subhashin Uditha Bandara Dassanayake and Munkhjargal Ayurzana and Gulnara Aghayeva and Mark Dhinesh Muthiah and Nahum Mendez-Sanchez and Catherine Ann Stedman and Khalid Alswat and Ala Sharara and Nabil Debzi and Nathalie Carvalho Leite and Maryam Salem Alkhatry and Laurens van Kleef and Salma Barakat and Said Al-Busafi and Adwoa Agyei-Nkansah and Yasser Fouad and Jordi Gracia-Sancho and Monica Lupsor-Platon and John Ryan and Wah-Kheong Chan and Helena Cortez-Pinto and Mattias Mandorfer and Ajay Duseja and Georgios Papatheodoridis and Sven Francque and Christopher Byrne and Giovanni Targher and Jacob George and Ming-Hua Zheng},
journal = {JHEP Reports Innovation in Hepatology},
year = {2026},
month = oct,
doi = {10.1016/j.jhepr.2026.101942},
url = {https://hal.science/hal-05840320v1},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Delphi survey to explore core curriculum for training the next generation of hepatologists
AU - Xinyi Xu
AU - Yu Shi
AU - Frank Tacke
AU - Vincent Wai-Sun Wong
AU - Wenhao Li
AU - Giada Sebastiani
AU - Philip Newsome
AU - Manuel Romero-Gomez
AU - Calvin Pan
AU - Laurent Castera
AU - Jin Chai
AU - Won Kim
AU - Luca Valenti
AU - Yusuf Yilmaz
AU - Khin Maung Win
AU - Xianbin Xu
AU - Ponsiano Ocama
AU - Hasmik Ghazinyan
AU - Mamun Al Mahtab
AU - Saeed Hamid
AU - Cosmas Rinaldi A. Lesmana
AU - Stefano Romeo
AU - Marlen Ivon Castellanos Fernandez
AU - Xia Yu
AU - Panu Luukkonen
AU - Hirokazu Takahashi
AU - Phunchai Charatcharoenwitthaya
AU - Jerome Boursier
AU - Ian Homer Cua
AU - Hang Viet Dao
AU - C. Wendy Spearman
AU - Subhashin Uditha Bandara Dassanayake
AU - Munkhjargal Ayurzana
AU - Gulnara Aghayeva
AU - Mark Dhinesh Muthiah
AU - Nahum Mendez-Sanchez
AU - Catherine Ann Stedman
AU - Khalid Alswat
AU - Ala Sharara
AU - Nabil Debzi
AU - Nathalie Carvalho Leite
AU - Maryam Salem Alkhatry
AU - Laurens van Kleef
AU - Salma Barakat
AU - Said Al-Busafi
AU - Adwoa Agyei-Nkansah
AU - Yasser Fouad
AU - Jordi Gracia-Sancho
AU - Monica Lupsor-Platon
AU - John Ryan
AU - Wah-Kheong Chan
AU - Helena Cortez-Pinto
AU - Mattias Mandorfer
AU - Ajay Duseja
AU - Georgios Papatheodoridis
AU - Sven Francque
AU - Christopher Byrne
AU - Giovanni Targher
AU - Jacob George
AU - Ming-Hua Zheng
PY - 2026
DA - 2026/10/27
JO - JHEP Reports Innovation in Hepatology
DO - 10.1016/j.jhepr.2026.101942
UR - https://hal.science/hal-05840320v1
AB - BACKGROUND & AIMS: Hepatology is experiencing major shifts in disease etiologies and is raising demand for multidisciplinary care. However, a globally harmonized framework defining core training content remains lacking. We aimed to develop a globally informed expert consensus framework for the content of core hepatology training, to provide a structured foundation for curriculum development. METHODS: A two-round modified Delphi using the RAND/UCLA Appropriateness Method was conducted. A comprehensive list of curriculum items was developed from international training standards, refined by a steering committee, and rated by a stratified international panel. Consensus was determined using medians and a disagreement index (DI), which classified curriculum items as essential, desirable, or optional. RESULTS: A total of 456 experts completed Round 1, of whom 78.7% also completed Round 2. Consensus was strongest for foundational knowledge and core diagnostic skills, including interpretation of abnormal liver function and liver screening test results, and non-invasive fibrosis assessment (both DI = 0). Management of major liver diseases was consistently prioritized as essential. Procedures with the highest endorsement for independent performance were paracentesis, transient elastography, variceal screening, and endoscopic variceal therapy. Consensus was limited for conventional ultrasonography and advanced interventions, reflecting regional variability in resources and scope of practice. Most experts (79.1%) supported formal training in research methodology, and the median recommended fellowship length was 24 months. Subgroup differences were mainly observed in selected resource-dependent or highly specialized items. CONCLUSIONS: This global consensus offers a priority-stratified outline of core hepatology training content providing a practical foundation for curriculum development and staged implementation across diverse health systems. IMPACT AND IMPLICATIONS: Our study provides a consensus-based, priority-stratified framework for core hepatology training content that may inform curriculum development and local adaptation, given the growing global burden of liver disease and the heterogeneity of training standards. This framework may support curriculum mapping and local adaptation for trainees, program directors, professional societies, and policymakers, including in settings where structured hepatology training pathways are still evolving. In practical terms, these findings may assist educators and institutions in reviewing and refining national curricula and training structures. However, specific implementation decisions, including accreditation requirements and procedural training standards, will need to be adapted to local regulatory and resource contexts. Recognizing that these recommendations are based on expert consensus rather than outcome data and may be variably implementable in resource-limited settings, the next steps are pilot implementation in diverse settings, evaluation of trainee and patient outcomes, and iterative revision, supported by coordinated efforts from societies, governments, and training institutions.
SN - 2589-5559
ER -