Gaps in MASLD/MASH Education: A Quantitative and Qualitative Survey with Leaders of US Graduate Medical Education Programs.

Abstract

Purpose: Metabolic dysfunction-associated steatotic liver disease (MASLD) and its inflammatory subtype, metabolic dysfunction-associated steatohepatitis (MASH), are associated with cardiometabolic risk factors, including obesity and type 2 diabetes. The prevalence of both conditions is rising rapidly and is underdiagnosed (<5%). We aimed to gather qualitative and quantitative insights from program leaders in US medical education training on their experience with MASH-related training and education.

Participants and methods: A cross-sectional study consisting of a quantitative survey and qualitative discussions with individuals in primary care (internal medicine and family medicine) and specialty programs (hepatology, gastroenterology, and endocrinology) were held from February 21 to August 28, 2023. Descriptive statistics were used for data analysis.

Results: A total of 190 leaders participated in the online survey and 11 leaders joined the focus groups. Almost all respondents reported that MASLD (96%) and MASH (92%) were included in their program's curricula. However, many believed that little time was devoted to discussing MASH in their program. Most respondents agreed that MASH is extremely underdiagnosed. Program leaders agreed that the interconnectedness of MASH with other cardiometabolic conditions necessitates instruction time on MASH beyond that of its dedicated curriculum time. All participants believed that emergence of regulatory-approved drugs for MASH will drive a decision to increase the time allotted for MASH in the curriculum.

Conclusion: Although program leaders agreed that MASH has an important place in medical education curricula, the relative paucity of treatment options reduces its coverage in training, thereby limiting healthcare practitioners' understanding of MASH.