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

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. Plain Language Summary: Metabolic dysfunction–associated steatotic liver disease (MASLD) and metabolic dysfunction–associated steatohepatitis (MASH) are liver conditions that often appear with obesity and type 2 diabetes. Despite the high prevalence and increasing impact of MASLD and MASH, the majority of affected patients are not diagnosed and present late in the course of disease. These observations suggest limits in awareness. This study aimed to understand how US healthcare providers (HCPs) felt about the level of attention MASLD and MASH receive in medical education training programs. An online survey (N = 190) and focus group discussions (N = 11) were held with people who were familiar with their program’s education and training. Most participants said that MASH is often not diagnosed, which can lead to problems; however, it is important to include it in the school’s curriculum. Many people said they think MASH is connected to other conditions, and that meant that HCPs were being trained on it indirectly. Once a treatment for MASH is approved, most participants believed MASH will be covered more in their education programs. Even though MASH is thought to have an important place in the training of HCPs, program leaders saw limited treatment options as a barrier to having more focused time spent on it in their educational programs.