The International Hepato-Pancreato-Biliary Association (IHPBA) was founded in 1994. The origins of the IHPBA come from the International Biliary Association (IBA), which later became the International Hepato-Biliary-Pancreatic Association (IHBPA) and the World Association of Hepato-Pancreato-Biliary Surgery (WAHPBS). The IHBPA and the WAHPBS merged into the IHPBA, which met for the first time in June 1994 in Boston. World Congresses have subsequently been held in the even years in Bologna, Italy in 1996; in Madrid, Spain in 1998; in Brisbane, Australia in 2000; in Tokyo, Japan in 2002; and in Washington, USA in 2004. The IHPBA was incorporated in the United States in June, 2001.
Regional Associations currently affiliated with the IHPBA include the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato-Pancreato-Biliary Association (A-PHPBA), and the European Hepato-Pancreato-Biliary Association (EHPBA). The AHPBA became incorporated in the United States in 1994 and held its first regional Americas Congress in 1997. The A-PHPBA is being incorporated in Hong Kong, but its predecessor the Asian Society of Hepato-Biliary-Pancreatic Surgery began holding regional congresses in Asia in the odd years in 1991. The EHPBA became incorporated in Germany in 2005, but its predecessor the European Chapter of the IHPBA initiated European Congresses in the odd years in 1995.
National Chapters variably affiliated with the IHPBA have existed in Argentina, Greece, Italy, Japan, and the United States for a number of years. In recent years new National Chapters have emerged in Brazil, Canada, China, the Czech Republic, Ecuador, Egypt, Germany, India, Korea, Scandinavia, South Africa and the United Kindom. In 1999 the IHPBA began publishing its official journal, HPB, which has included regular IHPBA Newsletters. Over the past 5 years, the IHPBA has become incorporated (2001), developed the Warren Research Fellowship (2001), hired professional management (Medconnnect), developed a website (www.ihpba.org), published a Membership Directory (2003, 2005), signed a publishing agreement with Taylor and Francis (2004), initiated an electronic Newsletter (2005), conducted a Member Survey (2005), held a strategic planning meeting (2005), and developed an HPB Fellowship Registry (2006).
Member survey
In 2004 the new IHPBA President, Henry A. Pitt, outlined 10 goals for the IHPBA over the next 2 years. Three of these goals were to: (1) conduct a membership survey, (2) complete a strategic planning process, and (3) redefine the vision and mission. By January, 2005, President Pitt with input from the Executive Committee developed a comprehensive member survey to assist in the strategic planning process. The 2005 IHPBA Member Survey was designed to characterize the memberships and to evaluate the importance of current services and potential new services, as well as to obtain member input regarding the official journal, HPB, the World Congresses, the Regional Associations, and the overall mission of the association. The survey with 95 variables was conducted online between January 29 and March 2, 2005. E-mail addresses were available for 1012 of the 1059 members (95%). In all, 380 members responded (38%), which exceeded the response rate (34–35%) from other societies recently surveyed by Al Fisher Associates, Inc. With this response rate the accuracy was estimated to be±4%.
Members’ profile
The demographics of the IHPBA members responding to the survey are presented in Table I. The median age of IHPBA members is 47, and 63% of members are under 50 years of age. In all, 98% of survey respondents were men, and only 2% were women. Approximately 40% of the membership resides in the Europe/Africa region, 38% in the Asian/Pacific region, and 22% in the Americas. Of the survey respondents, 98% had received a medical degree, and 12% also had a basic science degree; 96% described their primary specialty as surgery, whereas 3% specialized in gastroenterology or hepatology, and only 1% stated that they were radiologists, basic scientists or any other medical specialty.
Table I. IHPBA membership profile.
| Parameter | % of members |
|---|---|
| Age | |
| 30s | 21 |
| 40s | 42 |
| 50s | 27 |
| 60s | 9 |
| 70s | 1 |
| Gender | |
| Male | 98 |
| Female | 2 |
| Region | |
| Americas | 22 |
| Asian/Pacific | 38 |
| Europe/Africa | 40 |
| Education | |
| Medical | 98 |
| Basic science | 12 |
| Public health | 2 |
| Business | 1 |
| Specialty | |
| Surgery | 96 |
| Gastroenterology | 3 |
| Other | 1 |
Interestingly, 88% of IHPBA members reported doing advanced training beyond general surgery residency (Figure 1A). The most common form of advanced training was HPB surgery (59%), followed by transplantation (15%), surgical oncology (9%), and gastroenterology (5%). Approximately 73% of respondents have a university faculty appointment (Figure 1B), with 46% describing their current position as full-time faculty, 27% as clinical faculty, and 23% in clinical practice. Most respondents engaged in clinical practice (99%), teaching (94%), research (88%), and administration (77%). However, the percentage of respondents who devote more than half their time to each activity were clinical (82%), teaching (8%), research (3%), and administration (4%). Most respondents (87%) devoted > 25% of their time to non-transplant HPB surgery.
Figure 1. .
Membership profile: (A) advanced training; (B) practice settings.
Member's opinions
The most important services currently provided by the IHPBA are listed in Figure 2. The IHPBA World Congress was rated ‘very important’ by 71% and ‘somewhat important’ by an additional 25% of respondents. The official journal, HPB, was rated ‘very important’ by 58% and ‘somewhat important’ by another 29% of respondents. The IHPBA website is ranked third in importance. Regional Congresses, an electronic newsletter, and the membership directory were similarly rated as ‘very important’ (32–35%) and ‘somewhat important’ (45–48%). The Warren Fellowship, National Chapter, and a hard-copy newsletter were considered less important than the first six services.
Figure 2. .
The importance of current services to members.
The majority of respondents (56%) attended the 2004 World Congress in Washington, DC. Less than one-third attended the 2002 World Congress in Tokyo (32%), the 2000 World Congress in Brisbane (31%), and the 1998 World Congress in Madrid (22%). The most important factors in the decision to attend a World Congress were topic relevance of the program (71% ‘very important’), opportunities to interact with colleagues (65%), and speaker quality (62%). Location (40%) and cost (39%) were less important. Respondents who attended recent World Congresses considered the invited lectures most valuable (62% ‘very valuable’) followed by symposia (53%), debates (49%), free papers (36%), and videos (34%). Least valuable were the satellite symposia (14%), posters (9%), and exhibits (8%).
Two-thirds of respondents thought that future World Congresses should place more emphasis on clinical practice. An increased emphasis on new technology was sought by 60% and outcomes research by 56%. On the other hand, 71% of respondents thought that the World Congresses should ‘Stay as is.’ The vast majority of respondents (83%) wanted to continue holding the World Congresses only in even years and to continue rotating to the three regions (82%). In addition, the majority (53%) thought that future World Congresses should not be held with other international societies. Similarly, most respondents thought that Regional Congresses should be held only in odd years (68%) and throughout the region (77%). Respondents also thought that Regional Associations should host postgraduate courses (75%).
As mentioned above, IHPBA members considered the official journal, HPB, second only to the World Congresses in importance. However, regional differences existed with more importance expressed by respondents from Europe/Africa and the Americas, with a lower degree of importance coming from Asian/Pacific respondents (p<0.01, Figure 3A). Similarly, regional differences (p<0.01) existed when four journals, HPB, the Journal of Hepato-Biliary PancreaticSurgery, the Journal of Gastrointestinal Surgery, and Liver Transplantation were rated by the respondents. To improve HPB, many respondents considered it very important to increase the number of original articles (63%) and review articles (49%). Interestingly, 84% of respondents thought that the IHPBA should require submission of free papers from the World Congresses, Regional Congresses, or both.
Figure 3. .
(A) Members’ percentage rating of HPB as ‘very important’ and ‘somewhat important’ by region. *p<0.01 vs other regions. (B) Members’ percentage rating of HPB and other specialty surgical journals as ‘most valuable’ by region. Differences among regions were significant (p<0.01).
Four missions were ‘very important’ to most respondents: education (82%), research (61%), training (58%), and patient care (58%) (Figure 4). To enhance education and patient care, most respondents thought that improving HPB (60%) and developing practice guidelines (60%) were ‘very important’ (Figure 5A). In comparison, less than half of respondents thought that supporting Regional Association meetings (43%), encouraging National Chapter meetings (37%), and developing public policy (24%) were ‘very important.’ To enhance research and training, 45% of respondents thought that overseeing clinical trials and developing an HPB Fellowship Registry were ‘very important’ (Figure 5B). In addition, 44% thought that accreditation of HPB Fellowships by the IHPBA was ‘very important’, and 36% wanted the Warren Fellowship expanded. Finally, 90% of respondents were ‘very satisfied’ (33%) or ‘somewhat satisfied’ (57%) with membership in the IHPBA.
Figure 4. .
Members’ responses to the question: ‘How important are these IHPBA missions?’.
Figure 5. .
Members’ responses to the questions: (A) ‘What should IHPBA do to enhance education and patient care?’ (B) ‘What should IHPBA do to enhance research and training?’.
Strategic planning
The results of the Member Survey were distributed to the IHPBA Council prior to their May 24, 2005 Strategic Planning Meeting in Heidelberg, Germany. The members’ opinions were discussed in detail, and breakout sessions with subgroup reports were employed to consider the relationship with the Regional Associations, improvement of HPB, and the role that the IHPBA should play in fellowship training, practice guidelines, and clinical trials. During this meeting the IHPBA Council developed an updated vision, a mission statement, five principles, and 15 strategic objectives for the next few years.
Vision
The IHPBA will be the premiere international organization devoted to relief of worldwide human suffering caused by hepato-pancreato-biliary (HPB) disorders by improving education, training, innovation, and patient care.
Mission
The Mission of the IHPBA is to improve evidence-based care and optimize the outcomes of patients with HPB disorders throughout the world by:
Disseminating research findings and best treatment practices
Advancing HPB specific training
Fostering research and innovation
Encouraging multidisciplinary collaboration.
Principles
The Principles of the IHPBA are as follows:
The IHPBA is committed to excellence in patient care and is devoted to elevating standards of care throughout the world.
The IHPBA encourages the recruitment, mentorship, training, and career development of individuals interested in hepato-pancreato-biliary disorders.
The IHPBA embraces a multidisciplinary approach to the treatment of hepato-pancreato-biliary disorders and fosters collegial relationships.
The IHPBA encourages membership by qualified candidates interested in hepato-pancreato-biliary disorders including anesthesiologists, hepatologists, gastroenterologists, radiologists, oncologists, surgeons, transplant physicians, nurses, allied health professionals, and investigators.
The IHPBA is committed to the highest ethical standards in research, education, organizational operation, and interaction with industry.
Objectives
The objectives of the IHPBA are to:
Foster the development of HPB as a specialty.
Have the World Congress be the premiere international HPB meeting.
Establish HPB as an outstanding journal in the field.
Set standards for and accredit HPB fellowship training programs.
Strengthen ties with HPB Regional Associations and National Chapters.
Foster mutually beneficial relationships with other specialty organizations supporting our mission and principles.
Expand education and support for HPB patients.
Support HPB research and career development through the Warren Fellowship.
Encourage HPB clinical trials to advance evidence-based medicine.
Develop HPB-related practice guidelines.
Expand membership to 1500.
Manage the association in a financially sound, effective, and efficient manner.
Optimize communication by a web-based membership directory, an e-newsletter, and an online journal.
Acknowledge significant individual contributions through the HPB medallion.
Document the rich history of the association.
The future
Clearly, hepato-pancreato-biliary (HPB) surgery is emerging as a specialty. The relationship between volume and outcome has been established for hepatic, pancreatic, and complex biliary surgery. Shortly after publication of this issue of HPB another superb World Congress will be held in Edinburgh. HPB is being published six times in 2006 with improved original articles and review articles as well a Medline application pending. An HPB Fellowship Registry was established in 2006, and guidelines for fellowship training will be developed in Edinburgh. The next step will be for the IHPBA, the Regional Associations, and/or the National Chapters to become involved in fellowship accreditation. In 2005 an agreement was signed between the IHPBA and the AHPBA with respect to HPB. A similar HPB agreement was signed with the EHPBA in 2006. Hopefully, the A-PHPBA also will become a partner with respect to the official journal. In 2005 HPB became profitable, and this accomplishment will assist the IHPBA in negotiating a new Publishing Agreement in 2009.
The IHPBA still has challenges in expanding education and support for HPB patients. The development of an updated website in 2007 should help in this regard. With respect to research and career development, a new IHPBA Kenneth Warren Foundation has been established in 2006 with the goal to fully support two Warren Fellows each year. In the next few years the role that the IHPBA will play in clinical trials and practice guidelines will become clearer. In 2005 an e-newsletter was initiated, and HPB became available online. In 2007 an online Membership Directory will be developed, and efforts will continue to grow membership. The IHPBA is currently being managed in a financially sound manner, and following the Edinburgh World Congress, the Association's financial reserves should approach one year's budget. To date, the HPB Medallion has been awarded to Robin Williamson (2004), Frank Moody (2005), and Russell Strong (2006). In 2008 the IHPBA will celebrate the 30th anniversary of the development of the IBA. To acknowledge this milestone, a supplement to HPB is being developed to document the rich history of the association. Thus, progress has already been made on many of the strategic objectives, and the future of the IHPBA is clearly bright.