Training methods and assessment in endoscopic ultrasound

Endoscopic ultrasound (EUS) is a valuable diagnostic and therapeutic procedure widely available in the United States. Expanding indications for its use have led to an increased interest in performing the procedure and a demand for training opportunities among both experienced endoscopists and fellowship trainees. Training most commonly occurs in supervised, structured, hands-on settings, with competency being assessed using procedure numbers and subjective assessments. Other means of training are available but are recommended only as an adjunct to closely supervised training. Recently, methods for standardized assessment of procedural competency have been studied, and show that the absolute procedure numbers are a suboptimal method for assessing competency, and that trainees achieve competency at different rates. Published guidelines from national societies are available regarding competency and credentialing for EUS, and propose minimum case numbers before competency can be assessed. This article will focus on training pathways available in EUS, the most current national guidelines for competency assessment, a review of available evidence regarding competency assessment and learning curves for EUS trainees, and a review of the evolving quality indicators in EUS performance.