Training pathways and competency assessment in endoscopic retrograde cholangiopancreatography

Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most technically demanding and high-risk procedures performed by gastrointestinal endoscopists. It requires significant focused training and experience to maximize success and to minimize poor outcomes. Ensuring competence in ERCP has recently emerged as an area of intense scrutiny as training programs and hospital credentialing committees attempt to approve, respectively, adequately trained endoscopists. Despite this, universally accepted standards for competence in ERCP have not been established. It is not a question of overall numbers, although we know that more is better. With the appreciation that different trainees develop endoscopic skills at different rates, there has been a shift toward competency-based training and certification. An assessment of individual performance is probably more robust than the use of minimum numbers for defining competence. It is still not clear what the exact measures should be and how to measure them, and no one has defined how trainee involvement in a procedure count as a “case” for the trainee. In this review, we sought to define ERCP competence, performance measures, quality indicators for training, maintenance of competency, and credentialing to help ensure that future ERCPists receive adequate quality and quantity of training to achieve procedural competency.