Training methods for endoscopic retrograde cholangiopancreatography

Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most challenging endoscopic procedures performed by gastroenterologists and carries substantial risks. Therefore, gastroenterologists should be properly trained to be competent with ERCP and minimize risks to the patient. ERCP training can be divided into two broad categories: cognitive and technical/hands-on aspects. Although traditional clinical ERCP training is in the format of the teacher–apprentice system with supervised hands-on practice on patients, simulator training can supplement the trainee experience. Examples of different types of ERCP simulators include live anesthetized animals, ex vivo porcine, computer, and mechanical models. Most of these models have been the subject of published studies testing the face and construct validities, but there has only been 1 randomized controlled trial on the clinical effect of such simulator training. Several studies have compared different simulator models with respect to qualities such as realism compared with clinical ERCPs and utility for training. Evaluation of trainee competency is another important aspect of ERCP training.