9 - ERCP Training

Abstract

ERCP remains one of the most technically complex endoscopic procedures and is associated with a higher complication rate than standard endoscopy. Comprehensive training in both the technical and cognitive aspects of ERCP is essential for an endoscopist to be able to perform this procedure safely and effectively. Current ERCP training continues to be based on an apprenticeship model focused on procedural volumes and subjective assessment. This is largely due to the fact that international societal thresholds for competence in ERCP are primarily based on volume. Current data, however, shows significant variability in training volumes and in trainee learning curves. With the implementation of Competency-Based Medical Education as part of the Accreditation Council for Graduate Medical Accreditation's Next Accreditation System for trainees in the US. the assessment of competence is shifting toward well-defined and validated competency thresholds. The use of a standardized assessment tool will therefore be critical to the development of generalizable learning curves and competency benchmarks. The EUS and ERCP skills assessment tool, a validated tool for the assessment of technical and cognitive aspects of ERCP utilizing well-defined scoring anchors, has demonstrated significant variability in competence among trainees in a large multicenter study highlighting the limited role of procedural volumes in assessing competency. However, performing sufficient procedural volumes following the completion of training and continuing quality monitoring are integral to maintaining proficiency and safety in ERCP in practice.