ERCP training in the 1990s. Time for new ideas.

Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most demanding procedures performed by gastrointestinal endoscopists; however, surprisingly little is known about how the necessary hand-eye coordination and cognitive skills are acquired. Prospective studies are needed to confirm (or refute) retrospective data suggesting that ERCP training is protracted; many aspiring ERCP endoscopists complete their fellowships with inadequate diagnostic and therapeutic skills. Prospective data on the evolution of skills can be used to create mathematical models that predict and define competence. Computer simulation technology is rapidly evolving to provide standardized, reproducible training in all endoscopic procedures.