Effect of MRCP introduction on ERCP practice: are there implications for service and training?

Training is an increasingly relevant issue in the UK.1 The structure of postgraduate medical training is undergoing significant change at present, with attempts to streamline and shorten duration. Modernising medical careers (MMC) marks a major reform in postgraduate medical education.2 Endoscopic retrograde cholangiopancreatography (ERCP) requires considerable training to perform effectively and safely.3 Competency has been based on total procedure numbers performed by trainees. Consensus suggests 180–200 diagnostic/therapeutic ERCPs are required to obtain competence within a training facility with sufficient case volume for viable training opportunities.2 Selective cannulation of the bile duct has been used as a benchmark for technical success.4 Moreover, multivariate analyses find case volume to independently predict ERCP related complications.5–8 “Diagnostic” ERCP should rarely be required with …