How to Develop a Training Program for Third-Space Endoscopic Procedures in Western Countries

We reviewed the literature in order to determine the best system to develop a training program for third space endoscopic procedures in the West. There has been a steady growth in the number and type of advanced endoscopic procedures over the past several decades, including the expansion of “third-space” or submucosal endoscopy. Most of our knowledge on training in third-space endoscopy stems from the East, with a lack of consensus regarding the optimal training model for Western endoscopists. We review the current literature and provide insight into a potential training algorithm that can be adopted in the West. A multipronged, stepwise training approach, involving self-directed learning, exposure courses, hands-on explant models, observation of experts, followed by performing cases with gradually increasing difficulty preferably under direct supervision, is the foundation for third-space endoscopy training in the West. Learning and performing third-space endoscopy in the West will continue to be facilitated by the ongoing development of dedicated devices and accessories and the establishment of training benchmarks.