It has become increasingly clear that no longer is it appropriate or practical to train all specialist gastroenterology registrars in endoscopic retrograde cholangiopancreatography (ERCP). This realisation has caused much disquiet and uncertainty among trainees, concern among trainers, and debate in the journals.1 At present the implication of the Joint Committee for Higher Medical Training (JCHMT) curriculum for higher specialist training in gastroenterology is that all trainees are expected to become proficient in all areas of endoscopy. In recent months this issue has been extensively discussed by the appropriate bodies—Training Committee of the British Society of Gastroenterology (BSG), Joint Advisory Group on Endoscopy Training (JAG), and in particular the Specialist Advisory Committee in Gastroenterology to the Joint Committee for Higher Medical Training (SAC to JCHMT). It is the JCHMT alone that has the statutory powers to enforce decisions on training.

The SAC Gastroenterology, with the approval of the other bodies, has decided that from now, ERCP will no longer be an essential requirement for a certificate of completion of specialist training.

Most gastroenterologists would accept the need for full training in oesophago-gastro-duodenoscopy and in colonoscopy. These are areas of endoscopy where demand can be expected to continue to rise, especially with the increasing need for cancer screening. In contrast, despite the recent sharp rise in demand for ERCP coming on the back of laparoscopic cholecystectomy, it is likely that numbers will plateau or even fall as magnetic resonance cholangiopancreography and laparoscopic exploration of the common bile duct become more widespread. Even with the existing numbers of cases it is not possible for all trainees to meet the requirements of JAG and become proficient in ERCP, nor would trainers be able to maintain their expertise.

These concerns were very clearly expressed in a recent paper by Wickset al, with …