Efficacy and determinants of success in a structured ERCP training program: a retrospective cohort study from a national training center in China

Background Endoscopic retrograde cholangiopancreatography (ERCP) is a complex procedure, and there is a significant shortage of trained practitioners in China. Aim To evaluate effectiveness of a structured ERCP training program at a national training center and identify key determinants of success. Methods A retrospective cohort study was conducted among 68 graduates (response rate 62.5%) of the ERCP training program at Beijing Friendship Hospital (2017–2024). Data on demographics, training content, and post-training ERCP practice were collected via questionnaire. Primary competence was defined as performing > 10 ERCPs annually with a cannulation success rate ≥ 70% (entry-level). A secondary analysis used the > 90% cannulation rate (advanced mastery) to align with international benchmarks. Multivariate logistic regression identified factors associated with competence. Results Most trainees (83.8%) successfully performed ERCP post-training; 63.2% achieved entry-level competence, while only 25.0% reached the advanced ≥ 90% standard. Subgroup analysis showed that 3-month and 6-month groups achieved higher entry-level competence (69.6% and 67.7%, respectively) than the 12-month group (42.9%), attributed to greater weekly hands-on density. Multivariate analysis identified longer training duration (OR 1.32, P = 0.011), greater weekly hands-on opportunities (OR 2.05, P = 0.013), and sufficient mentor guidance (OR 3.49, P = 0.016) as independent predictors. Conclusion The structured ERCP training program effectively establishes entry-level competence for most trainees, but achieving international mastery remains challenging. Success is associated with adequate training duration, frequent hands-on experience, and quality mentorship. We propose a tiered accreditation system and post-training remediation pathways to safely address the national shortage of ERCPists.