Training in interventional endoscopy: Challenges and opportunities

With the evolution of advanced procedures, the landscape of interventional endoscopy training evolved from traditional apprenticeship "Gurukul" model (where one learns through practice and observation of a single or few mentors) to formal structured curricula with standardized competencies. This evolution occurred simultaneously with an emphasis and paradigm shift from volume-based competency metrics (number of procedures performed) to competency-based assessment with a key focus on skill acquisition. Modern training should transition from procedure-specific learning to mastery of fundamental principles and transferable skills, enabling trainees to adapt to rapidly emerging novel techniques and technologies. Substantial heterogeneity characterizes interventional endoscopy training globally, with marked variation in training methodologies, competency assessment frameworks, feedback and cognitive evaluation. Despite consensus supporting competency-based training, most programs continue to rely on time and volume-based metrics, yielding inconsistent trainee quality without standardized graduation benchmarks. While structured, objective competency assessment tools exist, their implementation remains limited. Comprehensive skills assessment is time-intensive and conflicts with escalating clinical demands-including high patient volumes and productivity expectations-constraining faculty's availability for meaningful trainee supervision. This tension between educational ideals and practical realities results in inadequate formative feedback and sub-optimal support for trainee competency development. In this narrative review, we examine key challenges in modern interventional endoscopy training, including escalating procedure complexity, variability in learning curves, case exposure, limitations of volume-based training models, gaps in competency assessment, faculty development needs and both institutional and system-level constraints. We also highlight emerging opportunities to improve training in interventional endoscopy through competency-based educational frameworks, mastery learning, video-based audit and feedback, simulation-based training, artificial intelligence-enabled analytics and standardized assessment tools. Collectively, these approaches to addressing the challenges of interventional endoscopy training offer a path towards more scalable, data-driven and competency-focused training paradigms that align educational goals with patient safety and evolving clinical demands.