The American Society of Gastrointestinal Endoscopic Surgeons considers physicians who are interested in and have received training in the management of hepatobiliary and pancreatic diseases to be suitable candidates for training in diagnostic and therapeutic endoscopic cholangiopancreatography. Physicians who wish to undergo ERCP training should be confident in their abilities, should perform a sufficient number of procedures to maintain their proficiency in the future, and should have the desire to work hard to improve themselves in this ever-advancing field. Training in ERCP and advanced therapeutic procedures should be done during surgical residency. Fellow gastroenterologists, endoscopists and mentors are expected to contribute to ERCP training accordingly. The training includes both theoretical and practical aspects. 1. various instruments and equipment used for ERCP; 2. indications and contraindications; 3. lecture and demonstration of diagnostic and therapeutic techniques; 4. appropriate sedation techniques; 5. complications and their management; and 6. immediate and long-term outcomes. Since there is no “purely diagnostic” ERCP, trainees are expected to acquire comprehensive competence in both diagnostic and therapeutic procedures. It is worthwhile to introduce endoscopic ultrasonography alongside ERCP training because of the similarities between these two techniques in the management of biliary and pancreatic disease. A small number of procedures is not sufficient to demonstrate competence, but a large number of ERCP procedures under the supervision of a highly qualified instructor is necessary to achieve a satisfactory rate of selective tube placement. Short-term courses include computer simulation of ERCP and animal experiments, but participation in these courses alone is still not sufficient to gain admission to ERCP. However, these courses provide an initial exposure to diagnostic ERCP techniques and an opportunity for clinicians to practice and become familiar with the use of relevant instruments. ERCP-trained physicians can also participate in short courses to hone their surgical skills and learn other procedures that they have not yet mastered. The competencies required for admission to diagnostic ERCP are as follows: 1) the ability to reliably place a trocar in the target duct; 2) the ability to perform papillary sphincterotomy comfortably; 3) the ability to perform biliary/pancreatic duct decompression; and 4) the ability to apply endoscopic, radiological, imaging, and pathological information to implement an accurate and efficient treatment plan. In addition, knowledge of certain therapeutic procedures such as stone removal, stent placement and management of bleeding from papillary sphincterotomy is required. More advanced therapeutic procedures such as dilation of stenotic ducts, papillary sphincter pre-incision, metal stent placement and bile duct manometry should be performed by experienced physicians. Physicians who wish to master these more advanced procedures should undergo relevant training. The immediate and long-term postoperative results should be evaluated by a quality assurance mechanism. The granting of clinical access is the responsibility of each hospital. All physicians who apply for admission to similar endoscopic procedures should be evaluated according to the same admission criteria. Whether an applicant is granted ERCP access depends largely on whether his or her supervisor is positive about his or her ability. The mentor evaluates and verifies the applicant’s competence in all aspects of ERCP, including theoretical mastery, diagnostic operations, and therapeutic operations. A supervisory evaluation of the applicant by another highly qualified physician prior to the granting of access or renewal of access may help to verify the level of competence to operate ERCP. V. Maintenance of Technical Competence Once a physician has been granted access, he or she should maintain his or her level of ERCP operation. Hospitals should also continuously promote quality of care and evaluate physicians’ competence in endoscopic procedures. Maintaining physician competency in diagnostic and therapeutic ERCP requires not only the completion of a sufficient number of procedures, but also ongoing medical education and the adoption of new and emerging therapeutic techniques.