ERCP is an advanced interventional technique requiring structured training. Moreover, the delicacy of the procedure with ensuing high risk of complications makes continuous quality control a necessity. Validated assessment and performance measures guide competency, with the ESGE Quality Improvement Initiative explicitly recommending implementation of these measures to identify services and individual endoscopists with lower performance levels. Additionally, trainees are recommended to keep a contemporaneous logbook of their procedures. Performance targets are published both for learners and practicing interventionists. Yet at present, there is no easily accessible tool for real-time data tracking and analysis. The objective was to design an open, digital tool for procedural logging, performance tracking, and competency assessment in line with published ERCP performance indicators. Special focus was put on providing real-time visualizations and analytics at the point-of-care to provide interventionists with immediate feedback.

An online platform for point-of-care input and visualization of ERCP training data was created. Fields were adapted from performance measures published by ESGE. Anonymized patient characteristics, indications, success measures, and complications were included to calculate key performance indicators (bile duct cannulation rate, appropriate stent placement in patients with biliary obstruction below the hilum, bile duct stone extraction, post-ERCP pancreatitis). For complexity assessment, the modified Schutz score as well as the SASE and H.O.U.S.E. grading systems were used. A mobile client and a dashboard were implemented for rapid onsite data collection and accessible statistics visualization. Functionality was provided to build teams of interventionists for evaluation at endoscopy unit level. Online access was protected and server communication was encrypted. Rolling personal performance as well as minimum and target standards were visualized in a graphical dashboard with graphs that were generated in real-time to provide actionable insights on learning progress and quality assessment. Team performance was displayed to gauge relative performance. Excel export functionality was added to allow for data sharing of a personal logbook.

As proof-of-concept, the individual learning experience of a first-time ERCP trainee at a tertiary care facility was tracked. All 127 procedures performed over the course of 14 months were entered into the tool. Most ERCPs were done for ASA 2 patients (91/127; 71.7%); SASE success probability grading was “high” for the majority of interventions (90/127; 70.9%). Virgin papilla (48% of procedures) rolling intubation rate showed a clear upward trend for later cases (first to last quarter: 41.7%, 56.5%, 65.9%, 72.0%), as did rolling stone clearance rate (85.7%, 94.7%, 97.1%, 100.0%). Stenting was successful in all cases with subhilar obstruction (100.0%). Overall (0.8%) and virgin papilla post-ERCP pancreatitis rates (1.6%) at the end of the logging period were in line with quality recommendations. The tool was effective in enabling real-time, granular tracking of technical skills and identifying learning gaps (e.g., lower stone extraction scores in early cases).

The proof-of-concept tool enhanced training by combining structured assessment with real-time outcome tracking and visualized feedback. It shows potential to improve competency evaluation and reduce learning curve variability for complex endoscopic procedures. Additionally, it allows for up-to-date transparency about interventionists' performance and development regarding quality targets. This feedback is vital for both the individual interventionist as well as endoscopy units, as transparency about performance is an indispensable prerequisite for accountability. A future opportunity is to evolve the self-assessment platform into an open, ESGE-approved quality management instrument with trend analysis and learning curve visualization for ERCP trainees as well as experienced interventionists. A summative report by the tool could form the basis for commencing independent practice for trainees by providing robust and standardized evidence of procedure volume and competence. Likewise, yearly quality report cards produced by the tool could provide certification of skill levels for experienced endoscopists and service unit teams.