The objective of this study is to assess endoscopists’ training needs in Endoscopic Ultrasound (EUS) via an anonymous survey and to identify the key challenges faced to develop appropriate training programs.

This prospective cross-sectional study used an anonymous online survey completed by over one hundred endoscopists involved in EUS practice or training. The needs assessment was conducted using the FGP grid (frequency, gravity, and problems) across seven items. Each item was evaluated based on its frequency (0, 1, 2), severity (0, 1, 2), and the difficulties related to knowledge, skills, and attitudes (0, 2, 4). Data processing and statistical analysis were performed using Jamovi version 2.4.

A total of 85 responses were collected from 30 countries spanning five continents. Of the respondents, 60% were male (male-to-female ratio: 1.5). Half of the participants were aged between 30 and 40 (48.2%), followed by those aged between 40 and 50 (30%). One in three participants was a teacher.

Endoscopy had been practised by 49.4% of participants for more than 10 years, while EUS had been performed by 62.4% for less than 5 years. Although 83.6% of training centres had EUS equipment, only 55.3% of participants had received EUS training.

Several EUS training methods were reported, including hands-on training with patients (63.5%), a university or inter-university diploma (47.1%), webinars or distance learning (35.3%), hands-on training with models or animals (30.6%), and certification programmes (25.9%). The majority of participants preferred hands-on training with patients (84.7%) or models (42.4%), followed by a university diploma (42.4%).

55,3% of the participants felt that the training they had received was inadequate. According to the FGP grid, the main difficulties encountered were related to knowledge, followed by skills.

81.2% of participants reported theoretical difficulties in interpreting EUS and understanding interventional EUS techniques. The availability of equipment was challenging for 3 out of 4 participants (75,3%).

From a practical perspective, interventional EUS and EUS interpretation were the most problematic issues for 3 out of 4 participants (75.3%, 77.6%).

When comparing the training methods, the group with hands-on training with patients reported fewer difficulties in performing EUS (p = 0.003) and professional skills (p = 0.019). The statistical analysis comparing the group of participants working in centers performing 10 to 20 EUS procedures per week and those working in expert centers (more than 20 EUS procedures per week) showed a significant difference regarding practical difficulties in performing and interpreting EUS (p = 0.001).

EUS is a fundamental modality for both diagnosing and treating digestive and biliopancreatic disease. Findings from our international multicenter survey indicate significant training needs, especially in EUS interpretation and interventional practice. We observed that theoretical and technical challenges were fewer for endoscopists working in expert centers with high volumes of procedures, and that hands-on training with patients provided a clear performance advantage, reinforcing its importance in EUS education.