Gastroenterology training in Europe: unmet educational needs beyond the machines.

We read with interest the paper by Ekkelenkamp et al, who found that the early use of validated simulators during endoscopy training expedites the learning of procedural skills. Authors propose the structured employment of simulators within endoscopy training curricula. Endoscopic learning represents an essential component of gastroenterology training and would surely benefit from the application of virtual reality techniques. Nevertheless, beyond the necessity of high-tech gadgets, other basic educational needs of gastroenterology trainees appear to remain unmet in Europe to date. In 2002, Bisschops et al compared the training programmes of 10 different European countries, finding marked dissimilarities in several aspects of gastroenterology training, including duration, workload, earnings and programmes. In particular, the teaching of some fundamental techniques (eg, abdominal ultrasound) was not provided by all Training Centres. Furthermore, the average number of endoscopic procedures was different among the included countries, and the overall endoscopy training appeared to be inadequate in at least four of them. Additionally, a third of lastyear trainees were not confident of their competence in endoscopy. Seven years later, Telleman et al confirmed the discrepancies among European (and also non-European) countries in terms of curriculum duration, compulsoriness of entrance and final exams, and required minimum number of endoscopic and ultrasonographic procedures. Additionally, gender imbalance towards interest in advanced endoscopy training appears to represent, still in the 21th Century, another relevant issue, despite the absence of pertinent reports from Europe. Disparities in the education of trainees will lead to differences in the quality of their competences, with deleterious consequences for the European healthcare system. One of the key objectives of the European Board of Gastroenterology and Hepatology (EBGH) is to define, secure and assess the European standards of training in gastroenterology and hepatology. In 2012, the EBGH released the latest version of the Blue Book, which includes the competences of the European specialists in gastroenterology