Hijioka et al. [1] have demonstrated an array of factors that can determine the accuracy of endoscopic ultrasound-guided fine-needle aspiration of pancreatic neuroendocrine neoplasms. As a medical educationalist and gastroenterology trainee, I wonder if additional factors may be of relevance to spark further interest in this area. It is noted that experts primarily performed the procedures. The interest here would therefore lie in the definition of an expert and how the experts were mentored. What factors played a role in their mentoring. What forms of pedagogy and what assessment strategies were used?

Current movements in medical education are demonstrating value in the use of more active methods of teaching in terms of endoscopy. Furthermore, from an assessment perspective, we are beginning to shed light on more novel methods of assessment. These may include programmatic assessment which allows repeated cycles of testing and feedback accordingly [2]. There are also movements to enhance competency gains from knowledge, skills and attitudes to that of entrustment, ensuring learners can be truly trusted to perform a skill unsupervised [3].

Therefore in addition to the factors highlighted in this study, I wonder if training methods also may impact success. How do non-experts who also undertake such procedures fare?