This study was carried out to assess the impact of therapeutic endoscopy training on the endoscopic retrograde cholangiopancreatography (ERCP) practice of a physician who was practicing ERCP for many years in a community setting in the United States. A retrospective chart review of 390 ERCPs performed by the physician was accomplished; 176 and 214 ERCPs were performed before and after undergoing therapeutic endoscopy training respectively. Rates of common bile duct cannulation; postprocedure pancreatitis; use of common bile duct and pancreatic stents, as well as frequency of biliary and pancreatic sphincterotomies were assessed. The rate of common bile duct cannulation increased from 87% to 96% (P=0.008), while post-ERCP pancreatitis decreased from 8% to 3% (P=0.056), demonstrating that further guided experience in ERCP improved technical competency and decreased complications of ERCP for a physician already performing ERCPs independently in the USA.