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To maintain the high quality of endoscopic ultrasound (EUS) and EUS-fine-needle aspiration (EUS-FNA) currently available in the United States and yet accommodate the increasing demand for EUS, the availability of and resources for EUS training must continue to increase. There are currently 28 formal EUS training centers in the US and one in Canada, which produce a total of approximately 30–35 expert endosonographers per year. In addition, there are an increasing number of endosonographers being trained through informal or non-traditional methods. Training in EUS includes three aspects: cognitive (e.g. indications), pattern recognition (normal and pathologic EUS images), and manual dexterity (scope insertion, positioning, FNA). While all these aspects are readily addressed in a formal training setting, it becomes much more challenging in the informal setting. Case observation, but more importantly, hands-on experience with patients is the rate-limiting step for accelerated EUS training. Technology advancements (e.g. simulators, tele-mentoring) may address some of these limitations. Collaborative efforts among different countries may also provide‘win-win’ solutions. [ABSTRACT FROM AUTHOR]