There is general consensus in national and societal guidelines that training for sedation should be part of basic training for endoscopy. There is no clear consensus, however, on the structure of that training. More importantly, these same guidelines are often silent on the specific requirements to demonstrate competency for administration of sedation, ways to document that competency and measures to assure that competency is maintained. In the absence of data demonstrating improved outcomes with specific approaches, the process and principles in this paper are proposed as a starting point to be modified by future research and data.