Over the last decade there have been significant improvements in the standards of training across both the UK and US. Improvements in the UK have been catalysed by the need for high quality colonoscopy within the bowel cancer screening programme. In both the UK and US, central organisations now oversee the quality of endoscopic training and ensure that training standards are being met. Improvements in patient care are at the centre of quality assurance of training. Better training results in better doctors who provide better care for patients resulting in better patient outcomes.