March 2026

GASTROENTEROLOGY

SIMULATION-BASED MASTERY LEARNING IMPROVES COLONOSCOPY AND POLYPECTOMY SKILLS

Featuring: ​Srinadh Komanduri, MD, and Jeffrey Barsuk, MD
A new Northwestern Medicine study suggests that a structured simulation‑based training program can significantly improve how gastroenterologists remove precancerous colon polyps, according to findings published in Gastroenterology. 

Investigators found that after completing a simulation‑based mastery learning (SBML) curriculum, gastroenterologists nearly doubled their rate of performing polypectomies at or above the minimum passing standard, rising from 37% before training to 74% afterward. 

The findings represent the first evidence that simulation‑based polypectomy training can translate into improved performance during real-patient procedures, says Srinadh Komanduri, MD, who was first author of the study. 

Opportunities for Better Training
Colonoscopy with polypectomy is one of the most common procedures in gastroenterology, but research shows wide variation in how clinicians execute key steps of the technique. There is no universal method for removing polyps, and most gastroenterologists rely on skills they learned during fellowship with little required ongoing assessment. 

This variability has real consequences, Dr. Komanduri says. The study investigators found that before simulation training, only 49% of recorded polypectomies included correct identification and treatment of residual polyp tissue. 

“We wanted to utilize the highest degree of assessment in education now, which is mastery learning, and couple it with a very basic skillset that everyone needs — removing polyps during colonoscopy — and see if this type of education could help practicing gastroenterologists improve skillsets,”  Dr. Komanduri says. 

A Multifaceted Curriculum
The simulation curriculum used in the study included: 
  • A simulated skills pretest
  • Instructional videos and lecture content
  • Expert‑guided deliberate practice on an ex vivo bovine colon model containing both sessile and stalked polyps
  • A skills post-test in which participants had to meet or exceed a predetermined minimum passing standard

The Impact of Innovative Training
Investigators compared gastroenterologists’ performance using nearly 350 de‑identified patient polypectomy videos from before and after the training. After simulation training, gastroenterologists showed significant improvement across multiple areas. The median pass rate jumped from 33% to 80%, and performance improved in almost every specific technique category, including polyp positioning, lesion evaluation, snare selection and post-polypectomy inspection.  

The improvements occurred regardless of the physician’s years in practice, suggesting that even seasoned clinicians benefit meaningfully from targeted technique retraining. 

Looking Forward
Incomplete polypectomy is considered a major driver of post‑colonoscopy (interval) colorectal cancers. By elevating technical performance, SBML could play a critical role in reducing these preventable cancers, study authors said. 

“Our research has demonstrated again and again that a curriculum founded in simulation with deliberate practice and mastery learning standards improves patient care and outcomes,” says the study’s senior author Jeffrey Barsuk, MD, MS.

The authors said the work provides strong justification for expanding SBML into wider CE programs for core endoscopic skills. Moving forward, Dr. Komanduri, Dr. Barsuk and their collaborators hope to expand the training  across the Northwestern Medicine health system along with other endoscopic skills in gastroenterology. 

The study was supported by grant R21 DK124816-01 from the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. ​
Srinadh Komanduri, MD, Professor of Gastroenterology and Hepatology and of Gastrointestinal Surgery at Northwestern Medicine.

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