Productivity pressures, shrinking training time and a high bar for patient care drove a Northwestern Medicine gastroenterologist to test whether a simulation could fill a growing skills gap.
Sri Komanduri, MD, associate chief of the division of gastroenterology and hepatology at Northwestern Medicine in Chicago and lead author of a National Institutes of Health-funded study published in Gastroenterology, joined Becker’s to discuss what prompted the research and what it could mean for GI training going forward.
The study found that the share of polypectomies meeting the minimum passing standard nearly doubled after training, rising from 36.9% to 73.6%. It also found the median attending pass rate jumped from 33% to 80%, and overall median checklist scores improved from 86.67% to 100% of items performed correctly.
Dr. Komanduri said the study was motivated by the limited procedural training available to gastroenterologists after fellowship. He said that post-training assessment in the U.S. is largely driven by written exams rather than procedural evaluations, removing a key incentive for physicians to continue sharpening technical skills.
Compounding the problem, he said, is the rise of productivity-based compensation in academic medical centers, the same settings where GI fellows are trained.
“As you can imagine, time is money, and the ability to train our fellows has gone down dramatically because we just can’t afford to give them the same amount of time for procedural learning,” he said. “We then continue to hire junior faculty who have progressively fewer skill sets. So we’re developing a scenario where training, even for fellows, is not optimal, and we need other ways to augment that. That’s what really pushed us to look at simulation.”
That environment pushed his team toward simulation, and specifically toward mastery learning, which he described as “the highest rigor in medical education in 2026.”
Unlike traditional competency scales, mastery learning sets a binary standard where either a physician performed a skill correctly or they didn’t.
“If you’re having a colonoscopy tomorrow and there are 10 key skills a doctor should have, you don’t really want them at two or three,” he said. “That’s how mastery works, and that’s why, when you look at the percentages in our study, it’s not that Northwestern produces poor doctors — it’s that we set a very high bar, which patients deserve.”
One of the study’s most striking findings involved incomplete polyp removal. Before training, only 49% of procedures demonstrated proper identification and treatment of residual polyp tissue, a critical gap since incomplete polypectomy is a leading cause of interval colorectal cancers. That rate rose to 80% post-intervention.
“Looking back at interval cancers, incomplete resection of larger polyps tends to be one of the highest risk factors,” Dr. Komanduri said. “Prior to the study, a lot of our doctors were not achieving complete resection of some polyps — and what we ultimately showed is that it improved dramatically.”
The study was conducted across roughly 20 gastroenterologists at a single academic center, but Dr. Komanduri said the next step is scaling across Northwestern Medicine’s 11-hospital network, which includes more than 100 gastroenterologists in rural and non-academic settings.
“That would really represent the country as a whole,” he said.
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