Effective colorectal cancer (CRC) screening relies on early identification and removal of both polypoid and non-polypoid lesions with neoplastic potential. The investigators hypothesize that an intensive training program designed to enhance both recognition and classification of lesions with neoplastic potential, will result in an increase in non-polypoid adenoma detection in addition to and independent of an increase in overall adenoma detection rates.

Our Endoscopic Quality Improvement Program (EQUIP) was a prospective educational intervention with our staff endoscopist as our study population. The investigators measured adenoma detection rates for a baseline period then randomly assigned half of the endoscopists to undergo EQUIP training. The investigators then examined baseline and post-training study adenoma detection rates (ADR's) for all endoscopist (trained and un-trained) to evaluate the impact of training.

Inclusion Criteria:

• Colonoscopies performed at Mayo clinic ambulatory surgical center

Exclusion Criteria:

• Procedures for the indication of acute GI hemorrhage
• Active colitis
• Hereditary polyposis syndrome
• Inflammatory bowel disease
• Incomplete procedures
• Procedures with surgically altered anatomy (i.e. prior colectomy)
• Poor bowel preparation (Boston Bowel preparation score <5) were also excluded.