Process-oriented feedback for surgical procedures in medical training through process mining: the ultrasound-guided central venous catheter placement case

Abstract

Feedback plays a crucial role in medical education and teaching of procedural skills. Developing high levels of competence in the execution of surgical procedures through training is a key factor for obtaining good clinical results in healthcare. To improve the effectiveness of the training, it is advisable to provide feedback to each student tailored to how the student has performed the procedure on each occasion. Current state-of-the-art feedback, commonly delivered under the mentor-apprentice model, is based on Checklists and Global Rating Scales, which indicate whether all process steps have been carried out and the quality of each execution step. However, there is a process perspective that is not captured successfully by these instruments, e.g., steps performed, but in an undesired order, group of activities that are repeated an unnecessary number of times, or an excessive transition time between two consecutive steps. In this research, we propose a novel use of process mining techniques to effectively identify desired and undesired process patterns regarding rework, the order in which activities are performed, and time performance, in order to complement the tailored feedback for surgical procedures using a process perspective. The approach is detailed in a general way so that it can be replicated in any surgical procedure and then it is detailed how it was effectively applied to analyze a real case of ultrasound-guided Central Venous Catheter placement training. It was quantitatively and qualitatively validated that the students who participated in the training program value the impact that the process-oriented feedback has on their learning. As future work, it is expected to be able to evaluate the impact of the process-oriented feedback on student learning.