Process Mining in Medical Education

Surgeons receive training in many skills. One of them are procedural skills, which enable physicians to correctly perform surgical procedures. An important aspect of procedural skills is the sequence of steps that describes the order in which the actions involved in a surgical procedure should be performed. However, this aspect is often not reinforced or emphasized in procedural skills training, and typical instruments for assessing the learning of these competencies do not consider the sequence of steps.

It has been proposed in the literature that a surgical procedure can be understood as a process, which enables the analysis of surgical procedures using process mining algorithms. Some studies have been conducted using process mining to understand the learning of surgical procedures, finding that there is a high variability in the sequence of steps performed by residents during their training. However, it is not clear how the sequence of steps should be incorporated as a learning objective during resident training. Consequently, the learning of this aspect cannot be assessed, and its teaching is difficult due to the absence of proven tools to do so.

The Process-Oriented Medical Education (POME) approach will be presented. POME is composed of a method and some artifacts developed to help instructors to incorporate the sequence of steps as a learning objective when teaching procedural skills. The POME artifacts developed allow instructors to provide feedback to students, identify deficiencies in their learning, and analyze their performance throughout the course. Central venous catheter placement and percutaneous dilatational tracheostomy trainings are used as case studies.

After developing POME artifacts, three conclusions can be drawn. First, the POME approach provides useful artifacts to teach the sequence of steps. Second, the development of POME artifacts requires both process knowledge and medical expertise. Third, residents do not perform the procedural skills used as case studies as they are supposed to, even upon completion of the training. Future work is needed to build and validate POME artifacts for training and assessment tasks, as well as to demonstrate their impact on learning.