Bibliographic record
Abstract
esidency is the time when young surgeons learn to operate.We start with the basics and progressively gain skills as we practice our future trade.We learn to "open and close," we become experts at holding the sucker, we learn to sew in drains, and we learn to cut sutures and tie knots.At some point in our training, someone hands us the lauer and time stops.The lauer can go by many names -the right angle, negus forceps, etc.It is the key instrument used to guide the surgical assistant and is held by the primary surgeon.When the lauer is passed to you, the moment has finally come.You have been entrusted with this exceedingly important tool; to guide the person on the other side of the table to cauterize here or cauterize there.Trumpets sound.Doves are released.Euphoria ensues.All of which comes to a crashing halt when you hear, "What… are you doing?" from your beloved staff.Happy Lauer Syndrome (HLS) is a condition in which the learner is given the primary surgical instrument and becomes so overcome with feelings of happiness that said learner is unable to proceed with the case.Sometimes he/she will stare at the lauer mutely, not knowing what to do next.Other times he/she may slow the progression of the case by nervously repeating a move the staff has just done, or make seemingly random moves that are not in keeping with the next logical step, which then must be safely corrected.This results in staff surgeon frustration and the inevitable "taking away of the lauer."HLS was inadvertently coined by Dr. Robert Nam during the partial nephrectomy incident of 2018, where he suggested a resident (who shall remain nameless) may have this terrible condition.We now look to further explore this seemingly widespread malady.Any surgical resident can develop this condition, but those at highest risk include the junior population (PGY1-3), senior residents with exposure to a new surgical procedure, learners with an unfounded high degree of confidence, or those in training programs where the resident does not reach the operating room (OR) until a late stage.HLS is very difficult to avoid altogether; the best one can hope for is to suffer a quick bout and move on unscarred.Those with lingering HLS are doomed to suffer the most.This is explored further in our proposed grading system (Table 1).With good staff mentorship, HLS can quickly dissipate, similar to an allergic reaction.Once the excitement is removed with repetitive exposure to the lauer, the learner will naturally become more thoughtful and show more controlled motions.You know you have been cured of HLS when you ask for the lauer yourself in a calm and controlled voice, and proceed to use the tool with precision and care.You may receive such uplifting compliments as, "mm-hmm," or "keep going," or even "excellent!"At this point, the resident can rest assured he/she has made a full recovery.A high rate of HLS seen in a surgical training program may indicate that the time has come to re-evaluate resident teaching.A combination of earlier exposure to the OR, increased guidance and communication from the primary surgeon, simulation models, and of course, preparation from the residents themselves, can facilitate a better and safer operating experience.Surgical teaching at a reasonable pace and volume (whenever possible) is needed.One promising move towards a cure is the introduction of Competency-By-Design (CBD).The CBD model for surgical training focuses on increased direct observation with assessments and more direct feedback.This allows for early identification of weaknesses and guidance for improvements of core competencies.In these times of highly prevalent HLS, we can look to such advancements in urological surgery education as a beacon of light.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.003 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 0.004 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".